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Pariser KM, Donlin MC, Downer KE, Higginson JS. Adaptive treadmill control can be manipulated to increase propulsive impulse while maintaining walking speed. J Biomech 2022; 133:110971. [PMID: 35121382 PMCID: PMC8891055 DOI: 10.1016/j.jbiomech.2022.110971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 01/20/2022] [Accepted: 01/21/2022] [Indexed: 11/18/2022]
Abstract
Adaptive treadmills (ATM) designed to promote increased propulsion may be an effective tool for gait training since propulsion is often impaired post-stroke. Our lab developed a novel ATM controller that adjusts belt speed via real-time changes in step length, propulsive impulse, and position. This study modified the relative importance of propulsion to step length in the controller to determine the effect of increased propulsive feedback gain on measures of propulsion and walking speed. Twenty-two participants completed five trials at their self-selected speed, each with a unique ATM controller. Walking speed, peak AGRF and PGRF, and AGRF, PGRF, and net impulse were compared between the modifications using one-way repeated measures ANOVAs at a significance level of 0.05. Participants chose similar walking speeds across all conditions (all p > 0.2730). There were no significant differences in peak AGRF (p = 0.1956) or PGRF (p = 0.5159) between conditions. AGRF impulse significantly increased as the gain on the propulsive impulse term was increased relative to the gain on step length (p < 0.0001) while PGRF and net impulse were similar across all conditions (p = 0.5487). Increasing the propulsive impulse gain essentially alters the treadmill environment by providing a controlled amount of resistance to increases in propulsive forces. Our findings demonstrate that the ATM can be modified to promote increased propulsive impulse while maintaining a consistent walking speed. Since increasing propulsion is a common goal of post-stroke gait training, these ATM modifications may improve the efficacy of the ATM for gait rehabilitation.
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Affiliation(s)
- Kayla M Pariser
- Department of Mechanical Engineering, University of Delaware, Newark, DE, USA.
| | - Margo C Donlin
- Department of Biomedical Engineering, University of Delaware, Newark, DE, USA
| | - Kaitlyn E Downer
- Department of Mechanical Engineering, University of Delaware, Newark, DE, USA
| | - Jill S Higginson
- Department of Mechanical Engineering, University of Delaware, Newark, DE, USA; Department of Biomedical Engineering, University of Delaware, Newark, DE, USA
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Rendos NK, Zajac-Cox L, Thomas R, Sato S, Eicholtz S, Kesar TM. Verbal feedback enhances motor learning during post-stroke gait retraining. Top Stroke Rehabil 2020; 28:362-377. [PMID: 32942960 DOI: 10.1080/10749357.2020.1818480] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Fast treadmill walking combined with functional electrical stimulation to ankle muscles (FastFES) is a well-studied gait intervention that improves post-stroke walking function. Although individualized verbal feedback is commonly incorporated during clinical gait training, and a variable practice structure is posited to enhance learning, the influence of these two factors on motor learning during locomotor interventions such as FastFES is poorly understood. OBJECTIVES To determine if the addition of individualized verbal feedback or variable practice to a FastFES training session enhances motor learning of targeted gait patterns. METHODS Nine individuals with post-stroke hemiparesis completed a crossover study comprising exposure to 3 dose-matched types of gait training: (1) FastFES (FF), comprising five 6-minute bouts of training with intermittent FES, (2) FF with addition of individualized verbal instructions and faded feedback delivered by a physical therapist (FF+PT), (3) FF with variable gait speed and FES timing (FF+Var). Gait biomechanics data were collected before (Pre), immediately after (Post), and 24-h following (Retention) each training type. Within-session and retention change scores of 3 targeted gait variables were calculated to assess locomotor learning. RESULTS FF+PT resulted in larger improvements within-session and at retention in trailing limb angle, and a trend for larger improvements in paretic pushoff compared to FF. FF+Var failed to show greater learning of biomechanical variables compared to FF. CONCLUSIONS Addition of individualized verbal feedback (FF+PT) to a single session of gait training may enhance within- and across-session learning of targeted gait variables in people post-stroke, and merits more investigation.
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Affiliation(s)
- Nicole K Rendos
- Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University School of Medicine, Atlanta, GA, USA
| | - Laura Zajac-Cox
- Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University School of Medicine, Atlanta, GA, USA
| | - Rahul Thomas
- Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University School of Medicine, Atlanta, GA, USA
| | - Sumire Sato
- Neuroscience and Behavior Graduate Program, University of Massachusetts Amherst, Amherst, MA, USA
| | - Steven Eicholtz
- Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University School of Medicine, Atlanta, GA, USA
| | - Trisha M Kesar
- Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University School of Medicine, Atlanta, GA, USA
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Sombric CJ, Calvert JS, Torres-Oviedo G. Large Propulsion Demands Increase Locomotor Adaptation at the Expense of Step Length Symmetry. Front Physiol 2019; 10:60. [PMID: 30800072 PMCID: PMC6376174 DOI: 10.3389/fphys.2019.00060] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 01/18/2019] [Indexed: 11/23/2022] Open
Abstract
There is an interest to identify factors facilitating locomotor adaptation induced by split-belt walking (i.e., legs moving at different speeds) because of its clinical potential. We hypothesized that augmenting braking forces, rather than propulsion forces, experienced at the feet would increase locomotor adaptation during and after split-belt walking. To test this, forces were modulated during split-belt walking with distinct slopes: incline (larger propulsion than braking), decline (larger braking than propulsion), and flat (similar propulsion and braking). Step length asymmetry was compared between groups because it is a clinically relevant measure robustly adapted on split-belt treadmills. Unexpectedly, the group with larger propulsion demands (i.e., the incline group) changed their gait the most during adaptation, reached their final adapted state more quickly, and had larger after-effects when the split-belt perturbation was removed. We also found that subjects who experienced larger disruptions of propulsion forces in early adaptation exhibited greater after-effects, which further highlights the catalytic role of propulsion forces on locomotor adaptation. The relevance of mechanical demands on shaping our movements was also indicated by the steady state split-belt behavior, during which each group recovered their baseline leg orientation to meet leg-specific force demands at the expense of step length symmetry. Notably, the flat group was nearly symmetric, whereas the incline and decline group overshot and undershot step length symmetry, respectively. Taken together, our results indicate that forces propelling the body facilitate gait changes during and after split-belt walking. Therefore, the particular propulsion demands to walk on a split-belt treadmill might explain the gait symmetry improvements in hemiparetic gait following split-belt training.
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Affiliation(s)
| | | | - Gelsy Torres-Oviedo
- Sensorimotor Learning Laboratory, Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States
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Roelker SA, Bowden MG, Kautz SA, Neptune RR. Paretic propulsion as a measure of walking performance and functional motor recovery post-stroke: A review. Gait Posture 2019; 68:6-14. [PMID: 30408710 PMCID: PMC6657344 DOI: 10.1016/j.gaitpost.2018.10.027] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 09/25/2018] [Accepted: 10/19/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Although walking speed is the most common measure of gait performance post-stroke, improved walking speed following rehabilitation does not always indicate the recovery of paretic limb function. Over the last decade, the measure paretic propulsion (Pp, defined as the propulsive impulse generated by the paretic leg divided by the sum of the propulsive impulses of both legs) has been established as a measure of paretic limb output and recently targeted in post-stroke rehabilitation paradigms. However, the literature lacks a detailed synthesis of how paretic propulsion, walking speed, and other biomechanical and neuromuscular measures collectively relate to post-stroke walking performance and motor recovery. OBJECTIVE The aim of this review was to assess factors associated with the ability to generate Pp and identify rehabilitation targets aimed at improving Pp and paretic limb function. METHODS Relevant literature was collected in which paretic propulsion was used to quantify and assess propulsion symmetry and function in hemiparetic gait. RESULTS Paretic leg extension during terminal stance is strongly associated with Pp. Both paretic leg extension and propulsion are related to step length asymmetry, revealing an interaction between spatiotemporal, kinematic and kinetic metrics that underlies hemiparetic walking performance. The importance of plantarflexor function in producing propulsion is highlighted by the association of an independent plantarflexor excitation module with increased Pp. Furthermore, the literature suggests that although current rehabilitation techniques can improve Pp, these improvements depend on the patient's baseline plantarflexor function. SIGNIFICANCE Pp provides a quantitative measure of propulsion symmetry and should be a primary target of post-stroke gait rehabilitation. The current literature suggests rehabilitation techniques that target both plantarflexor function and leg extension may restore paretic limb function and improve gait asymmetries in individuals post stroke.
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Affiliation(s)
- Sarah A. Roelker
- Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Mark G. Bowden
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA.,Division of Physical Therapy, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA,Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - Steven A. Kautz
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA.,Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - Richard R. Neptune
- Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX, USA
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Hsiao H, Gray VL, Creath RA, Binder-Macleod SA, Rogers MW. Control of lateral weight transfer is associated with walking speed in individuals post-stroke. J Biomech 2017; 60:72-78. [PMID: 28687151 DOI: 10.1016/j.jbiomech.2017.06.021] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 03/21/2017] [Accepted: 06/13/2017] [Indexed: 10/19/2022]
Abstract
Restoring functional gait speed is an important goal for rehabilitation post-stroke. During walking, transferring of one's body weight between the limbs and maintaining balance stability are necessary for independent functional gait. Although it is documented that individuals post-stroke commonly have difficulties with performing weight transfer onto their paretic limbs, it remains to be determined if these deficits contributed to slower walking speeds. The primary purpose of this study was to compare the weight transfer characteristics between slow and fast post-stroke ambulators. Participants (N=36) with chronic post-stroke hemiparesis walked at their comfortable and maximal walking speeds on a treadmill. Participants were stratified into 2 groups based on their comfortable walking speeds (≥0.8m/s or <0.8m/s). Minimum body center of mass (COM) to center of pressure (COP) distance, weight transfer timing, step width, lateral foot placement relative to the COM, hip moment, peak vertical and anterior ground reaction forces, and changes in walking speed were analyzed. Results showed that slow walkers walked with a delayed and deficient weight transfer to the paretic limb, lower hip abductor moment, and more lateral paretic limb foot placement relative to the COM compared to fast walkers. In addition, propulsive force and walking speed capacity was related to lateral weight transfer ability. These findings demonstrated that deficits in lateral weight transfer and stability could potentially be one of the limiting factors underlying comfortable walking speeds and a determinant of chronic stroke survivors' ability to increase walking speed.
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Affiliation(s)
- HaoYuan Hsiao
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD 21201, United States.
| | - Vicki L Gray
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD 21201, United States.
| | - Robert A Creath
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD 21201, United States.
| | | | - Mark W Rogers
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD 21201, United States.
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Hsiao H, Zabielski TM, Palmer JA, Higginson JS, Binder-Macleod SA. Evaluation of measurements of propulsion used to reflect changes in walking speed in individuals poststroke. J Biomech 2016; 49:4107-4112. [PMID: 27756571 DOI: 10.1016/j.jbiomech.2016.10.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 08/31/2016] [Accepted: 10/03/2016] [Indexed: 10/20/2022]
Abstract
Recent rehabilitation approaches for individuals poststroke have focused on improving walking speed because it is a reliable measurement that is associated with quality of life. Previous studies have demonstrated that propulsion, the force used to propel the body forward, determines walking speed. However, there are several different ways of measuring propulsion and no studies have identified which measurement best reflects differences in walking speed. The primary purposes of this study were to determine for individuals poststroke, which measurement of propulsion (1) is most closely related to their self-selected walking speeds and (2) best reflects changes in walking speed within a session. Participants (N=43) with chronic poststroke hemiparesis walked at their self-selected and maximal walking speeds on a treadmill. Propulsive impulse, peak propulsive force, and mean propulsive value (propulsive impulse divided by duration) were analyzed. In addition, each participant׳s cadence was calculated. Pearson correlation coefficients were used to determine the relationships between different measurements of propulsion versus walking speed as well as changes in propulsion versus changes in walking speed. Stepwise linear regression was used to determine which measurement of propulsion best predicted walking speed and changes in walking speed. The results showed that all 3 measurements of propulsion were correlated to walking speed, with peak propulsive force showed the strongest correlation. Similarly, when participants increased their walking speeds, changes in peak propulsive forces showed the strongest correlation to changes in walking speed. In addition, multiplying each measurement by cadence improved the correlations. The present study suggests that measuring peak propulsive force and cadence may be most appropriate of the variables studied to characterize propulsion in individuals poststroke.
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Affiliation(s)
- HaoYuan Hsiao
- Biomechanics and Movement Science Program, University of Delaware, DE 19716, United States.
| | - Thomas M Zabielski
- Department of Kinesiology and Applied Physiology, University of Delaware, DE 19716, United States.
| | - Jacqueline A Palmer
- Biomechanics and Movement Science Program, University of Delaware, DE 19716, United States.
| | - Jill S Higginson
- Department of Mechanical Engineering, University of Delaware, DE 19716, United States.
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Hsiao H, Awad LN, Palmer JA, Higginson JS, Binder-Macleod SA. Contribution of Paretic and Nonparetic Limb Peak Propulsive Forces to Changes in Walking Speed in Individuals Poststroke. Neurorehabil Neural Repair 2016; 30:743-52. [PMID: 26721869 PMCID: PMC4930429 DOI: 10.1177/1545968315624780] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Recent rehabilitation efforts after stroke often focus on increasing walking speed because it is associated with quality of life. For individuals poststroke, propulsive force generated from the paretic limb has been shown to be correlated to walking speed. However, little is known about the relative contribution of the paretic versus the nonparetic propulsive forces to changes in walking speed. OBJECTIVE The primary purpose of this study was to determine the contribution of propulsive force generated from each limb to changes in walking speed during speed modulation within a session and as a result of a 12-week training program. METHODS Gait analysis was performed as participants (N = 38) with chronic poststroke hemiparesis walked at their self-selected and faster walking speeds on a treadmill before and after a 12-week gait retraining program. RESULTS Prior to training, stroke survivors increased nonparetic propulsive forces as the primary mechanism to change walking speed during speed modulation within a session. Following gait training, the paretic limb played a larger role during speed modulation within a session. In addition, the increases in paretic propulsive forces observed following gait training contributed to the increases in the self-selected walking speeds seen following training. CONCLUSIONS Gait retraining in the chronic phase of stroke recovery facilitates paretic limb neuromotor recovery and reduces the reliance on the nonparetic limb's generation of propulsive force to increase walking speed. These findings support gait rehabilitation efforts directed toward improving the paretic limb's ability to generate propulsive force.
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Hsiao H, Higginson JS, Binder-Macleod SA. Baseline predictors of treatment gains in peak propulsive force in individuals poststroke. J Neuroeng Rehabil 2016; 13:2. [PMID: 26767921 PMCID: PMC4714457 DOI: 10.1186/s12984-016-0113-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 01/10/2016] [Indexed: 01/31/2023] Open
Abstract
Background Current rehabilitation for individuals poststroke focuses on increasing walking speed because it is an indicator of community walking ability and quality of life. Propulsive force generated from the paretic limb is critical to walking speed and may reflect actual neural recovery that restores the affected neural systems. A wide variation across individuals in the improvements in paretic propulsive force was observed following an intervention that targeted paretic propulsive force. This study aimed to determine if specific baseline characteristics can be used to predict patients who would respond to the intervention. Methods Participants (N = 19) with chronic poststroke hemiparesis walked at their self-selected and maximal walking speeds on a treadmill before and after a 12-week gait training program. Propulsive forces from the paretic limb were analyzed. Pearson correlation coefficient was used to determine the relationships between (1) treatment gains in walking speed and propulsive force following intervention, and (2) treatment gains in propulsive force and baseline propulsive forces. Results Treatment gains in self-selected walking speed were correlated to treatment gains in paretic propulsive force following intervention. In addition, changes in paretic propulsive force between self-selected and maximal walking speeds at baseline were strongly correlated to treatment gains in paretic propulsive force. Conclusions The capacity to modulate paretic propulsive force, rather than the absolute propulsive force during self-selected or maximal walking speed, predicted treatment gains in propulsive force following the intervention. Findings from this research could help to inform clinicians and researchers to target the appropriate patient population for rehabilitation interventions.
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Affiliation(s)
- HaoYuan Hsiao
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE, 19716, USA. .,, 540 S. College Avenue, Suite 201F, Newark, DE, 19716, USA.
| | - Jill S Higginson
- Department of Mechanical Engineering, University of Delaware, Newark, DE, 19716, USA.
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Hsiao H, Knarr BA, Pohlig RT, Higginson JS, Binder-Macleod SA. Mechanisms used to increase peak propulsive force following 12-weeks of gait training in individuals poststroke. J Biomech 2015; 49:388-95. [PMID: 26776931 DOI: 10.1016/j.jbiomech.2015.12.040] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 11/05/2015] [Accepted: 12/24/2015] [Indexed: 11/16/2022]
Abstract
Current rehabilitation efforts for individuals poststroke focus on increasing walking speed because it is a predictor of community ambulation and participation. Greater propulsive force is required to increase walking speed. Previous studies have identified that trailing limb angle (TLA) and ankle moment are key factors to increases in propulsive force during gait. However, no studies have determined the relative contribution of these two factors to increase propulsive force following intervention. The purpose of this study was to quantify the relative contribution of ankle moment and TLA to increases in propulsive force following 12-weeks of gait training for individuals poststroke. Forty-five participants were assigned to 1 of 3 training groups: training at self-selected speeds (SS), at fastest comfortable speeds (Fast), and Fast with functional electrical stimulation (FastFES). For participants who gained paretic propulsive force following training, a biomechanical-based model previously developed for individuals poststroke was used to calculate the relative contributions of ankle moment and TLA. A two-way, mixed-model design, analysis of covariance adjusted for baseline walking speed was performed to analyze changes in TLA and ankle moment across groups. The model showed that TLA was the major contributor to increases in propulsive force following training. Although the paretic TLA increased from pre-training to post-training, no differences were observed between groups. In contrast, increases in paretic ankle moment were observed only in the FastFES group. Our findings suggested that specific targeting may be needed to increase ankle moment.
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Affiliation(s)
- HaoYuan Hsiao
- Biomechanics and Movement Science Program, University of Delaware, United States.
| | - Brian A Knarr
- Delaware Rehabilitation Institute, University of Delaware, United States.
| | - Ryan T Pohlig
- Biostatistics Core Facility, University of Delaware, United States.
| | - Jill S Higginson
- Department of Mechanical Engineering, University of Delaware, United States.
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Padulo J, Vando S, Chamari K, Chaouachi A, Bagno D, Pizzolato F. Validity of the MarkWiiR for kinematic analysis during walking and running gaits. Biol Sport 2015; 32:53-8. [PMID: 25729150 PMCID: PMC4314604 DOI: 10.5604/20831862.1127282] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 02/07/2014] [Accepted: 06/26/2014] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to validate the MarkWiiR (MW) captured by the Nintendo Wii-Remote (100-Hz) to assess active marker displacement by comparison with 2D video analysis. Ten participants were tested on a treadmill at different walking (1<6 km · h−1) and running (10<13 km · h−1) speeds. During the test, the active marker for MW and a passive marker for video analysis were recorded simultaneously with the two devices. The displacement of the marker on the two axes (x-y) was computed using two different programs, Kinovea 0.8.15 and CoreMeter, for the camera and MW, respectively. Pearson correlation was acceptable (x-axis r≥0.734 and y-axis r≥0.684), and Bland–Altman plots of the walking speeds showed an average error of 0.24±0.52% and 1.5±0.91% for the x- and y-axis, respectively. The difference of running speeds showed average errors of 0.67±0.33% and 1.26±0.33% for the x- and y-axes, respectively. These results demonstrate that the two measures are similar from both the x- and the y-axis perspective. In conclusion, these findings suggest that the MarkWiiR is a valid and reliable tool to assess the kinematics of an active marker during walking and running gaits.
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Affiliation(s)
- J Padulo
- University e-Campus, Novedrate, Italy ; Tunisian Research Laboratory "Sports Performance Optimization" National Center of Medicine and Science in Sport, Tunis, Tunisia
| | - S Vando
- Department of Human, Social and Health Sciences, University of Cassino and Southern Lazio, Cassino, Italy
| | - K Chamari
- Athlete Health and Performance Research Centre, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - A Chaouachi
- Tunisian Research Laboratory "Sports Performance Optimization" National Center of Medicine and Science in Sport, Tunis, Tunisia ; AUT University, Sports Performance Research Institute New Zealand, Auckland, New Zealand
| | - D Bagno
- Faculty of Informatics Engineering, University of "La Sapienza", Rome, Italy
| | - F Pizzolato
- Department of Neurological and Movement Sciences, University of Verona, Italy
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