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de Almeida FO, Santana V, Corcos DM, Ugrinowitsch C, Silva-Batista C. Effects of Endurance Training on Motor Signs of Parkinson's Disease: A Systematic Review and Meta-Analysis. Sports Med 2022; 52:1789-1815. [PMID: 35113386 DOI: 10.1007/s40279-022-01650-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Evidence has demonstrated that endurance training (ET) reduces the motor signs of Parkinson's disease (PD). However, there has not been a comprehensive meta-analysis of studies to date. OBJECTIVE The aim of this study was to compare the effect of ET versus nonactive and active control conditions on motor signs as assessed by either the Unified Parkinson's Disease Rating Scale part III (UPDRS-III) or Movement Disorder Society-UPDRS-III (MDS-UPDRS-III). METHODS A random-effect meta-analysis model using standardized mean differences (Hedges' g) determined treatment effects. Moderators (e.g., combined endurance and physical therapy training [CEPTT]) and meta-regressors (e.g., number of sessions) were used for sub-analyses. Methodological quality was assessed by the Physiotherapy Evidence Database. RESULTS Twenty-seven randomized controlled trials (RCTs) met inclusion criteria (1152 participants). ET is effective in decreasing UPDRS-III scores when compared with nonactive and active control conditions (g = - 0.68 and g = - 0.33, respectively). This decrease was greater (within- and between-groups average of - 8.0 and - 6.8 point reduction on UPDRS-III scores, respectively) than the moderate range of clinically important changes to UPDRS-III scores (- 4.5 to - 6.7 points) suggested for PD. Although considerable heterogeneity was observed between RCTs (I2 = 74%), some moderators that increased the effect of ET on motor signs decreased the heterogeneity of the analyses, such as CEPTT (I2 = 21%), intensity based on treadmill speed (I2 = 0%), self-perceived exertion rate (I2 = 33%), and studies composed of individuals with PD and freezing of gait (I2 = 0%). Meta-regression did not produce significant relationships between ET dosage and UPDRS-III scores. CONCLUSIONS ET is effective in decreasing UPDRS-III scores. Questions remain about the dose-response relationship between ET and reduction in motor signs.
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Affiliation(s)
| | - Vagner Santana
- Exercise Neuroscience Research Group, University of São Paulo, São Paulo, Brazil
| | - Daniel M Corcos
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
| | - Carlos Ugrinowitsch
- Laboratory of Adaptations To Strength Training, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Carla Silva-Batista
- Exercise Neuroscience Research Group, University of São Paulo, São Paulo, Brazil. .,School of Arts, Sciences and Humanities of University of São Paulo, St. Arlindo Béttio, 1000, 03828-000, Vila Guaraciaba, São Paulo, Brazil. .,Laboratory of Adaptations To Strength Training, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil.
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Barela A, Celestino M, Gama G, Russo-Junior D, Santana D, Barela J. Gait alterations induced by unloaded body weight in individuals with stroke while walking on moveable and fixed surfaces. Med Eng Phys 2021; 95:9-14. [PMID: 34479697 DOI: 10.1016/j.medengphy.2021.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 06/25/2021] [Accepted: 07/06/2021] [Indexed: 10/20/2022]
Abstract
This study examined the effects of the support surface (i.e., treadmill or ground) and the quantity of body weight unloading provided by a partial body weight support (PBWS) system on the spatiotemporal gait characteristics of individuals with stroke. Fifteen individuals, aged 57.2 ± 9.8 years, with chronic stroke walked on a treadmill and on the ground with 0%, 10%, and 20% of PBWS. Inertial sensors placed on the participants' feet registered 3-D acceleration and 3-D angular velocity during walking, and some gait parameters were calculated. Overall, individuals with stroke walked with shorter and slower strides and spent more time in contact with the support surface when walking on the treadmill compared to when walking on the ground. The duration of double limb support decreased when the percentage of PBWS increased. Stride length and speed were more variable in the paretic limb than in the non-paretic limb. Treadmill walking was more consistent and less similar to ordinary walking than walking on the ground. The gait pattern of individuals with stroke was modulated according to the support surface on which walking was performed, and the use of a PBWS system seems suitable to develop walking proficiencies on a daily basis.
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Affiliation(s)
- Ana Barela
- Institute of Physical Activity and Sport Sciences, Cruzeiro do Sul University, Rua Galvão Bueno, 868, São Paulo, SP 01506-000, Brazil.
| | - Melissa Celestino
- Institute of Physical Activity and Sport Sciences, Cruzeiro do Sul University, Rua Galvão Bueno, 868, São Paulo, SP 01506-000, Brazil
| | - Gabriela Gama
- Institute of Physical Activity and Sport Sciences, Cruzeiro do Sul University, Rua Galvão Bueno, 868, São Paulo, SP 01506-000, Brazil
| | - Douglas Russo-Junior
- Institute of Physical Activity and Sport Sciences, Cruzeiro do Sul University, Rua Galvão Bueno, 868, São Paulo, SP 01506-000, Brazil
| | - Dinah Santana
- Institute of Physical Activity and Sport Sciences, Cruzeiro do Sul University, Rua Galvão Bueno, 868, São Paulo, SP 01506-000, Brazil
| | - José Barela
- Department of Physical Education, Institute of Biosciences, São Paulo State University, Av. 24-A, 1515, Rio Claro, SP 13506-000, Brazil.
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MacLean MK, Ferris DP. Human muscle activity and lower limb biomechanics of overground walking at varying levels of simulated reduced gravity and gait speeds. PLoS One 2021; 16:e0253467. [PMID: 34260611 PMCID: PMC8279339 DOI: 10.1371/journal.pone.0253467] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 06/04/2021] [Indexed: 12/03/2022] Open
Abstract
Reducing the mechanical load on the human body through simulated reduced gravity can reveal important insight into locomotion biomechanics. The purpose of this study was to quantify the effects of simulated reduced gravity on muscle activation levels and lower limb biomechanics across a range of overground walking speeds. Our overall hypothesis was that muscle activation amplitudes would not decrease proportionally to gravity level. We recruited 12 participants (6 female, 6 male) to walk overground at 1.0, 0.76, 0.55, and 0.31 G for four speeds: 0.4, 0.8, 1.2, and 1.6 ms-1. We found that peak ground reaction forces, peak knee extension moment in early stance, peak hip flexion moment, and peak ankle extension moment all decreased substantially with reduced gravity. The peak knee extension moment at late stance/early swing did not change with gravity. The effect of gravity on muscle activity amplitude varied considerably with muscle and speed, often varying nonlinearly with gravity level. Quadriceps (rectus femoris, vastus lateralis, & vastus medialis) and medial gastrocnemius activity decreased in stance phase with reduced gravity. Soleus and lateral gastrocnemius activity had no statistical differences with gravity level. Tibialis anterior and biceps femoris increased with simulated reduced gravity in swing and stance phase, respectively. The uncoupled relationship between simulated gravity level and muscle activity have important implications for understanding biomechanical muscle functions during human walking and for the use of bodyweight support for gait rehabilitation after injury.
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Affiliation(s)
- Mhairi K. MacLean
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida, United States of America
- * E-mail: (MKM); (DPF)
| | - Daniel P. Ferris
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida, United States of America
- * E-mail: (MKM); (DPF)
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van Zant RS, Colchagoff WR, Cox AM, Eggleston BR, Griffith AD, Harrison LM, Newberry AS, Price BL. Metabolic and cardiovascular effects of body weight supported treadmill walking in healthy older adults. J Sports Med Phys Fitness 2021; 62:705-709. [PMID: 33871242 DOI: 10.23736/s0022-4707.21.12254-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The purpose of this study was to determine if body weight supported treadmill training (BWSTT) decreased metabolic and cardiovascular demand in older (50-74 years) healthy adults while walking a self-selected speeds. The results of this study could impact clinician application to exercise therapy. METHODS Twenty subjects (50% female, 58.3+7.3 yr) completed 3, 5-minute treadmill walking trials at a self-selected pace, with 0%, 15%, and 30% body weight support (BWS). Blood pressure (BP), heart rate (HR), and oxygen uptake (VO2) were measured at rest, and during walking trials. Mean data from minutes 3-5 were analyzed for difference by repeated measures ANOVA and Bonferroni post-hoc testing. RESULTS At rest, HR was 70.8+8.2 bpm and BP was 126.8+12.2 / 84.3+8.6 mmHg. Mean walking speed was 67.1 m/min. Tested parameters during exercise trials were significantly (p<0.05) different from rest, but no significant differences were detected among the 3 exercise trials. CONCLUSIONS In older adults walking at self-selected speeds, up to 30% BWS had no significant impact on metabolic or cardiovascular demand.
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Affiliation(s)
| | | | - Anya M Cox
- Physical Therapy Department, University of Findlay Findlay, OH, USA
| | | | | | - Linda M Harrison
- Physical Therapy Department, University of Findlay Findlay, OH, USA
| | - Amie S Newberry
- Physical Therapy Department, University of Findlay Findlay, OH, USA
| | - Blake L Price
- Physical Therapy Department, University of Findlay Findlay, OH, USA
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Ibrahim MB, Labib M, Khozamy H, Badawy WM. Efficacy of physical activities on children with juvenile idiopathic arthritis: a randomized controlled trial. BULLETIN OF FACULTY OF PHYSICAL THERAPY 2020. [DOI: 10.1186/s43161-020-00008-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Juvenile idiopathic arthritis (JIA) is one of the serious chronic rheumatic disorders in children and adolescents which results in less physical activities and restlessness hours than their peer. The study aims to assess the efficacy of physical fitness training exercises on aerobic capacity and muscular strength of children with JIA. Sixty-five children with JIA were included in the study, out of a total of 70 children who were screened for eligibility. Children were randomized to a control group (n = 32) who received hot packs, transcutaneous electrical nerve stimulation (TENS), and strengthening exercises, or a study group (n = 33) who received a physical fitness training program (hydrotherapy pool exercises, bicycle ergometer, and treadmill apparatus) in addition to what had been given to the control group. Both groups were engaged in a training program for 12 consecutive weeks for three times per week. Evaluation was done pre- and post-interventions included: peak oxygen uptake (Vo2 peak) during an incremental treadmill test and muscle strength assessed by isokinetic dynamometer.
Results
The current study showed that there were significant differences between pre- and post-interventions in both groups (P < 0.05). Comparing the two groups, there were statistically significant differences between children in both groups in favor of the study group (P < 0.05).
Conclusions
Physical fitness exercise training resulted in improved aerobic capacity and muscle strength of children with JIA. The obtained results suggested that children with arthritis could participate in formal exercise testing and structural physical fitness program.
Trial registration
PACTR, PACTR201907504136763. Registered on May 21, 2019. Retrospectively registered, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID = 8150.
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Metabolic and Cardiovascular Effects of Body Weight Support Treadmill Walking in Healthy Adults. Cardiopulm Phys Ther J 2020. [DOI: 10.1097/cpt.0000000000000137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Oxygen Consumption While Walking With Multijoint Neuromuscular Electrical Stimulation After Stroke. Am J Phys Med Rehabil 2020; 99:e138-e141. [PMID: 32149817 DOI: 10.1097/phm.0000000000001416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This case study evaluated the effect of implanted multijoint neuromuscular electrical stimulation gait assistance on oxygen consumption relative to walking without neuromuscular electrical stimulation after stroke. The participant walked slowly with an asymmetric gait pattern after stroke. He completed repeated 6-min walk tests at a self-selected walking speed with and without hip, knee, and ankle stimulation assistance. His walking speed with neuromuscular electrical stimulation more than doubled from 0.28 ± 0.01 m/sec to 0.58 ± 0.04 m/sec, whereas average step length and cadence increased by 0.12 m and 24 steps/min, respectively. As a result, energy cost of walking with neuromuscular electrical stimulation decreased by 0.19 ml O2/kg per meter as compared with walking without stimulation while oxygen consumption increased by 1.1 metabolic equivalent of tasks (3.9 ml O2/kg per minute). These metabolic demands are similar to those reported for stroke survivors capable of walking at equivalent speeds without stimulation, suggesting the increase in oxygen consumption and decreased energy cost result from improved efficiency of faster walking facilitated by neuromuscular electrical stimulation. Although the effect of neuromuscular electrical stimulation on gait economy has implications for community walking within the user's metabolic reserves, this case study's results should be interpreted with caution and the hypothesis that multijoint neuromuscular electrical stimulation improves metabolic efficiency should be tested in a wide population of stroke survivors with varied deficits.
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Alqahtani AS, Alajam R, Eickmeyer SM, Vardey R, Liu W. Feasibility and trend of pulmonary function in a pilot trial of aerobic walking exercise in non-ambulatory stroke survivors. Top Stroke Rehabil 2019; 27:190-198. [PMID: 31622173 DOI: 10.1080/10749357.2019.1673590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Lung function is compromised in stroke survivors, which may cause fatigue and exercise intolerance. Furthermore, past studies of aerobic exercise have involved only stroke survivors who could walk independently. Stroke survivors who were unable to walk were not included in the previous research-investigating changes in lung function from walking exercise interventions. In this pilot study, the feasibility and the effect of aerobic walking exercise on lung function was examined in non-ambulatory stroke survivors using a treadmill, bodyweight support system, and a gait training device.Methods: This study was a single group trial. Eight non-ambulatory stroke survivors (five males, mean age 63.3 ± 13.7 years, seven with ischemic stroke) completed a low intensity walking exercise program (30 min/session; three sessions/week for 8 weeks) and lung function test. Before and after the intervention, vital capacity (VC) and forced vital capacity (FVC) using a spirometer were measured according to the guideline from American Thoracic Society/European Respiratory Society.Results: The rates of compliance and attrition were 100% and 10%; respectively, and no adverse events were reported. There were significant differences between pre- and post-intervention assessments in FVC (p = .09), percentage of predicted VC (p = .08), and percentage of predicted FVC (p = .08).Conclusions: In non-ambulatory stroke survivors, aerobic walking exercise is feasible and safe. Also, the results are promising and suggest that aerobic walking exercise may improve lung function; more data are needed.
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Affiliation(s)
- Abdulfattah S Alqahtani
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, MO, USA.,Department of Health Rehabilitation Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Ramzi Alajam
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, MO, USA.,Department of Physical Therapy, Jazan University, Gazan, Saudi Arabia
| | - Sarah M Eickmeyer
- Department of Physical Medicine and Rehabilitation, University of Kansas Medical Center, Kansas City, MO, USA
| | - Rakesh Vardey
- Department of Physical Medicine and Rehabilitation, University of Kansas Medical Center, Kansas City, MO, USA
| | - Wen Liu
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, MO, USA
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Atan T, Özyemişci Taşkıran Ö, Bora Tokçaer A, Kaymak Karataş G, Karakuş Çalışkan A, Karaoğlan B. Effects of different percentages of body weight-supported treadmill training in Parkinson’s disease: a double-blind randomized controlled trial. Turk J Med Sci 2019; 49:999-1007. [PMID: 31292107 PMCID: PMC7018238 DOI: 10.3906/sag-1812-57] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background/aim Body weight-supported treadmill training (BWSTT) might have greater effects than conventional treadmill training (TT) in neurological diseases such as Parkinson’s disease (PD). The aim of this study was to evaluate the effects of different percentages of BWSTT on gait, balance, quality of life, and fatigue in PD. Materials and methods Thirty-five patients with moderate to advanced PD were randomized into three BWSTT groups according to the supported percentage of body weight: 0% BWSTT (control group; unsupported TT), 10% BWSTT, or 20% BWSTT. Five patients were excluded due to early discharge and 30 patients completed BWSTT sessions lasting 30 min, 5 days a week, for 6 weeks during their inpatient rehabilitation stay. The primary outcome was 6-min walk distance (6MWD). Secondary outcomes were Unified Parkinson’s Disease Rating Scale (UPDRS), Berg Balance Scale (BBS), Nottingham Health Profile (NHP), Fatigue Impact Scale, and Fatigue Severity Scale scores. Measurements were performed before and after the training. Results The unsupported TT group demonstrated no significant improvement in the outcome measures after a 6-week training except for BBS and NHP emotional subscores. Moreover, the NHP pain subscore increased in the unsupported TT group after training. The 10% and 20% supported BWSTT groups demonstrated significant improvements in 6MWD (P = 0.004 and P < 0.001, respectively), UPDRS - motor score (P = 0.012 and P = 0.005, respectively), NHP pain subscore (P = 0.003 and P = 0.002, respectively), and fatigue (P = 0.005 for both) after training. The 20% BWSTT provided the highest improvement in balance among the three groups (P < 0.001) and greater relief of fatigue than 10% BWSTT (P = 0.002). Conclusion Six weeks of BWSTT improved walking distance and balance ability, relieved fatigue, and additionally reduced pain in patients with moderate to advanced PD.
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Affiliation(s)
- Tuğba Atan
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - Özden Özyemişci Taşkıran
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Koç University, İstanbul, Turkey
| | - Ayşe Bora Tokçaer
- Department of Neurology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Gülçin Kaymak Karataş
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Gazi University, Ankara, Turkey
| | | | - Belgin Karaoğlan
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Gazi University, Ankara, Turkey
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Kim J, Oh S, Kim J, Kim J. A two-wire body weight support system for interactive treadmill. IEEE Int Conf Rehabil Robot 2019; 2019:349-354. [PMID: 31374654 DOI: 10.1109/icorr.2019.8779549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Body weight support (BWS) system is widely used for patients to help their gait training. However, that existing systems require large workspace and elastic component in actuation makes the systems inappropriate for wide clinical use. The interactive treadmill was reported to be cost/space effectively simulate overground walking, but there was no suitable BWS system for the treadmill. We proposed a new concept of body weight support system for interactive treadmill. For wide clinical use, we applied a two-wire driven mechanism with simple actuator and a custom pelvic-type harness. With three healthy subjects, the performance of the proposed BWS system on unloading force control was evaluated, and the result showed that the feasibility of the proposed BWS system.
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Lefeber N, De Buyzer S, Dassen N, De Keersmaecker E, Kerckhofs E, Swinnen E. Energy consumption and cost during walking with different modalities of assistance after stroke: a systematic review and meta-analysis. Disabil Rehabil 2019; 42:1650-1666. [DOI: 10.1080/09638288.2018.1531943] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Nina Lefeber
- Rehabilitation Research—Neurological Rehabilitation research group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotic Research Center, Vrije Universiteit Brussel, Brussels, Belgium
| | - Sam De Buyzer
- Rehabilitation Research—Neurological Rehabilitation research group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Nikkie Dassen
- Rehabilitation Research—Neurological Rehabilitation research group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Emma De Keersmaecker
- Rehabilitation Research—Neurological Rehabilitation research group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotic Research Center, Vrije Universiteit Brussel, Brussels, Belgium
| | - Eric Kerckhofs
- Rehabilitation Research—Neurological Rehabilitation research group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotic Research Center, Vrije Universiteit Brussel, Brussels, Belgium
| | - Eva Swinnen
- Rehabilitation Research—Neurological Rehabilitation research group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotic Research Center, Vrije Universiteit Brussel, Brussels, Belgium
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Lefeber N, De Keersmaecker E, Henderix S, Michielsen M, Kerckhofs E, Swinnen E. Physiological Responses and Perceived Exertion During Robot-Assisted and Body Weight-Supported Gait After Stroke. Neurorehabil Neural Repair 2018; 32:1043-1054. [PMID: 30417724 DOI: 10.1177/1545968318810810] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Physiological responses are rarely considered during walking after stroke and if considered, only during a short period (3-6 minutes). The aims of this study were to examine physiological responses during 30-minute robot-assisted and body weight-supported treadmill and overground walking and compare intensities with exercise guidelines. METHODS A total of 14 ambulatory stroke survivors (age: 61 ± 9 years; time after stroke: 2.8 ± 2.8 months) participated in 3 separate randomized walking trials. Patients walked overground, on a treadmill, and in the Lokomat (60% robotic guidance) for 30 minutes at matched speeds (2.0 ± 0.5 km/h) and matched levels of body weight support (BWS; 41% ± 16%). Breath-by-breath gas analysis, heart rate, and perceived exertion were assessed continuously. RESULTS Net oxygen consumption, net carbon dioxide production, net heart rate, and net minute ventilation were about half as high during robot-assisted gait as during body weight-supported treadmill and overground walking ( P < .05). Net minute ventilation, net breathing frequency, and net perceived exertion significantly increased between 6 and 30 minutes (respectively, 1.8 L/min, 2 breaths/min, and 3.8 units). During Lokomat walking, exercise intensity was significantly below exercise recommendations; during body weight-supported overground and treadmill walking, minimum thresholds were reached (except for percentage of heart rate reserve during treadmill walking). CONCLUSION In ambulatory stroke survivors, the oxygen and cardiorespiratory demand during robot-assisted gait at constant workload are considerably lower than during overground and treadmill walking at matched speeds and levels of body weight support. Future studies should examine how robotic devices can be Future studies should examine how robotic devices can be exploited to induce aerobic exercise.
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Affiliation(s)
- Nina Lefeber
- 1 Rehabilitation Research-Neurological Rehabilitation Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Emma De Keersmaecker
- 1 Rehabilitation Research-Neurological Rehabilitation Group, Vrije Universiteit Brussel, Brussels, Belgium
| | | | | | - Eric Kerckhofs
- 1 Rehabilitation Research-Neurological Rehabilitation Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Eva Swinnen
- 1 Rehabilitation Research-Neurological Rehabilitation Group, Vrije Universiteit Brussel, Brussels, Belgium
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Apte S, Plooij M, Vallery H. Influence of body weight unloading on human gait characteristics: a systematic review. J Neuroeng Rehabil 2018; 15:53. [PMID: 29925400 PMCID: PMC6011391 DOI: 10.1186/s12984-018-0380-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 04/30/2018] [Indexed: 11/15/2022] Open
Abstract
Background Body weight support (BWS) systems have shown promise as rehabilitation tools for neurologically impaired individuals. This paper reviews the experiment-based research on BWS systems with the aim: (1) To investigate the influence of body weight unloading (BWU) on gait characteristics; (2) To study whether the effects of BWS differ between treadmill and overground walking and (3) To investigate if modulated BWU influences gait characteristics less than unmodulated BWU. Method A systematic literature search was conducted in the following search engines: Pubmed, Scopus, Web of Science and Google Scholar. Statistical analysis was used to quantify the effects of BWU on gait parameters. Results 54 studies of experiments with healthy and neurologically impaired individuals walking in a BWS system were included and 32 of these were used for the statistical analysis. Literature was classified using three distinctions: (1) treadmill or overground walking; (2) the type of subjects and (3) the nature of unloading force. Only 27% studies were based on neurologically impaired subjects; a low number considering that they are the primary user group for BWS systems. The studies included BWU from 5% to 100% and the 30% and 50% BWU conditions were the most widely studied. The number of participants varied from 1 to 28, with an average of 12. It was seen that due to the increase in BWU level, joint moments, muscle activity, energy cost of walking and ground reaction forces (GRF) showed higher reduction compared to gait spatio-temporal and joint kinematic parameters. The influence of BWU on kinematic and spatio-temporal gait parameters appeared to be limited up to 30% unloading. 5 gait characteristics presented different behavior in response to BWU for overground and treadmill walking. Remaining 21 gait characteristics showed similar behavior but different magnitude of change for overground and treadmill walking. Modulated unloading force generally led to less difference from the 0% condition than unmodulated unloading. Conclusion This review has shown that BWU influences all gait characteristics, albeit with important differences between the kinematic, spatio-temporal and kinetic characteristics. BWU showed stronger influence on the kinetic characteristics of gait than on the spatio-temporal parameters and the kinematic characteristics. It was ascertained that treadmill and overground walking can alter the effects of BWU in a different manner. Our results indicate that task-specific gait training is likely to be achievable at a BWU level of 30% and below. Electronic supplementary material The online version of this article (10.1186/s12984-018-0380-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Salil Apte
- Mechanical, Maritime and Materials Engineering (3mE), TU Delft, Mekelweg 2, Delft, 2628 CD, Netherlands
| | - Michiel Plooij
- Mechanical, Maritime and Materials Engineering (3mE), TU Delft, Mekelweg 2, Delft, 2628 CD, Netherlands.,Motekforce Link, Hogehilweg 18-C, Amsterdam, 1101 CD, Netherlands
| | - Heike Vallery
- Mechanical, Maritime and Materials Engineering (3mE), TU Delft, Mekelweg 2, Delft, 2628 CD, Netherlands.
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Lim H, Azurdia D, Jeng B, Jung T. Influence of water depth on energy expenditure during aquatic walking in people post stroke. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2018; 23:e1717. [DOI: 10.1002/pri.1717] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 12/05/2017] [Accepted: 02/16/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Hyosok Lim
- Department of Kinesiology; California State University, Northridge; Northridge CA USA
| | - Daniel Azurdia
- Department of Kinesiology; California State University, Northridge; Northridge CA USA
| | - Brenda Jeng
- Department of Kinesiology; California State University, Northridge; Northridge CA USA
| | - Taeyou Jung
- Department of Kinesiology; California State University, Northridge; Northridge CA USA
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Stucky F, Vesin JM, Kayser B, Uva B. The Effect of Lower-Body Positive Pressure on the Cardiorespiratory Response at Rest and during Submaximal Running Exercise. Front Physiol 2018; 9:34. [PMID: 29441025 PMCID: PMC5797649 DOI: 10.3389/fphys.2018.00034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 01/10/2018] [Indexed: 11/13/2022] Open
Abstract
Anti-gravity treadmills facilitate locomotion by lower-body positive pressure (LBPP). Effects on cardiorespiratory regulation are unknown. Healthy men (30 ± 8 y, 178.3 ± 5.7 cm, 70.3 ± 8.0 kg; mean ± SD) stood upright (n = 10) or ran (n = 9) at 9, 11, 13, and 15 km.h−1 (5 min stages) with LBPP (0, 15, 40 mmHg). Cardiac output (CO), stroke volume (SV), heart rate (HR), blood pressure (BP), peripheral resistance (PR), and oxygen uptake (VO2) were monitored continuously. During standing, LBPP increased SV [by +29 ± 13 (+41%) and +42 ± 15 (+60%) ml, at 15 and 40 mmHg, respectively (p < 0.05)] and decreased HR [by −15 ± 6 (−20%) and −22 ± 9 (−29%) bpm (p < 0.05)] resulting in a transitory increase in CO [by +1.6 ± 1.0 (+32%) and +2.0 ± 1.0 (+39%) l.min−1 (p < 0.05)] within the first seconds of LBPP. This was accompanied by a transitory decrease in end-tidal PO2 [by −5 ± 3 (−5%) and −10 ± 4 (−10%) mmHg (p < 0.05)] and increase in VO2 [by +66 ± 53 (+26%) and +116 ± 64 (+46%) ml.min−1 (p < 0.05)], suggesting increased venous return and pulmonary blood flow. The application of LBPP increased baroreflex sensitivity (BRS) [by +1.8 ± 1.6 (+18%) and +4.6 ± 3.7 (+47%) at 15 and 40 mmHg LBPP, respectively P < 0.05]. After reaching steady-state exercise CO vs. VO2 relationships remained linear with similar slope and intercept for each participant (mean R2 = 0.84 ± 0.13) while MAP remained unchanged. It follows that (1) LBPP affects cardiorespiratory integration at the onset of exercise; (2) at a given LBPP, once reaching steady-state exercise, the cardiorespiratory load is reduced proportionally to the lower metabolic demand resulting from the body weight support; (3) the balance between cardiovascular response, oxygen delivery to the exercising muscles and blood pressure regulation is maintained at exercise steady-state; and (4) changes in baroreflex sensitivity may be involved in the regulation of cardiovascular parameters during LBPP.
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Affiliation(s)
- Frédéric Stucky
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Jean-Marc Vesin
- Applied Signal Processing Group, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Bengt Kayser
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Barbara Uva
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
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Polese JC, Ribeiro-Samora GA, Lana RC, Rodrigues-De-Paula FV, Teixeira-Salmela LF. Energy expenditure and cost of walking and stair climbing in individuals with chronic stroke. Braz J Phys Ther 2017; 21:192-198. [PMID: 28473284 PMCID: PMC5537476 DOI: 10.1016/j.bjpt.2017.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 05/31/2016] [Accepted: 06/27/2016] [Indexed: 01/06/2023] Open
Abstract
Stroke subjects had lower EE during the 6MWT and SCT compared to the healthy subjects. Stroke subjects had higher EC during the 6MWT and SCT compared to the healthy subjects. Walking speed differentiated healthy from stroke subjects gait. The stroke subjects who walked faster showed better energy efficiency. Evidence-based interventions to improve walking speed should be implemented.
Background Subjects with stroke show higher energy cost (EC) during walking, when compared to healthy individuals, but the mechanisms are not fully understood. Additionally, the behavior of physiological variables during other activities has not been investigated. Objectives To investigate energy expenditure (EE) and EC during the six-minute walking test (6MWT) and stair climb test (SCT) in chronic stroke subjects compared to healthy controls. Methods Cross-sectional study in which stroke subjects (n = 18) (community-walking speed ≥0.8 m/s) or limited-community <0.8 m/s walkers and matched healthy controls (n = 18) had their EE and EC assessed during the 6MWT and SCT with a portable monitoring system. Results Significant differences in EE were observed for both the 6MWT (MD 7.29; 95%CI 4.08–10.50) and SCT (MD 8.53; 95%CI 5.07–12.00) between the stroke and control groups, but not between the stroke subgroups. Significant between-group differences in EC were found for both the 6MWT and SCT. For the 6MWT, differences were significant between the limited-community and the community walkers (MD 0.19; 95%CI 0.05–0.33) and controls (MD 0.17; 95%CI 0.04–0.29). No significant differences were found between the community walkers and controls (MD 0.02; 95%CI −0.09 to 0.13). For the SCT, the limited-community walkers showed highest EC, followed by the community walkers, and controls. Conclusions Both stroke subgroups demonstrated lower EE compared to healthy controls. During the 6MWT, the limited-community walkers demonstrated higher EC compared to the community walkers and controls. During the SCT, the limited-community walkers demonstrated higher EC, followed by the community walkers, and controls.
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Affiliation(s)
- Janaine C Polese
- NeuroGroup, Departamento de Fisioterapia, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil; Departamento de Fisioterapia, Faculdade de Ciências Médicas de Minas Gerais (FCMMG), Belo Horizonte, MG, Brazil.
| | - Giane A Ribeiro-Samora
- Departamento de Fisioterapia, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Raquel C Lana
- NeuroGroup, Departamento de Fisioterapia, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Fátima V Rodrigues-De-Paula
- NeuroGroup, Departamento de Fisioterapia, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil; Departamento de Fisioterapia, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Luci F Teixeira-Salmela
- NeuroGroup, Departamento de Fisioterapia, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil; Departamento de Fisioterapia, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
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Lefeber N, Swinnen E, Kerckhofs E. The immediate effects of robot-assistance on energy consumption and cardiorespiratory load during walking compared to walking without robot-assistance: a systematic review. Disabil Rehabil Assist Technol 2016; 12:657-671. [DOI: 10.1080/17483107.2016.1235620] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Nina Lefeber
- Faculty of Physical Education and Physiotherapy, Rehabilitation Research, Vrije Universiteit Brussel, Brussels, Belgium
- C4N, Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium
- BruBotics, Brussels Human Robotic Research Center, Vrije Universiteit Brussel, Brussels, Belgium
| | - Eva Swinnen
- Faculty of Physical Education and Physiotherapy, Rehabilitation Research, Vrije Universiteit Brussel, Brussels, Belgium
- C4N, Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium
- BruBotics, Brussels Human Robotic Research Center, Vrije Universiteit Brussel, Brussels, Belgium
| | - Eric Kerckhofs
- Faculty of Physical Education and Physiotherapy, Rehabilitation Research, Vrije Universiteit Brussel, Brussels, Belgium
- C4N, Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium
- BruBotics, Brussels Human Robotic Research Center, Vrije Universiteit Brussel, Brussels, Belgium
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Sandberg K, Kleist M, Falk L, Enthoven P. Effects of Twice-Weekly Intense Aerobic Exercise in Early Subacute Stroke: A Randomized Controlled Trial. Arch Phys Med Rehabil 2016; 97:1244-53. [DOI: 10.1016/j.apmr.2016.01.030] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 01/14/2016] [Accepted: 01/29/2016] [Indexed: 10/22/2022]
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Selzer ME, Zorowitz RD. Designing Prospective, Randomized, Multicenter Clinical Trials of Physical Rehabilitation Treatment Modalities. Neurorehabil Neural Repair 2016; 17:135-6. [PMID: 14503434 DOI: 10.1177/0888439003257318] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Comparison of Heart Rate Reserve-Guided and Ratings of Perceived Exertion-Guided Methods for High-Intensity Robot-Assisted Gait Training in Patients With Chronic Stroke. TOPICS IN GERIATRIC REHABILITATION 2016. [DOI: 10.1097/tgr.0000000000000098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Energy Expenditure and Cost During Walking After Stroke: A Systematic Review. Arch Phys Med Rehabil 2016; 97:619-632.e1. [DOI: 10.1016/j.apmr.2015.11.007] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 10/23/2015] [Accepted: 11/17/2015] [Indexed: 11/19/2022]
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Efficacy of Feedback-Controlled Robotics-Assisted Treadmill Exercise to Improve Cardiovascular Fitness Early After Stroke: A Randomized Controlled Pilot Trial. J Neurol Phys Ther 2016; 39:156-65. [PMID: 26050073 PMCID: PMC4484666 DOI: 10.1097/npt.0000000000000095] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE Cardiovascular fitness is greatly reduced after stroke. Although individuals with mild to moderate impairments benefit from conventional cardiovascular exercise interventions, there is a lack of effective approaches for persons with severely impaired physical function. This randomized controlled pilot trial investigated efficacy and feasibility of feedback-controlled robotics-assisted treadmill exercise (FC-RATE) for cardiovascular rehabilitation in persons with severe impairments early after stroke. METHODS Twenty individuals (age 61 ± 11 years; 52 ± 31 days poststroke) with severe motor limitations (Functional Ambulation Classification 0-2) were recruited for FC-RATE or conventional robotics-assisted treadmill exercise (RATE) (4 weeks, 3 × 30-minute sessions/wk). Outcome measures focused on peak cardiopulmonary performance parameters, training intensity, and feasibility, with examiners blinded to allocation. RESULTS All 14 allocated participants (70% of recruited) completed the intervention (7/group, withdrawals unrelated to intervention), without serious adverse events occurring. Cardiovascular fitness increased significantly in both groups, with peak oxygen uptake increasing from 14.6 to 17.7 mL · kg · min (+17.8%) after 4 weeks (45.8%-55.7% of predicted maximal aerobic capacity; time effect P = 0.01; no group-time interaction). Training intensity (% heart rate reserve) was significantly higher for FC-RATE (40% ± 3%) than for conventional RATE (14% ± 2%) (P = 0.001). DISCUSSION AND CONCLUSIONS Substantive overall increases in the main cardiopulmonary performance parameters were observed, but there were no significant between-group differences when comparing FC-RATE and conventional RATE. Feedback-controlled robotics-assisted treadmill exercise significantly increased exercise intensity, but recommended intensity levels for cardiovascular training were not consistently achieved. Future research should focus on appropriate algorithms within advanced robotic systems to promote optimal cardiovascular stress.Video abstract available for more insights from the authors (Supplemental Digital Content 1, http://links.lww.com/JNPT/A107).
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Jeffries EC, Hoffman SM, de Leon R, Dominguez JF, Semerjian TZ, Melgar IA, Dy CJ. Energy expenditure and heart rate responses to increased loading in individuals with motor complete spinal cord injury performing body weight-supported exercises. Arch Phys Med Rehabil 2015; 96:1467-73. [PMID: 25887699 DOI: 10.1016/j.apmr.2015.03.020] [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: 12/19/2014] [Revised: 03/18/2015] [Accepted: 03/27/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To examine acute metabolic and heart rate responses in individuals with motor complete spinal cord injury (SCI) during stepping and standing with body weight support (BWS). DESIGN Cohort study. SETTING Therapeutic exercise research laboratory. PARTICIPANTS Nonambulatory individuals with chronic, motor complete SCI between T5 and T12 (n=8) and healthy, able-bodied controls (n=8). INTERVENTION Not applicable. MAIN OUTCOME MEASURES Oxygen consumption (V˙o2) and heart rate. RESULTS Individuals with motor complete SCI performed standing and stepping exercises in a BWS system with manual assistance of lower body kinematics. V˙o2 and heart rate responses were assessed in relation to level of BWS. Weight support was provided by an overhead lift at high (≥50% BWS) or low (20%-35% BWS) levels during stepping and standing. Although participants with motor complete SCI were unable to stand or step without assistance, levels of V˙o2 and heart rate were elevated by 38% and 37%, respectively, when load was maximized during stepping (ie, low BWS). Participants without an SCI (able-bodied group) had a similar acute response to exercise. None of the participants met the target range for V˙o2 response in any of the tasks. However, stepping was sufficient to enable half of the participants in the SCI group to attain the target range for heart rate response to exercise. CONCLUSIONS Individuals with motor complete SCI exhibit cardiovascular responses during body weight-supported exercise. Findings indicate that body weight-supported stepping provides a minimal cardiovascular challenge for individuals with paraplegia. Emphasis on low weight support during locomotor training can trigger additional heart rate adaptations.
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Affiliation(s)
- Evan C Jeffries
- School of Kinesiology and Nutritional Science, California State University, Los Angeles, CA
| | | | - Ray de Leon
- School of Kinesiology and Nutritional Science, California State University, Los Angeles, CA
| | - Jesus F Dominguez
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA
| | | | - Ivana A Melgar
- School of Kinesiology and Nutritional Science, California State University, Los Angeles, CA
| | - Christine J Dy
- School of Kinesiology and Nutritional Science, California State University, Los Angeles, CA.
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Watanabe S, Someya F. Effect of Body Weight-supported Walking on Exercise Capacity and Walking Speed in Patients with Knee Osteoarthritis: A Randomized Controlled Trial. JOURNAL OF THE JAPANESE PHYSICAL THERAPY ASSOCIATION 2015; 16:28-35. [PMID: 25792901 DOI: 10.1298/jjpta.vol16_004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Accepted: 05/21/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To compare the effect of body-weight-supported treadmill training (BWSTT) and full-body-weight treadmill training (FBWTT) on patients with knee osteoarthritis (OA). METHODS Design was Randomized controlled trial. Patients with knee osteoarthritis (n = 30; mean age, 76.0±7.5 y) were randomly assigned to BWSTT or FBWTT group. All patients performed 20 min walking exercise twice a week for 6 weeks under the supervision of the therapist. Main measures were 10-meter walking test (10MWT), functional reach test (FRT), timed get up and go test (TUG), one-leg standing test, 6-minute walking test (6MWT), the parameters set on the treadmill, MOS Short-Form 36-Item Health Survey (SF36), Japanese Knee Osteoarthritis Measure (JKOM). RESULTS Twenty-five patients (10 men, 15 women; mean age, 76.5 ± 8.0 y) completed the experiment. Exercise capacity, indicated by the heart rate, was similar in both groups. After 3 weeks of BWSTT, the patients performed significantly better in the 10-m and 6-min walking tests. This was not the case with FBWTT even after 6 weeks training. Pain levels assessed were significantly improved after 3 weeks of BWSTT and 6 weeks of FBWTT. There were no significant improvements in either group assessed by the FRT, one-leg standing time test, TUG, or SF -36 questionnaire. CONCLUSIONS BWSTT enhanced exercise capacity in terms of walking speed and pain reduction after 3 weeks; however, there was no significant improvement in patients' functional abilities or quality of life.
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Affiliation(s)
- Shinichi Watanabe
- Graduate School of Medical Science, Division of Health Sciences, Graduate Course of Rehabilitation Science, Kanazawa University: 5-11-80 Kodatsuno, Kanazawa, Ishikawa 920-0942, Japan ; Department of Rehabilitation Medicine, Nanao Hospital, National Hospital Organization: 3-1 Matto, Nanao, Ishikawa 920-8531, Japan
| | - Fujiko Someya
- Pharmaceutical and Health Sciences, School of Health Sciences, College of Medical, Kanazawa University: 5-11-80 Kodatsuno, Kanazawa, Ishikawa 920-0942, Japan
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Khadilkar A, Phillips K, Jean N, Lamothe C, Milne S, Sarnecka J. Ottawa Panel Evidence-Based Clinical Practice Guidelines for Post-Stroke Rehabilitation. Top Stroke Rehabil 2015; 13:1-269. [PMID: 16939981 DOI: 10.1310/3tkx-7xec-2dtg-xqkh] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this project was to create guidelines for 13 types of physical rehabilitation interventions used in the management of adult patients (>18 years of age) presenting with hemiplegia or hemiparesis following a single clinically identifiable ischemic or hemorrhagic cerebrovascular accident (CVA). METHOD Using Cochrane Collaboration methods, the Ottawa Methods Group identified and synthesized evidence from comparative controlled trials. The group then formed an expert panel, which developed a set of criteria for grading the strength of the evidence and the recommendation. Patient-important outcomes were determined through consensus, provided that these outcomes were assessed with a validated and reliable scale. RESULTS The Ottawa Panel developed 147 positive recommendations of clinical benefit concerning the use of different types of physical rehabilitation interventions involved in post-stroke rehabilitation. DISCUSSION AND CONCLUSION The Ottawa Panel recommends the use of therapeutic exercise, task-oriented training, biofeedback, gait training, balance training, constraint-induced movement therapy, treatment of shoulder subluxation, electrical stimulation, transcutaneous electrical nerve stimulation, therapeutic ultrasound, acupuncture, and intensity and organization of rehabilitation in the management of post stroke.
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Veneri D. Combining the Treatment Modalities of Body Weight Support Treadmill Training and Thera-Band: A Case Study of an Individual with Hemiparetic Gait. Top Stroke Rehabil 2015; 18:402-16. [DOI: 10.1310/tsr1804-402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Cao J, Xie SQ, Das R, Zhu GL. Control strategies for effective robot assisted gait rehabilitation: The state of art and future prospects. Med Eng Phys 2014; 36:1555-66. [DOI: 10.1016/j.medengphy.2014.08.005] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 08/01/2014] [Accepted: 08/12/2014] [Indexed: 11/29/2022]
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Stoller O, de Bruin ED, Schindelholz M, Schuster-Amft C, de Bie RA, Hunt KJ. Cardiopulmonary exercise testing early after stroke using feedback-controlled robotics-assisted treadmill exercise: test-retest reliability and repeatability. J Neuroeng Rehabil 2014; 11:145. [PMID: 25306061 PMCID: PMC4271449 DOI: 10.1186/1743-0003-11-145] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 10/03/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Exercise capacity is seriously reduced after stroke. While cardiopulmonary assessment and intervention strategies have been validated for the mildly and moderately impaired populations post-stroke, there is a lack of effective concepts for stroke survivors suffering from severe motor limitations. This study investigated the test-retest reliability and repeatability of cardiopulmonary exercise testing (CPET) using feedback-controlled robotics-assisted treadmill exercise (FC-RATE) in severely motor impaired individuals early after stroke. METHODS 20 subjects (age 44-84 years, <6 month post-stroke) with severe motor limitations (Functional Ambulatory Classification 0-2) were selected for consecutive constant load testing (CLT) and incremental exercise testing (IET) within a powered exoskeleton, synchronised with a treadmill and a body weight support system. A manual human-in-the-loop feedback system was used to guide individual work rate levels. Outcome variables focussed on standard cardiopulmonary performance parameters. Relative and absolute test-retest reliability were assessed by intraclass correlation coefficients (ICC), standard error of the measurement (SEM), and minimal detectable change (MDC). Mean difference, limits of agreement, and coefficient of variation (CoV) were estimated to assess repeatability. RESULTS Peak performance parameters during IET yielded good to excellent relative reliability: absolute peak oxygen uptake (ICC =0.82), relative peak oxygen uptake (ICC =0.72), peak work rate (ICC =0.91), peak heart rate (ICC =0.80), absolute gas exchange threshold (ICC =0.91), relative gas exchange threshold (ICC =0.88), oxygen cost of work (ICC =0.87), oxygen pulse at peak oxygen uptake (ICC =0.92), ventilation rate versus carbon dioxide output slope (ICC =0.78). For these variables, SEM was 4-13%, MDC 12-36%, and CoV 0.10-0.36. CLT revealed high mean differences and insufficient test-retest reliability for all variables studied. CONCLUSIONS This study presents first evidence on reliability and repeatability for CPET in severely motor impaired individuals early after stroke using a feedback-controlled robotics-assisted treadmill. The results demonstrate good to excellent test-retest reliability and appropriate repeatability for the most important peak cardiopulmonary performance parameters. These findings have important implications for the design and implementation of cardiovascular exercise interventions in severely impaired populations. Future research needs to develop advanced control strategies to enable the true limit of functional exercise capacity to be reached and to further assess test-retest reliability and repeatability in larger samples.
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Affiliation(s)
- Oliver Stoller
- />Department of Engineering and Information Technology, Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, Burgdorf, Switzerland
- />Department of Epidemiology, Maastricht University and Caphri Research School, Maastricht, Netherlands
- />Research Department, Reha Rheinfelden,, Rheinfelden, Switzerland
| | - Eling D de Bruin
- />Department of Epidemiology, Maastricht University and Caphri Research School, Maastricht, Netherlands
- />Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
- />Centre for Evidence Based Physiotherapy, Maastricht University, Maastricht, Netherlands
| | - Matthias Schindelholz
- />Department of Engineering and Information Technology, Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, Burgdorf, Switzerland
- />Research Department, Reha Rheinfelden,, Rheinfelden, Switzerland
| | - Corina Schuster-Amft
- />Department of Engineering and Information Technology, Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, Burgdorf, Switzerland
- />Research Department, Reha Rheinfelden,, Rheinfelden, Switzerland
| | - Rob A de Bie
- />Department of Epidemiology, Maastricht University and Caphri Research School, Maastricht, Netherlands
- />Centre for Evidence Based Physiotherapy, Maastricht University, Maastricht, Netherlands
| | - Kenneth J Hunt
- />Department of Engineering and Information Technology, Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, Burgdorf, Switzerland
- />Research Department, Reha Rheinfelden,, Rheinfelden, Switzerland
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Kitatani R, Ohata K, Takahashi H, Shibuta S, Hashiguchi Y, Yamakami N. Reduction in energy expenditure during walking using an automated stride assistance device in healthy young adults. Arch Phys Med Rehabil 2014; 95:2128-33. [PMID: 25064779 DOI: 10.1016/j.apmr.2014.07.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 06/18/2014] [Accepted: 07/07/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To investigate the effects of an automated stride assistance device that assists hip joint flexion and extension movement in energy expenditure during walking in healthy young adults using an expired gas method. DESIGN Prospective, single-group design to compare the differences of energy expenditure between 2 assistive conditions. SETTING Laboratory. PARTICIPANTS Healthy volunteers (N=10) aged 21 to 32 years. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Oxygen consumption per unit time (V˙o2) cost (ml·kg(-1)·m(-1)), and heart rate (beats/min) were measured in 2 assistive conditions (with 3-Nm hip motion assistance and without assistance) and at 2 walking speeds (comfortable walking speed [CWS] and maximum walking speed [MWS]). RESULTS There were no significant differences in walking speed between the with- and without-assistance conditions at either the CWS or MWS. The V˙o2 cost and heart rate were significantly reduced in the with-assistance condition compared with the without-assistance condition, at both the CWS and MWS. The reduction in the V˙o2 cost during the with-assistance condition, relative to the without-assistance condition, was 7.06% at the CWS and 10.52% at the MWS. CONCLUSIONS The automated stride assistance device is useful for reducing energy expenditure during walking in healthy adults. Further studies are warranted to investigate if this device provides substantial help to individuals with impaired mobility as a result of strength deficits.
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Affiliation(s)
- Ryosuke Kitatani
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Japan Society for the Promotion of Science, Tokyo, Japan.
| | - Koji Ohata
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | | | - Yu Hashiguchi
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Japan Society for the Promotion of Science, Tokyo, Japan
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Sheffler LR, Chae J. Technological advances in interventions to enhance poststroke gait. Phys Med Rehabil Clin N Am 2013; 24:305-23. [PMID: 23598265 DOI: 10.1016/j.pmr.2012.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Neurologic rehabilitation interventions may be either therapeutic or compensatory. Included in this article are lower extremity functional electrical stimulation, body weight-supported treadmill training, and lower extremity robotic-assisted gait training. These poststroke gait training therapies are predicated on activity-dependent neuroplasticity. All three interventions have been trialed extensively in research and clinical settings to show a positive effect on various gait parameters and measures of walking performance. This article provides an overview of evidence-based research that supports the efficacy of these three interventions to improve gait, as well as providing perspective on future developments to enhance poststroke gait in neurologic rehabilitation.
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Affiliation(s)
- Lynne R Sheffler
- Department of Physical Medicine and Rehabilitation, MetroHealth Medical Center, Cleveland Functional Electrical Stimulation Center, Case Western Reserve University, Cleveland, OH 44109, USA.
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Heart Rate Variability in Stroke Patients Submitted to an Acute Bout of Aerobic Exercise. Transl Stroke Res 2013; 4:488-99. [DOI: 10.1007/s12975-013-0263-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 05/02/2013] [Accepted: 05/10/2013] [Indexed: 10/26/2022]
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Roper JA, Stegemöller EL, Tillman MD, Hass CJ. Oxygen consumption, oxygen cost, heart rate, and perceived effort during split-belt treadmill walking in young healthy adults. Eur J Appl Physiol 2012; 113:729-34. [PMID: 23011122 DOI: 10.1007/s00421-012-2477-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Accepted: 08/06/2012] [Indexed: 12/01/2022]
Abstract
During split-belt treadmill walking the speed of the treadmill under one limb is faster than the belt under the contralateral limb. This unique intervention has shown evidence of acutely improving gait impairments in individuals with neurologic impairment such as stroke and Parkinson's disease. However, oxygen use, heart rate and perceived effort associated with split-belt treadmill walking are unknown and may limit the utility of this locomotor intervention. To better understand the intensity of this new intervention, this study was undertaken to examine the oxygen consumption, oxygen cost, heart rate, and rating of perceived exertion associated with split-belt treadmill walking in young healthy adults. Fifteen participants completed three sessions of treadmill walking: slow speed with belts tied, fast speed with belts tied, and split-belt walking with one leg walking at the fast speed and one leg walking at the slow speed. Oxygen consumption, heart rate, and rating of perceived exertion were collected during each walking condition and oxygen cost was calculated. Results revealed that oxygen consumption, heart rate, and perceived effort associated with split-belt walking were higher than slow treadmill walking, but only oxygen consumption was significantly lower during both split-belt walking than fast treadmill walking. Oxygen cost associated with slow treadmill walking was significantly higher than fast treadmill walking. These findings have implications for using split-belt treadmill walking as a rehabilitation tool as the cost associated with split-belt treadmill walking may not be higher or potentially more detrimental than that associated with previously used treadmill training rehabilitation strategies.
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Affiliation(s)
- Jaimie A Roper
- Department of Applied Physiology and Kinesiology, University of Florida, 122 Florida Gym, PO Box 118205, Gainesville, FL 32611-8205, USA.
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Stoller O, de Bruin ED, Knols RH, Hunt KJ. Effects of cardiovascular exercise early after stroke: systematic review and meta-analysis. BMC Neurol 2012; 12:45. [PMID: 22727172 PMCID: PMC3495034 DOI: 10.1186/1471-2377-12-45] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 05/17/2012] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Previous studies have shown the beneficial effects of aerobic exercise in chronic stroke. Most motor and functional recovery occurs in the first months after stroke. Improving cardiovascular capacity may have potential to precipitate recovery during early stroke rehabilitation. Currently, little is known about the effects of early cardiovascular exercise in stroke survivors. The aim of this systematic review was to evaluate the effectiveness of cardiovascular exercise early after stroke. METHODS A systematic literature search was performed. For this review, randomized and non-randomized prospective controlled cohort studies using a cardiovascular, cardiopulmonary or aerobic training intervention starting within 6 months post stroke were considered. The PEDro scale was used to detect risk of bias in individual studies. Inter-rater agreement was calculated (kappa). Meta-analysis was performed using a random-effects model. RESULTS A total of 11 trials were identified for inclusion. Inter-rater agreement was considered to be "very good" (Kappa: 0.81, Standard Error: 0.06, CI95%: 0.70-0.92), and the methodological quality was "good" (7 studies) to "fair" (4 studies). Peak oxygen uptake data were available for 155 participants. Pooled analysis yielded homogenous effects favouring the intervention group (standardised mean difference (SMD) = 0.83, CI95% = 0.50-1.16, Z = 4.93, P < 0.01). Walking endurance assessed with the 6 Minute Walk Test comprised 278 participants. Pooled analysis revealed homogenous effects favouring the cardiovascular training intervention group (SMD = 0.69, CI95% = 0.45-0.94, Z = 5.58, P < 0.01). Gait speed, measured in 243 participants, did not show significant results (SMD = 0.51, CI95% = -0.25-1.26, Z = 1.31, P = 0.19) in favour of early cardiovascular exercise. CONCLUSION This meta-analysis shows that stroke survivors may benefit from cardiovascular exercise during sub-acute stages to improve peak oxygen uptake and walking distance. Thus, cardiovascular exercise should be considered in sub-acute stroke rehabilitation. However, concepts to influence and evaluate aerobic capacity in severely affected individuals with sub-acute stroke, as well as in the very early period after stroke, are lacking.Further research is needed to develop appropriate methods for cardiovascular rehabilitation early after stroke and to evaluate long-term effects of cardiovascular exercise on aerobic capacity, physical functioning, and quality-of-life.
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Affiliation(s)
- Oliver Stoller
- Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, Burgdorf, Switzerland
- Department of Epidemiology, Maastricht University and Caphri Research School, Maastricht, Netherlands
| | - Eling D de Bruin
- Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
| | - Ruud H Knols
- Physiotherapy Occupational Therapy Research, Center for Clinical Research, University Hospital Zurich, Zurich, Switzerland
| | - Kenneth J Hunt
- Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, Burgdorf, Switzerland
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Nadeau S, Duclos C, Bouyer L, Richards CL. Guiding task-oriented gait training after stroke or spinal cord injury by means of a biomechanical gait analysis. PROGRESS IN BRAIN RESEARCH 2011; 192:161-80. [PMID: 21763525 DOI: 10.1016/b978-0-444-53355-5.00011-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
To recover the ability to walk is one of the most important goals of persons recovering from a stroke or spinal cord injury (SCI). While a task-oriented approach to gait training is recommended, randomized controlled trials or meta-analyses comparing different methods of delivering training have failed in general to demonstrate the superiority of one approach over the other. The large variations in the mean outcome gait measures reported in these studies reflect, at least in part, the heterogeneity of the sensorimotor impairments underlying the gait disability as well as variations in the therapeutic response. The purpose of this chapter is to demonstrate that biomechanical gait analysis can reveal information pertinent to the selection of a task-oriented approach to enhance gait training as well as the therapeutic response that clinical evaluations alone cannot provide. We first briefly review locomotor impairments underlying the gait disability after stroke and SCI as well as the effects of selected technological task-oriented gait training interventions. We then give examples that demonstrate the use of gait analysis to pinpoint underlying impairments that can guide the choice of sensorimotor therapy and then immediately identify responders to the intervention. Such an individualized approach should promote therapeutic efficacy while leading over time to the identification of clinical indices to guide therapy when gait analysis is not feasible. Given the requirements of a gait analysis laboratory and the qualified personnel to capture and interpret the data, future studies will need to demonstrate the feasibility of the technological proposed approach and assess the costs and benefits for the health care system.
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Affiliation(s)
- Sylvie Nadeau
- Pathokinesiology Laboratory, Centre for Interdisciplinary Research in Rehabilitation, Institut de réadaptation Gingras-Lindsay-de-Montréal, Montréal, Québec, Canada.
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Jung T, Lee D, Charalambous C, Vrongistinos K. The Influence of Applying Additional Weight to the Affected Leg on Gait Patterns During Aquatic Treadmill Walking in People Poststroke. Arch Phys Med Rehabil 2010; 91:129-36. [DOI: 10.1016/j.apmr.2009.09.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2009] [Revised: 08/02/2009] [Accepted: 09/14/2009] [Indexed: 11/24/2022]
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Ruckstuhl H, Kho J, Weed M, Wilkinson MW, Hargens AR. Comparing two devices of suspended treadmill walking by varying body unloading and Froude number. Gait Posture 2009; 30:446-51. [PMID: 19674901 DOI: 10.1016/j.gaitpost.2009.07.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2008] [Revised: 06/19/2009] [Accepted: 07/01/2009] [Indexed: 02/02/2023]
Abstract
In rehabilitation, treadmill walking with body weight support is commonly used to reduce loads on lower extremities. (1) However, gait pattern alterations during unloading at constant Froude number are infrequently reported. (2) Furthermore, differences between two common devices for unloading are not well known. Therefore, we investigated two devices; a waist-high chamber with increased pressure called Lower Body Positive Pressure (LBPP), and a harness system (LiteGait), considered a standard system for unloading the lower body. Four gait parameters (cadence, normalized stride length, duty factor, and leg angle at touch down), heart rate, and comfort level were monitored in 12 healthy volunteers. Subjects walked at three body weight (BW) conditions (100%, 66%, and 33% BW) and three Froude numbers (Fr), which refer to a dimensionless speed reflecting slow walking (Fr=0.09), comfortable walking (Fr=0.25), and walk-run transition (Fr=0.5). Absolute treadmill speed was determined using Froude numbers reflecting dynamically similar motions during unloading. We found that (1) the normal gait pattern is altered during unloading at a constant Froude number. In rehabilitation, physical therapists should be aware that normal gait pattern may not need to be maintained during unloaded treadmill walking. (2) Gait parameters were not different when comparing LBPP to harness supported walking. However, heart rate was lower and comfort higher during unloaded LBPP ambulation compared to suspended harness walking. Therefore, suspended LBPP walking may be more appropriate for patients with cardiovascular disease and for conditions at high unloading.
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Affiliation(s)
- Heidi Ruckstuhl
- Department of Orthopaedic Surgery, University of California, San Diego, CA, USA.
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Abstract
BACKGROUND AND PURPOSE Although many people who have had a stroke are primarily interested in learning to walk, some are able to focus on a return to recreational and sporting activities. This study was carried out to investigate the feasibility and effectiveness of the use of intensive task-oriented training in the body-weight-support/treadmill environment to improve running for a subject after stroke. SUBJECT The subject was a 38-year-old man who had a stroke 2.5 years previously. METHODS A single-subject design with baseline, intervention, immediate postintervention, and 6-month postintervention phases was conducted. Dependent variables included 25-m sprint time, single-leg balance, running step width, running step length ratio, Stroke Impact Scale, 6-minute walk test, and lower-extremity strength (force-generating capacity). RESULTS At the 6-month postintervention phase, sprint speed, left single-leg balance, and step width changed significantly from the baseline phase. Step length ratio trended toward less symmetry but more consistency, and muscle strength improved more than 20% in 6 of 8 muscle groups in the involved lower extremity and 4 of 8 muscle groups in the uninvolved lower extremity. DISCUSSION AND CONCLUSION Intensive task-specific training was feasible and effective for retraining running ability in the study subject. He returned to recreational running, which provided him with a greatly improved outlook and a better quality of life.
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Locomotor Treadmill Training With Partial Body-Weight Support Before Overground Gait in Adults With Acute Stroke: A Pilot Study. Arch Phys Med Rehabil 2008; 89:684-91. [DOI: 10.1016/j.apmr.2007.09.050] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2007] [Accepted: 09/27/2007] [Indexed: 11/19/2022]
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Cardiorespiratory capacity after weight-supported treadmill training in patients with traumatic brain injury. Phys Ther 2008; 88:77-87. [PMID: 17940106 DOI: 10.2522/ptj.20070022] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE The primary goal of body-weight-supported treadmill training (BWSTT) has been to improve the temporal and spatial characteristics of unsupported overground walking; however, little attention has been given to cardiorespiratory adaptations. The purpose of this case report is to describe the effects of BWSTT on cardiorespiratory fitness in 2 patients recovering from severe traumatic brain injury (TBI). CASE DESCRIPTION Both patients were involved in motor vehicle accidents and were studied after admission to a postacute residential treatment program. Patient 1 was a 25-year-old man (initial Glasgow Coma Scale [GCS] score=3) who began observation and treatment 3 months after the injury. Patient 2 was an 18-year-old woman (initial GCS=6) who began observation and treatment 1 year after the injury. OUTCOMES Each patient received 2 to 3 sessions of BWSTT per week. Aerobic capacity was measured while they ambulated on a treadmill without body-weight support before and after BWSTT. Both patients' submaximal and peak responses improved. For patient 1 and patient 2, total treadmill work performed increased 134% and 53%, respectively. Peak oxygen uptake increased 24% for patient 1 and 16% for patient 2. Estimated cardiac stroke volume (oxygen pulse) increased 32% and 26% for patient 1 and patient 2, respectively. DISCUSSION The observations made on these 2 patients suggest that BWSTT has the potential to favorably change cardiorespiratory capacity after TBI.
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Krewer C, Müller F, Husemann B, Heller S, Quintern J, Koenig E. The influence of different Lokomat walking conditions on the energy expenditure of hemiparetic patients and healthy subjects. Gait Posture 2007; 26:372-7. [PMID: 17113774 DOI: 10.1016/j.gaitpost.2006.10.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2006] [Revised: 09/26/2006] [Accepted: 10/05/2006] [Indexed: 02/02/2023]
Abstract
To determine the strenuousness and efficacy of therapy, the energy expenditure of 10 healthy and 10 hemiparetic subjects were measured while they walked on a treadmill that was combined with a robot-driven gait orthosis, the Lokomat, which physiologically exercises the legs of a patient on a moving treadmill. Subjects performed different Lokomat conditions after measurement of the baseline, i.e., standing in the Lokomat with 30% body weight support (BWS). Robotic strategies with a position control scheme used fixed gait patterns to produce the following conditions: walking with 100% BWS at a speed of 1 km/h versus 2 km/h and walking with 30% BWS at a speed of 1 km/h versus 2 km/h. Another robotic control option with a force control scheme allowed the force to be reduced on only one leg of the orthosis. In this option a reduction to 60% and to 0% assistance was tested. Oxygen consumption and heart rate were measured by a breath-by-breath respiratory gas analyzing system using standard open circuit methodology. The results for O(2) rate [ml/kg/min] indicate that: (1) walking in the Lokomat is not passive; (2) oxygen uptake is significantly increased due to an effect of loading during active stance phase; (3) speed is not a factor leading to increased oxygen consumption; (4) patients do not significantly increase their oxygen uptake due to the advanced force control scheme.
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Affiliation(s)
- Carmen Krewer
- Neurologische Klinik Bad Aibling, Kolbermoorer Strasse 72, D-83043 Bad Aibling, Germany.
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Fredrickson E, Ruff RL, Daly JJ. Physiological Cost Index as a proxy measure for the oxygen cost of gait in stroke patients. Neurorehabil Neural Repair 2007; 21:429-34. [PMID: 17409390 DOI: 10.1177/1545968307300400] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Stroke survivors can exhibit abnormally elevated oxygen consumption during walking. Therapeutic interventions can improve gait deficits and oxygen consumption. A practical measure of oxygen cost is not available. This study tested the usefulness of an indirect index of oxygen cost, the Physiological Cost Index, and the ability of this index to discriminate between healthy adults and stroke survivors. METHODS The authors studied 17 subjects with stroke and 10 healthy control participants. Participants walked 10 minutes at their chosen comfortable speed on a treadmill. Oxygen consumption and heart rate data were collected. Primary measures were oxygen cost and the Physiological Cost Index. Secondary measures were age and gait speed. RESULTS The Physiological Cost Index and oxygen cost had a good to excellent correlation (r = .83, P < .001) for subjects with stroke. Both oxygen cost and the Physiological Cost Index were comparable in detecting a significantly abnormal elevation for stroke survivors versus healthy adults (P = .003 and .002, respectively). Age was not correlated with oxygen cost, the Physiological Cost Index, or chosen gait speed. A moderate correlation of gait speed to both the Physiological Cost Index and oxygen cost was found. CONCLUSIONS The Physiological Cost Index can be used as a proxy index for the oxygen cost of walking in subjects after stroke because it is correlated with oxygen cost and is comparable to oxygen cost in its capability to discriminate between healthy controls and subjects with stroke. The Physiological Cost Index can be performed inexpensively on a routine basis in a clinical environment.
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Affiliation(s)
- Eric Fredrickson
- Department of Veterans Affairs, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio 44106, USA
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Courbon A, Calmels P, Roche F, Ramas J, Fayolle-Minon I. Relation entre les capacités de marche et les capacités maximales à l'effort, les capacités musculaires et la déficience motrice après hémiplégie vasculaire chez l'adulte. ACTA ACUST UNITED AC 2006; 49:614-20. [PMID: 16713006 DOI: 10.1016/j.annrmp.2006.04.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2006] [Accepted: 04/03/2006] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the relation between walking capacity and maximal exercise capacity, strength and motor deficiency in hemiplegic stroke patients. DESIGN Uncontrolled observational study. SETTING Physical medicine and rehabilitation unit in a teaching hospital. PARTICIPANTS Twenty hemiplegic stroke patients (17 men and 3 women) aged 18-70 years, whose stroke occurred more than 3 months before the study and who could walk independently with or without walking aids. MAIN OUTCOME MEASURES Peak oxygen uptake (VO(2peak)), maximal power output walking capacity (6-min walk test) and motor deficiency (Fugl-Meyer scale). RESULTS Walking capacity was correlated with both VO(2peak) and maximal power output (Pmax) [r=0.609, P<0.003 and r=0.868, P<0.0001, respectively] but also with strength (from r=0.640 to r=0.734; P=0.0018 to P=0.0001) and motor deficiency (r=0.6; P=0.004). CONCLUSIONS Aerobic capacity and walking capacity are correlated and decreased in hemiplegic stroke patients. These results underscore the need for future studies to confirm the role of fitness in relation to walking capacity and to evaluate the benefit of integrating aerobic training into more traditional rehabilitation programs after stroke.
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Affiliation(s)
- A Courbon
- Unité PPEH-GIP E2S EA 3062, service de médecine physique et de réadaptation, faculté de médecine Jacques-Lisfranc, université Jean-Monnet, hôpital Bellevue, CHU de Saint-Etienne, 42055 Saint-Etienne cedex 02, France.
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Barbeau H, Nadeau S, Garneau C. Physical Determinants, Emerging Concepts, and Training Approaches in Gait of Individuals with Spinal Cord Injury. J Neurotrauma 2006; 23:571-85. [PMID: 16629638 DOI: 10.1089/neu.2006.23.571] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The aim of this review is to examine the physical determinants for functional walking as well as the efficacy of gait rehabilitation after spinal cord injury (SCI) in humans. The results indicate several important physical determinants in gait. Examples are provided of different interventions that produce beneficial effects on outcome measures of gait such as gait speed, stride length, walking endurance, motor recovery, and gait quality. These findings need to be considered in current SCI rehabilitation practices, but the efficacy of certain interventions remains unclear. Well-designed clinical trials are needed to provide evidence of the role of physical determinants in the development of new concepts and principles in locomotor recovery after SCI. This review focuses on relevant literature, and informs rehabilitation specialists and basic scientists about the physical determinants and factors to consider for optimization of gait training in individuals with incomplete SCI.
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Affiliation(s)
- Hugues Barbeau
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada.
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Abstract
OBJECTIVE To assess whether one-legged bicycling correlates with muscle strength and thereby could work as an outcome measure for persons with stroke. METHODS The study comprised 29 men (age 35-65) with a first occurrence of stroke 6-35 months earlier. Each leg was evaluated separately. A ramp protocol was used (10 W/min), with continuous recording of the ventilatory uptake (Vo(2)) and heart rate. An isokinetic dynamometer was used to assess strength and endurance. Enzyme assays were performed on muscle biopsy samples. RESULTS The peak isometric strength and isokinetic strength of the paretic leg correlated with the max. W on the bicycle. The oxidative enzyme citrate synthase correlated with the workload for both legs on the bicycle and lactate dehydrogenase correlated with peak isometric strength in both legs. CONCLUSIONS The one-legged bicycle exercise test can be used to assess endurance in persons with a previous stroke as it correlates with dynamometer testing and muscle biopsies.
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Affiliation(s)
- K S Sunnerhagen
- The Arvid Carlsson Institute, The Sahlgrenska Academy, Göteborg University, Göteborg, Sweden.
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Calmels P, Degache F, Fayolle-Minon I, Condemine A, Courbon A, Ramas J, Richard R, Roche F, Degache A, Girardin N, Gautheron V, Devillard X. [Hemiplegia and a hiking tour of Mont Blanc: from hope to reality]. ANNALES DE READAPTATION ET DE MEDECINE PHYSIQUE : REVUE SCIENTIFIQUE DE LA SOCIETE FRANCAISE DE REEDUCATION FONCTIONNELLE DE READAPTATION ET DE MEDECINE PHYSIQUE 2005; 48:180-6. [PMID: 15848260 DOI: 10.1016/j.annrmp.2004.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2004] [Accepted: 10/26/2004] [Indexed: 05/02/2023]
Abstract
INTRODUCTION At the end of an endurance training program for stroke patients with hemiplegia, we offered a hiking tour around the Mont Blanc Pedestrian Tour. We found no publication describing a similar experience and no scientific data in the literature to determine the physiological characteristics required for this performance, particularly regarding cardiac and vascular capacities, level of impairment, and functional abilities. OBJECTIVE To complete a part of the Mont Blanc Pedestrian Tour over six days, with a group of adults with hemiparesis and aphasia due to stroke. POPULATION Seven of 20 subjects with right hemiparesis and aphasia were selected on the basis of results of physiological tests, after an endurance training program and two tests hikes at medium altitude. Mean age was 51.71 +/- 7.13 years, mean VO(2max) 19.76 +/- 3.46 ml.g(-1).mm(-1), mean P(max) 90 +/- 22.68 and mean walking speed 3.60 +/- 1.30 km/hour. ORGANIZATION Organization involved setting up the itinerary, recruiting accompanying personnel (9 people), and arranging security. No specific adaptations for accessibility were available, and no specific equipment was used, except for standard walking sticks. RESULTS During this pedestrian tour, the subjects demonstrated strong motivation, as well as exceptional physical and functional performance, despite significant changes in elevation (up to 1500 m per day) and long walking times (from 5 to 9 hours per day). DISCUSSION This experience has enriched our reflection about the medical, functional, and psychological conditions required for this type of physical effort, both from patients and accompanying personnel. In the absence of reports on similar experiences with this patient population, we thought it interesting, six months after this challenge, to present our observations as well as the patients' point of view. This may encourage other rehabilitation teams to offer intensive walking activities for stroke patients.
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Affiliation(s)
- P Calmels
- Service de médecine physique et de réadaptation, centre hospitalier universitaire de Saint-Etienne, France.
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Hömberg V. Evidence based medicine in neurological rehabilitation — a critical review. RE-ENGINEERING OF THE DAMAGED BRAIN AND SPINAL CORD 2005; 93:3-14. [PMID: 15986721 DOI: 10.1007/3-211-27577-0_1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- V Hömberg
- Neurological Rehabilitation, Heinrich-Heine-University of Düsseldorf, Düsseldorf, Germany.
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Danielsson A, Sunnerhagen KS. Energy expenditure in stroke subjects walking with a carbon composite ankle foot orthosis. J Rehabil Med 2004; 36:165-8. [PMID: 15370732 DOI: 10.1080/16501970410025126] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE To measure walking speed and energy cost in patients with prior stroke with and without a carbon composite ankle foot orthosis. DESIGN Within-group comparisons of 2 walking conditions. PARTICIPANTS Convenience sample of 10 hemiparetic patients with a stroke at least 6 months earlier (average age 52 years) habituated to a carbon composite ankle foot orthosis. METHODS Subjects walked on a treadmill at self-selected speed both with and without ankle foot orthosis for 5 minutes on each occasion. Energy expenditure was measured by breath-by-breath analysis and electrocardiography. Main outcome measures were walking speed, oxygen consumption, heart rate and energy cost per metre. RESULTS Walking speed: without ankle foot orthosis 0.27 (SEM +/- 0.03) m/s, with 0.34 (+/- 0.06) m/s, difference 20%. Oxygen consumption: without ankle foot orthosis 8.6 (+/- 0.4) ml/kg/min, with 8.8 (+/- 0.5) ml/kg/min. Energy cost: without ankle foot orthosis 0.58 (+/- 0.07) ml/kg/m, with 0.51 (+/- 0.06) ml/kg/m, difference 12%. CONCLUSION Use of a carbon composite ankle foot orthosis in patients with stroke may increase speed and decrease energy cost during walking.
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Affiliation(s)
- Anna Danielsson
- Department of Clinical Neuroscience - Rehabilitation Medicine, The Sahlgrenska Academy, Göteborg University, Göteborg, Sweden.
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Pohl PS, Perera S, Duncan PW, Maletsky R, Whitman R, Studenski S. Gains in distance walking in a 3-month follow-up poststroke: what changes? Neurorehabil Neural Repair 2004; 18:30-6. [PMID: 15035962 DOI: 10.1177/0888439003260494] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
STATEMENT OF PROBLEM Distance walking remains compromised for many adults poststroke. The purpose of this study was to examine if the amelioration of stroke-related neuromuscular impairments, improved cardiovascular fitness, or better balance contributed to gains in distance walking. METHOD OF STUDY The authors gathered baseline data of 92 adults at an average of 75 days poststroke and again 3 months later. Participants performed a bicycle ergometry stress test, a 6-min walk, and a Fugl-Meyer assessment for motor control, strength, and balance testing. The gain in walk distance was modeled using multiple regression with the variables of gains in peak VO2, lower limb control, plantar flexion strength, and balance. Separate analyses were done for poor performers, that is, participants who walked less than the median distance (213 m) at baseline and good performers, that is, participants who walked more than 213 m. RESULTS For poor performers, the gain in balance was the only significant predictor of the gain in distance walking and accounted for 16% of the variance. For good performers, gains in peak VO2 and the lower limb Fugl-Meyer score were significant predictors and accounted for 28% of the variance. DISCUSSION These results suggest that rehabilitation efforts to improve distance walking should focus on different factors depending on initial distance walked.
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Affiliation(s)
- Patricia S Pohl
- University of Kansas Medical Center, Kansas City, KS 66160, USA.
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Abstract
A major component of stroke rehabilitation focuses on gait restoration. The purpose of this review is to examine the efficacy of a variety of gait retraining techniques currently in clinical use, including strength training, functional electrical stimulation, treadmill training, partial body-weight support, EMG biofeedback, and splinting of the lower extremity. Forty-eight studies evaluating six gait enhancement techniques were reviewed. There is either strong or moderate evidence to support the use of strength training, EMG/biofeedback, and functional electrical stimulation as an adjunctive therapy in gait training, and there is either limited or conflicting evidence to support the use of ankle-foot orthosis, treadmill training, and partial body-weight support.
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Affiliation(s)
- Robert W Teasell
- Department of Physical Medicine and Rehabilitation, St. Joseph's Health Care London and University of Western Ontario, London, Ontario, Canada
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