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Sterke B, Jabeen S, Baines P, Vallery H, Ribbers G, Heijenbrok-Kal M. Direct biomechanical manipulation of human gait stability: A systematic review. PLoS One 2024; 19:e0305564. [PMID: 38990959 PMCID: PMC11239080 DOI: 10.1371/journal.pone.0305564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 05/31/2024] [Indexed: 07/13/2024] Open
Abstract
People fall more often when their gait stability is reduced. Gait stability can be directly manipulated by exerting forces or moments onto a person, ranging from simple walking sticks to complex wearable robotics. A systematic review of the literature was performed to determine: What is the level of evidence for different types of mechanical manipulations on improving gait stability? The study was registered at PROSPERO (CRD42020180631). Databases Embase, Medline All, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, and Google Scholar were searched. The final search was conducted on the 1st of December, 2022. The included studies contained mechanical devices that influence gait stability for both impaired and non-impaired subjects. Studies performed with prosthetic devices, passive orthoses, and analysing post-training effects were excluded. An adapted NIH quality assessment tool was used to assess the study quality and risk of bias. Studies were grouped based on the type of device, point of application, and direction of forces and moments. For each device type, a best-evidence synthesis was performed to quantify the level of evidence based on the type of validity of the reported outcome measures and the study quality assessment score. Impaired and non-impaired study participants were considered separately. From a total of 4701 papers, 53 were included in our analysis. For impaired subjects, indicative evidence was found for medio-lateral pelvis stabilisation for improving gait stability, while limited evidence was found for hip joint assistance and canes. For non-impaired subjects, moderate evidence was found for medio-lateral pelvis stabilisation and limited evidence for body weight support. For all other device types, either indicative or insufficient evidence was found for improving gait stability. Our findings also highlight the lack of consensus on outcome measures amongst studies of devices focused on manipulating gait.
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Affiliation(s)
- Bram Sterke
- Rehabilitation Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Saher Jabeen
- Department of Biomechanical Engineering, Technical University of Delft, Delft, The Netherlands
| | - Patricia Baines
- Department of Biomechanical Engineering, Technical University of Delft, Delft, The Netherlands
| | - Heike Vallery
- Rehabilitation Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Biomechanical Engineering, Technical University of Delft, Delft, The Netherlands
| | - Gerard Ribbers
- Rehabilitation Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
- Rijndam Rehabilitation Center, Rotterdam, The Netherlands
| | - Majanka Heijenbrok-Kal
- Rehabilitation Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
- Rijndam Rehabilitation Center, Rotterdam, The Netherlands
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Çoban O, Mutluay F. The effects of mechanical hippotherapy riding on postural control, balance, and quality of life (QoL) in patients with stroke. Disabil Rehabil 2024; 46:2338-2347. [PMID: 37303153 DOI: 10.1080/09638288.2023.2221458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/21/2023] [Accepted: 05/28/2023] [Indexed: 06/13/2023]
Abstract
PURPOSED This study aimed to investigate the effects of exercises by mechanical hippotherapy devices on postural control, balance, mobility, and Quality of Life in patients with stroke. MATERIAL AND METHODS This was a randomized controlled clinical trial with a total of 30 which were randomly divided into two groups. The participants in the mechanical hippotherapy group (MHG) (n = 15) were given exercises with a mechanical hippotherapy device for 15 min in addition to intensive conventional treatments (45 min), while the control group (CG) (n = 15) received additional 15 min of postural control and balance exercises for five days per week for four consecutive weeks. The primary outcome was The Berg Balance Scale (BBS). Secondary outcomes were the Fugl-Meyer (FM) Rating Scale, Biodex Balance Measurement (BBM), Trunk Impairment Scale (TIS), the Timed Up and Go Test (TUG) and quality of Life Short Form (SF-36). RESULTS In the MHG, FM-Lower extremity score (-6.4, p = 0.024), FM-Upper extremity score (-12.87, p = 0.013), TIS (-5.87, p = 0.04) and TUG (5.73, p = 0.027) improved statistically significant compared to CG. CONCLUSION Exercises using mechanical hippotherapy devices could improve postural control, functional mobility and balance in patients with stroke. It may also improve the quality of life. CLINICAL TRIAL REGISTRATION NUMBER NCT03528993IMPLICATIONS FOR REHABILITATIONNCT03528993It was concluded from our results that mechanical hippotherapy could be included in the treatment programs of stroke patients.
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Affiliation(s)
- Osman Çoban
- Department of Physical Therapy and Rehabilitation, Faculty of Health Science, Istanbul Uskudar University, Istanbul, Turkey
| | - Fatma Mutluay
- Department of Physical Therapy and Rehabilitation, Faculty of Health Science, Istanbul Medipol University, Istanbul, Turkey
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de Miguel Fernandez J, Rey-Prieto M, Rio MSD, Lopez-Matas H, Guirao-Cano L, Font-Llagunes JM, Lobo-Prat J. Adapted Assistance and Resistance Training With a Knee Exoskeleton After Stroke. IEEE Trans Neural Syst Rehabil Eng 2023; 31:3265-3274. [PMID: 37556332 DOI: 10.1109/tnsre.2023.3303777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
Studies on robotic interventions for gait rehabilitation after stroke require: (i) rigorous performance evidence; (ii) systematic procedures to tune the control parameters; and (iii) combination of control modes. In this study, we investigated how stroke individuals responded to training for two weeks with a knee exoskeleton (ABLE-KS) using both Assistance and Resistance training modes together with auditory feedback to train peak knee flexion angle. During the training, the torque provided by the ABLE-KS and the biofeedback were systematically adapted based on the subject's performance and perceived exertion level. We carried out a comprehensive experimental analysis that evaluated a wide range of biomechanical metrics, together with usability and users' perception metrics. We found significant improvements in peak knee flexion ( p = 0.0016 ), minimum knee angle during stance ( p = 0.0053 ), paretic single support time ( p = 0.0087 ) and gait endurance ( p = 0.022 ) when walking without the exoskeleton after the two weeks of training. Participants significantly ( ) improved the knee angle during the stance and swing phases when walking with the exoskeleton powered in the high Assistance mode in comparison to the No Exo and the Unpowered conditions. No clinically relevant differences were found between Assistance and Resistance training sessions. Participants improved their performance with the exoskeleton (24-55 %) for the peak knee flexion angle throughout the training sessions. Moreover, participants showed a high level of acceptability of the ABLE-KS (QUEST 2.0 score: 4.5 ± 0.3 out of 5). Our preliminary findings suggest that the proposed training approach can produce similar or larger improvements in post-stroke individuals than other studies with knee exoskeletons that used higher training intensities.
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Daumas L, Zory R, Garcia A, Jaafar A, Ientile L, Michel E, Sacco G, Chorin F. Effects of individualized lower limb isokinetic strengthening in clinical rehabilitation of older post-stroke patients: A retrospective study. J Rehabil Med 2023; 55:jrm7803. [PMID: 37548388 PMCID: PMC10424099 DOI: 10.2340/jrm.v55.7803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 06/01/2023] [Indexed: 08/08/2023] Open
Abstract
OBJECTIVE Muscle weakness in the lower limbs is a motor consequence of stroke that causes functional impairment. The aim of this study was to assess the effectiveness of an individualized isokinetic strengthening programme, using the moment-velocity profile, on functional recovery during post-stroke rehabilitation of older patients. A further objective was to describe the effects of the individualized isokinetic strengthening on muscular parameters. DESIGN Retrospective study. PATIENTS Older post-stroke patients. METHODS Using the Barthel Index, functional abilities in basic daily tasks were assessed and retrospectively analysed for 88 patients in a post-stroke rehabilitation unit. Of these, 44 patients received conventional rehabilitation (conventional group) and 44 received individualized isokinetic strengthening in addition to conventional rehabilitation (isokinetic group). A 2-Group (isokinetic, conventional) × 2-Time (before, after intervention) repeated measures analysis of variance (ANOVA) was conducted. For muscular parameters, Student t-tests and Wilcoxon tests were performed. RESULTS The Barthel Index score increased more in the isokinetic group (61.59 ± 26.34 to 88.18 ± 12.16) than in the conventional group (61.70 ± 26.5 to 76.93 ± 18.12). A significant Time × Group interaction was found (F(1,86) = 5.95, p = 0.02). In the isokinetic group all muscular parameters improved. CONCLUSION This retrospective clinical study suggests that lower limb isokinetic strengthening, individualized using the moment-velocity profile, is clinically efficient for functional recovery during post-stroke rehabilitation of older patients. Intragroup effects of isokinetic strengthening also suggest benefits for muscular parameters.
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Affiliation(s)
- Lyne Daumas
- University Côte d'Azur, Laboratory Human Motricity Expertise Sport and Health, France; University Côte d'Azur, Cognition Behaviour Technology, France.
| | - Raphaël Zory
- University Côte d'Azur, Laboratory Human Motricity Expertise Sport and Health, France; University Institute of France
| | - Axelle Garcia
- University Côte d'Azur, University Hospital Center of Nice, France, Nice
| | - Amyn Jaafar
- University Côte d'Azur, University Hospital Center of Nice, France, Nice
| | - Luisa Ientile
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, France
| | - Emeline Michel
- University Côte d'Azur, Laboratory Human Motricity Expertise Sport and Health, France; University Côte d'Azur, University Hospital Center of Nice, France, Nice
| | - Guillaume Sacco
- University Côte d'Azur, Cognition Behaviour Technology, France; University Côte d'Azur, University Hospital Center of Nice, France, Nice; UPRES EA 4638, University of Angers, France
| | - Frédéric Chorin
- University Côte d'Azur, Laboratory Human Motricity Expertise Sport and Health, France; University Côte d'Azur, University Hospital Center of Nice, France, Nice
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Kowalczyk K, Mukherjee M, Malcolm P. Can a passive unilateral hip exosuit diminish walking asymmetry? A randomized trial. J Neuroeng Rehabil 2023; 20:88. [PMID: 37438846 DOI: 10.1186/s12984-023-01212-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/03/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Asymmetric walking gait impairs activities of daily living in neurological patient populations, increases their fall risk, and leads to comorbidities. Accessible, long-term rehabilitation methods are needed to help neurological patients restore symmetrical walking patterns. This study aimed to determine if a passive unilateral hip exosuit can modify an induced asymmetric walking gait pattern. We hypothesized that a passive hip exosuit would diminish initial- and post-split-belt treadmill walking after-effects in healthy young adults. METHODS We divided 15 healthy young adults evenly between three experimental groups that each completed a baseline trial, an adaptation period with different interventions for each group, and a post-adaptation trial. To isolate the contribution of the exosuit we compared a group adapting to the exosuit and split-belt treadmill (Exo-Sb) to groups adapting to exosuit-only (Exo-only) and split-belt only (Sb-only) conditions. The independent variables step length, stance time, and swing time symmetry were analyzed across five timepoints (baseline, early- and late adaptation, and early- and late post-adaptation) using a 3 × 5 mixed ANOVA. RESULTS We found significant interaction and time effects on step length, stance time and swing time symmetry. Sb-only produced increased step length asymmetry at early adaptation compared to baseline (p < 0.0001) and an after-effect with increased asymmetry at early post-adaptation compared to baseline (p < 0.0001). Exo-only increased step length asymmetry (in the opposite direction as Sb-only) at early adaptation compared to baseline (p = 0.0392) but did not influence the participants sufficiently to result in a post-effect. Exo-Sb produced similar changes in step length asymmetry in the same direction as Sb-only (p = 0.0014). However, in contrast to Sb-only there was no significant after-effect between early post-adaptation and baseline (p = 0.0885). CONCLUSION The passive exosuit successfully diminished asymmetrical step length after-effects induced by the split-belt treadmill in Exo-Sb. These results support the passive exosuit's ability to alter walking gait patterns.
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Affiliation(s)
- Kayla Kowalczyk
- Department of Biomechanics and Center for Research in Human Movement Variability, University of Nebraska at Omaha, 6160 University Drive, Omaha, NE, 68182-0860, USA
- UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens, GA, USA
| | - Mukul Mukherjee
- Department of Biomechanics and Center for Research in Human Movement Variability, University of Nebraska at Omaha, 6160 University Drive, Omaha, NE, 68182-0860, USA
| | - Philippe Malcolm
- Department of Biomechanics and Center for Research in Human Movement Variability, University of Nebraska at Omaha, 6160 University Drive, Omaha, NE, 68182-0860, USA.
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Park SH, Yan S, Dee W, Keefer R, Roth EJ, Rymer WZ, Wu M. Overground walking with a constraint force on the nonparetic leg during swing improves weight shift toward the paretic side in people after stroke. J Neurophysiol 2023; 130:43-55. [PMID: 37198133 PMCID: PMC10292974 DOI: 10.1152/jn.00008.2023] [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: 01/09/2023] [Revised: 05/12/2023] [Accepted: 05/16/2023] [Indexed: 05/19/2023] Open
Abstract
Targeting enhancing the use of the paretic leg during locomotor practice might improve motor function of the paretic leg. The purpose of this study was to determine whether application of constraint force to the nonparetic leg in the posterior direction during overground walking would enhance the use of the paretic leg in people with chronic stroke. Fifteen individuals after stroke participated in two experimental conditions, i.e., overground walking with a constraint force applied to the nonparetic leg and overground walking only. Each participant was tested in the following procedures that consisted of overground walking with either constraint force or no constraint force, instrumented split-belt treadmill walking, and pressure-sensitive gait mat walking before and after the overground walking. Overground walking practice with constraint force resulted in greater enhancement in lateral weight shift toward the paretic side (P < 0.01), muscle activity of the paretic hip abductors (P = 0.04), and propulsion force of the paretic leg (P = 0.05) compared with the results of the no-constraint condition. Overground walking practice with constraint force tended to induce greater increase in self-selected overground walking speed (P = 0.06) compared with the effect of the no-constraint condition. The increase in propulsion force from the paretic leg was positively correlated with the increase in self-selected walking speed (r = 0.6, P = 0.03). Overground walking with constraint force applied to the nonparetic leg during swing phase of gait may enhance use of the paretic leg, improve weight shifting toward the paretic side and propulsion of the paretic leg, and consequently increase walking speed.NEW & NOTEWORTHY Application of constraint force to the nonparetic leg during overground walking induced improved lateral weight shifts toward the paretic leg and enhanced muscle activity of the paretic leg during walking. In addition, one session of overground walking with constraint force might induce an increase in propulsive force of the paretic leg and an increase in self-selected overground walking speed, which might be partially due to the improvement in motor control of the paretic leg.
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Affiliation(s)
- Seoung Hoon Park
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, Illinois, United States
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, United States
| | - Shijun Yan
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, Illinois, United States
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, United States
| | - Weena Dee
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, Illinois, United States
| | - Renee Keefer
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, Illinois, United States
| | - Elliot J Roth
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, Illinois, United States
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, United States
| | - William Z Rymer
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, Illinois, United States
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, United States
| | - Ming Wu
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, Illinois, United States
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, United States
- Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, Illinois, United States
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Park SH, Dee W, Keefer R, Roth EJ, Rymer WZ, Wu M. Enhanced phasic sensory afferents paired with controlled constraint force improve weight shift toward the paretic side in individuals post-stroke. J Stroke Cerebrovasc Dis 2023; 32:107035. [PMID: 36739709 PMCID: PMC10065899 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107035] [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: 11/24/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 02/05/2023] Open
Abstract
PURPOSE The goal of this study was to determine whether enhanced phasic sensory afferent input paired with the application of controlled constraint force during walking would improve weight shift toward the paretic side and enhance use of the paretic leg. METHODS Fourteen stroke survivors participated in two experimental conditions, sessions that consisted of 1 min treadmill walking without force and stimulation (baseline), 7 min walking with either "constraint force and sensory stimulation (constraint+stim)" or "constraint force only (constraint)" (adaptation), and then 2 min walking without force and stimulation (post-adaptation). Kinematics of the pelvis and legs, and muscle activity of the paretic leg were recorded. RESULTS Participants showed greater increases in hip abductor (p < 0.001) and adductor (p = 0.04) muscle activities, weight shift toward the paretic side (p = 0.002), and step length symmetry (p < 0.01) during the late post-adaptation period in the "constraint+stim" condition, compared with the effect of the "constraint" condition. In addition, changes in overground walking speed from baseline to 10 min post treadmill walking was significantly greater for the "constraint force and stimulation" condition than for the "constraint force only" condition (p = 0.04). CONCLUSION Enhanced targeted sensory afferent input during locomotor training may facilitate recruitment of targeted muscles of the paretic leg and facilitate use-dependent motor learning of locomotor tasks, which might retain longer and partially transfer from treadmill to overground walking, in stroke survivors.
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Affiliation(s)
- Seoung Hoon Park
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, USA; Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Weena Dee
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Renee Keefer
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Elliot J Roth
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, USA; Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - William Z Rymer
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, USA; Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Ming Wu
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, USA; Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA; Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL, USA.
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de Miguel-Fernández J, Lobo-Prat J, Prinsen E, Font-Llagunes JM, Marchal-Crespo L. Control strategies used in lower limb exoskeletons for gait rehabilitation after brain injury: a systematic review and analysis of clinical effectiveness. J Neuroeng Rehabil 2023; 20:23. [PMID: 36805777 PMCID: PMC9938998 DOI: 10.1186/s12984-023-01144-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/07/2023] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND In the past decade, there has been substantial progress in the development of robotic controllers that specify how lower-limb exoskeletons should interact with brain-injured patients. However, it is still an open question which exoskeleton control strategies can more effectively stimulate motor function recovery. In this review, we aim to complement previous literature surveys on the topic of exoskeleton control for gait rehabilitation by: (1) providing an updated structured framework of current control strategies, (2) analyzing the methodology of clinical validations used in the robotic interventions, and (3) reporting the potential relation between control strategies and clinical outcomes. METHODS Four databases were searched using database-specific search terms from January 2000 to September 2020. We identified 1648 articles, of which 159 were included and evaluated in full-text. We included studies that clinically evaluated the effectiveness of the exoskeleton on impaired participants, and which clearly explained or referenced the implemented control strategy. RESULTS (1) We found that assistive control (100% of exoskeletons) that followed rule-based algorithms (72%) based on ground reaction force thresholds (63%) in conjunction with trajectory-tracking control (97%) were the most implemented control strategies. Only 14% of the exoskeletons implemented adaptive control strategies. (2) Regarding the clinical validations used in the robotic interventions, we found high variability on the experimental protocols and outcome metrics selected. (3) With high grade of evidence and a moderate number of participants (N = 19), assistive control strategies that implemented a combination of trajectory-tracking and compliant control showed the highest clinical effectiveness for acute stroke. However, they also required the longest training time. With high grade of evidence and low number of participants (N = 8), assistive control strategies that followed a threshold-based algorithm with EMG as gait detection metric and control signal provided the highest improvements with the lowest training intensities for subacute stroke. Finally, with high grade of evidence and a moderate number of participants (N = 19), assistive control strategies that implemented adaptive oscillator algorithms together with trajectory-tracking control resulted in the highest improvements with reduced training intensities for individuals with chronic stroke. CONCLUSIONS Despite the efforts to develop novel and more effective controllers for exoskeleton-based gait neurorehabilitation, the current level of evidence on the effectiveness of the different control strategies on clinical outcomes is still low. There is a clear lack of standardization in the experimental protocols leading to high levels of heterogeneity. Standardized comparisons among control strategies analyzing the relation between control parameters and biomechanical metrics will fill this gap to better guide future technical developments. It is still an open question whether controllers that provide an on-line adaptation of the control parameters based on key biomechanical descriptors associated to the patients' specific pathology outperform current control strategies.
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Affiliation(s)
- Jesús de Miguel-Fernández
- Biomechanical Engineering Lab, Department of Mechanical Engineering and Research Centre for Biomedical Engineering, Universitat Politècnica de Catalunya, Diagonal 647, 08028 Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Santa Rosa 39-57, 08950 Esplugues de Llobregat, Spain
| | | | - Erik Prinsen
- Roessingh Research and Development, Roessinghsbleekweg 33b, 7522AH Enschede, Netherlands
| | - Josep M. Font-Llagunes
- Biomechanical Engineering Lab, Department of Mechanical Engineering and Research Centre for Biomedical Engineering, Universitat Politècnica de Catalunya, Diagonal 647, 08028 Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Santa Rosa 39-57, 08950 Esplugues de Llobregat, Spain
| | - Laura Marchal-Crespo
- Cognitive Robotics Department, Delft University of Technology, Mekelweg 2, 2628 Delft, Netherlands
- Motor Learning and Neurorehabilitation Lab, ARTORG Center for Biomedical Engineering Research, University of Bern, Freiburgstrasse 3, 3010 Bern, Switzerland
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
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Mizrachi N, Bar-Haim S, Treger I, Melzer I. Unilaterally Applied Resistance to Swing Leg Shows a Different Adaptation Pattern Compared to Split-Belt Treadmill in Patients with Stroke. Brain Sci 2023; 13:brainsci13020264. [PMID: 36831806 PMCID: PMC9954706 DOI: 10.3390/brainsci13020264] [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: 01/04/2023] [Revised: 01/25/2023] [Accepted: 01/28/2023] [Indexed: 02/09/2023] Open
Abstract
Persons with chronic stroke (PwCS) have a decreased ability to ambulate and walk independently. We aimed to investigate the differences between the motor adaptation process for two different perturbation methods: split-belt treadmill walking and unilaterally applied resistance to the swing leg during walking. Twenty-two PwCS undergo split-belt treadmill walking and unilaterally applied resistance to the swing leg during walking, each one week apart. The test included three phases: the baseline period, the early-adaptation period and the late-adaptation period, as well as the early-de-adaptation period and the late-de-adaptation period. The average step length, swing duration, double-limb support duration, and coefficient of variance (CV) of these parameters were measured. During the split-belt treadmill walking, PwCS showed an adaptation of double-limb support duration symmetry (p = 0.004), specifically a trend between baseline versus early-adaptation (p = 0.07) and an after-effect (late-adaptation compare to early-de-adaptation, p = 0.09). In unilaterally applied resistance to the swing leg during walking, PwCS showed lower swing phase duration CV, in the adaptation period (baseline compare to adaptation, p = 0.006), and a trend toward increased variability of gait in the de-adaptation period compare to the adaptation periods (p = 0.099). The rate of adaptation and de-adaptation were alike between the two perturbation methods. Our findings show that the learning process happening in the central nervous system of PwCS may be dependent on the nature of the perturbation (mechanical resistance vs. split-belt) and that PwCS are able to adapt to two types of errors.
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Affiliation(s)
- Nama Mizrachi
- Physical Therapy Department, Faculty of Health Sciences, Recanati School of Community Health Professions, Ben-Gurion University of the Negev, Beer-Sheva 84417, Israel
| | - Simona Bar-Haim
- Physical Therapy Department, Faculty of Health Sciences, Recanati School of Community Health Professions, Ben-Gurion University of the Negev, Beer-Sheva 84417, Israel
- The BGU Adi-Negev Translational Laboratory, Merhavim Regional Council, Ofakim 80300, Israel
| | - Iuly Treger
- Rehabilitation Department, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84417, Israel
| | - Itshak Melzer
- Physical Therapy Department, Faculty of Health Sciences, Recanati School of Community Health Professions, Ben-Gurion University of the Negev, Beer-Sheva 84417, Israel
- Correspondence:
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Hulleck AA, Menoth Mohan D, Abdallah N, El Rich M, Khalaf K. Present and future of gait assessment in clinical practice: Towards the application of novel trends and technologies. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 4:901331. [PMID: 36590154 PMCID: PMC9800936 DOI: 10.3389/fmedt.2022.901331] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 11/17/2022] [Indexed: 12/23/2022] Open
Abstract
Background Despite being available for more than three decades, quantitative gait analysis remains largely associated with research institutions and not well leveraged in clinical settings. This is mostly due to the high cost/cumbersome equipment and complex protocols and data management/analysis associated with traditional gait labs, as well as the diverse training/experience and preference of clinical teams. Observational gait and qualitative scales continue to be predominantly used in clinics despite evidence of less efficacy of quantifying gait. Research objective This study provides a scoping review of the status of clinical gait assessment, including shedding light on common gait pathologies, clinical parameters, indices, and scales. We also highlight novel state-of-the-art gait characterization and analysis approaches and the integration of commercially available wearable tools and technology and AI-driven computational platforms. Methods A comprehensive literature search was conducted within PubMed, Web of Science, Medline, and ScienceDirect for all articles published until December 2021 using a set of keywords, including normal and pathological gait, gait parameters, gait assessment, gait analysis, wearable systems, inertial measurement units, accelerometer, gyroscope, magnetometer, insole sensors, electromyography sensors. Original articles that met the selection criteria were included. Results and significance Clinical gait analysis remains highly observational and is hence subjective and largely influenced by the observer's background and experience. Quantitative Instrumented gait analysis (IGA) has the capability of providing clinicians with accurate and reliable gait data for diagnosis and monitoring but is limited in clinical applicability mainly due to logistics. Rapidly emerging smart wearable technology, multi-modality, and sensor fusion approaches, as well as AI-driven computational platforms are increasingly commanding greater attention in gait assessment. These tools promise a paradigm shift in the quantification of gait in the clinic and beyond. On the other hand, standardization of clinical protocols and ensuring their feasibility to map the complex features of human gait and represent them meaningfully remain critical challenges.
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Affiliation(s)
- Abdul Aziz Hulleck
- Mechanical Engineering Department, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Dhanya Menoth Mohan
- School of Mechanical and Aerospace Engineering, Monash University, Clayton Campus, Melbourne, Australia
| | - Nada Abdallah
- Weill Cornell Medicine, New York City, NY, United States
| | - Marwan El Rich
- Mechanical Engineering Department, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Kinda Khalaf
- Biomedical Engineering Department, Khalifa University, Abu Dhabi, United Arab Emirates,Health Engineering Innovation Center, Khalifa University, Abu Dhabi, United Arab Emirates,Correspondence: Kinda Khalaf
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11
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Johnson AK, Brown SR, Palmieri-Smith RM, Krishnan C. Functional Resistance Training After Anterior Cruciate Ligament Reconstruction Improves Knee Angle and Moment Symmetry During Gait: A Randomized Controlled Clinical Trial. Arthroscopy 2022; 38:3043-3055. [PMID: 35690253 DOI: 10.1016/j.arthro.2022.04.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/07/2022] [Accepted: 04/27/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to determine 1) whether progressive functional resistance training (FRT) during walking would improve knee biomechanical symmetry after anterior cruciate ligament (ACL) reconstruction and 2) whether the mode of delivery of FRT would have a differential effect on symmetry. METHODS Thirty individuals who underwent primary ACL reconstruction at a single institution volunteered for this study. Participants were randomized into one of three groups: 1) BRACE, 2) BAND, or 3) CONTROL. The BRACE group received FRT with a novel robotic knee brace along with real-time kinematic feedback. The BAND group received FRT with a custom resistance band device along with real-time kinematic feedback. The CONTROL group received only real-time kinematic feedback. Participants in all groups received training (2-3/week for 8 weeks) while walking on a treadmill. Knee angle and moment symmetry were calculated immediately prior to beginning the intervention and within 1 week of completing the intervention. Statistical Parametric Mapping was used to assess differences in biomechanical symmetry between groups across time. RESULTS There was a significant interaction in knee moment symmetry from 21 and 24% of the stance phase (P = .046), in which the BAND group had greater improvements following training compared with both BRACE (P = .043) and CONTROL groups (P = .002). There was also a significant time effect in knee angle symmetry from 68 to 79% of the stance phase (P = .028) and from 97 to 100% of the swing phase (P = .050) in which only the BRACE group showed significant improvements after the intervention (stance: P = .020 and swing: P < .001). CONCLUSION The results of this randomized controlled clinical trial indicate that 8 weeks of progressive FRT during treadmill walking in individuals with ACL reconstruction improves knee angle and moment symmetry during gait. The findings suggest that FRT could serve as a potential therapeutic adjuvant to traditional rehabilitation after ACL reconstruction and can help restore knee joint biomechanical symmetry. LEVEL OF EVIDENCE Level II, randomized controlled trial.
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Affiliation(s)
- Alexa K Johnson
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Scott R Brown
- Department of Kinesiology, Aquinas College, Grand Rapids, Michigan, U.S.A
| | - Riann M Palmieri-Smith
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan, U.S.A; Department of Orthopedic Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A.
| | - Chandramouli Krishnan
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan, U.S.A; Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, U.S.A; Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, U.S.A.
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12
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Washabaugh EP, Brown SR, Palmieri-Smith RM, Krishnan C. Functional Resistance Training Differentially Alters Gait Kinetics After Anterior Cruciate Ligament Reconstruction: A Pilot Study. Sports Health 2022; 15:372-381. [PMID: 35766451 PMCID: PMC10170229 DOI: 10.1177/19417381221104042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Quadriceps weakness is common after anterior cruciate ligament (ACL) reconstruction and can alter gait mechanics. Functional resistance training (FRT) is a novel approach to retraining strength after injury, but it is unclear how it alters gait mechanics. Therefore, we tested how 3 different types of FRT devices: a knee brace resisting extension (unidirectional brace), a knee brace resisting extension and flexion (bidirectional brace), and an elastic band pulling backwards on the ankle (elastic band)-acutely alter gait kinetics in this population. HYPOTHESIS The type of FRT device will affect ground-reaction forces (GRFs) during and after the training. Specifically, the uni- and bidirectional braces will increase GRFs when compared with the elastic band. STUDY DESIGN Crossover study. LEVEL OF EVIDENCE Level 2. METHODS A total of 15 individuals with ACL reconstruction received FRT with each device over 3 separate randomized sessions. During training, participants walked on a treadmill while performing a tracking task with visual feedback. Sessions contained 5 training trials (180 seconds each) with rest between. Vertical and anterior-posterior GRFs were assessed on the ACL-reconstructed leg before, during, and after training. Changes in GRFs were compared across devices using 1-dimensional statistical parametric mapping. RESULTS Resistance applied via bidirectional brace acutely increased gait kinetics during terminal stance/pre-swing (ie, push-off), while resistance applied via elastic band acutely increased gait kinetics during initial contact/loading (ie, braking). Both braces behaved similarly, but the unidirectional brace was less effective for increasing push-off GRFs. CONCLUSION FRT after ACL reconstruction can acutely alter gait kinetics during training. Devices can be applied to selectively alter gait kinetics. However, the long-term effects of FRT after ACL reconstruction with these devices are still unknown. CLINICAL RELEVANCE FRT may be applied to alter gait kinetics of the involved limb after ACL reconstruction, depending on the device used.
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Affiliation(s)
- Edward P Washabaugh
- Neuromuscular and Rehabilitation Robotics Laboratory (NeuRRo Lab), Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.,Department of Biomedical Engineering, Wayne State University, Detroit, Michigan
| | - Scott R Brown
- Neuromuscular and Rehabilitation Robotics Laboratory (NeuRRo Lab), Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.,Department of Kinesiology, Aquinas College, Grand Rapids, Michigan
| | - Riann M Palmieri-Smith
- Neuromuscular and Rehabilitation Robotics Laboratory (NeuRRo Lab), Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.,School of Kinesiology, University of Michigan, Ann Arbor, Michigan.,Department of Orthopaedic Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Chandramouli Krishnan
- Neuromuscular and Rehabilitation Robotics Laboratory (NeuRRo Lab), Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.,School of Kinesiology, University of Michigan, Ann Arbor, Michigan.,Michigan Robotics Institute, University of Michigan, Ann Arbor, Michigan
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13
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Park SH, Yan S, Dee W, Reed R, Roth EJ, Rymer WZ, Wu M. Repeated adaptation and de-adaptation to the pelvis resistance force facilitate retention of motor learning in stroke survivors. J Neurophysiol 2022; 127:1642-1654. [PMID: 35583975 DOI: 10.1152/jn.00046.2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Locomotor adaptation to novel walking patterns induced by external perturbation has been tested to enhance motor learning for improving gait parameters in individuals post-stroke. However, little is known regarding whether repeated adaptation and de-adaptation to the externally perturbed walking pattern may facilitate or degrade the retention of locomotor learning. In this study, we examined whether the intermittent adaptation to novel walking patterns elicited by external perturbation induces greater retention of the adapted locomotion in stroke survivors, compared with effects of the continuous adaptation. Fifteen individuals post-stroke participated in two experimental conditions consisting of 1) treadmill walking with intermittent (i.e., interspersed 2 intervals of no perturbation) or continuous (no interval) adaptation to externally perturbed walking patterns and 2) overground walking before, immediately, and 10 min after treadmill walking. During the treadmill walking, we applied a laterally pulling force to the pelvis toward the non-paretic side during the stance phase of the paretic leg to disturb weight shifts toward the paretic side. Participants showed improved weight shift toward the paretic side and enhanced muscle activation of hip abductor/adductors immediately after the removal of the pelvis perturbation for both intermittent and continuous conditions (P<0.05), and showed longer retention of the improved weight shift and enhanced muscle activation for the intermittent condition, which transferred from treadmill to overground walking (P<0.05). In conclusion, repeated motor adaptation and de-adaptation to the pelvis resistance force during walking may promote the retention of error-based motor learning for improving weight shift toward the paretic side in individuals post-stroke.
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Affiliation(s)
- Seoung Hoon Park
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, United States.,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, United States
| | - Shijun Yan
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, United States.,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, United States
| | - Weena Dee
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, United States
| | - Renee Reed
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, United States
| | - Elliot J Roth
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, United States.,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, United States
| | - William Zev Rymer
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, United States.,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, United States
| | - Ming Wu
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, United States.,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, United States.,Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL, United States
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14
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Washabaugh EP, Krishnan C. Functional resistance training methods for targeting patient-specific gait deficits: A review of devices and their effects on muscle activation, neural control, and gait mechanics. Clin Biomech (Bristol, Avon) 2022; 94:105629. [PMID: 35344781 DOI: 10.1016/j.clinbiomech.2022.105629] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 03/11/2022] [Accepted: 03/15/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Injuries to the neuromusculoskeletal system often result in weakness and gait impairments. Functional resistance training during walking-where patients walk while a device increases loading on the leg-is an emerging approach to combat these symptoms. However, there are many methods that can be used to resist the patient, which may alter the biomechanics of the training. Thus, all methods may not address patient-specific deficits. METHODS We performed a comprehensive electronic database search to identify articles that acutely (i.e., after a single training session) examined how functional resistance training during walking alters muscle activation, gait biomechanics, and neural plasticity. Only articles that examined these effects during training or following the removal of resistance (i.e., aftereffects) were included. FINDINGS We found 41 studies that matched these criteria. Most studies (24) used passive devices (e.g., weighted cuffs or resistance bands) while the remainder used robotic devices. Devices varied on if they were wearable (14) or externally tethered, and the type of resistance they applied (i.e., inertial [14], elastic [8], viscous [7], or customized [12]). Notably, these methods provided device-specific changes in muscle activation, biomechanics, and spatiotemporal and kinematic aftereffects. Some evidence suggests this training results in task-specific increases in neural excitability. INTERPRETATION These findings suggest that careful selection of resistive strategies could help target patient-specific strength deficits and gait impairments. Also, many approaches are low-cost and feasible for clinical or in-home use. The results provide new insights for clinicians on selecting an appropriate functional resistance training strategy to target patient-specific needs.
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Affiliation(s)
- Edward P Washabaugh
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA; Michigan Medicine Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Chandramouli Krishnan
- Michigan Medicine Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA; Michigan Robotics, University of Michigan, Ann Arbor, MI, USA.
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15
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A Systematic Review of Non-Pharmacological Interventions to Improve Gait Asymmetries in Neurological Populations. Symmetry (Basel) 2022. [DOI: 10.3390/sym14020281] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Gait asymmetries are commonly observed in neurological populations and linked to decreased gait velocity, balance decrements, increased fall risk, and heightened metabolic cost. Interventions designed to improve gait asymmetries have varying methods and results. The purpose of this systematic review was to investigate non-pharmacological interventions to improve gait asymmetries in neurological populations. Keyword searches were conducted using PubMed, CINAHL, and Academic Search Complete. The search yielded 14 studies for inclusion. Gait was assessed using 3D motion capture systems (n = 7), pressure-sensitive mats (e.g., GAITRite; n = 5), and positional sensors (n = 2). The gait variables most commonly analyzed for asymmetry were step length (n = 11), stance time (n = 9), and swing time (n = 5). Interventions to improve gait asymmetries predominantly used gait training techniques via a split-belt treadmill (n = 6), followed by insoles/orthoses (n = 3). The literature suggests that a wide range of methods can be used to improve spatiotemporal asymmetries. However, future research should further examine kinematic and kinetic gait asymmetries. Additionally, researchers should explore the necessary frequency and duration of various intervention strategies to achieve the greatest improvement in gait asymmetries, and to determine the best symmetry equation for quantifying gait asymmetries.
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16
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Küçüktabak EB, Kim SJ, Wen Y, Lynch K, Pons JL. Human-machine-human interaction in motor control and rehabilitation: a review. J Neuroeng Rehabil 2021; 18:183. [PMID: 34961530 PMCID: PMC8714449 DOI: 10.1186/s12984-021-00974-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 12/07/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Human-human (HH) interaction mediated by machines (e.g., robots or passive sensorized devices), which we call human-machine-human (HMH) interaction, has been studied with increasing interest in the last decade. The use of machines allows the implementation of different forms of audiovisual and/or physical interaction in dyadic tasks. HMH interaction between two partners can improve the dyad's ability to accomplish a joint motor task (task performance) beyond either partner's ability to perform the task solo. It can also be used to more efficiently train an individual to improve their solo task performance (individual motor learning). We review recent research on the impact of HMH interaction on task performance and individual motor learning in the context of motor control and rehabilitation, and we propose future research directions in this area. METHODS A systematic search was performed on the Scopus, IEEE Xplore, and PubMed databases. The search query was designed to find studies that involve HMH interaction in motor control and rehabilitation settings. Studies that do not investigate the effect of changing the interaction conditions were filtered out. Thirty-one studies met our inclusion criteria and were used in the qualitative synthesis. RESULTS Studies are analyzed based on their results related to the effects of interaction type (e.g., audiovisual communication and/or physical interaction), interaction mode (collaborative, cooperative, co-active, and competitive), and partner characteristics. Visuo-physical interaction generally results in better dyadic task performance than visual interaction alone. In cases where the physical interaction between humans is described by a spring, there are conflicting results as to the effect of the stiffness of the spring. In terms of partner characteristics, having a more skilled partner improves dyadic task performance more than having a less skilled partner. However, conflicting results were observed in terms of individual motor learning. CONCLUSIONS Although it is difficult to draw clear conclusions as to which interaction type, mode, or partner characteristic may lead to optimal task performance or individual motor learning, these results show the possibility for improved outcomes through HMH interaction. Future work that focuses on selecting the optimal personalized interaction conditions and exploring their impact on rehabilitation settings may facilitate the transition of HMH training protocols to clinical implementations.
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Affiliation(s)
- Emek Barış Küçüktabak
- Department of Mechanical Engineering, McCormick School of Engineering, Northwestern University, 60208 Evanston, IL USA
- Legs + Walking Lab, Shirley Ryan Ability Lab, 60611 Chicago, IL USA
| | - Sangjoon J. Kim
- Legs + Walking Lab, Shirley Ryan Ability Lab, 60611 Chicago, IL USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, 60611 Chicago, IL USA
| | - Yue Wen
- Legs + Walking Lab, Shirley Ryan Ability Lab, 60611 Chicago, IL USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, 60611 Chicago, IL USA
| | - Kevin Lynch
- Department of Mechanical Engineering, McCormick School of Engineering, Northwestern University, 60208 Evanston, IL USA
| | - Jose L. Pons
- Department of Mechanical Engineering, McCormick School of Engineering, Northwestern University, 60208 Evanston, IL USA
- Legs + Walking Lab, Shirley Ryan Ability Lab, 60611 Chicago, IL USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, 60611 Chicago, IL USA
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, 60208 Evanston, IL USA
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17
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A Brake-Based Overground Gait Rehabilitation Device for Altering Propulsion Impulse Symmetry. SENSORS 2021; 21:s21196617. [PMID: 34640938 PMCID: PMC8512803 DOI: 10.3390/s21196617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/25/2021] [Accepted: 09/25/2021] [Indexed: 11/17/2022]
Abstract
This paper introduces a new device for gait rehabilitation, the gait propulsion trainer (GPT). It consists of two main components (a stationary device and a wearable system) that work together to apply periodic stance-phase resistance as the user walks overground. The stationary device provides the resistance forces via a cable that tethers the user’s pelvis to a magnetic-particle brake. The wearable system detects gait events via foot switches to control the timing of the resistance forces. A hardware verification test confirmed that the GPT functions as intended. We conducted a pilot study in which one healthy adult and one stroke survivor walked with the GPT with increasing resistance levels. As hypothesized, the periodic stance-phase resistance caused the healthy participant to walk asymmetrically, with greatly reduced propulsion impulse symmetry; as GPT resistance increased, the walking speed also decreased, and the propulsion impulse appeared to increase for both legs. In contrast, the stroke participant responded to GPT resistance by walking faster and more symmetrically in terms of both propulsion impulse and step length. Thus, this paper shows promising results of short-term training with the GPT, and more studies will follow to explore its long-term effects on hemiparetic gait.
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18
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Park SH, Hsu CJ, Dee W, Roth EJ, Rymer WZ, Wu M. Enhanced error facilitates motor learning in weight shift and increases use of the paretic leg during walking at chronic stage after stroke. Exp Brain Res 2021; 239:3327-3341. [PMID: 34477919 DOI: 10.1007/s00221-021-06202-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 08/18/2021] [Indexed: 12/22/2022]
Abstract
The purpose of this study was to determine whether the application of lateral pelvis pulling force toward the non-paretic side during the stance phase of the paretic leg would enhance forced use of the paretic leg and increase weight shift toward the paretic side in stroke survivors. Eleven chronic stroke survivors participated in two experimental sessions, which consisted of (1) treadmill walking with the application of "pelvis resistance" or "pelvis assistance" and (2) overground walking. During the treadmill walking, the laterally pulling force was applied during the stance phase of the paretic leg toward the non-paretic side for the "pelvis resistance" condition or toward the paretic side for the "pelvis assistance" condition during the stance phase of the paretic leg. After force release, the "pelvis resistance" condition exhibited greater enhancement in muscle activation of hip ABD, ADD, and SOL and greater improvement in lateral weight shift toward the paretic side, compared with the effect of the "pelvis assistance" condition (P < 0.03). This improved lateral weight shift was associated with the enhanced muscle activation of hip ABD and ADD (R2 = 0.67, P = 0.01). The pelvis resistance condition also improved overground walking speed and stance phase symmetry when measured 10 min after the treadmill walking (P = 0.004). In conclusion, applying pelvis resistance forces to increase error signals may facilitate motor learning of weight shift toward the paretic side and enhance use of the paretic leg in chronic stroke survivors. Results from this study may be utilized to develop an intervention approach to improve walking in stroke survivors.
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Affiliation(s)
- Seoung Hoon Park
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 E. Erie Street, 23rd floor, Chicago, IL, 60611, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Chao-Jung Hsu
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 E. Erie Street, 23rd floor, Chicago, IL, 60611, USA
| | - Weena Dee
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 E. Erie Street, 23rd floor, Chicago, IL, 60611, USA
| | - Elliot J Roth
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 E. Erie Street, 23rd floor, Chicago, IL, 60611, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - William Z Rymer
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 E. Erie Street, 23rd floor, Chicago, IL, 60611, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Ming Wu
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 E. Erie Street, 23rd floor, Chicago, IL, 60611, USA.
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA.
- Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL, USA.
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19
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Jung J, Choi W, Lee S. Immediate augmented real-time forefoot weight bearing using visual feedback improves gait symmetry in chronic stroke. Technol Health Care 2021; 28:733-741. [PMID: 32444583 DOI: 10.3233/thc-192016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Symmetry of gait is an important component of rehabilitation in stroke patients. Insufficient weight-bearing causes gait asymmetry. OBJECTIVE This study aimed to identify the immediate effects of sufficient weight-bearing on the forefoot during the stance phase using visual feedback. METHODS Twenty-seven individuals with stroke enrolled in this study. All patients were evaluated for gait parameters with and without visual feedback. Visual feedback was provided through a smart application and a beam projector screen that showed a weight shift as a change in color. Spatiotemporal gait parameters were evaluated, resulting in values for a calculated symmetry index, in addition to heel % and toe % temporal values. RESULTS Velocity and cadence were significantly decreased when visual feedback was provided (p< 0.05). Spatiotemporal parameters, except for bilateral step length, swing time of affected side, and single-limb support of less affected side, showed significant improvement (p< 0.05). The gait pattern of subjects was more symmetrical with visual feedback compared to non-visual feedback (p< 0.05). The toe-on time significantly improved on the affected side with visual feedback (p< 0.05). CONCLUSION This study suggests that visual feedback aids in the improvement of gait symmetry, forefoot weight-bearing on the affected side, and spatiotemporal parameters.
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Affiliation(s)
- Jihye Jung
- Department of Physical Therapy, The Graduate School of Sahmyook University, Seoul, Korea
| | - Wonjae Choi
- Institute of the SMART Rehabilitation, Sahmyook University, Seoul, Korea
| | - Seungwon Lee
- Department of Physical Therapy, Sahmyook University, Seoul, Korea
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20
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Aguirre-Ollinger G, Yu H. Lower-Limb Exoskeleton With Variable-Structure Series Elastic Actuators: Phase-Synchronized Force Control for Gait Asymmetry Correction. IEEE T ROBOT 2021. [DOI: 10.1109/tro.2020.3034017] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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21
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Reimold NK, Knapp HA, Chesnutt AN, Agne A, Dean JC. Effects of Targeted Assistance and Perturbations on the Relationship Between Pelvis Motion and Step Width in People With Chronic Stroke. IEEE Trans Neural Syst Rehabil Eng 2021; 29:134-143. [PMID: 33196440 PMCID: PMC8844911 DOI: 10.1109/tnsre.2020.3038173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
During walking in neurologically-intact controls, larger mediolateral pelvis displacements or velocities away from the stance foot are accompanied by wider steps. This relationship contributes to gait stabilization, as modulating step width based on pelvis motion (hereby termed a “mechanically-appropriate” step width) reduces the risk of lateral losses of balance. The relationship between pelvis displacement and step width is often weakened among people with chronic stroke (PwCS) for steps with the paretic leg. Our objective was to investigate the effects of a single exposure to a novel force-field on the modulation of paretic step width. This modulation was quantified as the partial correlation between paretic step width and pelvis displacement at the step’s start (step start paretic ρdisp). Following 3-minutes of normal walking, participants were exposed to 5-minutes of either force-field assistance (n = 10; pushing the swing leg toward mechanically-appropriate step widths) or perturbations (n = 10: pushing the swing leg away from mechanically-appropriatestep widths). This period of assistance or perturbations was followed by a 1-minute catch period to identify after-effects, a sign of altered sensorimotor control. The effects of assistance were equivocal, without a significant direct effect or after-effect on step start paretic ρdisp. In contrast, perturbations directly reduced step start paretic ρdisp (p = 0.004), but were followed by a positive after-effect (p = 0.02). These results suggest that PwCS can strengthen the link between pelvis motion and paretic step width if exposed to a novel mechanical environment. Future work is needed to determine whether this effect is extended with repeated perturbation exposure.
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22
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Bertrand-Charette M, Nielsen JB, Bouyer LJ. A simple, clinically applicable motor learning protocol to increase push-off during gait: A proof-of-concept. PLoS One 2021; 16:e0245523. [PMID: 33465113 PMCID: PMC7815130 DOI: 10.1371/journal.pone.0245523] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 12/30/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Task-specific training is often used in functional rehabilitation for its potential to improve performance at locomotor tasks in neurological populations. As push-off impairment are often seen with these patients, this functional approach shows potential to retrain gait overground to normalize the gait pattern and retrain the ability to improve gait speed. The main objective of this project was to validate, in healthy participants, a simple, low-cost push-off retraining protocol based on task-specific training that could be implemented during overground walking in the clinic. METHODS 30 healthy participants walked in an 80-meter long corridor before, during, and after the application of an elastic resistance to the right ankle. Elastic tubing attached to the front of a modified ankle-foot orthosis delivered the resistance during push-off. Relative ankle joint angular displacements were recorded bilaterally and continuously during each walking condition. RESULTS On the resisted side, participants presented aftereffects (increased peak plantarflexion angle from 13.4±4.2° to 20.0±6.4°, p<0.0001 and increased peak plantarflexion angular velocity from 145.8±22.7°/s to 174.4±37.4°/s, p<0.0001). On the non-resisted side, aftereffects were much smaller than on the resisted side suggesting that the motor learning process was mainly specific to the trained leg. CONCLUSION This study shows the feasibility of modifying push-off kinematics using an elastic resistance applied at the ankle while walking overground. This approach represents an interesting venue for future gait rehabilitation.
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Affiliation(s)
- Michaël Bertrand-Charette
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec City, Quebec, Canada
| | - Jens Bo Nielsen
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark
| | - Laurent J. Bouyer
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec City, Quebec, Canada
- Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
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23
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French MA, Morton SM, Reisman DS. Use of explicit processes during a visually guided locomotor learning task predicts 24-h retention after stroke. J Neurophysiol 2021; 125:211-222. [PMID: 33174517 PMCID: PMC8087382 DOI: 10.1152/jn.00340.2020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 01/19/2023] Open
Abstract
Implicit and explicit processes can occur within a single locomotor learning task. The combination of these learning processes may impact how individuals acquire/retain the task. Because these learning processes rely on distinct neural pathways, neurological conditions may selectively impact the processes that occur, thus, impacting learning and retention. Thus, our purpose was to examine the contribution of implicit and explicit processes during a visually guided walking task and characterize the relationship between explicit processes and performance/retention in stroke survivors and age-matched healthy adults. Twenty chronic stroke survivors and twenty healthy adults participated in a 2-day treadmill study. Day 1 included baseline, acquisition1, catch, acquisition2, and immediate retention phases, and day 2 included 24-h retention. During acquisition phases, subjects learned to take a longer step with one leg through distorted visual feedback. During catch and retention phases, visual feedback was removed and subjects were instructed to walk normally (catch) or how they walked during the acquisition phases (retention). Change in step length from baseline to catch represented implicit processes. Change in step length from catch to the end of acquisition2 represented explicit processes. A mixed ANOVA found no difference in the type of learning between groups (P = 0.74). There was a significant relationship between explicit processes and 24-h retention in stroke survivors (r = 0.47, P = 0.04) but not in healthy adults (r = 0.34, P = 0.15). These results suggest that stroke may not affect the underlying learning mechanisms used during locomotor learning, but that these mechanisms impact how well stroke survivors retain the new walking pattern.NEW & NOTEWORTHY This study found that stroke survivors used implicit and explicit processes similar to age-matched healthy adults during a visually guided locomotion learning task. The amount of explicit processes was related to how well stroke survivors retained the new walking pattern but not to how well they performed during the task. This work illustrates the importance of understanding the underlying learning mechanisms to maximize retention of a newly learned motor behavior.
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Affiliation(s)
- Margaret A French
- Department of Physical Therapy, University of Delaware, Newark, Delaware
- Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware
| | - Susanne M Morton
- Department of Physical Therapy, University of Delaware, Newark, Delaware
- Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware
| | - Darcy S Reisman
- Department of Physical Therapy, University of Delaware, Newark, Delaware
- Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware
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Park SH, Lin JT, Dee W, Hsu CJ, Roth EJ, Rymer WZ, Wu M. Targeted Pelvic Constraint Force Induces Enhanced Use of the Paretic Leg During Walking in Persons Post-Stroke. IEEE Trans Neural Syst Rehabil Eng 2020; 28:2184-2193. [PMID: 32816677 DOI: 10.1109/tnsre.2020.3018397] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The purpose of this study was to determine whether activation of muscles in the paretic leg, particularly contributing to propulsion, and gait symmetry can be improved by applying a targeted resistance force to the pelvis in the backward direction during stance phase while walking in individuals post-stroke. Thirteen individuals post-stroke participated in two experimental sessions, which consisted of treadmill walking, with either targeted or constant resistances, together with overground walking. For the targeted condition, a resistance force was applied to the pelvis during the stance phase of the paretic leg. For the constant condition, the resistance force was applied throughout the whole gait cycle. Participants showed greater increase in medial hamstring muscle activity in the paretic leg and improved step length symmetry after the removal of targeted resistance force, compared to effects of a constant resistance force (P < 0.03). In addition, treadmill walking with the targeted resistance induced more symmetrical step length during overground walking 10 min after the treadmill walking, compared to the result of the constant resistance force (P = 0.01). Applying a targeted resistance force to the pelvis during the stance phase of the paretic leg may induce an enhanced use of the paretic leg and an improvement in gait symmetry in individuals post-stroke. These results provide evidence showing that applying a targeted resistance to the pelvis may induce a forced use of the paretic leg during walking.
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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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Wood JM, Kim HE, French MA, Reisman DS, Morton SM. Use-dependent plasticity explains aftereffects in visually guided locomotor learning of a novel step length asymmetry. J Neurophysiol 2020; 124:32-39. [PMID: 32432516 DOI: 10.1152/jn.00083.2020] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Studies of upper extremity reaching show that use-dependent plasticity, or learning from repetition, plays an important role in shaping motor behaviors. Yet the impact of repetition on locomotor learning is unclear, despite the fact that gait is developed and practiced over millions of repetitions. To test whether repetition alone can induce storage of a novel walking pattern, we instructed two groups of young healthy subjects to learn an asymmetric walking pattern through two distinct learning paradigms. The first group learned a new pattern through an established visual distortion paradigm, which provided both sensory prediction error and repetition of movement patterns to induce walking aftereffects, and the second received veridical feedback with a target change, which provided only repetition (use-dependent plasticity) to induce aftereffects. When feedback was removed, both groups demonstrated aftereffects in the primary outcome, step asymmetry index. Surprisingly, despite the different task demands, both groups produced similar aftereffect magnitudes, which also had similar rates of decay, suggesting that the addition of sensory prediction errors did not improve storage of learning beyond that induced by the use-dependent process alone. To further characterize the use-dependent process, we conducted a second experiment to quantify aftereffect size in a third group who practiced double the asymmetry magnitude. This new group showed a proportionately greater magnitude of the use-dependent aftereffect. Together, these findings show that the primary driver of storage of a new step length asymmetry during visually guided locomotor learning is repetition, not sensory prediction error, and this effect scales with the learning magnitude.NEW & NOTEWORTHY Use-dependent plasticity, or learning from repetition, is an important process for upper extremity reaching tasks, but its contribution to walking is not well established. Here, we demonstrate the existence of a dose-dependent, use-dependent process during visually guided treadmill walking. We also show that sensory prediction errors, previously thought to drive aftereffects in similar locomotor learning paradigms, do not appear to play a significant role in visually driven learning of a novel step asymmetry during treadmill walking.
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Affiliation(s)
- Jonathan M Wood
- Physical Therapy Department, University of Delaware, Newark, Delaware.,Graduate Program in Biomechanics and Movement Science, University of Delaware, Newark, Delaware
| | - Hyosub E Kim
- Physical Therapy Department, University of Delaware, Newark, Delaware.,Graduate Program in Biomechanics and Movement Science, University of Delaware, Newark, Delaware
| | - Margaret A French
- Physical Therapy Department, University of Delaware, Newark, Delaware.,Graduate Program in Biomechanics and Movement Science, University of Delaware, Newark, Delaware
| | - Darcy S Reisman
- Physical Therapy Department, University of Delaware, Newark, Delaware.,Graduate Program in Biomechanics and Movement Science, University of Delaware, Newark, Delaware
| | - Susanne M Morton
- Physical Therapy Department, University of Delaware, Newark, Delaware.,Graduate Program in Biomechanics and Movement Science, University of Delaware, Newark, Delaware
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Mizrachi N, Treger I, Melzer I. Effects of mechanical perturbation gait training on gait and balance function in patients with stroke: A pre-post research study. J Clin Neurosci 2020; 78:301-306. [PMID: 32389546 DOI: 10.1016/j.jocn.2020.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/04/2020] [Indexed: 11/16/2022]
Abstract
Patients with stroke (PwS) demonstrate impaired gait and balance, and asymmetric gait, placing them at high risk of falls. We aimed to investigate the effects of a single training session that included mechanical external perturbation which resists forward movement of the paretic leg during its swing phase of walking on gait and balance in PwS. In a pre-post pilot study, gait asymmetry and balance function were assessed in 22 first-event chronic PwS (i.e., unilateral hemiparesis). PwS underwent tests during baseline and one week later, after participating in a single training session that resisted forward stepping during the swing phase of walking with a device secured around the patient's waist and connected diagonally to the patient's foot by a tension cord. Ground reaction forces and center of pressure were sampled during treadmill gait to assess step length asymmetry. Performance-oriented mobility assessment (POMA), a two-minute walk test (2MWT), and the voluntary step execution test were also measured. We found no significant improvement in step length asymmetry. However, POMA scores, as well as voluntary step execution tests improved with a moderate effect size. It seems that applying diagonal resistance force to the swinging leg resulted in insufficient horizontal force. However, the improvement in the preparation phase, i.e., better weight-bearing abilities during the voluntary stepping, may be due to the compression force applied to the lower limb joints thus providing proprioceptive training. This suggests that proprioceptive training may improve gait performance in stroke patients in a very short training period.
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Affiliation(s)
- Nama Mizrachi
- Physical Therapy Department, Recanati School of Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Iuli Treger
- Rehabilitation Department, Soroka University Medical Center, and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Itshak Melzer
- Physical Therapy Department, Recanati School of Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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The effectiveness of a novel cable-driven gait trainer (Robowalk) combined with conventional physiotherapy compared to conventional physiotherapy alone following stroke: a randomised controlled trial. Int J Rehabil Res 2020; 42:377-384. [PMID: 31567605 DOI: 10.1097/mrr.0000000000000375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There is increasing interest in gait training devices to improve walking ability in people following stroke. This randomised controlled trial aimed to compare the effectiveness of the Robowalk, a novel cable-driven gait trainer combined with conventional physiotherapy to conventional physiotherapy alone in improving walking speed, endurance, balance, functional outcomes, and quality of life in people following stroke. Rehabilitation inpatients within 3 months following stroke (n = 40) were randomised to standard care with conventional physiotherapy ('control,' n = 20) and cable-driven gait trainer combined with conventional physiotherapy ('intervention,' n = 20). All participants received 1 hour of physiotherapy a day, 5 days a week. The control group received conventional physiotherapy only; the intervention group received a combination of 30 minutes of conventional physiotherapy and 30 minutes of cable-driven gait trainer consecutively. Outcome measures were 10-metre walk test (primary outcome), 6-minute walk test, timed up and go, step test, Functional Independence Measure, and EuroQol five-dimension scale. Evaluation timepoints were on admission (T0), discharge (T1), and 4 weeks post discharge (T2). There were no differences between groups at T0, T1, and T2 in all outcome measures although there was a trend towards a larger and more sustained improvement in 10-metre walk test in favour of the intervention group and in Functional Independence Measure motor and self-care in favour of the control group, both at T2. The combination of cable-driven gait trainer with conventional physiotherapy appears as effective as conventional physiotherapy alone in improving gait outcomes in people following a recent stroke. Further studies are required to confirm these findings and determine optimal dosing regimens and long-term outcomes.
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Ju S. Correlation between lower limb muscle asymmetry during the sit-to-stand task and spatiotemporal gait asymmetry in subjects with stroke. J Exerc Rehabil 2020; 16:64-68. [PMID: 32161736 PMCID: PMC7056475 DOI: 10.12965/jer.2040030.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 02/05/2020] [Indexed: 11/22/2022] Open
Abstract
The purpose of this study was to investigate the relationship between the both lower limb muscle asymmetry during sit-to-stand (STS) and spatiotemporal gait asymmetry in subjects with stroke. Twenty-nine patients were included in this study, lower limb muscle (rectus femoris, tibialis anterior, gastrocnemius) asymmetry during STS, five times sit-to-stand (FTSTS) and spatiotemporal (speed, step length, step time, swing time, stance time, single support time) gait asymmetry were measured. According to the results of the measurement, significant positive correlations between gastrocnemius and rectus femoris asymmetry during STS and step length asymmetry. Furthermore, significant positive correlations between rectus femoris asymmetry during STS and step time asymmetry. In addition, significant negative correlations between the FTSTS and gait speed. This study's results suggested that necessary to apply exercise that the gastrocnemius and rectus femoris symmetry during STS for improving step length and step time symmetry of gait, and necessary to apply exercise that increase STS speed for gait speed.
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Affiliation(s)
- Sungkwang Ju
- Department of Physical Therapy, Kaya University, Gimhae, Korea
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Delayed Output Feedback Control for Gait Assistance and Resistance Using a Robotic Exoskeleton. IEEE Robot Autom Lett 2019. [DOI: 10.1109/lra.2019.2927937] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Aguirre-Ollinger G, Narayan A, Yu H. Phase-Synchronized Assistive Torque Control for the Correction of Kinematic Anomalies in the Gait Cycle. IEEE Trans Neural Syst Rehabil Eng 2019; 27:2305-2314. [PMID: 31567098 DOI: 10.1109/tnsre.2019.2944665] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Gait anomalies give rise to several clinical problems in stroke survivors, which restrict their functional mobility and have a negative impact on their quality of life. Robotics-aided gait training post-stroke has proven capable of improving patients' functional walking, but so far it has not performed significantly better than conventional therapy. We hypothesize that an exoskeleton-based training program, aimed at correcting deficits in the leg joints' movement, could produce greater improvements in gait function than conventional therapy. As a first step towards testing this hypothesis, we designed an exoskeleton control to correct a typical kinematic deficit post-stroke, namely, reduced knee flexion on the paretic side during swing. The proposed control attempts to minimize this deficit by delivering assistive torque synchronized with the continuous phase of the patient's gait. Nine healthy male participants walked in a unilateral cable-driven exoskeleton while subject to an artificial knee flexion impairment produced by a custom-made knee brace. The experiments employed a treadmill featuring a variable-velocity control to allow self-selected gait speed. The artificial impairment by itself caused a significant reduction in peak flexion angle (p = 0.000129). Exoskeleton assistance compensated most of the knee flexion deficit, yielding no significant difference with unrestricted flexion (p = 0.3393). No significant changes in self-selected gait speed or stride frequency were detected. The proposed control can be expanded to correct motion deficits in other joints at different stages of the gait cycle.
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Marchal-Crespo L, Tsangaridis P, Obwegeser D, Maggioni S, Riener R. Haptic Error Modulation Outperforms Visual Error Amplification When Learning a Modified Gait Pattern. Front Neurosci 2019; 13:61. [PMID: 30837824 PMCID: PMC6390202 DOI: 10.3389/fnins.2019.00061] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 01/21/2019] [Indexed: 11/22/2022] Open
Abstract
Robotic algorithms that augment movement errors have been proposed as promising training strategies to enhance motor learning and neurorehabilitation. However, most research effort has focused on rehabilitation of upper limbs, probably because large movement errors are especially dangerous during gait training, as they might result in stumbling and falling. Furthermore, systematic large movement errors might limit the participants' motivation during training. In this study, we investigated the effect of training with novel error modulating strategies, which guarantee a safe training environment, on motivation and learning of a modified asymmetric gait pattern. Thirty healthy young participants walked in the exoskeletal robotic system Lokomat while performing a foot target-tracking task, which required an increased hip and knee flexion in the dominant leg. Learning the asymmetric gait pattern with three different strategies was evaluated: (i) No disturbance: no robot disturbance/guidance was applied, (ii) haptic error amplification: unsafe and discouraging large errors were limited with haptic guidance, while haptic error amplification enhanced awareness of small errors relevant for learning, and (iii) visual error amplification: visually observed errors were amplified in a virtual reality environment. We also evaluated whether increasing the movement variability during training by adding randomly varying haptic disturbances on top of the other training strategies further enhances learning. We analyzed participants' motor performance and self-reported intrinsic motivation before, during and after training. We found that training with the novel haptic error amplification strategy did not hamper motor adaptation and enhanced transfer of the practiced asymmetric gait pattern to free walking. Training with visual error amplification, on the other hand, increased errors during training and hampered motor learning. Participants who trained with visual error amplification also reported a reduced perceived competence. Adding haptic disturbance increased the movement variability during training, but did not have a significant effect on motor adaptation, probably because training with haptic disturbance on top of visual and haptic error amplification decreased the participants' feelings of competence. The proposed novel haptic error modulating controller that amplifies small task-relevant errors while limiting large errors outperformed visual error augmentation and might provide a promising framework to improve robotic gait training outcomes in neurological patients.
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Affiliation(s)
- Laura Marchal-Crespo
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
- Sensory-Motor Systems (SMS) Lab, Institute of Robotics and Intelligent Systems (IRIS), Department of Health Sciences and Technology (D-HEST), ETH Zürich, Zurich, Switzerland
| | - Panagiotis Tsangaridis
- Sensory-Motor Systems (SMS) Lab, Institute of Robotics and Intelligent Systems (IRIS), Department of Health Sciences and Technology (D-HEST), ETH Zürich, Zurich, Switzerland
| | - David Obwegeser
- Sensory-Motor Systems (SMS) Lab, Institute of Robotics and Intelligent Systems (IRIS), Department of Health Sciences and Technology (D-HEST), ETH Zürich, Zurich, Switzerland
| | - Serena Maggioni
- Sensory-Motor Systems (SMS) Lab, Institute of Robotics and Intelligent Systems (IRIS), Department of Health Sciences and Technology (D-HEST), ETH Zürich, Zurich, Switzerland
- Reharobotics Group, Spinal Cord Injury Center, Balgrist University Hospital, Medical Faculty, University of Zurich, Zurich, Switzerland
- Hocoma AG, Volketswil, Switzerland
| | - Robert Riener
- Sensory-Motor Systems (SMS) Lab, Institute of Robotics and Intelligent Systems (IRIS), Department of Health Sciences and Technology (D-HEST), ETH Zürich, Zurich, Switzerland
- Reharobotics Group, Spinal Cord Injury Center, Balgrist University Hospital, Medical Faculty, University of Zurich, Zurich, Switzerland
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Gradual increase of perturbation load induces a longer retention of locomotor adaptation in children with cerebral palsy. Hum Mov Sci 2018; 63:20-33. [PMID: 30481722 DOI: 10.1016/j.humov.2018.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 11/15/2018] [Accepted: 11/20/2018] [Indexed: 11/22/2022]
Abstract
The goal of this study is to determine whether the size and the variability of error have an impact on the retention of locomotor adaptation in children with cerebral palsy (CP). Eleven children with CP, aged 7-16 years old, were recruited to participate in this study. Three types of force perturbations (i.e., abrupt, gradual and noisy loads) were applied to the right leg above the ankle starting from late stance to mid-swing in three test sessions while the subject walked on a treadmill. Spatial-temporal gait parameters were recorded using a custom designed 3D position sensor during treadmill walking. We observed that children with CP adapted to the resistance force perturbation and showed an aftereffect consisting of increased step length after load release. Further, we observed a longer retention of the aftereffect for the condition with a gradual load than that with an abrupt load. Results from this study suggested that the size of error might have an impact on the retention of motor adaptation in children with CP with a longer retention of motor adaptation for the condition with a small size of error than that with a large error. In addition, enhanced variability of error seems facilitate motor learning during treadmill training. Results from this study may be used for the development of force perturbation based training paradigms for improving walking function in children with CP.
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Serel Arslan S, Azola A, Sunday K, Vose A, Plowman E, Tabor L, Singer M, Robison R, Humbert IA. Effects of Submental Surface Electrical Stimulation on Swallowing Kinematics in Healthy Adults: An Error-Based Learning Paradigm. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2018; 27:1375-1384. [PMID: 30076418 PMCID: PMC6436455 DOI: 10.1044/2018_ajslp-17-0224] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 04/20/2018] [Accepted: 04/25/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE Hyoid bone and laryngeal approximation aid airway protection (laryngeal vestibule closure) while moving toward their peak superior and anterior positions during swallowing. Submental surface electrical stimulation (SES) is a therapeutic technique that targets the muscles that move the hyoid bone during swallowing. It is unknown whether submental SES only increases peak hyoid bone swallowing positions but not peak laryngeal swallowing positions, which could require faster or greater laryngeal movement to achieve adequate laryngeal vestibule closure. METHOD We examined the effects of submental SES on hyo-laryngeal kinematics in 30 healthy adults who swallowed 50 times using an error-based learning paradigm. RESULTS Submental SES did not alter any hyo-laryngeal swallowing kinematic. However, submental SES significantly changed the starting position of the hyoid bone just prior to the swallow onset (more anterior; p = .003). On average, submental SES immediately prior to swallow onset can position the hyoid approximately 20% closer to its peak swallowing point. CONCLUSIONS These findings indicate that electrical stimulation of the agonists for hyoid movement might not alter swallowing outcomes tested in this study. However, submental SES could have clinical utility by minimizing swallowing impairments related to reduced hyoid swallowing range of motion in individuals with dysphagia.
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Affiliation(s)
| | - Alba Azola
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD
| | - Kirstyn Sunday
- Swallowing Systems Core, Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville
| | - Alicia Vose
- Swallowing Systems Core, Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville
- Department of Physical Therapy, University of Florida, Gainesville
| | - Emily Plowman
- Swallowing Systems Core, Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville
- Department of Physical Therapy, University of Florida, Gainesville
| | - Lauren Tabor
- Swallowing Systems Core, Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville
- Department of Physical Therapy, University of Florida, Gainesville
| | - Michele Singer
- Swallowing Systems Core, Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville
- Department of Physical Therapy, University of Florida, Gainesville
| | - Raele Robison
- Swallowing Systems Core, Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville
- Department of Physical Therapy, University of Florida, Gainesville
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Penke K, Scott K, Sinskey Y, Lewek MD. Propulsive Forces Applied to the Body's Center of Mass Affect Metabolic Energetics Poststroke. Arch Phys Med Rehabil 2018; 100:1068-1075. [PMID: 30391412 DOI: 10.1016/j.apmr.2018.10.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 10/11/2018] [Accepted: 10/15/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To investigate the effect of timing and magnitude of horizontally directed propulsive forces to the center of mass (COM) on the metabolic cost of walking (COW) for individuals poststroke. DESIGN Repeated-measures, within-subject design. SETTING Research laboratory. PARTICIPANTS A total of 9 individuals with chronic hemiparesis poststroke and 7 unimpaired similarly aged controls (N=16). INTERVENTION Individuals walked on a treadmill in 2 separate studies. First, we compared the metabolic COW with an anterior force applied to the COM that (1) coincided with paretic propulsion or (2) was applied throughout the gait cycle. Next, we compared the metabolic COW with anterior (assistive) or posterior (resistive) forces applied during paretic propulsion. MAIN OUTCOME MEASURE Metabolic COW. RESULTS The COW was significantly greater in the Stroke group. Anterior (propulsive) assistance reduced the COW differently based on group. The Stroke group exhibited a 12% reduction in COW when assistance was provided only during paretic propulsion, but not when assistance was provided throughout the gait cycle. In contrast, the Control group demonstrated reduced COW during both anterior assistance conditions. In addition, we observed that resistance during paretic propulsion (simulated hemiparesis for Control group) significantly increased the COW. CONCLUSIONS Systematically manipulating propulsive forces at the body's COM had a profound influence on metabolic cost. The timing of propulsive forces to the COM is important and needs to coincide with paretic terminal stance. Additional internally or externally generated propulsive forces applied to the body's COM poststroke may produce a lower metabolic COW.
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Affiliation(s)
- Kelly Penke
- Department of Allied Health Sciences, Division of Physical Therapy, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Korre Scott
- Department of Allied Health Sciences, Division of Physical Therapy, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Yunna Sinskey
- Department of Allied Health Sciences, Division of Physical Therapy, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Michael D Lewek
- Department of Allied Health Sciences, Division of Physical Therapy, The University of North Carolina at Chapel Hill, Chapel Hill, NC.
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Wu M, Hsu CJ, Kim J. Motor adaptation to lateral pelvis assistance force during treadmill walking in individuals post-stroke. IEEE Int Conf Rehabil Robot 2018; 2017:300-303. [PMID: 28813835 DOI: 10.1109/icorr.2017.8009263] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The goal of this study was to determine how individuals post-stroke response to the lateral assistance force applied to the pelvis during treadmill walking. Ten individuals post chronic (> 6 months) stroke were recruited to participate in this study. A controlled assistance force (∼10% of body weight) was applied to the pelvis in the lateral direction toward the paretic side during stance of the paretic leg. Kinematics of the pelvis and legs were recorded. Applying pelvis assistance force facilitated weight shifting toward the paretic side, resulting in a more symmetrical gait pattern but also inducing an enlarged range of motion of the pelvis during early adaptation period. The neural system of individuals post stroke adapted to the pelvis assistance force and showed an aftereffect consists of reduced range of motion of the pelvis following load release during post adaptation period.
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Hada T, Momosaki R, Abo M. Impact of orthotic therapy for improving activities of daily living in individuals with spinal cord injury: a retrospective cohort study. Spinal Cord 2018. [DOI: 10.1038/s41393-018-0088-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Gama GL, Savin DN, Keenan T, Waller SM, Whitall J. Comparing the effects of adapting to a weight on one leg during treadmill and overground walking: A pilot study. Gait Posture 2018; 59:35-39. [PMID: 28987764 DOI: 10.1016/j.gaitpost.2017.09.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 09/11/2017] [Accepted: 09/22/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Locomotor adaptation has been suggested as a way to improve gait symmetry in individuals post-stroke. Most perturbation methods utilize costly, specialized equipment. The use of a unilateral leg weight may provide a low cost, clinically translatable alternative. Furthermore, previous studies have suggested that adaptation context may affect movement outcomes. The purpose of this study was to assess the ability of a unilaterally applied ankle weight to drive locomotor adaptation and determine the effect of context (treadmill versus overground) in young, non-disabled participants. METHODS Eighteen young non-disabled adults were randomly assigned to receive 10min of walking on a treadmill with a weight (TG), overground with a weight (OG) or as a control on a treadmill/overground without a weight (CG). Outcomes measured before, during and after adaptation were: step length symmetry, single limb support symmetry and gait speed. RESULTS After adding the weight, single limb support immediately became asymmetrical for all participants without changes in step length symmetry. After walking for 10min, TG step length became asymmetrical. After weight removal, both TG and OG had increased step length asymmetry. TG decreased single limb support asymmetry while OG did not. After walking overground without the weight, walking parameters eventually returned to baseline in both weighted groups. The control group showed no changes. CONCLUSION A unilaterally applied ankle weight appears able to cause gait adaptation in young, non-disabled participants. However different adaptive changes in the gait pattern are made by the nervous system when the perturbation is applied in different contexts.
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Affiliation(s)
- Gabriela Lopes Gama
- Institute of Physical Activity and Sport Sciences, Universidade Cruzeiro do Sul, 686 Galvão Bueno St., São Paulo, SP, 01506-000, Brazil
| | - Douglas N Savin
- University of Maryland, School of Medicine, Department of Physical Therapy and Rehabilitation Science, 100 Penn St., Baltimore, MD, 21201, United States.
| | - Taylor Keenan
- University of Maryland, College Park, MD, 20742, United States
| | - Sandy McCombe Waller
- University of Maryland, School of Medicine, Department of Physical Therapy and Rehabilitation Science, 100 Penn St., Baltimore, MD, 21201, United States
| | - Jill Whitall
- University of Maryland, School of Medicine, Department of Physical Therapy and Rehabilitation Science, 100 Penn St., Baltimore, MD, 21201, United States; Faculty of Health Sciences, University of Southampton, Southampton, SO17 1BJ, UK
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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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Vasudevan EVL, Hamzey RJ, Kirk EM. Using a Split-belt Treadmill to Evaluate Generalization of Human Locomotor Adaptation. J Vis Exp 2017. [PMID: 28872105 DOI: 10.3791/55424] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Understanding the mechanisms underlying locomotor learning helps researchers and clinicians optimize gait retraining as part of motor rehabilitation. However, studying human locomotor learning can be challenging. During infancy and childhood, the neuromuscular system is quite immature, and it is unlikely that locomotor learning during early stages of development is governed by the same mechanisms as in adulthood. By the time humans reach maturity, they are so proficient at walking that it is difficult to come up with a sufficiently novel task to study de novo locomotor learning. The split-belt treadmill, which has two belts that can drive each leg at a different speed, enables the study of both short- (i.e., immediate) and long-term (i.e., over minutes-days; a form of motor learning) gait modifications in response to a novel change in the walking environment. Individuals can easily be screened for previous exposure to the split-belt treadmill, thus ensuring that all experimental participants have no (or equivalent) prior experience. This paper describes a typical split-belt treadmill adaptation protocol that incorporates testing methods to quantify locomotor learning and generalization of this learning to other walking contexts. A discussion of important considerations for designing split-belt treadmill experiments follows, including factors like treadmill belt speeds, rest breaks, and distractors. Additionally, potential but understudied confounding variables (e.g., arm movements, prior experience) are considered in the discussion.
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Affiliation(s)
- Erin V L Vasudevan
- Physical Therapy, School of Health Technology and Management, Stony Brook University; Motor Learning Lab, Moss Rehabilitation Research Institute, Einstein Healthcare Network;
| | - Rami J Hamzey
- Physical Therapy, School of Health Technology and Management, Stony Brook University; Motor Learning Lab, Moss Rehabilitation Research Institute, Einstein Healthcare Network
| | - Eileen M Kirk
- Motor Learning Lab, Moss Rehabilitation Research Institute, Einstein Healthcare Network
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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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Wu M, Kim J, Gaebler-Spira DJ, Schmit BD, Arora P. Robotic Resistance Treadmill Training Improves Locomotor Function in Children With Cerebral Palsy: A Randomized Controlled Pilot Study. Arch Phys Med Rehabil 2017; 98:2126-2133. [PMID: 28576629 DOI: 10.1016/j.apmr.2017.04.022] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 03/09/2017] [Accepted: 04/17/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine whether applying controlled resistance forces to the legs during the swing phase of gait may improve the efficacy of treadmill training as compared with applying controlled assistance forces in children with cerebral palsy (CP). DESIGN Randomized controlled study. SETTING Research unit of a rehabilitation hospital. PARTICIPANTS Children with spastic CP (N=23; mean age, 10.6y; range, 6-14y; Gross Motor Function Classification System levels, I-IV). INTERVENTIONS Participants were randomly assigned to receive controlled assistance (n=11) or resistance (n=12) loads applied to the legs at the ankle. Participants underwent robotic treadmill training 3 times a week for 6 weeks (18 sessions). A controlled swing assistance/resistance load was applied to both legs starting from the toe-off to mid-swing phase of gait during training. MAIN OUTCOME MEASURES Outcome measures consisted of overground walking speed, 6-minute walk distance, and Gross Motor Function Measure scores and were assessed pre and post 6 weeks of training and 8 weeks after the end of training. RESULTS After 6 weeks of treadmill training in participants from the resistance training group, fast walking speed and 6-minute walk distance significantly improved (18% and 30% increases, respectively), and 6-minute walk distance was still significantly greater than that at baseline (35% increase) 8 weeks after the end of training. In contrast, overground gait speed and 6-minute walk distance had no significant changes after robotic assistance training. CONCLUSIONS The results of the present study indicated that robotic resistance treadmill training is more effective than assistance training in improving locomotor function in children with CP.
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Affiliation(s)
- Ming Wu
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, IL; Northwestern University Medical School, Chicago, IL.
| | - Janis Kim
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, IL
| | | | - Brian D Schmit
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, IL; Northwestern University Medical School, Chicago, IL; Marquette University, Milwaukee, WI
| | - Pooja Arora
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, IL
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Cai X, Han G, Song X, Wang J. Single-Camera-Based Method for Step Length Symmetry Measurement in Unconstrained Elderly Home Monitoring. IEEE Trans Biomed Eng 2017; 64:2618-2627. [PMID: 28092516 DOI: 10.1109/tbme.2017.2653246] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE single-camera-based gait monitoring is unobtrusive, inexpensive, and easy-to-use to monitor daily gait of seniors in their homes. However, most studies require subjects to walk perpendicularly to camera's optical axis or along some specified routes, which limits its application in elderly home monitoring. To build unconstrained monitoring environments, we propose a method to measure step length symmetry ratio (a useful gait parameter representing gait symmetry without significant relationship with age) from unconstrained straight walking using a single camera, without strict restrictions on walking directions or routes. METHODS according to projective geometry theory, we first develop a calculation formula of step length ratio for the case of unconstrained straight-line walking. Then, to adapt to general cases, we propose to modify noncollinear footprints, and accordingly provide general procedure for step length ratio extraction from unconstrained straight walking. RESULTS Our method achieves a mean absolute percentage error (MAPE) of 1.9547% for 15 subjects' normal and abnormal side-view gaits, and also obtains satisfactory MAPEs for non-side-view gaits (2.4026% for 45°-view gaits and 3.9721% for 30°-view gaits). The performance is much better than a well-established monocular gait measurement system suitable only for side-view gaits with a MAPE of 3.5538%. CONCLUSION Independently of walking directions, our method can accurately estimate step length ratios from unconstrained straight walking. SIGNIFICANCE This demonstrates our method is applicable for elders' daily gait monitoring to provide valuable information for elderly health care, such as abnormal gait recognition, fall risk assessment, etc. OBJECTIVE single-camera-based gait monitoring is unobtrusive, inexpensive, and easy-to-use to monitor daily gait of seniors in their homes. However, most studies require subjects to walk perpendicularly to camera's optical axis or along some specified routes, which limits its application in elderly home monitoring. To build unconstrained monitoring environments, we propose a method to measure step length symmetry ratio (a useful gait parameter representing gait symmetry without significant relationship with age) from unconstrained straight walking using a single camera, without strict restrictions on walking directions or routes. METHODS according to projective geometry theory, we first develop a calculation formula of step length ratio for the case of unconstrained straight-line walking. Then, to adapt to general cases, we propose to modify noncollinear footprints, and accordingly provide general procedure for step length ratio extraction from unconstrained straight walking. RESULTS Our method achieves a mean absolute percentage error (MAPE) of 1.9547% for 15 subjects' normal and abnormal side-view gaits, and also obtains satisfactory MAPEs for non-side-view gaits (2.4026% for 45°-view gaits and 3.9721% for 30°-view gaits). The performance is much better than a well-established monocular gait measurement system suitable only for side-view gaits with a MAPE of 3.5538%. CONCLUSION Independently of walking directions, our method can accurately estimate step length ratios from unconstrained straight walking. SIGNIFICANCE This demonstrates our method is applicable for elders' daily gait monitoring to provide valuable information for elderly health care, such as abnormal gait recognition, fall risk assessment, etc.
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Affiliation(s)
- Xi Cai
- College of Information Science and EngineeringNortheastern University
| | - Guang Han
- College of Information Science and Engineering, Northeastern University, Shenyang, China
| | - Xin Song
- College of Information Science and EngineeringNortheastern University
| | - Jinkuan Wang
- College of Information Science and EngineeringNortheastern University
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Na E, Hwang H, Woo Y. Study of acceleration of center of mass during sit-to-stand and stand-to-sit in patients with stroke. J Phys Ther Sci 2016; 28:2457-2460. [PMID: 27799669 PMCID: PMC5080151 DOI: 10.1589/jpts.28.2457] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 05/23/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to compare the center of mass during sit-to-stand
and stand-to-sit activities in the timed up and go test between healthy subjects and
patients with stroke. [Subjects and Methods] Thirty healthy participants and thirty
patients with stroke volunteered for this study. Acceleration of the center of mass was
measured using a wireless tri-axial accelerometer during sit-to-stand and stand-to-sit
activities in the timed up and go test. Accelerometer data were analyzed using BTS
G-studio software. [Results] The phase duration was significantly longer and the
anterior-posterior, mediolateral, and vertical acceleration ranges were significantly
lower during sit-to-stand for patients with stroke than for healthy controls. Further,
phase duration and the mediolateral acceleration range during stand-to-sit differed
significantly between healthy controls and subjects with stroke. [Conclusions] During
training for the sit-to-stand activity, the focus should be all three balance dimensions,
but during training for the stand-to-sit activity, the focus should be on improving
mediolateral balance and asymmetrical foot positioning should be recommended.
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Affiliation(s)
- Eunjin Na
- Department of Physical Therapy, Dream Hospital, Republic of Korea
| | - Hyesun Hwang
- Department of Physical Therapy, Dream Hospital, Republic of Korea
| | - Youngkeun Woo
- Department of Physical Therapy, College of Medical Sciences, Jeonju University, Republic of Korea
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A Novel Application of Eddy Current Braking for Functional Strength Training During Gait. Ann Biomed Eng 2016; 44:2760-73. [PMID: 26817456 DOI: 10.1007/s10439-016-1553-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 01/13/2016] [Indexed: 10/22/2022]
Abstract
Functional strength training is becoming increasingly popular when rehabilitating individuals with neurological injury such as stroke or cerebral palsy. Typically, resistance during walking is provided using cable robots or weights that are secured to the distal shank of the subject. However, there exists no device that is wearable and capable of providing resistance across the joint, allowing over ground gait training. In this study, we created a lightweight and wearable device using eddy current braking to provide resistance to the knee. We then validated the device by having subjects wear it during a walking task through varying resistance levels. Electromyography and kinematics were collected to assess the biomechanical effects of the device on the wearer. We found that eddy current braking provided resistance levels suitable for functional strength training of leg muscles in a package that is both lightweight and wearable. Applying resistive forces at the knee joint during gait resulted in significant increases in muscle activation of many of the muscles tested. A brief period of training also resulted in significant aftereffects once the resistance was removed. These results support the feasibility of the device for functional strength training during gait. Future research is warranted to test the clinical potential of the device in an injured population.
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