Effect of GEMS-H on Locomotor Function in Adults

Measure of fast walking speeds by measuring the time it takes a participant to walk 10 meters. The test is performed using a "flying start," the participant walks 10 meters (33 ft) and the time is measured when the leading foot crosses the start line and the finish line. The instructions are: "Please walk this distance as fast as you can safely when I say go."

Measure of self-selected walking speeds by measuring the time it takes a participant to walk 10 meters. The test is performed using a "flying start," the participant walks 10 meters (33 ft) and the time is measured when the leading foot crosses the start line and the finish line. The instructions are: "Please walk this distance at your normal pace when I say go."

The FGA is used to assess postural stability during walking and assesses a participant's ability to perform multiple motor tasks while walking. The tool is a modification of the 8-item Dynamic Gait Index, developed to improve reliability and reduce ceiling effect. Scores of 22/30 on the FGA is effective in predicting falls.

The SPPB is an assessment tool for evaluation of lower extremity function.

The FRT assesses a participant's stability by measuring the maximum distance the participant can reach forward while standing in a fixed position.

The FSST is used to assess dynamic stability and the ability of the participant to step over low objects forward, sideways, and backward

The 5XSST is used to assess functional lower extremity strength, transitional movements, balance, and fall risk. The instructions are: "Please stand up straight as quickly as you can 5 times, without stopping in between. Keep your arms folded across your chest. I'll be timing you with a stopwatch. Ready, begin."

The BBS is a 14-item objective measure that assesses static balance and fall risk.

The TUG is a simple test used to assess a participant's mobility and requires both static and dynamic balance. TUG uses the time that a participant takes to rise from a chair, walk three meters, turn around, walk back to the chair, and sit down. During the test, the participant is expected to wear their regular footwear and use any mobility aids that they would normally require.

Each participant is given an activity monitor band and instructed to wear it on the wrist during waking hours until completion of the training program (between Visit 2 and Visit 21).

The EQ-5D is a standardized instrument for measuring generic health status. The EQ-5D questionnaire has two components: health state description and evaluation. In the description part, health status is measured in terms of five dimensions (5D); mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Mobility dimension asks about the participant's walking ability. Self-care dimension asks about the ability to wash or dress by oneself, and usual activities dimension measures performance in "work, study, housework, family or leisure activities". In pain/discomfort dimension, it asks how much pain or discomfort they have, and in anxiety/depression dimension, it asks how anxious or depressed they are.

The K-MBI is an ordinal scale used to measure performance in activities of daily living (ADL). Each performance item is rated on this scale with a given number of points assigned to each level or ranking. It uses ten variables describing ADL and mobility. A higher number is associated with a greater likelihood of being able to live at home with a degree of independence following discharge from hospital.

The FES-K is the measures of "fear of falling" or, more properly, "concerns about falling", which are suitable for use in research and clinical practice.

The VAS is a pain rating scale. Scores are based on self-reported measures of symptoms that are recorded with a single handwritten mark placed at one point along the length of a 10-cm line that represents a continuum between the two ends of the scale; "no pain" on the left end (0 cm) of the scale and the "worst pain" on the right end of the scale (10 cm).

The GDS is a 15-item self-report assessment used to identify depression in the elderly. A score of 0 to 5 is normal. A score greater than 5 suggests depression.

The maximal isometric strength of the 12 muscles in lower extremity will be measured with 12 channels surface electromyography (NORAXON™, USA).

All participants perform over-ground walking to assess the change of muscle activation pattern and effort (%MVC) using 12channels surface EMG

All participants perform over-ground walking to assess the change of kinematic (lower extremity joint angles), kinetics (lower extremity joint moments) and ground reaction force using motion analysis (Kestrel Digital RealTime System, Motion Analysis Corporation, USA) and force plate ( TF-4060-B, Tec Gihan Co., Ltd. Japan), respectively.

All participants perform treadmill 6 minute walk test (6MWT) to assess the change of metabolic energy expenditure using a portable cardiopulmonary metabolic system (Cosmed K4b², Rome, Italy).