1
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Shen KH, Borrelli J, Gray VL, Rogers MW, Hsiao HY. Lower limb vertical stiffness and frontal plane angular impulse during perturbation-induced single limb stance and their associations with gait in individuals post-stroke. J Biomech 2024; 163:111917. [PMID: 38184906 DOI: 10.1016/j.jbiomech.2023.111917] [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: 07/14/2023] [Revised: 11/30/2023] [Accepted: 12/31/2023] [Indexed: 01/09/2024]
Abstract
After stroke, deficits in paretic single limb stance (SLS) are commonly observed and affect walking performance. During SLS, the hip abductor musculature is critical in providing vertical support and regulating balance. Although disrupted paretic hip abduction torque production has been identified in individuals post-stroke, interpretation of previous results is limited due to the discrepancies in weight-bearing conditions. Using a novel perturbation-based assessment that could induce SLS by removing the support surface underneath one limb, we aim to investigate whether deficits in hip abduction torque production, vertical body support, and balance regulation remain detectable during SLS when controlling for weight-bearing, and whether these measures are associated with gait performance. Our results showed that during the perturbation-induced SLS, individuals post-stroke had lower hip abduction torque, less vertical stiffness, and increased frontal plane angular impulse at the paretic limb compared to the non-paretic limb, while no differences were found between the paretic limb and healthy controls. In addition, vertical stiffness during perturbation-induced SLS was positively correlated with single support duration during gait at the paretic limb and predicted self-selected and fast walking speeds in individuals post-stroke. The findings indicate that reduced paretic hip abduction torque during SLS likely affects vertical support and balance control. Enhancing SLS hip abduction torque production could be an important rehabilitation target to improve walking function for individuals post-stroke.
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Affiliation(s)
- Keng-Hung Shen
- Department of Kinesiology and Health Education, The University of Texas at Austin, TX, USA
| | - James Borrelli
- Department of Biomedical Engineering, Stevenson University, MD, USA; Department of Physical Therapy and Rehabilitation Science, University of Maryland Baltimore, MD, USA
| | - Vicki L Gray
- Department of Physical Therapy and Rehabilitation Science, University of Maryland Baltimore, MD, USA
| | - Mark W Rogers
- Department of Physical Therapy and Rehabilitation Science, University of Maryland Baltimore, MD, USA
| | - Hao-Yuan Hsiao
- Department of Kinesiology and Health Education, The University of Texas at Austin, TX, USA; Department of Physical Therapy and Rehabilitation Science, University of Maryland Baltimore, MD, USA.
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2
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Yamagata S, Yamaguchi T, Shinya M, Milosevic M, Masani K. Comparison of sensitivity among dynamic balance measures during walking with different tasks. ROYAL SOCIETY OPEN SCIENCE 2024; 11:230883. [PMID: 38298402 PMCID: PMC10827416 DOI: 10.1098/rsos.230883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 01/10/2024] [Indexed: 02/02/2024]
Abstract
Although various measures have been proposed to evaluate dynamic balance during walking, it is currently unclear which measures are most sensitive to dynamic balance. We aimed to investigate which dynamic balance measure is most sensitive to detecting differences in dynamic balance during walking across various gait parameters, including short- and long-term Lyapunov exponents (λs and λl), margin of stability (MOS), distance between the desired and measured centre of pressure (dCOP-mCOP) and whole-body angular momentum (WBAM). A total of 10 healthy young adults were asked to walk on a treadmill under three different conditions (normal walking, dual-task walking with a Stroop task as an unstable walking condition, and arm-restricted walking with arms restricted in front of the chest as another unstable walking condition) that were expected to have different dynamic balance properties. Overall, we found that λs of the centre of mass velocity, λs of the trunk velocity, λs of the hip joint angle, and the magnitude of the mediolateral dCOP-mCOP at heel contact can identify differences between tasks with a high sensitivity. Our findings provide new insights into the selection of sensitive dynamic balance measures during human walking.
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Affiliation(s)
| | - Takeshi Yamaguchi
- Department of Finemechanics, Graduate School of Engineering, Tohoku University, 6-6-01 Aramaki-Aza-Aoba, Aoba-ku, Sendai, Miyagi 980-8579, Japan
- Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan
| | - Masahiro Shinya
- Graduate School of Humanities and Social Sciences, Hiroshima University, Higashi-Hiroshima, Japan
| | - Matija Milosevic
- The Miami Project to Cure Paralysis, University of Miami, Miami, FL, USA
- Department of Neurological Surgery, University of Miami, Miami, FL, USA
- Department of Biomedical Engineering, University of Miami, Miami, FL, USA
| | - Kei Masani
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada
- KITE Research Institute, University Health Network, Toronto, Canada
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Caderby T, Lesport A, Turpin NA, Dalleau G, Watier B, Robert T, Peyrot N, Begue J. Influence of aging on the control of the whole-body angular momentum during volitional stepping: An UCM-based analysis. Exp Gerontol 2023; 178:112217. [PMID: 37224932 DOI: 10.1016/j.exger.2023.112217] [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: 09/23/2022] [Revised: 05/11/2023] [Accepted: 05/21/2023] [Indexed: 05/26/2023]
Abstract
Evidence suggests that whole-body angular momentum (WBAM) is a highly controlled mechanical variable for performing our daily motor activities safely and efficiently. Recent findings have revealed that, compared to young adults, older adults exhibit larger range of WBAM during various motor tasks, such as walking and stepping. However, it remains unclear whether these age-related changes are ascribed to a poorer control of WBAM with age or not. The purpose of the present study was to examine the effect of normal aging on WBAM control during stepping. Twelve young adults and 14 healthy older adults performed a series of volitional stepping at their preferred selected speed. An Uncontrolled Manifold (UCM) analysis was conducted to explore the presence of synergies among the angular momenta of the body segments (elemental variables) to control WBAM (performance variable); i.e., to stabilize or destabilize it. Results revealed the existence of a stronger synergy destabilizing the WBAM in the sagittal-plane older adults compared to young adults during stepping, while there was no difference between the two groups in the frontal and transversal planes. Although older participants also had a larger range of WBAM in the sagittal plane compared to young adults, we found no significant correlation between synergy index and the range of WBAM in the sagittal plane. We concluded that the age-related changes in WBAM during stepping are not ascribed to alterations in the ability to control this variable with aging.
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Affiliation(s)
- Teddy Caderby
- Laboratoire IRISSE, EA4075, UFR des Sciences de l'Homme et de l'Environnement, Université de la Réunion, Le Tampon, France.
| | - Angélique Lesport
- Laboratoire IRISSE, EA4075, UFR des Sciences de l'Homme et de l'Environnement, Université de la Réunion, Le Tampon, France
| | - Nicolas A Turpin
- Laboratoire IRISSE, EA4075, UFR des Sciences de l'Homme et de l'Environnement, Université de la Réunion, Le Tampon, France
| | - Georges Dalleau
- Laboratoire IRISSE, EA4075, UFR des Sciences de l'Homme et de l'Environnement, Université de la Réunion, Le Tampon, France
| | - Bruno Watier
- LAAS-CNRS, CNRS, UPS, Université de Toulouse, Toulouse, France
| | - Thomas Robert
- Laboratoire de Biomécanique et Mécanique des Chocs, LBMC UMR_T9406, Univ Lyon - Univ Gustave Eiffel, Lyon, France
| | - Nicolas Peyrot
- Laboratoire IRISSE, EA4075, UFR des Sciences de l'Homme et de l'Environnement, Université de la Réunion, Le Tampon, France; Mouvement - Interactions - Performance, MIP, Le Mans Université, EA 4334, 72000 Le Mans, France
| | - Jérémie Begue
- Laboratoire IRISSE, EA4075, UFR des Sciences de l'Homme et de l'Environnement, Université de la Réunion, Le Tampon, France
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4
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Shen KH, Borrelli J, Gray VL, Rogers MW, Hsiao HY. Lower Limb Vertical Stiffness and Frontal Plane Angular Impulse during Perturbation-Induced Single Limb Stance and Their Associations with Gait in Individuals Post-Stroke. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.04.10.536288. [PMID: 37090545 PMCID: PMC10120673 DOI: 10.1101/2023.04.10.536288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Background After stroke, deficits in paretic single limb stance (SLS) are commonly observed and affect walking performance. During SLS, the hip abductor musculature is critical in providing vertical support and regulating balance. Although disrupted paretic hip abduction torque production has been identified in individuals post-stroke, interpretation of previous results is limited due to the discrepancies in weight-bearing conditions. Objective To investigate whether deficits in hip abduction torque production, vertical body support, and balance regulation remain during SLS when controlling for weight-bearing using a perturbation-based assessment, and whether these measures are associated with gait performance. Methods We compared hip abduction torque, vertical stiffness, and frontal plane angular impulse between individuals post-stroke and healthy controls when SLS was induced by removing the support surface underneath one limb. We also tested for correlations between vertical stiffness and angular impulse during perturbation-induced SLS and gait parameters during overground walking. Results During the perturbation-induced SLS, lower hip abduction torque, less vertical stiffness, and increased frontal plane angular impulse were observed at the paretic limb compared to the non-paretic limb, while no differences were found between the paretic limb and healthy controls. Vertical stiffness during perturbation-induced SLS was positively correlated with single support duration during gait at the paretic limb and predicted self-selected and fast walking speeds in individuals post-stroke. Conclusions Reduced paretic hip abduction torque during SLS likely affects vertical support and balance control. Enhancing SLS hip abduction torque production could be an important rehabilitation target to improve walking function for individuals post-stroke.
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Affiliation(s)
- Keng-Hung Shen
- Department of Kinesiology and Health Education, The University of Texas at Austin, TX, USA
| | - James Borrelli
- Department of Biomedical Engineering, Stevenson University, MD, USA
- Department of Physical Therapy and Rehabilitation Science, University of Maryland Baltimore, MD, USA
| | - Vicki L. Gray
- Department of Physical Therapy and Rehabilitation Science, University of Maryland Baltimore, MD, USA
| | - Mark W. Rogers
- Department of Physical Therapy and Rehabilitation Science, University of Maryland Baltimore, MD, USA
| | - Hao-Yuan Hsiao
- Department of Kinesiology and Health Education, The University of Texas at Austin, TX, USA
- Department of Physical Therapy and Rehabilitation Science, University of Maryland Baltimore, MD, USA
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Sánchez Silverio V, Abuín Porras V, Rodríguez Costa I, Cleland JA, Villafañe JH. Effects of action observation training on the walking ability of patients post stroke: a systematic review. Disabil Rehabil 2022; 44:7339-7348. [PMID: 34644226 DOI: 10.1080/09638288.2021.1989502] [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: 01/18/2023]
Abstract
OBJECTIVE To determine the effect of action observation (AO) training on the walking ability of patients post stroke. METHODS MEDLINE, CINAHL, EMBASE and PEDro were searched systematically for human studies written in English up to August 31st 2021. Two authors screened titles and abstracts against predefined inclusion criteria; a third author resolved discrepancies. Data were analyzed through qualitative synthesis. Articles evaluating the effects of AO training on the walking ability of patients post stroke were included. Methodological quality was assessed using the PEDro scale. RESULTS From first search that included 1,578 studies, 7 were included in this review. According to the PEDro scale, most of the studies exhibited a methodological quality between Good and Fair (N = 6). Most of the studies applied a protocol based on a 30-minute training session applied 3 to 5 times per week over a 4-week period (N = 5). Using clinical measures and gait parameters, all studies confirmed the beneficial effects of AO training on walking ability. However, the effects of AO training on walking ability were not confirmed at the long-term follow-up. CONCLUSIONS AO training has a positive effect on the walking ability of patients post stroke. Additional studies are needed to confirm these results across the entire spectrum of patient's post stoke including long-term clinical effects.Implications for RehabilitationAction observation training can have potentially positive effects on the walking ability of stroke patients.Clinical measurements (10-meter walk test) and gait parameters (stride length and gait speed) could be used to assess the effect of action observation training on walking ability.The patient's concentration is an important factor to consider when applying observational training.
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Affiliation(s)
- Víctor Sánchez Silverio
- School of Applied Health Sciences, Pontificia Universidad Católica Madre y Maestra, Santiago De Los Caballeros, Dominican Republic
| | - Vanesa Abuín Porras
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Spain Madrid.,Fundación DACER. Área de investigación, Madrid, Spain
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Kooncumchoo P, Namdaeng P, Hanmanop S, Rungroungdouyboon B, Klarod K, Kiatkulanusorn S, Luangpon N. Gait Improvement in Chronic Stroke Survivors by Using an Innovative Gait Training Machine: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:224. [PMID: 35010482 PMCID: PMC8750435 DOI: 10.3390/ijerph19010224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/17/2021] [Accepted: 12/22/2021] [Indexed: 06/14/2023]
Abstract
Chronic stroke leads to the impairment of lower limb function and gait performance. After in-hospital rehabilitation, most individuals lack continuous gait training because of the limited number of physical therapists. This study aimed to evaluate the effects of a newly invented gait training machine (I-Walk) on lower limb function and gait performance in chronic stroke individuals. Thirty community-dwelling chronic stroke individuals were allocated to the I-Walk machine group (n = 15) or the overground gait training (control) group (n = 15). Both groups received 30 min of upper limb and hand movement and sit-to-stand training. After that, the I-Walk group received 30 min of I-Walk training, while the control followed a 30-minute overground training program. All the individuals were trained 3 days/week for 8 weeks. The primary outcome of the motor recovery of lower limb impairment was measured using the Fugl-Meyer Assessment (FMA). The secondary outcomes for gait performance were the 6-minute walk test (6 MWT), the 10-meter walk test (10 MWT), and the Timed Up and Go (TUG). The two-way mixed-model ANOVA with the Bonferroni test was used to compare means within and between groups. The post-intervention motor and sensory subscales of the FMA significantly increased compared to the baseline in both groups. Moreover, the 6 MWT and 10 MWT values also improved in both groups. In addition, the mean difference of TUG in the I-Walk was higher than the control. The efficiency of I-Walk training was comparable to overground training and might be applied for chronic stroke gait training in the community.
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Affiliation(s)
- Patcharee Kooncumchoo
- Department of Physical Therapy, Faculty of Allied Health Sciences, Thammasat University, Pathumthani 12120, Thailand; (P.K.); (P.N.); (S.H.)
- Center of Excellence in Creative Engineering Design and Development, Thammasat University, Pathumthani 12120, Thailand;
| | - Phuwarin Namdaeng
- Department of Physical Therapy, Faculty of Allied Health Sciences, Thammasat University, Pathumthani 12120, Thailand; (P.K.); (P.N.); (S.H.)
| | - Somrudee Hanmanop
- Department of Physical Therapy, Faculty of Allied Health Sciences, Thammasat University, Pathumthani 12120, Thailand; (P.K.); (P.N.); (S.H.)
| | - Bunyong Rungroungdouyboon
- Center of Excellence in Creative Engineering Design and Development, Thammasat University, Pathumthani 12120, Thailand;
- Department of Mechanical Engineering, Faculty of Engineering, Thammasat University, Pathumthani 12120, Thailand
| | - Kultida Klarod
- Department of Physical Therapy, Faculty of Allied Health Sciences, Burapha University, Chonburi 20131, Thailand; (K.K.); (S.K.)
| | - Sirirat Kiatkulanusorn
- Department of Physical Therapy, Faculty of Allied Health Sciences, Burapha University, Chonburi 20131, Thailand; (K.K.); (S.K.)
| | - Nongnuch Luangpon
- Department of Physical Therapy, Faculty of Allied Health Sciences, Burapha University, Chonburi 20131, Thailand; (K.K.); (S.K.)
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Rhyu HS, Rhi SY. THE EFFECTS OF TRAINING ON DIFFERENT SURFACES, ON BALANCE AND GAIT PERFORMANCE IN STROKE HEMIPLEGIA. REV BRAS MED ESPORTE 2021. [DOI: 10.1590/1517-8692202127062020_0089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Although many studies have focused on balance exercises for elderly or stroke patients, no comprehensive studies have investigated the use of training on different surfaces (TDS) with analysis of gait performance in elderly male stroke patients. The active properties of balance and subjective reporting of functional gait ability were used to identify the effects of TDS. Static balance (SB), dynamic balance (DB) and gait analysis was measured in 30 elderly stroke patients. The patients were divided into the TDS group (n=15) and a control group (CG, n=15). Fifteen elderly stroke patients underwent TDS five times a week for 12 weeks. The data was analyzed using repeated measures analysis of variance. Significant differences were observed between the two groups (TDS and Control): SB (p < 0.0001), DB (OSI: p < 0.0001, APSI: p < 0.001, MLSI: p < 0.004) and gait analysis (right: temporal step time: p < 0.0001, temporal cycle time: p < 0.001, temporal double support time: p < 0.0001; left: temporal step time: p < 0.0001, temporal cycle time: p < 0.0001, temporal double support time: p < 0.0001). TDS in elderly male stroke patients suggests that the characteristics of gait performance in these patients may be improved by increasing static balance, dynamic balance and gait velocity. It is hoped that the results of this trial will provide new information on the effects of TDS on balance stability and gait ability in stroke patients, through changes in stability of the lower extremities. Level III, Case-control Study.
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Vistamehr A, Neptune RR. Differences in balance control between healthy younger and older adults during steady-state walking. J Biomech 2021; 128:110717. [PMID: 34530294 DOI: 10.1016/j.jbiomech.2021.110717] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 08/04/2021] [Accepted: 08/23/2021] [Indexed: 11/29/2022]
Abstract
Each year approximately one third of older adults fall and experience extensive musculoskeletal injuries and functional disabilities. An important element in maintaining dynamic balance is the regulation of whole-body angular momentum, which is achieved by proper foot placement with respect to the body center-of-mass as well as generation of appropriate ground reaction forces. Analyzing these quantities in younger and older adults may provide insight into differences in their underlying mechanics for maintaining dynamic balance. This study examined three-dimensional whole-body angular momentum in 13 healthy older (71.8 ± 8.3 years) and 9 younger (23.2 ± 2.8 years) adults walking at their self-selected and fastest-comfortable speeds. The older adults had a significantly higher range of frontal-plane angular momentum compared to the younger adults at both speeds, suggesting poorer mediolateral balance control. This difference was related to the older adults having a wider foot placement with respect to the body center-of-mass, which when combined with the vertical ground reaction force, created a higher destabilizing external moment during single-limb stance that acts to rotate the body towards the contralateral swing leg. To counteract this destabilizing moment, the older adults generated a higher hip abduction moment. There were no differences in the range of sagittal- and transverse-plane angular momentum between age groups at either speed. These results suggest that control of dynamic balance in the frontal-plane is more challenging than in the sagittal-plane for older adults and highlight the importance of proper weight transfer mechanisms and hip abductor force production for maintaining mediolateral balance during walking.
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Affiliation(s)
- Arian Vistamehr
- Motion Analysis Center, Brooks Rehabilitation, Jacksonville, FL, USA.
| | - Richard R Neptune
- Walker Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX, USA
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9
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Begue J, Peyrot N, Lesport A, Turpin NA, Watier B, Dalleau G, Caderby T. Segmental contribution to whole-body angular momentum during stepping in healthy young and old adults. Sci Rep 2021; 11:19969. [PMID: 34620974 PMCID: PMC8497562 DOI: 10.1038/s41598-021-99519-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 09/15/2021] [Indexed: 11/23/2022] Open
Abstract
Recent evidence suggests that during volitional stepping older adults control whole-body angular momentum (H) less effectively than younger adults, which may impose a greater challenge for balance control during this task in the elderly. This study investigated the influence of aging on the segment angular momenta and their contributions to H during stepping. Eighteen old and 15 young healthy adults were instructed to perform a series of stepping at two speed conditions: preferred and as fast as possible. Full-body kinematics were recorded to compute angular momenta of the trunk, arms and legs and their contributions to total absolute H on the entire stepping movement. Results indicated that older adults exhibited larger angular momenta of the trunk and legs in the sagittal plane, which contributed to a higher sagittal plane H range during stepping compared to young adults. Results also revealed that older adults had a greater trunk contribution and lower leg contribution to total absolute H in the sagittal plane compared to young adults, even though there was no difference in the other two planes. These results stress that age-related changes in H control during stepping arise as a result of changes in trunk and leg rotational dynamics.
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Affiliation(s)
- Jérémie Begue
- Laboratoire IRISSE - EA4075, UFR des Sciences de l'Homme et de l'Environnement, Université de la Réunion, 117 rue du Général Ailleret, 97430, Le Tampon, Ile de la Réunion, France.
| | - Nicolas Peyrot
- Laboratoire IRISSE - EA4075, UFR des Sciences de l'Homme et de l'Environnement, Université de la Réunion, 117 rue du Général Ailleret, 97430, Le Tampon, Ile de la Réunion, France
- Mouvement - Interactions - Performance, MIP, Le Mans Université, EA 4334, 72000, Le Mans, France
| | - Angélique Lesport
- Laboratoire IRISSE - EA4075, UFR des Sciences de l'Homme et de l'Environnement, Université de la Réunion, 117 rue du Général Ailleret, 97430, Le Tampon, Ile de la Réunion, France
| | - Nicolas A Turpin
- Laboratoire IRISSE - EA4075, UFR des Sciences de l'Homme et de l'Environnement, Université de la Réunion, 117 rue du Général Ailleret, 97430, Le Tampon, Ile de la Réunion, France
| | - Bruno Watier
- LAAS-CNRS, CNRS, UPS, Université de Toulouse, Toulouse, France
| | - Georges Dalleau
- Laboratoire IRISSE - EA4075, UFR des Sciences de l'Homme et de l'Environnement, Université de la Réunion, 117 rue du Général Ailleret, 97430, Le Tampon, Ile de la Réunion, France
| | - Teddy Caderby
- Laboratoire IRISSE - EA4075, UFR des Sciences de l'Homme et de l'Environnement, Université de la Réunion, 117 rue du Général Ailleret, 97430, Le Tampon, Ile de la Réunion, France
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10
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Chandler EA, Stone T, Pomeroy VM, Clark AB, Kerr A, Rowe P, Ugbolue UC, Smith J, Hancock NJ. Investigating the Relationships Between Three Important Functional Tasks Early After Stroke: Movement Characteristics of Sit-To-Stand, Sit-To-Walk, and Walking. Front Neurol 2021; 12:660383. [PMID: 34054703 PMCID: PMC8160116 DOI: 10.3389/fneur.2021.660383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Walking, sit-to-stand (STS) and sit-to-walk (STW) are all considered important functional tasks in achieving independence after stroke. Despite knowledge that sensitive measurement of movement patterns is crucial to understanding neuromuscular restitution, there is surprisingly little information available about the detailed biomechanical characteristics of, and relationships between, walking, sit-to-stand and sit-to-walk, particularly in the important time window early after stroke. Hence, here, the study aimed to:
Identify the biomechanical characteristics of and determine any differences in both movement fluidity (hesitation, coordination and smoothness) and duration of movement phases, between sit-to-stand (STS) and sit-to-walk (STW) in people early after stroke. Determine whether measures of movement fluidity (hesitation, coordination, and smoothness) and movement phases during sit-to-stand (STS) and/or sit-to-walk (STW) are correlated strongly to commonly used measures of walking speed and/or step length ratio in people early after stroke.
Methods: This study consisted of secondary data analysis from the SWIFT Cast Trial. Specifically, we investigated movement fluidity using established assessments of smoothness, hesitation and coordination and the time duration for specific movement phases in a group of 48 people after stroke. Comparisons were made between STS and STW and relationships to walking measures were explored. Results: Participants spent significantly more time in the initial movement phase, flexion momentum, during STS [mean time (SD) 1.74 ±1.45 s] than they did during STW [mean time (SD) 1.13 ± 1.03 s]. STS was also completed more smoothly but with more hesitation and greater coordination than the task of STW. No strong relationships were found between movement fluidity or duration with walking speed or step length symmetry. Conclusions: Assessment of movement after stroke requires a range of functional tasks and no one task should predominate over another. Seemingly similar or overlapping tasks such as STS and STW create distinct biomechanical characteristics which can be identified using sensitive, objective measures of fluidity and movement phases but there are no strong relationships between the functional tasks of STS and STW with walking speed or with step-length symmetry.
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Affiliation(s)
- Elizabeth Ann Chandler
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Thomas Stone
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom.,Department of Clinical Engineering (Addenbrookes), Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, United Kingdom
| | - Valerie Moyra Pomeroy
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom.,National Institute for Health Research Brain Injury MedTech Cooperative, Cambridge, United Kingdom
| | - Allan Brian Clark
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Andrew Kerr
- Department of Biomedical Engineering, Faculty of Engineering, University of Strathclyde, Glasgow, United Kingdom
| | - Phillip Rowe
- Department of Biomedical Engineering, Faculty of Engineering, University of Strathclyde, Glasgow, United Kingdom
| | - Ukadike Chris Ugbolue
- School of Science and Sport, University of West of Scotland, Hamilton, United Kingdom
| | - Jessica Smith
- Department of Performance Analysis, English Institute of Sport, Sheffield, United Kingdom
| | - Nicola Joanne Hancock
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom
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11
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Frame HB, Finetto C, Dean JC, Neptune RR. The influence of lateral stabilization on walking performance and balance control in neurologically-intact and post-stroke individuals. Clin Biomech (Bristol, Avon) 2020; 73:172-180. [PMID: 32004909 PMCID: PMC7183884 DOI: 10.1016/j.clinbiomech.2020.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 11/19/2019] [Accepted: 01/07/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Individuals post-stroke have an increased risk of falling, which can lead to injuries and reduced quality of life. This increased fall risk can be partially attributed to poorer balance control, which has been linked to altered post-stroke gait kinematics (e.g. an increased step width). The application of lateral stabilization to the pelvis reduces step width among neurologically-intact young and older adults, suggesting that lateral stabilization reduces the need for active frontal plane balance control. This study sought to determine if lateral stabilization is effective at improving common measures of gait performance and dynamic balance in neurologically-intact and post-stoke individuals who responded to the stabilization by reducing their step width. METHODS Gait performance was assessed by foot placement and propulsion symmetry while dynamic balance was assessed by peak-to-peak range of frontal plane whole body angular momentum (HR) and pelvis and trunk sway. FINDINGS Controls and post-stroke Responders who reduced their step width in response to stabilization also reduced their mediolateral pelvis sway, but did not exhibit changes in gait performance. Contrary to expectations, both groups exhibited an increased HR, possibly indicative of decreased balance control. This increase was the result of increased relative velocity between the pelvis and head, arms and trunk segment. INTERPRETATION These results suggest that a reduction in pelvis motion alone, as opposed to relative motion between the pelvis and upper body, may increase HR, decrease balance control and diminish gait performance. This finding has important implications for locomotor therapies that may seek to reduce pelvis motion.
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Affiliation(s)
- Hannah B Frame
- Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Christian Finetto
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC, USA
| | - Jesse C Dean
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC, USA
| | - Richard R Neptune
- Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX, USA.
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Begue J, Peyrot N, Dalleau G, Caderby T. Age-related changes in the control of whole-body angular momentum during stepping. Exp Gerontol 2019; 127:110714. [DOI: 10.1016/j.exger.2019.110714] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 08/20/2019] [Accepted: 08/26/2019] [Indexed: 02/06/2023]
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Vistamehr A, Kautz SA, Bowden MG, Neptune RR. The influence of locomotor training on dynamic balance during steady-state walking post-stroke. J Biomech 2019; 89:21-27. [PMID: 30981426 DOI: 10.1016/j.jbiomech.2019.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 03/04/2019] [Accepted: 04/02/2019] [Indexed: 12/01/2022]
Abstract
Slow walking speed and lack of balance control are common impairments post-stroke. While locomotor training often improves walking speed, its influence on dynamic balance is unclear. The goal of this study was to assess the influence of a locomotor training program on dynamic balance in individuals post-stroke during steady-state walking and determine if improvements in walking speed are associated with improved balance control. Kinematic and kinetic data were collected pre- and post-training from seventeen participants who completed a 12-week locomotor training program. Dynamic balance was quantified biomechanically (peak-to-peak range of frontal plane whole-body angular-momentum) and clinically (Berg-Balance-Scale and Dynamic-Gait-Index). To understand the underlying biomechanical mechanisms associated with changes in angular-momentum, foot placement and ground-reaction-forces were quantified. As a group, biomechanical assessments of dynamic balance did not reveal any improvements after locomotor training. However, improved dynamic balance post-training, observed in a sub-group of 10 participants (i.e., Responders), was associated with a narrowed paretic foot placement and higher paretic leg vertical ground-reaction-force impulse during late stance. Dynamic balance was not improved post-training in the remaining seven participants (i.e., Non-responders), who did not alter their foot placement and had an increased reliance on their nonparetic leg during weight-bearing. As a group, increased walking speed was not correlated with improved dynamic balance. However, a higher pre-training walking speed was associated with higher gains in dynamic balance post-training. These findings highlight the importance of the paretic leg weight bearing and mediolateral foot placement in improving frontal plane dynamic balance post-stroke.
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Affiliation(s)
- Arian Vistamehr
- Motion Analysis Center, Brooks Rehabilitation, Jacksonville, FL, USA.
| | - Steven A Kautz
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC, USA; Ralph H Johnson VA Medical Center, Charleston, SC, USA
| | - Mark G Bowden
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC, USA; Ralph H Johnson VA Medical Center, Charleston, SC, USA
| | - Richard R Neptune
- Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX, USA
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14
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Honda K, Sekiguchi Y, Muraki T, Izumi SI. The differences in sagittal plane whole-body angular momentum during gait between patients with hemiparesis and healthy people. J Biomech 2019; 86:204-209. [PMID: 30827701 DOI: 10.1016/j.jbiomech.2019.02.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 02/11/2019] [Accepted: 02/14/2019] [Indexed: 11/27/2022]
Abstract
Regulation of whole-body angular momentum (WBAM) is essential for maintaining dynamic balance during gait. Patients with hemiparesis frequently fall toward the anterior direction; however, whether this is due to impaired WBAM control in the sagittal plane during gait remains unknown. The present study aimed to investigate the differences in WBAM in the sagittal plane during gait between patients with hemiparesis and healthy individuals. Thirty-three chronic stroke patients with hemiparesis and twenty-two age- and gender-matched healthy controls walked along a 7-m walkway while gait data were recorded using a motion analysis system and force plates. WBAM and joint moment were calculated in the sagittal plane during each gait cycle. The range of WBAM in the sagittal plane in the second half of the paretic gait cycle was significantly larger than that in the first and second halves of the right gait cycle in the controls (P = 0.015 and P = 0.011). Furthermore, multiple regression analysis revealed the slower walking speed (P < 0.001) and larger knee extension moment on the non-paretic side (P = 0.003) contributed to the larger range of WBAM in the sagittal plane in the second half of the paretic gait cycle. Our findings suggest that dynamic stability in the sagittal plane is impaired in the second half of the paretic gait cycle. In addition, the large knee extension moment on the non-paretic side might play a role in the dynamic instability in the sagittal plane during gait in patients with hemiparesis.
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Affiliation(s)
- Keita Honda
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan
| | - Yusuke Sekiguchi
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan
| | - Takayuki Muraki
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan
| | - Shin-Ichi Izumi
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan; Graduate School of Biomedical Engineering, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan.
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Neptune RR, Vistamehr A. Dynamic Balance during Human Movement: Measurement and Control Mechanisms. J Biomech Eng 2018; 141:2718203. [PMID: 30516241 PMCID: PMC6611347 DOI: 10.1115/1.4042170] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 11/16/2018] [Indexed: 11/08/2022]
Abstract
Walking can be exceedingly complex to analyze due to highly nonlinear multi-body dynamics, nonlinear relationships between muscle excitations and resulting muscle forces, dynamic coupling that allows muscles to accelerate joints and segments they do not span, and redundant muscle control. Walking requires the successful execution of a number of biomechanical functions such as providing body support, forward propulsion and balance control, with specific muscle groups contributing to their execution. Thus, muscle injury or neurological impairment that affects muscle output can alter the successful execution of these functions and impair walking performance. The loss of balance control in particular can result in falls and subsequent injuries that lead to the loss of mobility and functional independence. Thus, it is important to assess the mechanisms used to control balance in clinical populations using reliable methods with the ultimate goal of improving rehabilitation outcomes. In this review, we highlight common clinical and laboratory-based measures used to assess balance control and their potential limitations, show how these measures have been used to analyze balance in several clinical populations, and consider the translation of specific laboratory-based measures from the research laboratory to the clinic.
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Affiliation(s)
- Richard R. Neptune
- Walker Department of Mechanical Engineering,
The University of Texas at Austin,
Austin 204 E. Dean Keeton Street,
Stop C2200,
Austin, TX 78712
e-mail:
| | - Arian Vistamehr
- Brooks Rehabilitation Motion Analysis Center,
Jacksonville, FL 32216
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