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Liu W, Bai J. Meta-analysis of the quantitative assessment of lower extremity motor function in elderly individuals based on objective detection. J Neuroeng Rehabil 2024; 21:111. [PMID: 38926890 PMCID: PMC11202321 DOI: 10.1186/s12984-024-01409-7] [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: 11/09/2023] [Accepted: 06/20/2024] [Indexed: 06/28/2024] Open
Abstract
OBJECTIVE To avoid deviation caused by the traditional scale method, the present study explored the accuracy, advantages, and disadvantages of different objective detection methods in evaluating lower extremity motor function in elderly individuals. METHODS Studies on lower extremity motor function assessment in elderly individuals published in the PubMed, Web of Science, Cochrane Library and EMBASE databases in the past five years were searched. The methodological quality of the included trials was assessed using RevMan 5.4.1 and Stata, followed by statistical analyses. RESULTS In total, 19 randomized controlled trials with a total of 2626 participants, were included. The results of the meta-analysis showed that inertial measurement units (IMUs), motion sensors, 3D motion capture systems, and observational gait analysis had statistical significance in evaluating the changes in step velocity and step length of lower extremity movement in elderly individuals (P < 0.00001), which can be used as a standardized basis for the assessment of motor function in elderly individuals. Subgroup analysis showed that there was significant heterogeneity in the assessment of step velocity [SMD=-0.98, 95%CI(-1.23, -0.72), I2 = 91.3%, P < 0.00001] and step length [SMD=-1.40, 95%CI(-1.77, -1.02), I2 = 86.4%, P < 0.00001] in elderly individuals. However, the sensors (I2 = 9%, I2 = 0%) and 3D motion capture systems (I2 = 0%) showed low heterogeneity in terms of step velocity and step length. The sensitivity analysis and publication bias test demonstrated that the results were stable and reliable. CONCLUSION observational gait analysis, motion sensors, 3D motion capture systems, and IMUs, as evaluation means, play a certain role in evaluating the characteristic parameters of step velocity and step length in lower extremity motor function of elderly individuals, which has good accuracy and clinical value in preventing motor injury. However, the high heterogeneity of observational gait analysis and IMUs suggested that different evaluation methods use different calculation formulas and indicators, resulting in the failure to obtain standardized indicators in clinical applications. Thus, multimodal quantitative evaluation should be integrated.
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Affiliation(s)
- Wen Liu
- Rehabilitation Medicine Center, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
- Department of Spine and Spinal Cord Surgery, Beijing Boai Hospital, China Rehabilitation Research Centre, Beijing, China
| | - Jinzhu Bai
- Rehabilitation Medicine Center, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China.
- Department of Spine and Spinal Cord Surgery, Beijing Boai Hospital, China Rehabilitation Research Centre, Beijing, China.
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China.
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Seo JW, Kang G, Kim CH, Jung J, Kim J, Kang H, Lee S. Characteristics of Gait Event and Muscle Activation Parameters of the Lower Limb on the Affected Side in Patients With Hemiplegia After Stroke: A Pilot Study. Arch Rehabil Res Clin Transl 2023; 5:100274. [PMID: 38163027 PMCID: PMC10757156 DOI: 10.1016/j.arrct.2023.100274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Objectives To confirm the characteristics of gait events and muscle activity in the lower limbs of the affected and unaffected sides in patients with hemiplegia. Design Cross-sectional study. Setting Motion analysis laboratory of the Wonkwang University Gwangju Hospital. Participants Outpatients, diagnosed with ischemic stroke more than 3 months and less than 9 months before participating in the study (N=29; 11 men, 18 women). Interventions Not applicable. Main Outcome Measures The gait event parameters and time- and frequency-domain electromyogram (EMG) parameters of the lower limbs of the affected and unaffected sides was determined using BTS motion capture with the Delsys Trigno Avanti EMG wireless system. Results The swing time, stance phase, swing phase, single support phase, and median power frequency of the gastrocnemius muscle showed a significant difference between the affected and unaffected sides. Using a logistic regression model, the swing phase, single support phase, and median frequency of the gastrocnemius muscle were selected to classify the affected side. Conclusion The single support phase of the affected side is shortened to reduce load bearing, which causes a reduction in the stance phase ratio. Unlike gait-event parameters, EMG data of hemiplegic stroke patients are difficult to generalize. Among them, the logistic regression model with some affected side parameters expected to be set as the severity and improvement baseline of the affected side. Additional data collection and generalization of muscle activity is required to improve the classification model.
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Affiliation(s)
- Jeong-Woo Seo
- Digital Health Research Division, Korea Institute of Oriental Medicine, Daejeon, Korea
| | - Geon‐hui Kang
- Stroke Korean Medicine Research Center, Wonkwang University, Iksan, Korea
| | - Cheol-hyun Kim
- Stroke Korean Medicine Research Center, Wonkwang University, Iksan, Korea
- Department of Internal Medicine and Neuroscience, College of Korean Medicine, Wonkwang University, Iksan, Korea
| | - Jeeyoun Jung
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Korea
| | - Junggil Kim
- Department of Biomedical Engineering, College of Science & Technology, Konkuk University, Chungju, Korea
| | - Hyeon Kang
- Department of Biomedical Engineering, College of Science & Technology, Konkuk University, Chungju, Korea
| | - Sangkwan Lee
- Stroke Korean Medicine Research Center, Wonkwang University, Iksan, Korea
- Department of Internal Medicine and Neuroscience, College of Korean Medicine, Wonkwang University, Iksan, Korea
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Sinovas-Alonso I, Herrera-Valenzuela D, de-Los-Reyes-Guzmán A, Cano-de-la-Cuerda R, Del-Ama AJ, Gil-Agudo Á. Construct Validity of the Gait Deviation Index for People With Incomplete Spinal Cord Injury (GDI-SCI). Neurorehabil Neural Repair 2023; 37:705-715. [PMID: 37864467 DOI: 10.1177/15459683231206747] [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] [Indexed: 10/22/2023]
Abstract
BACKGROUND The Gait Deviation Index for Spinal Cord Injury (SCI-GDI) was recently proposed as a dimensionless multivariate kinematic measure based on 21 gait features derived from 3-dimensional kinematic data which quantifies gait impairment of adult population with incomplete spinal cord injury (iSCI) relative to the normative gait of a healthy group. Nevertheless, no validity studies of the SCI-GDI have been published to date. OBJECTIVE To assess the construct validity of the SCI-GDI in adult population following iSCI. Methods. SCI-GDI data were obtained from a sample of 50 healthy volunteers and 35 adults with iSCI. iSCI group was also assessed with the following measures: 10-Meter Walk Test (10MWT) at both self-selected (SS) and maximum speeds, Timed Up and Go Test (TUGT), SS and maximum levels of the Walking Index for Spinal Cord Injury (WISCI) II, mobility items of the Spinal Cord Independence Measure III (SCIM IIIIOMob), Lower Extremity Motor Score (LEMS), and Modified Ashworth Scale (MAS). Spearman's correlation coefficient was used to investigate the relationship with the SCI-GDI. RESULTS SCI-GDI shows strong correlation with the 10MWT (r ≥ -.716) and good correlation with LEMS (r = .638), TUGT (r = -.582), SS WISCI II levels (r = .521), and SCIM IIIIOMob (r = .501). No significant correlations were found with maximum WISCI II levels and MAS (P > .006). CONCLUSIONS Construct validity of the SCI-GDI was demonstrated with the 10MWT, TUGT, LEMS, SCIM IIIIOMob, and SS WISCI II levels for independently walking adults with iSCI. Future work will include assessing the psychometric characteristics with a more heterogeneous sample, also considering the pediatric population.
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Affiliation(s)
- Isabel Sinovas-Alonso
- Biomechanics and Technical Aids Unit, National Hospital for Paraplegics (SESCAM), Toledo, Spain
- International Doctoral School, Rey Juan Carlos University, Madrid, Spain
| | - Diana Herrera-Valenzuela
- Biomechanics and Technical Aids Unit, National Hospital for Paraplegics (SESCAM), Toledo, Spain
- International Doctoral School, Rey Juan Carlos University, Madrid, Spain
| | - Ana de-Los-Reyes-Guzmán
- Biomechanics and Technical Aids Unit, National Hospital for Paraplegics (SESCAM), Toledo, Spain
- Neurorehabilitation, Biomechanics and Sensory-Motor Function (HNP-SESCAM), RDI Associated Unit of the CSIC, Toledo, Spain
| | - Roberto Cano-de-la-Cuerda
- Movement Analysis, Biomechanics, Ergonomics and Motor Control Laboratory (LAMBECOM), Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - Antonio J Del-Ama
- Department of Applied Mathematics, Materials Science and Engineering, and Electronic Technology, School of Science and Technology, Rey Juan Carlos University, Madrid, Spain
| | - Ángel Gil-Agudo
- Biomechanics and Technical Aids Unit, National Hospital for Paraplegics (SESCAM), Toledo, Spain
- Neurorehabilitation, Biomechanics and Sensory-Motor Function (HNP-SESCAM), RDI Associated Unit of the CSIC, Toledo, Spain
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Hosiasson M, Rigotti-Thompson M, Appelgren-Gonzalez JP, Covarrubias-Escudero F, Urzua B, Barria P, Aguilar R. Biomechanical Gait Effects of a Single Intervention with Wearable Closed Loop Control FES System in Chronic Stroke Patients. A Proof-of-Concept Pilot Study. IEEE Int Conf Rehabil Robot 2023; 2023:1-6. [PMID: 37941278 DOI: 10.1109/icorr58425.2023.10304779] [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: 11/10/2023]
Abstract
Foot drop is a gait disturbance characterized by difficulty in performing ankle dorsiflexion during the swing phase of the gait cycle. Current available evidence shows that functional electrical stimulation (FES) on the musculature responsible for dorsal ankle flexion during gait can have positive effects on walking ability. This study aims to present a proof of concept for a novel easy-to-use FES system and evaluates the biomechanical effects during gait in stroke patients, compared to unassisted walking. Gait was quantitatively evaluated in a movement analysis laboratory for five subjects with chronic stroke, in basal condition without assistance and in gait assisted with FES. Improvements were found in all temporospatial parameters during FES-assisted gait, evidenced by statistically significant differences only in gait speed (p=0.02). Joint kinematics showed positive changes in hip abduction and ankle dorsiflexion variables during the swing phase of the gait cycle. No significant differences were found in the Gait Deviation Index. In conclusion, the present pilot study demonstrates that the use of this FES system in the tibialis anterior muscle can cause gait functional improvements in subjects with foot drop due to chronic stroke.
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Sun Z, Lin YR, Lu MJ, Huang KY, Sun K, Zhang JB. Acupuncture for gait disturbance of patients with subacute and chronic stroke: a systematic review and meta-analysis protocol. BMJ Open 2023; 13:e071590. [PMID: 37344117 DOI: 10.1136/bmjopen-2023-071590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/23/2023] Open
Abstract
INTRODUCTION Hemiparetic gait is one of the most common sequelae of a stroke. Acupuncture has shown potential in correcting hemiplegic gait patterns and improving motor function recovery after stroke. However, controversial findings and a lack of supportive evidence on the effectiveness of acupuncture for post-stroke hemiplegia. The intelligent gait analysis system provides a new perspective for the study of hemiparetic gait. This systematic review aims to collect relevant studies and critically evaluate the efficacy and safety of acupuncture in alleviating gait disturbance of post-stroke hemiplegia based on quantified gait parameters. METHODS AND ANALYSIS A comprehensive search of PubMed, Embase, Cochrane stroke group trials register, Cochrane Central Register of Controlled Trials, CINAHL, AMED, three Chinese databases (Chinese Biomedical Literatures database (CBM), National Knowledge Infrastructure (CNKI), and Wan fang Digital Periodicals), four trails registries (The WHO International Clinical Trials Registry Platform, The Chinese Clinical Trial Registry, The US National Institutes of Health Ongoing Trials Register, and The Australian New Zealand Clinical Trials Registry) will be conducted to identify randomised controlled trials of acupuncture for gait disturbance in post-stroke patients. No restrictions on language or publication status. The primary outcomes are gait temporospatial parameters (eg, step length, stride length, step width, step frequency (cadence), walking speed, etc), and gait kinematic parameters (eg, hip peak flex/extend angle, knee peak flex/extend angle, ankle peak dorsi/plantar-flexion angle, etc). We will assess bias using the approach recommended by the Cochrane Handbook for Systematic Reviews of Interventions. A meta-analysis will be conducted to synthesise the evidence for each outcome measure. The χ2 test and I2 statistic will be used for assessing heterogeneity between studies. ETHICS AND DISSEMINATION No ethical approval is needed because no primary data is collected. Scientific conferences or peer-reviewed journals will publish the findings. PROSPERO REGISTRATION NUMBER CRD42022384348.
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Affiliation(s)
- Zheng Sun
- Department of Acupuncture and Moxibustion, The Second Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Yi-Ren Lin
- Department of Chinese Rehabilitaiton Center, The Second Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Meng-Jiang Lu
- Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing, China
| | - Kai-Yu Huang
- Department of Acupuncture, Ningbo Hospital of Traditional Chinese Medicine, Affiliated Hospital of Zhejiang Chinese Medical University, Ningbo, China
| | - Ke Sun
- Department of Acupuncture and Message, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Jian-Bin Zhang
- Department of Acupuncture and Moxibustion, The Second Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
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Herrera-Valenzuela D, Sinovas-Alonso I, Moreno JC, Gil-Agudo Á, Del-Ama AJ. Derivation of the Gait Deviation Index for Spinal Cord Injury. Front Bioeng Biotechnol 2022; 10:874074. [PMID: 35875486 PMCID: PMC9299068 DOI: 10.3389/fbioe.2022.874074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/24/2022] [Indexed: 11/13/2022] Open
Abstract
The Gait Deviation Index (GDI) is a dimensionless multivariate measure of overall gait pathology represented as a single score that indicates the gait deviation from a normal gait average. It is calculated using kinematic data recorded during a three-dimensional gait analysis and an orthonormal vectorial basis with 15 gait features that was originally obtained using singular value decomposition and feature analysis on a dataset of children with cerebral palsy. Ever since, it has been used as an outcome measure to study gait in several conditions, including spinal cord injury (SCI). Nevertheless, the validity of implementing the GDI in a population with SCI has not been studied yet. We investigate the application of these mathematical methods to derive a similar metric but with a dataset of adults with SCI (SCI-GDI). The new SCI-GDI is compared with the original GDI to evaluate their differences and assess the need for a specific GDI for SCI and with the WISCI II to evaluate its sensibility. Our findings show that a 21-feature basis is necessary to account for most of the variance in gait patterns in the SCI population and to provide high-quality reconstructions of the gait curves included in the dataset and in foreign data. Furthermore, using only the first 15 features of our SCI basis, the fidelity of the reconstructions obtained in our population is higher than that when using the basis of the original GDI. The results showed that the SCI-GDI discriminates most levels of the WISCI II scale, except for levels 12 and 18. Statistically significant differences were found between both indexes within each WISCI II level except for 12, 20, and the control group (p < 0.05). In all levels, the average GDI value was greater than the average SCI-GDI value, but the difference between both indexes is larger in data with greater impairment and it reduces progressively toward a normal gait pattern. In conclusion, the implementation of the original GDI in SCI may lead to overestimation of gait function, and our new SCI-GDI is more sensitive to larger gait impairment than the GDI. Further validation of the SCI-GDI with other scales validated in SCI is needed.
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Affiliation(s)
- Diana Herrera-Valenzuela
- International Doctoral School, Rey Juan Carlos University, Madrid, Spain.,Biomechanics and Technical Aids Unit, National Hospital for Paraplegics, Toledo, Spain
| | - Isabel Sinovas-Alonso
- International Doctoral School, Rey Juan Carlos University, Madrid, Spain.,Biomechanics and Technical Aids Unit, National Hospital for Paraplegics, Toledo, Spain
| | - Juan C Moreno
- Neural Rehabilitation Group, Cajal Institute, CSIC-Spanish National Research Council, Madrid, Spain
| | - Ángel Gil-Agudo
- Biomechanics and Technical Aids Unit, National Hospital for Paraplegics, Toledo, Spain
| | - Antonio J Del-Ama
- School of Science and Technology, Department of Applied Mathematics, Materials Science and Engineering and Electronic Technology, Rey Juan Carlos University, Madrid, Spain
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Brain Asymmetry and Its Effects on Gait Strategies in Hemiplegic Patients: New Rehabilitative Conceptions. Brain Sci 2022; 12:brainsci12060798. [PMID: 35741683 PMCID: PMC9220897 DOI: 10.3390/brainsci12060798] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/08/2022] [Accepted: 06/17/2022] [Indexed: 11/16/2022] Open
Abstract
Brain asymmetry is connected with motor performance, suggesting that hemiparetic patients have different gait patterns depending on the side of the lesion. This retrospective cohort study aims to further investigate the difference between right and left hemiplegia in order to assess whether the injured side can influence the patient’s clinical characteristics concerning gait, thus providing insights for new personalized rehabilitation strategies. The data from 33 stroke patients (17 with left and 16 with right hemiplegia) were retrospectively compared with each other and with a control group composed of 20 unaffected age-matched individuals. The 3D gait analysis was used to assess kinematic data and spatio-temporal parameters. Compared to left hemiplegic patients, right hemiplegic patients showed worse spatio-temporal parameters (p < 0.05) and better kinematic parameters (p < 0.05). Both pathological groups were characterized by abnormal gait parameters in comparison with the control group (p < 0.05). These findings show an association between the side of the lesion—right or left—and the different stroke patients’ gait patterns: left hemiplegic patients show better spatio-temporal parameters, whereas right hemiplegic patients show better segmentary motor performances. Therefore, further studies may develop and assess new personalized rehabilitation strategies considering the injured hemisphere and brain asymmetry.
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Three decades of gait index development: A comparative review of clinical and research gait indices. Clin Biomech (Bristol, Avon) 2022; 96:105682. [PMID: 35640522 DOI: 10.1016/j.clinbiomech.2022.105682] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 03/14/2022] [Accepted: 05/17/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND A wide variety of indices have been developed to quantify gait performance markers and associate them with their respective pathologies. Indices scores have enabled better decisions regarding patient treatments and allowed for optimized monitoring of the evolution of their condition. The extensive range of human gait indices presented over the last 30 years is evaluated and summarized in this narrative literature review exploring their application in clinical and research environments. METHODS The analysis will explore historical and modern gait indices, focusing on the clinical efficacy with respect to their proposed pathology, age range, and associated parameter limits. Features, methods, and clinically acceptable errors are discussed while simultaneously assessing indices advantages and disadvantages. This review analyses all indices published between 1994 and February 2021 identified using the Medline, PubMed, ScienceDirect, CINAHL, EMBASE, and Google Scholar databases. FINDINGS A total of 30 indices were identified as noteworthy for clinical and research purposes and another 137 works were included for discussion. The indices were divided in three major groups: observational (13), instrumented (16) and hybrid (1). The instrumented indices were further sub-divided in six groups, namely kinematic- (4), spatiotemporal- (5), kinetic- (2), kinematic- and kinetic- (2), electromyographic- (1) and Inertial Measurement Unit-based indices (2). INTERPRETATION This work is one of the first reviews to summarize observational and instrumented gait indices, exploring their applicability in research and clinical contexts. The aim of this review is to assist members of these communities with the selection of the proper index for the group in analysis.
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Sinovas-Alonso I, Herrera-Valenzuela D, Cano-de-la-Cuerda R, Reyes-Guzmán ADL, del-Ama AJ, Gil-Agudo Á. Application of the Gait Deviation Index to Study Gait Impairment in Adult Population With Spinal Cord Injury: Comparison With the Walking Index for Spinal Cord Injury Levels. Front Hum Neurosci 2022; 16:826333. [PMID: 35444522 PMCID: PMC9013754 DOI: 10.3389/fnhum.2022.826333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/07/2022] [Indexed: 11/26/2022] Open
Abstract
The Gait Deviation Index (GDI) is a multivariate measure of overall gait pathology based on 15 gait features derived from three-dimensional (3D) kinematic data. GDI aims at providing a comprehensive, easy to interpret, and clinically meaningful metric of overall gait function. It has been used as an outcome measure to study gait in several conditions: cerebral palsy (CP), post-stroke hemiparetic gait, Duchenne muscular dystrophy, and Parkinson’s disease, among others. Nevertheless, its use in population with Spinal Cord Injury (SCI) has not been studied yet. The aim of the present study was to investigate the applicability of the GDI to SCI through the assessment of the relationship of the GDI with the Walking Index for Spinal Cord Injury (WISCI) II. 3D gait kinematics of 34 patients with incomplete SCI (iSCI) was obtained. Besides, 3D gait kinematics of a sample of 50 healthy volunteers (HV) was also gathered with Codamotion motion capture system. A total of 302 (iSCI) and 446 (HV) strides were collected. GDI was calculated for each stride and grouped for each WISCI II level. HV data were analyzed as an additional set. Normal distribution for each group was assessed with Kolmogorov-Smirnov tests. Afterward, ANOVA tests were performed between each pair of WISCI II levels to identify differences among groups (p < 0.05). The results showed that the GDI was normally distributed across all WISCI II levels in both iSCI and HV groups. Furthermore, our results showed an increasing relationship between the GDI values and WISCI II levels in subjects with iSCI, but only discriminative in WISCI II levels 13, 19, and 20. The index successfully distinguished HV group from all the individuals with iSCI. Findings of this study indicated that the GDI is not an appropriate multivariate walking metric to represent the deviation of gait pattern in adult population with iSCI from a normal gait profile when it is compared with the levels of walking impairment described by the WISCI II. Future work should aim at defining and validating an overall gait index derived from 3D kinematic gait variables appropriate for SCI, additionally taking into account other walking ability outcome measures.
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Affiliation(s)
- Isabel Sinovas-Alonso
- International Doctoral School, Rey Juan Carlos University, Madrid, Spain
- Biomechanics and Technical Aids Unit, National Hospital for Paraplegics, Toledo, Spain
- *Correspondence: Isabel Sinovas-Alonso,
| | - Diana Herrera-Valenzuela
- International Doctoral School, Rey Juan Carlos University, Madrid, Spain
- Biomechanics and Technical Aids Unit, National Hospital for Paraplegics, Toledo, Spain
| | - Roberto Cano-de-la-Cuerda
- Faculty of Health Sciences, Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Rey Juan Carlos University, Alcorcón, Spain
- Roberto Cano-de-la-Cuerda,
| | | | - Antonio J. del-Ama
- School of Science and Technology, Department of Applied Mathematics, Materials Science, Engineering and Electronic Technology, Rey Juan Carlos University, Móstoles, Spain
| | - Ángel Gil-Agudo
- Biomechanics and Technical Aids Unit, National Hospital for Paraplegics, Toledo, Spain
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Lee Y, Shin S. Improvement of Gait in Patients with Stroke Using Rhythmic Sensory Stimulation: A Case-Control Study. J Clin Med 2022; 11:jcm11020425. [PMID: 35054122 PMCID: PMC8780685 DOI: 10.3390/jcm11020425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/03/2022] [Accepted: 01/11/2022] [Indexed: 12/14/2022] Open
Abstract
Patients with stroke suffer from impaired locomotion, exhibiting unstable walking with increased gait variability. Effects of rhythmic sensory stimulation on unstable gait of patients with chronic stroke are unclear. This study aims to determine the effects of rhythmic sensory stimulation on the gait of patients with chronic stroke. Twenty older adults with stroke and twenty age- and gender-matched healthy controls walked 60 m under four conditions: normal walking with no stimulation, walking with rhythmic auditory stimulation (RAS) through an earphone in the ear, walking with rhythmic somatosensory stimulation (RSS) through a haptic device on the wrist of each participant, and walking with rhythmic combined stimulation (RCS: RAS + RSS). Gait performance in the stroke group significantly improved during walking with RAS, RSS, and RCS compared to that during normal walking (p < 0.008). Gait variability significantly decreased under the RAS, RSS, and RCS conditions compared to that during normal walking (p < 0.008). Rhythmic sensory stimulation is effective in improving the gait of patients with chronic stroke, regardless of the type of rhythmic stimuli, compared to healthy controls. The effect was greater in patients with reduced mobility, assessed by the Rivermead Mobility Index (RMI).
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Affiliation(s)
- Yungon Lee
- Research Institute of Human Ecology, Yeungnam University, Gyeongsan-si 38541, Korea;
- Neuromuscular Control Laboratory, Yeungnam University, Gyeongsan-si 38541, Korea
- School of Kinesiology, College of Human Ecology & Kinesiology, Yeungnam University, 221ho, 280 Daehak-ro, Gyeongsan-si 38541, Korea
| | - Sunghoon Shin
- Research Institute of Human Ecology, Yeungnam University, Gyeongsan-si 38541, Korea;
- Neuromuscular Control Laboratory, Yeungnam University, Gyeongsan-si 38541, Korea
- School of Kinesiology, College of Human Ecology & Kinesiology, Yeungnam University, 221ho, 280 Daehak-ro, Gyeongsan-si 38541, Korea
- Correspondence: ; Tel.: +82-10-8940-2406
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Haruyama K, Kawakami M, Okada K, Okuyama K, Tsuzuki K, Liu M. Pelvis-Toe Distance: 3-Dimensional Gait Characteristics of Functional Limb Shortening in Hemiparetic Stroke. SENSORS 2021; 21:s21165417. [PMID: 34450859 PMCID: PMC8401521 DOI: 10.3390/s21165417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/06/2021] [Accepted: 08/09/2021] [Indexed: 12/17/2022]
Abstract
We aimed to investigate whether a newly defined distance in the lower limb can capture the characteristics of hemiplegic gait compared to healthy controls. Three-dimensional gait analyses were performed on 42 patients with chronic stroke and 10 age-matched controls. Pelvis-toe distance (PTD) was calculated as the absolute distance between an anterior superior iliac spine marker and a toe marker during gait normalized by PTD in the bipedal stance. The shortening peak during the swing phase was then quantified as PTDmin. The sagittal clearance angle, the frontal compensatory angle, gait speed, and the observational gait scale were also collected. PTDmin in the stroke group showed less shortening on the affected side and excessive shortening on the non-affected side compared to controls. PTDmin on the affected side correlated negatively with the sagittal clearance peak angle and positively with the frontal compensatory peak angle in the stroke group. PTDmin in stroke patients showed moderate to high correlations with gait speed and observational gait scale. PTDmin adequately reflected gait quality without being affected by apparent improvements due to frontal compensatory patterns. Our results showed that various impairments and compensations were included in the inability to shorten PTD, which can provide new perspectives on gait rehabilitation in stroke patients.
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The Actuation System of the Ankle Exoskeleton T-FLEX: First Use Experimental Validation in People with Stroke. Brain Sci 2021; 11:brainsci11040412. [PMID: 33805216 PMCID: PMC8064364 DOI: 10.3390/brainsci11040412] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 12/17/2022] Open
Abstract
Robotic devices can provide physical assistance to people who have suffered neurological impairments such as stroke. Neurological disorders related to this condition induce abnormal gait patterns, which impede the independence to execute different Activities of Daily Living (ADLs). From the fundamental role of the ankle in walking, Powered Ankle-Foot Orthoses (PAFOs) have been developed to enhance the users’ gait patterns, and hence their quality of life. Ten patients who suffered a stroke used the actuation system of the T-FLEX exoskeleton triggered by an inertial sensor on the foot tip. The VICONmotion capture system recorded the users’ kinematics for unassisted and assisted gait modalities. Biomechanical analysis and usability assessment measured the performance of the system actuation for the participants in overground walking. The biomechanical assessment exhibited changes in the lower joints’ range of motion for 70% of the subjects. Moreover, the ankle kinematics showed a correlation with the variation of other movements analyzed. This variation had positive effects on 70% of the participants in at least one joint. The Gait Deviation Index (GDI) presented significant changes for 30% of the paretic limbs and 40% of the non-paretic, where the tendency was to decrease. The spatiotemporal parameters did not show significant variations between modalities, although users’ cadence had a decrease of 70% of the volunteers. Lastly, the satisfaction with the device was positive, the comfort being the most user-selected aspect. This article presents the assessment of the T-FLEX actuation system in people who suffered a stroke. Biomechanical results show improvement in the ankle kinematics and variations in the other joints. In general terms, GDI does not exhibit significant increases, and the Movement Analysis Profile (MAP) registers alterations for the assisted gait with the device. Future works should focus on assessing the full T-FLEX orthosis in a larger sample of patients, including a stage of training.
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Gait Indices for Characterization of Patients with Unilateral Cerebral Palsy. J Clin Med 2020; 9:jcm9123888. [PMID: 33265919 PMCID: PMC7760302 DOI: 10.3390/jcm9123888] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 11/25/2020] [Accepted: 11/27/2020] [Indexed: 11/21/2022] Open
Abstract
As cerebral palsy (CP) is a complex disorder, classification of gait pathologies is difficult. It is assumed that unclassified patients show less functional impairment and less gait deviation. The aim of this study was to assess the different subgroups and the unclassified patients with unilateral CP using different gait indices. The Gillette Gait Index (GGI), Gait Deviation Index (GDI), Gait Profile Score (GPS) and spatiotemporal parameters derived from instrumented 3D-Gait Analysis (IGA) were assessed. Subgroups were defined using morphological and functional classification systems. Regarding the different gait indices, a ranking of the different gait patterns is evident. Significant differences were found between GMFCS level I and II, Winters et al. (Winters, Gage, Hicks; WGH) type IV and type I and the WGH-unclassified. Concerning the spatiotemporal parameters significant differences were found between GMFCS level I and II concerning velocity. The unclassified patients showed mean values for the different gait indices that were comparable to those of established subgroups. Established gait patterns cause different degrees of gait deviation and functional impairment. The unclassified patients do not differ from established gait patterns but from the unimpaired gait. Further evaluation using 3D-IGA is necessary to identify the underlying gait pathologies of the unclassified patients.
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Guzik A, Drużbicki M, Wolan-Nieroda A, Turolla A, Kiper P. Estimating Minimal Clinically Important Differences for Knee Range of Motion after Stroke. J Clin Med 2020; 9:jcm9103305. [PMID: 33076214 PMCID: PMC7602397 DOI: 10.3390/jcm9103305] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 09/30/2020] [Accepted: 10/11/2020] [Indexed: 12/21/2022] Open
Abstract
The importance of knee sagittal kinematic parameters, as a predictor of walking performance in post-stroke gait has been emphasised by numerous researchers. However, no studies so far were designed to determine the minimal clinically important differences (MCID), i.e., the smallest difference in the relevant score for the kinematic gait parameters, which are perceived as beneficial for patients with stroke. Studies focusing on clinically important difference are useful because they can identify the clinical relevance of changes in the scores. The purpose of the study was to estimate the MCID for knee range of motion (ROM) in the sagittal plane for the affected and unaffected side at a chronic stage post-stroke. Fifty individuals were identified in a database of a rehabilitation clinic. We estimated MCID values using: an anchor-based method, distribution-based method, linear regression analysis and specification of the receiver operating characteristic (ROC) curve. In the anchor-based study, the mean change in knee flexion/extension ROM for the affected/unaffected side in the MCID group amounted to 8.48°/6.81° (the first MCID estimate). In the distribution-based study, the standard error of measurement for the no-change group was 1.86°/5.63° (the second MCID estimate). Method 3 analyses showed 7.71°/4.66° change in the ROM corresponding to 1.85-point change in the Barthel Index. The best cut-off point, determined with ROC curve, was the value corresponding to 3.9°/3.8° of change in the knee sagittal ROM for the affected/unaffected side (the fourth MCID estimate). We have determined that, in chronic stroke, MCID estimates of knee sagittal ROM for the affected side amount to 8.48° and for the unaffected side to 6.81°. These findings will assist clinicians and researchers in interpreting the significance of changes observed in kinematic sagittal plane parameters of the knee. The data are part of the following clinical trial: Australian New Zealand Clinical Trials Registry: ACTRN12617000436370
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Affiliation(s)
- Agnieszka Guzik
- Department of Physiotherapy, Institute of Health Sciences, Medical College, University of Rzeszów, 35-959 Rzeszów, Poland; (M.D.); (A.W.-N.)
- Correspondence: ; Tel.: +48-17-872-1153; Fax: +48-17-872-19-30
| | - Mariusz Drużbicki
- Department of Physiotherapy, Institute of Health Sciences, Medical College, University of Rzeszów, 35-959 Rzeszów, Poland; (M.D.); (A.W.-N.)
| | - Andżelina Wolan-Nieroda
- Department of Physiotherapy, Institute of Health Sciences, Medical College, University of Rzeszów, 35-959 Rzeszów, Poland; (M.D.); (A.W.-N.)
| | - Andrea Turolla
- Laboratory of Kinematics and Robotics IRCCS San Camillo Hospital, 30126 Venice, Italy;
| | - Pawel Kiper
- Azienda ULSS 3 Serenissima Physical Medicine and Rehabilitation Unit, 30126 Venice, Italy;
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