Effect of cycling and functional electrical stimulation with linear and interval patterns of timing on gait parameters in patients after stroke: a randomized clinical trial

Prediction of leg muscle activities from arm muscle activities in arm and leg cycling

Functional electrical stimulation (FES) driven leg cycling is usually controlled by previously established stimulation patterns. We investigated the potential utilization of a particular computational method for controlling electrical stimulation of lower limb muscles by real-time electromyography (EMG) signals of arm muscles during hybrid arm and leg cycling. In hybrid arm and leg cycling, arm cranking is performed voluntarily, while leg cycling is driven by FES. In this study, we investigate arm and leg cycling movements of able-bodied persons when both arm and leg cycling is performed voluntarily without FES. We present a neural network-based model in which the input of the neural network is given by a time series of upper limb muscle activities (EMG), and the output provides potential lower limb muscle activities. The particular neural network was a nonlinear autoregressive exogen (NARX) neural network. The measured EMG signals of the lower limb muscles were compared to the signals that were predicted by the neural network. The neural network was trained with data recorded from four participants. Our preliminary results show notable differences between the predicted and the experimentally measured lower limb muscle activities. The prediction was good only for 60% of the movement time. We conclude that-while including arm cycling in the movement-simpler control modalities or further consideration of applying machine-learning techniques has to be taken into account to improve voluntary upper limb-controlled FES assisted leg cycling.

Effects of a lower limb rehabilitation robot with various training modes in patients with stroke: A randomized controlled trial

BACKGROUND

The effect of robot-assisted gait training has been demonstrated to improve gait recovery in patients with stroke. The aim of this study was to determine effects of robot-assisted gait training with various training modes in patients post stroke.

METHODS

Forty-seven patients post stroke were randomly assigned to one of 4 groups: Healbot T with pelvic off mode (pelvic off group; n = 11); Healbot T with pelvic control mode (pelvic on group; n = 12); Healbot T with constraint-induced movement therapy (CIMT) mode (CIMT group; n = 10); and conventional physiotherapy (control group; n = 10). All patients received a 30-minute session 10 times for 4 weeks. The primary outcomes were the 10-meter walk test (10MWT) and Berg Balance Scale (BBS). The secondary outcomes were functional ambulation category, timed up and go (TUG), and motricity index of the lower extremities (MI-Lower).

RESULTS

The pelvic off group showed significant improvements in BBS, TUG, and MI-Lower (P < .05). The pelvic on and CIMT groups showed significant improvement in 10MWT, BBS, TUG, and MI-Lower (P < .05). Compared with control group, the pelvic on group showed greater improvement in the TUG and BBS scores; the CIMT group showed greater improvement in 10MWT and MI-Lower (P < .05).

CONCLUSION

This study suggested that Healbot T-assisted gait training benefited patients with stroke. The Healbot T with pelvic motion and CIMT modes were more helpful in improving balance and walking ability and lower limb strength, respectively, compared with conventional physiotherapy.

Effects of Pelvic Stabilization Training with Lateral and Posterior Tilt Taping on Pelvic Inclination, Muscle Strength, and Gait Function in Patients with Stroke: A Randomized Controlled Study

Background

This study was aimed at investigating the effect of pelvic tilt taping on muscle strength, pelvic inclination, and gait function in patients with stroke.

Methods

A total of 60 patients with stroke were included in our study and randomly divided into three groups: the posterior pelvic tilt taping (PPTT, n = 20), the lateral pelvic tilt taping (LPPP) with PPTT (LPPP+PPTT, n = 20), and the control (n = 20) groups. All participants performed pelvic stabilization exercises consisting of 6 movements: supine, side lying, quadruped, sitting, squatting, and standing (30 min/day, five days/week, for six weeks). PPTT to correct anterior pelvic tilt was applied to the LPTT+PPTT and PPTT groups, and lateral pelvic tilt taping was additionally applied to the LPTT+PPTT group. LPTT was performed to correct the pelvis tilted to the affected side, and PPTT was performed to correct the anterior pelvic tilt. The control group did not undergo taping. A hand-held dynamometer was used to measure the hip abductor muscle strength. In addition, a palpation meter and 10-meter walk test were used to assess pelvic inclination and gait function.

Results

Muscle strength was significantly stronger in the LPTT+PPTT group than in the other two groups (p = 0.01). The anterior pelvic tilt was significantly improved in the taping group compared to the control group (p < 0.001), and the lateral pelvic tilt was significantly improved in the LPTT+PPTT group compared to the other two groups (p < 0.001). Significantly greater improvements in gait speed were observed in the LPTT+PPTT group than in the other two groups (p = 0.02).

Conclusions

PPPT can significantly affect pelvic alignment and walking speed in patients with stroke, and the additional application of LPTT can further strengthen these effects. Therefore, we suggest using taping as an auxiliary therapeutic-intervention method in postural control training.

Proprioceptive Neuromuscular Facilitation-Based Physical Therapy on the Improvement of Balance and Gait in Patients with Chronic Stroke: A Systematic Review and Meta-Analysis

The present study aims to determine the potential benefits of PNF on balance and gait function in patients with chronic stroke by using a systematic review and meta-analysis. Systematic review in the following databases: MEDLINE/PubMed, Physiotherapy Evidence Database (PEDro), Cochrane Library and Google Scholar. Studies up to September 2020 are included. A systematic database search was conducted for randomized control trials (RCTs) that investigated the effects of PNF intervention in patients with chronic stroke using balance and gait parameters as outcome measures. The primary outcomes of interest were Berg Balance Scale (BBS), Functional Reach Test (FRT), Timed Up and Go Test (TUG) and 10-Meter Walking Test (10MWT). Nineteen studies with 532 participants were included, of which twelve studies with 327 participants were included for meta-analysis. When the data were pooled, PNF made statistically significant improvements in balance with BBS, FRT and TUG (p < 0.05) or gait velocity with 10MWT (p < 0.001) when compared to the control. This review indicates that PNF is a potential treatment strategy in chronic stroke rehabilitation on balance and gait speed. Further high-quality research is required for concluding a consensus of intervention and research on PNF.

The effects of cycling using lower limb active passive trainers in people with neurological conditions: a systematic review

Background Active passive trainers are frequently used as a safe, feasible way for people with neurological disabilities to exercise. However, evidence regarding their efficacy is limited. The aim of this study was to review the literature investigating the effects of lower limb active passive trainer cycling, with or without functional electrical stimulation, on spasticity, cardiovascular fitness, function and quality of life in people with neurological conditions

Methods Five electronic databases were searched from inception to June 2021. Studies included: randomised controlled trials using lower limb active passive trainers as a cycling intervention; participants with neurological conditions, such as multiple sclerosis, spinal cord injury, stroke and Parkinson's disease; and at least one outcome related to spasticity, cardiovascular fitness, physical function or quality of life.

Results A total of 12 articles were included (n=423 participants, 52% male). Of these, six used functional electrical stimulation-assisted active passive trainer interventions, and the remaining six used active passive trainer interventions alone. A meta-analysis demonstrated statistically significant improvement in walking endurance; however, this only included stroke studies (6-Minute Walk Test performance, P<0.00001). No statistically significant improvement in walking speed was found (P=0.31). A significant improvement in spasticity was reported by three studies (two using the active passive trainer intervention alone, one using the active passive trainer with functional electrical stimulation). One study reported improvement in quality of life. Few studies considered cardiovascular fitness.

Conclusions The included studies featured heterogeneous designs, outcome measures, exercise prescriptions and participant disability levels, which made comparison difficult. Active passive trainer interventions appear to improve walking endurance in people with stroke; however, the effect on other outcomes and in other conditions remains unclear. It also remains uncertain as to whether functional electrical stimulation-assisted cycling is more beneficial than active passive trainer cycling alone.

Immediate changes in post-stroke gait using a shoe lift on the nonaffected lower limb: A preliminary study

INTRODUCTION

Gait impairment is one of the most important post-stroke complications and is associated with reduced mobility, limitations in activities of daily living and decreased quality of life. Gait recovery is an important goal in post-stroke rehabilitation and shoe lifts have been used on the nonaffected lower limb (NLL) to reduce compensatory strategies such as vaulting, pelvic hiking and hip circumduction during the swing phase of the affected lower limb. Moreover, in clinical practice shoe lifts seem to reduce tripping and the risk of falls.

OBJECTIVE

Evaluate walking speed and functional mobility with and without a 1.5 cm shoe lift under the non-affected lower limb in post-stroke gait.

METHODS

Forty-two subjects with hemiparesis after stroke were evaluated on a single day, under two conditions: with and without a 1.5 cm shoe lift. The assessment sequence was randomized and clinical tests (Ten-meter walk Test - 10MWT and Timed Up and Go - TUG) were performed one after the other.

RESULTS

There was a significant increase in walking speed in the 10MWT and shorter TUG times, with mean differences of 0.78 (CI95% 0.15-1.41, P ≤ 0.001, EF = 0.55) and 0.57 seconds (-0.11-1.25, P = .022, EF = 0.35), respectively.

CONCLUSION

The results showed that the immediate use of 1.5 cm shoe lifts seems to improve gait speed and functional mobility in chronic stroke patients. Further studies should focus on understanding the kinematics strategies and gait pattern alterations caused by shoe lifts under the NLL of post-stroke individuals.

The Effect of Dry Needling on Lower Limb Dysfunction in Poststroke Survivors

BACKGROUND

Spasticity is one of the main complications in poststroke survivors leading to difficulties in walking and standing resulting in high levels of disability.

OBJECTIVE

The aim of the study was to investigate the effects of deep dry needling on lower limb dysfunction in poststroke spastic patients.

METHODS

A randomized clinical trial conducted in poststroke survivors who were assigned to one of 2 groups: Deep dry needling (intervention group) and sham dry needling (control group). The primary outcome measures were Modified Modified Ashworth Scale (MMAS) and functional tests (timed up and go test, 10-meter walk test). Secondary outcome measures were active ankle dorsiflexion range of motion (AROM), passive ankle dorsiflexion range of motion (PROM), single leg stance test, and Barthel index. All measurements were assessed at baseline (T0), immediately after the third session 1 week later (T1), and 1 month after the end of the intervention (T2).

RESULTS

We recruited 24 patients (71% male; mean age 57 ± 10 years; 26.4 ± 1.8 kg•m^-2; time since event: 25.2 ± 12.5 months). There were significant improvements in MMAS, timed up and go test, 10-meter walk test, Barthel scale, and PROM (P < .05) in the intervention group compared to controls across the time-points. There were no significant improvements in AROM assessments (P > .05).

CONCLUSIONS

Deep dry needling decreases muscle spasticity and improves lower limb function and gait speed in poststroke survivors.