Individuals with incomplete spinal cord injury (iSCI) exhibit diverse walking capabilities due to partial sensory and/or motor impairment below the injury level. This study examined how neuromuscular weakness patterns influence compensatory gait strategies, dynamic balance (margins of stability, MoS), and joint-level mechanics across iSCI subgroups compared to non-disabled controls. We analyzed gait data from 21 iSCI participants previously classified into four subgroups through dynamic time warping and hierarchical clustering. Temporospatial parameters, anterior-posterior (AP) and mediolateral (ML) MoS, and joint kinetics were analyzed using linear mixed-effects models with walking speed as a covariate to isolate group differences beyond speed. The most functional individuals, with mild plantarflexor weakness, walked comparably to controls but exhibited elevated peak hip flexion moments, suggesting a possible long-term hip joint health concern. The individuals with moderate plantarflexor weakness adopted slower walking speed as their primary compensation, with no residual differences from controls once speed was accounted for. The two most impaired groups of individuals, with combined plantarflexor and hip muscle weakness, additionally compromised frontal-plane balance - adopting wider step widths and higher ML MoS - and showed a redistribution of mechanical demand during stance, with the hips contributing a larger proportion of total positive joint work than the ankles. The individuals with most impairment further showed elevated AP MoS persisting beyond speed reduction, lower peak plantarflexion moment, and a shift of mechanical work toward the knee. These findings indicate that gait adaptations in iSCI depend on the muscle weakness profile rather than severity alone, supporting tailored rehabilitation strategies.

Background Incomplete spinal cord injury (iSCI) often causes heterogeneous locomotion dysfunctions, depending on remaining sensorimotor function. Clinical tests and traditional gait analysis have limited ability to quantify the diversity of gait impairments. Unsupervised learning techniques can objectively identify common gait patterns among the overall heterogeneity. Explainable artificial intelligence approaches, when combined with machine learning models, can reveal important features often missed by traditional gait analyses. This study presents a framework to characterize gait heterogeneity among persons with iSCI based on several data-driven methods. We aimed to stratify overall gait heterogeneity by deriving clusters with similarities without a priori identification of parameters, and to assess possible clinical correlations in the derived clusters. Methods A cohort of 28 adults with iSCI and control group of 21 non-disabled adults were recruited. The iSCI group underwent a standard physical assessment of overall mobility, lower extremity strength, and spasticity. Both groups underwent instrumented 3D gait analysis, walking at self-selected pace. Distinct iSCI gait pattern subgroups were identified with dependent dynamic time warping and hierarchical agglomerative clustering. Distribution of clinical descriptives and outcome measures among and between groups were evaluated. Gait predictors that distinguish each cluster from control gait were identified with a random forest classifier and explainable AI. Results Six distinct gait clusters were identified among the 280 iSCI gait cycles. Clusters with relatively low walking speed exhibited shorter step lengths and less ankle plantarflexion in pre-swing than controls. Gait patterns and walking performance in clusters with high walking speed were relatively similar to controls. Overall muscle strength, walking independence, walking speed, step length, step width, sex distribution, and types of walking aids significantly differed between all six clusters. Ankle plantarflexion angle in pre-swing correlated strongly with walking speed and step length. Conclusion Through a series of advanced data-driven approaches, common gait patterns can be objectively identified and comprehensively characterized within a heterogeneous iSCI population. This work represents an initial step in developing individualized rehabilitation programs for persons with iSCI.

STUDY DESIGN:Cross-sectional design. OBJECTIVES:To study motor-cognitive interaction during walking while performing a cognitive task (dual-task [DT]) in ambulatory adults with spina bifida (SB). SETTING:A specialized spinal cord center, The Spinalis clinic at Aleris Rehab Station Stockholm, Sweden. METHODS:Assessments of muscle strength and ambulatory function were performed. Gait was assessed with a sensor-based system with/without the auditory Stroop. Timed-up-and-go (TUG) with/without a cognitive task was also assessed. Regarding cognitive function, episodic memory, executive function, and processing speed were assessed. The percentage of difference between single-task (ST) and dual-task (DT) was used to calculate the DT effect (DTE) as cost or benefit. Differences were analyzed with t-test and Wilcoxon's signed rank test. RESULTS:Forty-one persons were included, mean age 37 years (SD 12) and 20 (49%) were women. Thirty-four completed the DTE analysis. Seven could not perform the cognitive task and/or gait data and could not be registered. There was a DT cost on gait speed (4%), stride length (3%) and double support phase (3%), and cognitive function showed a cost of 3%. DTE for TUG was a 26% cost. CONCLUSION:We showed a DT cost on gait, possibly indicating fall risk during DT walking. The largest DT cost was seen during TUG with a cognitive task, indicating a valuable clinical test for motor-cognitive performance for adults with SB. This study is pioneering in that it increases our understanding of DT performance in ambulatory adults with SB which could facilitate development of targeted rehabilitation interventions and self-management strategies.

Spinal cord injury (SCI) can impair sensorimotor pathways and reduce walking ability. The effects of sensorimotor impairments are complex, as they interact with other factors such as age, pain, injury level, and injury severity. Traditional regression analyses have been used to describe relationships, but they frequently assume linearity. Explainable AI methods such as SHapley Additive ex-Planations (SHAP), based on cooperative game theory, can reveal feature importance globally and locally. Gaussian Process Regression (GPR) can handle limited datasets, a common challenge in observational clinical studies with small sample sizes. In this study, we proposed and evaluated a framework applying GPR and SHAP to quantify how neurological impairments and other factors, including muscle strength, sensory function, age, pain, spasticity, etc., contribute to walking performance, specifically walking speed and net oxygen cost during a six-minute walk test. This approach estimates each factor’s contribution both on a group level and for each individual. Thirty four adults with SCI underwent a clinical assessment and the six-minute walk test with preferred walking aids if relevant. Muscle strength was the most influential factor in both walking speed and net oxygen cost. Male sex, lower age, and less pain were associated with increased walking speed. More pain, higher body mass index, and higher sensory score were associated with lower net oxygen cost. Spasticity, injury level and sensory injury levels had relatively small influence on either outcome measure. Individual SHAP analyses quantified how neurological factors influenced walking performance for each participant. We demonstrate how nonparametric regression and explainable AI provide insights into the complex neurological factors affecting walking ability in persons with SCI.

Aims Cholinesterase inhibitors (ChEIs) have beneficial effects on the heart. Associations between ChEI-use and reduced mortality and cardiovascular events in Alzheimer's disease (AD) have been shown. Whether these associations exist in those with both heart failure (HF) and AD is unknown. Methods and results A propensity score (PS) matched cohort with patients with HF and AD was obtained through linking registers for cognitive/dementia disorders, comorbidities, drug prescription, and death, in Sweden, to analyse associations between ChEI-use and risk of mortality or hospitalization for HF, stroke, or myocardial infarction, were examined. In 455 patients with and 455 without ChEI treatment, ChEI use was associated with reductions of mortality and hospitalization due to HF by 21% [0.79; (confidence interval) CI 0.66-0.96] and 47% (0.53; CI 0.38-0.75), respectively. Donepezil and galantamine but not rivastigmine were associated with a lower risk of death compared with non-users. Donepezil was associated with a lower risk of hospitalization due to HF compared with non-users. There was no significant difference in hospitalization for bradycardia, AV block, or implantation of pacemaker between ChEI use and non-use. Conclusion This study suggests that in persons with HF and AD, treatment with ChEIs is associated with improved survival and a decreased risk of hospital care for HF, but results due to the type of ChEI vary.

OBJECTIVE:To assess the effects of oral screen training in patients with dysphagia post-stroke. BACKGROUND:Oral screen training has been identified as an effective method for improving orofacial and oropharyngeal motor functions. However, the evidence supporting a positive transfer effect on swallowing capacity post-primary stroke rehabilitation is still unclear. The aim of this randomised controlled trial was to investigate the effect of a 12-week oral screen training programme using a prefabricated oral screen, with swallowing capacity as the primary outcome. MATERIALS AND METHODS:In a randomised trial, stroke survivors with residual dysphagia post-rehabilitation were randomised into intervention group (n = 12) and control group (n = 12). The intervention group underwent 12 weeks of oral screen training. The main outcome was swallowing capacity, with lip force as a training indicator. Secondary outcomes were assessed by the Eating Assessment Tool, Masticatory performance, Nordic Orofacial Test-Screening, Life Satisfaction Questionnaire and the Edmonton Symptom Assessment System. RESULTS:At the 3-month follow-up, the group that trained with an oral screen showed a significantly greater increase in lip force than the control group (mean lip force increase 10.2 N vs. 3.1 N; p = 0.02). There was no significant improvement in swallowing capacity (mean increase 0.7 mL/min vs. 0.8 mL/min; p = 0.43), or in any of the secondary variables in the intervention group relative to the control group. CONCLUSION:The findings from this study showed that oral screen training initiated after completion of regular rehabilitation post-stroke can increase lip force. However, there was no indication of any transfer effect on swallowing capacity. TRIAL REGISTRATION:Clinicaltrial.gov identifier: NCT03167892.

Background: Research on heart failure (HF) has often focused on younger patients. The aim of this study was to analyze extent of investigation and treatment changes among patients during inpatient geriatric care for worsening of HF as well as information given to next caregiver. Methods: Data were retrospectively collected from 134 individuals treated for heart failure (HF) as main diagnosis in wards specialized in geriatric medicine. Data on referral content, Natriuretic peptide type B(NT-pro-BNP), echocardiography (ECHO) and drug treatment as well as length of care episode and information to the next caregiver, were collected. Results: During the investigated geriatric care episode, 20 % of the patients were analyzed for NT-pro-BNP and 2 % were investigated with ECHO. No significant changes in drug treatment with angiotensin-converting-enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB) or beta blockers (BB) were made, but significant increase in treatment with furosemide (55 to 83 %, p<0.001) and spironolactone (19 to 28 %, p=0.033) was observed. Five patients were at discharge treated with target doses of both ACEI/ARB and BB. A subgroup of patients was prescribed more spironolactone during the care episode (higher dose or new prescription). These patients had more weight loss (p<0.001), longer care episodes (p=0.002) and more NT-pro-BNP assessments (p=0.008) where the longer care episode seemed to influence the increase of spironolactone most. There was a significant wash out of information in the referrals at discharge to primary care, compared to the referrals at admission to geriatric care. Information on etiology dropped from 31.4 % to 5.8 % (p<0.001) and information on ejection fraction (EF) dropped from 19.8% to 3.5% (p<0.001). Conclusions: The contribution by geriatric care to investigations was modest or low. During the geriatric care episode, no net changes in pharmacological treatments for heart failure were made, except for spironolactone and furosemide. The wash out of information about the patients in referrals from geriatricians to primary care physicians is worrying. More collaboration between cardiologists, geriatricians and primary care physicians may improve the health situation among geriatric HF patients.

This is a protocol for comprehensive analysis of gait and affecting factors in individuals with incomplete paraplegia due to spinal cord injury (SCI). A SCI is a devastating event affecting both sensory and motor functions. Due to better care, the SCI population is changing, with a greater proportion retaining impaired ambulatory function. Optimizing ambulatory function after SCI remains challenging. To investigate factors influencing optimal ambulation, a multi-professional research project was grounded with expertise from clinical rehabilitation, neurophysiology, and biomechanical engineering from Karolinska Institutet, the Spinalis Unit at Aleris Rehab Station (Sweden’s largest center for specialized neurorehabilitation), and the Promobilia MoveAbility Lab at KTH Royal Institute of Technology. Ambulatory adults with paraplegia will be consecutively invited to participate. Muscle strength, sensitivity, and spasticity will be assessed, and energy expenditure, 3D movements, and muscle function (EMG) during gait and submaximal contractions will be analyzed. Innovative computational modeling and data-driven analyses will be performed, including the identification of clusters of similar movement patterns among the heterogeneous population and analyses that study the link between complex sensorimotor function and movement performance. These results may help optimize ambulatory function for persons with SCI and decrease the risk of secondary conditions during gait with a life-long perspective.

OBJECTIVEThis paper describes the study protocol in an ongoing clinical trial evaluating oral screen training as part of a post-stroke rehabilitation programme. Baseline data were related to four domains: dysphagia, lip function, masticatory performance and patient-related outcome measures (PROM).BACKGROUNDStroke is one of the most common causes of disability-adjusted life years, and dysphagia is a common remaining problem after stroke. Rehabilitation using oral screen training has been suggested to improve swallowing, but evidence is still insufficient.MATERIALS AND METHODSPatients diagnosed with stroke with persisting objective and/or subjective swallowing dysfunction after primary rehabilitation were assessed for eligibility. In total, 25 patients were included. Objective function was assessed by swallowing capacity test (SCT), lip force and masticatory performance, subjective function by EAT-10 and NOT-S and PROM by LiSat-11 and ESAS.RESULTSBaseline data presented a heterogeneous pattern with no significant association between objective and subjective dysfunction. Most of the participants (20/25) showed impaired swallowing capacity in SCT, and 23/24 revealed orofacial dysfunction according to NOT-S. The most common subjective item reported was chewing and swallowing problems (19/24).CONCLUSIONThe heterogenous findings in the included tests and the lack of correlations emphasise the importance of multidisciplinary approaches to identify objective and subjective orofacial post-stroke dysfunction in clinical practice to be able to offer evidence-based individualised care. The included participants were representative of stroke patients with dysphagia, which supports proceeding with the planned intervention.

AIMS:To examine the number and types of urological surgical procedures carried out in a regional prevalence population of patients with traumatic spinal cord injury (SCI) during five decades, evaluate objective and patient-reported outcomes and to consider lessons learned for further improvement of surgical treatment in this patient group. METHODS:In a cross-sectional study of 412 patients with traumatic SCI, one-third had undergone urological surgery through a period of up to 50 years. Data on types of surgery, complications, follow-up and outcomes were collected in a retrospective review of patient files. S-creatinine, S-cystatin-C, renal ultrasound and a questionnaire regarding complications during the preceding year were assembled as part of a yearly follow-up. Descriptive statistics were calculated. Logistic regression was used to determine risk profiles for the incidence of urological surgery. RESULTS:A total of 137 patients had undergone 262 urological surgical interventions. The incidence was highest amongst persons with a cervical-thoracic neurological level of spinal cord lesion and during the first 2 years after SCI. Surgery for urinary stones constituted 29% of all procedures. One-fourth of the patients had undergone 47% of all procedures, notably urinary diversion and ensuing complications, implants and revisions, repeated stone interventions or bladder outlet procedures. After reconstructive surgery functional outcomes and patient-reported satisfaction were generally favourable, but long-term signs of renal complications were frequent. CONCLUSIONS:Urological surgery after SCI involves imperative as well as reconstructive procedures, some of which are challenging and call for centralisation to devoted teams. Prospective studies of reconstructive urology are warranted, including more extensive patient-reported outcomes.

BACKGROUND Masticatory parameters, such as reduced number of teeth and posterior contacts, have been shown to be associated with reduced cognitive status. The underlying mechanisms that affect these associations, are however, not well understood. OBJECTIVES The study aims to investigate the association between masticatory dysfunction and cognition and explore the mediating effect of brain structure. METHODS In this cross-sectional study, 45 older adults with subjective masticatory dysfunction (mean age 72.3 ± 4.0 years) were included. Mini-Mental State Examination score <25, brain trauma, neurological disease, neurodegenerative disorders, depression or poor Swedish language skills were criteria for exclusion. Cognitive functions (executive function and episodic memory) and masticatory dysfunction defined by functional occluding status (FOS; the number of occluding units and number of remaining teeth) were analysed with partial correlation models. Structural magnetic resonance imaging was performed on 28 feasible participants. Multiple regression analyses were performed to evaluate the predictive value of brain structure and white matter hypointensities (WM-hypo) on cognitive functions. A mediation analysis was applied to assess significant predictor/s of the association between FOS and cognition. RESULTS Both episodic memory and executive functions were positively correlated with FOS. WM-hypo predicted cognitive status (executive function, p ≤ .01). WM-hypo mediated 66.6% (p = 0.06) of the association between FOS and executive functions. CONCLUSION Associations between FOS and cognitive functions are reported, where FOS, a potential modifiable risk factor, was related to both episodic memory and executive functions. The mediating effect of WM-hypo on the association between FOS and executive functions highlights the impact of the vascularisation of the brain on the link between mastication and cognition. The present study provides increased knowledge that bridges the gap between masticatory dysfunction and cognition.

Background Research on heart failure (HF) has often focused on younger patients. The aim of this study was to analyze extent of investigation and treatment among older patients prior to referral to inpatient geriatric care for worsening of HF. Methods Data on etiology, ejection fraction (EF) by echocardiography (ECHO), level of functioning according to New York Heart Association (NYHA), analysis of N-terminal-pro-brain natriuretic peptide (NT-Pro-BNP), ongoing treatment, adherence to guidelines, and information from previous caregiver were collected from patient records prior to admission from a sample of 134 patients. Results Few patients had been examined by a cardiologist (14%) during the year prior to referral. EF assessment had been performed in 78% ( n = 105). The patients were categorized as having HF with reduced (HFrEF 28%), preserved (HFpEF 53%) or mid-range (HFmrEF 19%) EF. HFpEF patients had older EF assessments (mean 517 days) than those with HFrEF (385 days). In 61% ( n = 82) at least one assessment with NT-Pro-BNP had been performed, being older among patients with HFpEF (290 days vs 16 days). There was a strong positive correlation (OR 4.9, p = 0.001) between having recent assessments of EF and NT-Pro-BNP ( n = 30, 21%) and being presented with etiology in the referral, adjusted for EF, age, sex, and comorbidity. Among the HFrEF patients, 78% were treated with ACEI/ARB and BB according to ESC guidelines but reaching only half of target doses. In the HFpEF group the corresponding treatment was 46%. Among patients with EF ≤ 35% only 14% were treated with mineral receptor antagonists, ie low adherence to guidelines. Conclusions HF care in this population of older individuals showed deficiencies. There was little contact with cardiologists, lack of information of etiology in referrals and low adherence to treatment guidelines. Improving adherence to HF guidelines regarding investigation and treatment for HF in older people is therefore urgent and calls for more collaboration between specialists in cardiology and geriatric medicine.

Cholinesterase inhibitors (ChEIs) are approved for treatment of Alzheimer’s dementia (AD). ChEIs inhibit the enzyme acetylcholinesterase, increasing the duration of action of acetylcholine in the central and peripheral nervous systems. ChEIs are known to be anti-inflammatory and to have negative chronotropic effects. Observational studies by us and other groups have indeed shown an association with use of ChEIs in AD with lower risk of death and cardiovascular events (CVD) including myocardial infarction, heart failure (HF), and stroke. We next wanted to investigate whether ChEI treatment in AD patients with HF is associated with reduced risk for mortality and for hospitalization due to CVD. Data from the Swedish registry for dementia disorders, SveDem,was linked to the Patient-, Prescribed Drug- and Cause of death registries. In a propensity score (PS) matched cohort of patients with AD and HF, the association between ChEI use and all-cause death or hospitalization due to CVD was examined with Cox proportional hazards models. The PS matched cohort included 455 patients with HF prior to the AD diagnosis with ChEI and 455 non-ChEI users. During a median follow-up time of 2.14 years, 549 deaths occurred. Compared to non-users, ChEI use was associated with 21% lower risk of death (adjusted HR 0.79; 0.66-0.96). Galantamine and donepezil (0.64; CI 0.47-0.87 and 0.80; CI 0.64-0.98) but not rivastigmine (0.96; CI 0.73-1.28) were associated with lower risk of death. Any ChEI use was associated with a 47% (CI 0.38-0.75) reduction in risk of hospitalization due to HF and a 52% reduction (CI 0.32-072) among donepezil-users. This study supports previous reports that treatment with ChEIs in AD is associated with reduced mortality risk. We here show that this association is also found in patients with HF and AD but with differential effects among the ChEIs. Further studies are needed to elucidate the mechanisms. The study also showed a substantial reduction in hospitalization due to CVD. Our results highlight the impact of cardiovascular comorbidities in AD which need to be considered in clinical trials as would the impact of the baseline treatment with ChEIs in new anti-dementia drug trials.

Exercise and protein for function and self-confidence - The OPEN model for community care of older persons Experiences from the COVID-19 pandemic indicate the need to introduce care routines for health promotion among recipients of care for older persons. A treatment model with daily repeated sit-to-stand exercises in combination with oral protein supplements twice daily has been evaluated in community care for older persons in the Stockholm Region; the Older Person's Exercise and Nutrition (OPEN) Study. The 3-month controlled study included 102 residents. A substantial part of the residents were able to follow the intervention, and to maintain or improve their chair-rising capacity, while also increasing their weight and muscle mass. Interview studies showed that the participants found the OPEN concept was easy to adopt, gave increased self-confidence and an increased sense of hope. The staff perceived the intervention as a potentially positive concept. The OPEN model is a method that may contribute to a health-promoting way of working in the care of older persons.

BackgroundBasal forebrain cholinergic neurons are dependent on nerve growth factor (NGF) for growth and survival and these cells are among the first to degenerate in Alzheimer’s disease (AD). Targeted delivery of NGF has been suggested as a potential therapy for AD. This hypothesis was tested in a clinical trial with encapsulated cell biodelivery of NGF (NGF-ECB) in AD patients. Three of six patients showed improved biomarkers for cognition by the end of the study. Here, we report on the effects of targeted delivery of NGF on human resting EEG.Materials and methodsNGF-ECB implants were implanted bilaterally in the basal forebrain of six AD patients for 12 months. EEG recordings and quantitative analysis were performed at baseline, 3 and 12 months of NGF delivery, and analyzed for correlation with changes in Mini-mental state examination (MMSE) and levels of the cholinergic marker choline acetyltransferase (ChAT) in cerebrospinal fluid (CSF).ResultsWe found significant correlations between the topographic variance of EEG spectral power at the three study points (baseline, 3 and 12 months) and changes in MMSE and CSF ChAT. This possible effect of NGF was identified in a narrow window of alpha frequency 10–11.5 Hz, where a stabilization in MMSE score during treatment was related to an increase in EEG alpha power. A similar relation was observed between the alpha power and ChAT. More theta power at 6.5 Hz was on the contrary associated with a decrease in CSF ChAT during the trial period.ConclusionIn this exploratory study, there was a positive correlative pattern between physiological high-frequency alpha activity and stabilization in MMSE and increase in CSF ChAT in AD patients receiving targeted delivery of NGF to the cholinergic basal forebrain.

Local neuromodulation of brain functions can be accomplished in many ways: electrical stimulation, local micro-infusion of drugs, implantations of viruses or engineered cells, etc. We have studied targeted encapsulated cell implants delivering active substances locally in Alzheimer patients (AD). AD is associated with early loss of basal forebrain cholinergic neurons (BFCNs) and cognitive dysfunction. BFCNs are dependent on nerve growth factor (NGF). Previously, we have developed an encapsulated cell biodelivery (ECB) platform and utilized it to stimulate BFCNs in two cholinergic target sites (Ch4 [nucl.

Purpose: Health-related quality of life (HRQoL) is an important patient-related outcome for the assessment of interventions and treatments in older people. Understanding underlying mechanisms for HRQoL is crucial for improving care, rehabilitation and symptom relief. This study examined the associations between HRQoL and frailty, sarcopenia, dependence of ADL, physical function and nutritional status in older nursing home (NH) residents. Patients and Methods: This is a cross-sectional study employing baseline data from the Older Person's Exercise and Nutrition (OPEN) study. Residents >= 75 years and able to stand up from seated position, residing in eight nursing homes in Sweden, were recruited. The EuroQoL 5-dimension Questionnaire (EQ-5D-5L, 0-1) was used to assess HRQoL. For exposure, the FRAIL and SARC-F questionnaires, Bergs Balance Scale, Functional Independence Measure (FIM), and Mini Nutritional Assessment-Short Form (MNA-SF) were used, including chair-stand test, walking speed and some biochemical markers. Descriptive and inferential statistics including linear regression models were applied. Results: Data from 113 residents (59% women, mean age 85 years) revealed a mean EQ-5D index of 0.76. After relevant adjustments, factors associated with low HRQoL were sarcopenia (p<0.001), cognitive function (p<0.001), dependence in ADL (p=0.002), low plasma-albumin (p=0.002) and impaired nutritional status (p=0.038). Conclusion: This study displays evidence that modifiable conditions like sarcopenia and malnutrition are related to HRQoL in older NH residents. Such findings indicate a potential for physical exercise, including muscle training, and improved nutritional routines, including protein supplementation, to enhance nursing home care. Future studies, in larger NH populations, on exercise and nutrition for effects on HRQoL are needed.

Background: Spina bifida (SB) is a complex congenital malformation, often causing impaired gait performance depending on the level and extent of malformation. Research regarding gait and balance performance in adults with SB, has not been sufficiently described yet. Research question: What are the characteristics of spatiotemporal gait parameters and balance performance in adults with SB? Further, do persons with muscle function (MF) level 3 differ regarding gait and balance performance from those with MF level 1-2? Methods: Cross-sectional observational study at an outpatient clinic. 41 adults with SB (18-65 years), who walked regularly. Spatiotemporal parameters of gait was assessed with the APDM system and balance performance with the Mini Balance Evaluation Systems Test (Mini-BESTest). Muscle strength in the legs was assessed with 0-5 manual muscle test, and participants were classified according to level of MF into groups MF1, MF2, and MF3. Two-sided t-test was used for parametric independent variables, and Cohen's d was used for effect sizes. The Mann-Whitney U test was used for non-parametric independent data and effect size was calculated by the z value (r = z/root n). Results: Mean gait speed was 0.96 (SD 0.20) m/s and mean stride length 1.08 m (SD 0.17), individuals with MF3 showed significantly slower gaitspeed and shorter stride length (p < 0.05). Lumbar rotation was 21 degrees (SD 11), and thoracic lateral sway 15 degrees (IQR 15) with significantley difference (p < 0.001 and p < 0.05) for individuals in MF3. Mini-BESTest showed a mean score of 11.3 (SD 6.9), and individuals with MF3 showed significantly lower scores (p <= 0.001). Significance: Gait and balance performance was reduced compared to normative data in almost all parameters, especially in persons with less muscle function. Increased knowledge from advanced gait analysis may help healthcare professionals to design rehabilitation programmes, in order to achieve and maintain a sustainable gait and balance performance.