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Skovgaard Jensen J, Holsgaard-Larsen A, Stengaard Sørensen A, Aagaard P, Bojsen-Møller J. Acute effects of robot-assisted body weight unloading on biomechanical movement patterns during overground walking. J Biomech 2024; 162:111862. [PMID: 37976689 DOI: 10.1016/j.jbiomech.2023.111862] [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: 04/13/2023] [Revised: 11/01/2023] [Accepted: 11/03/2023] [Indexed: 11/19/2023]
Abstract
Body weight unloading (BWU) is used in rehabilitation/training settings to reduce kinetic requirements, however different BWU methods may be unequally capable of preserving biomechanical movement patterns. Biomechanical analysis of both kinetic and kinematic movement trajectories rather than discrete variables has not previously been performed to describe the effect of BWU on gait patterns during horizontal walking. The aim of the present study was to investigate how robot-assisted BWU producing an dynamic unloading force on the body centre of mass, affects kinematic, kinetic, and spatiotemporal gait parameters in healthy young adults by use of time-continuous analysis. Twenty participants walked overground in a 3-D motion-capture lab at 0, 10, 20, 30, 40, and 50 % BWU at a self-selected speed. Vertical and anterior-posterior ground reaction forces (GRFs) and lower limb internal joint moments were obtained during the stance phase, while joint angles were obtained during entire strides. Time-continuous data were analysed using Statistical Parametric Mapping (SPM) and discrete data using conventional statistics to compare different BWU conditions by means of One-Way Repeated Measures Anova. With increasing BWU, corresponding reductions were observed for GRFs, internal joint moments, joint angles, walking speed, stride/step length and cadence. Observed effects were partially caused by decreased walking speed and increased BWU. While amplitude reductions were observed for kinetic and kinematic variables, trajectory shapes were largely preserved. In conclusion, dynamic robot-assisted BWU enables reduced kinetic requirements without distorting biomechanically normal gait patterns during overground walking in young healthy adults.
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Affiliation(s)
| | | | | | - Per Aagaard
- Research Unit of Muscle Physiology and Biomechanics, Department of Sport Science and Clinical Biomechanics, SDU, Denmark
| | - Jens Bojsen-Møller
- Research Unit of Muscle Physiology and Biomechanics, Department of Sport Science and Clinical Biomechanics, SDU, Denmark
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Heo JS, Lee HJ, Ko BW, Yoon HS, Bae YH. Usability of the novel ankle training equipment with spring resistance-based plantar press exercises in the standing position: A focus on chronic stroke patients with hemiplegic gait. Technol Health Care 2024; 32:1149-1158. [PMID: 38073345 DOI: 10.3233/thc-230747] [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: 03/23/2024]
Abstract
BACKGROUND To improve gait disability in patients with chronic stroke, ankle muscle strengthening and calf muscle stretching exercises are required. However, currently available ankle training equipment limit ankle exercises based on the position. Recently developed ankle training equipment enables spring resistance-based plantar press exercises to be performed in the standing position with weight support. OBJECTIVE To conduct a usability test of the ankle training equipment in the standing position by stroke patients with hemiplegic gait and verify its effects on ankle movements. METHODS The ankle training equipment was applied to five patients with chronic stroke and hemiplegic gait. In the standing position, the patients performed forefoot and rearfoot press exercises in the affected side with a day's interval at 20 repetitions maximum (RM). During the exercises, surface electromyography (sEMG) was used to measure the maximum voluntary isometric contraction (%MVIC) of the leg muscles. The System Usability Scale (SUS) was used to assess the ankle training equipment. Wilcoxon signed-rank test was used to evaluate the differences in muscle activity between the two exercises. RESULTS Forefoot and rearfoot press exercises increased the %MVIC in the biceps femoris. Additionally, the tibialis anterior and medial gastrocnemius activity was significantly different between the two exercises. The SUS was 78.75% (SD 12.7). CONCLUSION The usability test of the passive-control foot press trainer (PFPT) that with improvements in the structure and functions for convenience, it could be commercialized. PFPT could be an alternative to the ankle rehabilitation robot that necessitates a sitting position.
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Affiliation(s)
- Jin-Su Heo
- Department of Clinical Rehabilitation Research, National Rehabilitation Research Institute, Seoul, Korea
| | - Hyung-Joo Lee
- Department of Rehabilitation and Assistive Technology, National Rehabilitation Research Institute, Seoul, Korea
| | - Byung-Woo Ko
- Department of Rehabilitation and Assistive Technology, National Rehabilitation Research Institute, Seoul, Korea
| | - Hyun-Soo Yoon
- Daegu Gyeongbuk Institute of Science and Technology, Daegu, Korea
| | - Young-Hyeon Bae
- Department of Healthcare and Public Health Research, National Rehabilitation Research Institute, Seoul, Korea
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Kantha P, Hsu WL, Chen PJ, Tsai YC, Lin JJ. A novel balance training approach: Biomechanical study of virtual reality-based skateboarding. Front Bioeng Biotechnol 2023; 11:1136368. [PMID: 36845193 PMCID: PMC9950389 DOI: 10.3389/fbioe.2023.1136368] [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: 01/03/2023] [Accepted: 01/26/2023] [Indexed: 02/12/2023] Open
Abstract
Introduction: The use of virtual reality (VR) technology in training and rehabilitation gained increasing attention in recent years due to its potential to provide immersive and interactive experiences. We developed a novel VR-based balance training, VR-skateboarding, for improving balance. It is important to investigate the biomechanical aspects of this training, as it would have benefited both health professionals and software engineers. Aims: This study aimed to compare the biomechanical characteristics of VR-skateboarding with those of walking. Materials and Methods: Twenty young participants (10 males and 10 females) were recruited. Participants underwent VR-skateboarding and walking at the comfortable walking speed, with the treadmill set at the same speed for both tasks. The motion capture system and electromyography were used to determine joint kinematics and muscle activity of the trunk and legs, respectively. The force platform was also used to collect the ground reaction force. Results: Participants demonstrated increased trunk flexion angles and muscle activity of trunk extensor during VR-skateboarding than during walking (p < 0.01). For the supporting leg, participants' joint angles of hip flexion and ankle dorsiflexion, as well as muscle activity of knee extensor, were higher during VR-skateboarding than during walking (p < 0.01). For the moving leg, only hip flexion increased in VR-skateboarding when compared to walking (p < 0.01). Furthermore, participants increased weight distribution in the supporting leg during VR-skateboarding (p < 0.01). Conclusion: VR-skateboarding is a novel VR-based balance training that has been found to improve balance through increased trunk and hip flexion, facilitated knee extensor muscles, and increased weight distribution on the supporting leg compared to walking. These differences in biomechanical characteristics have potential clinical implications for both health professionals and software engineers. Health professionals may consider incorporating VR-skateboarding into training protocols to improve balance, while software engineers may use this information to design new features in VR systems. Our study suggests that the impact of VR-skateboarding particularly manifest when focusing on the supporting leg.
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Affiliation(s)
- Phunsuk Kantha
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wei-Li Hsu
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan,Physical Therapy Center, National Taiwan University Hospital, Taipei, Taiwan,*Correspondence: Wei-Li Hsu,
| | - Po-Jung Chen
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Ching Tsai
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jiu-Jenq Lin
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan,Division of Physical Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
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De Martino E, Green DA, Ciampi de Andrade D, Weber T, Herssens N. Human movement in simulated hypogravity-Bridging the gap between space research and terrestrial rehabilitation. Front Neurol 2023; 14:1062349. [PMID: 36815001 PMCID: PMC9939477 DOI: 10.3389/fneur.2023.1062349] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 01/18/2023] [Indexed: 02/09/2023] Open
Abstract
Human movement is optimized to Earth's gravity and based on highly complex interactions between sensory and neuro-muscular systems. Yet, humans are able to adapt-at least partially-to extreme environments upon and beyond Earth's surface. With upcoming Lunar Gateway and Artemis missions, it is crucial to increase our understanding of the impact of hypogravity-i.e., reduced vertical loading-on physiological and sensory-motor performances to improve countermeasure programs, and define crewmember's readiness to perform mission critical tasks. Several methodologies designed to reduce vertical loading are used to simulate hypogravity on Earth, including body weight support (BWS) devices. Countering gravity and offloading the human body is also used in various rehabilitation scenarios to improve motor recovery in neurological and orthopedic impairments. Thus, BWS-devices have the potential of advancing theory and practice of both space exploration and terrestrial rehabilitation by improving our understanding of physiological and sensory-motor adaptations to reduced vertical loading and sensory input. However, lack of standardization of BWS-related research protocols and reporting hinders the exchange of key findings and new advancements in both areas. The aim of this introduction paper is to review the role of BWS in understanding human movement in simulated hypogravity and the use of BWS in terrestrial rehabilitation, and to identify relevant research areas contributing to the optimization of human spaceflight and terrestrial rehabilitation. One of the main aims of this research topic is to facilitate standardization of hypogravity-related research protocols and outcome reporting, aimed at optimizing knowledge transfer between space research and BWS-related rehabilitation sciences.
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Affiliation(s)
- Enrico De Martino
- Department of Health Science and Technology, Center for Neuroplasticity and Pain, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - David A. Green
- Space Medicine Team, European Astronaut Centre, Cologne, Germany,KBR GmbH, Cologne, Germany,Centre of Human and Applied Physiological Sciences, King's College London, London, United Kingdom
| | - Daniel Ciampi de Andrade
- Department of Health Science and Technology, Center for Neuroplasticity and Pain, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Tobias Weber
- Space Medicine Team, European Astronaut Centre, Cologne, Germany,KBR GmbH, Cologne, Germany
| | - Nolan Herssens
- Space Medicine Team, European Astronaut Centre, Cologne, Germany,*Correspondence: Nolan Herssens ✉
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Meek WM, Kucharik MP, Eberlin CT, Naessig SA, Rudisill SS, Martin SD. Calf Strain in Athletes. JBJS Rev 2022; 10:01874474-202203000-00015. [PMID: 35316243 DOI: 10.2106/jbjs.rvw.21.00183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Calf strain is a common condition. In high-performance athletes, calf strain contributes to a substantial absence from competition. » Player age and history of a calf strain or other leg injury are the strongest risk factors for calf strain injury and reinjury. » Although the diagnosis is often clinical, magnetic resonance imaging and ultrasound are valuable to confirm the location of the strain and the grade of injury. » Nonoperative treatment is effective for most calf strain injuries. Operative management, although rarely indicated, may be appropriate for severe cases with grade-III rupture or complications. » Further investigation is necessary to elucidate the benefits of blood flow restriction therapy, deep water running, lower-body positive pressure therapy, platelet-rich plasma, and stem cell therapy for calf strain rehabilitation.
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Ison C, Neilsen C, DeBerardinis J, Trabia MB, Dufek JS. Use of Pressure-Measuring Insoles to Characterize Gait Parameters in Simulated Reduced-Gravity Conditions. SENSORS 2021; 21:s21186244. [PMID: 34577451 PMCID: PMC8473299 DOI: 10.3390/s21186244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/28/2021] [Accepted: 09/14/2021] [Indexed: 11/16/2022]
Abstract
Prior researchers have observed the effect of simulated reduced-gravity exercise. However, the extent to which lower-body positive-pressure treadmill (LBPPT) walking alters kinematic gait characteristics is not well understood. The purpose of the study was to investigate the effect of LBPPT walking on selected gait parameters in simulated reduced-gravity conditions. Twenty-nine college-aged volunteers participated in this cross-sectional study. Participants wore pressure-measuring insoles (Medilogic GmBH, Schönefeld, Germany) and completed three 3.5-min walking trials on the LBPPT (AlterG, Inc., Fremont, CA, USA) at 100% (normal gravity) as well as reduced-gravity conditions of 40% and 20% body weight (BW). The resulting insole data were analyzed to calculate center of pressure (COP) variables: COP path length and width and stance time. The results showed that 100% BW condition was significantly different from both the 40% and 20% BW conditions, p < 0.05. There were no significant differences observed between the 40% and 20% BW conditions for COP path length and width. Conversely, stance time significantly differed between the 40% and 20% BW conditions. The findings of this study may prove beneficial for clinicians as they develop rehabilitation strategies to effectively unload the individual's body weight to perform safe exercises.
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Affiliation(s)
- Christian Ison
- Department of Kinesiology and Nutrition Sciences, University of Nevada, Las Vegas, NV 89154, USA;
- Correspondence: ; Tel.: +1-626-824-4007
| | - Connor Neilsen
- Department of Mechanical Engineering, University of Nevada, Las Vegas, NV 89154, USA; (C.N.); (J.D.); (M.B.T.)
| | - Jessica DeBerardinis
- Department of Mechanical Engineering, University of Nevada, Las Vegas, NV 89154, USA; (C.N.); (J.D.); (M.B.T.)
| | - Mohamed B. Trabia
- Department of Mechanical Engineering, University of Nevada, Las Vegas, NV 89154, USA; (C.N.); (J.D.); (M.B.T.)
| | - Janet S. Dufek
- Department of Kinesiology and Nutrition Sciences, University of Nevada, Las Vegas, NV 89154, USA;
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MacLean MK, Ferris DP. Human muscle activity and lower limb biomechanics of overground walking at varying levels of simulated reduced gravity and gait speeds. PLoS One 2021; 16:e0253467. [PMID: 34260611 PMCID: PMC8279339 DOI: 10.1371/journal.pone.0253467] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 06/04/2021] [Indexed: 12/03/2022] Open
Abstract
Reducing the mechanical load on the human body through simulated reduced gravity can reveal important insight into locomotion biomechanics. The purpose of this study was to quantify the effects of simulated reduced gravity on muscle activation levels and lower limb biomechanics across a range of overground walking speeds. Our overall hypothesis was that muscle activation amplitudes would not decrease proportionally to gravity level. We recruited 12 participants (6 female, 6 male) to walk overground at 1.0, 0.76, 0.55, and 0.31 G for four speeds: 0.4, 0.8, 1.2, and 1.6 ms-1. We found that peak ground reaction forces, peak knee extension moment in early stance, peak hip flexion moment, and peak ankle extension moment all decreased substantially with reduced gravity. The peak knee extension moment at late stance/early swing did not change with gravity. The effect of gravity on muscle activity amplitude varied considerably with muscle and speed, often varying nonlinearly with gravity level. Quadriceps (rectus femoris, vastus lateralis, & vastus medialis) and medial gastrocnemius activity decreased in stance phase with reduced gravity. Soleus and lateral gastrocnemius activity had no statistical differences with gravity level. Tibialis anterior and biceps femoris increased with simulated reduced gravity in swing and stance phase, respectively. The uncoupled relationship between simulated gravity level and muscle activity have important implications for understanding biomechanical muscle functions during human walking and for the use of bodyweight support for gait rehabilitation after injury.
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Affiliation(s)
- Mhairi K. MacLean
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida, United States of America
- * E-mail: (MKM); (DPF)
| | - Daniel P. Ferris
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida, United States of America
- * E-mail: (MKM); (DPF)
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Tang HF, Yang B, Lin Q, Liang JJ, Mou ZW. Dynamic biomechanical effect of lower body positive pressure treadmill training for hemiplegic gait rehabilitation after stroke: A case report. World J Clin Cases 2021; 9:632-638. [PMID: 33553401 PMCID: PMC7829723 DOI: 10.12998/wjcc.v9.i3.632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/18/2020] [Accepted: 11/29/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Lower body positive pressure (LBPP) treadmill has potential applications for improving the gait of patients after stroke, but the related mechanism remains unclear.
CASE SUMMARY A 62-year-old male patient suffered from ischemic stroke with hemiplegic gait. He was referred to our hospital because of a complaint of left limb weakness for 2 years. The LBPP training was performed one session per day and six times per week for 2 wk. The dynamic plantar pressure analysis was taken every 2 d. Meanwhile, three-digital gait analysis and synchronous electromyography as well as clinical assessments were taken before and after LBPP intervention and at the 4-wk follow-up. During LBPP training, our patient not only improved his lower limb muscle strength and walking speed, but more importantly, the symmetry index of various biomechanical indicators improved. Moreover, the patient’s planter pressure transferring from the heel area to toe area among the LBPP training process and the symmetry of lower body biomechanical parameters improved.
CONCLUSION In this study, we documented a dynamic improvement of gait performance in a stroke patient under LBPP training, which included lower limb muscle strength, walking speed, and symmetry of lower limb biomechanics. Our study provides some crucial clues about the potential dynamic mechanism for LBPP training on gait and balance improvement, which is related to rebuilding foot pressure distribution and remodeling symmetry of biomechanics of the lower limb.
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Affiliation(s)
- Hui-Fang Tang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Jinan University, Guangzhou 510630, Guangdong Province, China
| | - Bing Yang
- Department of Neurology, The First Affiliated Hospital of Jinan University, Guangzhou 510630, Guangdong Province, China
| | - Qiang Lin
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou 510070, Guangdong Province, China
| | - Jun-Jie Liang
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou 510070, Guangdong Province, China
| | - Zhi-Wei Mou
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Jinan University, Guangzhou 510630, Guangdong Province, China
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Whiteley R, Hansen C, Thomson A, Sideris V, Wilson MG. Lower limb EMG activation during reduced gravity running on an incline. Speed matters more than hills irrespective of indicated bodyweight. Gait Posture 2021; 83:52-59. [PMID: 33075719 DOI: 10.1016/j.gaitpost.2020.09.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/14/2020] [Accepted: 09/30/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Progressive loading of the lower limb muscles during running on a positive pressure or reduced gravity (Alter-G™) treadmill is suggested as a rehabilitation strategy after muscle and tendon injury but the influence of running up or downhill and at higher speeds is not known, nor are the interaction effects of speed, inclination, and indicated bodyweight. RESEARCH QUESTION What are the lower limb EMG activation levels and cadence when running up and downhill in normal and reduced gravity? METHODS 10 recreationally active male athletes ran on a positive-pressure Alter-G™ treadmill at: 3 indicated bodyweights (60 %, 80 %, and 100 %); 5 speeds (12, 15, 18, 21, and 24 km/h); for incline, decline, and flat conditions (-15 %, -10 %, -5%, 0%, 5%, 10 %, and 15 %); while monitoring the surface EMG of 11 leg muscles as well as cadence (strides per minute). RESULTS AND SIGNIFICANCE Linear mixed models showed significant effect of running speed, inclination, and indicated bodyweight, with interaction effects observed. Increasing running speed was associated with the largest change in activity, with smaller effects for increasing bodyweight and inclination. Downhill running was associated with reduced activity in all muscle groups, and more tightly clustered activity patterns independent of speed. Substantial variation in sEMG activity occurred in the flat and uphill conditions. Subject responses were quite variable for sEMG, less so for cadence. For the conditions examined, increasing running speed induced the largest changes in EMG of all muscles examined with smaller changes seen for manipulations of inclination and bodyweight.
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Affiliation(s)
- Rod Whiteley
- Aspetar Orthopaedic and Sports Medicine Hospital, Rehabilitation Department, Doha, Qatar.
| | - Clint Hansen
- Neurogeriatrics Kiel, Kiel University, Department of Neurology, UKSH Campus Kiel, Kiel, Germany
| | - Athol Thomson
- Aspetar Orthopaedic and Sports Medicine Hospital, Rehabilitation Department, Doha, Qatar
| | - Vasileios Sideris
- Aspetar Orthopaedic and Sports Medicine Hospital, Rehabilitation Department, Doha, Qatar
| | - Mathew G Wilson
- Aspetar Orthopaedic and Sports Medicine Hospital, Rehabilitation Department, Doha, Qatar; Institute of Sport, Exercise and Health, University College London, London, United Kingdom
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Calabrò RS, Billeri L, Andronaco VA, Accorinti M, Milardi D, Cannavò A, Aliberti E, Militi A, Bramanti P, Naro A. Walking on the Moon: A randomized clinical trial on the role of lower body positive pressure treadmill training in post-stroke gait impairment. J Adv Res 2020; 21:15-24. [PMID: 31641534 PMCID: PMC6796731 DOI: 10.1016/j.jare.2019.09.005] [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: 06/03/2019] [Revised: 09/09/2019] [Accepted: 09/18/2019] [Indexed: 12/14/2022] Open
Abstract
The effects of LBPP on locomotion in neurologic patients are poorly predictable. The mechanisms through which LPBB acts on gait are partially unknown. Gait training using AlterG improves functional gait in post-stroke patients. AlterG increases muscle activation and/or phasic muscle activation in post-stroke. This knowledge may be useful to plan patient-tailored LBPP locomotor training.
Body weight–supported treadmill training (BWSTT) can be usefully employed to facilitate gait recovery in patients with neurological injuries. Specifically, lower body positive pressure support system (LBPPSS) decreases weight-bearing and ground reaction forces with potentially positive effects on qualitative gait indices. However, which gait features are being shaped by LBPPSS in post-stroke patients is yet poorly predictable. A pilot study on the effects of LBPPSS on qualitative and quantitative gait indices was carried out in patients with hemiparesis due to stroke in the chronic phase. Fifty patients, who suffered from a first, single, ischemic, supra-tentorial stroke that occurred at least 6 months before study inclusion, were enrolled in the study. They were provided with 24 daily sessions of gait training using either the AlterG device or conventional treadmill gait training (TGT). These patients were compared with 25 age-matched healthy controls (HC), who were provided with the same amount of AlterG. Qualitative and quantitative gait features, including Functional Ambulation Categories, gait cycle features, and muscle activation patterns were analyzed before and after the training. It was found that AlterG provided the patients with higher quantitative but not qualitative gait features, as compared to TGT. In particular, AlterG specifically shaped muscle activation phases and gait cycle features in patients, whereas it increased only overall muscle activation in HC. These data suggest that treadmill gait training equipped with LBPPSS specifically targets the gait features that are abnormal in chronic post-stroke patients. It is hypothesizable that the specificity of AlterG effects may depend on a selective reshape of gait rhythmogenesis elaborated by the locomotor spinal circuits receiving a deteriorated corticospinal drive. Even though further studies are warranted to clarify the role of treadmills equipped with LBPPSS in gait training of chronic post-stroke patients, the knowledge of the exact gait pattern during weight-relief is potentially useful to plan patient-tailored locomotor training.
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Affiliation(s)
- Rocco Salvatore Calabrò
- Robotic Neurorehabilitation Unit, IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
- Corresponding author at: Rocco Salvatore Calabrò, IRCCS Centro Neurolesi Bonino Pulejo; via Palermo, SS 113, ctr. Casazza, 98124 Messina, Italy.
| | - Luana Billeri
- Robotic Neurorehabilitation Unit, IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
| | | | - Maria Accorinti
- Robotic Neurorehabilitation Unit, IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
| | - Demetrio Milardi
- Robotic Neurorehabilitation Unit, IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
- Department of Biomorphology and Biotechnologies, University of Messina, Messina, Italy
| | - Antonino Cannavò
- Robotic Neurorehabilitation Unit, IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
| | - Enrico Aliberti
- Department of Motor Sciences, University of Messina, Messina, Italy
| | - Angela Militi
- Department of Motor Sciences, University of Messina, Messina, Italy
| | - Placido Bramanti
- Robotic Neurorehabilitation Unit, IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
| | - Antonino Naro
- Robotic Neurorehabilitation Unit, IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
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