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Huber SK, Knols RH, Held JPO, Betschart M, de Bruin ED. PEMOCS: Evaluating the effects of a concept-guided, PErsonalised, MOtor-Cognitive exergame training on cognitive functions and gait in chronic Stroke-study protocol for a randomised controlled trial. Trials 2024; 25:451. [PMID: 38965612 PMCID: PMC11223407 DOI: 10.1186/s13063-024-08283-7] [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: 01/16/2024] [Accepted: 06/21/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Many stroke survivors remain with residual cognitive and motor impairments despite receiving timely acute and sub-acute rehabilitation. This indicates that rehabilitation following stroke should be continuous to meet the needs of individual stroke patients. Both cognitive and motor functions are essential for mastering daily life and, therefore, should be aimed at with rehabilitation. Exergames, motor-cognitive exercises performed using video games, are an auspicious method to train both motor and cognitive functions and at the same time may foster the long-term motivation for training. This study aims to assess the effect of concept-guided, personalised, motor-cognitive exergame training on cognitive and motor functions in chronic stroke survivors. METHODS This study is a single-blinded, randomised controlled trial. Assessments are performed at baseline, after a 12-week intervention, and at a 24-weeks follow-up. Chronic stroke patients (≥ 18 years old, ≥ 6 months post-stroke) able to stand for 3 min, independently walk 10 m, follow a two-stage command, and without other neurological diseases apart from cognitive deficits or dementia are included. Participants in the intervention group perform the exergame training twice per week for 30 (beginning) up to 40 (end) minutes additionally to their usual care programme. Participants in the control group receive usual care without additional intervention(s). Global cognitive functioning (total Montreal Cognitive Assessment (MoCA) score) is the primary outcome. Secondary outcomes include health-related quality of life, specific cognitive functions, single- and dual-task mobility, and spatiotemporal gait parameters. The target sample size for this trial is 38 participants. Linear mixed models with the post-outcome scores as dependent variables and group and time as fixed effects will be performed for analysis. DISCUSSION Superior improvements in global cognitive functioning and in the abovementioned secondary outcomes in the intervention group compared to the control group are hypothesised. The results of this study may guide future design of long-term rehabilitation interventions after stroke. TRIAL REGISTRATION ClinicalTrials.gov (NCT05524727). Registered on September 1, 2022.
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Affiliation(s)
- S K Huber
- Physiotherapy Occupational Therapy Research Center, Directorate of Research and Education, University Hospital Zurich, Zurich, Switzerland.
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.
| | - R H Knols
- Physiotherapy Occupational Therapy Research Center, Directorate of Research and Education, University Hospital Zurich, Zurich, Switzerland
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - J P O Held
- Rehabilitation Center Triemli Zurich, Valens Clinics, Zurich, Switzerland
| | - M Betschart
- Department of Health, OST - Eastern Swiss University of Applied Sciences, St. Gallen, Switzerland
- Institute of Therapy and Rehabilitation, Kantonsspital Winterthur, Winterthur, Switzerland
| | - E D de Bruin
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Department of Health, OST - Eastern Swiss University of Applied Sciences, St. Gallen, Switzerland
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
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Bonato P, Feipel V, Corniani G, Arin-Bal G, Leardini A. Position paper on how technology for human motion analysis and relevant clinical applications have evolved over the past decades: Striking a balance between accuracy and convenience. Gait Posture 2024; 113:191-203. [PMID: 38917666 DOI: 10.1016/j.gaitpost.2024.06.007] [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] [Received: 01/24/2024] [Revised: 05/30/2024] [Accepted: 06/10/2024] [Indexed: 06/27/2024]
Abstract
BACKGROUND Over the past decades, tremendous technological advances have emerged in human motion analysis (HMA). RESEARCH QUESTION How has technology for analysing human motion evolved over the past decades, and what clinical applications has it enabled? METHODS The literature on HMA has been extensively reviewed, focusing on three main approaches: Fully-Instrumented Gait Analysis (FGA), Wearable Sensor Analysis (WSA), and Deep-Learning Video Analysis (DVA), considering both technical and clinical aspects. RESULTS FGA techniques relying on data collected using stereophotogrammetric systems, force plates, and electromyographic sensors have been dramatically improved providing highly accurate estimates of the biomechanics of motion. WSA techniques have been developed with the advances in data collection at home and in community settings. DVA techniques have emerged through artificial intelligence, which has marked the last decade. Some authors have considered WSA and DVA techniques as alternatives to "traditional" HMA techniques. They have suggested that WSA and DVA techniques are destined to replace FGA. SIGNIFICANCE We argue that FGA, WSA, and DVA complement each other and hence should be accounted as "synergistic" in the context of modern HMA and its clinical applications. We point out that DVA techniques are especially attractive as screening techniques, WSA methods enable data collection in the home and community for extensive periods of time, and FGA does maintain superior accuracy and should be the preferred technique when a complete and highly accurate biomechanical data is required. Accordingly, we envision that future clinical applications of HMA would favour screening patients using DVA in the outpatient setting. If deemed clinically appropriate, then WSA would be used to collect data in the home and community to derive relevant information. If accurate kinetic data is needed, then patients should be referred to specialized centres where an FGA system is available, together with medical imaging and thorough clinical assessments.
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Affiliation(s)
- Paolo Bonato
- Dept of PM&R, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, USA
| | - Véronique Feipel
- Laboratory of Functional Anatomy, Faculty of Motor Sciences, Laboratory of Anatomy, Biomechanics and Organogenesis, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Giulia Corniani
- Dept of PM&R, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, USA
| | - Gamze Arin-Bal
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey; Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Araki S, Matsuura H, Miyazaki T, Matsuzawa Y, Nakai Y, Kawada M, Takeshita Y, Takamura M, Kiyama R. Longitudinal changes in vertical stride regularity, hip flexion, and knee flexion contribute to the alteration in gait speed during hospitalization for stroke. Hum Mov Sci 2024; 95:103227. [PMID: 38723306 DOI: 10.1016/j.humov.2024.103227] [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: 09/02/2023] [Revised: 04/25/2024] [Accepted: 05/05/2024] [Indexed: 06/15/2024]
Abstract
Changes in stride regularity and joint motion during gait appear to be related to improved gait speed in hospitalized patients with stroke. We aimed to clarify the changes in stride regularity and joint motion during gait through longitudinal observations. Furthermore, we aimed to clarify the relationship between changes in gait speed, stride regularity, and joint motion during gait. Seventeen inpatients with stroke were assessed for physical and gait functions at baseline, when they reached functional ambulation category 3, and before discharge. Physical function was assessed using the Fugl-Meyer assessment for the lower extremities and the Berg Balance Scale. Gait function was assessed on the basis of gait speed, joint motion, stride regularity, and step symmetry using inertial sensors. The correlations between the ratio of change in gait speed and each indicator from baseline to discharge were analyzed. Both physical and gait functions improved significantly during the hospital stay. The ratio of change in gait speed was significantly and positively correlated with the ratio of change in vertical stride regularity (r = 0.662), vertical step symmetry (rs = 0.627), hip flexion (rs = 0.652), knee flexion (affected side) (r = 0.611), and ankle plantarflexion (unaffected side) (rs = 0.547). Vertical stride regularity, hip flexion, and knee flexion (affected side) were significant factors in determining the ratio of changes in gait speed. Our results suggest that stride regularity, hip flexion, and knee flexion could explain the entire gait cycle and that of the affected side. These parameters can be used as indices to improve gait speed.
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Affiliation(s)
- Sota Araki
- Department of Rehabilitation, Faculty of Health Sciences, Tohoku Fukushi University, Miyagi, Japan; Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima, Japan.
| | - Hisanori Matsuura
- Course of Health Sciences, Graduate School of Health Sciences, Kagoshima University, Kagoshima, Japan; Department of Rehabilitation, Acras Central Hospital, Kagoshima, Japan +81 99 203 0100
| | - Takasuke Miyazaki
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Yuta Matsuzawa
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Yuki Nakai
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima, Japan; Department of Mechanical Systems Engineering, Faculty of Engineering, Daiichi Institute of Technology, Kagoshima, Japan
| | - Masayuki Kawada
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Yasufumi Takeshita
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima, Japan; Department of Mechanical Systems Engineering, Faculty of Engineering, Daiichi Institute of Technology, Kagoshima, Japan
| | - Motoaki Takamura
- Department of Rehabilitation, Faculty of Health Sciences, Tohoku Fukushi University, Miyagi, Japan
| | - Ryoji Kiyama
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
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Pradhan D, Mohanty RK. Impact of plantar flexion resistive moment of dynamic ankle foot orthosis on measures of center of pressure and clinical gait outcomes in individuals with post-stroke hemiparesis. Gait Posture 2024; 113:58-66. [PMID: 38850851 DOI: 10.1016/j.gaitpost.2024.05.024] [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] [Received: 10/20/2023] [Revised: 05/12/2024] [Accepted: 05/22/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND An ankle-foot orthosis (AFO) with plantar flexion resistance (PFR) can improve the first rocker function during gait, but the incremental changes in the resistive moment on balance and gait have not been well identified. OBJECTIVES To investigate the effect of changing the PFR moment of dynamic AFO (DAFO) on measures of the center of pressure (COP) and clinical gait outcomes in individuals with post-stroke hemiparesis. METHOD In this randomized repeated measure study of 36 stroke individuals, the customized DAFO using foot drop ankle units set in three PFR situations (low, medium, and high) was evaluated. The balance parameters for COP measures were investigated by HUMAC® Balance & Tilt System. Gait parameters and ankle kinematics were recorded using the 3D motion analysis through force platform and optoelectronic system. The comparison was made using a parametric ANOVA test and the P value was set at 0.05 for statistical significance. RESULTS Significant differences were observed for COP average velocity (1.30 ± 0.64, 1.10 ± 0.05, and 1.37 ± 0.43), COP path length (43.3 ± 4.6, 33.4 ± 4.3, and 36.3 ± 5.4), walking velocity (11.0 ± 3.1, 13.2 ± 4.4, and 9.9 ± 3.5), and cadence (31.5 ± 2.0, 33.0 ± 3.1, and 29.0 ± 1.6) respectively for low, medium and high PFR settings (P < 0.05). Except for the COP path length and cadence, posthoc multiple comparisons revealed significant differences between low and medium (P < 0.05) and medium and high (P < 0.05) PFR grades. PFR with medium resistance demonstrated near-normal maximal peak ankle dorsiflexion (mean deviation of 8 degrees, P < 0.05). CONCLUSION Medium PFR grade should be encouraged since it can enhance balance parameters like path length and average velocity of COP, increase cadence and average velocity during gait, and improve maximal peak ankle dorsiflexion.
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Affiliation(s)
- Diptirani Pradhan
- MPO section, Department of Prosthetics and Orthotics, Swami Vivekanand National Institute of Rehabilitation Training and Research, Cuttack, Odisha 754010, India.
| | - Rajesh Kumar Mohanty
- MPO section, Department of Prosthetics and Orthotics, Swami Vivekanand National Institute of Rehabilitation Training and Research, Cuttack, Odisha 754010, India.
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Wareńczak-Pawlicka A, Lisiński P. Can We Target Close Therapeutic Goals in the Gait Re-Education Algorithm for Stroke Patients at the Beginning of the Rehabilitation Process? SENSORS (BASEL, SWITZERLAND) 2024; 24:3416. [PMID: 38894207 PMCID: PMC11174520 DOI: 10.3390/s24113416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 05/13/2024] [Accepted: 05/24/2024] [Indexed: 06/21/2024]
Abstract
(1) Background: The study aimed to determine the most important activities of the knee joints related to gait re-education in patients in the subacute period after a stroke. We focused on the tests that a physiotherapist could perform in daily clinical practice. (2) Methods: Twenty-nine stroke patients (SG) and 29 healthy volunteers (CG) were included in the study. The patients underwent the 5-meter walk test (5mWT) and the Timed Up and Go test (TUG). Tests such as step up, step down, squat, step forward, and joint position sense test (JPS) were also performed, and the subjects were assessed using wireless motion sensors. (3) Results: We observed significant differences in the time needed to complete the 5mWT and TUG tests between groups. The results obtained in the JPS show a significant difference between the paretic and the non-paretic limbs compared to the CG group. A significantly smaller range of knee joint flexion (ROM) was observed in the paretic limb compared to the non-paretic and control limbs in the step down test and between the paretic and non-paretic limbs in the step forward test. (4) Conclusions: The described functional tests are useful in assessing a stroke patient's motor skills and can be performed in daily clinical practice.
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Affiliation(s)
- Agnieszka Wareńczak-Pawlicka
- Department of Rehabilitation and Physiotherapy, University of Medical Sciences, 28 Czerwca 1956 Str., No 135/147, 60-545 Poznań, Poland;
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Brambilla C, Beltrame G, Marino G, Lanzani V, Gatti R, Portinaro N, Molinari Tosatti L, Scano A. Biomechanical Analysis of Human Gait When Changing Velocity and Carried Loads: Simulation Study with OpenSim. BIOLOGY 2024; 13:321. [PMID: 38785803 PMCID: PMC11118041 DOI: 10.3390/biology13050321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/22/2024] [Accepted: 05/02/2024] [Indexed: 05/25/2024]
Abstract
Walking is one of the main activities of daily life and gait analysis can provide crucial data for the computation of biomechanics in many fields. In multiple applications, having reference data that include a variety of gait conditions could be useful for assessing walking performance. However, limited extensive reference data are available as many conditions cannot be easily tested experimentally. For this reason, a musculoskeletal model in OpenSim coupled with gait data (at seven different velocities) was used to simulate seven carried loads and all the combinations between the two parameters. The effects on lower limb biomechanics were measured with torque, power, and mechanical work. The results demonstrated that biomechanics was influenced by both speed and load. Our results expand the previous literature: in the majority of previous work, only a subset of the presented conditions was investigated. Moreover, our simulation approach provides comprehensive data that could be useful for applications in many areas, such as rehabilitation, orthopedics, medical care, and sports.
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Affiliation(s)
- Cristina Brambilla
- Institute of Intelligent Industrial Systems and Technologies for Advanced Manufacturing (STIIMA), Italian Council of National Research (CNR), 20133 Milan, Italy; (C.B.); (V.L.); (L.M.T.)
| | - Giulia Beltrame
- Residency Program in Orthopedics and Traumatology, Universitá degli Studi di Milano, 20122 Milan, Italy; (G.B.); (N.P.)
| | - Giorgia Marino
- Physiotherapy Unit, IRCCS Humanitas Research Hospital, Rozzano, 20098 Milan, Italy; (G.M.); (R.G.)
| | - Valentina Lanzani
- Institute of Intelligent Industrial Systems and Technologies for Advanced Manufacturing (STIIMA), Italian Council of National Research (CNR), 20133 Milan, Italy; (C.B.); (V.L.); (L.M.T.)
| | - Roberto Gatti
- Physiotherapy Unit, IRCCS Humanitas Research Hospital, Rozzano, 20098 Milan, Italy; (G.M.); (R.G.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
| | - Nicola Portinaro
- Residency Program in Orthopedics and Traumatology, Universitá degli Studi di Milano, 20122 Milan, Italy; (G.B.); (N.P.)
- Department of Pediatric Surgery, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Lorenzo Molinari Tosatti
- Institute of Intelligent Industrial Systems and Technologies for Advanced Manufacturing (STIIMA), Italian Council of National Research (CNR), 20133 Milan, Italy; (C.B.); (V.L.); (L.M.T.)
| | - Alessandro Scano
- Institute of Intelligent Industrial Systems and Technologies for Advanced Manufacturing (STIIMA), Italian Council of National Research (CNR), 20133 Milan, Italy; (C.B.); (V.L.); (L.M.T.)
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Felius RAW, Wouda NC, Geerars M, Bruijn SM, van Dieën JH, Punt M. Beyond gait speed: exploring the added value of Inertial Measurement Unit-based measurements of gait in the estimation of the walking ability in daily life. BMC Neurol 2024; 24:129. [PMID: 38627674 PMCID: PMC11022465 DOI: 10.1186/s12883-024-03632-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 04/09/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Gait speed is often used to estimate the walking ability in daily life in people after stroke. While measuring gait with inertial measurement units (IMUs) during clinical assessment yields additional information, it remains unclear if this information can improve the estimation of the walking ability in daily life beyond gait speed. OBJECTIVE We evaluated the additive value of IMU-based gait features over a simple gait-speed measurement in the estimation of walking ability in people after stroke. METHODS Longitudinal data during clinical stroke rehabilitation were collected. The assessment consisted of two parts and was administered every three weeks. In the first part, participants walked for two minutes (2MWT) on a fourteen-meter path with three IMUs attached to low back and feet, from which multiple gait features, including gait speed, were calculated. The dimensionality of the corresponding gait features was reduced with a principal component analysis. In the second part, gait was measured for two consecutive days using one ankle-mounted IMU. Next, three measures of walking ability in daily life were calculated, including the number of steps per day, and the average and maximal gait speed. A gait-speed-only Linear Mixed Model was used to estimate the association between gait speed and each of the three measures of walking ability. Next, the principal components (PC), derived from the 2MWT, were added to the gait-speed-only model to evaluate if they were confounders or effect modifiers. RESULTS Eighty-one participants were measured during rehabilitation, resulting in 198 2MWTs and 135 corresponding walking-performance measurements. 106 Gait features were reduced to nine PCs with 85.1% explained variance. The linear mixed models demonstrated that gait speed was weakly associated with the average and maximum gait speed in daily life and moderately associated with the number of steps per day. The PCs did not considerably improve the outcomes in comparison to the gait speed only models. CONCLUSIONS Gait in people after stroke assessed in a clinical setting with IMUs differs from their walking ability in daily life. More research is needed to determine whether these discrepancies also occur in non-laboratory settings, and to identify additional non-gait factors that influence walking ability in daily life.
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Affiliation(s)
- R A W Felius
- Research group lifestyle and health, Utrecht University of Applied Sciences, Utrecht, The Netherlands.
- Department of Human Movement Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - N C Wouda
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
- Department of neurorehabilitation, De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - M Geerars
- Physiotherapy Department Neurology, Axioncontinu, Rehabilitation Center de Parkgraaf, Utrecht, The Netherlands
| | - S M Bruijn
- Department of Human Movement Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - J H van Dieën
- Department of Human Movement Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M Punt
- Research group lifestyle and health, Utrecht University of Applied Sciences, Utrecht, The Netherlands
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Dengiz A, Baskan E. Effects of Cervical Mobilization on Balance and Gait Parameters in Individuals With Stroke: A Randomized Controlled Trial. Percept Mot Skills 2024; 131:469-488. [PMID: 38166477 DOI: 10.1177/00315125231226039] [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: 01/04/2024]
Abstract
Stroke is a significant health problem that may result in long-term functional deficits. Balance and walking problems are among the most common post-stroke deficits, and they may negatively affect quality of life. Our aim in this study was to investigate the effects of cervical mobilization on balance and gait parameters after stroke. Participants were 24 adults (aged 30-65 years), who scored 24 or above on the Standardized Mini-Mental State Exam (MMSE) and no more than 3 on the Modified Rankin scale. Participants were randomly assigned to either an experimental Bobath therapy and cervical mobilization group (n = 12) or a control group who received Bobath therapy and a sham application (n = 12). Both groups received 60 minutes of Bobath therapy three times a week for four weeks; additionally, the experimental group received 15 minutes of cervical mobilization in each session, while the control group received 15 minutes of spinal sham mobilization each session. Pre and post treatment, we assessed all participants' demographic characteristics, gait parameters, balance parameters, and forward head posture values using a clinical data assessment form, spatiotemporal gait analysis (LEGSystm), portable computerized kinesthetic balance device (SportKAT 550), and craniovertebral angle (CVA), respectively. The groups showed no significant differences in their initial demographic and clinical characteristics (age, sex, stroke duration and disability levels.). In comparing changes on variables of interest, we observed significant experimental versus control group improvements in balance parameters except for their left side balance score (right side, left side, forward, backward and total balance scores were significant at p = .003, p = .089, p < .001, p = .022, p < .001, respectively), gait parameters (stride number, stride length, stride time, stride velocity, cadance at p = .007, p = .019, p = .013, p = .005, p = .001, respectively) and CVA (p < .001). Also, there were findings in favor of the experimental group on the modified timed up and go test on walk out, mid turn, walk back and total times (p = .028, p = .001, p = .016, and p = .001, respectively),but not for sit-to-stand time or stand-to-sit time. Clinicians involved in stroke rehabilitation should assess and treat the cervical region to enhance rehabilitation effectiveness.
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Affiliation(s)
- Aziz Dengiz
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Muş Alparslan University, Muş, Türkiye
| | - Emre Baskan
- Faculty of Physiotherapy and Rehabilitation, Pamukkale University, Denizli, Türkiye
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ul-ain Q, Ilyas S, Ali H, Ali I, Ullah R, Arshad H, Khalid S, Azim ME, Liu T, Wang J. Exploring the Differential Effects of Transcranial Direct Current Stimulation: A Comparative Analysis of Motor Cortex and Cerebellar Stimulation. Heliyon 2024; 10:e26838. [PMID: 38515670 PMCID: PMC10955213 DOI: 10.1016/j.heliyon.2024.e26838] [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: 06/08/2023] [Revised: 02/07/2024] [Accepted: 02/20/2024] [Indexed: 03/23/2024] Open
Abstract
Background Transcranial Direct Current Stimulation (tDCS) is a non-invasive brain stimulation technique. Constant electric current is passed through the patient's scalp with the aim of modulating cortical excitability. Stroke is a cerebrovascular disease characterized by hemorrhage or cerebral ischemia. This systematic review and meta-analysis are aimed at comparing the efficacy of motor cortex stimulation with that of cerebellar stimulation by using transcranial direct current stimulation. Method Google Scholar, PubMed, EMBASE, Cochrane CENTRAL, and Physiotherapy Evidence Database (Pedro) databases were searched for studies. The extracted qualitative data was synthesized systematically. Cochrane RevMan software was used to conduct a meta-analysis of quantitative data. The fixed effects mean difference of the collected data was calculated at a 95% confidence interval (CI) for the changes in balance and side effects. Results This research included 10 articles with seven studies assessing changes in balance (outcome measured in CoP and FMA scores) and side effects (tingling and itching were the most prevalent). There was no significant difference between the efficacy levels of m1-tDCS versus ctDCS (P = 0.18), m1-tDCS versus sham (P = 0.92), and ctDCS versus sham (P = 0.19). Itching and tingling sensation were the most common and were significantly prevalent in sham interventions (P < 0.00001). Conclusion We found that motor cortex and cerebellar stimulations are both effective in improving motor function in stroke patients. There are no adverse effects to using the interventions besides mild itching and tingling experienced during the stimulation.
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Affiliation(s)
- Qurat ul-ain
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Health and Rehabilitation Science, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, PR China
- National Engineering Research Center for Healthcare Devices Guangzhou, Guangdong, PR China
- The Key Laboratory of Neuro-informatics & Rehabilitation Engineering of Ministry of Civil Affairs Xi'an, Shaanxi, PR China
| | - Saad Ilyas
- Faculty of Computing, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Hamid Ali
- Department of Biosciences, COMSATS University Islamabad, Pakistan
| | - Ijaz Ali
- Centre for Applied Mathematics and Bioinformatics, Gulf University for Science and Technology, Hawally, Kuwait
| | - Riaz Ullah
- Department of Pharmacognosy, College of Pharmacy King Saud University, Riyadh, Saudi Arabia
| | - Hafsah Arshad
- Department of Physiotherapy and Rehabilitation, Ibadat International University, Islamabad, Pakistan
| | - Sana Khalid
- Department of Physiotherapy and Rehabilitation, Foundation University Islamabad, Pakistan
| | - Muhammad Ehab Azim
- Department of Physiotherapy and Rehabilitation, Foundation University Islamabad, Pakistan
| | - Tian Liu
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Health and Rehabilitation Science, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, PR China
- National Engineering Research Center for Healthcare Devices Guangzhou, Guangdong, PR China
- The Key Laboratory of Neuro-informatics & Rehabilitation Engineering of Ministry of Civil Affairs Xi'an, Shaanxi, PR China
| | - Jue Wang
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Health and Rehabilitation Science, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, PR China
- National Engineering Research Center for Healthcare Devices Guangzhou, Guangdong, PR China
- The Key Laboratory of Neuro-informatics & Rehabilitation Engineering of Ministry of Civil Affairs Xi'an, Shaanxi, PR China
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Lee JH, Kim EJ. Optimizing Rehabilitation Outcomes for Stroke Survivors: The Impact of Speed and Slope Adjustments in Anti-Gravity Treadmill Training. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:542. [PMID: 38674188 PMCID: PMC11052273 DOI: 10.3390/medicina60040542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 03/14/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024]
Abstract
Background and Objectives: This study explored the efficacy of customized anti-gravity treadmill (AGT) training, with adjustments in speed and incline, on rehabilitation outcomes for stroke patients, focusing on knee extensor muscle strength, joint angle, balance ability, and activities of daily living (ADLs). Materials and Methods: In this study, 30 individuals diagnosed with a stroke were divided into three groups. Experimental group 1 (EG1) underwent training without changes to speed and incline, experimental group 2 (EG2) received training with an increased incline, and experimental group 3 (EG3) underwent training with increased speed. Initially, all participants received AGT training under uniform conditions for two weeks. Subsequently, from the third to the sixth week, each group underwent their specified training intervention. Evaluations were conducted before the intervention and six weeks post-intervention using a manual muscle strength tester for knee strength, TETRAX for balance ability, Dartfish software for analyzing knee angle, and the Korean version of the Modified Barthel Index (K-MBI) for assessing activities of daily living. Results: Within-group comparisons revealed that AGT training led to enhancements in muscle strength, balance ability, joint angle, and ADLs across all participant groups. Between-group analyses indicated that EG2, which underwent increased incline training, demonstrated significant improvements in muscle strength and balance ability over EG1. EG3 not only showed significant enhancements in muscle strength, joint angle, and ADLs when compared to EG1 but also surpassed EG2 in terms of knee strength improvement. Conclusions: In conclusion, the application of customized AGT training positively impacts the rehabilitation of stroke patients, underscoring the importance of selecting a treatment method tailored to the specific needs of each patient.
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Affiliation(s)
| | - Eun-Ja Kim
- Department of Physical Therapy, Kyungdong University, 815 Gyeonhwon-ro, Munmak-eup, Wonju-si 26495, Republic of Korea;
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Takahashi A, Kitsunai S, Kawana H, Saito N, Yoshihara A, Furukawa K. Physiotherapy management focusing on proprioceptive impairment in a patient with gait and balance impairments following stroke: A case report. Physiother Theory Pract 2024:1-15. [PMID: 38516762 DOI: 10.1080/09593985.2024.2332792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 03/11/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Proprioceptive impairment contributes to gait and balance impairments in patients with stroke. Diagnosis functional impairments and evaluation treatment efficacy require quantitative proprioception assessment. However, proprioception assessment has remained limited to ordinal scale measurement, with a lack of ratio scale measurements. PURPOSE This case report describes a physiotherapy management program focusing on proprioceptive impairment in patients with stroke using quantitative tests such as Threshold to Detect Passive Motion (TDPM) and Joint Position Sense (JPS). CASE DESCRIPTION A63-year-old male patient with an acute pontine lacunar infarction was admitted to our hospital. His muscle strength, selective movement, and trunk activity were preserved. However, the Berg Balance Scale (BBS) and Gait Assessment andIntervention Tool (GAIT) score were 42 and 9 points, observing balance impairment and the buckling knee pattern with hip ataxia during gait. Based on these, TDPM and JPS using image capture were performed. In physiotherapeuticdiagnosis, proprioceptive impairments in the hip and knee joints were the primary functional impairments related to balance and gait. To address these proprioceptive impairments, a 13-day treatment protocol incorporating transcutaneous electrical nerve stimulation (intensity: sensory threshold, frequency: 100 Hz) targeting the quadriceps femoris was performed. OUTCOMES The patient was discharged after achieving independent ambulation and improvement in BBS (56 points) and GAIT (2 points) scores, exceeding the minimum clinically important difference. Recovery of proprioceptive impairment corresponded withimproved balance and gait ability. CONCLUSION Quantitatively evaluating proprioceptive impairments may provide novel rehabilitation for patients with stroke who have proprioceptive impairments and contribute to clinical decision-making.
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Affiliation(s)
- Aisuke Takahashi
- Department of Medical Rehabilitation, Ohara General Hospital, Fukushima, Japan
| | - Shun Kitsunai
- Department of Medical Rehabilitation, Ohara General Hospital, Fukushima, Japan
| | - Hikaru Kawana
- Department of Medical Rehabilitation, Ohara General Hospital, Fukushima, Japan
| | - Naoshi Saito
- Department of Neurology, Ohara General Hospital, Fukushima, Japan
| | - Akioh Yoshihara
- Department of Neurology, Ohara General Hospital, Fukushima, Japan
| | - Katsuhiro Furukawa
- Department of Physical Therapy, Faculty of Health Sciences, Iryo Sosei University, Fukushima, Japan
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Varas-Diaz G, Bhatt T, Oken B, Roth E, Hayes J, Cordo P. Concurrent ankle-assisted movement, biofeedback, and proprioceptive stimulation reduces lower limb motor impairment and improves gait in persons with stroke. Physiother Theory Pract 2024; 40:477-486. [PMID: 36102364 DOI: 10.1080/09593985.2022.2122763] [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: 10/07/2021] [Revised: 07/20/2022] [Accepted: 09/05/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Persons with stroke live with residual sensorimotor impairments in their lower limbs (LL), which affects their gait. PURPOSE We investigated whether these residual impairments and resulting gait deficits can be reduced through concurrently applied assisted movement, biofeedback, and proprioceptive stimulation. METHODS A robotic device provided impairment-oriented training to the affected LL of 24 persons with stroke (PwS) with moderate-to-severe LL impairment. Participants were given 22-30 training sessions over 2-3 months. During training, the interventional device cyclically dorsiflexed and plantarflexed the ankle at 5 deg/s through ±15 deg for 30 min while the participant assisted with the imposed movement. Concurrently, participants received visual biofeedback of assistive joint torque or agonist EMG while mechanical vibration was applied to the currently lengthening (i.e. antagonist) tendon. RESULTS Sensorimotor impairment significantly decreased over the training period, which was sustained over 3 months, based on the Fugl-Meyer Assessment (FMA-LL) (p < .001), modified Ashworth scale in dorsiflexors (p < .05), and an ankle strength test (dorsiflexors and plantarflexors) (p < .05). Balance and gait also improved, based on the Tinetti Performance Oriented Mobility Assessment (POMA) (p < .05). CONCLUSION Impairment-oriented training using a robotic device capable of applying assisted movement, biofeedback, and proprioceptive stimulation significantly reduces LL impairment and improves gait in moderately-to-severely impaired PwS.
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Affiliation(s)
- Gonzalo Varas-Diaz
- School of Kinesiology, Faculty of Medicine, Universidad Finis Terrae, Santiago, Chile
- Department of Physical Therapy, University of Illinois at Chicago, College of Applied Health Sciences, Chicago, IL, USA
| | - Tanvi Bhatt
- Department of Physical Therapy, University of Illinois at Chicago, College of Applied Health Sciences, Chicago, IL, USA
| | - Barry Oken
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA
| | - Elliot Roth
- Department of Physical Medicine and Rehabilitation, Northwestern University, Evanston, IL, USA
| | - John Hayes
- College of Optometry, Pacific University, Forest Grove, OR, USA
| | - Paul Cordo
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA
- AMES Technology Inc, Portland, OR, USA
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Jiao Y, Hart R, Reading S, Zhang Y. Systematic review of automatic post-stroke gait classification systems. Gait Posture 2024; 109:259-270. [PMID: 38367457 DOI: 10.1016/j.gaitpost.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 01/11/2024] [Accepted: 02/12/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Gait classification is a clinically helpful task performed after a stroke in order to guide rehabilitation therapy. Gait disorders are commonly identified using observational gait analysis in clinical settings, but this approach is limited due to low reliability and accuracy. Data-driven gait classification can quantify gait deviations and categorise gait patterns automatically possibly improving reliability and accuracy; however, the development and clinical utility of current data driven systems has not been reviewed previously. RESEARCH QUESTION The purpose of this systematic review is to evaluate the literature surrounding the methodology used to develop automatic gait classification systems, and their potential effectiveness in the clinical management of stroke-affected gait. METHOD The database search included PubMed, IEEE Xplore, and Scopus. Twenty-one studies were identified through inclusion and exclusion criteria from 407 available studies published between 2015 and 2022. Development methodology, classification performance, and clinical utility information were extracted for review. RESULTS AND SIGNIFICANCE Most of gait classification systems reported a classification accuracy between 80%-100%. However, collated studies presented methodological errors in machine learning (ML) model development. Further, many studies neglected model components such as clinical utility (e.g., predictions don't assist clinicians or therapists in making decisions, interpretability, and generalisability). We provided recommendations to guide development of future post-stroke automatic gait classification systems to better assist clinicians and therapists. Future automatic gait classification systems should emphasise the clinical significance and adopt a standardised development methodology of ML model.
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Affiliation(s)
- Yiran Jiao
- Department of Exercise Sciences, Faculty of Science, University of Auckland, Auckland 1023, New Zealand
| | - Rylea Hart
- Department of Exercise Sciences, Faculty of Science, University of Auckland, Auckland 1023, New Zealand
| | - Stacey Reading
- Department of Exercise Sciences, Faculty of Science, University of Auckland, Auckland 1023, New Zealand
| | - Yanxin Zhang
- Department of Exercise Sciences, Faculty of Science, University of Auckland, Auckland 1023, New Zealand.
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Jeon H, Chung EH, Bak SY, Kim H, Shin S, Baek H, Kim M. Comparison of biomechanical parameters in lower limb joints of stroke patients according to conventional evaluation scores during level walking. Front Bioeng Biotechnol 2024; 12:1320337. [PMID: 38468688 PMCID: PMC10925633 DOI: 10.3389/fbioe.2024.1320337] [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: 10/12/2023] [Accepted: 02/09/2024] [Indexed: 03/13/2024] Open
Abstract
Objective: Patients with chronic stroke capable of independent gait were classified into functional ambulation category (FAC) 4 or 5, and the kinetic and kinematic data on their lower limb joints on the affected and unaffected sides were compared with that of healthy individuals. Finally, the qualitative changes in the gait of patients with stroke were investigated based on the differences in FAC scores. Methods: Twelve healthy participants and 19 patients with stroke capable of independent gait were included. The three-dimensional (3D) motion analysis and conventional assessment were conducted for all patients with stroke. Results: The FAC 5 group exhibited a larger range of motion (ROM) than the FAC 4 group in knee and hip joints on the affected side and only in the hip on the unaffected side. In the FAC 5 group, ROM differences in the healthy group on either the affected or unaffected side were absent. The peak of the hip flexion moment on the affected side in both the FAC 4 and 5 groups was smaller than that in the healthy group and in the FAC 4 group on the unaffected side. The absorption power minimum on the affected side was smaller only in the FAC 4 group than that in the healthy group and was larger in the FAC 5 group than that in the FAC 4 group. On the unaffected side, the absorption power minimum was smaller only in the FAC 4 group than that in the healthy group. Conclusion: Functional differences in gait were found in patients classified based on conventional evaluation capable of independent gait after post-stroke rehabilitation. Patients may not exhibit complete recovery in the kinetic indices even if they are judged to be normal in the conventional evaluation, and the kinematic gait indices indicate recovery. Evaluating kinetic indices in addition to kinematic indices is necessary, and joint power may be an especially useful index.
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Affiliation(s)
- HyeongMin Jeon
- Digital Therapeutics Research Team, CHA Bundang Medical Center, CHA Future Medicine Research Institute, CHA University School of Medicine, Seongnam, Republic of Korea
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Eun-Hye Chung
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Se-Young Bak
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Heegoo Kim
- Digital Therapeutics Research Team, CHA Bundang Medical Center, CHA Future Medicine Research Institute, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Seyoung Shin
- Digital Therapeutics Research Team, CHA Bundang Medical Center, CHA Future Medicine Research Institute, CHA University School of Medicine, Seongnam, Republic of Korea
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Hongseok Baek
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - MinYoung Kim
- Digital Therapeutics Research Team, CHA Bundang Medical Center, CHA Future Medicine Research Institute, CHA University School of Medicine, Seongnam, Republic of Korea
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
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15
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Wiley E, Sakakibara B, Park S, Barclay R, Bayley M, Eng JJ, Harris A, Inness E, MacKay-Lyons M, MacDermid J, Pollock C, Pooyania S, Teasell R, Yao J, Tang A. Exploring the experiences of an exercise-based telerehabilitation program among Canadian community-dwelling adults with stroke. Disabil Rehabil 2024:1-11. [PMID: 38361375 DOI: 10.1080/09638288.2024.2316772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 02/06/2024] [Indexed: 02/17/2024]
Abstract
PURPOSE Telerehabilitation is emerging as a means for delivering stroke rehabilitation to address unmet lower extremity rehabilitation needs. However, there is currently limited and low-quality evidence supporting the use telerehabilitation interventions for lower extremity recovery after stroke. Thus, we developed an exercise-based telerehabilitation program (TRAIL) for safe and effective promotion of lower extremity function after stroke. This study reports on the qualitative findings from the feasibility study of the TRAIL program. METHODS An interpretive description methodology and inductive thematic analysis approach were undertaken. One-on-one semi-structured interviews were conducted on a subset of participants who completed the TRAIL feasibility study. Participants were recruited via email and enrolled into the study based on pre-determined purposeful sampling strategies. RESULTS Ten participants (6 men, 4 women) completed a semi-structured interview. Two main themes emerged: (i) TRAIL ingredients for success and (ii) telerehabilitation is a viable option for stroke rehabilitation. CONCLUSION Exercise-based telerehabilitation appears to be well-received by men and women post-stroke when social support, professional guidance, and program resources are offered. TRAIL may also prolong the continuum of care that individuals receive once they are discharged back into the community, and contribute to improvements in mobility, lower extremity strength and balance.
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Affiliation(s)
- Elise Wiley
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Brodie Sakakibara
- Department of Occupational Science & Occupational Therapy, Centre for Chronic Disease Prevention and Management, Southern Medical Program, University of British Columbia, Kelowna, BC, Canada
| | - Sarah Park
- School of Rehabilitation Sciences, University of British Columbia, Vancouver, British Columbia, BC, Canada
| | - Ruth Barclay
- Department of Physical Therapy, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Mark Bayley
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON
| | - Janice J Eng
- Department of Physical Therapy, University of British Columbia and Centre for Aging SMART at Vancouver Coastal Health, Vancouver, BC, Canada
- G.F Strong Rehabilitation Centre, Vancouver, BC, Canada
| | - Anne Harris
- G.F Strong Rehabilitation Centre, Vancouver, BC, Canada
| | - Elizabeth Inness
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Marilyn MacKay-Lyons
- School of Physiotherapy, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Joy MacDermid
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
- School of Physical Therapy, Western University, London, ON, Canada
| | - Courtney Pollock
- Department of Physical Therapy, University of British Columbia and Centre for Aging SMART at Vancouver Coastal Health, Vancouver, BC, Canada
| | - Sepideh Pooyania
- Department of Internal Medicine, Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Robert Teasell
- Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, University of Western Ontario, ON, London
| | - Jennifer Yao
- G.F Strong Rehabilitation Centre, Vancouver, BC, Canada
- Department and Faculty of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver
| | - Ada Tang
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
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Nam HS, Clancy C, Smuck M, Lansberg MG. Insole Pressure Sensors to Assess Post-Stroke Gait. Ann Rehabil Med 2024; 48:42-49. [PMID: 38200402 PMCID: PMC10915303 DOI: 10.5535/arm.23064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/12/2023] [Accepted: 11/13/2023] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVE To confirm that the simplified insole does not affect the gait speed and to identify objective sensor-based gait parameters that correlate strongly with existing clinical gait assessment scales. METHODS Ten participants with gait impairment due to hemiplegic stroke were enrolled in this study. Pairs of insoles with four pressure sensors on each side were manufactured and placed in each shoe. Data were extracted during the 10-Meter Walk Test. Several sensor-derived parameters (for example stance time, heel_on-to-toe_peak time, and toe_peak pressure) were calculated and correlated with gait speed and lower extremity Fugl-Meyer (F-M) score. RESULTS The insole pressure sensor did not affect gait, as indicated by a strong correlation (ρ=0.988) and high agreement (ICC=0.924) between the gait speeds with and without the insole. The parameters that correlated most strongly with highest β coefficients against the clinical measures were stance time of the non-hemiplegic leg (β=-0.87 with F-M and β=-0.95 with gait speed) and heel_on-to-toe_peak time of the non-hemiplegic leg (β=-0.86 with F-M and -0.94 with gait speed). CONCLUSION Stance time of the non-hemiparetic leg correlates most strongly with clinical measures and can be assessed using a non-obtrusive insole pressure sensor that does not affect gait function. These results suggest that an insole pressure sensor, which is applicable in a home environment, may be useful as a clinical endpoint in post-stroke gait therapy trials.
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Affiliation(s)
- Hyung Seok Nam
- Department of Rehabilitation Medicine, Sheikh Khalifa Specialty Hospital, Ras al Khaimah, United Arab Emirates
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea
- Wearable Health Lab, Department of Orthopaedic Surgery, Stanford University, Redwood City, CA, United States
| | - Caitlin Clancy
- Stanford Stroke Center, Stanford University, Palo Alto, CA, United States
| | - Matthew Smuck
- Wearable Health Lab, Department of Orthopaedic Surgery, Stanford University, Redwood City, CA, United States
| | - Maarten G Lansberg
- Stanford Stroke Center, Stanford University, Palo Alto, CA, United States
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Marimon X, Mengual I, López-de-Celis C, Portela A, Rodríguez-Sanz J, Herráez IA, Pérez-Bellmunt A. Kinematic Analysis of Human Gait in Healthy Young Adults Using IMU Sensors: Exploring Relevant Machine Learning Features for Clinical Applications. Bioengineering (Basel) 2024; 11:105. [PMID: 38391591 PMCID: PMC10886386 DOI: 10.3390/bioengineering11020105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/12/2023] [Accepted: 01/22/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Gait is the manner or style of walking, involving motor control and coordination to adapt to the surrounding environment. Knowing the kinesthetic markers of normal gait is essential for the diagnosis of certain pathologies or the generation of intelligent ortho-prostheses for the treatment or prevention of gait disorders. The aim of the present study was to identify the key features of normal human gait using inertial unit (IMU) recordings in a walking test. METHODS Gait analysis was conducted on 32 healthy participants (age range 19-29 years) at speeds of 2 km/h and 4 km/h using a treadmill. Dynamic data were obtained using a microcontroller (Arduino Nano 33 BLE Sense Rev2) with IMU sensors (BMI270). The collected data were processed and analyzed using a custom script (MATLAB 2022b), including the labeling of the four relevant gait phases and events (Stance, Toe-Off, Swing, and Heel Strike), computation of statistical features (64 features), and application of machine learning techniques for classification (8 classifiers). RESULTS Spider plot analysis revealed significant differences in the four events created by the most relevant statistical features. Among the different classifiers tested, the Support Vector Machine (SVM) model using a Cubic kernel achieved an accuracy rate of 92.4% when differentiating between gait events using the computed statistical features. CONCLUSIONS This study identifies the optimal features of acceleration and gyroscope data during normal gait. The findings suggest potential applications for injury prevention and performance optimization in individuals engaged in activities involving normal gait. The creation of spider plots is proposed to obtain a personalised fingerprint of each patient's gait fingerprint that could be used as a diagnostic tool. A deviation from a normal gait pattern can be used to identify human gait disorders. Moving forward, this information has potential for use in clinical applications in the diagnosis of gait-related disorders and developing novel orthoses and prosthetics to prevent falls and ankle sprains.
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Affiliation(s)
- Xavier Marimon
- Bioengineering Institute of Technology, Universitat Internacional de Catalunya (UIC), 08195 Barcelona, Spain
- Automatic Control Department, Universitat Politècnica de Catalunya (UPC-BarcelonaTECH), 08034 Barcelona, Spain
- Institut de Recerca Sant Joan de Déu (IRSJD), 08950 Barcelona, Spain
| | - Itziar Mengual
- Bioengineering Institute of Technology, Universitat Internacional de Catalunya (UIC), 08195 Barcelona, Spain
| | - Carlos López-de-Celis
- ACTIUM Research Group, Universitat Internacional de Catalunya (UIC), 08195 Barcelona, Spain
- Institut Universitari d'Investigació en Atenció Primària (IDIAP Jordi Gol), 08007 Barcelona, Spain
| | - Alejandro Portela
- Bioengineering Institute of Technology, Universitat Internacional de Catalunya (UIC), 08195 Barcelona, Spain
| | - Jacobo Rodríguez-Sanz
- ACTIUM Research Group, Universitat Internacional de Catalunya (UIC), 08195 Barcelona, Spain
| | - Iria Andrea Herráez
- Bioengineering Institute of Technology, Universitat Internacional de Catalunya (UIC), 08195 Barcelona, Spain
| | - Albert Pérez-Bellmunt
- ACTIUM Research Group, Universitat Internacional de Catalunya (UIC), 08195 Barcelona, Spain
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Labrozzi GC, Warner H, Makowski NS, Audu ML, Triolo RJ. Center of Mass Estimation for Impaired Gait Assessment Using Inertial Measurement Units. IEEE Trans Neural Syst Rehabil Eng 2024; 32:12-22. [PMID: 38090847 PMCID: PMC10849874 DOI: 10.1109/tnsre.2023.3341436] [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] [Indexed: 01/14/2024]
Abstract
Injury or disease often compromise walking dynamics and negatively impact quality of life and independence. Assessing methods to restore or improve pathological gait can be expedited by examining a global parameter that reflects overall musculoskeletal control. Center of mass (CoM) kinematics follow well-defined trajectories during unimpaired gait, and change predictably with various gait pathologies. We propose a method to estimate CoM trajectories from inertial measurement units (IMUs) using a bidirectional Long Short-Term Memory neural network to evaluate rehabilitation interventions and outcomes. Five non-disabled volunteers participated in a single session of various dynamic walking trials with IMUs mounted on various body segments. A neural network trained with data from four of the five volunteers through a leave-one-subject out cross validation estimated the CoM with average root mean square errors (RMSEs) of 1.44cm, 1.15cm, and 0.40cm in the mediolateral (ML), anteroposterior (AP), and inferior/superior (IS) directions respectively. The impact of number and location of IMUs on network prediction accuracy was determined via principal component analysis. Comparing across all configurations, three to five IMUs located on the legs and medial trunk were the most promising reduced sensor sets for achieving CoM estimates suitable for outcome assessment. Lastly, the networks were tested on data from an individual with hemiparesis with the greatest error increase in the ML direction, which could stem from asymmetric gait. These results provide a framework for assessing gait deviations after disease or injury and evaluating rehabilitation interventions intended to normalize gait pathologies.
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Rong H, Ramezani S, Ambro A, Lei CH, Choi H. Design and characterization of a variable-stiffness ankle-foot orthosis. Prosthet Orthot Int 2024:00006479-990000000-00213. [PMID: 38180143 DOI: 10.1097/pxr.0000000000000323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 11/17/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Ankle-foot orthoses (AFOs) are a type of assistive device that can improve the walking ability of individuals with neurological disorders. Adjusting stiffness is a common way to customize settings according to individuals' impairment. OBJECTIVE This study aims to design a variable-stiffness AFO by stiffness module and characterize the AFO stiffness range to provide subject-specific settings for the users. METHODS We modeled AFO using bending beams with varying fulcrum positions to adjust the stiffness. To characterize the stiffness range and profile, we used the superposition method to generate the theoretical model to analyze the AFO numerically. The intrinsic deformation of the bending beam in the AFO is considered a combination of 2 bending deformations to replicate actual bending conditions. The corresponding experiments in different fulcrum positions were performed to compare with and optimize the theoretical model. The curve fitting method was applied to tune the theoretical model by adding a fulcrum position-related coefficient. RESULTS The AFO stiffness increased as the fulcrum moved to the proximal position. The maximum stiffness obtained was 1.77 Nm/° at a 6-cm fulcrum position, and the minimum stiffness was 0.82 Nm/° at a 0.5-cm fulcrum position with a 0.43-cm thick fiberglass beam. The corresponding theoretical model had maximum and minimum stiffness of 1.71 and 0.80 Nm/°, respectively. The theoretical model had a 4.08% difference compared with experimental values. CONCLUSIONS The stiffness module can provide adjustable stiffness with the fulcrum position and different kinds of fiberglass bars, especially the thickness and material of the beam. The theoretical model with different fulcrum positions can be used to profile the real-time stiffness of the AFO in a dynamic motion and to determine the appropriate dimensions of the bending beam.
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Affiliation(s)
- Haochen Rong
- Department of Aerospace and Mechanical Engineering, Saint Louis University, St. Louis, MO
| | - Sepehr Ramezani
- Department of Mechanical and Aerospace Engineering, Biionix Cluster, University of Central Florida, Orlando, FL
| | - Alex Ambro
- Department of Aerospace and Mechanical Engineering, Saint Louis University, St. Louis, MO
| | - Chi Hou Lei
- Department of Aerospace and Mechanical Engineering, Saint Louis University, St. Louis, MO
| | - Hwan Choi
- Department of Mechanical and Aerospace Engineering, Biionix Cluster, University of Central Florida, Orlando, FL
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Montané E, Cormier C, Scandella M, Cangelosi A, Marque P, Moissenet F, Gasq D. ToulGaitViz: a tool for the systematic description of lower limb clearance during the swing phase of hemiparetic gait after stroke. A cohort study. Eur J Phys Rehabil Med 2023; 59:669-681. [PMID: 37869760 PMCID: PMC10899889 DOI: 10.23736/s1973-9087.23.07979-0] [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: 03/20/2023] [Revised: 09/04/2023] [Accepted: 10/04/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND In post-stroke hemiparetic subjects, a systematic and quantified description of the shortening default and compensatory movements during the swing phase of gait is essential to guide treatments and assess the impact of therapeutic interventions. However, such a systematic approach does not exist in the current clinical practice. AIM The aim of this study was to present a method improving the quantification and visualization of the kinematics of both lower limbs during the swing phase of gait, more specifically the origin of shortening default and the weight of compensations, based on a tool specifically developed: ToulGaitViz. DESIGN Observational cohort study. SETTING Three-dimensional kinematic gait analyses of outpatients evaluated in Toulouse university hospital. POPULATION ToulGaitViz was applied to 151 post-stroke hemiparetic participants and 48 healthy control participants. METHODS ToulGaitViz is a standalone software allowing to compute 1) limb clearance as the sum of the shortening related to hip, knee and ankle flexion in the sagittal plane; 2) compensations related to the abduction of the limb and hip hiking at mid-swing. Both centimetric and angular values of the clearance were reported as well as their correlations with walking speed. RESULTS Overall, the contribution of compensations in clearance was higher in post-stroke hemiparetic subjects than in healthy control participants with both centimetric (130% vs. 33%; P<0.001) and angular methods (23% vs. 1.4%; P<0.001). The centimetric method better represents the specific contribution of each segment to the clearance than the angular method. Symbolically, mean kinematic data from the cohort supports the claim that 2° of pelvic obliquity is equivalent to 10° of knee flexion to increase clearance by 1 cm, emphasizing the non-proportionality between the angular values and the actual contribution to the shortening. ToulGaitViz allows visualization of clearance, segmental shortening and compensation evolution before and after any therapeutic intervention with quantitative and comprehensive data. CONCLUSIONS The ToulGaitViz could be systematically used in clinical practice to extract relevant kinematic data from the origin of shortening default and the weight of compensations. CLINICAL REHABILITATION IMPACT This tool allows better understanding of the mechanisms of action of treatments to better link them to the subjects' needs.
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Affiliation(s)
- Emmeline Montané
- Toulouse University Hospital Center, Department of Physiological Explorations, Toulouse, France
| | - Camille Cormier
- Toulouse University Hospital Center, Department of Physiological Explorations, Toulouse, France
- Toulouse NeuroImaging Center (ToNIC), Inserm, Toulouse University3, Toulouse III - Paul Sabatier University, Toulouse, France
| | - Marino Scandella
- Gait Analysis Laboratory, Toulouse University Hospital, Toulouse, France
| | - Adrian Cangelosi
- Toulouse University Hospital Center, Department of Physiological Explorations, Toulouse, France
| | - Philippe Marque
- Toulouse NeuroImaging Center (ToNIC), Inserm, Toulouse University3, Toulouse III - Paul Sabatier University, Toulouse, France
- Department of Physical and Rehabilitation Medicine, Toulouse University Hospital, Toulouse, France
| | - Florent Moissenet
- Kinesiology Laboratory, Geneva University Hospitals, Geneva University, Geneva, Switzerland
| | - David Gasq
- Toulouse University Hospital Center, Department of Physiological Explorations, Toulouse, France -
- Toulouse NeuroImaging Center (ToNIC), Inserm, Toulouse University3, Toulouse III - Paul Sabatier University, Toulouse, France
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21
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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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22
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Couto AGB, Vaz MAP, Pinho L, Félix J, Moreira J, Pinho F, Mesquita IA, Mesquita Montes A, Crasto C, Sousa ASP. Interlimb Coordination during Double Support Phase of Gait in People with and without Stroke. J Mot Behav 2023; 56:195-210. [PMID: 37990958 DOI: 10.1080/00222895.2023.2282088] [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: 02/16/2023] [Accepted: 10/12/2023] [Indexed: 11/23/2023]
Abstract
This study aims to identify differences between participants with and without stroke regarding the ipsilesional and contralesional lower limbs kinematics, kinetics, muscle activity and their variability during double support phase of gait. Eleven post-stroke and thirteen healthy participants performed 10 gait trials at a self-selected speed while being monitored by an optoelectronic motion capture system, two force plates and an electromyographic system. The following outcomes were evaluated during the double support: the time and the joint position; the external mechanical work on the centre of mass; and the relative electromyographic activity. Both, contralesional/ipsilesional and dominant/non-dominant of participants with and without stroke, respectively, were evaluated during double support phase of gait in trailing or leading positions. The average value of each parameter and the coefficient of variation of the 10 trials were analysed. Post-stroke participants present bilateral decreased mechanical work on the centre of mass and increased variability, decreased contralesional knee and ankle flexion in trailing position, increased ipsilesional knee flexion in leading position and increased variability. Increased relative muscle activity was observed in post-stroke participants with decreased variability. Mechanical work on the centre of mass seems to be the most relevant parameter to identify interlimb coordination impairments in post-stroke subjects.
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Affiliation(s)
- Ana G B Couto
- Department of Physiotherapy and Research Center and Projects (NIP), Santa Maria Health School, Porto, Portugal
- Center for Rehabilitation Research (CIR), ESS, Polytechnic of Porto, rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal
- Faculty of Engineering, University of Porto, Porto, Portugal
| | - Mário A P Vaz
- Institute of Mechanical Engineering and Industrial Management, Faculty of Engineering, University of Porto, Porto, Portugal
- Porto Biomechanics Laboratory (LABIOMEP), University of Porto, Porto, Portugal
| | - Liliana Pinho
- Center for Rehabilitation Research (CIR), ESS, Polytechnic of Porto, rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal
- College of Health Sciences - Escola Superior de Saúde do Vale do Ave, Cooperative for Higher, Polytechnic and University Education, Vila Nova de Famalicão, Portugal
- Faculty of Sport, University of Porto, Porto, Portugal
| | - José Félix
- Department of Physics and Center for Rehabilitation Research (CIR), ESS, Polytechnic of Porto, rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal
- Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - Juliana Moreira
- Department of Physiotherapy and Center for Rehabilitation Research (CIR), ESS, Polytechnic of Porto, rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal
| | - Francisco Pinho
- College of Health Sciences - Escola Superior de Saúde do Vale do Ave and Health and Human Movement Unit (H2M), Cooperative for Higher, Polytechnic and University Education, Vila Nova de Famalicão, Portugal
| | - Inês Albuquerque Mesquita
- Research Center and Projects (NIP), Santa Maria Health School, Porto, Portugal
- Department of Functional Sciences and Center for Rehabilitation Research (CIR), ESS, Polytechnic of Porto, rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal
| | - António Mesquita Montes
- Department of Physiotherapy and Center for Rehabilitation Research (CIR), ESS, Polytechnic of Porto, rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal
- Research Center and Projects (NIP), Santa Maria Health School, Porto, Portugal
| | - Carlos Crasto
- Department of Physiotherapy and Center for Rehabilitation Research (CIR), ESS, Polytechnic of Porto, rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal
- Research Center and Projects (NIP), Santa Maria Health School, Porto, Portugal
| | - Andreia S P Sousa
- Department of Physiotherapy and Center for Rehabilitation Research (CIR), ESS, Polytechnic of Porto, rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal
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Nedergård H, Sandlund M, Häger CK, Palmcrantz S. Users' experiences of intensive robotic-assisted gait training post-stroke - "a push forward or feeling pushed around?". Disabil Rehabil 2023; 45:3861-3868. [PMID: 36342771 DOI: 10.1080/09638288.2022.2140848] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/17/2022] [Accepted: 10/23/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE Robotic-assisted gait training (RAGT) is suggested to improve walking ability after stroke. The purpose of this study was to describe experiences of robotic-assisted gait training as part of a gait training intervention among persons in the chronic phase after stroke. MATERIALS AND METHODS Semi-structured interviews were performed with 13 participants after a 6-week intervention including treadmill gait training with the Hybrid Assistive Limb® (HAL) exoskeleton. Data were analysed using qualitative content analysis. RESULTS Four categories emerged: (1) A rare opportunity for potential improvements describes the mindset before the start of the intervention; (2) Being pushed to the limit represents the experience of engaging in intensive gait training; (3) Walking with both resistance and constraints reveals barriers and facilitators during HAL training; (4) Reaching the end and taking the next step alone illustrates feelings of confidence or concern as the intervention ended. CONCLUSIONS The gait training intervention including RAGT was considered demanding but appreciated. Support and concrete, individual feedback was crucial for motivation, whilst the lack of variation was a barrier. Results encourage further development of exoskeletons that are comfortable to wear and stimulate active participation by enabling smoothly synchronised movements performed during task-specific activities in different environments. IMPLICATIONS FOR REHABILITATIONWhen provided in a suitable context, the mental and physical challenges of intensive robotic-assisted gait training can be both inspiring and motivating.Support and engagement along with informative feedback from therapists are suggested crucial for motivation.Intensive task-specific gait training may preferably be performed in an enriched environment and combined with other physiotherapy treatments to stimulate engagement.
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Affiliation(s)
- Heidi Nedergård
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Marlene Sandlund
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Charlotte K Häger
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Susanne Palmcrantz
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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Yoo M, Chun MH, Hong GR, Lee C, Lee JK, Lee A. Effects of Training with a Powered Exoskeleton on Cortical Activity Modulation in Hemiparetic Chronic Stroke Patients: A Randomized Controlled Pilot Trial. Arch Phys Med Rehabil 2023; 104:1620-1629. [PMID: 37295705 DOI: 10.1016/j.apmr.2023.05.012] [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: 05/02/2022] [Revised: 04/26/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To investigate the effects of exoskeleton-assisted gait training in stroke patients. DESIGN Prospective randomized controlled trial. SETTING Rehabilitation department in a single tertiary hospital. PARTICIPANTS Thirty (N=30) chronic stroke patients with Functional Ambulatory Category scale (FAC) between 2 and 4. INTERVENTION Patients were randomly assigned to 1 of 2 groups: training with Healbot G, a wearable powered exoskeleton (Healbot G group; n=15), or treadmill training (control group; n=15). All participants received 30 minutes of training, 10 times per week, for 4 weeks. OUTCOME MEASUREMENTS The primary outcome was oxyhemoglobin level changes, representing cortical activity in both motor cortices using functional near-infrared spectroscopy. The secondary outcomes included FAC, Berg Balance Scale, Motricity Index for the lower extremities (MI-Lower), 10-meter walk test, and gait symmetry ratio (spatial step and temporal symmetry ratio). RESULTS Compared to the control group, during the entire training session, the pre-training and post-training mean cortical activity, and the amount of increment between pre- and post-training were significantly higher in the Healbot G group (∆mean ± SD; pre-training, 0.245±0.119, post-training, 0.697±0.429, between pre- and post-training, 0.471±0.401μmol, P<.001). There was no significant difference in cortical activity between affected- and unaffected hemispheres after Healbot G training. FAC (∆mean ± SD; 0.35 ± 0.50, P=.012), MI-Lower (∆mean ± SD; 7.01 ± 0.14, P=.001), and spatial step gait symmetry ratio (∆mean ± SD; -0.32 ± 0.25, P=.049) were improved significantly in the Healbot G group. CONCLUSION Exoskeleton-assisted gait training induces cortical modulation effect in both motor cortices, a balanced cortical activation pattern with improvements in spatial step symmetry ratio, walking ability, and voluntary strength.
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Affiliation(s)
- Miran Yoo
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Min Ho Chun
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Ga Ram Hong
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Changmin Lee
- School of Electrical and Electronic Engineering, Yonsei University, Seoul, Republic of Korea
| | - June Kyoung Lee
- Department of Rehabilitation Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Gyeonggi-do, Republic of Korea
| | - Anna Lee
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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25
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Brandenbarg P, Hoekstra F, Barakou I, Seves BL, Hettinga FJ, Hoekstra T, van der Woude LHV, Dekker R, Krops LA. Measurement properties of device-based physical activity instruments in ambulatory adults with physical disabilities and/or chronic diseases: a scoping review. BMC Sports Sci Med Rehabil 2023; 15:115. [PMID: 37735403 PMCID: PMC10512652 DOI: 10.1186/s13102-023-00717-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 08/22/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND People with physical disabilities and/or chronic diseases tend to have an inactive lifestyle. Monitoring physical activity levels is important to provide insight on how much and what types of activities people with physical disabilities and/or chronic diseases engage in. This information can be used as input for interventions to promote a physically active lifestyle. Therefore, valid and reliable physical activity measurement instruments are needed. This scoping review aims 1) to provide a critical mapping of the existing literature and 2) directions for future research on measurement properties of device-based instruments assessing physical activity behavior in ambulant adults with physical disabilities and/or chronic diseases. METHODS Four databases (MEDLINE, CINAHL, Web of Science, Embase) were systematically searched from 2015 to April 16th 2023 for articles investigating measurement properties of device-based instruments assessing physical activity in ambulatory adults with physical disabilities and/or chronic diseases. For the majority, screening and selection of eligible studies were done in duplicate. Extracted data were publication data, study data, study population, device, studied measurement properties and study outcome. Data were synthesized per device. RESULTS One hundred three of 21566 Studies were included. 55 Consumer-grade and 23 research-grade devices were studied on measurement properties, using 14 different physical activity outcomes, in 23 different physical disabilities and/or chronic diseases. ActiGraph (n = 28) and Fitbit (n = 39) devices were most frequently studied. Steps (n = 68) was the most common used physical activity outcome. 97 studies determined validity, 11 studies reliability and 6 studies responsiveness. CONCLUSION This scoping review shows a large variability in research on measurement properties of device-based instruments in ambulatory adults with physical disabilities and/or chronic diseases. The variability highlights a need for standardization of and consensus on research in this field. The review provides directions for future research.
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Affiliation(s)
- Pim Brandenbarg
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands.
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands.
| | - Femke Hoekstra
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
- School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, BC, V1V 1V7, Canada
| | - Ioulia Barakou
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
| | - Bregje L Seves
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
| | - Florentina J Hettinga
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle, NE1 8ST, UK
| | - Trynke Hoekstra
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
- Department of Health Sciences and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, 1081 BT, The Netherlands
| | - Lucas H V van der Woude
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
| | - Rienk Dekker
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
| | - Leonie A Krops
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
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26
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Yamamoto A, Fujita K, Yamada E, Ibara T, Nihey F, Inai T, Tsukamoto K, Kobayashi Y, Nakahara K, Okawa A. Foot characteristics of the daily-life gait in postmenopausal females with distal radius fractures: a cross-sectional study. BMC Musculoskelet Disord 2023; 24:706. [PMID: 37670304 PMCID: PMC10478493 DOI: 10.1186/s12891-023-06845-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/30/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Gait decline in older adults is related to falling risk, some of which contribute to injurious falls requiring medical attention or restriction of activity of daily living. Among injurious falls, distal radius fracture (DRF) is a common initial fragility fracture associated with the subsequent fracture risk in postmenopausal females. The recent invention of an inertial measurement unit (IMU) facilitates the assessment of free-living gait; however, little is known about the daily gait characteristics related to the risk of subsequent fractures. We hypothesized that females with DRF might have early changes in foot kinematics in daily gait. The aim of this study was to evaluate the daily-life gait characteristics related to the risk of falls and fracture. METHODS In this cross-sectional study, we recruited 27 postmenopausal females with DRF as their first fragility fracture and 28 age-matched females without a history of fragility fractures. The participants underwent daily gait assessments for several weeks using in-shoe IMU sensors. Eight gait parameters and each coefficient of variance were calculated. Some physical tests, such as hand grip strength and Timed Up and Go tests, were performed to check the baseline functional ability. RESULTS The fracture group showed lower foot angles of dorsiflexion and plantarflexion in the swing phase. The receiver operating characteristic curve analyses revealed that a total foot movement angle (TFMA) < 99.0 degrees was the risk of subsequent fracture. CONCLUSIONS We extracted the daily-life gait characteristics of patients with DRF using in-shoe IMU sensors. A lower foot angle in the swing phase, TFMA, may be associated with the risk of subsequent fractures, which may be effective in evaluating future fracture risk. Further studies to predict and prevent subsequent fractures from daily-life gait are warranted.
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Affiliation(s)
- Akiko Yamamoto
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan
| | - Koji Fujita
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan.
| | - Eriku Yamada
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan
| | - Takuya Ibara
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan
| | - Fumiyuki Nihey
- Biometrics Research Laboratories, NEC Corporation, 1131, Hinode, Abiko-City, Chiba, 270-1198, Japan
| | - Takuma Inai
- QOL and Materials Research Group, Department of Life Science and Technology, National Institute of Advanced Industrial Science and Technology, Health and Medical Research Institute, 2217-14 Hayashi-Cho, Takamatsu-City, Kagawa, 761-0301, Japan
| | - Kazuya Tsukamoto
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan
| | - Yoshiyuki Kobayashi
- Human Augmentation Research Center, National Institute of Advanced Industrial Science and Technology, 2-8-5 Aomi, Koto-Ku, Tokyo, 135-0064, Japan
| | - Kentaro Nakahara
- Biometrics Research Laboratories, NEC Corporation, 1131, Hinode, Abiko-City, Chiba, 270-1198, Japan
| | - Atsushi Okawa
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan
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27
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Recenti M, Gargiulo P, Chang M, Ko SB, Kim TJ, Ko SU. Predicting stroke, neurological and movement disorders using single and dual-task gait in Korean older population. Gait Posture 2023; 105:92-98. [PMID: 37515891 DOI: 10.1016/j.gaitpost.2023.07.282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 05/19/2023] [Accepted: 07/23/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND Single and motor or cognitive dual-gait analysis is often used in clinical settings to evaluate older adults affected by neurological and movement disorders or with a stroke history. Gait features are frequently investigated using Machine Learning (ML) with significant results that can help clinicians in diagnosis and rehabilitation. The present study aims to classify patients with stroke, neurological and movement disorders using ML to analyze gait characteristics and to understand the importance of the single and dual-task features among Korean older adults. METHODS A cohort of 122 non-hospitalized Korean older adult participated in a single and a cognitive dual-task gait performance analysis. The extracted temporal and spatial features, together with clinical data, were used as input for the binary classification using tree-based ML algorithms. A repeated-stratified 10-fold cross-validation was performed to better evaluate multiple classification metrics with a final feature importance analysis. RESULTS AND SIGNIFICANCE The best accuracy - maximum >90 % - for gait and neurological disorders classification was obtained with Random Forest. In the stroke classification a 91.7 % of maximum accuracy was reached, with a significant recall of 92 %. The feature importance analysis showed a substantial balance between single and dual-task, while clinical data did not show elevated importance. The current findings indicate that a cognitive dual-task gait performance is highly recommendable together with a single-task in the analysis of older population, particularly for patients with a history of stroke. The results could be useful to medical professionals in treating and diagnosing motor and neurological disorders, and to improve rehabilitation strategies for stroke patients. Furthermore, the results confirm the proficiency of the tree-based ML algorithms in biomedical data analysis. Finally, in the future, this research could be replicated with a non-Asian population dataset to deepen the understanding of gait differences between Asian-Korean population and other ethnicities.
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Affiliation(s)
- Marco Recenti
- Institute of Biomedical and Neural Engineering, Reykjavik University, Menntavegur 1, Reykjavik 102, Iceland; Department of Mechanical Engineering, Chonnam National University, 50 Daehak-ro, Yeosu, Jeonnam 550-749, South Korea.
| | - Paolo Gargiulo
- Institute of Biomedical and Neural Engineering, Reykjavik University, Menntavegur 1, Reykjavik 102, Iceland; Department of Science, Landspitali University Hospital, Hringbraut 101, Reykjavík 101, Iceland
| | - Milan Chang
- The Icelandic Gerontological Research Institute, Landspitali University Hospital, Tungata 26, Reykjavik 101, Iceland
| | - Sang Bae Ko
- Department of Neurology and Critical Care, Seoul National University Hospital, 101 Daehak-ro Jongno-gu, Seoul 03080, South Korea
| | - Tae Jung Kim
- Department of Neurology and Critical Care, Seoul National University Hospital, 101 Daehak-ro Jongno-gu, Seoul 03080, South Korea
| | - Seung Uk Ko
- Department of Mechanical Engineering, Chonnam National University, 50 Daehak-ro, Yeosu, Jeonnam 550-749, South Korea
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Kamimoto T, Hosoi Y, Tanamachi K, Yamamoto R, Yamada Y, Teramae T, Noda T, Kaneko F, Tsuji T, Kawakami M. Combined Ankle Robot Training and Robot-assisted Gait Training Improved the Gait Pattern of a Patient with Chronic Traumatic Brain Injury. Prog Rehabil Med 2023; 8:20230024. [PMID: 37593197 PMCID: PMC10427343 DOI: 10.2490/prm.20230024] [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: 04/03/2023] [Accepted: 06/28/2023] [Indexed: 08/19/2023] Open
Abstract
Background : Walking disability caused by central nervous system injury often lingers. In the chronic phase, there is great need to improve walking speed and gait, even for patients who walk independently. Robot-assisted gait training (RAGT) has been widely used, but few studies have focused on improving gait patterns, and its effectiveness for motor function has been limited. This report describes the combination of "RAGT to learn the gait pattern" and "ankle robot training to improve motor function" in a patient with chronic stage brain injury. Case : A 34-year-old woman suffered a traumatic brain injury 5 years ago. She had residual right hemiplegia [Fugl-Meyer Assessment-Lower Extremity (FMA-LE): 18 points] and mild sensory impairment, but she walked independently with a short leg brace and a cane. Her comfortable gait speed was 0.57 m/s without an orthosis, and her 6-m walk test distance was 240 m. The Gait Assessment and Intervention Tool (G.A.I.T.) score was 35 points. After hospitalization, ankle robot training was performed daily, with RAGT performed 10 times in total. Post-intervention evaluation performed on Day 28 showed: FMA-LE, 23 points; comfortable walking speed, 0.69 m/s; G.A.I.T., 27 points; and three-dimensional motion analysis showed ankle dorsiflexion improved from 3.22° to 12.59° and knee flexion improved from 1.75° to 16.54° in the swing phase. Discussion : This is one of few studies to have examined the combination of two robots. Combining the features of each robot improved the gait pattern and motor function, even in the chronic phase.
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Affiliation(s)
- Takayuki Kamimoto
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yuichiro Hosoi
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kenya Tanamachi
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
- Department of Physical Therapy, Graduate School of Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Rieko Yamamoto
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
- Center for Environmental and Health Sciences, Hokkaido University, Sapporo, Japan
| | - Yuka Yamada
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Tatsuya Teramae
- Department of Brain Robot Interface, Brain Information Communication Research Laboratory Group, Advanced Telecommunications Research Institute International, Kyoto, Japan
| | - Tomoyuki Noda
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
- Department of Brain Robot Interface, Brain Information Communication Research Laboratory Group, Advanced Telecommunications Research Institute International, Kyoto, Japan
| | - Fuminari Kaneko
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
- Department of Physical Therapy, Graduate School of Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Tetsuya Tsuji
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Michiyuki Kawakami
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
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Manto M, Serrao M, Filippo Castiglia S, Timmann D, Tzvi-Minker E, Pan MK, Kuo SH, Ugawa Y. Neurophysiology of cerebellar ataxias and gait disorders. Clin Neurophysiol Pract 2023; 8:143-160. [PMID: 37593693 PMCID: PMC10429746 DOI: 10.1016/j.cnp.2023.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/19/2023] [Accepted: 07/11/2023] [Indexed: 08/19/2023] Open
Abstract
There are numerous forms of cerebellar disorders from sporadic to genetic diseases. The aim of this chapter is to provide an overview of the advances and emerging techniques during these last 2 decades in the neurophysiological tests useful in cerebellar patients for clinical and research purposes. Clinically, patients exhibit various combinations of a vestibulocerebellar syndrome, a cerebellar cognitive affective syndrome and a cerebellar motor syndrome which will be discussed throughout this chapter. Cerebellar patients show abnormal Bereitschaftpotentials (BPs) and mismatch negativity. Cerebellar EEG is now being applied in cerebellar disorders to unravel impaired electrophysiological patterns associated within disorders of the cerebellar cortex. Eyeblink conditioning is significantly impaired in cerebellar disorders: the ability to acquire conditioned eyeblink responses is reduced in hereditary ataxias, in cerebellar stroke and after tumor surgery of the cerebellum. Furthermore, impaired eyeblink conditioning is an early marker of cerebellar degenerative disease. General rules of motor control suggest that optimal strategies are needed to execute voluntary movements in the complex environment of daily life. A high degree of adaptability is required for learning procedures underlying motor control as sensorimotor adaptation is essential to perform accurate goal-directed movements. Cerebellar patients show impairments during online visuomotor adaptation tasks. Cerebellum-motor cortex inhibition (CBI) is a neurophysiological biomarker showing an inverse association between cerebellothalamocortical tract integrity and ataxia severity. Ataxic gait is characterized by increased step width, reduced ankle joint range of motion, increased gait variability, lack of intra-limb inter-joint and inter-segmental coordination, impaired foot ground placement and loss of trunk control. Taken together, these techniques provide a neurophysiological framework for a better appraisal of cerebellar disorders.
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Affiliation(s)
- Mario Manto
- Service des Neurosciences, Université de Mons, Mons, Belgium
- Service de Neurologie, CHU-Charleroi, Charleroi, Belgium
| | - Mariano Serrao
- Department of Medical and Surgical Sciences and Biotechnologies, University of Rome Sapienza, Polo Pontino, Corso della Repubblica 79 04100, Latina, Italy
- Gait Analysis LAB Policlinico Italia, Via Del Campidano 6 00162, Rome, Italy
| | - Stefano Filippo Castiglia
- Department of Medical and Surgical Sciences and Biotechnologies, University of Rome Sapienza, Polo Pontino, Corso della Repubblica 79 04100, Latina, Italy
- Gait Analysis LAB Policlinico Italia, Via Del Campidano 6 00162, Rome, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, via Bassi, 21, 27100 Pavia, Italy
| | - Dagmar Timmann
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Essen University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Elinor Tzvi-Minker
- Department of Neurology, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
- Syte Institute, Hamburg, Germany
| | - Ming-Kai Pan
- Cerebellar Research Center, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin 64041, Taiwan
- Department and Graduate Institute of Pharmacology, National Taiwan University College of Medicine, Taipei 10051, Taiwan
- Department of Medical Research, National Taiwan University Hospital, Taipei 10002, Taiwan
- Institute of Biomedical Sciences, Academia Sinica, Taipei City 11529, Taiwan
- Initiative for Columbia Ataxia and Tremor, Columbia University Irving Medical Center, New York, NY, USA
| | - Sheng-Han Kuo
- Institute of Biomedical Sciences, Academia Sinica, Taipei City 11529, Taiwan
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, Fukushima Medical University, Fukushima, Japan
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30
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Lee CH, Mendoza T, Huang CH, Sun TL. Comparative Analysis of Fall Risk Assessment Features in Community-Elderly and Stroke Survivors: Insights from Sensor-Based Data. Healthcare (Basel) 2023; 11:1938. [PMID: 37444772 PMCID: PMC10341555 DOI: 10.3390/healthcare11131938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
Fall-risk assessment studies generally focus on identifying characteristics that affect postural balance in a specific group of subjects. However, falls affect a multitude of individuals. Among the groups with the most recurrent fallers are the community-dwelling elderly and stroke survivors. Thus, this study focuses on identifying a set of features that can explain fall risk for these two groups of subjects. Sixty-five community dwelling elderly (forty-nine female, sixteen male) and thirty-five stroke-survivors (twenty-two male, thirteen male) participated in our study. With the use of an inertial sensor, some features are extracted from the acceleration data of a Timed Up and Go (TUG) test performed by both groups of individuals. A short-form berg balance scale (SFBBS) score and the TUG test score were used for labeling the data. With the use of a 100-fold cross-validation approach, Relief-F and Extra Trees Classifier algorithms were used to extract sets of the top 5, 10, 15, 20, 25, and 30 features. Random Forest classifiers were trained for each set of features. The best models were selected, and the repeated features for each group of subjects were analyzed and discussed. The results show that only the stand duration was an important feature for the prediction of fall risk across all clinical tests and both groups of individuals.
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Affiliation(s)
- Chia-Hsuan Lee
- Department of Data Science, Soochow University, No. 70, Linxi Road, Shilin District, Taipei 111, Taiwan;
| | - Tomas Mendoza
- Department of Industrial Engineering and Management, Yuan Ze University, 135 Yuan Tung Road, Chungli District, Taoyuan 320, Taiwan;
| | - Chien-Hua Huang
- Department of Eldercare, Central Taiwan University of Science and Technology, Taichung 40601, Taiwan;
| | - Tien-Lung Sun
- Department of Industrial Engineering and Management, Yuan Ze University, 135 Yuan Tung Road, Chungli District, Taoyuan 320, Taiwan;
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31
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Bonanno M, De Nunzio AM, Quartarone A, Militi A, Petralito F, Calabrò RS. Gait Analysis in Neurorehabilitation: From Research to Clinical Practice. Bioengineering (Basel) 2023; 10:785. [PMID: 37508812 PMCID: PMC10376523 DOI: 10.3390/bioengineering10070785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/16/2023] [Accepted: 06/28/2023] [Indexed: 07/30/2023] Open
Abstract
When brain damage occurs, gait and balance are often impaired. Evaluation of the gait cycle, therefore, has a pivotal role during the rehabilitation path of subjects who suffer from neurological disorders. Gait analysis can be performed through laboratory systems, non-wearable sensors (NWS), and/or wearable sensors (WS). Using these tools, physiotherapists and neurologists have more objective measures of motion function and can plan tailored and specific gait and balance training early to achieve better outcomes and improve patients' quality of life. However, most of these innovative tools are used for research purposes (especially the laboratory systems and NWS), although they deserve more attention in the rehabilitation field, considering their potential in improving clinical practice. In this narrative review, we aimed to summarize the most used gait analysis systems in neurological patients, shedding some light on their clinical value and implications for neurorehabilitation practice.
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Affiliation(s)
- Mirjam Bonanno
- IRCCS Centro Neurolesi "Bonino-Pulejo", Via Palermo, SS 113, C. da Casazza, 98123 Messina, Italy
| | - Alessandro Marco De Nunzio
- Department of Research and Development, LUNEX International University of Health, Exercise and Sports, Avenue du Parc des Sports, 50, 4671 Differdange, Luxembourg
| | - Angelo Quartarone
- IRCCS Centro Neurolesi "Bonino-Pulejo", Via Palermo, SS 113, C. da Casazza, 98123 Messina, Italy
| | - Annalisa Militi
- IRCCS Centro Neurolesi "Bonino-Pulejo", Via Palermo, SS 113, C. da Casazza, 98123 Messina, Italy
| | - Francesco Petralito
- IRCCS Centro Neurolesi "Bonino-Pulejo", Via Palermo, SS 113, C. da Casazza, 98123 Messina, Italy
| | - Rocco Salvatore Calabrò
- IRCCS Centro Neurolesi "Bonino-Pulejo", Via Palermo, SS 113, C. da Casazza, 98123 Messina, Italy
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32
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Yeo SS, Koo DK, Ko SY, Park SY. Effect of Balance Training in Sitting Position Using Visual Feedback on Balance and Gait Ability in Chronic Stroke Patients. J Clin Med 2023; 12:4383. [PMID: 37445418 DOI: 10.3390/jcm12134383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
Chronic stroke often results in balance and gait impairments, significantly impacting patients' quality of life. The purpose of this study was to investigate whether the combined effect of unstable surface balance training and visual feedback, based on proprioceptive neuromuscular stimulation in patients with chronic stroke, is effective in restoring balance and gait ability. A total of 39 chronic stroke patients were randomly assigned to a visual feedback combined with unstable surface balance training group (VUSBG), an unstable surface balance training group (USBG), or a conventional physical therapy group (CG). This study was conducted with the Trunk Impairment Scale, the Bug Balance Scale, the Timed Get Up and Go Test, and Gait Analysis. VUSBG and USBG improved function and gait (stride length and hip/knee flexion angle), but there was no significant difference in the CG group. Specific results showed that the stride length in the VUSBG improved by 25% (p < 0.05), and the hip/knee flexion angle improved by 18% (p < 0.05). The post-hoc analysis revealed that VUSBG had a greater impact on the hip/knee flexion angle relative to the other two groups, as well as gait velocity and stride length relative to CG. Visual feedback complex exercise based on the principle of proprioceptive neuromuscular facilitation could be an intervention strategy to improve gait speed, trunk stability, and mobility in chronic stroke patients.
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Affiliation(s)
- Sang-Seok Yeo
- Department of Physical Therapy, College of Health Sciences, Dankook University, 119 Dandae-ro, Dongnam-gu, Cheonan-si 31116, Republic of Korea
| | - Dong-Kyun Koo
- Department of Public Health Sciences, Graduate School, Dankook University, 119 Dandae-ro, Dongnam-gu, Cheonan-si 31116, Republic of Korea
| | - Seong-Young Ko
- Department of Physical Therapy, Graduate School of Health and Welfare, Dankook University, 119 Dandae-ro, Dongnam-gu, Cheonan-si 31116, Republic of Korea
| | - Seo-Yoon Park
- Department of Physical Therapy, College of Health and Welfare, Woosuk University, 443 Samnye-ro, Samnye-eup, Wanju-gun 55338, Republic of Korea
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33
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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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34
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Cohen JC, de Souza Muniz AM, Carvalho Junior RB, de Oliveira HLC, Miranda ST, Gomes MK, da Cunha AJLA, Menegaldo LL. Gait analysis of leprosy patients with foot drop using principal component analysis. Clin Biomech (Bristol, Avon) 2023; 105:105983. [PMID: 37167843 DOI: 10.1016/j.clinbiomech.2023.105983] [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] [Received: 12/26/2022] [Revised: 04/25/2023] [Accepted: 05/01/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Peripheral nerve injury caused by leprosy can lead to foot drop, resulting in an altered gait pattern that has not been previously described using 3D gait analysis. METHODS Gait kinematics and dynamics were analyzed in 12 patients with unilateral foot drop caused by leprosy and in 15 healthy controls. Biomechanical data from patients' affected and unaffected limbs were compared with controls using inferential statistics and a standard distance, based on principal components analysis (PCA). FINDINGS Patients walked slower than controls (0.8 ± 0.2 vs. 1.1 ± 0.2 m/s, p = 0.003), with a reduced stance and increased swing percentage. The affected limb increased (p < 0.05) plantar flexion at the initial contact (-16.8o ± 8.3), terminal stance (-29.1o ± 11.5), and swing (-12.4o ± 6.2) in the affected limb compared to unaffected (-6.6o ± 10.3; -14.6o ± 11.6; 2.4o ± 7.6) and controls (-5.4o ± 2.5; -18.8o ± 5.8; -1.4o ± 3.9). Increased pelvic tilt and knee adduction/abduction range, with lower hip adduction, were observed. The second peak of ground reaction force (98.6 ± 5.2 %BW), ankle torque (0.99 ± 0.33 Nm/kg), and net ankle work in stance (-0.03 ± 5.4 J/Kg) decreased in the affected limb compared to controls (104.1 ± 5.5 %BW; 1.24 ± 0.4 Nm/kg; -4.58 ± 5.19 J/kg; p < 0.05). There were decreasing multivariate standard distances in the affected limb compared with the unaffected and controls. PCA loading factors highlighted the major differences between groups. INTERPRETATION Leprosy patients with foot drop presented altered gait patterns in affected and unaffected limbs. There were remarkable differences in ankle kinematics and dynamics. Rehabilitation devices, such as ankle foot orthosis or tendon transfer surgeries to increase ankle dorsiflexion, could benefit these patients and reduce deviations from normal gait.
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Affiliation(s)
- Jose Carlos Cohen
- Hospital Universitário, Universidade Federal do Rio de Janeiro (UFRJ), Brazil
| | - Adriane Mara de Souza Muniz
- Programa de Engenharia Biomédica (PEB/COPPE), Universidade Federal do Rio de Janeiro (UFRJ), Brazil; Escola de Educação Física do Exército (EsEFEx) - (Brazilian Army), Brazil
| | | | | | - Silvana T Miranda
- Hospital Universitário, Universidade Federal do Rio de Janeiro (UFRJ), Brazil
| | - Maria Kátia Gomes
- Hospital Universitário, Universidade Federal do Rio de Janeiro (UFRJ), Brazil
| | | | - Luciano L Menegaldo
- Programa de Engenharia Biomédica (PEB/COPPE), Universidade Federal do Rio de Janeiro (UFRJ), Brazil.
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Lee JH, Kim EJ. The Effects of Shock Wave Therapy on Spasticity and Walking Ability in People with Stroke: A Comparative Study of Different Application Sites. Brain Sci 2023; 13:brainsci13040687. [PMID: 37190652 DOI: 10.3390/brainsci13040687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND This study was conducted to investigate the effects of extracorporeal shock wave therapy on the improvement of walking ability through a reduction in spasticity in stroke patients. METHODS Thirty-three patients diagnosed with ischemic stroke by a rehabilitation medicine specialist were randomly assigned to three groups. The patients were divided into experimental group 1 in which shock waves were applied to the muscle-tendon junction, experimental group 2 in which shock waves were applied to the middle of the muscle, and experimental group 3 in which shock waves were applied to both the muscle-tendon junction and the middle of the muscle. The MAS was used to evaluate spasticity in the subjects, and the Dartfish software was used to measure knee and ankle angles during heel-off when walking. RESULTS Based on the results of the study, a significant decrease in spasticity and increased joint angles were found in experimental groups 1 and 3 compared to experimental group 2, and the change in joint angle was significantly greater in experimental group 3 than in experimental groups 1 and 2. CONCLUSIONS These results indicate that treatment effect may vary depending on the application site of the shock wave, and to obtain the best treatment effect, the shock wave should be applied to both the muscle-tendon junction and the middle part of the muscle.
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Affiliation(s)
- Jung-Ho Lee
- Department of Physical Therapy, Kyungdong University, 815, Gyeonhwon-ro, Munmak-eup, Wonju-si 26495, Gang-won-do, Republic of Korea
| | - Eun-Ja Kim
- Department of Physical Therapy, Kyungdong University, 815, Gyeonhwon-ro, Munmak-eup, Wonju-si 26495, Gang-won-do, Republic of Korea
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Kim M, Kaneko F. Virtual reality-based gait rehabilitation intervention for stroke individuals: a scoping review. J Exerc Rehabil 2023; 19:95-104. [PMID: 37163183 PMCID: PMC10164524 DOI: 10.12965/jer.2346114.057] [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: 02/22/2023] [Accepted: 03/15/2023] [Indexed: 05/11/2023] Open
Abstract
Virtual reality (VR)-based rehabilitation is rapidly gaining interest and has been shown to be an intervention to facilitate motor learning in balance and gait rehabilitation. A review of the current literature is needed to provide an overview of the current state of knowledge of VR-based gait physiotherapy for stroke patients. A systematic literature search was performed in PubMed and Scopus. Search terms included: "virtual reality," "stroke," "gait," and "physical therapy." Articles published in a peer-reviewed journal between 2017 and 2021 were considered. The intervention was mainly related to the use of VR as a therapeutic modality, and the outcome was gait performance. The initial search identified 329 articles. After an eligibility review, 13 articles that met the inclusion criteria were included in the study. Most of participants were in a chronic stage and were between 14 and 85 years old. The VR-based gait training ranged from nonimmersive to immersive, was mostly performed on a treadmill, and was usually combined with conventional physiotherapy. The duration of the program varied from 10 to 60 min, and there were about 9 to 30 sessions. VR-based gait rehabilitation has a positive effect on gait ability. The existing literature suggests that VR-based rehabilitation combined with conventional physiotherapy could improve gait ability of people with stroke, especially in the chronic stage. However, the duration of VR-based programs should be customized to suit individuals to avoid stimulation sickness. Further research is needed to investigate the long-term effects of this approach.
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Affiliation(s)
- Minjoon Kim
- Department of Clinical Rehabilitation Research, National Rehabilitation Center and National Rehabilitation Research Institute, Seoul,
Korea
- Department of Public Health Sciences, College of Health Sciences, Korea University, Seoul,
Korea
- Corresponding author: Minjoon Kim, Department of Clinical Rehabilitation Research, National Rehabilitation Center, 58 Samgaksan-ro, Gangbuk-gu, Seoul 01022, Korea,
| | - Fuminari Kaneko
- Department of Physical Therapy, Tokyo Metropolitan University, Tokyo,
Japan
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37
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Van Bladel A, De Ridder R, Palmans T, Van der Looven R, Cambier D. Comparing spatiotemporal gait parameters between overground walking and self-paced treadmill walking in persons after stroke. Disabil Rehabil 2023; 45:1016-1021. [PMID: 35332811 DOI: 10.1080/09638288.2022.2046875] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE Since self-paced treadmills enable more natural gait patterns compared to fixed-speed treadmills we examined the use of a self-paced treadmill as a alternative for overground gait analysis in persons after stroke. MATERIAL AND METHODS Twenty-five persons after stroke (10 males/15 females; 53 ± 12.05 years; 40.72 ± 42.94 months post-stroke) walked at self-selected speed overground (GAITRite, CIR Systems) and on a self-paced treadmill (GRAIL, Motek) in randomized order. Spatiotemporal parameters, variability and symmetry measures were compared using paired-sample t-tests or Wilcoxon Signed Rank tests. Concurrent validity was assessed using intraclass correlation coefficients and Bland-Altman plots. A regression model determined the contribution of the walking velocity to the changes in spatiotemporal parameters. RESULTS The velocity on the treadmill was significant lower compared to overground (p < 0.001). This difference predicted the significant changes in other spatiotemporal parameters to varying degrees (27.7%-83.8%). Bland-Altman plots showed large percentage of bias and limits of agreement. Variability and symmetry measures were similar between conditions. CONCLUSIONS When considering gait analysis in persons after stroke a self-paced treadmill may be a valuable alternative for overground analysis. Although a slower walking velocity, and accompanying changes in other spatiotemporal parameters, should be taken into account compared to overground walking.Implications for rehabilitationConsidering the advantages regarding space and time, instrumented treadmills provide opportunities for gait assessment and training in a stroke population.When using self-paced treadmills for clinical gait analysis in persons after stroke, the slower walking velocity and accompanying changes in other spatiotemporal parameters need to be taken into account.Stroke patients seem to preserve their walking pattern on a self-paced treadmill.
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Affiliation(s)
- Anke Van Bladel
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
- Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium
| | - Roel De Ridder
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Tanneke Palmans
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Ruth Van der Looven
- Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium
| | - Dirk Cambier
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
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Couto AGB, Vaz MAP, Pinho L, Félix J, Moreira J, Pinho F, Mesquita IA, Montes AM, Crasto C, Sousa ASP. Repeatability and Temporal Consistency of Lower Limb Biomechanical Variables Expressing Interlimb Coordination during the Double-Support Phase in People with and without Stroke Sequelae. SENSORS (BASEL, SWITZERLAND) 2023; 23:2526. [PMID: 36904730 PMCID: PMC10007500 DOI: 10.3390/s23052526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/08/2023] [Accepted: 02/22/2023] [Indexed: 06/18/2023]
Abstract
Reliable biomechanical methods to assess interlimb coordination during the double-support phase in post-stroke subjects are needed for assessing movement dysfunction and related variability. The data obtained could provide a significant contribution for designing rehabilitation programs and for their monitorisation. The present study aimed to determine the minimum number of gait cycles needed to obtain adequate values of repeatability and temporal consistency of lower limb kinematic, kinetic, and electromyographic parameters during the double support of walking in people with and without stroke sequelae. Eleven post-stroke and thirteen healthy participants performed 20 gait trials at self-selected speed in two separate moments with an interval between 72 h and 7 days. The joint position, the external mechanical work on the centre of mass, and the surface electromyographic activity of the tibialis anterior, soleus, gastrocnemius medialis, rectus femoris, vastus medialis, biceps femoris, and gluteus maximus muscles were extracted for analysis. Both the contralesional and ipsilesional and dominant and non-dominant limbs of participants with and without stroke sequelae, respectively, were evaluated either in trailing or leading positions. The intraclass correlation coefficient was used for assessing intra-session and inter-session consistency analysis. For most of the kinematic and the kinetic variables studied in each session, two to three trials were required for both groups, limbs, and positions. The electromyographic variables presented higher variability, requiring, therefore, a number of trials ranging from 2 to >10. Globally, the number of trials required inter-session ranged from 1 to >10 for kinematic, from 1 to 9 for kinetic, and 1 to >10 for electromyographic variables. Thus, for the double support analysis, three gait trials were required in order to assess the kinematic and kinetic variables in cross-sectional studies, while for longitudinal studies, a higher number of trials (>10) were required for kinematic, kinetic, and electromyographic variables.
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Affiliation(s)
- Ana G. B. Couto
- Department of Physiotherapy, Santa Maria Health School, 4049-024 Porto, Portugal
- Centre for Rehabilitation Research (CIR), School of Health of Polytechnic Institute of Porto, 4200-072 Porto, Portugal
- Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal
- Research Centre and Projects (NIP), Santa Maria Health School, 4049-024 Porto, Portugal
| | - Mário A. P. Vaz
- Institute of Mechanical Engineering and Industrial Management, Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal
- Porto Biomechanics Laboratory (LABIOMEP), University of Porto, 4200-450 Porto, Portugal
| | - Liliana Pinho
- Centre for Rehabilitation Research (CIR), School of Health of Polytechnic Institute of Porto, 4200-072 Porto, Portugal
- College of Health Sciences—Escola Superior de Saúde do Vale do Ave, Cooperative for Higher, Polytechnic and University Education, 4760-409 Vila Nova de Famalicão, Portugal
- Faculty of Sport, University of Porto, 4200-450 Porto, Portugal
| | - José Félix
- Centre for Rehabilitation Research (CIR), School of Health of Polytechnic Institute of Porto, 4200-072 Porto, Portugal
- Department of Physics, School of Health of Polytechnic Institute of Porto, 4200-072 Porto, Portugal
- Department of Medical Sciences, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Juliana Moreira
- Centre for Rehabilitation Research (CIR), School of Health of Polytechnic Institute of Porto, 4200-072 Porto, Portugal
- Department of Physiotherapy, School of Health of Polytechnic Institute of Porto, 4200-072 Porto, Portugal
| | - Francisco Pinho
- College of Health Sciences—Escola Superior de Saúde do Vale do Ave, Cooperative for Higher, Polytechnic and University Education, 4760-409 Vila Nova de Famalicão, Portugal
- Human Movement Unit (H2M), Cooperative for Higher, Polytechnic and University Education, 4760-409 Vila Nova de Famalicão, Portugal
| | - Inês Albuquerque Mesquita
- Centre for Rehabilitation Research (CIR), School of Health of Polytechnic Institute of Porto, 4200-072 Porto, Portugal
- Research Centre and Projects (NIP), Santa Maria Health School, 4049-024 Porto, Portugal
- Department of Functional Sciences, School of Health of Polytechnic Institute of Porto, 4200-072 Porto, Portugal
| | - António Mesquita Montes
- Department of Physiotherapy, Santa Maria Health School, 4049-024 Porto, Portugal
- Research Centre and Projects (NIP), Santa Maria Health School, 4049-024 Porto, Portugal
- Department of Physiotherapy, School of Health of Polytechnic Institute of Porto, 4200-072 Porto, Portugal
| | - Carlos Crasto
- Department of Physiotherapy, Santa Maria Health School, 4049-024 Porto, Portugal
- Research Centre and Projects (NIP), Santa Maria Health School, 4049-024 Porto, Portugal
- Department of Physiotherapy, School of Health of Polytechnic Institute of Porto, 4200-072 Porto, Portugal
| | - Andreia S. P. Sousa
- Department of Physiotherapy, School of Health of Polytechnic Institute of Porto, 4200-072 Porto, Portugal
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Maje AU, Ibrahim AA. Effectiveness of an 8-week overground walking with paretic lower limb loading on spatiotemporal gait parameters and motor function among chronic stroke survivors: a protocol for randomised controlled trial. Trials 2023; 24:124. [PMID: 36803399 PMCID: PMC9942389 DOI: 10.1186/s13063-022-07057-3] [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: 10/06/2022] [Accepted: 12/28/2022] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Post-stroke gait deviations contribute to significant functional disability, impaired walking ability and poor quality of life. Prior studies suggest that gait training with paretic lower limb loading may improve gait parameters and walking ability in post-stroke. However, most gait training methods used in these studies are not readily available, and studies using cheaper methods are limited. OBJECTIVE The purpose of this study is to describe a protocol for a randomised controlled trial on the effectiveness of an 8-week overground walking with paretic lower limb loading on spatiotemporal gait parameters and motor function among chronic stroke survivors. METHODS This is a two-center, single-blind, two-arm parallel randomised controlled trial. Forty-eight stroke survivors with mild to moderate disability will be recruited from two tertiary facilities and randomly assigned into two intervention arms; overground walking with paretic lower limb loading or overground walking without paretic lower limb loading in a 1:1 ratio. All interventions will be administered thrice weekly for 8 weeks. Primary outcomes will be step length and gait speed whereas the secondary outcomes will include step length symmetry ratio, stride length, stride length symmetry ratio, stride width, cadence and motor function. All outcomes will be assessed at baseline, 4, 8 and 20 weeks after the start of intervention. DISCUSSION This will be the first randomised controlled trial to report the effects of overground walking with paretic lower limb loading on spatiotemporal gait parameters and motor function among chronic stroke survivors from low-resource setting. TRIAL REGISTRATION ClinicalTrials.gov NCT05097391. Registered on 27 October 2021.
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Affiliation(s)
- Abdulhamid U. Maje
- Department of Physiotherapy, Muhammadu Abdullahi Wase Teaching Hospital, Hospitals Management Board, P.M.B 3160, Kano, Kano State Nigeria ,grid.411585.c0000 0001 2288 989XDepartment of Physiotherapy, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University, P.M.B 3011, Kano, Kano State Nigeria
| | - Aminu A. Ibrahim
- grid.510479.eDepartment of Physiotherapy, School of Basic Medical Sciences, Skyline University Nigeria, Kano, Kano State Nigeria
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Ha Y, Park M. Effects of Stroke Rehabilitation Using Gait Robot-Assisted Training and Person-Centered Goal Setting: A Single Blinded Pilot Study. Healthcare (Basel) 2023; 11:healthcare11040588. [PMID: 36833122 PMCID: PMC9956145 DOI: 10.3390/healthcare11040588] [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: 01/18/2023] [Revised: 02/10/2023] [Accepted: 02/12/2023] [Indexed: 02/18/2023] Open
Abstract
Many stroke survivors have difficulties due to the mobility and activities required in daily living. A walking impairment negatively affects the independent lifestyle of stroke patients, requiring intensive post-stroke rehabilitation. Therefore, the purpose of this study was to examine the effects of stroke rehabilitation using gait robot-assisted training and person-centered goal setting on mobility, the activities of daily living, stroke self-efficacy, and health-related QoL in stroke patients with hemiplegia. An assessor-blinded quasi-experimental study with a pre-posttest nonequivalent control group was used. Participants who were admitted to the hospital with a gait robot-assisted training system were assigned to the experimental group, and those without gait robots were assigned to the control group. Sixty stroke patients with hemiplegia from two hospitals specialized in post-stroke rehabilitation participated. Stroke rehabilitation using gait robot-assisted training and person-centered goal setting for stroke patients with hemiplegia was conducted for a total of six weeks. There were significant differences between the experimental group and control group in the Functional Ambulation Category (t = 2.89, p = 0.005), balance (t = 3.73, p < 0.001), Timed Up and Go (t = -2.27, p = 0.027), Korean Modified Barthel Index (t = 2.58, p = 0.012), 10 m Walking test (t = -2.27, p = 0.040), stroke self-efficacy (t = 2.23, p = 0.030), and health-related quality of life (t = 4.90, p < 0.001). A gait robot-assisted rehabilitation using goal setting for stroke patients with hemiplegia improved gait ability, balance ability, stroke self-efficacy, and health-related quality of life in stroke patients.
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Affiliation(s)
- Yeongmi Ha
- College of Nursing, Institute of Health Sciences, Gyeongsang National University, Jinju 52727, Republic of Korea
| | - Mingyeong Park
- Yeson Rehabilitation Medicine Hospital, Jinju 52717, Republic of Korea
- Correspondence:
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Ling H, Guo H, Zhou H, Chang XQ, Guo ZY, Yamamoto S, Cai LF, Zhao J. Effect of a rigid ankle foot orthosis and an ankle foot orthosis with an oil damper plantar flexion resistance on pelvic and thoracic movements of patients with stroke during gait. Biomed Eng Online 2023; 22:9. [PMID: 36747170 PMCID: PMC9901085 DOI: 10.1186/s12938-023-01068-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 01/16/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Impairments of trunk movements in gait of stroke are often reported. Ankle foot orthosis (AFO) is commonly used to improve gait of stroke; however, the effect of different types of AFOs on the pelvic and thoracic movements during gait in stroke has not been clarified. METHODS Thirty-four patients with stroke were randomly allocated to undergo 2 weeks of gait training by physiotherapists while wearing a rigid AFO (RAFO) with a fixed ankle or an AFO with an oil damper (AFO-OD) that provides plantarflexion resistance and free dorsiflexion. A motion capture system was used for measurements of shod gait without AFO at baseline and with and without AFO after gait training. Two-way repeated ANOVA, Wilcoxon signed-rank test, and Mann-Whitney U test were performed for the data after the gait training to know the effect of different kinds of AFOs. RESULTS Twenty-nine patients completed the study (AFO-OD group: 14, RAFO group: 15). Interactions were found in pelvic rotation angle, change of shank-to-vertical angle (SVA) in the stance, and paretic to non-paretic step length, which increased in AFO-OD group with AFOs (p < 0.05), while the SVA decreased in RAFO group with AFOs (p < 0.05). The main effects were found in pelvic rotation at the contralateral foot off, and thoracic tilt at foot off when an AFO was worn. The change of SVA in stance was positively correlated with the pelvic rotation in the AFO-OD group (r = 0.558). At initial contact, pelvic rotation was positively correlated with thoracic rotation in both groups. CONCLUSIONS The findings in 29 patients with stroke showed that pelvic and thoracic movements especially the rotation were affected by the type of AFOs. Pelvic rotation and lower limb kinematics exhibited significant improvements with AFO-OD, reflecting more desirable gait performance. On the other hand, the increase in thoracic in-phase rotation might expose the effect of insufficient trunk control and dissociation movement. Trial registration UMIN000038694, Registered 21 November 2019, https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_his_list.cgi?recptno=R000044048 .
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Affiliation(s)
- Hua Ling
- Rehabilitation Engineering Institute, China Rehabilitation Science Institute, No.18, Jiaomen Beilu, Beijing, 100068, China
| | - Hui Guo
- Beijing Bo'ai Hospital, China Rehabilitation Research Center, No.10, Jiaomen Beilu, Beijing, 100068, China
| | - Hao Zhou
- Beijing Bo'ai Hospital, China Rehabilitation Research Center, No.10, Jiaomen Beilu, Beijing, 100068, China
| | - Xiao-Qian Chang
- Rehabilitation Engineering Institute, China Rehabilitation Science Institute, No.18, Jiaomen Beilu, Beijing, 100068, China
| | - Zi-Yang Guo
- Rehabilitation Engineering Institute, China Rehabilitation Science Institute, No.18, Jiaomen Beilu, Beijing, 100068, China
| | - Sumiko Yamamoto
- Graduate School, International University of Health & Welfare, 4‑1‑26 Akasaka, Minato‑ku, Tokyo, 107‑8402, Japan
| | - Li-Fei Cai
- Rehabilitation Engineering Institute, China Rehabilitation Science Institute, No.18, Jiaomen Beilu, Beijing, 100068, China.
| | - Jun Zhao
- Beijing Bo'ai Hospital, China Rehabilitation Research Center, No.10, Jiaomen Beilu, Beijing, 100068, China.
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The contribution of walking speed versus recent stroke to temporospatial gait variability. Gait Posture 2023; 100:216-221. [PMID: 36621194 DOI: 10.1016/j.gaitpost.2022.12.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/25/2022] [Accepted: 12/26/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Inconsistent results have been reported for temporospatial gait variability after stroke. Given the large differences in gait speed across stroke subjects and relative to healthy controls, it is not clear which changes in temporospatial gait variability can be ascribed to the walking speed during gait evaluation versus the consequences of stroke. RESEARCH QUESTIONS Does temporospatial gait variability differ between (1) stroke subjects grouped in clinically-relevant functional ambulation classes, (2) the paretic and non-paretic legs within each class, and (3) stroke and healthy subjects after controlling for gait speed? METHODS Stroke subjects were evaluated at their comfortable speed < 2 months post-onset and classified into the household (<40 cm/s, n = 38), limited-community (40-80 cm/s, n = 35), and full-community (>80 cm/s, n = 14) walkers. Coefficients of variation (CVs) for paretic and non-paretic stance, initial double-support, and single-support times, step length, step cadence, and step width were compared across the stroke ambulation classes and between the two legs. For the parameters with significantly different CVs between stroke subjects and 33 age-matched controls walking at very-slow and free speeds, a 1-way ANCOVA was used with the gait speed as a covariate. RESULTS For most step parameters, CVs were greater in slower stroke ambulation classes except for the smaller step width CV. The differences between the paretic and non-paretic legs emerged in slower walkers only. After controlling for the gait speed, CVs of stroke subjects no longer significantly differed from controls walking at very-slow speed. With controls walking at free speed, however, CVs for the paretic and non-paretic single-support times and the non-paretic step time remained significantly different. SIGNIFICANCE Gait is more variable at slower speeds both in stroke subjects and healthy controls. After accounting for the free gait speed, the increased variability of only a few temporal parameters may be attributed to a recent stroke.
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Schwarz A, Al-Haj Husain A, Einaudi L, Thürlimann E, Läderach J, Awai Easthope C, Held JPO, Luft AR. Reliability and Validity of a Wearable Sensing System and Online Gait Analysis Report in Persons after Stroke. SENSORS (BASEL, SWITZERLAND) 2023; 23:624. [PMID: 36679424 PMCID: PMC9862973 DOI: 10.3390/s23020624] [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: 12/09/2022] [Revised: 12/29/2022] [Accepted: 01/03/2023] [Indexed: 06/17/2023]
Abstract
The restoration of gait and mobility after stroke is an important and challenging therapy goal due to the complexity of the potentially impaired functions. As a result, precise and clinically feasible assessment methods are required for personalized gait rehabilitation after stroke. The aim of this study is to investigate the reliability and validity of a sensor-based gait analysis system in stroke survivors with different severities of gait deficits. For this purpose, 28 chronic stroke survivors (9 women, ages: 62.04 ± 11.68 years) with mild to moderate walking impairments performed a set of ambulatory assessments (3× 10MWT, 1× 6MWT per session) twice while being equipped with a sensor suit. The derived gait reports provided information about speed, step length, step width, swing and stance phases, as well as joint angles of the hip, knee, and ankle, which we analyzed for test-retest reliability and hypothesis testing. Further, test-retest reliability resulted in a mean ICC of 0.78 (range: 0.46-0.88) for walking 10 m and a mean ICC of 0.90 (range: 0.63-0.99) for walking 6 min. Additionally, all gait parameters showed moderate-to-strong correlations with clinical scales reflecting lower limb function. These results support the applicability of this sensor-based gait analysis system for individuals with stroke-related walking impairments.
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Affiliation(s)
- Anne Schwarz
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University of Zurich, 8091 Zurich, Switzerland
| | - Adib Al-Haj Husain
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University of Zurich, 8091 Zurich, Switzerland
| | - Lorenzo Einaudi
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University of Zurich, 8091 Zurich, Switzerland
| | - Eva Thürlimann
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University of Zurich, 8091 Zurich, Switzerland
| | - Julia Läderach
- Cereneo Foundation, Center for Interdisciplinary Research (CEFIR), 6354 Vitznau, Switzerland
| | - Chris Awai Easthope
- Cereneo Foundation, Center for Interdisciplinary Research (CEFIR), 6354 Vitznau, Switzerland
| | - Jeremia P. O. Held
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University of Zurich, 8091 Zurich, Switzerland
- Rehabilitation Center Triemli Zurich, Valens Clinics, 8063 Zurich, Switzerland
| | - Andreas R. Luft
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University of Zurich, 8091 Zurich, Switzerland
- Cereneo, Center for Neurology and Rehabilitation, 6354 Vitznau, Switzerland
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Chambers V, Artemiadis P. Using robot-assisted stiffness perturbations to evoke aftereffects useful to post-stroke gait rehabilitation. Front Robot AI 2023; 9:1073746. [PMID: 36686210 PMCID: PMC9846529 DOI: 10.3389/frobt.2022.1073746] [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: 10/18/2022] [Accepted: 12/13/2022] [Indexed: 01/06/2023] Open
Abstract
Stroke is a major global issue, affecting millions every year. When a stroke occurs, survivors are often left with physical disabilities or difficulties, frequently marked by abnormal gait. Post-stroke gait normally presents as one of or a combination of unilaterally shortened step length, decreased dorsiflexion during swing phase, and decreased walking speed. These factors lead to an increased chance of falling and an overall decrease in quality of life due to a reduced ability to locomote quickly and safely under one's own power. Many current rehabilitation techniques fail to show lasting results that suggest the potential for producing permanent changes. As technology has advanced, robot-assisted rehabilitation appears to have a distinct advantage, as the precision and repeatability of such an intervention are not matched by conventional human-administered therapy. The possible role in gait rehabilitation of the Variable Stiffness Treadmill (VST), a unique, robotic treadmill, is further investigated in this paper. The VST is a split-belt treadmill that can reduce the vertical stiffness of one of the belts, while the other belt remains rigid. In this work, we show that the repeated unilateral stiffness perturbations created by this device elicit an aftereffect of increased step length that is seen for over 575 gait cycles with healthy subjects after a single 10-min intervention. These long aftereffects are currently unmatched in the literature according to our knowledge. This step length increase is accompanied by kinematics and muscle activity aftereffects that help explain functional changes and have their own independent value when considering the characteristics of post-stroke gait. These results suggest that repeated unilateral stiffness perturbations could possibly be a useful form of post-stroke gait rehabilitation.
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Immediate Effects of the Honda Walking Assist on Spatiotemporal Gait Characteristics in Older Adults. TOPICS IN GERIATRIC REHABILITATION 2023. [DOI: 10.1097/tgr.0000000000000384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Uhlenberg L, Derungs A, Amft O. Co-simulation of human digital twins and wearable inertial sensors to analyse gait event estimation. Front Bioeng Biotechnol 2023; 11:1104000. [PMID: 37122859 PMCID: PMC10132030 DOI: 10.3389/fbioe.2023.1104000] [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: 11/21/2022] [Accepted: 03/29/2023] [Indexed: 05/02/2023] Open
Abstract
We propose a co-simulation framework comprising biomechanical human body models and wearable inertial sensor models to analyse gait events dynamically, depending on inertial sensor type, sensor positioning, and processing algorithms. A total of 960 inertial sensors were virtually attached to the lower extremities of a validated biomechanical model and shoe model. Walking of hemiparetic patients was simulated using motion capture data (kinematic simulation). Accelerations and angular velocities were synthesised according to the inertial sensor models. A comprehensive error analysis of detected gait events versus reference gait events of each simulated sensor position across all segments was performed. For gait event detection, we considered 1-, 2-, and 4-phase gait models. Results of hemiparetic patients showed superior gait event estimation performance for a sensor fusion of angular velocity and acceleration data with lower nMAEs (9%) across all sensor positions compared to error estimation with acceleration data only. Depending on algorithm choice and parameterisation, gait event detection performance increased up to 65%. Our results suggest that user personalisation of IMU placement should be pursued as a first priority for gait phase detection, while sensor position variation may be a secondary adaptation target. When comparing rotatory and translatory error components per body segment, larger interquartile ranges of rotatory errors were observed for all phase models i.e., repositioning the sensor around the body segment axis was more harmful than along the limb axis for gait phase detection. The proposed co-simulation framework is suitable for evaluating different sensor modalities, as well as gait event detection algorithms for different gait phase models. The results of our analysis open a new path for utilising biomechanical human digital twins in wearable system design and performance estimation before physical device prototypes are deployed.
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Affiliation(s)
- Lena Uhlenberg
- Hahn-Schickard, Freiburg, Germany
- Intelligent Embedded Systems Lab, University of Freiburg, Freiburg, Germany
- *Correspondence: Lena Uhlenberg,
| | - Adrian Derungs
- F. Hoffmann–La Roche Ltd, pRED, Roche Innovation Center Basel, Basel, Switzerland
| | - Oliver Amft
- Hahn-Schickard, Freiburg, Germany
- Intelligent Embedded Systems Lab, University of Freiburg, Freiburg, Germany
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Immediate effects of the honda walking assist on spatiotemporal gait characteristics in individuals after stroke. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2022. [DOI: 10.1016/j.medntd.2022.100173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Livolsi C, Conti R, Guanziroli E, Friðriksson Þ, Alexandersson Á, Kristjánsson K, Esquenazi A, Molino Lova R, Romo D, Giovacchini F, Crea S, Molteni F, Vitiello N. An impairment-specific hip exoskeleton assistance for gait training in subjects with acquired brain injury: a feasibility study. Sci Rep 2022; 12:19343. [PMID: 36369462 PMCID: PMC9652374 DOI: 10.1038/s41598-022-23283-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 10/27/2022] [Indexed: 11/13/2022] Open
Abstract
This study was designed to investigate the feasibility and the potential effects on walking performance of a short gait training with a novel impairment-specific hip assistance (iHA) through a bilateral active pelvis orthosis (APO) in patients with acquired brain injury (ABI). Fourteen subjects capable of independent gait and exhibiting mild-to-moderate gait deficits, due to an ABI, were enrolled. Subjects presenting deficit in hip flexion and/or extension were included and divided into two groups based on the presence (group A, n = 6) or absence (group B, n = 8) of knee hyperextension during stance phase of walking. Two iHA-based profiles were developed for the groups. The protocol included two overground gait training sessions using APO, and two evaluation sessions, pre and post training. Primary outcomes were pre vs. post-training walking distance and steady-state speed in the 6-min walking test. Secondary outcomes were self-selected speed, joint kinematics and kinetics, gait symmetry and forward propulsion, assessed through 3D gait analysis. Following the training, study participants significantly increased the walked distance and average steady-state speed in the 6-min walking tests, both when walking with and without the APO. The increased walked distance surpassed the minimal clinically important difference for groups A and B, (respectively, 42 and 57 m > 34 m). In group A, five out of six subjects had decreased knee hyperextension at the post-training session (on average the peak of the knee extension angle was reduced by 36%). Knee flexion during swing phase increased, by 16% and 31%, for A and B groups respectively. Two-day gait training with APO providing iHA was effective and safe in improving walking performance and knee kinematics in ABI survivors. These preliminary findings suggest that this strategy may be viable for subject-specific post-ABI gait rehabilitation.
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Affiliation(s)
- Chiara Livolsi
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Pisa, Italy.
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy.
| | | | - Eleonora Guanziroli
- Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Lecco, Italy
| | | | | | | | - Alberto Esquenazi
- Department of PM&R, MossRehab and Einstein Healthcare Network, Elkins Park, PA, USA
| | | | | | | | - Simona Crea
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Pisa, Italy
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Florence, Italy
| | - Franco Molteni
- Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Lecco, Italy
| | - Nicola Vitiello
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Pisa, Italy
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Florence, Italy
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Lee J, Chun MH, Seo YJ, Lee A, Choi J, Son C. Effects of a lower limb rehabilitation robot with various training modes in patients with stroke: A randomized controlled trial. Medicine (Baltimore) 2022; 101:e31590. [PMID: 36343085 PMCID: PMC9646640 DOI: 10.1097/md.0000000000031590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The effect of robot-assisted gait training has been demonstrated to improve gait recovery in patients with stroke. The aim of this study was to determine effects of robot-assisted gait training with various training modes in patients post stroke. METHODS Forty-seven patients post stroke were randomly assigned to one of 4 groups: Healbot T with pelvic off mode (pelvic off group; n = 11); Healbot T with pelvic control mode (pelvic on group; n = 12); Healbot T with constraint-induced movement therapy (CIMT) mode (CIMT group; n = 10); and conventional physiotherapy (control group; n = 10). All patients received a 30-minute session 10 times for 4 weeks. The primary outcomes were the 10-meter walk test (10MWT) and Berg Balance Scale (BBS). The secondary outcomes were functional ambulation category, timed up and go (TUG), and motricity index of the lower extremities (MI-Lower). RESULTS The pelvic off group showed significant improvements in BBS, TUG, and MI-Lower (P < .05). The pelvic on and CIMT groups showed significant improvement in 10MWT, BBS, TUG, and MI-Lower (P < .05). Compared with control group, the pelvic on group showed greater improvement in the TUG and BBS scores; the CIMT group showed greater improvement in 10MWT and MI-Lower (P < .05). CONCLUSION This study suggested that Healbot T-assisted gait training benefited patients with stroke. The Healbot T with pelvic motion and CIMT modes were more helpful in improving balance and walking ability and lower limb strength, respectively, compared with conventional physiotherapy.
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Affiliation(s)
- Junekyung Lee
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Min Ho Chun
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- * Correspondence: Min Ho Chun, Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-Gil, Songpa-gu, Seoul 05505, Republic of Korea (e-mail: )
| | - Yu Jin Seo
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Anna Lee
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Junho Choi
- The Center for Bionics, Korea Institute of Science and Technology, Seoul, Republic of Korea
| | - Choonghyun Son
- The Center for Bionics, Korea Institute of Science and Technology, Seoul, Republic of Korea
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Swaminathan K, Tolkova I, Baker L, Arumukhom Revi D, Awad LN, Walsh CJ, Mahadevan L. A continuous statistical-geometric framework for normative and impaired gaits. J R Soc Interface 2022; 19:20220402. [PMID: 36321374 PMCID: PMC9627451 DOI: 10.1098/rsif.2022.0402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 09/29/2022] [Indexed: 06/16/2023] Open
Abstract
A quantitative analysis of human gait patterns in space-time provides an opportunity to observe variability within and across individuals of varying motor capabilities. Impaired gait significantly affects independence and quality of life, and thus a large part of clinical research is dedicated to improving gait through rehabilitative therapies. Evaluation of these paradigms relies on understanding the characteristic differences in the kinematics and underlying biomechanics of impaired and unimpaired locomotion, which has motivated quantitative measurement and analysis of the gait cycle. Previous analysis has largely been limited to a statistical comparison of manually selected pointwise metrics identified through expert knowledge. Here, we use a recent statistical-geometric framework, elastic functional data analysis (FDA), to decompose kinematic data into continuous 'amplitude' (spatial) and 'phase' (temporal) components, which can then be integrated with established dimensionality reduction techniques. We demonstrate the utility of elastic FDA through two unsupervised applications to post-stroke gait datasets. First, we distinguish between unimpaired, paretic and non-paretic gait presentations. Then, we use FDA to reveal robust, interpretable groups of differential response to exosuit assistance. The proposed methods aim to benefit clinical practice for post-stroke gait rehabilitation, and more broadly, to automate the quantitative analysis of motion.
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Affiliation(s)
- Krithika Swaminathan
- School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Irina Tolkova
- School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Lauren Baker
- School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Dheepak Arumukhom Revi
- College of Health and Rehabilitation Sciences, Sargent College, Boston University, Boston, MA, USA
- Department of Mechanical Engineering, Boston University, Boston, MA, USA
| | - Louis N. Awad
- College of Health and Rehabilitation Sciences, Sargent College, Boston University, Boston, MA, USA
- Department of Mechanical Engineering, Boston University, Boston, MA, USA
| | - Conor J. Walsh
- School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - L. Mahadevan
- School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
- Department of Physics, Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA, USA
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