Gait Characteristics and Functional Ambulation Profile in Patients with Chronic Unilateral Stroke

Effects of acupuncture combined with trunk strengthening training on balance and gait abilities in stroke hemiplegic patients

This study aimed to observe the effects of acupuncture combined with trunk strengthening training on balance and gait abilities in stroke hemiplegic patients. Sixty stroke hemiplegic patients were selected and randomly divided into a treatment group and a control group, with 30 patients in each group. The control group received conventional rehabilitation training and trunk strengthening exercises, while the treatment group received acupuncture in addition to the same interventions. Before and after 8 weeks of treatment, patients were assessed using the Holden Functional Ambulation Categories and Berg Balance Scale, and measurements were taken for step length, step width, and gait speed. Prior to treatment, there were no significant differences in Holden scores, Berg scores, step length, step width, or gait speed between the 2 groups (P > .05). After 8 weeks of treatment, significant improvements were observed in the aforementioned parameters in both groups (P < .05), with the acupuncture group showing significantly greater improvement compared to the control group (P < .05). Acupuncture combined with trunk strengthening training can significantly improve balance and gait impairments in stroke hemiplegic patients.

Immediate effects of insoles applied to the sound side lower extremity of patients with chronic hemiplegia during walking

Background

Asymmetric gait patterns are mostly observed in hemiplegic stroke patients. These abnormal gait patterns resulting in abnormal speed, and decreased ability in daily of activity living.

Objective

This study aimed to determine the immediate changes in gait parameters and plantar pressure during elevation by wearing an insole on the sound side lower extremity of patients with hemiplegia.

Methods

Thirty-six participants were recruited, comprising those with a post-stroke follow-up of ≥3 months and a functional ambulation category score of ≥2. The participants were asked to walk with and without a 1 cm insole in the shoe of their sound side, and the order of wearing or not wearing the insole was randomized. Gait parameters, bilateral gait parameters, and dynamic plantar pressure were measured using the GAITRite Walkway System.

Results

Paired t-test was used to examine immediate changes in gait parameters and plantar pressure with and without insoles during walking in the same group. Overall, gait velocity and step length significantly decreased (p < 0.05), whereas step time significantly increased (p < 0.05). The swing phase of the affected sidelower extremities significantly increased (p < 0.05), and the stance phase significantly decreased (p < 0.05). Double-support unloading phase (pre-swing phase) significantly increased (p < 0.05). The changes in plantar pressure were significantly increased in some lateral zones and significantly decreased in the medial zone of the mid-hindfoot, both in terms of pressure per time and peak pressure (p < 0.05).

Conclusion

Although this study did not show immediate positive effects on gait parameters and gait cycle, it is expected that sensory input from the sole of the foot through changes in plantar pressure may help improve gait asymmetry and regulate postural symmetry.

Neurophysiology of cerebellar ataxias and gait disorders

There are numerous forms of cerebellar disorders from sporadic to genetic diseases. The aim of this chapter is to provide an overview of the advances and emerging techniques during these last 2 decades in the neurophysiological tests useful in cerebellar patients for clinical and research purposes. Clinically, patients exhibit various combinations of a vestibulocerebellar syndrome, a cerebellar cognitive affective syndrome and a cerebellar motor syndrome which will be discussed throughout this chapter. Cerebellar patients show abnormal Bereitschaftpotentials (BPs) and mismatch negativity. Cerebellar EEG is now being applied in cerebellar disorders to unravel impaired electrophysiological patterns associated within disorders of the cerebellar cortex. Eyeblink conditioning is significantly impaired in cerebellar disorders: the ability to acquire conditioned eyeblink responses is reduced in hereditary ataxias, in cerebellar stroke and after tumor surgery of the cerebellum. Furthermore, impaired eyeblink conditioning is an early marker of cerebellar degenerative disease. General rules of motor control suggest that optimal strategies are needed to execute voluntary movements in the complex environment of daily life. A high degree of adaptability is required for learning procedures underlying motor control as sensorimotor adaptation is essential to perform accurate goal-directed movements. Cerebellar patients show impairments during online visuomotor adaptation tasks. Cerebellum-motor cortex inhibition (CBI) is a neurophysiological biomarker showing an inverse association between cerebellothalamocortical tract integrity and ataxia severity. Ataxic gait is characterized by increased step width, reduced ankle joint range of motion, increased gait variability, lack of intra-limb inter-joint and inter-segmental coordination, impaired foot ground placement and loss of trunk control. Taken together, these techniques provide a neurophysiological framework for a better appraisal of cerebellar disorders.

Unilaterally Applied Resistance to Swing Leg Shows a Different Adaptation Pattern Compared to Split-Belt Treadmill in Patients with Stroke

Persons with chronic stroke (PwCS) have a decreased ability to ambulate and walk independently. We aimed to investigate the differences between the motor adaptation process for two different perturbation methods: split-belt treadmill walking and unilaterally applied resistance to the swing leg during walking. Twenty-two PwCS undergo split-belt treadmill walking and unilaterally applied resistance to the swing leg during walking, each one week apart. The test included three phases: the baseline period, the early-adaptation period and the late-adaptation period, as well as the early-de-adaptation period and the late-de-adaptation period. The average step length, swing duration, double-limb support duration, and coefficient of variance (CV) of these parameters were measured. During the split-belt treadmill walking, PwCS showed an adaptation of double-limb support duration symmetry (p = 0.004), specifically a trend between baseline versus early-adaptation (p = 0.07) and an after-effect (late-adaptation compare to early-de-adaptation, p = 0.09). In unilaterally applied resistance to the swing leg during walking, PwCS showed lower swing phase duration CV, in the adaptation period (baseline compare to adaptation, p = 0.006), and a trend toward increased variability of gait in the de-adaptation period compare to the adaptation periods (p = 0.099). The rate of adaptation and de-adaptation were alike between the two perturbation methods. Our findings show that the learning process happening in the central nervous system of PwCS may be dependent on the nature of the perturbation (mechanical resistance vs. split-belt) and that PwCS are able to adapt to two types of errors.

Using robot-assisted stiffness perturbations to evoke aftereffects useful to post-stroke gait rehabilitation

Stroke is a major global issue, affecting millions every year. When a stroke occurs, survivors are often left with physical disabilities or difficulties, frequently marked by abnormal gait. Post-stroke gait normally presents as one of or a combination of unilaterally shortened step length, decreased dorsiflexion during swing phase, and decreased walking speed. These factors lead to an increased chance of falling and an overall decrease in quality of life due to a reduced ability to locomote quickly and safely under one's own power. Many current rehabilitation techniques fail to show lasting results that suggest the potential for producing permanent changes. As technology has advanced, robot-assisted rehabilitation appears to have a distinct advantage, as the precision and repeatability of such an intervention are not matched by conventional human-administered therapy. The possible role in gait rehabilitation of the Variable Stiffness Treadmill (VST), a unique, robotic treadmill, is further investigated in this paper. The VST is a split-belt treadmill that can reduce the vertical stiffness of one of the belts, while the other belt remains rigid. In this work, we show that the repeated unilateral stiffness perturbations created by this device elicit an aftereffect of increased step length that is seen for over 575 gait cycles with healthy subjects after a single 10-min intervention. These long aftereffects are currently unmatched in the literature according to our knowledge. This step length increase is accompanied by kinematics and muscle activity aftereffects that help explain functional changes and have their own independent value when considering the characteristics of post-stroke gait. These results suggest that repeated unilateral stiffness perturbations could possibly be a useful form of post-stroke gait rehabilitation.

Instantaneous effect of real-time avatar visual feedback on interlimb coordination during walking post-stroke

BACKGROUND

Gait asymmetry, which is common after stroke, is typically characterized using spatiotemporal parameters of gait that do not consider the aspect of movement coordination. In this manuscript, we examined whether an avatar-based feedback provided as a single-session intervention to improve gait symmetry also improved inter-limb coordination among people with stroke and we examined the relationship between changes in coordination and step length symmetry.

METHODS

Twelve stroke participants walked on a self-paced treadmill with and without a self-avatar that replicated their locomotor movements in real time. Continuous relative phase and angular coefficient of correspondence calculated using bilateral sagittal hip movements were used to quantify temporal and spatial interlimb coordination, respectively. Spatial gait symmetry, previously shown to improve with the avatar feedback, was quantified using step length ratio between both limbs, with the largest value as numerator.

FINDINGS

Participants who improved their spatial symmetry during avatar exposure also improved their temporal coordination, while spatial coordination remained unchanged. Overall, improvements in spatial symmetry correlated positively with improvements in temporal coordination. The non-paretic hip and paretic ankle angle excursion in the sagittal plane also significantly increased during avatar exposure.

INTERPRETATION

Improvements in gait symmetry may be explained by changes in interlimb coordination. Current data and existing literature further suggest that such improvements are largely driven by adaptations in non-paretic leg movements, notably at the hip. By providing real-time information on walking movements not affordable in other ways, avatar-based feedback shows great potential to improve gait symmetry and interlimb coordination post-stroke.

Impact of Constraint-Induced Movement Therapy (CIMT) on Functional Ambulation in Stroke Patients-A Systematic Review and Meta-Analysis

Constraint-induced movement therapy (CIMT) has been delivered in the stroke population to improve lower-extremity functions. However, its efficacy on prime components of functional ambulation, such as gait speed, balance, and cardiovascular outcomes, is ambiguous. The present review aims to delineate the effect of various lower-extremity CIMT (LECIMT) protocols on gait speed, balance, and cardiovascular outcomes. Material and methods: The databases used to collect relevant articles were EBSCO, PubMed, PEDro, Science Direct, Scopus, MEDLINE, CINAHL, and Web of Science. For this analysis, clinical trials involving stroke populations in different stages of recovery, >18 years old, and treated with LECIMT were considered. Only ten studies were included in this review, as they fulfilled the inclusion criteria. The effect of CIMT on gait speed and balance outcomes was accomplished using a random or fixed-effect model. CIMT, when compared to controlled interventions, showed superior or similar effects. The effect of LECIMT on gait speed and balance were non-significant, with mean differences (SMDs) of 0.13 and 4.94 and at 95% confidence intervals (Cis) of (-0.18-0.44) and (-2.48-12.37), respectively. In this meta-analysis, we observed that despite the fact that several trials claimed the efficacy of LECIMT in improving lower-extremity functions, gait speed and balance did not demonstrate a significant effect size favoring LECIMT. Therefore, CIMT treatment protocols should consider the patient's functional requirements, cardinal principles of CIMT, and cardiorespiratory parameters.

Accurate Real-time Phase Estimation for Normal and Asymmetric Gait

An accurate real-time gait phase estimator for normal and asymmetric gait is developed by training and testing a time-delay neural network on gait data collected from six participants during treadmill walking. The trained model can generate smooth and highly accurate predictions of the gait phase with a root mean square error of less than 3.48% and 4.31% in normal and asymmetric gait, respectively. The coefficient of determination between the estimated and target phase is greater than 99% for all subjects with both normal and asymmetric gait. The proposed gait estimator also exhibits precise heel-strike event detection with an RMSE of 2.56% and 3.70% in normal and asymmetric gait, respectively. A spatial impedance controller is then employed and tested based on the estimated gait phase of a new participant. Obtained results confirm that the controller provided assistance in coordination with the user's motion both in normal and asymmetric gait conditions. The estimated gait phase is compared in the case of walking without and with the exoskeleton in passive and active modes, indicating persistent accuracy of the gait phase estimator regardless of the walking conditions.

Effects of Subtalar Joint Mobilization with Movement on Muscle Strength, Balance, Functional Performance, and Gait Parameters in Patients with Chronic Stroke: A Single-Blind Randomized Controlled Study

BACKGROUND

Losses in muscle strength, balance, and gait are common in patients with chronic stroke (CS). Ankle joint movements play a key role in this population to maintain a sufficient level of functional activity. The aim of this study was to investigate the effects of the subtalar joint (STJ) mobilization with movement (MWM) technique on muscle strength, balance, functional performance, and gait speed (GS) in patients with CS.

METHODS

Twenty-eight patients with CS were randomly divided into the control group (n = 14) and the STJ MWM group (n = 14). A 30-min neurodevelopmental treatment program and talocrural joint MWM were applied to both groups. Also, STJ MWM was applied to the STJ MWM group. The patients were treated 3 days a week for 4 weeks. Ankle dorsiflexion and plantarflexion muscle strength, Berg Balance Scale, Timed Up and Go test, and GS were evaluated before and after treatment.

RESULTS

Berg Balance Scale and Timed Up and Go test scores, dorsiflexion and plantarflexion muscle strength, and GS improved in both groups after the treatment sessions (P < .05), but the improvements were greater in the STJ MWM group compared with the control group (P < .05).

CONCLUSIONS

According to these results, STJ MWM together with neurodevelopmental treatment and talocrural joint MWM can increase ankle muscle strength, balance, functional performance, and GS on the affected leg in patients with CS.

Baduanjin exercise ameliorates motor function in patients with post-stroke cognitive impairment: A randomized controlled trial

BACKGROUND AND PURPOSE

As a traditional Chinese mind-body exercise, Baduanjin has been documented to have a positive effect on cognitive and physical function in a wide range of populations, but it is unclear whether it helps improve motor function in patients with post-stroke cognitive impairment (PSCI). The aim of this two-arm, randomized, parallel controlled study was to explore the rehabilitation effect of Baduanjin exercise on motor function in patients with PSCI.

MATERIALS AND METHODS

Forty-eight patients with PSCI were randomly assigned to control and intervention groups. The control group received health education sessions on stroke prevention and rehabilitation. The intervention group received Baduanjin training in addition to the health education intervention. Before and after the 24-week intervention, both groups completed the Fugl-Meyer Assessment (FMA), Berg Balance Scale (BBS), Manual Muscle Test (MMT), Modified Ashworth Scale (MAS), and Three-Dimensional Gait Analysis (3DGA).

RESULTS

After the 24-week intervention, both groups showed significant improvements in the FMA, BBS, MMT and MAS test results, but the Baduanjin group exhibited significantly better FMA, BBS and MMT test results than the control group (all P < 0.05). Furthermore, the Baduanjin exercise group showed significant improvements in spatial gait parameters, including the step length, walking speed and cadence, which were significantly better than the control group (all P < 0.05). No adverse events were reported during the study period.

CONCLUSION

The 24-week Baduanjin exercise training may improve the limb motor function, balance, muscle strength and gait function of individuals with PSCI.

Estimation of Walking Speed and Its Spatiotemporal Determinants Using a Single Inertial Sensor Worn on the Thigh: From Healthy to Hemiparetic Walking

We present the use of a single inertial measurement unit (IMU) worn on the thigh to produce stride-by-stride estimates of walking speed and its spatiotemporal determinants (i.e., stride time and stride length). Ten healthy and eight post-stroke individuals completed a 6-min walk test with an 18-camera motion capture system used for ground truth measurements. Subject-specific estimation models were trained to estimate walking speed using the polar radius extracted from phase portraits produced from the IMU-measured thigh angular position and velocity. Consecutive flexion peaks in the thigh angular position data were used to define each stride and compute stride times. Stride-by-stride estimates of walking speed and stride time were then used to compute stride length. In both the healthy and post-stroke cohorts, low error and high consistency were observed for the IMU estimates of walking speed (MAE < 0.035 m/s; ICC > 0.98), stride time (MAE < 30 ms; ICC > 0.97), and stride length (MAE < 0.037 m; ICC > 0.96). This study advances the use of a single wearable sensor to accurately estimate walking speed and its spatiotemporal determinants during both healthy and hemiparetic walking.

Centre of pressure modulations in double support effectively counteract anteroposterior perturbations during gait

Centre of mass (CoM) motion during human balance recovery is largely influenced by the ground reaction force (GRF) and the centre of pressure (CoP). During gait, foot placement creates a region of possible CoP locations in the following double support (DS). This study aims to increase insight into how humans modulate the CoP during DS, and which CoP modulations are theoretically possible to maintain balance in the sagittal plane. Three variables sufficient to describe the shape, length and duration of the DS CoP trajectory of the total GRF, were assessed in perturbed human walking. To counteract the forward perturbations, braking was required and all CoP variables showed modulations correlated to the observed change in CoM velocity over the DS phase. These correlations were absent after backward perturbations, when only little propulsion was needed to counteract the perturbation. Using a linearized inverted pendulum model we could explore how the observed parameter modulations are effective in controlling the CoM. The distance the CoP travels forward and the instant the leading leg was loaded largely affected the CoM velocity, while the duration mainly affected the CoM position. The simulations also showed that various combinations of CoP parameters can reach a desired CoM position and velocity at the end of DS, and that even a full recovery in the sagittal plane within DS would theoretically have been possible. However, the human subjects did not exploit the therefore required CoP modulations. Overall, modulating the CoP trajectory in DS does effectively contributes to balance recovery.

Evaluating the Accuracy of Virtual Reality Trackers for Computing Spatiotemporal Gait Parameters

Ageing, disease, and injuries result in movement defects that affect daily life. Gait analysis is a vital tool for understanding and evaluating these movement dysfunctions. In recent years, the use of virtual reality (VR) to observe motion and offer augmented clinical care has increased. Although VR-based methodologies have shown benefits in improving gait functions, their validity against more traditional methods (e.g., cameras or instrumented walkways) is yet to be established. In this work, we propose a procedure aimed at testing the accuracy and viability of a VIVE Virtual Reality system for gait analysis. Seven young healthy subjects were asked to walk along an instrumented walkway while wearing VR trackers. Heel strike (HS) and toe off (TO) events were assessed using the VIVE system and the instrumented walkway, along with stride length (SL), stride time (ST), stride width (SW), stride velocity (SV), and stance/swing percentage (STC, SWC%). Results from the VR were compared with the instrumented walkway in terms of detection offset for time events and root mean square error (RMSE) for gait features. An absolute offset between VR- and walkway-based data of (15.3 ± 12.8) ms for HS, (17.6 ± 14.8) ms for TOs and an RMSE of 2.6 cm for SW, 2.0 cm for SL, 17.4 ms for ST, 2.2 m/s for SV, and 2.1% for stance and swing percentage were obtained. Our findings show VR-based systems can accurately monitor gait while also offering new perspectives for VR augmented analysis.

Exploring the predictive value of lesion topology on motor function outcomes in a porcine ischemic stroke model

Harnessing the maximum diagnostic potential of magnetic resonance imaging (MRI) by including stroke lesion location in relation to specific structures that are associated with particular functions will likely increase the potential to predict functional deficit type, severity, and recovery in stroke patients. This exploratory study aims to identify key structures lesioned by a middle cerebral artery occlusion (MCAO) that impact stroke recovery and to strengthen the predictive capacity of neuroimaging techniques that characterize stroke outcomes in a translational porcine model. Clinically relevant MRI measures showed significant lesion volumes, midline shifts, and decreased white matter integrity post-MCAO. Using a pig brain atlas, damaged brain structures included the insular cortex, somatosensory cortices, temporal gyri, claustrum, and visual cortices, among others. MCAO resulted in severely impaired spatiotemporal gait parameters, decreased voluntary movement in open field testing, and higher modified Rankin Scale scores at acute timepoints. Pearson correlation analyses at acute timepoints between standard MRI metrics (e.g., lesion volume) and functional outcomes displayed moderate R values to functional gait outcomes. Moreover, Pearson correlation analyses showed higher R values between functional gait deficits and increased lesioning of structures associated with motor function, such as the putamen, globus pallidus, and primary somatosensory cortex. This correlation analysis approach helped identify neuroanatomical structures predictive of stroke outcomes and may lead to the translation of this topological analysis approach from preclinical stroke assessment to a clinical biomarker.

Functional Electrical Stimulation for Foot Drop in Post-Stroke People: Quantitative Effects on Step-to-Step Symmetry of Gait Using a Wearable Inertial Sensor

The main purpose of the present study was to assess the effects of foot drop stimulators (FDS) in individuals with stroke by means of spatio-temporal and step-to-step symmetry, harmonic ratio (HR), parameters obtained from trunk accelerations acquired using a wearable inertial sensor. Thirty-two patients (age: 56.84 ± 9.10 years; 68.8% male) underwent an instrumental gait analysis, performed using a wearable inertial sensor before and a day after the 10-session treatment (PRE and POST sessions). The treatment consisted of 10 sessions of 20 min of walking on a treadmill while using the FDS device. The spatio-temporal parameters and the HR in the anteroposterior (AP), vertical (V), and mediolateral (ML) directions were computed from trunk acceleration data. The results showed that time had a significant effect on the spatio-temporal parameters; in particular, a significant increase in gait speed was detected. Regarding the HRs, the HR in the ML direction was found to have significantly increased (+20%), while those in the AP and V directions decreased (approximately 13%). Even if further studies are necessary, from these results, the HR seems to provide additional information on gait patterns with respect to the traditional spatio-temporal parameters, advancing the assessment of the effects of FDS devices in stroke patients.

Effects of different acupuncture methods combined with routine rehabilitation on gait of stroke patients

BACKGROUND

Stroke refers to a group of cerebrovascular diseases associated with organic brain injury. It is characterized by the sudden and rapid onset of focal or diffuse dysfunction. In recent years, in addition to routine treatment, Chinese medicine acupuncture has been administered to patients with hemiplegia, and it can be considered a new treatment for rehabilitation.

AIM

To investigate the effects of eye acupuncture needle retention and body acupuncture combined with routine rehabilitation on gait performance and plantar pressure in patients recovering from stroke.

METHODS

Thirty-two stroke patients who met the inclusion criteria were randomly divided into an experimental group and a control group, with 16 patients in each group. Both groups underwent routine rehabilitation. The experimental group was treated by eye acupuncture needle retention, and the control group was treated by body acupuncture. Before and after 4 wk of treatment, both groups underwent kinematic and plantar pressure synchronous tests to assess gait performance.

RESULTS

The step length, gait speed, step frequency, joint angles of the lower limbs, and ground reaction force impulse in the anterior region of the affected foot in both groups significantly increased from before to after treatment (P < 0.05); the center of mass displacement, peak pressure values, and impulse in the anterior region of the healthy foot and posterior regions of both the affected and healthy feet significantly decreased from before to after treatment (P < 0.05). The patients in the experimental group showed greater improvement in the following parameters than the control group: Step length, gait speed, step frequency, lower extremity joint angles, center of gravity displacement, and peak pressure values and impulse in the anterior and posterior regions of both the affected and healthy feet (P < 0.05).

CONCLUSION

Eye acupuncture needle retention and body acupuncture combined with routine rehabilitation can effectively improve the gait performance of patients recovering from stroke. Between these two treatments, eye acupuncture needle retention combined with routine treatment is better than body acupuncture, and it can be considered a practical and effective clinical treatment.

Repetitive Transcranial Magnetic Stimulation With H-Coil Coupled With Cycling for Improving Lower Limb Motor Function After Stroke: An Exploratory Study

BACKGROUND/OBJECTIVES

Repetitive transcranial magnetic stimulation (rTMS) has been recognized as a promising intervention for the treatment of post-stroke motor deficits. Here, we explore safety, feasibility, and potential effectiveness of high-frequency rTMS (HF-rTMS) delivered with the Hesed coil (H-coil) during active cycling on paretic lower extremity (LE) motor function in chronic stroke.

MATERIALS AND METHODS

Twelve subjects with a first-ever stroke were recruited in this double-blind, placebo controlled, crossover study. Eleven sessions of HF-rTMS (40 2s-trains of 20 Hz at 90% resting leg motor threshold) were delivered over the LE motor areas using the H-coil during active cycling for three weeks. Each subject underwent both real and sham rTMS treatments separated by a four-week washout period, in a random sequence. Vital signs were recorded before and after each rTMS session. Any discomfort related to stimulation and side effects were recorded. LE function was also evaluated with Fugl-Meyer assessment (FMA-LE), spasticity was assessed with modified-Ashworth scale and measures of gait speed and endurance (10-meter and 6-min walk tests, respectively) were recorded.

RESULTS

No participant reported serious adverse effects. During real rTMS, 4 of 12 subjects reported mild side effects including transitory dizziness and muscle twitches on shoulder, so that intensity of stimulation initially set at 90% of RMT was reduced to 80% of RMT on average in these four subjects. Only real treatment was associated with a significant and sustained improvement in FMA-LL (67% responders vs. 9% of the sham). Spasticity significantly ameliorated only after the real rTMS. Real treatment did not offer advantages on walking timed measures when compared with sham.

CONCLUSIONS

This exploratory study suggests that bilateral HF-rTMS combined with cycling is safe and potentially effective in ameliorating paretic LE motor function and spasticity, rather than gait speed or endurance, in chronic stroke.

Effects of joint mobilization and stretching on the range of motion for ankle joint and spatiotemporal gait variables in stroke patients

BACKGROUND AND PURPOSE

Stroke patients have limited ranges of motion and gait disturbances due to neurological deficits and connective tissue changes. We assessed the effects of joint mobilization and active stretching on ankle joint range of motion and gait in stroke patients.

METHODS

In total, 45 stroke patients were evenly divided into three groups: joint mobilization, active stretching, and combination (joint mobilization and active stretching) groups. Patients in each group received the corresponding interventions in a non-simultaneous manner for 6 weeks in total (3 days per week, 15 min per day). The range of motion of the ankle joint was measured using a goniometer, and spatiotemporal gait variables were measured using G-walk. All measurements were taken immediately before and after the 6-week intervention.

RESULTS

The joint mobilization group exhibited significantly increased range of motion for ankle joint after the intervention (p < 0.05), while the spatiotemporal gait variables were unchanged. In the active stretching group, both the range of motion of the ankle joint in the supine position and the spatiotemporal gait variables (cadence, speed, stride length) were significantly increased (p < 0.05). In the combination group, both the range of motion of the ankle joint and spatiotemporal gait variables (cadence, speed, stride length) were significantly increased (p < 0.05).

CONCLUSION

Combination therapy of joint mobilization and active stretching improves the range of motion of the ankle joint and spatiotemporal gait variables in stroke patients, suggesting that ankle rehabilitation of stroke patients should include limited joint structure and muscles shortness.

Real-Time Avatar-Based Feedback to Enhance the Symmetry of Spatiotemporal Parameters After Stroke: Instantaneous Effects of Different Avatar Views

Gait asymmetry, one of the hallmarks of post stroke locomotion, often persists despite gait rehabilitation interventions, impacting negatively on functional mobility. Real-time feedback and biological cues have been studied extensively in recent years, but their applicability to post-stroke gait symmetry remain questionable. This proof-of-concept study examined the feasibility and instantaneous effects of real-time visual feedback provided in the form of an avatar in twelve participants with stroke on gait symmetry and other gait-related outcomes. The visual avatar was presented via three different views from the back, front and paretic side. Avatar feedback from the paretic side view showed significant increase in bilateral step length, paretic swing time and treadmill walking speed, but no significant differences were found in symmetry measures in any of the three views. Those who had changes in symmetry ratio >0 were grouped as responders to spatial symmetry improvement in the side view. The responders had a significantly higher Chedoke-McMaster Stroke Assessment foot score and presented with a larger initial step length on the paretic side. Furthermore, all participants provided positive feedback and no adverse effects were observed during the experiment. Overall, these findings suggest that real-time avatar-based feedback can be used as an intervention to improve post-stroke gait asymmetry.

Difference in gait recovery rate of hemiparetic stroke patients according to paralyzed side: A cross-sectional study based on a retrospective chart review

In Donguibogam, a representative encyclopedic source of knowledge on traditional Korean medicine, left-sided hemiparesis due to stroke is called "Tan" as a sort of "Heyol-Byeong," while right-sided hemiparesis due to stroke is called "Tan" as a sort of "Gi-Byeong." According to the theory of Donguibogam, diseases on the left or right side of the human body must be treated differently. Clinically, the symptoms caused by left and right hemisphere lesions in stroke patients differ, as the functions of the left and right hemispheres differ. Considering these facts, when treating patients in clinical practice, it may be useful to distinguish between diseases on the left or right side according to Donguibogam. This study set out to confirm whether side-dependent gait rehabilitation could be used to treat hemiparetic stroke patients. Gait was selected for analysis, as it is the most important factor in returning stroke patients to daily life.This study conducted a retrospective chart review of stroke patients who satisfied the following criteria: outpatient or inpatient at the Wonkwang University Korean Medicine Hospital in Gwangju (WKUGH) with hemiparesis due to stroke; aged between 19 and 85 years old; with a stroke onset within the past 6 months; having undergone gait analysis (GAITRite) more than twice between September 1, 2017 and June 30, 2018 at the WKUGH, with a minimum 2-week interval between the first and next gait analysis; right-handed stroke patient; able to walk unaided. The spatio-temporal parameters for analysis included the FAP, walking velocity, step length, stance time, and swing time as obtained with GAITRite.In the initial gait analysis, there was no significant difference between the 2 groups in all spatio-temporal parameters. However, in the follow-up gait analysis, the left hemiparesis group showed a significantly higher FAP and faster walking velocity than the right hemiparesis group.This study found a difference in the recovery rate between the left and right hemiparesis groups. Based on this, we suggest that a different treatment strategy for gait rehabilitation can be used according to the paralyzed side.This study was approved by the Institutional Review Board (IRB) of the Wonkwang University Korean Medicine Hospital in Gwangju (WKUGH), Republic of Korea (WKIRB 2018 - 25, November 28, 2018). This trial was registered with the Clinical Research Information Service (CRIS) of the Korea National Institute of Health (NIH), Republic of Korea (KCT0002984).

Immediate effects of ankle eversion taping on gait ability of chronic stroke patients

OBJECTIVES

The purpose of this study is to assess the immediate effects of applying ankle eversion taping using kinesiology tape in patients with foot drop after stroke.

DESIGN

Randomized cross-over trial.

METHOD

In this study, fifteen subjects with stroke underwent three interventions in a random order. Subjects were randomly initially assigned to an ankle balance taping, placebo taping, and no taping each group. The ankle eversion taping was used for mechanical correction. Ankle eversion taping is involved in ankle dorsiflexion and eversion. The placebo taping began from both malleolus and was applied up to the middle point of the lower limb. Gait ability was assessed by the GAITRite System. The measured gait variables are gait velocity, step length, stride length, H-H base support, and cadence. All of the measurements were performed immediately after intervention.

RESULTS

Our results showed gait function in chronic stroke patients was improved after ankle eversion taping. Velocity, step length, stride length and cadence under the ankle eversion taping conditions significantly increased (p < 0.05) compared to the placebo and no taping conditions. Ankle eversion taping significantly reduced (p < 0.05) H-H base support compared to the no taping condition.

CONCLUSIONS

We conclude that the application of ankle eversion taping that uses kinesiology tape instantly increased the gait ability of chronic stroke patients with foot drop. However, more research is necessary to identify the long-term effects of the ankle eversion taping.

The effects of functional action-observation training on gait function in patients with post-stroke hemiparesis: A randomized controlled trial

BACKGROUND

Functional action observation (FAO) is likely to activate the corticospinal tract and is likely to increase the potential ability of a functional task.

OBJECTIVE

The purpose of this study was to investigate the effects of FAO training on gait ability in patients with post-stroke hemiparesis.

METHODS

Thirty-five patients with hemiparesis caused by stroke participated in this study. All subjects had suffered from stroke for more than 6 months. Subjects received either a FAO or a general action observation (GAO) training for 30 minutes each time, five times per week, for four weeks. The GAITRite was used to measure walking velocities and spatio-temporal variables. The functional gait assessment (FGA) was used to assess gait ability. The independent t-test was used to analyze whether there were significant differences of all dependent variables between groups.

RESULTS

After four weeks of training, the step length, stride length, cadence, velocity, and FGA score in FAO group were statistically different from GAO group (p< 0.05).

CONCLUSION

The results of this study suggest that FAO is an effective and easy method for improvement of gait ability in chronic stroke patients.

Gait Impairments in Patients Without Lower Limb Hypertonia Early Poststroke Are Related to Weakness of Paretic Knee Flexors

OBJECTIVE

To describe gait characteristics of patients without clinical evidence of lower limb hypertonia within 2 months of stroke and explore the relationship between gait and residual motor function.

DESIGN

Cohort study.

SETTING

Motion analysis laboratory in a tertiary-care free-standing rehabilitation hospital.

PARTICIPANTS

Consecutive sample of 73 eligible inpatients (first-known stroke <2 months postonset, walking independently, modified Ashworth score of 0 in the paretic lower limb) and 27 healthy controls (N=100).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Gait speed, stride and step lengths and cadences, stance time, single-support and double-support times, and associated symmetry measures in patients at self-selected normal speed and controls at very slow speed (51.1±32.6 cm/s and 61.9±21.8 cm/s, respectively, P=.115); Fugl-Meyer lower extremity motor score (FM-LE) and isometric knee flexion and extension strength in patients.

RESULTS

Except the stride/step cadence, all temporospatial parameters significantly differed between the stroke and control participants. Furthermore, significantly greater asymmetries were found in the patients for the overall stance time, initial double-support and single-support times, and step cadence, reflecting smaller values in the paretic than nonparetic limb. Most temporospatial parameters moderately to strongly correlated with the gait speed (|r|: .72-.94, P<.0001), FM-LE (|r|: .42-.62, P≤.0005), and paretic knee flexor strength (|r|: .47-.57, P≤.0004).

CONCLUSIONS

Gait of patients without clinical evidence of lower limb hypertonia within 2 months of stroke is characterized by many temporospatial deviations and asymmetries. The self-selected normal gait speed, FM-LE, and paretic knee flexor strength can discriminate gait impairments in these patients shortly before inpatient discharge. It remains to be determined whether the observed relationships between paretic knee flexor strength and gait measures warrant the development of interventions for strengthening of the paretic knee flexors in order to improve gait early poststroke.

Study on the design development of a multi joint ankle foot orthosis

[Purpose] The purpose of this study was to investigate the effects of a newly designed multi joint ankle-foot orthosis on the gait and dynamic balance of stroke patients having foot drop. [Participants and Methods] This study was investigated 10 participants who were diagnosed with stroke. Patients were evaluated based on a 10-meter walk test, timed up and go test and Berg balance scale after each participant wore a plastic ankle-foot orthosis and a multi joint ankle-foot orthosis (AFO) that consisted of orthosis joints (having poster-stop joint and Klenzak joint functions). [Results] The 10-meter walk test, timed up and go test and Berg balance scale showed significant differences in the orthosis with the Klenzak joint function. [Conclusion] The appropriate use of Klenzak AFO of the newly designed multi joint AFO is expected to have a positive effect on improving the gait and balancing ability of stroke patients having foot drop.

Comparison of recovery patterns of gait patterns according to the paralyzed side in Korean stroke patients: Protocol for a retrospective chart review

INTRODUCTION

In Traditional Korean Medicine (TKM), diseases on the left or right side of the human body have been treated differently according to the theory of Donguibogam, which is an encyclopedic source for TKM. In the Wind chapter of Donguibogam, left hemiparesis due to stroke is called Tan, a sort of Hyeol-Byeong, and right hemiparesis due to stroke is called Tan, a sort of Gi-Byeong. As neuroscience develops, it has been shown that the functions of the left and right hemispheres differ, as do the symptoms caused by differently located lesions in the brain. In light of these recent findings and the theory of Donguibogam, it may be useful when treating patients in clinical practice to consider the side of the human body on which symptoms appear. The aim here is to establish whether side-dependent treatments are more effective in treating patients with symptoms on different sides of the body. Specifically, this exploratory study investigates changes in gait pattern among stroke patients with hemiparesis or hemiplegia during gait recovery.

METHODS

To develop this protocol, a retrospective review of charts will be used to assess differences in gait recovery patterns among stroke patients with left or right hemiparesis, using gait analysis systems that include GAITRite, G-walk, and Treadmill. The data will be selected from gait analysis performed more than twice in the period from September 1, 2017 to June 31, 2018 at Wonkwang University Gwangju Hospital (WKUGH).

RESULTS

The primary outcomes include spatiotemporal parameters obtained using GAITRite (FAP, velocity, step length, swing time, and stance time); symmetric parameters obtained using G-walk (tilt, obliquity, and pelvis rotation symmetry); and center of pressure (COP) area and velocity as measured by Treadmill.

DISCUSSION

This will be the first study to analyze the gait recovery pattern of stroke patients according to the paralyzed side by comparing spatiotemporal, symmetric, and COP parameters using gait analysis systems. Like all retrospective studies, the present research was subject to certain limitations related to bias (selection bias, recall bias, misclassification bias, confounding value bias), difficulty in assessing temporal relationships, and small sample size. However, these limitations were of less significance here because gait parameters and body side of symptoms of hemiplegia or hemiparesis are relatively clear.

CONCLUSION

If the use of gait analysis systems (GAITRite, G-walk, and Treadmill) confirms differences in gait recovery pattern among stroke patients according to the paralyzed side, the findings will provide essential evidence for differential treatment of stroke patients on that basis.

Longitudinal Walking Analysis in Hemiparetic Patients Using Wearable Motion Sensors: Is There Convergence Between Body Sides?

Background: Longitudinal movement parameter analysis of hemiparetic patients over several months could reveal potential recovery trends and help clinicians adapting therapy strategies to maximize recovery outcome. Wearable sensors offer potential for day-long movement recordings in realistic rehabilitation settings including activities of daily living, e.g., walking. The measurement of walking-related movement parameters of affected and non-affected body sides are of interest to determine mobility and investigate recovery trends. Methods: By comparing movement of both body sides, recovery trends across the rehabilitation duration were investigated. We derived and validated selected walking segments from free-living, day-long movement by using rules that do not require data-based training or data annotations. Automatic stride segmentation using peak detection was applied to walking segments. Movement parameters during walking were extracted, including stride count, stride duration, cadence, and sway. Finally, linear regression models over each movement parameter were derived to forecast the moment of convergence between body sides. Convergence points were expressed as duration and investigated in a patient observation study. Results: Convergence was analyzed in walking-related movement parameters in an outpatient study including totally 102 full-day recordings of inertial movement data from 11 hemiparetic patients. The recordings were performed over several months in a day-care centre. Validation of the walking extraction method from sensor data yielded sensitivities up to 80 % and specificity above 94 % on average. Comparison of automatically and manually derived movement parameters showed average relative errors below 6 % between affected and non-affected body sides. Movement parameter variability within and across patients was observed and confirmed by case reports, reflecting individual patient behavior. Conclusion: Convergence points were proposed as intuitive metric, which could facilitate training personalization for patients according to their individual needs. Our continuous movement parameter extraction and analysis, was feasible for realistic, day-long recordings without annotations. Visualizations of movement parameter trends and convergence points indicated that individual habits and patient therapies were reflected in walking and mobility. Context information of clinical case reports supported trend and convergence interpretation. Inconsistent convergence point estimation suggested individually varying deficiencies. Long-term recovery monitoring using convergence points could support patient-specific training strategies in future remote rehabilitation.

The immediate effect of FES and TENS on gait parameters in patients after stroke

[Purpose] This study was conducted to compare the immediate effects of different electrotherapies on the gait parameters for stroke patients. [Subjects and Methods] Thirty patients with stroke were randomly assigned either to the functional electrical stimulation group or the transcutaneous electrical nerve stimulation group, with 15 patients in each group. Each electrotherapy was performed for 30 minutes simultaneously with the therapeutic exercise, and the changes in the spatial and temporal parameters of gait were measured. [Results] After the intervention, a significant, immediate improvement in cadence and speed was observed only in the functional electrical stimulation group. [Conclusion] Based on this study, functional electrical stimulation that stimulates motor nerves of the dorsiflexor muscles on the paretic side is recommended to achieve immediate improvement in the gait ability of stroke patients.

Stimulation of the mesencephalic locomotor region for gait recovery after stroke

OBJECTIVE

One-third of all stroke survivors are unable to walk, even after intensive physiotherapy. Thus, other concepts to restore walking are needed. Because electrical stimulation of the mesencephalic locomotor region (MLR) is known to elicit gait movements, this area might be a promising target for restorative neurostimulation in stroke patients with gait disability. The present study aims to delineate the effect of high-frequency stimulation of the MLR (MLR-HFS) on gait impairment in a rodent stroke model.

METHODS

Male Wistar rats underwent photothrombotic stroke of the right sensorimotor cortex and chronic implantation of a stimulating electrode into the right MLR. Gait was assessed using clinical scoring of the beam-walking test and video-kinematic analysis (CatWalk) at baseline and on days 3 and 4 after experimental stroke with and without MLR-HFS.

RESULTS

Kinematic analysis revealed significant changes in several dynamic and static gait parameters resulting in overall reduced gait velocity. All rats exhibited major coordination deficits during the beam-walking challenge and were unable to cross the beam. Simultaneous to the onset of MLR-HFS, a significantly higher walking speed and improvements in several dynamic gait parameters were detected by the CatWalk system. Rats regained the ability to cross the beam unassisted, showing a reduced number of paw slips and misses.

INTERPRETATION

MLR-HFS can improve disordered locomotor function in a rodent stroke model. It may act by shielding brainstem and spinal locomotor centers from abnormal cortical input after stroke, thus allowing for compensatory and independent action of these circuits. Ann Neurol 2017;82:828-840.

Center of mass with the use of smartphone during walking in healthy individuals

[Purpose] The purpose of this study was to measure the center of mass using a smartphone application during walking in healthy. [Subjects and Methods] Forty eight healthy participants volunteered for this study. Measurements of center of mass were obtained by gait analysis application using smartphone while subjects performed 6 meter walking test. The measured data were automatically calculated by the application, subjects performed three trial walks to get a more accurate data analysis. [Results] There were no significant differences among subjects or between genders during the three trials in the vertical and lateral displacement of COM, and the results of the Kolmogorov-Simirnov test showed no differences in vertical and lateral displacement of COM in all subjects or between genders. However, the vertical displacement of COM significantly varied in male subjects than in female subjects, but the lateral displacement of COM did not significantly differ between the male and female subjects. [Conclusion] We can use the Smartphone application to measure the COM for walking; however more studies comparing advanced technological instruments with the smartphone application are needed.

Changes in Kinetic Parameters of Gait in Patients with Supratentorial Unilateral Stroke in Chronic Period

AIM

The aim of the study is to evaluate the changes of the kinetic parameters of gait in patients with supratentorial unilateral stroke in the chronic period (SUSChP).

MATERIAL AND METHODS

The study was conducted with 67 patients with SUSChP (56 patients included in the experimental group - 32 men and 24 women, with duration of disease 7.8 ± 2.0 months, and 11 patients in the control group - 9 men and 2 women, with duration of disease 7.3 ± 1.5 months). To evaluate the changes in the gait were followed cadence of 6 m and 10 m and the speed of movement which are the most informative kinetic parameters. Patients in the experimental group were treated with a specialised 10-day KT, which later continued to be performed as an adapted exercise program at home for one month.

RESULTS

After applying specialised kinesitherapeutic methodology (SKTM), the highest trend towards improvement in the kinetic parameters of gait was established after the 1st month with a level of significance during treatment p < 0.001.

CONCLUSION

The enclosed SKTM in the experimental group continued later as an adapted exercise program at home, significantly improving the kinetic parameters of gait in patients with SUSChP, compared with the usual kinesi-therapeutic methodology applied in the control group.

Impact of the difference in the plantar flexor strength of the ankle joint in the affected side among hemiplegic patients on the plantar pressure and walking asymmetry

[Purpose] This study was to examine the changes in the gait lines and plantar pressures in static and dynamic circumstances, according to the differences in the strengths of the plantar flexors in the ankle joints on the affected sides of hemiplegic patients, and to determine their impacts on walking symmetry. [Subjects and Methods] A total of thirty hospitalized stroke patients suffering from hemiplegia were selected in this study. The subjects had ankylosing patterns in the ankle joints of the affected sides. Fifteen of the patients had plantar flexor manual muscle testing scores between poor and fair, while fifteen of the patients had zero and trace. [Results] The contact pattern of the plantar surface with the ground is a reliable method for walking analysis, which is an important index for understanding the ankle mechanism and the relationship between the plantar surface and the ground. [Conclusion] The functional improvement of patients with stroke could be supported through a verification of the analysis methods of the therapy strategy and walking pattern.

Wearable tubing assistive walking device immediately enhances gait parameters in subjects with stroke: A randomized controlled study

BACKGROUND

Stroke patients develop compensatory movements due to limitations of ankle dorsiflexion and knee flexion. To solve the limitations, there are many adjustable walking assistive devices such as robotic devices, ankle-foot orthoses, and functional electric stimulation in rehabilitation session. However, these assistive devices have some disadvantages, including expense and discomforts. Therefore, the development of a new assistive device for stroke patients is needed to assist ankle dorsiflexion and knee flexion.

OBJECTIVE

This study investigated the effects of a wearable tubing assistive walking device (WTAWD) on gait parameters (gait speed, cadence, and step length and stride length on affected and less affected sides) in patients with stroke.

METHODS

Gait parameters were measured using the GAITRite system. One-way repeated measures analysis of variance was used to determine gait differences under three conditions (WTAWD, barefoot, and conventional elastic band orthosis).

RESULTS

Gait speed, cadence, and step length and stride length on both affected and less affected sides were significantly greater with WTAWD, compared to barefoot and conventional elastic band orthosis conditions.

CONCLUSION

WTAWD could be effective for patients with stroke.

Um modelo diferente de brace para a reeducação da marcha hemiparética com genu recurvatum: efeitos sobre a distribuição das pressões plantares

RESUMO O modelo de brace desenvolvido consiste em uma joelheira de neoprene que apresenta um balonete inflável posicionado sobre a região poplítea do joelho. Ele proporciona estímulos sobre estruturas articulares, bem como um melhor alinhamento biomecânico durante a fase de apoio da marcha. O objetivo do estudo foi quantificar as alterações e adaptações induzidas pelo treinamento da marcha com a utilização do dispositivo ortótico em pacientes hemiparéticos. Realizou-se um estudo quase-experimental do tipo antes e depois com doze pacientes adultos com hemiparesia decorrente de acidente vascular encefálico. Os picos de pressão plantares foram os marcadores utilizados para comparar os três momentos do estudo: na linha de base, quando estivessem utilizando o brace e após o treinamento da marcha. Depois das sessões de reeducação da marcha com auxílio da órtese, a redistribuição das pressões plantares evidenciou aumento na simetria durante a fase de apoio, principalmente pela diminuição da pressão sobre o antepé parético (p=0,024) e pelo aumento no retropé no lado parético (p=0,010). Além disso, essas alterações foram associadas a uma diminuição da pressão sobre todas as regiões do pé não afetado, especialmente no retropé no momento de pós-treinamento. Os resultados do estudo sugerem uma mudança no padrão de marcha dos participantes depois da utilização do brace. Houve maior simetria dos valores dos picos de pressão plantar quando se comparou o lado afetado com o não afetado. O treino com o brace contribui no processo de reabilitação, uma vez que forneceu valores baropodométricos que se aproximaram ao padrão normal de distribuição plantar.

Study of acceleration of center of mass during sit-to-stand and stand-to-sit in patients with stroke

[Purpose] The purpose of this study was to compare the center of mass during sit-to-stand and stand-to-sit activities in the timed up and go test between healthy subjects and patients with stroke. [Subjects and Methods] Thirty healthy participants and thirty patients with stroke volunteered for this study. Acceleration of the center of mass was measured using a wireless tri-axial accelerometer during sit-to-stand and stand-to-sit activities in the timed up and go test. Accelerometer data were analyzed using BTS G-studio software. [Results] The phase duration was significantly longer and the anterior-posterior, mediolateral, and vertical acceleration ranges were significantly lower during sit-to-stand for patients with stroke than for healthy controls. Further, phase duration and the mediolateral acceleration range during stand-to-sit differed significantly between healthy controls and subjects with stroke. [Conclusions] During training for the sit-to-stand activity, the focus should be all three balance dimensions, but during training for the stand-to-sit activity, the focus should be on improving mediolateral balance and asymmetrical foot positioning should be recommended.

Knee loading patterns of the non-paretic and paretic legs during post-stroke gait

BACKGROUND

Post-stoke gait disorders could cause secondary musculoskeletal complications associated with excessive repetitive loading. The study objectives were to 1) determine the feasibility of measuring common proxies for dynamic medial knee joint loading during gait post-stroke with external knee adduction (KAM) and flexion moments (KFM) and 2) characterize knee loading and typical load-reducing compensations post-stroke.

METHODS

Participants with stroke (n=9) and healthy individuals (n=17) underwent 3D gait analysis. The stroke and healthy groups were compared with unpaired t-tests on peak KAM and peak KFM and on typical medial knee joint load-reducing compensations; toe out and trunk lean. The relationship between KAM and load-reducing compensations in the stroke group were investigated with Spearman correlations.

RESULTS

Mean (SD) values for KAM and KFM in the healthy group[KAM=2.20 (0.88)%BW*ht; KFM=0.64 (0.60)%BW*ht] were not significantly different from the values for the paretic [KAM=2.64 (0.98)%BW*ht; KFM=1.26 (1.13)%BW*ht] or non-paretic leg of the stroke group[KAM=2.23(0.62)%BW*ht; KFM=1.10 (1.20)%BW*ht]. Post hoc one sample t-tests revealed greater loading in stroke participants on the paretic (n=3), non-paretic (n=1) and both legs (n=2) compared to the healthy group. The angle of trunk lean and the angle of toe out were not related to KAM in the stroke group.

DISCUSSION

Measurement of limb loading during a gait post-stroke is feasible and revealed excessive loading in individuals with mild to moderate stroke compared to healthy adults. Further investigation of potential joint degeneration and pain due to repetitive excessive loading associated with post-stroke gait is warranted.

Reliability and minimum detectable change of the gait profile score for post-stroke patients

The objectives of this work were (i) to determine Gait Profile Score (GPS) for hemiparetic stroke patients, (ii) to evaluate its reliability within and between sessions, and (iii) to establish its minimal detectable change (MDC). Seventeen hemiparetic patients (mean age 54.9±10.5years; 9 men and 8 women; 6 hemiparetic on the left side and 11 on the right side; mean time after stroke 6.1±3.5months) participated in 2 gait assessment sessions within an interval of 2-7 days. Intra-session reliability was obtained from the intraclass correlation coefficient (ICC) between the three strides of each session. Inter-session reliability was estimated by the ICC from the averages of that three strides. GPS value of non paretic lower limb (NPLL) (13.9±2.4°) was greater than that of paretic lower limb (PLL) (12.0±2.8°) and overall GPS (GPS_O) was 13.7±2.5°. The Gait Variable Scores (GVS), GPS and GPS_O exhibited intra-session ICC values between 0.70 and 0.99, suggesting high intra-day stability. Most of GVS exhibited excellent inter-session reliability (ICC between 0.81 and 0.93). Only hip rotation, hip abduction of PLL exhibited moderate reliability with ICC/MDC values of 0.57/10.0° and 0.71/3.1°, respectively. ICC/MDC values of GPS were 0.92/2.3° and 0.93/1.9° for PLL and NPLL, respectively. GPS_O exhibited excellent test-retest reliability (ICC=0.95) and MDC of 1.7°. Given its reliability, the GPS has proven to be a suitable tool for therapeutic assessment of hemiparetic patients after stroke.

The effect of external cues with vibratory stimulation on spatiotemporal gait parameters in chronic stroke patients

[Purpose] The aim of current study was to investigate the effect of external cues using vibratory stimulation on spatiotemporal gait parameters in patients with chronic stroke. [Subjects] Thirty patients, who had suffered a stroke, were selected from general hospitals in Seoul, Republic of Korea. [Methods] Each participant was subjected to six walking trials: three trials with vibratory stimulation of the tibialis anterior muscle and three trials without any stimulation. The spatiotemporal gait parameters were measured with a GAITRite system. [Results] The global gait parameters—velocity and cadence—were significantly more increased, and the temporal parameters—step time, stride time, and double limb support—were significantly more decreased with vibratory stimulation of the tibialis anterior muscle than with no stimulation. While single limb support was increased under vibratory stimulation, the difference was not significant between the two groups. The spatial gait parameter—stride length—showed a significant improvement; however, there was no significant enhancement in gait symmetry with regard to step length and step time [Conclusion] These results indicate that the application of external cues using vibratory stimulation during gait may control gait parameters and improve gait performance. Thus, this intervention could be used for gait rehabilitation in chronic stroke patients.

Effect of the class and individual applications of task-oriented circuit training on gait ability in patients with chronic stroke

[Purpose] This study aimed to determine differences in gait abilities by comparing class-based task-oriented circuit training (CTCT) and individual-based task-oriented circuit training (ITCT). [Subjects and Methods] The subjects were 30 patients who were diagnosed with hemiplegia due to stroke more than six months previously. They were divided into Group I (n=10), which received conventional physiotherapy, Group II (n=10), which received conventional physiotherapy and ITCT, and Group III (n=10), which received conventional physiotherapy and CTCT. To determine the qualitative aspect of gait ability, a GAITRite (CIR Systems Inc., Sparta NJ, USA) was employed, while a two-minute walking test (2MWT) was conducted to determine the quantitative aspect. [Results] The gait ability showed significant differences in velocity, cadence, and 2MWT between groups in the significance test. As a result, the Bonferroni post test showed that gait velocity was significantly different between Groups I and II and between Groups I and III, while cadence showed a significant difference between Groups I and III. In the 2MWT, Groups I and II and Groups I and III also showed significant differences. [Conclusion] Both the individual and class applications task-oriented circuit training were effective for improving gait ability. This result indicates that CTCT can improve the physical ability of stroke patients as much as ITCT.

Locomotor Treadmill Training with Body-Weight Support Prior to Over-Ground Gait: Promoting Symmetrical Gait in a Subject with Acute Stroke

BACKGROUND AND PURPOSE

An asymmetrical gait pattern is frequently observed in persons recovering from stroke. Locomotor training with partial body-weight support (BWS) has been demonstrated to be effective for restoring ambulation abilities in persons poststroke. However, the optimal treatment parameters for this intervention have not been defined. The purpose of this case study was to report outcomes for a person in the acute period poststroke who experienced locomotor treadmill training with BWS prior to walking over ground.

METHOD

The subject of this report was a 60-year-old male with a large right-sided infarct extending into the basal ganglia. Locomotor training with BWS began on day 10 following the infarct. The subject had five sessions, totaling 40 minutes of walking practice, prior to starting gait training over ground.

RESULTS

The subject walked with a single-point cane (contact guard to standby assistance) for a total of 1,000 feet at a speed of 0.94 m/s (185 ft/min) when discharged on day 25 of rehabilitation. He demonstrated comparable stance time and step length bilaterally.

DISCUSSION/CONCLUSION

The subject of this case report experienced a good outcome using a combination of early locomotor treadmill training and traditional therapeutic activities. Further investigation of early treadmill training may be warranted in subjects with acute stroke.

Effect of Task Specific Exercises, Gait Training, and Visual Biofeedback on Equinovarus Gait among Individuals with Stroke: Randomized Controlled Study

Background and Purpose. Equinovarus foot is a common sign after stroke. The aim of this study is to investigate the effect of task specific exercises, gait training, and visual biofeedback on correcting equinovarus gait among individuals with stroke. Subjects and Methods. Sixteen subjects with ischemic stroke were randomly assigned to two equal groups (G1 and G2). All the patients were at stage 4 of motor recovery of foot according to Chedoke-McMaster Stroke Assessment without any cognitive dysfunction. E-med pedography was used to measure contact time, as well as force underneath hind and forefoot during walking. Outcome measures were collected before randomization, one week after the last session, and four weeks later. Participants in G1 received task specific exercises, gait training, and visual biofeedback and a traditional physical therapy program was applied for participants in G2 for 8 weeks. Results. Significant improvement was observed among G1 patients (P ≤ 0.05) which lasts one month after therapy termination. On the other hand, there were no significant differences between measurements of the participants in G2. Between groups comparison also revealed a significant improvement in G1 with long lasting effect. Conclusion. The results of this study showed a positive long lasting effect of the task specific exercises, gait training, and visual biofeedback on equinovarus gait pattern among individuals with stroke.

Gait disturbances in patients with stroke

Poststroke hemiplegic gait is a mixture of deviations and compensatory motion dictated by residual functions, and thus each patient must be examined and his/her unique gait pattern identified and documented. Quantitative 3-dimensional gait analysis is the best way to understand the complex multifactorial gait dysfunction in hemiparetic patients. The goals of the present work are to (1) review the temporospatial, kinematic, kinetic, and electromyographic deviations from normal gait that commonly occur after stroke and are of clinical significance, along with the most likely causes of these deviations, and (2) differentiate the departures from normal gait parameters that arise as a direct consequence of poststroke motor problems and those that arise as learned or adaptive compensations for poststroke motor problems.

An ankle proprioceptive control program improves balance, gait ability of chronic stroke patients

[Purpose] Balance and gait ability determine to a large degree the level of independence of daily living which is an important goal of rehabilitation. This study was conducted in order to examine the effectiveness of an ankle proprioceptive control program on ankle muscle strength, balance, and gait of chronic stroke patients. [Methods] Thirteen chronic stroke patients more than six months post-stroke were recruited. All subjects received ankle proprioceptive control training for 30 minutes per session, two days per week, over a period of six weeks. Outcome measures were ankle strength (BTE-Primus), the Timed Up and Go test (TUG), and spatiotemporal parameters measured by a GAITRite instrument. [Results] Significant improvements in ankle dorsiflexor strength, TUG, gait speed and cadence, step length, and stride length were observed on the paretic side. [Conclusion] The results of this study provide evidence in support of incorporation of an ankle proprioceptive control program for effective improvement of both balance and gait ability of chronic stroke patients. The findings of this study suggest the feasibility and suitability of an ankle proprioceptive control program for chronic stroke patients.

The characteristics of physical activity and gait in patients receiving radiotherapy in cancer induced bone pain

BACKGROUND AND PURPOSE

An objective measure of pain relief may add important information to patients' self assessment, particularly after a treatment. The study aims were to determine whether measures of physical activity and/or gait can be used in characterizing cancer-induced bone pain (CIBP) and whether these biomarkers are sensitive to treatment response, in patients receiving radiotherapy (XRT) for CIBP.

MATERIALS AND METHODS

Patients were assessed before (baseline) and 6-8weeks after XRT (follow up). The following assessments were done: Brief Pain Inventory (BPI), activPAL™ activity meter, and GAITRite® electronic walkway (measure of gait). Wilcoxon, Mann-Whitney and Pearson statistical analyses were done.

RESULTS

Sixty patients were assessed at baseline; median worst pain was 7 and walking interference was 5. At follow up 42 patients were assessed. BPI worst pain, average pain, walking interference and total functional interference all improved (p<0.001). An improvement in functional interference correlated with aspects of physical activity (daily hours standing r=0.469, p=0.002) and gait (cadence r=0.341, p=0.03). The activPAL and GAITRite parameters did not change following XRT (p>0.05). In responder analyses there were no differences in activPAL and GAITRite parameters (p>0.05).

CONCLUSION

Assessment of physical activity and gait allow a characterization of the functional aspects of CIBP, but not in the evaluation of XRT.

Static ankle-foot orthosis improves static balance and gait functions in hemiplegic patients after stroke

The purpose was to examine the effects of static anterior and posterior ankle-foot orthoses (AAFOs & PAFOs) using with regular shoes on improving static and gait function in patients recovering from stroke. Static and dynamic balance control were measured under four conditions: barefeet, wearing regular shoes only, and wearing regular shoes with AAFOs or PAFOs. The results indicated that wearing regular shoes markedly increased the center of pressure (CoP) sway (p < 0.05) in static standing conditions. Both AAFOs and PAFOs decreased CoP sway and increased bilateral limb loading symmetry compared to barefoot and wearing shoes alone (p < 0.05). PAFOs decreased CoP sway more than AAFOs (p > 0.05) and also boosted medial-lateral weight shifting more effectively (p < 0.05). Both types of AFOs increased walking efficiency but influenced the roll-over shape of the CoP adversely during level walking. The conclusions are that both AAFOs and PAFOs improved static and dynamic balance control when they were used with regular shoes and PAFOs appeared to be more efficient than AAFOs. Shoes worn daily with AFOs is a key consideration influencing balance control in stroke patients. However, AFOs with static design impeded the function of the three rocker systems of the foot during ambulation.

Gait impairment in a rat model of focal cerebral ischemia

The availability of proper tests for gait evaluation following cerebral ischemia in rats has been limited. The automated, quantitative CatWalk system, which was initially designed to measure gait in models of spinal cord injury, neuropathic pain, and peripheral nerve injury, is said to be a useful tool for the study of motor impairment in stroke animals. Here we report our experiences of using CatWalk XT with rats subjected to transient middle cerebral artery occlusion (MCAO), during their six-week followup. Large corticostriatal infarct was confirmed by MRI in all MCAO rats, which was associated with severe sensorimotor impairment. In contrast, the gait impairment was at most mild, which is consistent with seemingly normal locomotion of MCAO rats. Many of the gait parameters were affected by body weight, walking speed, and motivation despite the use of a goal box. In addition, MCAO rats showed bilateral compensation, which was developed to stabilize proper locomotion. All of these interferences may confound the data interpretation. Taken together, the translational applicability of CatWalk XT in evaluating motor impairment and treatment efficacy remains to be limited at least in rats with severe corticostriatal infarct and loss of body weight.

Biomechanical assessments of the effect of visual feedback on cycling for patients with stroke

Stroke patients exhibit abnormal pattern in leg cycling exercise. The aim of this study was to investigate the effects of visual feedback on the control of cycling motion in stroke patients from kinesiological, kinematic and kinetic aspects. The cycling performance derived from cycling electromyography (EMG), cycling cadence, and torque of forty stroke subjects was evaluated under conditions with and without visual feedback of cycling cadence. Kinesiological indices, shape symmetry index (SSI) and area symmetry index (ASI) were extracted from EMG linear envelopes to evaluate the symmetry of muscle firing patterns during cycling. Roughness index (RI) was calculated from cycling cadence to represent cycling smoothness from kinematic aspects. Averaged cycling power (Pav), the product of cadence and torque, was used to represent force output. The rectus femoris EMG showed significantly greater ASI with visual feedback, however, the difference in SSI between the two conditions was not significant. For the biceps femoris, there was a significant decrease in SSI with visual feedback, while the ASI was not affected significantly by the task conditions. The cycling smoothness was better and the average power generated was larger when visual feedback was provided. This study found that the addition of visual feedback improved both neuromuscular control and overall performance. Such improvement is likely to be the result of better control of the rectus femoris muscle activation and coordination of both legs.