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Erdoğan MŞ, Arpak ES, Keles CSK, Villagra F, Işık EÖ, Afşar N, Yucesoy CA, Mur LAJ, Akanyeti O, Saybaşılı H. Biochemical, biomechanical and imaging biomarkers of ischemic stroke: Time for integrative thinking. Eur J Neurosci 2024; 59:1789-1818. [PMID: 38221768 DOI: 10.1111/ejn.16245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/12/2023] [Accepted: 12/16/2023] [Indexed: 01/16/2024]
Abstract
Stroke is one of the leading causes of adult disability affecting millions of people worldwide. Post-stroke cognitive and motor impairments diminish quality of life and functional independence. There is an increased risk of having a second stroke and developing secondary conditions with long-term social and economic impacts. With increasing number of stroke incidents, shortage of medical professionals and limited budgets, health services are struggling to provide a care that can break the vicious cycle of stroke. Effective post-stroke recovery hinges on holistic, integrative and personalized care starting from improved diagnosis and treatment in clinics to continuous rehabilitation and support in the community. To improve stroke care pathways, there have been growing efforts in discovering biomarkers that can provide valuable insights into the neural, physiological and biomechanical consequences of stroke and how patients respond to new interventions. In this review paper, we aim to summarize recent biomarker discovery research focusing on three modalities (brain imaging, blood sampling and gait assessments), look at some established and forthcoming biomarkers, and discuss their usefulness and complementarity within the context of comprehensive stroke care. We also emphasize the importance of biomarker guided personalized interventions to enhance stroke treatment and post-stroke recovery.
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Affiliation(s)
| | - Esra Sümer Arpak
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey
| | - Cemre Su Kaya Keles
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey
- Institute of Structural Mechanics and Dynamics in Aerospace Engineering, University of Stuttgart, Stuttgart, Germany
| | - Federico Villagra
- Department of Life Sciences, Aberystwyth University, Aberystwyth, Wales, UK
| | - Esin Öztürk Işık
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey
| | - Nazire Afşar
- Neurology, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Turkey
| | - Can A Yucesoy
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey
| | - Luis A J Mur
- Department of Life Sciences, Aberystwyth University, Aberystwyth, Wales, UK
| | - Otar Akanyeti
- Department of Computer Science, Llandinam Building, Aberystwyth University, Aberystwyth, UK
| | - Hale Saybaşılı
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey
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Hinton EH, Bierner S, Reisman DS, Likens A, Knarr BA. Paretic propulsion changes with handrail Use in individuals post-stroke. Heliyon 2024; 10:e26924. [PMID: 38463863 PMCID: PMC10920377 DOI: 10.1016/j.heliyon.2024.e26924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 02/13/2024] [Accepted: 02/21/2024] [Indexed: 03/12/2024] Open
Abstract
Background Roughly 800,000 people experience a stroke every year in the United States, and about 30% of people require walking assistance (walker, cane, etc.) after a stroke. Gait training on a treadmill is a common rehabilitation activity for individuals post-stroke and handrails are typically used to assist with walking during this training, however individual interaction with these handrails are not usually considered and quantitatively reported. Individuals may exert force onto the handrails to aid with propulsive force, but the relationship between limb propulsive force and handrail propulsive force are not known. Research question How do individuals post-stroke alter paretic propulsive force when using an assistive device, such as handrails on a treadmill? Methods Twenty-one individuals post-stroke (eight current assistive device users and thirteen individuals who do not use an assistive device) walked on a treadmill for 3 min during three conditions: no handrail use, light handrail use (<5% BW) and self-selected handrail use. Three multilevel models were used to compare percent handrail, paretic and nonparetic propulsion between handrail conditions and assistive device groups. Results The handrail propulsive impulse was more during the self-selected handrail condition compared to the light handrail condition (p = 0.002). The assistive device use group and the handrail condition fixed effects significantly improved the model fit for paretic propulsive impulse (p = 0.01). The interaction between assistive device use group and handrail condition significantly improved the model fit for nonparetic propulsive impulse (p < 0.001). Significance These results suggest that handrail use may impact paretic propulsive impulse. Our initial results suggest that if the goal of rehabilitation treadmill training is to increase the paretic propulsive impulse, having the clinician encourage walking with the handrails may be optimal to promote paretic propulsion.
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Song J, Hardin EC. Monitoring walking asymmetries and endpoint control in persons living with chronic stroke: Implications for remote diagnosis and telerehabilitation. Digit Health 2024; 10:20552076231220450. [PMID: 38188863 PMCID: PMC10768577 DOI: 10.1177/20552076231220450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/23/2023] [Indexed: 01/09/2024] Open
Abstract
Objective The objective of this study was to assess the feasibility of monitoring and diagnosing compromised walking motion in the frontal plane, particularly in persons living with the chronic effects of stroke (PwCS). The study aimed to determine whether active control of walking in the frontal plane could be monitored and provide diagnostic insights into compensations made by PwCS during community living. Methods The study recruited PwCS with noticeable walking asymmetries and employed a monitoring method to assess frontal plane motion. Monitoring was conducted both within a single assessment and between assessments. The study aimed to uncover baseline data and diagnostic information about active control in chronic stroke survivors. Data were collected using sensors during 6 minutes of walking and compared between the paretic and non-paretic legs. Results The study demonstrated the feasibility of monitoring frontal plane motion and diagnosing disturbed endpoint control (p < 0.0125) in chronic stroke survivors when comparing the paretic leg to the non-paretic leg. A greater variability was observed in the paretic leg (p < 0.0125), and sensors were able to diagnose a stronger coupling of the body with its endpoint on the paretic side (p < 0.0125). Similar results were obtained when monitoring was conducted over a six-minute walking period, and no significant diagnostic differences were found between the two monitoring assessments. Monitoring did not reveal performance fatigue or debilitation over time. Conclusions This study's findings indicate that monitoring frontal plane motion is a feasible approach for diagnosing compromised walking motion. The results suggest that individuals with walking asymmetries, exhibit differences in endpoint control and variability between their paretic and non-paretic legs. These insights could contribute to more effective rehabilitation strategies and highlight the potential for monitoring compensations during various activities of daily living.
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Affiliation(s)
- Jiafeng Song
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
- Department of Biomedical Informatics, Emory University, Atlanta, GA, USA
| | - Elizabeth C Hardin
- Human Performance Virtual Reality Lab, Cleveland FES Center, Cleveland VA Medical Center, Cleveland, OH, USA
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Odanye O, Steffensen E, Hinton E, Bierner S, Hsiao HY, Knarr B. Treadmill Handrail-Use Increases the Anteroposterior Margin of Stability in Individuals' Post-Stroke. J Mot Behav 2023; 56:253-262. [PMID: 37994869 PMCID: PMC10957321 DOI: 10.1080/00222895.2023.2285383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 10/28/2023] [Indexed: 11/24/2023]
Abstract
Treadmills are important rehabilitation tools used with or without handrails. The handrails could be used to attain balance, prevent falls, and improve the walking biomechanics of stroke survivors, but it is yet unclear how the treadmill handrails impact their stability margins. Here, we investigated how 3 treadmill handrail-use conditions (no-hold, self-selected support, and light touch) impact stroke survivors' margins of stability (MoS). The anteroposterior MoS significantly increased for both legs with self-selected support while the mediolateral MoS of the unaffected leg decreased significantly when the participants walked with self-selected support in comparison to no-hold in both cases. We concluded that the contextual use of the handrail should guide its prescription for fall prevention or balance training in rehabilitation programs.
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Affiliation(s)
- Oluwaseye Odanye
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, Nebraska, USA
| | - Emily Steffensen
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, Nebraska, USA
| | - Erica Hinton
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, Nebraska, USA
| | - Samuel Bierner
- Department of Physical Medicine and Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Hao-Yuan Hsiao
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, Texas, USA
| | - Brian Knarr
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, Nebraska, USA
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Xu Q, Li Z, Su J, Hu M, Yin Q, Chen S, Song J, Chen H. Body Weight Support Treadmill Training Combined With Sciatic Nerve Electrical Stimulation Ameliorating Motor Function by Enhancing PI3K/Akt Proteins Expression via BDNF/TrkB Signaling Pathway in Rats with Spinal Cord Injury. World Neurosurg 2023; 178:e239-e253. [PMID: 37467957 DOI: 10.1016/j.wneu.2023.07.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 07/08/2023] [Accepted: 07/10/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE To investigate the effects of body weight support treadmill training (BWSTT) and sciatic nerve electrical stimulation (SNES) on motor function recovery in spinal cord injury (SCI) rats and its possible mechanism. METHODS Modified Allen's method was utilized for T10 incomplete SCI. The Basso-Beattie-Bresnahan (BBB) score and modified Tarlov score were applied to assess motor function. Pathologic alterations of the spinal cord and muscles were observed by hematoxylin and eosin (HE) staining. The positive staining region of collagen fibers was assessed with Masson staining. Immunofluorescence was applied to count the positive cells of brain-derived neurotrophic factor (BDNF) and tropomyosin-related kinase B (TrkB). BDNF, TrkB, phosphatidylinositol-3-kinase (PI3K), and protein kinase B (Akt) relative mRNA and protein expressions were evaluated by reverse transcription polymerase chain reaction (RT-PCR) and Western blotting. RESULTS On the 21st day of the intervention, the motor scores in SNES and BWSTT + SNES groups were higher than that in SCI group (P < 0.05). Compared with SCI group, mRNA and protein expressions of BDNF/TrkB and PI3K/Akt were more significant on the 21st day of the intervention in SNES and BWSTT + SNES groups (P < 0.05), but there was no difference in BWSTT group (P > 0.05). CONCLUSIONS This experiment demonstrated that BWSTT combined with SNES contributed to alleviating spinal cord tissue injury, delaying muscle atrophy and improving locomotion. One of the possible mechanisms may be related to the regulation of the BDNF/TrkB signaling pathway, which changes the expression of PI3K/Akt protein. Furthermore, it was discovered that the ultra-early BWSTT may not be conducive to recovery.
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Affiliation(s)
- Qingqin Xu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China
| | - Zhen Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China
| | - Junhong Su
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China
| | - Mengxuan Hu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China
| | - Qiyong Yin
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China
| | - Shi Chen
- Department of Orthopedic Surgery, The First Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China
| | - Juan Song
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China
| | - Hemu Chen
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China.
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Dong Y, Wang K, He R, Zheng K, Wang X, Huang G, Song R. Hybrid and adaptive control of functional electrical stimulation to correct hemiplegic gait for patients after stroke. Front Bioeng Biotechnol 2023; 11:1246014. [PMID: 37609119 PMCID: PMC10441235 DOI: 10.3389/fbioe.2023.1246014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 07/26/2023] [Indexed: 08/24/2023] Open
Abstract
Introduction: Gait, as a fundamental human movement, necessitates the coordination of muscles across swing and stance phases. Functional electrical stimulation (FES) of the tibialis anterior (TA) has been widely applied to foot drop correction for patients with post-stroke during the swing phase. Although the gastrocnemius (GAS) during the stance phase is also affected, the Functional electrical stimulation of the gastrocnemius received less attention. Methods: To address this limitation, a timing- and intensity-adaptive Functional electrical stimulation control strategy was developed for both the TA and GAS. Each channel incorporates a speed-adaptive (SA) module to control stimulation timing and an iterative learning control (ILC) module to regulate the stimulation intensity. These modules rely on real-time kinematic or kinetic data during the swing or stance phase, respectively. The orthotic effects of the system were evaluated on eight patients with post-stroke foot drop. Gait kinematics and kinetics were assessed under three conditions: no stimulation (NS), Functional electrical stimulation to the ankle dorsiflexor tibialis anterior (SA-ILC DS) and FES to the tibialis anterior and the ankle plantarflexor gastrocnemius (SA-ILC DPS). Results: The ankle plantarflexion angle, the knee flexion angle, and the anterior ground reaction force (AGRF) in the SA-ILC DPS condition were significantly larger than those in the NS and SA-ILC DS conditions (p < 0.05). The maximum dorsiflexion angle during the swing phase in the SA-ILC DPS condition was similar to that in the SA-ILC DS condition, with both being significantly larger than the angle observed in the NS condition (p < 0.05). Furthermore, the angle error and force error relative to the set targets were minimized in the SA-ILC DPS condition. Discussion: The observed improvements can be ascribed to the appropriate stimulation timing and intensity provided by the SA-ILC DPS strategy. This study demonstrates that the hybrid and adaptive control strategy of functional electrical stimulation system offers a significant orthotic effect, and has considerable potential for future clinical application.
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Affiliation(s)
- Yiqun Dong
- School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, Shenzhen, China
- The Key Laboratory of Sensing Technology and Biomedical Instrument of Guangdong Province, School of Biomedical Engineering, Sun Yat-sen University, Guangzhou, China
| | - Kangling Wang
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- School of Rehabilitation Medicine, Southern Medical University, Guangzhou, China
| | - Ruxin He
- School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, Shenzhen, China
- The Key Laboratory of Sensing Technology and Biomedical Instrument of Guangdong Province, School of Biomedical Engineering, Sun Yat-sen University, Guangzhou, China
| | - Kai Zheng
- School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, Shenzhen, China
- The Key Laboratory of Sensing Technology and Biomedical Instrument of Guangdong Province, School of Biomedical Engineering, Sun Yat-sen University, Guangzhou, China
| | - Xiaohong Wang
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- School of Rehabilitation Medicine, Southern Medical University, Guangzhou, China
| | - Guozhi Huang
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- School of Rehabilitation Medicine, Southern Medical University, Guangzhou, China
| | - Rong Song
- School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, Shenzhen, China
- The Key Laboratory of Sensing Technology and Biomedical Instrument of Guangdong Province, School of Biomedical Engineering, Sun Yat-sen University, Guangzhou, China
- Shenzhen Research Institute of Sun Yat-sen University, Shenzhen, China
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Kesar T. The Effects of Stroke and Stroke Gait Rehabilitation on Behavioral and Neurophysiological Outcomes:: Challenges and Opportunities for Future Research. Dela J Public Health 2023; 9:76-81. [PMID: 37701480 PMCID: PMC10494801 DOI: 10.32481/djph.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023] Open
Abstract
Stroke continues to be a leading cause of adult disability, contributing to immense healthcare costs. Even after discharge from rehabilitation, post-stroke individuals continue to have persistent gait impairments, which in turn adversely affect functional mobility and quality of life. Multiple factors, including biomechanics, energy cost, psychosocial variables, as well as the physiological function of corticospinal neural pathways influence stroke gait function and training-induced gait improvements. As a step toward addressing this challenge, the objective of the current perspective paper is to outline knowledge gaps pertinent to the measurement and retraining of stroke gait dysfunction. The paper also has recommendations for future research directions to address important knowledge gaps, especially related to the measurement and rehabilitation-induced modulation of biomechanical and neural processes underlying stroke gait dysfunction. We posit that there is a need for leveraging emerging technologies to develop innovative, comprehensive, methods to measure gait patterns quantitatively, to provide clinicians with objective measure of gait quality that can supplement conventional clinical outcomes of walking function. Additionally, we posit that there is a need for more research on how the stroke lesion affects multiple parts of the nervous system, and to understand the neuroplasticity correlates of gait training and gait recovery. Multi-modal clinical research studies that can combine clinical, biomechanical, neural, and computational modeling data provide promise for gaining new information about stroke gait dysfunction as well as the multitude of factors affecting recovery and treatment response in people with post-stroke hemiparesis.
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Affiliation(s)
- Trisha Kesar
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine
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Takai A, Teramae T, Noda T, Ishihara K, Furukawa JI, Fujimoto H, Hatakenaka M, Fujita N, Jino A, Hiramatsu Y, Miyai I, Morimoto J. Development of split-force-controlled body weight support (SF-BWS) robot for gait rehabilitation. Front Hum Neurosci 2023; 17:1197380. [PMID: 37497041 PMCID: PMC10366359 DOI: 10.3389/fnhum.2023.1197380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/15/2023] [Indexed: 07/28/2023] Open
Abstract
This study introduces a body-weight-support (BWS) robot actuated by two pneumatic artificial muscles (PAMs). Conventional BWS devices typically use springs or a single actuator, whereas our robot has a split force-controlled BWS (SF-BWS), in which two force-controlled actuators independently support the left and right sides of the user's body. To reduce the experience of weight, vertical unweighting support forces are transferred directly to the user's left and right hips through a newly designed harness with an open space around the shoulder and upper chest area to allow freedom of movement. A motion capture evaluation with three healthy participants confirmed that the proposed harness does not impede upper-body motion during laterally identical force-controlled partial BWS walking, which is quantitatively similar to natural walking. To evaluate our SF-BWS robot, we performed a force-tracking and split-force control task using different simulated load weight setups (40, 50, and 60 kg masses). The split-force control task, providing independent force references to each PAM and conducted with a 60 kg mass and a test bench, demonstrates that our SF-BWS robot is capable of shifting human body weight in the mediolateral direction. The SF-BWS robot successfully controlled the two PAMs to generate the desired vertical support forces.
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Affiliation(s)
- Asuka Takai
- Department of Brain Robot Interface, Brain Information Communication Research Laboratory Group, Advanced Telecommunications Research Institute International (ATR), Kyoto, Japan
- Graduate School of Engineering Division of Mechanical Engineering, Osaka Metropolitan University, Osaka, Japan
| | - Tatsuya Teramae
- Department of Brain Robot Interface, Brain Information Communication Research Laboratory Group, Advanced Telecommunications Research Institute International (ATR), Kyoto, Japan
| | - Tomoyuki Noda
- Department of Brain Robot Interface, Brain Information Communication Research Laboratory Group, Advanced Telecommunications Research Institute International (ATR), Kyoto, Japan
| | - Koji Ishihara
- Department of Brain Robot Interface, Brain Information Communication Research Laboratory Group, Advanced Telecommunications Research Institute International (ATR), Kyoto, Japan
| | - Jun-ichiro Furukawa
- Department of Brain Robot Interface, Brain Information Communication Research Laboratory Group, Advanced Telecommunications Research Institute International (ATR), Kyoto, Japan
- Man-Machine Collaboration Research Team, Guardian Robot Project, RIKEN, Kyoto, Japan
| | - Hiroaki Fujimoto
- Neurorehabilitation Research Institute, Morinomiya Hospital, Osaka, Japan
| | - Megumi Hatakenaka
- Neurorehabilitation Research Institute, Morinomiya Hospital, Osaka, Japan
| | - Nobukazu Fujita
- Neurorehabilitation Research Institute, Morinomiya Hospital, Osaka, Japan
| | - Akihiro Jino
- Neurorehabilitation Research Institute, Morinomiya Hospital, Osaka, Japan
| | - Yuichi Hiramatsu
- Neurorehabilitation Research Institute, Morinomiya Hospital, Osaka, Japan
| | - Ichiro Miyai
- Neurorehabilitation Research Institute, Morinomiya Hospital, Osaka, Japan
| | - Jun Morimoto
- Department of Brain Robot Interface, Brain Information Communication Research Laboratory Group, Advanced Telecommunications Research Institute International (ATR), Kyoto, Japan
- Man-Machine Collaboration Research Team, Guardian Robot Project, RIKEN, Kyoto, Japan
- Graduate School of Informatics, Kyoto University, Kyoto, Japan
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Srivastava S, Seamon BA, Patten C, Kautz SA. Variation of body weight supported treadmill training parameters during a single session can modulate muscle activity patterns in post-stroke gait. Exp Brain Res 2023; 241:615-627. [PMID: 36639543 PMCID: PMC9895011 DOI: 10.1007/s00221-023-06551-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 01/05/2023] [Indexed: 01/15/2023]
Abstract
Evidence supporting the benefits of locomotor training (LT) to improve walking ability following stroke are inconclusive and could likely be improved with a better understanding of the effects of individual parameters i.e., body weight support (BWS), speed, and therapist assistance and their interactions with walking ability and specific impairments. We evaluated changes in muscle activity of thirty-seven individuals with chronic stroke (> 6 months), in response to a single session of LT at their self-selected or fastest-comfortable speed (FS) with three levels of BWS (0%, 15%, and 30%), and at FS with 30% BWS and seven different combinations of therapist assistance at the paretic foot, non-paretic foot, and trunk. Altered Muscle Activation Pattern (AMAP), a previously developed tool in our lab was used to evaluate the effects of LT parameter variation on eight lower-extremity muscle patterns in individuals with stroke. Repeated-measures mixed-model ANOVA was used to determine the effects of speed, BWS, and their interaction on AMAP scores. The Wilcoxon-signed rank test was used to determine the effects of therapist-assisted conditions on AMAP scores. Increased BWS mostly improved lower-extremity muscle activity patterns, but increased speed resulted in worse plantar flexor activity. Abnormal early plantar flexor activity during stance decreased with assistance at trunk and both feet, exaggerated plantar flexor activity during late swing decreased with assistance to the non-paretic foot or trunk, and diminished gluteus medius activity during stance increased with assistance to paretic foot and/or trunk. Therefore, different sets of training parameters have different immediate effects on activation patterns of each muscle and gait subphases.
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Affiliation(s)
- Shraddha Srivastava
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, 77 President Street, Charleston, SC 29425 USA
- Ralph H. Johnson VA Health Care System Medical Center, Charleston, SC 29401 USA
| | - Bryant A. Seamon
- Ralph H. Johnson VA Health Care System Medical Center, Charleston, SC 29401 USA
- Division of Physical Therapy, Department of Rehabilitation Sciences, Medical University of South Carolina, Charleston, SC 29425 USA
| | - Carolynn Patten
- Biomechanics, Rehabilitation, and Integrative Neuroscience (BRaIN) Lab, Department of Physical Medicine and Rehabilitation, University of California Davis School of Medicine, Sacramento, CA 95817 USA
- VA Northern California Health Care System, Martinez, CA 94553 USA
| | - Steven A. Kautz
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, 77 President Street, Charleston, SC 29425 USA
- Ralph H. Johnson VA Health Care System Medical Center, Charleston, SC 29401 USA
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Cherry-Allen KM, French MA, Stenum J, Xu J, Roemmich RT. Opportunities for Improving Motor Assessment and Rehabilitation After Stroke by Leveraging Video-Based Pose Estimation. Am J Phys Med Rehabil 2023; 102:S68-S74. [PMID: 36634334 DOI: 10.1097/phm.0000000000002131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
ABSTRACT Stroke is a leading cause of long-term disability in adults in the United States. As the healthcare system moves further into an era of digital medicine and remote monitoring, technology continues to play an increasingly important role in post-stroke care. In this Analysis and Perspective article, opportunities for using human pose estimation-an emerging technology that uses artificial intelligence to track human movement kinematics from simple videos recorded using household devices (e.g., smartphones, tablets)-to improve motor assessment and rehabilitation after stroke are discussed. The focus is on the potential of two key applications: (1) improving access to quantitative, objective motor assessment and (2) advancing telerehabilitation for persons post-stroke.
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Affiliation(s)
- Kendra M Cherry-Allen
- From the Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland (KMC-A, MAF, JS, RTR); Department of Physical Therapy Education, Western University of Health Sciences, Lebanon, Oregon (KMC-A); Center for Movement Studies, Kennedy Krieger Institute, Baltimore, Maryland (JS, RTR); and Department of Kinesiology, University of Georgia, Athens, Georgia (JX)
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Singular value decomposition-based gait characterization. Heliyon 2022; 8:e12006. [DOI: 10.1016/j.heliyon.2022.e12006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 08/16/2022] [Accepted: 11/23/2022] [Indexed: 12/05/2022] Open
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Riazati S, McGuirk TE, Perry ES, Sihanath WB, Patten C. Absolute Reliability of Gait Parameters Acquired With Markerless Motion Capture in Living Domains. Front Hum Neurosci 2022; 16:867474. [PMID: 35782037 PMCID: PMC9245068 DOI: 10.3389/fnhum.2022.867474] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/27/2022] [Indexed: 12/17/2022] Open
Abstract
Purpose: To examine the between-day absolute reliability of gait parameters acquired with Theia3D markerless motion capture for use in biomechanical and clinical settings. Methods: Twenty-one (7 M,14 F) participants aged between 18 and 73 years were recruited in community locations to perform two walking tasks: self-selected and fastest-comfortable walking speed. Participants walked along a designated walkway on two separate days.Joint angle kinematics for the hip, knee, and ankle, for all planes of motion, and spatiotemporal parameters were extracted to determine absolute reliability between-days. For kinematics, absolute reliability was examined using: full curve analysis [root mean square difference (RMSD)] and discrete point analysis at defined gait events using standard error of measurement (SEM). The absolute reliability of spatiotemporal parameters was also examined using SEM and SEM%. Results: Markerless motion capture produced low measurement error for kinematic full curve analysis with RMSDs ranging between 0.96° and 3.71° across all joints and planes for both walking tasks. Similarly, discrete point analysis within the gait cycle produced SEM values ranging between 0.91° and 3.25° for both sagittal and frontal plane angles of the hip, knee, and ankle. The highest measurement errors were observed in the transverse plane, with SEM >5° for ankle and knee range of motion. For the majority of spatiotemporal parameters, markerless motion capture produced low SEM values and SEM% below 10%. Conclusion: Markerless motion capture using Theia3D offers reliable gait analysis suitable for biomechanical and clinical use.
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Affiliation(s)
- Sherveen Riazati
- Biomechanics, Rehabilitation, and Integrative Neuroscience Lab, Department of Physical Medicine and Rehabilitation, School of Medicine, University of California, Davis, Sacramento, CA, United States
- UC Davis Healthy Aging in a Digital World Initiative, a UC Davis “Big Idea”, Sacramento, CA, United States
| | - Theresa E. McGuirk
- Biomechanics, Rehabilitation, and Integrative Neuroscience Lab, Department of Physical Medicine and Rehabilitation, School of Medicine, University of California, Davis, Sacramento, CA, United States
- UC Davis Healthy Aging in a Digital World Initiative, a UC Davis “Big Idea”, Sacramento, CA, United States
- Center for Neuroengineering and Medicine, University of California, Davis, Davis, CA, United States
- VA Northern California Health Care System, Martinez, CA, United States
| | - Elliott S. Perry
- Biomechanics, Rehabilitation, and Integrative Neuroscience Lab, Department of Physical Medicine and Rehabilitation, School of Medicine, University of California, Davis, Sacramento, CA, United States
- UC Davis Healthy Aging in a Digital World Initiative, a UC Davis “Big Idea”, Sacramento, CA, United States
- VA Northern California Health Care System, Martinez, CA, United States
| | - Wandasun B. Sihanath
- Biomechanics, Rehabilitation, and Integrative Neuroscience Lab, Department of Physical Medicine and Rehabilitation, School of Medicine, University of California, Davis, Sacramento, CA, United States
- UC Davis Healthy Aging in a Digital World Initiative, a UC Davis “Big Idea”, Sacramento, CA, United States
- Center for Neuroengineering and Medicine, University of California, Davis, Davis, CA, United States
| | - Carolynn Patten
- Biomechanics, Rehabilitation, and Integrative Neuroscience Lab, Department of Physical Medicine and Rehabilitation, School of Medicine, University of California, Davis, Sacramento, CA, United States
- UC Davis Healthy Aging in a Digital World Initiative, a UC Davis “Big Idea”, Sacramento, CA, United States
- Center for Neuroengineering and Medicine, University of California, Davis, Davis, CA, United States
- VA Northern California Health Care System, Martinez, CA, United States
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13
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Jarvis HL, Brown SJ, Butterworth C, Jackson K, Clayton A, Walker L, Rees N, Price M, Groenevelt R, Reeves ND. The gait profile score characterises walking performance impairments in young stroke survivors. Gait Posture 2022; 91:229-234. [PMID: 34741933 DOI: 10.1016/j.gaitpost.2021.10.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 10/23/2021] [Accepted: 10/26/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The Gait Profile Score (GPS) provides a composite measure of the quality of joint movement during walking, but the relationship between this measure and metabolic cost, temporal (e.g. walking speed) and spatial (e.g. stride length) parameters in stroke survivors has not been reported. RESEARCH QUESTION The aims of this study were to compare the GPS (paretic, non-paretic, and overall score) of young stroke survivors to the healthy able-bodied control and determine the relationship between the GPS and metabolic cost, temporal (walking speed, stance time asymmetry) and spatial (stride length, stride width, step length asymmetry) parameters in young stroke survivors to understand whether the quality of walking affects walking performance in stroke survivors. METHODS Thirty-nine young stroke survivors aged between 18 and 65years and 15 healthy age-matched able-bodied controls were recruited from six hospital sites in Wales, UK. Joint range of motion at the pelvis, hip, knee and ankle, and temporal and spatial parameters were measured during walking on level ground at self-selected speed with calculation of the Gait Variable Score and then the GPS. RESULTS GPS for the paretic leg (9.40° (8.60-10.21) p < 0.001), non-paretic leg (11.42° (10.20-12.63) p < 0.001) and overall score (11.18° (10.26-12.09) p < 0.001)) for stroke survivors were significantly higher than the control (4.25° (3.40-5.10), 5.92° (5.11 (6.73)). All parameters with the exception of step length symmetry ratio correlated moderate to highly with the GPS for the paretic, non-paretic, and/or overall score (ρ = <-0.732 (p < 0.001)). SIGNIFICANCE The quality of joint movement during walking measured via the GPS is directly related to the speed and efficiency of walking, temporal (stance time symmetry) and spatial (stride length, stride width) parameters in young stroke survivors.
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Affiliation(s)
- Hannah L Jarvis
- Research Centre for Musculoskeletal Science and Sports Medicine, Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK.
| | - Steven J Brown
- Research Centre for Musculoskeletal Science and Sports Medicine, Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - Claire Butterworth
- Cardiff and Vale University Health Board, Physiotherapy, Llandough Hospital, Penlan Road, Cardiff CF64 2XX, UK
| | - Karl Jackson
- Betsi Cadwaladr University Health Board, Physiotherapy, Ysbyty Gwynedd, Bangor LL57 2PW, UK
| | - Abigail Clayton
- Swansea Bay University Health Board, Therapy Services, Heol Maes Eglwys, Swansea SA6 6NL, UK
| | - Louisa Walker
- Cwm Taf Bro Morgannwg University Health Board, Physiotherapy Department, Keir Hardie Health Park, Merthyr Tydfil CF48 1BZ, UK
| | - Nia Rees
- Cwm Taf Bro Morgannwg University Health Board, Physiotherapy Department, Keir Hardie Health Park, Merthyr Tydfil CF48 1BZ, UK
| | - Michelle Price
- Powys Teaching Health Board, Neuro Rehabilitation, Newtown Hospital, Newtown SY6 2DW, UK
| | - Renee Groenevelt
- Hywel Dda University Health Board, Physiotherapy, Fishguard Road, Haverfordwest, Pembrokeshire SA61 2PZ, UK
| | - Neil D Reeves
- Research Centre for Musculoskeletal Science and Sports Medicine, Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
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An Q, Yang N, Yamakawa H, Kogami H, Yoshida K, Wang R, Yamashita A, Asama H, Ishiguro S, Shimoda S, Yamasaki H, Yokoyama M, Alnajjar F, Hattori N, Takahashi K, Fujii T, Otomune H, Miyai I, Kurazume R. Classification of Motor Impairments of Post-Stroke Patients Based on Force Applied to a Handrail. IEEE Trans Neural Syst Rehabil Eng 2021; 29:2399-2406. [PMID: 34762588 DOI: 10.1109/tnsre.2021.3127504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Many patients suffer from declined motor abilities after a brain injury. To provide appropriate rehabilitation programs and encourage motor-impaired patients to participate further in rehabilitation, sufficient and easy evaluation methodologies are necessary. This study is focused on the sit-to-stand motion of post-stroke patients because it is an important daily activity. Our previous study utilized muscle synergies (synchronized muscle activation) to classify the degree of motor impairment in patients and proposed appropriate rehabilitation methodologies. However, in our previous study, the patient was required to attach electromyography sensors to his/her body; thus, it was difficult to evaluate motor ability in daily circumstances. Here, we developed a handrail-type sensor that can measure the force applied to it. Using temporal features of the force data, the relationship between the degree of motor impairment and temporal features was clarified, and a classification model was developed using a random forest model to determine the degree of motor impairment in hemiplegic patients. The results show that hemiplegic patients with severe motor impairments tend to apply greater force to the handrail and use the handrail for a longer period. It was also determined that patients with severe motor impairments did not move forward while standing up, but relied more on the handrail to pull their upper body upward as compared to patients with moderate impairments. Furthermore, based on the developed classification model, patients were successfully classified as having severe or moderate impairments. The developed classification model can also detect long-term patient recovery. The handrail-type sensor does not require additional sensors on the patient's body and provides an easy evaluation methodology.
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Bacca O, Celestino ML, Barela JA, Yakovenko S, de Lima AJS, Barela AMF. Compensatory Strategies Due to Knee Flexion Constraint during Gait of Non-Disabled Adults. J Mot Behav 2021; 54:281-290. [PMID: 34402739 PMCID: PMC10792986 DOI: 10.1080/00222895.2021.1955653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/24/2021] [Accepted: 07/09/2021] [Indexed: 10/20/2022]
Abstract
Constraining knee flexion of non-disabled individuals could further our understanding regarding the importance of knee joint during gait, which is a common disturbance in individuals with gait impairment. In this study we investigated whether a mechanical constraint of knee flexion in non-disabled adults would lead to compensatory strategies. Eleven non-disabled male adults walked without and with an orthosis that permitted full extension and limited knee flexion up to either 45° or 30°. We analyzed the temporal organization of lower limb kinematics and electromyograms of the rectus femoris, vastus medialis and lateralis, tibialis anterior, semitendinosus, biceps femoris, and gastrocnemius medialis and lateralis. Non-disabled adults compensated for the reduced knee flexion by increasing hip and ankle joint excursions and ankle flexor activation amplitude. Also, these adults shortened pre-swing and lengthened swing duration in the constrained limb and increased the activity of bifunctional hip extensor and knee flexor muscles in the constrained limb in relation to the unconstrained limb. The use of an orthosis that limited knee flexion in non-disabled adults leaded to compensatory strategies in the temporal organization of joint excursions and muscle activations in the constrained limb. The compensatory effects were correlated with the extent of knee flexion constraint.
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Affiliation(s)
- Odair Bacca
- Institute of Physical Activity and Sport Sciences, Cruzeiro do Sul University, São Paulo, SP, Brazil
| | - Melissa Leandro Celestino
- Institute of Physical Activity and Sport Sciences, Cruzeiro do Sul University, São Paulo, SP, Brazil
| | - José Angelo Barela
- Department of Physical Education, São Paulo State University, Rio Claro, SP, Brazil
| | - Sergiy Yakovenko
- Department of Human Performance – Exercise Physiology, School of Medicine, West Virginia University, Morgantown, WV, United States of America
- Department of Biomedical Engineering, Benjamin M. Statler College of Engineering and Mineral Resources, West Virginia University, Morgantown, WV, United States of America
- Rockefeller Neuroscience Institute, School of Medicine, West Virginia University, Morgantown, WV, United States of America
- Mechanical and Aerospace Engineering, Benjamin M. Statler College of Engineering and Mineral Resources, West Virginia University, Morgantown, WV, United States of America
- Department of Neuroscience, School of Medicine, West Virginia University, Morgantown, WV, United States of America
| | - Ana Júlia Silva de Lima
- Institute of Physical Activity and Sport Sciences, Cruzeiro do Sul University, São Paulo, SP, Brazil
| | - Ana Maria Forti Barela
- Institute of Physical Activity and Sport Sciences, Cruzeiro do Sul University, São Paulo, SP, Brazil
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16
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Ribeiro TS, Silva EMG, Vasconcellos LS, Souza AA, Lindquist ARR. Are biomechanical strategies to perform functional activities different between individuals with subacute and chronic stroke? NeuroRehabilitation 2021; 49:95-101. [PMID: 33998552 DOI: 10.3233/nre-210027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate if the capacity to perform functional mobility activities change within the first year post-stroke using the Timed "Up and Go" Assessment of Biomechanical Strategies (TUG-ABS). METHODS A cross-sectional study was conducted with thirty-eight stroke individuals. A motion analysis system was used during the Timed "Up and Go" (TUG) test to evaluate the following activities: sit-to-stand, gait, turn, and stand-to-sit. Kinematic variables related to each activity were obtained in addition to TUG-ABS scores. The ability to perform the activities was compared between subacute (up to 3 months post-stroke, n = 21) and chronic participants (4 to 12 months post-stroke, n = 17) using Mann-Whitney U tests (α= 5%). RESULTS Results were expressed as median difference (MD) and 95% confidence intervals (95% CI). TUG-ABS scores: Sit-to-stand (MD = 0, 95% CI = 0.0 to 1), gait (MD = 0, 95% CI = 0.0 to 1), stand-to-sit (MD = 0, 95% CI = 0.0 to 1), and total score (MD = 2.0, 95% CI = 0.0 to 6) were not different between groups. Subacute participants presented significant better scores during turn activity (MD = 2.0, 95% CI 0.0 to 2.0). All kinematic variables were not different between participants. CONCLUSIONS Capacity to perform functional activities was not different within the first year post-stroke, suggesting that biomechanical strategies are developed within the first three months following stroke.
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Affiliation(s)
- Tatiana S Ribeiro
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal-RN, Brazil
| | - Emília M G Silva
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal-RN, Brazil
| | - Liliane S Vasconcellos
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal-RN, Brazil
| | - Aline A Souza
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal-RN, Brazil
| | - Ana Raquel R Lindquist
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal-RN, Brazil
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Smith MC, Stinear J, Stinear CM. The effects of unilateral step training and conventional treadmill training on gait asymmetry in patients with chronic stroke. Gait Posture 2021; 87:156-162. [PMID: 33933934 DOI: 10.1016/j.gaitpost.2021.04.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 04/17/2021] [Accepted: 04/20/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Step length asymmetry is common after stroke. Unilateral step training (UST) can improve step length asymmetry for patients who take a longer step with their paretic leg (P-long). UST has not been tested with patients who take a shorter step with their paretic leg (P-short). RESEARCH QUESTION Does training patients according to the direction of their asymmetry improve step length asymmetry? METHODS Adults 18 years and older with asymmetrical gait at least 6 months post-stroke completed three 20 min treadmill training sessions at least 48 h apart: Conventional treadmill; UST with the non-paretic leg stationary on the side of the treadmill and the paretic leg stepping on the moving treadmill belt (P-stepping); and UST with the paretic leg stationary on the side of the treadmill and the non-paretic leg stepping on the moving belt (NP-stepping). Spatiotemporal gait parameters before, immediately, 10 min and 30 min after training were recorded at self-selected and fastest walking pace. Asymmetry values for each parameter were calculated. RmANOVAs were used to investigate the effects of training type on spatiotemporal parameters and paired-samples t-tests used to investigate potential contributors to training effects on asymmetry. RESULTS Twenty participants (16 male, median age 65 (43-80) years; 11 P-long, 9 P-short) were included. Improvements in step length asymmetry were observed immediately after both Conventional (9.1 %; 95 % CI 2.7-15.4%) and P-stepping (11.6 %; 95 % CI 5.3-17.8 %) treadmill training in participants who take a shorter step with their paretic leg, however effects were only sustained after Conventional training. Step length asymmetry did not improve for P-long participants with any training type. SIGNIFICANCE The effectiveness of unilateral step training may be related to the direction of step length asymmetry. Further investigation is required before considering using unilateral step training as a rehabilitation tool for gait asymmetry after stroke.
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Affiliation(s)
- Marie-Claire Smith
- Department of Medicine, University of Auckland, Auckland, New Zealand; Centre for Brain Research, University of Auckland, Auckland, New Zealand; Department of Exercise Sciences, University of Auckland, Auckland, New Zealand
| | - James Stinear
- Department of Exercise Sciences, University of Auckland, Auckland, New Zealand
| | - Cathy M Stinear
- Department of Medicine, University of Auckland, Auckland, New Zealand; Centre for Brain Research, University of Auckland, Auckland, New Zealand.
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A Conceptual Blueprint for Making Neuromusculoskeletal Models Clinically Useful. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11052037] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The ultimate goal of most neuromusculoskeletal modeling research is to improve the treatment of movement impairments. However, even though neuromusculoskeletal models have become more realistic anatomically, physiologically, and neurologically over the past 25 years, they have yet to make a positive impact on the design of clinical treatments for movement impairments. Such impairments are caused by common conditions such as stroke, osteoarthritis, Parkinson’s disease, spinal cord injury, cerebral palsy, limb amputation, and even cancer. The lack of clinical impact is somewhat surprising given that comparable computational technology has transformed the design of airplanes, automobiles, and other commercial products over the same time period. This paper provides the author’s personal perspective for how neuromusculoskeletal models can become clinically useful. First, the paper motivates the potential value of neuromusculoskeletal models for clinical treatment design. Next, it highlights five challenges to achieving clinical utility and provides suggestions for how to overcome them. After that, it describes clinical, technical, collaboration, and practical needs that must be addressed for neuromusculoskeletal models to fulfill their clinical potential, along with recommendations for meeting them. Finally, it discusses how more complex modeling and experimental methods could enhance neuromusculoskeletal model fidelity, personalization, and utilization. The author hopes that these ideas will provide a conceptual blueprint that will help the neuromusculoskeletal modeling research community work toward clinical utility.
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19
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Machine learning classifies predictive kinematic features in a mouse model of neurodegeneration. Sci Rep 2021; 11:3950. [PMID: 33597593 PMCID: PMC7889656 DOI: 10.1038/s41598-021-82694-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 01/21/2021] [Indexed: 01/31/2023] Open
Abstract
Motor deficits are observed in Alzheimer's disease (AD) prior to the appearance of cognitive symptoms. To investigate the role of amyloid proteins in gait disturbances, we characterized locomotion in APP-overexpressing transgenic J20 mice. We used three-dimensional motion capture to characterize quadrupedal locomotion on a treadmill in J20 and wild-type mice. Sixteen J20 mice and fifteen wild-type mice were studied at two ages (4- and 13-month). A random forest (RF) classification algorithm discriminated between the genotypes within each age group using a leave-one-out cross-validation. The balanced accuracy of the RF classification was 92.3 ± 5.2% and 93.3 ± 4.5% as well as False Negative Rate (FNR) of 0.0 ± 0.0% and 0.0 ± 0.0% for the 4-month and 13-month groups, respectively. Feature ranking algorithms identified kinematic features that when considered simultaneously, achieved high genotype classification accuracy. The identified features demonstrated an age-specific kinematic profile of the impact of APP-overexpression. Trunk tilt and unstable hip movement patterns were important in classifying the 4-month J20 mice, whereas patterns of shoulder and iliac crest movement were critical for classifying 13-month J20 mice. Examining multiple kinematic features of gait simultaneously could also be developed to classify motor disorders in humans.
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20
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McCain EM, Libera TL, Berno ME, Sawicki GS, Saul KR, Lewek MD. Isolating the energetic and mechanical consequences of imposed reductions in ankle and knee flexion during gait. J Neuroeng Rehabil 2021; 18:21. [PMID: 33526053 PMCID: PMC7852087 DOI: 10.1186/s12984-021-00812-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 01/11/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Weakness of ankle and knee musculature following injury or disorder results in reduced joint motion associated with metabolically expensive gait compensations to enable limb support and advancement. However, neuromechanical coupling between the ankle and knee make it difficult to discern independent roles of these restrictions in joint motion on compensatory mechanics and metabolic penalties. METHODS We sought to determine relative impacts of ankle and knee impairment on compensatory gait strategies and energetic outcomes using an unimpaired cohort (N = 15) with imposed unilateral joint range of motion restrictions as a surrogate for reduced motion resulting from gait pathology. Participants walked on a dual-belt instrumented treadmill at 0.8 m s-1 using a 3D printed ankle stay and a knee brace to systematically limit ankle motion (restricted-ank), knee motion (restricted-knee), and ankle and knee motion (restricted-a + k) simultaneously. In addition, participants walked without any ankle or knee bracing (control) and with knee bracing worn but unrestricted (braced). RESULTS When ankle motion was restricted (restricted-ank, restricted-a + k) we observed decreased peak propulsion relative to the braced condition on the restricted limb. Reduced knee motion (restricted-knee, restricted-a + k) increased restricted limb circumduction relative to the restricted-ank condition through ipsilateral hip hiking. Interestingly, restricted limb average positive hip power increased in the restricted-ank condition but decreased in the restricted-a + k and restricted-knee conditions, suggesting that locking the knee impeded hip compensation. As expected, reduced ankle motion, either without (restricted-ank) or in addition to knee restriction (restricted-a + k) yielded significant increase in net metabolic rate when compared with the braced condition. Furthermore, the relative increase in metabolic cost was significantly larger with restricted-a + k when compared to restricted-knee condition. CONCLUSIONS Our methods allowed for the reproduction of asymmetric gait characteristics including reduced propulsive symmetry and increased circumduction. The metabolic consequences bolster the potential energetic benefit of targeting ankle function during rehabilitation. TRIAL REGISTRATION N/A.
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Affiliation(s)
- Emily M McCain
- North Carolina State University, 911 Oval Drive, Raleigh, NC, USA.
| | - Theresa L Libera
- North Carolina State University, 911 Oval Drive, Raleigh, NC, USA.,University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Matthew E Berno
- North Carolina State University, 911 Oval Drive, Raleigh, NC, USA
| | | | - Katherine R Saul
- North Carolina State University, 911 Oval Drive, Raleigh, NC, USA
| | - Michael D Lewek
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Cerebellar Transcranial Direct Current Stimulation for Motor Learning in People with Chronic Stroke: A Pilot Randomized Controlled Trial. Brain Sci 2020; 10:brainsci10120982. [PMID: 33327476 PMCID: PMC7764949 DOI: 10.3390/brainsci10120982] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/07/2020] [Accepted: 12/10/2020] [Indexed: 11/16/2022] Open
Abstract
Cerebellar transcranial direct current stimulation (ctDCS) is a non-invasive brain stimulation technique that alters neural plasticity through weak, continuous, direct currents delivered to the cerebellum. This study aimed to evaluate the feasibility of conducting a randomized controlled trial (RCT) delivering three consecutive days of ctDCS during split-belt treadmill training (SBTT) in people with chronic stroke. Using a double-blinded, parallel-group RCT design, eligible participants were randomly allocated to receive either active anodal ctDCS or sham ctDCS combined with SBTT on three consecutive days. Outcomes were assessed at one-week follow-up, using step length symmetry as a measure of motor learning and comfortable over-ground walking speed as a measure of walking capacity. The feasibility of the RCT protocol was evaluated based on recruitment, retention, protocol deviations and data completeness. The feasibility of the intervention was assessed based on safety, adherence and intervention fidelity. Of the 26 potential participants identified over four months, only four were enrolled in the study (active anodal ctDCS n = 1, sham ctDCS n = 3). Both the inclusion criteria and the fidelity of the SBTT relied upon the accurate estimation of step length asymmetry. The method used to determine the side of the step length asymmetry was unreliable and led to deviations in the protocol. The ctDCS intervention was well adhered to, safe, and delivered as per the planned protocol. Motor learning outcomes for individual participants revealed that treadmill step length symmetry remained unchanged for three participants but improved for one participant (sham ctDCS). Comfortable over-ground walking speed improved for two participants (sham ctDCS). The feasibility of the planned protocol and intervention was limited by intra-individual variability in the magnitude and side of the step length asymmetry. This limited the sample and compromised the fidelity of the SBTT intervention. To feasibly conduct a full RCT investigating the effect of ctDCS on locomotor adaptation, a reliable method of identifying and defining step length asymmetry in people with stroke is required. Future ctDCS research should either optimize the methods for SBTT delivery or utilize an alternative motor adaptation task.
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An Evaluation of Three Kinematic Methods for Gait Event Detection Compared to the Kinetic-Based 'Gold Standard'. SENSORS 2020; 20:s20185272. [PMID: 32942645 PMCID: PMC7571134 DOI: 10.3390/s20185272] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 09/05/2020] [Accepted: 09/12/2020] [Indexed: 12/15/2022]
Abstract
Video- and sensor-based gait analysis systems are rapidly emerging for use in ‘real world’ scenarios outside of typical instrumented motion analysis laboratories. Unlike laboratory systems, such systems do not use kinetic data from force plates, rather, gait events such as initial contact (IC) and terminal contact (TC) are estimated from video and sensor signals. There are, however, detection errors inherent in kinematic gait event detection methods (GEDM) and comparative study between classic laboratory and video/sensor-based systems is warranted. For this study, three kinematic methods: coordinate based treadmill algorithm (CBTA), shank angular velocity (SK), and foot velocity algorithm (FVA) were compared to ‘gold standard’ force plate methods (GS) for determining IC and TC in adults (n = 6), typically developing children (n = 5) and children with cerebral palsy (n = 6). The root mean square error (RMSE) values for CBTA, SK, and FVA were 27.22, 47.33, and 78.41 ms, respectively. On average, GED was detected earlier in CBTA and SK (CBTA: −9.54 ± 0.66 ms, SK: −33.41 ± 0.86 ms) and delayed in FVA (21.00 ± 1.96 ms). The statistical model demonstrated insensitivity to variations in group, side, and individuals. Out of three kinematic GEDMs, SK GEDM can best be used for sensor-based gait event detection.
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Lee DH, Chang WN, Jeon HJ. Comparison of ground reaction force during gait between the nonparetic side in hemiparetic patients and the dominant side in healthy subjects. J Exerc Rehabil 2020; 16:344-350. [PMID: 32913839 PMCID: PMC7463072 DOI: 10.12965/jer.2040488.244] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 07/16/2020] [Indexed: 12/05/2022] Open
Abstract
Considering the occurrence of gait impairment following stroke, walk-ing recovery is an important goal of rehabilitation. Ground reaction force (GRF) is used for gait assessment of rehabilitation progress during exercise in stroke patients. The aim of this study was to compare the GRF during gait of the nonparetic side in hemiparetic patients and the dominant side in healthy subjects. Twenty hemiparetic patients and 20 healthy subjects were enrolled in the study. Force plate was used to evaluate GRF during gait. Additionally, with the patients and subjects in supine position, we measured their range of motion (ROM) in ankle dor-siflexion using a digital goniometer. The force values of stance phase on the nonparetic side of hemiparetic patients were significantly less than on the dominant side of healthy subjects (P<0.05). The impulse values of stance phase on the paretic side and the nonparetic side of hemiparetic patients were significantly greater than on the dominant side of healthy subjects (P<0.05). The ankle ROM result was signifi-cantly correlated with the GRF values (P<0.05). It is important to assess and understand the nonparetic side as well as paretic side. These re-sults suggest that the analysis of GRF for exercise rehabilitation will be a valuable clinical evaluation in hemiparetic patients after a stroke.
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Affiliation(s)
- Dae-Hee Lee
- Department of Physical Therapy, U1 University, Yeongdong, Korea
| | - Woo-Nam Chang
- Department of Physical Therapy, Yongin University, Yongin, Korea
| | - Hye-Joo Jeon
- Department of Physical Therapy, U1 University, Yeongdong, Korea
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Linder SM, Davidson S, Rosenfeldt A, Lee J, Koop MM, Bethoux F, Alberts JL. Forced and Voluntary Aerobic Cycling Interventions Improve Walking Capacity in Individuals With Chronic Stroke. Arch Phys Med Rehabil 2020; 102:1-8. [PMID: 32918907 DOI: 10.1016/j.apmr.2020.08.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/16/2020] [Accepted: 08/06/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To determine the efficacy of high-intensity cycling to improve walking capacity in individuals with chronic stroke, identify variables that predict improvement in walking capacity, and quantify the relationship between the 6-minute walk test (6MWT) and cardiopulmonary exercise (CPX) test variables. DESIGN Secondary analysis of data from 2 randomized controlled trials. SETTING Research laboratory. PARTICIPANTS Individuals with chronic stroke (N=43). INTERVENTIONS Participants were randomized to 1 of the following time-matched interventions, occurring 3 times per week for 8 weeks: (1) forced aerobic exercise and upper extremity repetitive task practice (FE+RTP [n=16]), (2) voluntary aerobic exercise and upper extremity repetitive task practice (VE+RTP [n=14]), or (3) a non-aerobic control group (n=13). MAIN OUTCOME MEASURE Change in walking capacity as measured by the 6MWT from baseline to the end of treatment (EOT). RESULTS Significant increases were observed in distance traveled during the 6MWT at the EOT compared with baseline in the FE+RTP (P<.001) and VE+RTP (P<.001) groups, but not in the control group (P=.21). Among aerobic exercise participants, a multivariate regression analysis revealed that cycling cadence, power output, and baseline 6MWT distance were significant predictors of change in walking capacity. CONCLUSIONS An 8-week aerobic cycling intervention prescribed at 60% to 80% of heart rate reserve and moderate to high cadence and resistance led to significant improvements in walking capacity in our cohort of individuals with chronic stroke. Individuals with low baseline walking capacity levels may benefit most from aerobic cycling to improve over ground locomotion. Although the 6MWT did not elicit a cardiorespiratory response comparable to the maximal exertion CPX test, the 6MWT can be considered a valid and clinically relevant submaximal test of cardiorespiratory function in individuals with chronic stroke.
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Affiliation(s)
- Susan M Linder
- Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH; Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH; Concussion Center, Cleveland Clinic, Cleveland, OH.
| | | | - Anson Rosenfeldt
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH
| | - John Lee
- Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH
| | - Mandy Miller Koop
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH
| | - Francois Bethoux
- Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH
| | - Jay L Alberts
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH; Concussion Center, Cleveland Clinic, Cleveland, OH; Center for Neurologic Restoration, Cleveland Clinic, Cleveland, OH
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25
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Persons post-stroke improve step length symmetry by walking asymmetrically. J Neuroeng Rehabil 2020; 17:105. [PMID: 32746886 PMCID: PMC7397591 DOI: 10.1186/s12984-020-00732-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 07/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND PURPOSE Restoration of step length symmetry is a common rehabilitation goal after stroke. Persons post-stroke often retain the ability to walk with symmetric step lengths ("symmetric steps"); however, the resulting walking pattern remains effortful. Two key questions with direct implications for rehabilitation have emerged: 1) how do persons post-stroke generate symmetric steps, and 2) why do symmetric steps remain so effortful? Here, we aimed to understand how persons post-stroke generate symmetric steps and explored how the resulting gait pattern may relate to the metabolic cost of transport. METHODS We recorded kinematic, kinetic, and metabolic data as nine persons post-stroke walked on an instrumented treadmill under two conditions: preferred walking and symmetric stepping (using visual feedback). RESULTS Gait kinematics and kinetics remained markedly asymmetric even when persons post-stroke improved step length symmetry. Impaired paretic propulsion and aberrant movement of the center of mass were evident during both preferred walking and symmetric stepping. These deficits contributed to diminished positive work performed by the paretic limb on the center of mass in both conditions. Within each condition, decreased positive paretic work correlated with increased metabolic cost of transport and decreased walking speed across participants. CONCLUSIONS It is critical to consider the mechanics used to restore symmetric steps when designing interventions to improve walking after stroke. Future research should consider the many dimensions of asymmetry in post-stroke gait, and additional within-participant manipulations of gait parameters are needed to improve our understanding of the elevated metabolic cost of walking after stroke.
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Little VL, Perry LA, Mercado MWV, Kautz SA, Patten C. Gait asymmetry pattern following stroke determines acute response to locomotor task. Gait Posture 2020; 77:300-307. [PMID: 32126493 PMCID: PMC7887894 DOI: 10.1016/j.gaitpost.2020.02.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 02/18/2020] [Accepted: 02/20/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Given the prevalence of gait dysfunction following stroke, walking recovery is a primary goal of rehabilitation. However, current gait rehabilitation approaches fail to demonstrate consistent benefits. Gait asymmetry, prevalent among stroke survivors who regain the ability to walk, is associated with an increased energy cost of walking and is a significant predictor of falls post-stroke. Furthermore, differential patterns of gait asymmetry may respond differently to gait training parameters. RESEARCH QUESTION The purpose of this study was to determine whether differential responses to locomotor task condition occur on the basis of step length asymmetry pattern (Symmetrical, NPshort, Pshort) observed during overground walking. METHODS Participants first walked overground at their self-selected walking speed. Overground data were compared against three task conditions all tested during treadmill walking: self-selected speed with 0% body weight support (TM); self-selected speed with 30 % body weight support (BWS); and fastest comfortable speed with 30 % body weight support and nonparetic leg guidance (GuidanceNP). Our primary metrics were: symmetry indices of step length, stride length, and single limb support duration. RESULTS We identified differences in the response to locomotor task conditions for each step length asymmetry subgroup. GuidanceNP induced an acute spatial symmetry only in the NPshort group and temporal symmetry in the Symmetrical and Pshort groups. Importantly, we found the TM and BWS conditions were insufficient to impact either spatial or temporal gait symmetry. SIGNIFICANCE Task conditions consistent with locomotor training do not produce uniform effects across subpatterns of gait asymmetry. We identified differential responses to locomotor task conditions between groups with distinct asymmetry patterns, suggesting these subgroups may require unique intervention strategies. Despite group differences in asymmetry characteristics, improvements in symmetry noted in each group were driven by changes in both the paretic and nonparetic limbs.
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Affiliation(s)
- Virginia L Little
- Department of Physical Therapy, A.T. Still University, 5850 E. Still Circle, Mesa, AZ 85206 USA
| | - Lindsay A Perry
- Department of Physical Therapy, University of St. Augustine, 1 University Blvd., St. Augustine, FL 32086, USA
| | - Mae WV Mercado
- Dept of Physical Therapy, BenchMark Rehab Partners, 2255 Peachtree Rd NE, Ste G, Atlanta, GA 30309, USA
| | - Steven A Kautz
- Ralph H Johnson VA Medical Center, 109 Bee St, Charleston, SC 29401, USA and Department of Health Sciences & Research, Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Carolynn Patten
- Biomechanics, Rehabilitation, and Integrative Neuroscience (BRaIN) Lab, VA Northern California Health Care System, Martinez, CA, USA 94553; University of California, Davis School of Medicine, Department of Physical Medicine & Rehabilitation, Sacramento, CA, USA 95817,Corresponding author: UC Davis School of Medicine, Dept of Physical Medicine & Rehabilitation, 4860 Y Street, Suite 3850, Sacramento, CA 95817, Phone: (916) 734-5029,
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27
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Frame HB, Finetto C, Dean JC, Neptune RR. The influence of lateral stabilization on walking performance and balance control in neurologically-intact and post-stroke individuals. Clin Biomech (Bristol, Avon) 2020; 73:172-180. [PMID: 32004909 PMCID: PMC7183884 DOI: 10.1016/j.clinbiomech.2020.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 11/19/2019] [Accepted: 01/07/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Individuals post-stroke have an increased risk of falling, which can lead to injuries and reduced quality of life. This increased fall risk can be partially attributed to poorer balance control, which has been linked to altered post-stroke gait kinematics (e.g. an increased step width). The application of lateral stabilization to the pelvis reduces step width among neurologically-intact young and older adults, suggesting that lateral stabilization reduces the need for active frontal plane balance control. This study sought to determine if lateral stabilization is effective at improving common measures of gait performance and dynamic balance in neurologically-intact and post-stoke individuals who responded to the stabilization by reducing their step width. METHODS Gait performance was assessed by foot placement and propulsion symmetry while dynamic balance was assessed by peak-to-peak range of frontal plane whole body angular momentum (HR) and pelvis and trunk sway. FINDINGS Controls and post-stroke Responders who reduced their step width in response to stabilization also reduced their mediolateral pelvis sway, but did not exhibit changes in gait performance. Contrary to expectations, both groups exhibited an increased HR, possibly indicative of decreased balance control. This increase was the result of increased relative velocity between the pelvis and head, arms and trunk segment. INTERPRETATION These results suggest that a reduction in pelvis motion alone, as opposed to relative motion between the pelvis and upper body, may increase HR, decrease balance control and diminish gait performance. This finding has important implications for locomotor therapies that may seek to reduce pelvis motion.
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Affiliation(s)
- Hannah B Frame
- Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Christian Finetto
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC, USA
| | - Jesse C Dean
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC, USA
| | - Richard R Neptune
- Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX, USA.
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28
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Wang Y, Mukaino M, Ohtsuka K, Otaka Y, Tanikawa H, Matsuda F, Tsuchiyama K, Yamada J, Saitoh E. Gait characteristics of post-stroke hemiparetic patients with different walking speeds. Int J Rehabil Res 2020; 43:69-75. [PMID: 31855899 PMCID: PMC7028468 DOI: 10.1097/mrr.0000000000000391] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 12/02/2019] [Indexed: 11/26/2022]
Abstract
Hemiparesis resulting from stroke presents characteristic spatiotemporal gait patterns. This study aimed to clarify the spatiotemporal gait characteristics of hemiparetic patients by comparing them with height-, speed-, and age-matched controls while walking at various speeds. The data on spatiotemporal gait parameters of stroke patients and that of matched controls were extracted from a hospital gait analysis database. In total, 130 pairs of data were selected for analysis. Patients and controls were compared for spatiotemporal gait parameters and the raw value (RSI) and absolute value (ASI) of symmetry index and coefficient of variation (CV) of these parameters. Stroke patients presented with prolonged nonparetic stance (patients vs. controls: 1.01 ± 0.41 vs. 0.83 ± 0.25) and paretic swing time (0.45 ± 0.12 vs. 0.39 ± 0.07), shortened nonparetic swing phase (0.35 ± 0.07 vs. 0.39 ± 0.07), and prolonged paretic and nonparetic double stance phases [0.27 ± 0.13 (paretic)/0.27 ± 0.17 (nonparetic) vs. 0.22 ± 0.10]. These changes are especially seen in low-gait speed groups (<3.4 km/h). High RSIs of stance and swing times were also observed (-9.62 ± 10.32 vs. -0.79 ± 2.93, 24.24 ± 25.75 vs. 1.76 ± 6.43, respectively). High ASIs and CVs were more generally observed, including the groups with gait speed of ≥3.5 km/h. ASI increase of the swing phase (25.79 ± 22.69 vs. 4.83 ± 4.88) and CV of the step length [7.7 ± 4.9 (paretic)/7.6 ± 5.0 (nonparetic) vs. 5.3 ± 3.0] were observed in all gait speed groups. Our data suggest that abnormalities in the spatiotemporal parameters of hemiparetic gait should be interpreted in relation to gait speed. ASIs and CVs could be highly sensitive indices for detecting gait abnormalities.
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Affiliation(s)
- Yiji Wang
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
- Department of Spinal Cord Injury Rehabilitation, China Rehabilitation Research Center
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
| | - Masahiko Mukaino
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Kei Ohtsuka
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University
| | - Yohei Otaka
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Hiroki Tanikawa
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University
| | - Fumihiro Matsuda
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University
| | - Kazuhiro Tsuchiyama
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University
| | - Junya Yamada
- Department of Rehabilitation, Fujita Health University Hospital, Toyoake, Aichi, Japan
| | - Eiichi Saitoh
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
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Boehm WL, Gruben KG. Development of KIINCE: A kinetic feedback-based robotic environment for study of neuromuscular coordination and rehabilitation of human standing and walking. J Rehabil Assist Technol Eng 2019; 5:2055668318793585. [PMID: 31191950 PMCID: PMC6453043 DOI: 10.1177/2055668318793585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 07/04/2018] [Indexed: 11/25/2022] Open
Abstract
Introduction The objective of this article is to introduce the robotic platform KIINCE and
its emphasis on the potential of kinetic objectives for studying and
training human walking and standing. The device is motivated by the need to
characterize and train lower limb muscle coordination to address balance
deficits in impaired walking and standing. Methods The device measures the forces between the user and his or her environment,
particularly the force of the ground on the feet (F) that
reflects lower limb joint torque coordination. In an environment that allows
for exploration of the user’s capabilities, various forms of real-time
feedback guide neural training to produce F appropriate for
remaining upright. Control of the foot plate motion is configurable and may
be user driven or prescribed. Design choices are motivated from theory of
motor control and learning as well as empirical observations of
F during walking and standing. Results Preliminary studies of impaired individuals demonstrate the feasibility and
potential utility of patient interaction with kinetic immersive interface
for neuromuscular coordination enhancement. Conclusion Applications include study and rehabilitation of standing and walking after
injury, amputation, and neurological insult, with an initial focus on stroke
discussed here.
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Affiliation(s)
- Wendy L Boehm
- Department of Biomedical Engineering, Northwestern University, Chicago, USA
| | - Kreg G Gruben
- Department of Kinesiology, University of Wisconsin, Madison, USA.,Department of Biomedical Engineering, University of Wisconsin, Madison, USA
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30
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van Kammen K, Boonstra AM, van der Woude LHV, Visscher C, Reinders-Messelink HA, den Otter R. Lokomat guided gait in hemiparetic stroke patients: the effects of training parameters on muscle activity and temporal symmetry. Disabil Rehabil 2019; 42:2977-2985. [DOI: 10.1080/09638288.2019.1579259] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Klaske van Kammen
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
- Rehabilitation Center “Revalidatie Friesland”, Beetsterzwaag, The Netherlands
| | - Anne M. Boonstra
- Rehabilitation Center “Revalidatie Friesland”, Beetsterzwaag, The Netherlands
| | - Lucas H. V. van der Woude
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
- University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Groningen, The Netherlands
| | - Chris Visscher
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
| | - Heleen A. Reinders-Messelink
- Rehabilitation Center “Revalidatie Friesland”, Beetsterzwaag, The Netherlands
- University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Groningen, The Netherlands
| | - Rob den Otter
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
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31
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Kang J, Ghonasgi K, Walsh CJ, Agrawal SK. Simulating Hemiparetic Gait in Healthy Subjects Using TPAD With a Closed-Loop Controller. IEEE Trans Neural Syst Rehabil Eng 2019; 27:974-983. [PMID: 30932841 DOI: 10.1109/tnsre.2019.2907683] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Hemiparetic gait is abnormal asymmetric walking, often observed among patients with cerebral palsy or stroke. One of the major features of asymmetric gait is excessive reliance on the healthy leg, which results in improper load shift, slow walking speed, higher metabolic cost, and weakness of the unused leg. Hence, clinically it is desirable to promote gait symmetry to improve walking. While there are no clear methods to achieve this goal, we are exploring new methods where we guide the pelvis to change the gait symmetry. This controller is designed to mimic the hands of a physical therapist holding the pelvis and guiding it to promote the usage of both legs during walking. In this paper, we show that the essence of this method can be demonstrated by promoting asymmetry in the gait of healthy subjects when walking with the device. The results showed that their kinematics and kinetics changed asymmetrically during the intervention. Subjects demonstrated asymmetric lateral ground reaction force to compensate for the lateral forces applied on the pelvis. Muscle activities increased on the targeted leg show the forced use of the leg which can be used for rehabilitation of patients with an asymmetric gait.
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32
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Ghaffar A, Dehghani-Sanij AA, Xie SQ. A review of gait disorders in the elderly and neurological patients for robot-assisted training. Disabil Rehabil Assist Technol 2019; 15:256-270. [PMID: 30777472 DOI: 10.1080/17483107.2019.1568594] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: Ambulation is an important objective for people with pathological gaits. Exoskeleton robots can assist these people to complete their activities of daily living. There are exoskeletons that have been presented in literature to assist the elderly and other pathological gait users. This article presents a review of the degree of support required in the elderly and neurological gait disorders found in the human population. This will help to advance the design of robot-assisted devices based on the needs of the end users.Methods: The articles included in this review are collected from different databases including Science Direct, Springer Link, Web of Science, Medline and PubMed and with the purpose to investigate the gait parameters of elderly and neurological patients. Studies were included after considering the full texts and only those which focus on spatiotemporal, kinematic and kinetic gait parameters were selected as they are most relevant to the scope of this review. A systematic review and meta-analysis were conducted.Results: The meta-analysis report on the spatiotemporal, kinematic and kinetic gait parameters of elderly and neurological patients revealed a significant difference based on the type and level of impairment. Healthy elderly population showed deviations in the gait parameters due to age, however, significant difference is observed in the gait parameters of the neurological patients.Conclusion: A level of agreement was observed in most of the studies however the review also noticed some controversies among different studies in the same group. The review on the spatiotemporal, kinematics and kinetic gait parameters will provide a summary of the fundamental needs of the users for the future design and development of robotic assistive devices.Implications for rehabilitationThe support requirements provide the foundation for designing assistive devices.The findings will be crucial in defining the design criteria for robot assistive devices.
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Affiliation(s)
- Asim Ghaffar
- School of Mechanical Engineering, University of Leeds, Leeds, UK.,Department of Mechanical and Mechatronics Engineering, University of Engineering and Technology, Lahore, Faisalabad Campus, Pakistan
| | | | - Sheng Quan Xie
- Faculty of Engineering, School of Electronic and Electrical Engineering and School of Mechanical Engineering, University of Leeds, Leeds, UK
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Graham SA, Roth EJ, Brown DA. Walking and balance outcomes for stroke survivors: a randomized clinical trial comparing body-weight-supported treadmill training with versus without challenging mobility skills. J Neuroeng Rehabil 2018; 15:92. [PMID: 30382860 PMCID: PMC6211560 DOI: 10.1186/s12984-018-0442-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 10/18/2018] [Indexed: 01/08/2023] Open
Abstract
Background Treadmill training, with or without body-weight support (BWSTT), typically involves high step count, faster walking speed, and higher heart-rate intensity than overground walking training. The addition of challenging mobility skill practice may offer increased opportunities to improve walking and balance skills. Here we compare walking and balance outcomes of chronic stroke survivors performing BWSTT with BWSTT including challenging mobility skills. Methods Single-blind randomized clinical trial comparing two BWSTT interventions performed in a rehabilitation research laboratory facility over 6 weeks. Participants were 18+ years of age with chronic (≥5 months) poststroke hemiparesis due to a cortical or subcortical ischemic or hemorrhagic stroke and walking speeds < 1.1 m/s at baseline. A hands-free group (HF; n = 15) performed BWSTT without assistance from handrails or assistive devices, and a hands-free plus challenge group (HF + C; n = 14) performed the same protocol while additionally practicing challenging mobility skills. The primary outcome was change in comfortable walking speed (CWS), with secondary outcomes of fast walk speed (FWS), six-minute walk distance, Berg Balance Scale (BBS) scores, and Activities Specific Balance Confidence (ABC) scores. Results Significant pre-post improvement of CWS (Z = − 4.2, p ≤ 0.0001) from a median of 0.35 m/s (range 0.10 to 1.09) to a median of 0.54 m/s (range 0.1 to 1.17), but no difference observed between groups (U = 96.0, p = 0.69). Pre-post improvements across all participants resulted in reclassified baseline ambulation status from sixteen to ten household ambulators, three to seven limited community ambulators, and ten to twelve community ambulators. Secondary outcomes showed similar pre-post improvements with no between-group differences. Conclusions The addition of challenging mobility skills to a hands-free BWSTT protocol did not lead to greater improvements in CWS following 6 weeks of training. One reason for lack of group differences may be that both groups were adequately challenged by walking in an active, self-driven treadmill environment without use of handrails or assistive devices. Trial registration NCT02787759 Falls-based Training for Walking Post-Stroke (FBT); retrospectively registered June 1st, 2016.
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Affiliation(s)
- Sarah A Graham
- Departments of Physical and Occupational Therapy, University of Alabama at Birmingham, Building 516 20th Street South, Birmingham, AL, 35233-4555, USA.
| | - Elliot J Roth
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - David A Brown
- Departments of Physical and Occupational Therapy, University of Alabama at Birmingham, Building 516 20th Street South, Birmingham, AL, 35233-4555, USA
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De Luca A, Vernetti H, Capra C, Pisu I, Cassiano C, Barone L, Gaito F, Danese F, Antonio Checchia G, Lentino C, Giannoni P, Casadio M. Recovery and compensation after robotic assisted gait training in chronic stroke survivors. Disabil Rehabil Assist Technol 2018; 14:826-838. [PMID: 29741134 DOI: 10.1080/17483107.2018.1466926] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background: Gait re-education is a primary rehabilitation goal after stroke. In the last decades, robots with different mechanical structures have been extensively used in the clinical practice for gait training of stroke survivors. However, the effectiveness of robotic training is still controversial, especially for chronic subjects. In this study, we investigated the short-term effects of gait training assisted by an endpoint robot in a population of chronic stroke survivors.Methods: Subjects were evaluated before and after training with clinical scales and instrumented gait analysis. Our primary outcome indicator was the walking speed. Next, we investigated the changes in kinetic and kinematic gait patterns as well as the intersegmental coordination at the level of the lower limbs.Results: Most subjects improved their speed in over-ground walking, by modifying the temporal more than the spatial gait parameters. These changes led to an improvement in the ankle power for both sides and to a slight reduction of the inclination of the pelvis during the swing phase, mainly due to a decreased knee flexion and an increased hip extension on the unimpaired leg.Conclusions: These results indicate that the proposed training induced mainly a functional change rather than an improvement of the quality of gait.Implication for RehabilitationGait re-education is a primary goal in stroke rehabilitation.Nowadays several robotic devices for gait rehabilitation are used in the clinical practice, but their effectiveness is controversial, especially for chronic survivors.After a 20-session training with an endpoint robot the chronic stroke survivors showed an improvement in overground gait speed.The increased gait speed was mainly due to functional changes of the temporal parameters and of the kinetic variables at the level of both ankle joints, as well as to a reduction of compensatory strategies observable in the unimpaired side.
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Affiliation(s)
- Alice De Luca
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Genoa, Italy.,Recovery and Functional Reeducation Unit, Rehabilitation Department, Santa Corona Hospital, Pietra Ligure, Savona, Italy
| | - Honoré Vernetti
- Recovery and Functional Reeducation Unit, Rehabilitation Department, Santa Corona Hospital, Pietra Ligure, Savona, Italy
| | - Cristina Capra
- Recovery and Functional Reeducation Unit, Rehabilitation Department, Santa Corona Hospital, Pietra Ligure, Savona, Italy
| | - Ivano Pisu
- Recovery and Functional Reeducation Unit, Rehabilitation Department, Santa Corona Hospital, Pietra Ligure, Savona, Italy
| | - Cinzia Cassiano
- Recovery and Functional Reeducation Unit, Rehabilitation Department, Santa Corona Hospital, Pietra Ligure, Savona, Italy
| | - Laura Barone
- Recovery and Functional Reeducation Unit, Rehabilitation Department, Santa Corona Hospital, Pietra Ligure, Savona, Italy
| | - Federica Gaito
- Recovery and Functional Reeducation Unit, Rehabilitation Department, Santa Corona Hospital, Pietra Ligure, Savona, Italy
| | - Federica Danese
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Genoa, Italy
| | - Giovanni Antonio Checchia
- Recovery and Functional Reeducation Unit, Rehabilitation Department, Santa Corona Hospital, Pietra Ligure, Savona, Italy
| | - Carmelo Lentino
- Recovery and Functional Reeducation Unit, Rehabilitation Department, Santa Corona Hospital, Pietra Ligure, Savona, Italy
| | - Psiche Giannoni
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Genoa, Italy
| | - Maura Casadio
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Genoa, Italy
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Wüest S, Massé F, Aminian K, Gonzenbach R, de Bruin ED. Reliability and validity of the inertial sensor-based Timed "Up and Go" test in individuals affected by stroke. ACTA ACUST UNITED AC 2018; 53:599-610. [PMID: 27898161 DOI: 10.1682/jrrd.2015.04.0065] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 08/21/2015] [Indexed: 11/05/2022]
Abstract
The instrumented Timed "Up and Go" test (iTUG) has the potential for playing an important role in providing clinically useful information regarding an individual's balance and mobility that cannot be derived from the original single-outcome Timed "Up and Go" test protocol. The purpose of this study was to determine the reliability and validity of the iTUG using body-fixed inertial sensors in people affected by stroke. For test-retest reliability analysis, 14 individuals with stroke and 25 nondisabled elderly patients were assessed. For validity analysis, an age-matched comparison of 12 patients with stroke and 12 nondisabled controls was performed. Out of the 14 computed iTUG metrics, the majority showed excellent test-retest reliability expressed by high intraclass correlation coefficients (range 0.431-0.994) together with low standard error of measurement and smallest detectable difference values. Bland-Altman plots demonstrated good agreement between two repeated measurements. Significant differences between patients with stroke and nondisabled controls were found in 9 of 14 iTUG parameters analyzed. Consequently, these results warrant the future application of the inertial sensor-based iTUG test for the assessment of physical deficits poststroke in longitudinal study designs.
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Affiliation(s)
- Seline Wüest
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
| | - Fabien Massé
- Laboratory of Movement Analysis and Measurement, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Kamiar Aminian
- Laboratory of Movement Analysis and Measurement, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Roman Gonzenbach
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Eling D de Bruin
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
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Hsu CJ, Kim J, Roth EJ, Rymer WZ, Wu M. Forced Use of the Paretic Leg Induced by a Constraint Force Applied to the Nonparetic Leg in Individuals Poststroke During Walking. Neurorehabil Neural Repair 2017; 31:1042-1052. [PMID: 29145773 DOI: 10.1177/1545968317740972] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Individuals with stroke usually show reduced muscle activities of the paretic leg and asymmetrical gait pattern during walking. OBJECTIVE To determine whether applying a resistance force to the nonparetic leg would enhance the muscle activities of the paretic leg and improve the symmetry of spatiotemporal gait parameters in individuals with poststroke hemiparesis. METHODS Fifteen individuals with chronic poststroke hemiparesis participated in this study. A controlled resistance force was applied to the nonparetic leg using a customized cable-driven robotic system while subjects walked on a treadmill. Subjects completed 2 test sections with the resistance force applied at different phases of gait (ie, early and late swing phases) and different magnitudes (10%, 20%, and 30% of maximum voluntary contraction [MVC] of nonparetic leg hip flexors). Electromyographic (EMG) activity of the muscles of the paretic leg and spatiotemporal gait parameters were collected. RESULTS Significant increases in integrated EMG of medial gastrocnemius, medial hamstrings, vastus medialis, and tibialis anterior of the paretic leg were observed when the resistance was applied during the early swing phase of the nonparetic leg, compared with baseline. Additionally, resistance with 30% of MVC induced the greatest level of muscle activity than that with 10% or 20% of MVC. The symmetry index of gait parameters also improved with resistance applied during the early swing phase. CONCLUSION Applying a controlled resistance force to the nonparetic leg during early swing phase may induce forced use on the paretic leg and improve the spatiotemporal symmetry of gait in individuals with poststroke hemiparesis.
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Affiliation(s)
| | - Janis Kim
- 1 Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Elliot J Roth
- 1 Shirley Ryan AbilityLab, Chicago, IL, USA.,2 Northwestern University, Chicago, IL, USA
| | - William Z Rymer
- 1 Shirley Ryan AbilityLab, Chicago, IL, USA.,2 Northwestern University, Chicago, IL, USA
| | - Ming Wu
- 1 Shirley Ryan AbilityLab, Chicago, IL, USA.,2 Northwestern University, Chicago, IL, USA
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Choi W, Han D, Kim J, Lee S. Whole-Body Vibration Combined with Treadmill Training Improves Walking Performance in Post-Stroke Patients: A Randomized Controlled Trial. Med Sci Monit 2017; 23:4918-4925. [PMID: 29031023 PMCID: PMC5652248 DOI: 10.12659/msm.904474] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Stroke is characterized by an asymmetrical gait pattern that causes poor stability and reduces overall activity levels. The aim of this study was to investigate the effect of whole-body vibration combined with treadmill training (WBV-TT) on walking performance in patients with chronic stroke. MATERIAL AND METHODS Thirty ambulatory chronic stroke patients were randomly allocated to the WBV-TT group or the treadmill training (TT) group. The participants in the WBV-TT group performed 6 types of exercises on a vibrating platform for 4.5 minutes and then walked on the treadmill for 20 minutes. The participants in the TT group conducted the same exercise on a platform without vibration and then walked on the treadmill in the same manner. The vibration lasted for 45 seconds in each exercise, and the intervention was performed 3 times weekly for 6 weeks. The treadmill walking speed was gradually increased by 5% in both groups. The outcome measures included the temporospatial parameter of gait (GAITRite®) and 6-minute walk test. RESULTS The WBV-TT group showed significant improvements in walking performance with respect to walking speed, cadence, step length, stride length, single-limb support, double-limb support, and 6-minute walk test compared with baseline (p<0.05). Significant improvements were also seen in walking speed, step length, stride length, and double-limb support compared with the TT group (p<0.05). CONCLUSIONS These findings indicate that WBV-TT is more effective than TT for improving walking performance of patients with chronic stroke.
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Affiliation(s)
- Wonjae Choi
- Department of Physical Therapy, The Graduate School of Sahmyook University, Seoul, South Korea.,Department of Physical Therapy, College of Health Science, Korea University, Seoul, South Korea
| | - Donghun Han
- Department of Physical Therapy, The Graduate School of Sahmyook University, Seoul, South Korea
| | - Junesun Kim
- Department of Physical Therapy, College of Health Science, Korea University, Seoul, South Korea.,Rehabilitation Science Program, Department of Health Science, Korea University Graduate School, Seoul, South Korea
| | - Seungwon Lee
- Department of Physical Therapy, Sahmyook University, Seoul, South Korea
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Exploration of Two Training Paradigms Using Forced Induced Weight Shifting With the Tethered Pelvic Assist Device to Reduce Asymmetry in Individuals After Stroke: Case Reports. Am J Phys Med Rehabil 2017; 96:S135-S140. [PMID: 28661914 DOI: 10.1097/phm.0000000000000779] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Many robotic devices in rehabilitation incorporate an assist-as-needed haptic guidance paradigm to promote training. This error reduction model, while beneficial for skill acquisition, could be detrimental for long-term retention. Error augmentation (EA) models have been explored as alternatives. A robotic Tethered Pelvic Assist Device has been developed to study force application to the pelvis on gait and was used here to induce weight shift onto the paretic (error reduction) or nonparetic (error augmentation) limb during treadmill training. The purpose of these case reports is to examine effects of training with these two paradigms to reduce load force asymmetry during gait in two individuals after stroke (>6 mos). Participants presented with baseline gait asymmetry, although independent community ambulators. Participants underwent 1-hr trainings for 3 days using either the error reduction or error augmentation model. Outcomes included the Borg rating of perceived exertion scale for treatment tolerance and measures of force and stance symmetry. Both participants tolerated training. Force symmetry (measured on treadmill) improved from pretraining to posttraining (36.58% and 14.64% gains), however, with limited transfer to overground gait measures (stance symmetry gains of 9.74% and 16.21%). Training with the Tethered Pelvic Assist Device device proved feasible to improve force symmetry on the treadmill irrespective of training model. Future work should consider methods to increase transfer to overground gait.
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Applying a pelvic corrective force induces forced use of the paretic leg and improves paretic leg EMG activities of individuals post-stroke during treadmill walking. Clin Neurophysiol 2017; 128:1915-1922. [PMID: 28826022 DOI: 10.1016/j.clinph.2017.07.409] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 07/06/2017] [Accepted: 07/16/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine whether applying a mediolateral corrective force to the pelvis during treadmill walking would enhance muscle activity of the paretic leg and improve gait symmetry in individuals with post-stroke hemiparesis. METHODS Fifteen subjects with post-stroke hemiparesis participated in this study. A customized cable-driven robotic system based over a treadmill generated a mediolateral corrective force to the pelvis toward the paretic side during early stance phase. Three different amounts of corrective force were applied. Electromyographic (EMG) activity of the paretic leg, spatiotemporal gait parameters and pelvis lateral displacement were collected. RESULTS Significant increases in integrated EMG of hip abductor, medial hamstrings, soleus, rectus femoris, vastus medialis and tibialis anterior were observed when pelvic corrective force was applied, with pelvic corrective force at 9% of body weight inducing greater muscle activity than 3% or 6% of body weight. Pelvis lateral displacement was more symmetric with pelvic corrective force at 9% of body weight. CONCLUSIONS Applying a mediolateral pelvic corrective force toward the paretic side may enhance muscle activity of the paretic leg and improve pelvis displacement symmetry in individuals post-stroke. SIGNIFICANCE Forceful weight shift to the paretic side could potentially force additional use of the paretic leg and improve the walking pattern.
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Electroacupuncture improves neurobehavioral function and brain injury in rat model of intracerebral hemorrhage. Brain Res Bull 2017; 131:123-132. [PMID: 28395933 DOI: 10.1016/j.brainresbull.2017.04.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Accepted: 04/05/2017] [Indexed: 12/11/2022]
Abstract
Acupuncture has been widely used as a treatment for stroke in China for a long time. Recently, studies have demonstrated that electroacupuncture (EA) can accelerate intracerebral hemorrhage (ICH)-induced angiogenesis in rats. In the present study, we investigated the effect of EA on neurobehavioral function and brain injury in ICH rats. ICH was induced by stereotactic injection of collagenase type I and heparin into the right caudate putamen. Adult ICH rats were randomly divided into the following three groups: model control group (MC), EA at non-acupoint points group (non-acupoint EA) and EA at Baihui and Dazhui acupoints group (EA). The neurobehavioral deficits of ICH rats were assessed by modified neurological severity score (mNSS) and gait analysis. The hemorrhage volume and glucose metabolism of hemorrhagic foci were detected by PET/CT. The expression levels of MBP, NSE and S100-B proteins in serum were tested by ELISA. The histopathological features were examined by haematoxylin-eosin (H&E) staining. Apoptosis-associated proteins in the perihematomal region were observed by immunohistochemistry. EA treatment significantly promoted the recovery of neurobehavioral function in ICH rats. Hemorrhage volume reduced in EA group at day 14 when compared with MC and non-acupoint EA groups. ELISA showed that the levels of MBP, NSE and S100-B in serum were all down-regulated by EA treatment. The brain tissue of ICH rat in the EA group was more intact and compact than that in the MC and non-acupoint groups. In the perihematomal regions, the expression of Bcl-2 protein increased and expressions of Caspase-3 and Bax proteins decreased in the EA group vs MC and non-acupoint EA groups. Our data suggest that EA treatment can improve neurobehavioral function and brain injury, which were likely connected with the absorption of hematoma and regulation of apoptosis-related proteins.
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Srivastava S, Kao PC, Reisman DS, Scholz JP, Agrawal SK, Higginson JS. Robotic Assist-As-Needed as an Alternative to Therapist-Assisted Gait Rehabilitation. ACTA ACUST UNITED AC 2016; 4. [PMID: 28580370 DOI: 10.4172/2329-9096.1000370] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Body Weight Supported Treadmill Training (BWSTT) with therapists' assistance is often used for gait rehabilitation post-stroke. However, this training method is labor-intensive, requiring at least one or as many as three therapists at once for manual assistance. Previously, we demonstrated that providing movement guidance using a performance-based robot-aided gait training (RAGT) that applies a compliant, assist-as-needed force-field improves gait pattern and functional walking ability in people post-stroke. In the current study, we compared the effects of assist-as-needed RAGT combined with functional electrical stimulation and visual feedback with BWSTT to determine if RAGT could serve as an alternative for locomotor training. METHODS Twelve stroke survivors were randomly assigned to one of the two groups, either receiving BWSTT with manual assistance or RAGT with functional electrical stimulation and visual feedback. All subjects received fifteen 40-minutes training sessions. RESULTS Clinical measures, kinematic data, and EMG data were collected before and immediately after the training for fifteen sessions. Subjects receiving RAGT demonstrated significant improvements in their self-selected over-ground walking speed, Functional Gait Assessment, Timed Up and Go scores, swing-phase peak knee flexion angle, and muscle coordination pattern. Subjects receiving BWSTT demonstrated significant improvements in the Six-minute walk test. However, there was an overall trend toward improvement in most measures with both interventions, thus there were no significant between-group differences in the improvements following training. CONCLUSION The current findings suggest that RAGT worked at least as well as BWSTT and thus may be used as an alternative rehabilitation method to improve gait pattern post-stroke as it requires less physical effort from the therapists compared to BWSTT.
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Affiliation(s)
- Shraddha Srivastava
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Pei Chun Kao
- Department of Physical Therapy, University of Massachusetts Lowell, Lowell, MA 01854, USA
| | - Darcy S Reisman
- Department of Physical Therapy, University of Delaware, Newark, DE 19713, USA
| | - John P Scholz
- Department of Physical Therapy, University of Delaware, Newark, DE 19713, USA
| | - Sunil K Agrawal
- Department of Mechanical Engineering, Columbia University, USA
| | - Jill S Higginson
- Department of Mechanical Engineering, University of Delaware, USA
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Murata K, Asai H, Inaoka PT, Nakaizumi D. Walking gait changes after stepping-in-place training using a foot lifting device in chronic stroke patients. J Phys Ther Sci 2016; 28:1170-7. [PMID: 27190449 PMCID: PMC4868209 DOI: 10.1589/jpts.28.1170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 12/23/2015] [Indexed: 11/26/2022] Open
Abstract
[Purpose] The goal of this study was to investigate the efficacy of stepping-in-place
training using a foot lifting assist device on the walking gait of chronic hemiparetic
stroke patients. [Subjects] Seven patients with chronic hemiplegic stroke (age
80.9±4.9 years) who were attending a local adult daycare facility participated in this
study. [Methods] The participants had 2 or 16 weeks of intervention after a baseline
period of 2 weeks. Evaluations were performed before the baseline period and before and
after the intervention period. The evaluation consisted of a two-dimensional motion
analysis of walking and stepping-in-place exercises and a clinical evaluation. [Results]
Walking speed increased in three participants after 2 or 16 weeks of intervention. The
swing phase percentage increased in the paretic gait cycle, and the time from non-paretic
heel contact to paretic heel off decreased during stepping-in-place in these participants.
[Conclusion] Given that the transition from the support phase support to the swing phase
was shortened after the intervention, the stepping-in-place exercise using the device
designed for this study may improve the muscle strength of the lower limb and coordination
in the pre-swing phase of the paretic limb.
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Affiliation(s)
- Kanichirou Murata
- Physical Therapy Course, Department of Rehabilitation, Fukui College of Health Sciences, Japan
| | - Hitoshi Asai
- Department of Physical Therapy, Graduate Course of Rehabilitation Science, Kanazawa University, Japan
| | - Pleiades Tiharu Inaoka
- Department of Physical Therapy, Graduate Course of Rehabilitation Science, Kanazawa University, Japan
| | - Dai Nakaizumi
- Division of Health Sciences, Graduate School of Medical Science, Kanazawa University, Japan
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Comparison of Heart Rate Reserve-Guided and Ratings of Perceived Exertion-Guided Methods for High-Intensity Robot-Assisted Gait Training in Patients With Chronic Stroke. TOPICS IN GERIATRIC REHABILITATION 2016. [DOI: 10.1097/tgr.0000000000000098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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IJmker T, Lamoth CJ, Houdijk H, Tolsma M, van der Woude LHV, Daffertshofer A, Beek PJ. Effects of handrail hold and light touch on energetics, step parameters, and neuromuscular activity during walking after stroke. J Neuroeng Rehabil 2015; 12:70. [PMID: 26298647 PMCID: PMC4546819 DOI: 10.1186/s12984-015-0051-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 06/26/2015] [Indexed: 11/11/2022] Open
Abstract
Background Holding a handrail or using a cane may decrease the energy cost of walking in stroke survivors. However, the factors underlying this decrease have not yet been previously identified. The purpose of the current study was to fill this void by investigating the effect of physical support (through handrail hold) and/or somatosensory input (through light touch contact with a handrail) on energy cost and accompanying changes in both step parameters and neuromuscular activity. Elucidating these aspects may provide useful insights into gait recovery post stroke. Methods Fifteen stroke survivors participated in this study. Participants walked on a treadmill under three conditions: no handrail contact, light touch of the handrail, and firm handrail hold. During the trials we recorded oxygen consumption, center of pressure profiles, and bilateral activation of eight lower limb muscles. Effects of the three conditions on energy cost, step parameters and neuromuscular activation were compared statistically using conventional ANOVAs with repeated measures. In order to examine to which extent energy cost and step parameters/muscle activity are associated, we further employed a partial least squares regression analysis. Results Handrail hold resulted in a significant reduction in energy cost, whereas light touch contact did not. With handrail hold subjects took longer steps with smaller step width and improved step length symmetry, whereas light touch contact only resulted in a small but significant decrease in step width. The EMG analysis indicated a global drop in muscle activity, accompanied by an increased constancy in the timing of this activity, and a decreased co-activation with handrail hold, but not with light touch. The regression analysis revealed that increased stride time and length, improved step length symmetry, and decreased muscle activity were closely associated with the decreased energy cost during handrail hold. Conclusion Handrail hold, but not light touch, altered step parameters and was accompanied by a global reduction in muscle activity, with improved timing constancy. This suggests that the use of a handrail allows for a more economic step pattern that requires less muscular activation without resulting in substantial neuromuscular re-organization. Handrail use may thus have beneficial effects on gait economy after stroke, which cannot be accomplished through enhanced somatosensory input alone. Electronic supplementary material The online version of this article (doi:10.1186/s12984-015-0051-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- T IJmker
- MOVE Research Institute Amsterdam, Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, VU University Amsterdam, van der Boechorststraat 9, 1081 BT, Amsterdam, The Netherlands. .,Heliomare Rehabilitation, Research and Development, Relweg 51, 1949 EC, Wijk aan Zee, The Netherlands.
| | - C J Lamoth
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Center for Rehabilitation, Antonius Deusinglaan 1, 9713AV, Groningen, The Netherlands
| | - H Houdijk
- MOVE Research Institute Amsterdam, Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, VU University Amsterdam, van der Boechorststraat 9, 1081 BT, Amsterdam, The Netherlands.,Heliomare Rehabilitation, Research and Development, Relweg 51, 1949 EC, Wijk aan Zee, The Netherlands
| | - M Tolsma
- Heliomare Rehabilitation, Research and Development, Relweg 51, 1949 EC, Wijk aan Zee, The Netherlands
| | - L H V van der Woude
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Center for Rehabilitation, Antonius Deusinglaan 1, 9713AV, Groningen, The Netherlands
| | - A Daffertshofer
- MOVE Research Institute Amsterdam, Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, VU University Amsterdam, van der Boechorststraat 9, 1081 BT, Amsterdam, The Netherlands
| | - P J Beek
- MOVE Research Institute Amsterdam, Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, VU University Amsterdam, van der Boechorststraat 9, 1081 BT, Amsterdam, The Netherlands
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Abstract
Background Care-needing older adults and disabled individuals often require handrails for assistance of movements, such as sit-to-stand movements. Handrails must be set at the appropriate position; however, the effects of handrail height on joint movement and center-of-gravity movements during sit-to-stand movement remain unclear. In the present study, we sought to clarify the effects of handrail height on joint movement, center-of-gravity, and floor reaction force during sit-to-stand movement. Methods Subjects included 16 healthy young adults and 25 older adults who require long-term care. Kinetic and kinematic measurements during sit-to-stand movement of young adults were conducted using a 3-D motion analyzer and a force plate. Trunk forward tilt angle during sit-to-stand movement of older adults was measured using a still image from a video recording. Results Using low handrails, sit-to-stand movement resulted in an increased hip flexion angle, ankle dorsiflexion angle, and trunk forward tilt angle and a greater forward center-of-gravity shift than when not using handrails in young adults during seat-off. In contrast, using high handrails resulted in a smaller hip flexion angle and trunk forward tilt angle in young adults. The backward force on the floor was decreased in the low handrail condition, and was increased in the high handrail condition rather than that of sit-to-stand movement without handrails in young adults. The effect of handrail height on trunk forward tilt angle was the same in both healthy young adults and care-needing older adults during seat-off. Conclusion Because handrail height affects joint movement and shift in the center-of-gravity during sit-to-stand movement, handrail position should be selected to match the status of older adults with functional impairment.
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Affiliation(s)
- Satomi Kinoshita
- Doctor Course, Graduate School of Health Sciences, Kagoshima University, Kagoshima, Japan
- * E-mail:
| | - Ryoji Kiyama
- Course of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Yoichi Yoshimoto
- Course of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
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Ki KI, Kim MS, Moon Y, Choi JD. Effects of auditory feedback during gait training on hemiplegic patients' weight bearing and dynamic balance ability. J Phys Ther Sci 2015; 27:1267-9. [PMID: 25995603 PMCID: PMC4434024 DOI: 10.1589/jpts.27.1267] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 01/07/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study examined the effects of auditory feedback during gait on the weight
bearing of patients with hemiplegia resulting from a stroke. [Subjects] Thirty hemiplegic
patients participated in this experiment and they were randomly allocated to an
experimental group and a control group. [Methods] Both groups received neuro-developmental
treatment for four weeks and the experimental group additionally received auditory
feedback during gait training. In order to examine auditory feedback effects on weight
bearing during gait, a motion analysis system GAITRite was used to measure the duration of
the stance phase and single limb stance phase of the subjects. [Results] The experimental
group showed statistically significant improvements in the duration of the stance phase
and single limb stance phase of the paretic side and the results of the Timed Up and Go
Test after the training. [Conclusion] Auditory feedback during gait training significantly
improved the duration of the stance phase and single limb stance phase of hemiplegic
stroke patients.
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Affiliation(s)
- Kyong-Il Ki
- Department of Physical Therapy, Graduate School, Daejeon University, Republic of Korea
| | - Mi-Sun Kim
- Department of Physical Therapy, Graduate School, Daejeon University, Republic of Korea
| | - Young Moon
- Department of Physical Therapy, Graduate School, Daejeon University, Republic of Korea
| | - Jong-Duk Choi
- Department of Physical Therapy, College of Natural Science, Daejeon University, Republic of Korea
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Kwon OH, Woo Y, Lee JS, Kim KH. Effects of task-oriented treadmill-walking training on walking ability of stoke patients. Top Stroke Rehabil 2015; 22:444-52. [DOI: 10.1179/1074935715z.00000000057] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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48
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Park BS, Kim JH, Kim MY, Lee LK, Yang SM, Jeon HJ, Lee WD, Noh JW, Lee JU, Kwak TY, Lee TH, Kim JY, Kim J. Effect of a muscle strengthening exercise program for pelvic control on gait function of stroke patients. J Phys Ther Sci 2015; 27:641-4. [PMID: 25931698 PMCID: PMC4395682 DOI: 10.1589/jpts.27.641] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 10/07/2014] [Indexed: 11/25/2022] Open
Abstract
[Purpose] The purpose of this study was to investigate the effects of strengthening
exercises for the hip extensors on the gait performance and stability of patients with
hemiplegia. [Subjects and Methods] The subjects were fifteen stroke patients (ten males,
five females). The experimental subjects performed a hip extensor strengthening exercise
(HESE) program for a total of four weeks. [Results] The experimental subjects showed
significant improvements after the HESE program. Especially, walking speed and the
affected side stance phase time significantly increased after the HESE program.
Furthermore, the affected side stride length and symmetry index in the stance phase
significantly increased after HESE program. [Conclusion] These results suggest that the
HESE program may, in part, help to improve gait performance ability and stabilize physical
disability after stroke.
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Affiliation(s)
- Byoung-Sun Park
- Laboratory of Health Science and Nanophysiotherapy, Department of Physical Therapy, Graduate School, Yongin University, Republic of Korea ; Laboratory of Health Science and Nanophysiotherapy, Department of Physical Therapy, Graduate School, Yongin University, Republic of Korea
| | - Ju-Hyun Kim
- Laboratory of Health Science and Nanophysiotherapy, Department of Physical Therapy, Graduate School, Yongin University, Republic of Korea
| | - Mee-Young Kim
- Laboratory of Health Science and Nanophysiotherapy, Department of Physical Therapy, Graduate School, Yongin University, Republic of Korea
| | - Lim-Kyu Lee
- Laboratory of Health Science and Nanophysiotherapy, Department of Physical Therapy, Graduate School, Yongin University, Republic of Korea
| | - Seung-Min Yang
- Laboratory of Health Science and Nanophysiotherapy, Department of Physical Therapy, Graduate School, Yongin University, Republic of Korea
| | - Hye-Joo Jeon
- Laboratory of Health Science and Nanophysiotherapy, Department of Physical Therapy, Graduate School, Yongin University, Republic of Korea
| | - Won-Deok Lee
- Laboratory of Health Science and Nanophysiotherapy, Department of Physical Therapy, Graduate School, Yongin University, Republic of Korea
| | - Ji-Woong Noh
- Laboratory of Health Science and Nanophysiotherapy, Department of Physical Therapy, Graduate School, Yongin University, Republic of Korea
| | - Jeong-Uk Lee
- Department of Physical Therapy, College of Health Science, Honam University, Republic of Korea
| | - Taek-Yong Kwak
- Department of Taekwondo Instructor Education, College of Martial Arts, Yongin University, Republic of Korea
| | - Tae-Hyun Lee
- Department of Combative Martial Arts Training, College of Martial Arts, Yongin University, Republic of Korea
| | - Ju-Young Kim
- Department of Combative Martial Arts Training, College of Martial Arts, Yongin University, Republic of Korea
| | - Junghwan Kim
- Department of Physical Therapy, College of Public Health and Welfare, Yongin University, Republic of Korea
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Lathan C, Myler A, Bagwell J, Powers CM, Fisher BE. Pressure-controlled treadmill training in chronic stroke: a case study with AlterG. J Neurol Phys Ther 2015; 39:127-33. [PMID: 25742371 DOI: 10.1097/npt.0000000000000083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Body-weight-supported treadmill training has been shown to be an effective intervention to improve walking characteristics for individuals who have experienced a stroke. A pressure-controlled treadmill utilizes a sealed chamber in which air pressure can be altered in a controlled manner to counteract the effects of gravity. The focus of this case study was to assess the immediate and short-term impact of a pressure-controlled treadmill to improve gait parameters, reduce fall risk, improve participation, and reduce the self-perceived negative impact of stroke in an individual with chronic stroke. CASE DESCRIPTION The subject was an 81-year-old man (14.5 months poststroke). He had slow walking speed, poor endurance, and multiple gait deviations. INTERVENTION The subject trained 4 times per week for 4 weeks (40 minutes per session) on a pressure-controlled treadmill (AlterG M320) to counter the influence of gravity on the lower extremities. OUTCOMES Following training, self-selected gait speed increased from 0.50 m/s to 0.96 m/s, as measured by the 10-meter walk test. Stride length increased from 0.58 m to 0.95 m after training and to 1.00 m at 1-month follow-up. Peak hip flexion increased from 3.7° to 24.6° after training and to 19.4° at 1-month follow-up. Peak knee flexion increased from 19.4° to 34.3° after training and to 42.7° at 1-month follow-up. Measures of endurance, fall risk, and percentage of perceived recovery also were found to improve posttraining. DISCUSSION Training with a pressure-controlled treadmill may be a viable alternative to traditional body-weight-supported treadmill training for persons poststroke. Additional studies with larger sample sizes are needed to elucidate the role of pressure-controlled treadmill training in this population. Video abstract available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A97).
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Affiliation(s)
- Cherise Lathan
- Clinical Faculty and Clinical Physical Therapy (CL), Keck Medical Center of USC, Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles; Rancho Los Amigos National Rehabilitation Center (AM), Downey, California; Musculoskeletal Biomechanics Research Laboratory (JB), University of Southern California, Los Angeles; Biokinesiology and Musculoskeletal Biomechanics Research Lab (CMP), Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles; and Clinical Physical Therapy and Neuroplasticity and Imaging Laboratory (BEF), Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles
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Veneri D. Combining the Treatment Modalities of Body Weight Support Treadmill Training and Thera-Band: A Case Study of an Individual with Hemiparetic Gait. Top Stroke Rehabil 2015; 18:402-16. [DOI: 10.1310/tsr1804-402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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