Browsing by Person "Andreopoulou, Georgia"

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Ankle Kinematics and Temporal Gait Characteristics over the Duration of a 6-Minute Walk Test in People with Multiple Sclerosis Who Experience Foot Drop
(Hindawi Publishing Corporation, 2018-07-02) van der Linden, Marietta; Andreopoulou, Georgia; Scopes, Judy; Hooper, Julie; Mercer, Tom
Foot drop is a common gait impairment in people with MS (pwMS) but in some foot drop may only occur after a period of prolonged walking and may be a sign of motor fatigability. The purpose of the study was to explore whether, for pwMS, an adapted six-minute walk test (6minWT) would result in an increase in foot drop as measured using electrogoniometry. Sagittal ankle kinematics were recorded for fifteen participants (10 females and 5 males, aged 37-64) with MS (EDSS 4-6) throughout the 6minWT. Ankle kinematics and temporal stride parameters were compared between the first and last 10 gait cycles of the 6minWT. Peak dorsiflexion in swing was significantly reduced at the end of the 6minWT compared to the start, with six of the fifteen participants having a decrease of two degrees or more. Statistically significant changes in temporal stride parameters suggested a decrease in walking speed. Our results suggest that with the protocol used in this study it is feasible to identify patients who experience increased foot drop as a result of a prolonged exercise task.
Athlete-perceived impact of frame running on physical fitness, functional mobility and psychosocial outcomes
(2022-03-01) van der Linden, Marietta; Van Schie, Petra E. M.; Hjalmarsson, Emma; Andreopoulou, Georgia; Verheul, Martine H. G.; Von Walden, Ferdinand
Frame Running (RaceRunning) allows people with moderate-to-severe mobility impairments to participate in physical activity using a 3-wheeled frame with a saddle and handlebars. The aim of this study was to investigate athlete-perceived impact of Frame Running on aspects of physical fitness, functional mobility and psychosocial outcomes. Survey. Frame Running athletes aged 5 years and over. A survey was distributed to athletes through their club or sports organization. The survey was completed by 115 athletes (53 females). Median age was 17 years (range 5-62 years) and 64 (57%) used a wheelchair or walker for distances over 50 m. Many felt that Frame Running stretched their muscles (n=93, 87%) and increased their self-confidence (n=63, 93%). Four (4%) reported extreme fatigue or sore muscles after training (n=17, 15%). Of the 110 athletes who had been participating in Frame Running for over 3 months, 46 (47%) reported being less out of breath during mobility tasks and 66 (66%) felt they had improved their functional mobility. However, 7 (7%) reported increased muscle tightness and 4 (4%) reported a Frame Running-related injury lasting more than 4 weeks. Frame Running is a safe physical activity with athlete-perceived benefits on physical fitness, functional mobility and psychosocial outcomes.
Effect of RaceRunning on cardiometabolic disease risk factors and functional mobility in young people with moderate-to-severe cerebral palsy: Protocol for a feasibility study
(BMJ Publishing Group, 2020-07-01) Ryan, Jennifer; Theis, Nicola; Koufaki, Pelagia; Phillips, Shaun; Anokye, Nana; Andreopoulou, Georgia; Kennedy, Fiona; Jagadamma, Kavi; vanSchie, Petra; Dines, Hannah; van der Linden, Marietta; Funder: Chartered Society of Physiotherapy Charitable Trust; FundRef: http://dx.doi.org/10.13039/100011698; Grant(s): GN2767; Funder: Action Medical Research; FundRef: http://dx.doi.org/10.13039/501100000317; Grant(s): GN2767
Introduction: There is consistent evidence that people with cerebral palsy (CP) do not engage in the recommended physical activity guidelines for the general population from a young age. Participation in moderate-to-vigorous physical activity is particularly reduced in people with CP who have a moderate-to-severe disability. RaceRunning is a growing disability sport that provides an opportunity for people with moderate-to-severe disability to participate in physical activity in the community. It allows those who are unable to walk independently to propel themselves using a RaceRunning bike, which has a breastplate for support but no pedals. The aim of this study is to examine the feasibility and acceptability of RaceRunning for young people with moderate-to-severe CP and the feasibility of conducting a definitive study of the effect of RaceRunning on cardiometabolic disease risk factors and functional mobility. Methods and analysis: Twenty-five young people (age 5–21 years) with CP or acquired brain injury affecting coordination will be included in this single-arm intervention study. Participants will take part in one RaceRunning session each week for 24 weeks. Outcomes assessed at baseline, 12 and 24 weeks include body mass index, waist circumference, blood pressure, muscle strength, cardiorespiratory fitness, physical activity and sedentary behaviour, functional mobility, activity competence and psychosocial impact. Adverse events will be systematically recorded throughout the 24 weeks. Focus groups will be conducted with participants and/or parents to explore their views and experiences of taking part in RaceRunning. Ethics and dissemination: Approval has been granted by Queen Margaret University Research Ethics Committee (REC) and the South East of Scotland REC. Results will be disseminated through peer-reviewed journals and distributed to people with CP and their families through RaceRunning and Athletic Clubs, National Health Service trusts and organisations for people with disabilities. Trial registration number: NCT04034342; pre-results.
Exercise-induced changes in gait kinematics in multiple sclerosis with minimal neurological disability
(Elsevier, 2020-11-19) Andreopoulou, Georgia; Mercer, Tom; Guerrero Enriquez, Julia; Justin, Matthew; MacLeod, Nicola; Harrison, Emily; Mahad, Don J.; van der Linden, Marietta
Background Exercise-induced gait deterioration is a frequently encountered symptom that limits ambulation throughout the clinical course, becoming more prominent with increasing neurological disability in people with MS (pwMS).
FOOT DROP AND FATIGABILITY IN PEOPLE WITH MULTIPLE SCLEROSIS
(Queen Margaret University, Edinburgh, 2019) Andreopoulou, Georgia
People with Multiple Sclerosis (pwMS) often experience walking impairments such as foot drop which can lead to trip and falls. Foot drop can be either transient and is often induced by exercise (fatigability) in pwMS whose walking ability is not affected and can become more fixed with disease progression. The overall aim of this PhD was to explore foot drop, its presence in pwMS with different disability levels and the psychometric properties of outcomes used to evaluate walking impairments. The first study in this thesis was a systematic review into the level of evidence for the psychometric properties of walking measures that have been used to evaluate the effect of assistive technology such as FES for foot drop in MS. Moderate to strong psychometric evidence was found for the Multiple Sclerosis Walking Scale, Timed 25 Foot Walk, 6 minute and 10 meter walk tests. There were no psychometric studies for three-dimensional (3D) gait kinematics in pwMS even though it was one of the most frequently used outcome measures. The second study assessed the test-retest reliability of 3D ankle kinematics and spatiotemporal parameters in pwMS, with low Expanded Disability Status Scale (EDSS < 3.5) and in those with moderate to high EDSS (EDSS: 4-6). Reliability was excellent for ankle kinematics and spatiotemporal parameters in both groups, with lower minimal detectable change (MDC95%) values in the low EDSS group compared to the higher EDSS group. The third study investigated transient exercise induced foot drop in highly physically active pwMS (EDSS < 3.5) and health controls using 3D kinematics. It was found that 6 out of 15 pwMS and none of the healthy controls presented this phenomenon. The fourth study examined the direct orthotic effect of FES during dual-tasking (i.e. walking combined with a cognitive task) and after inducing fatigability. Low to moderate effect sizes indicated that the direct orthotic effect was higher under dual-task and fatiguing conditions but this needs to be confirmed in appropriately powered studies. In conclusion, the studies in this thesis have contributed to the psychometric evidence of gait kinematics in pwMS, have objectively documented the presence of transient foot drop in highly physically active pwMS and orthotic effect of FES under a variety of conditions simulating the perceived benefits in ‘real life’ reported by FES users. Key words: multiple sclerosis, foot drop, fatigability, FES, psychometric properties, 3D gait kinematics
Frame Running as a community-based exercise option for young people with moderate-to-severe walking impairments: a feasibility study
(Taylor & Francis Group, 2024-12-29) Andreopoulou, Georgia; van der Linden, Marietta; Theis, Nicola; Thacker, Elizabeth; McEwan, Gary; Koufaki, Pelagia; Jagadamma, Kavi; Curnow, Eleanor; Phillips, Shaun; van Schie, Petra E.M.; Ryan, Jennifer M.
Frame Running is an adapted community-based exercise option for people with moderate-to-severe walking impairments. This mixed-methods study aimed to examine the feasibility of 1) community-based Frame Running by young people with moderate-to-severe walking impairments and 2) conducting future studies on the impact of Frame Running on functional mobility and cardiometabolic disease risk factors. Weekly training sessions and data collection occurred in two sites. Quantitative data were collected at baseline, and after 12 (both sites) and 24 (one site) weeks of training, followed by interviews or focus groups. Consent and retention rates, attendance and outcome measure completion rates were calculated. Qualitative data were analysed abductively using concurrent inductive and deductive thematic content analysis. Data for the assessments at baseline, 12 and 24 weeks were available for 23, 15 and 5 participants respectively. Participants were aged 5-25 with most diagnosed with cerebral palsy (GMFCS II-IV). Consent, intervention drop-out and adherence rates were 55%, 17% and 83% respectively with no serious adverse events. Outcome measure completion rates ranged between 60% and 98%. Themes related to facilitators to participating in Frame Running were mostly identified in the personal and social domains with barriers more common in the environmental and policy domains. The study results support the existing evidence that Frame Running is a safe and acceptable community-based exercise option for those with moderate-to-severe walking impairments. Themes identified in personal, social, environmental, and policy domains can guide the implementation of community-based Frame Running participation. Our feasibility data can inform the design of future definitive studies.
Is functional electrical stimulation effective in improving walking in adults with lower limb impairment due to an upper motor neuron lesion? An umbrella review
(2023-06-01) Andreopoulou, Georgia; Busselli, Giulia; Street, Tamsyn; Bulley, Catherine; Safari, Reza; van der Linden, Marietta; Burridge, Jane
Purpose: To conduct an umbrella review of systematic reviews on functional electrical stimulation (FES) to improve walking in adults with an upper motor neuron lesion. Methods: Five electronic databases were searched, focusing on the effect of FES on walking. The methodological quality of reviews was evaluated using AMSTAR2 and certainty of evidence was established through the GRADE approach. Results: The methodological quality of the 24 eligible reviews (stroke, n = 16; spinal cord injury (SCI), n = 5; multiple sclerosis (MS); n = 2; mixed population, n = 1) ranged from critically low to high. Stroke reviews concluded that FES improved walking speed through an orthotic (immediate) effect and had a therapeutic benefit (i.e., over time) compared to usual care (low certainty evidence). There was low‐to‐moderate certainty evidence that FES was no better or worse than an Ankle Foot Orthosis regarding walking speed post 6 months. MS reviews concluded that FES had an orthotic but no therapeutic effect on walking. SCI reviews concluded that FES with or without treadmill training improved speed but combined with an orthosis was no better than orthosis alone. FES may improve quality of life and reduce falls in MS and stroke populations. Conclusion: FES has orthotic and therapeutic benefits. Certainty of evidence was low‐to‐moderate, mostly due to high risk of bias, low sample sizes, and wide variation in outcome measures. Future trials must be of higher quality, use agreed outcome measures, including measures other than walking speed, and examine the effects of FES for adults with cerebral palsy, traumatic and acquired brain injury, and Parkinson's disease.
Physical activity and exercise interventions in adults with cerebral palsy: a systematic review of quantitative and qualitative studies
(Taylor and Francis Group, 2024-08-24) Andreopoulou, Georgia; Meharry, John Buchanan; Jagadamma, Kavi; van der Linden, Marietta
Background and purpose Participating in physical activity may benefit health-related outcomes for adults with cerebral palsy (CP). The aim of this review is to provide a synthesis of the evidence from both qualitative and quantitative studies on the impact of physical activity and exercise interventions in adults with CP. Methods Literature searches were conducted from inception to November 2023 in nine electronic databases. A meta-analysis was carried out to evaluate the efficacy of the interventions on walking speed related outcomes and muscle strength. Results Twenty-two studies met the inclusion criteria. The interventions of the 9 studies included in the meta-analysis did not improve walking speed over a distance of 10 meters (SMD=-0.03, 95% CI:-0.34-0.40, p=0.88, I2=0%) or endurance (distance covered in 2 or 6 minutes) (SMD=0.25, 95% CI :-0.10-0.59, p=0.16, I2=0%), but there was an improvement in lower limb muscle strength in favour of the experimental groups (SMD =0.59, 95% CI:0.19-0.99, p=0.004. I2=20%). Only a few studies reported on psychosocial outcomes, quality of life or intervention sustainability. Discussion and Conclusions Further research is needed to explore the impact on psychosocial outcomes and quality of life in adults with CP and the sustainability of physical activity participation.
Test-retest reliability and minimal detectable change of ankle kinematics and spatiotemporal parameters in MS population
(Elsevier, 2019-09-16) Andreopoulou, Georgia; Mahad, Don J.; Mercer, Tom; van der Linden, Marietta
Background Many people with multiple sclerosis (pwMS) experience walking impairments often including foot drop, evident as either reduced dorsiflexion at initial contact and/or at the swing phase of the gait cycle. To measure even subtle differences in ankle kinematics 3D gait analysis is considered a ‘gold’ standard. However, the psychometric properties of ankle kinematics in the MS population have not yet been examined.
Walking measures to evaluate assistive technology for foot drop in multiple sclerosis: A systematic review of psychometric properties
(Elsevier, 2017-12-25) Andreopoulou, Georgia; Mercer, Tom; van der Linden, Marietta
Background: Foot drop in people with multiple sclerosis (pwMS) often managed with assistive technologies, such as functional electrical stimulation and ankle foot orthoses. No evidence synthesis exists for the psychometric properties of outcomes used to evaluate the efficacy of these interventions. Objective: This systematic review aimed to identify the outcome measures reported to assess the benefits of assistive technology for pwMS and then synthesize the psychometric evidence in pwMS for a subset of these measures. Methods: Two searches in eight databases were conducted up to May 2017. Methodological quality was rated using the COSMIN guidelines. Overall level of evidence was scored according to the Cochrane criteria. Results: The first search identified 27 measures, with the 10m walk test, gait kinematics and Physiological Cost Index (PCI) most frequently used. The second search resulted in 41 studies evaluating 10 measures related to walking performance. Strong levels of evidence were found for the internal consistency and test-retest reliability of the Multiple Sclerosis Walking Scale-12 and for the construct validity for Timed 25 Foot Walk. No psychometric studies were identified for gait kinematics and PCI in pwMS. There was a lack of evidence for measurement error and responsiveness. Conclusion: Although a strong level of evidence exists for some measures included in this review, there was an absence of psychometric studies on commonly used measures such as gait kinematics. Future psychometric studies should evaluate a wider range of walking related measures used to assess the efficacy of interventions to treat foot drop in pwMS.