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Hyngstrom AS, Nguyen JN, Uhrich TD, Wright MT, Gutterman DD, Schmit BD, Durand MJ. Quantification of Tissue Oxygen Saturation in the Vastus Lateralis Muscle of Chronic Stroke Survivors during a Graded Exercise Test. Cardiopulm Phys Ther J 2023; 34:39-50. [PMID: 36816465 PMCID: PMC9937433 DOI: 10.1097/cpt.0000000000000208] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Purpose This study examined tissue oxygen saturation (StO2) of the vastus lateralis (VL) muscles of chronic stroke survivors during a graded exercise test (GXT). We hypothesized the reduction in StO2 will be blunted in the paretic vs. non-paretic VL during a maximum-effort GXT. Methods Chronic stroke survivors performed a GXT and StO2 of the VL in each leg was measured using near infrared spectroscopy. Twenty-six stroke survivors performed a GXT. Results At rest, there was no difference in StO2 between the paretic and non-paretic VL (65±9% vs. 68±7%, respectively, p=0.32). The maximum change in StO2 from rest during the GXT was greater in the non-paretic vs. the paretic VL (-16±14% vs. -9±10%, respectively, p<0.001). The magnitude of the oxygen resaturation response was also greater in the non-paretic vs. the paretic VL (29±23% vs. 18±15%, respectively, p<0.001). VO2 Peak was associated with the magnitude of the VL StO2 change during (r2=0.54, p<0.0001) and after (r2=0.56, p<0.001) the GXT. Conclusions During a GXT there is a blunted oxygen desaturation response in the paretic vs. the non-paretic VL of chronic stroke survivors. In the paretic VL there was a positive correlation between the oxygen desaturation response during the GXT and VO2 Peak.
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Affiliation(s)
| | - Jennifer N. Nguyen
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Toni D. Uhrich
- Department of Physical Therapy, Marquette University, Milwaukee, WI, USA
| | - Michael T. Wright
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, WI, USA
| | - David D. Gutterman
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Brian D. Schmit
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, WI, USA
| | - Matthew J. Durand
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, WI, USA
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, USA
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Liu LY, Sangani S, Patterson KK, Fung J, Lamontagne A. Instantaneous effect of real-time avatar visual feedback on interlimb coordination during walking post-stroke. Clin Biomech (Bristol, Avon) 2022; 100:105821. [PMID: 36435074 DOI: 10.1016/j.clinbiomech.2022.105821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Gait asymmetry, which is common after stroke, is typically characterized using spatiotemporal parameters of gait that do not consider the aspect of movement coordination. In this manuscript, we examined whether an avatar-based feedback provided as a single-session intervention to improve gait symmetry also improved inter-limb coordination among people with stroke and we examined the relationship between changes in coordination and step length symmetry. METHODS Twelve stroke participants walked on a self-paced treadmill with and without a self-avatar that replicated their locomotor movements in real time. Continuous relative phase and angular coefficient of correspondence calculated using bilateral sagittal hip movements were used to quantify temporal and spatial interlimb coordination, respectively. Spatial gait symmetry, previously shown to improve with the avatar feedback, was quantified using step length ratio between both limbs, with the largest value as numerator. FINDINGS Participants who improved their spatial symmetry during avatar exposure also improved their temporal coordination, while spatial coordination remained unchanged. Overall, improvements in spatial symmetry correlated positively with improvements in temporal coordination. The non-paretic hip and paretic ankle angle excursion in the sagittal plane also significantly increased during avatar exposure. INTERPRETATION Improvements in gait symmetry may be explained by changes in interlimb coordination. Current data and existing literature further suggest that such improvements are largely driven by adaptations in non-paretic leg movements, notably at the hip. By providing real-time information on walking movements not affordable in other ways, avatar-based feedback shows great potential to improve gait symmetry and interlimb coordination post-stroke.
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Affiliation(s)
- Le Yu Liu
- School of Physical and Occupational Therapy of McGill University, 3654 Promenade Sir-William-Osler, Montreal H3G1Y5, Canada; Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital site of CISSS-Laval and research site of the Montreal Centre for Interdisciplinary Research in Rehabilitation (CRIR), 3205 Pl. Alton-Goldbloom, Laval H7V 1R2, Canada.
| | - Samir Sangani
- Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital site of CISSS-Laval and research site of the Montreal Centre for Interdisciplinary Research in Rehabilitation (CRIR), 3205 Pl. Alton-Goldbloom, Laval H7V 1R2, Canada
| | - Kara K Patterson
- Department of Physical Therapy of University of Toronto, 160-500 University Ave, Toronto M5G 1V7, Canada; KITE-University Health Network, 550 University Ave #12-165, Toronto M5G 2A2, Canada.
| | - Joyce Fung
- School of Physical and Occupational Therapy of McGill University, 3654 Promenade Sir-William-Osler, Montreal H3G1Y5, Canada; Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital site of CISSS-Laval and research site of the Montreal Centre for Interdisciplinary Research in Rehabilitation (CRIR), 3205 Pl. Alton-Goldbloom, Laval H7V 1R2, Canada.
| | - Anouk Lamontagne
- School of Physical and Occupational Therapy of McGill University, 3654 Promenade Sir-William-Osler, Montreal H3G1Y5, Canada; Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital site of CISSS-Laval and research site of the Montreal Centre for Interdisciplinary Research in Rehabilitation (CRIR), 3205 Pl. Alton-Goldbloom, Laval H7V 1R2, Canada.
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Cleland BT, Schindler-Ivens S. Symmetry Is Associated With Interlimb Coordination During Walking and Pedaling After Stroke. J Neurol Phys Ther 2021; 46:81-87. [PMID: 34507343 PMCID: PMC8904653 DOI: 10.1097/npt.0000000000000377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Asymmetry during walking may be explained by impaired interlimb coordination. We examined these associations: (1) propulsive symmetry with interlimb coordination during walking, (2) work symmetry with interlimb coordination during pedaling, and (3) work symmetry and interlimb coordination with clinical impairment. METHODS Nineteen individuals with chronic stroke and 15 controls performed bilateral, lower limb pedaling with a conventional device and a device with a bisected crank and upstroke assistance. Individuals with stroke walked on a split-belt treadmill. Measures of symmetry (%Propulsionwalk, %Workped) and interlimb phase coordination index (PCIwalk, PCIped) were computed. Clinical evaluations were the lower extremity Fugl-Meyer (FMLE) and walking speed. Associations were assessed with Spearman's rank correlations. RESULTS Participants with stroke displayed asymmetry and impaired interlimb coordination compared with controls (P ≤ 0.001). There were significant correlations between asymmetry and impaired interlimb coordination (walking: R2 = 0.79, P < 0.001; pedaling: R2 = 0.62, P < 0.001) and between analogous measures across tasks (%Workped, %Propulsionwalk: R2 = 0.41, P = 0.01; PCIped, PCIwalk: R2 = 0.52, P = 0.003). Regardless of task, asymmetry and interlimb coordination were correlated with FMLE (R2 ≥ 0.48, P ≤ 0.004) but not walking speed. There was larger within group variation for %Propulsionwalk than %Workped (Z = 2.6, P = 0.005) and for PCIped than PCIwalk (Z = 3.6, P = 0.003). DISCUSSION AND CONCLUSIONS Pedaling may provide useful insights about walking, and impaired interlimb coordination may contribute to asymmetry in walking. Pedaling and walking provide distinct insights into stroke-related impairments, related to whether the task allows compensation (walking > pedaling) or compels paretic limb use (pedaling > walking). Pedaling a device with a bisected crank shaft may have therapeutic value.Video Abstract available for more insight from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A365).
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Affiliation(s)
- Brice T Cleland
- Department of Physical Therapy, College of Health Sciences, Marquette University, Milwaukee, Wisconsin
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Cleland B, Madhavan S. Changes in Walking Speed After High-Intensity Treadmill Training Are Independent of Changes in Spatiotemporal Symmetry After Stroke. Front Neurol 2021; 12:647338. [PMID: 33868151 PMCID: PMC8049178 DOI: 10.3389/fneur.2021.647338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/11/2021] [Indexed: 12/22/2022] Open
Abstract
Objectives: Decreased walking speeds and spatiotemporal asymmetry both occur after stroke, but it is unclear whether and how they are related. It is also unclear whether rehabilitation-induced improvements in walking speed are associated with improvements in symmetry or greater asymmetry. High-intensity speed-based treadmill training (HISTT) is a recent rehabilitative strategy whose effects on symmetry are unclear. The purpose of this study was to: (1) assess whether walking speed is cross-sectionally associated with spatiotemporal symmetry in chronic stroke, (2) determine whether HISTT leads to changes in the spatiotemporal symmetry of walking, and (3) evaluate whether HISTT-induced changes in walking speed are associated with changes in spatiotemporal symmetry. Methods: Eighty-one participants with chronic stroke performed 4 weeks of HISTT. At pre, post, and 3-month follow-up assessments, comfortable and maximal walking speed were measured with the 10-meter walk test, and spatiotemporal characteristics of walking were measured with the GAITRite mat. Step length and swing time were expressed as symmetry ratios (paretic/non-paretic). Changes in walking speed and symmetry were calculated and the association was determined. Results: At pre-assessment, step length and swing time asymmetries were present (p < 0.001). Greater temporal symmetry was associated with faster walking speeds (p ≤ 0.001). After HISTT, walking speeds increased from pre-assessment to post-assessment and follow-up (p ≤ 0.002). There were no changes in spatiotemporal symmetry (p ≥ 0.10). Change in walking speed was not associated with change in spatial or temporal symmetry from pre- to post-assessment or from post-assessment to follow-up (R2 ≤ 0.01, p ≥ 0.37). Conclusions: HISTT improves walking speed but does not systematically improve or worsen spatiotemporal symmetry. Clinicians may need to pair walking interventions like HISTT with another intervention designed to improve walking symmetry simultaneously. The cross-sectional relation between temporal symmetry and walking speed may be mediated by other factors, and not be causative.
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Affiliation(s)
- Brice Cleland
- Brain Plasticity Lab, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States
| | - Sangeetha Madhavan
- Brain Plasticity Lab, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States
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Fujita K, Kobayashi Y, Miaki H, Hori H, Tsushima Y, Sakai R, Nomura T, Ogawa T, Kinoshita H, Nishida T, Hitosugi M. Pedaling improves gait ability of hemiparetic patients with stiff-knee gait: fall prevention during gait. J Stroke Cerebrovasc Dis 2020; 29:105035. [PMID: 32807447 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/01/2020] [Accepted: 06/04/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE Stiff-knee gait, which is a gait abnormality observed after stroke, is characterized by decreased knee flexion angles during the swing phase, and it contributes to a decline in gait ability. This study aimed to identify the immediate effects of pedaling exercises on stiff-knee gait from a kinesiophysiological perspective. METHODS Twenty-one patients with chronic post-stroke hemiparesis and stiff-knee gait were randomly assigned to a pedaling group and a walking group. An ergometer was set at a load of 5 Nm and rotation speed of 40 rpm, and gait was performed at a comfortable speed; both the groups performed the intervention for 10 min. Kinematic and electromyographical data while walking on flat surfaces were immediately measured before and after the intervention. RESULTS In the pedaling group, activity of the rectus femoris significantly decreased from the pre-swing phase to the early swing phase during gait after the intervention. Flexion angles and flexion angular velocities of the knee and hip joints significantly increased during the same period. The pedaling group showed increased step length on the paralyzed side and gait velocity. CONCLUSIONS Pedaling increases knee flexion during the swing phase in hemiparetic patients with stiff-knee gait and improves gait ability.
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Affiliation(s)
- Kazuki Fujita
- Department of Rehabilitation, Faculty of Health Science, Fukui Health Science University, 55-13-1 Egami, Fukui-city 910-3190, Fukui, Japan.
| | - Yasutaka Kobayashi
- Department of Rehabilitation, Faculty of Health Science, Fukui Health Science University, 55-13-1 Egami, Fukui-city 910-3190, Fukui, Japan.
| | - Hiroichi Miaki
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa-city, Ishikawa, Japan.
| | - Hideaki Hori
- Department of Rehabilitation, Faculty of Health Science, Fukui Health Science University, 55-13-1 Egami, Fukui-city 910-3190, Fukui, Japan.
| | - Yuichi Tsushima
- Department of Physical Therapy Rehabilitation, Fukui General Hospital, Fukui-city, Fukui, Japan.
| | - Ryo Sakai
- Department of Rehabilitation, Faculty of Health Science, Fukui Health Science University, 55-13-1 Egami, Fukui-city 910-3190, Fukui, Japan.
| | - Tomomi Nomura
- Department of Physical Therapy Rehabilitation, Fukui General Hospital, Fukui-city, Fukui, Japan.
| | - Tomoki Ogawa
- Department of Physical Therapy Rehabilitation, Fukui General Hospital, Fukui-city, Fukui, Japan.
| | - Hirotaka Kinoshita
- Department of Physical Therapy Rehabilitation, Fukui General Hospital, Fukui-city, Fukui, Japan.
| | - Tomoko Nishida
- Department of Physical Therapy Rehabilitation, Fukui General Hospital, Fukui-city, Fukui, Japan.
| | - Masahito Hitosugi
- Department of Legal Medicine, Shiga University of Medical Science, Otsu-city, Shiga, Japan.
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