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Kowalczyk K, Mukherjee M, Malcolm P. Can a passive unilateral hip exosuit diminish walking asymmetry? A randomized trial. J Neuroeng Rehabil 2023; 20:88. [PMID: 37438846 DOI: 10.1186/s12984-023-01212-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/03/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Asymmetric walking gait impairs activities of daily living in neurological patient populations, increases their fall risk, and leads to comorbidities. Accessible, long-term rehabilitation methods are needed to help neurological patients restore symmetrical walking patterns. This study aimed to determine if a passive unilateral hip exosuit can modify an induced asymmetric walking gait pattern. We hypothesized that a passive hip exosuit would diminish initial- and post-split-belt treadmill walking after-effects in healthy young adults. METHODS We divided 15 healthy young adults evenly between three experimental groups that each completed a baseline trial, an adaptation period with different interventions for each group, and a post-adaptation trial. To isolate the contribution of the exosuit we compared a group adapting to the exosuit and split-belt treadmill (Exo-Sb) to groups adapting to exosuit-only (Exo-only) and split-belt only (Sb-only) conditions. The independent variables step length, stance time, and swing time symmetry were analyzed across five timepoints (baseline, early- and late adaptation, and early- and late post-adaptation) using a 3 × 5 mixed ANOVA. RESULTS We found significant interaction and time effects on step length, stance time and swing time symmetry. Sb-only produced increased step length asymmetry at early adaptation compared to baseline (p < 0.0001) and an after-effect with increased asymmetry at early post-adaptation compared to baseline (p < 0.0001). Exo-only increased step length asymmetry (in the opposite direction as Sb-only) at early adaptation compared to baseline (p = 0.0392) but did not influence the participants sufficiently to result in a post-effect. Exo-Sb produced similar changes in step length asymmetry in the same direction as Sb-only (p = 0.0014). However, in contrast to Sb-only there was no significant after-effect between early post-adaptation and baseline (p = 0.0885). CONCLUSION The passive exosuit successfully diminished asymmetrical step length after-effects induced by the split-belt treadmill in Exo-Sb. These results support the passive exosuit's ability to alter walking gait patterns.
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Affiliation(s)
- Kayla Kowalczyk
- Department of Biomechanics and Center for Research in Human Movement Variability, University of Nebraska at Omaha, 6160 University Drive, Omaha, NE, 68182-0860, USA
- UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens, GA, USA
| | - Mukul Mukherjee
- Department of Biomechanics and Center for Research in Human Movement Variability, University of Nebraska at Omaha, 6160 University Drive, Omaha, NE, 68182-0860, USA
| | - Philippe Malcolm
- Department of Biomechanics and Center for Research in Human Movement Variability, University of Nebraska at Omaha, 6160 University Drive, Omaha, NE, 68182-0860, USA.
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Maje AU, Ibrahim AA. Effectiveness of an 8-week overground walking with paretic lower limb loading on spatiotemporal gait parameters and motor function among chronic stroke survivors: a protocol for randomised controlled trial. Trials 2023; 24:124. [PMID: 36803399 PMCID: PMC9942389 DOI: 10.1186/s13063-022-07057-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/28/2022] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Post-stroke gait deviations contribute to significant functional disability, impaired walking ability and poor quality of life. Prior studies suggest that gait training with paretic lower limb loading may improve gait parameters and walking ability in post-stroke. However, most gait training methods used in these studies are not readily available, and studies using cheaper methods are limited. OBJECTIVE The purpose of this study is to describe a protocol for a randomised controlled trial on the effectiveness of an 8-week overground walking with paretic lower limb loading on spatiotemporal gait parameters and motor function among chronic stroke survivors. METHODS This is a two-center, single-blind, two-arm parallel randomised controlled trial. Forty-eight stroke survivors with mild to moderate disability will be recruited from two tertiary facilities and randomly assigned into two intervention arms; overground walking with paretic lower limb loading or overground walking without paretic lower limb loading in a 1:1 ratio. All interventions will be administered thrice weekly for 8 weeks. Primary outcomes will be step length and gait speed whereas the secondary outcomes will include step length symmetry ratio, stride length, stride length symmetry ratio, stride width, cadence and motor function. All outcomes will be assessed at baseline, 4, 8 and 20 weeks after the start of intervention. DISCUSSION This will be the first randomised controlled trial to report the effects of overground walking with paretic lower limb loading on spatiotemporal gait parameters and motor function among chronic stroke survivors from low-resource setting. TRIAL REGISTRATION ClinicalTrials.gov NCT05097391. Registered on 27 October 2021.
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Affiliation(s)
- Abdulhamid U. Maje
- Department of Physiotherapy, Muhammadu Abdullahi Wase Teaching Hospital, Hospitals Management Board, P.M.B 3160, Kano, Kano State Nigeria ,grid.411585.c0000 0001 2288 989XDepartment of Physiotherapy, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University, P.M.B 3011, Kano, Kano State Nigeria
| | - Aminu A. Ibrahim
- grid.510479.eDepartment of Physiotherapy, School of Basic Medical Sciences, Skyline University Nigeria, Kano, Kano State Nigeria
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Fujimoto T, Sue K, Yamabe T, Momose K. Relative and absolute reliability of gait variables obtained from gait analysis with trunk acceleration in community-dwelling individuals with chronic stroke: a pilot study. J Phys Ther Sci 2023; 35:75-81. [PMID: 36628148 PMCID: PMC9822815 DOI: 10.1589/jpts.35.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 10/26/2022] [Indexed: 01/01/2023] Open
Abstract
[Purpose] This pilot study aimed to investigate the relative and absolute reliability of variables obtained from an acceleration-based gait analysis conducted at comfortable and maximal gait speeds in individuals with chronic stroke. [Participants and Methods] This study included 25 community-dwelling individuals with chronic stroke. The participants wore triaxial accelerometers, while an observed walking trial was performed at comfortable and maximal speeds on two separate days 1 week apart. Relative reliability was evaluated using the intraclass correlation coefficient, and absolute reliability was evaluated using the Bland-Altman analysis, standard error of measurement, and minimal detectable change. [Results] The intraclass correlation coefficient of gait varied according to the acceleration-based gait analysis, ranging from 0.70 to 0.99. The Bland-Altman analysis revealed no systematic bias in both comfortable and maximal gait speed conditions. Most of the minimal detectable changes were smaller at maximal gait speed than at comfortable gait speed. [Conclusion] Acceleration-based gait analysis is a reliable method, particularly in maximal gait speed conditions. It may be used to assess the effect of rehabilitation interventions in individuals with chronic stroke.
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Affiliation(s)
- Tomohiro Fujimoto
- Department of Rehabilitation, JA Nagano Kouseiren
Kakeyu-Misayama Rehabilitation Center Kakeyu Hospital, Japan, Department of Health Sciences, Graduate School of Medicine,
Shinshu University, Japan
| | - Keita Sue
- Department of Rehabilitation, JA Nagano Kouseiren
Kakeyu-Misayama Rehabilitation Center Kakeyu Hospital, Japan, Department of Health Sciences, Graduate School of Medicine,
Science and Technology, Shinshu University, Japan
| | - Takanori Yamabe
- Department of Rehabilitation, JA Nagano Kouseiren
Kakeyu-Misayama Rehabilitation Center Geriatric Health Services Facilities Izumino,
Japan
| | - Kimito Momose
- Department of Physical Therapy, School of Health Science,
Shinshu University: 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan,Corresponding author. Kimito Momose (E-mail: )
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Liu LY, Sangani S, Patterson KK, Fung J, Lamontagne A. Instantaneous effect of real-time avatar visual feedback on interlimb coordination during walking post-stroke. Clin Biomech (Bristol, Avon) 2022; 100:105821. [PMID: 36435074 DOI: 10.1016/j.clinbiomech.2022.105821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Le Yu Liu
- School of Physical and Occupational Therapy of McGill University, 3654 Promenade Sir-William-Osler, Montreal H3G1Y5, Canada; Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital site of CISSS-Laval and research site of the Montreal Centre for Interdisciplinary Research in Rehabilitation (CRIR), 3205 Pl. Alton-Goldbloom, Laval H7V 1R2, Canada.
| | - Samir Sangani
- Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital site of CISSS-Laval and research site of the Montreal Centre for Interdisciplinary Research in Rehabilitation (CRIR), 3205 Pl. Alton-Goldbloom, Laval H7V 1R2, Canada
| | - Kara K Patterson
- Department of Physical Therapy of University of Toronto, 160-500 University Ave, Toronto M5G 1V7, Canada; KITE-University Health Network, 550 University Ave #12-165, Toronto M5G 2A2, Canada.
| | - Joyce Fung
- School of Physical and Occupational Therapy of McGill University, 3654 Promenade Sir-William-Osler, Montreal H3G1Y5, Canada; Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital site of CISSS-Laval and research site of the Montreal Centre for Interdisciplinary Research in Rehabilitation (CRIR), 3205 Pl. Alton-Goldbloom, Laval H7V 1R2, Canada.
| | - Anouk Lamontagne
- School of Physical and Occupational Therapy of McGill University, 3654 Promenade Sir-William-Osler, Montreal H3G1Y5, Canada; Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital site of CISSS-Laval and research site of the Montreal Centre for Interdisciplinary Research in Rehabilitation (CRIR), 3205 Pl. Alton-Goldbloom, Laval H7V 1R2, Canada.
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Van Bladel A, De Ridder R, Palmans T, Oostra K, Cambier D. Biomechanical differences between self-paced and fixed-speed treadmill walking in persons after stroke. Hum Mov Sci 2022; 85:102983. [PMID: 35933827 DOI: 10.1016/j.humov.2022.102983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/22/2022] [Accepted: 07/22/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Using self-paced treadmills for gait analysis requires less space compared to overground gait labs while a more natural walking pattern could be preserved compared to fixed-speed treadmill walking. Although self-paced treadmills have been used in stroke related intervention studies, studies comparing self-paced to fixed-speed treadmill walking in this population are scarce. METHODS Twenty-five persons after stroke (10 males/15 females; 53 ± 12.05 years; 40.72 ± 42.94 months post stroke) walked on a treadmill in a virtual environment (GRAIL, Motek) in two conditions (self-paced and fixed-speed). After familiarization, all participants completed two trials (3 min) at comfortable walking velocity in randomized order. A paired-sample t-test or Wilcoxon Signed Rank test was used to calculate differences between both conditions for spatiotemporal parameters. Statistical Parametric mapping was conducted using the t-tests (SPM(t)), to statistically compare the kinematic and kinetic curves. RESULTS The self-selected walking velocity on the treadmill was higher in the self-paced condition compared to the fixed-speed condition (p < 0.001). However, most variability and symmetry measures were similar in both conditions. Only the standard deviation of the step length at the paretic side was significant higher (p = 0.007) and step length symmetry was significantly better (p = 0.032) in the self-paced condition. Detected kinematic and kinetic differences were small (< 3°, < 0.1 Nm/kg) and stride to stride variability was comparable in both conditions. CONCLUSION Based on the results of the current study, self-paced walking can be used as an equivalent to fixed-speed treadmill walking in persons after stroke. Accordingly, this justifies the use of this more functional mode in clinical gait assessment and rehabilitation trials.
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Affiliation(s)
- Anke Van Bladel
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium; Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium.
| | - Roel De Ridder
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.
| | - Tanneke Palmans
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.
| | - Kristine Oostra
- Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium.
| | - Dirk Cambier
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.
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Parati M, Ambrosini E, DE Maria B, Gallotta M, Dalla Vecchia LA, Ferriero G, Ferrante S. The reliability of gait parameters captured via instrumented walkways: a systematic review and meta-analysis. Eur J Phys Rehabil Med 2022; 58:363-377. [PMID: 34985239 PMCID: PMC9987464 DOI: 10.23736/s1973-9087.22.07037-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Electronic pressure-sensitive walkways are commonly available solutions to quantitatively assess gait parameters for clinical and research purposes. Many studies have evaluated their measurement properties in different conditions with variable findings. In order to be informed about the current evidence of their reliability for optimal clinical and scientific decision making, this systematic review provided a quantitative synthesis of the test-retest reliability and minimal detectable change of the captured gait parameters across different test conditions (single and cognitive dual-task conditions) and population groups. EVIDENCE ACQUISITION A literature search was conducted in PubMed, Embase, and Scopus until November 2021 to identify articles that examined the test-retest reliability properties of the gait parameters captured by pressure-sensitive walkways (gait speed, cadence, stride length and time, double support time, base of support) in adult healthy individuals or patients. The methodological quality was rated using the Consensus-Based Standards for the Selection of Health Measurement Instruments Checklist. Data were meta-analyzed on intraclass correlation coefficient to examine the test-retest relative reliability. Quantitative synthesis was performed for absolute reliability, examined by the weighted average of minimal detectable change values. EVIDENCE SYNTHESIS A total of 44 studies were included in this systematic review. The methodological quality was adequate in half of the included studies. The main finding was that pressure-sensitive walkways are reliable tools for objective assessment of spatial and temporal gait parameters both in single-and cognitive dual-task conditions. Despite few exceptions, the review identified intraclass correlation coefficient higher than 0.75 and minimal detectable change lower than 30%, demonstrating satisfactory relative and absolute reliability in all examined populations (healthy adults, elderly, patients with cognitive impairment, spinocerebellar ataxia type 14, Huntington's disease, multiple sclerosis, Parkinson's disease, rheumatoid arthritis, spinal cord injury, stroke or vestibular dysfunction). CONCLUSIONS Current evidence suggested that, despite different populations and testing protocols used in the included studies, the test-retest reliability of the examined gait parameters was acceptable under single and cognitive dual-task conditions. Further high-quality studies with powered sample sizes are needed to examine the reliability findings of the currently understudied and unexplored pathologies and test conditions.
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Affiliation(s)
- Monica Parati
- Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy.,Istituti Clinici Scientifici Maugeri IRCCS, Milan, Italy
| | - Emilia Ambrosini
- Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | | | | | | | - Giorgio Ferriero
- Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Varese, Italy -
| | - Simona Ferrante
- Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
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Felius RAW, Geerars M, Bruijn SM, van Dieën JH, Wouda NC, Punt M. Reliability of IMU-Based Gait Assessment in Clinical Stroke Rehabilitation. SENSORS 2022; 22:s22030908. [PMID: 35161654 PMCID: PMC8839370 DOI: 10.3390/s22030908] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/16/2022] [Accepted: 01/19/2022] [Indexed: 02/06/2023]
Abstract
Background: Gait is often impaired in people after stroke, restricting personal independence and affecting quality of life. During stroke rehabilitation, walking capacity is conventionally assessed by measuring walking distance and speed. Gait features, such as asymmetry and variability, are not routinely determined, but may provide more specific insights into the patient’s walking capacity. Inertial measurement units offer a feasible and promising tool to determine these gait features. Objective: We examined the test–retest reliability of inertial measurement units-based gait features measured in a two-minute walking assessment in people after stroke and while in clinical rehabilitation. Method: Thirty-one people after stroke performed two assessments with a test–retest interval of 24 h. Each assessment consisted of a two-minute walking test on a 14-m walking path. Participants were equipped with three inertial measurement units, placed at both feet and at the low back. In total, 166 gait features were calculated for each assessment, consisting of spatio-temporal (56), frequency (26), complexity (63), and asymmetry (14) features. The reliability was determined using the intraclass correlation coefficient. Additionally, the minimal detectable change and the relative minimal detectable change were computed. Results: Overall, 107 gait features had good–excellent reliability, consisting of 50 spatio-temporal, 8 frequency, 36 complexity, and 13 symmetry features. The relative minimal detectable change of these features ranged between 0.5 and 1.5 standard deviations. Conclusion: Gait can reliably be assessed in people after stroke in clinical stroke rehabilitation using three inertial measurement units.
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Affiliation(s)
- Richard A. W. Felius
- Research Group Lifestyle and Health, Utrecht University of Applied Sciences, 3584 CS Utrecht, The Netherlands; (M.G.); (N.C.W.); (M.P.)
- Faculty of Human Movement Sciences, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (S.M.B.); (J.H.v.D.)
- Correspondence:
| | - Marieke Geerars
- Research Group Lifestyle and Health, Utrecht University of Applied Sciences, 3584 CS Utrecht, The Netherlands; (M.G.); (N.C.W.); (M.P.)
- Physiotherapy Department Neurology, Rehabilitation Center de Parkgraaf, 3526 KJ Utrecht, The Netherlands
| | - Sjoerd M. Bruijn
- Faculty of Human Movement Sciences, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (S.M.B.); (J.H.v.D.)
| | - Jaap H. van Dieën
- Faculty of Human Movement Sciences, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (S.M.B.); (J.H.v.D.)
| | - Natasja C. Wouda
- Research Group Lifestyle and Health, Utrecht University of Applied Sciences, 3584 CS Utrecht, The Netherlands; (M.G.); (N.C.W.); (M.P.)
- Physiotherapy Department Neurology, De Hoogstraat Revalidatie, 3583 TM Utrecht, The Netherlands
| | - Michiel Punt
- Research Group Lifestyle and Health, Utrecht University of Applied Sciences, 3584 CS Utrecht, The Netherlands; (M.G.); (N.C.W.); (M.P.)
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Jarvis HL, Brown SJ, Butterworth C, Jackson K, Clayton A, Walker L, Rees N, Price M, Groenevelt R, Reeves ND. The gait profile score characterises walking performance impairments in young stroke survivors. Gait Posture 2022; 91:229-234. [PMID: 34741933 DOI: 10.1016/j.gaitpost.2021.10.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 10/23/2021] [Accepted: 10/26/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The Gait Profile Score (GPS) provides a composite measure of the quality of joint movement during walking, but the relationship between this measure and metabolic cost, temporal (e.g. walking speed) and spatial (e.g. stride length) parameters in stroke survivors has not been reported. RESEARCH QUESTION The aims of this study were to compare the GPS (paretic, non-paretic, and overall score) of young stroke survivors to the healthy able-bodied control and determine the relationship between the GPS and metabolic cost, temporal (walking speed, stance time asymmetry) and spatial (stride length, stride width, step length asymmetry) parameters in young stroke survivors to understand whether the quality of walking affects walking performance in stroke survivors. METHODS Thirty-nine young stroke survivors aged between 18 and 65years and 15 healthy age-matched able-bodied controls were recruited from six hospital sites in Wales, UK. Joint range of motion at the pelvis, hip, knee and ankle, and temporal and spatial parameters were measured during walking on level ground at self-selected speed with calculation of the Gait Variable Score and then the GPS. RESULTS GPS for the paretic leg (9.40° (8.60-10.21) p < 0.001), non-paretic leg (11.42° (10.20-12.63) p < 0.001) and overall score (11.18° (10.26-12.09) p < 0.001)) for stroke survivors were significantly higher than the control (4.25° (3.40-5.10), 5.92° (5.11 (6.73)). All parameters with the exception of step length symmetry ratio correlated moderate to highly with the GPS for the paretic, non-paretic, and/or overall score (ρ = <-0.732 (p < 0.001)). SIGNIFICANCE The quality of joint movement during walking measured via the GPS is directly related to the speed and efficiency of walking, temporal (stance time symmetry) and spatial (stride length, stride width) parameters in young stroke survivors.
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Affiliation(s)
- Hannah L Jarvis
- Research Centre for Musculoskeletal Science and Sports Medicine, Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK.
| | - Steven J Brown
- Research Centre for Musculoskeletal Science and Sports Medicine, Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - Claire Butterworth
- Cardiff and Vale University Health Board, Physiotherapy, Llandough Hospital, Penlan Road, Cardiff CF64 2XX, UK
| | - Karl Jackson
- Betsi Cadwaladr University Health Board, Physiotherapy, Ysbyty Gwynedd, Bangor LL57 2PW, UK
| | - Abigail Clayton
- Swansea Bay University Health Board, Therapy Services, Heol Maes Eglwys, Swansea SA6 6NL, UK
| | - Louisa Walker
- Cwm Taf Bro Morgannwg University Health Board, Physiotherapy Department, Keir Hardie Health Park, Merthyr Tydfil CF48 1BZ, UK
| | - Nia Rees
- Cwm Taf Bro Morgannwg University Health Board, Physiotherapy Department, Keir Hardie Health Park, Merthyr Tydfil CF48 1BZ, UK
| | - Michelle Price
- Powys Teaching Health Board, Neuro Rehabilitation, Newtown Hospital, Newtown SY6 2DW, UK
| | - Renee Groenevelt
- Hywel Dda University Health Board, Physiotherapy, Fishguard Road, Haverfordwest, Pembrokeshire SA61 2PZ, UK
| | - Neil D Reeves
- Research Centre for Musculoskeletal Science and Sports Medicine, Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
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Longitudinal Changes in Temporospatial Gait Characteristics during the First Year Post-Stroke. Brain Sci 2021; 11:brainsci11121648. [PMID: 34942950 PMCID: PMC8699066 DOI: 10.3390/brainsci11121648] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/02/2021] [Accepted: 12/13/2021] [Indexed: 12/03/2022] Open
Abstract
Given the paucity of longitudinal data in gait recovery after stroke, we compared temporospatial gait characteristics of stroke patients during subacute (<2 months post-onset, T0) and at approximately 6 and 12 months post-onset (T1 and T2, respectively) and explored the relationship between gait characteristics at T0 and the changes in gait speed from T0 to T1. Forty-six participants were assessed at T0 and a subsample of twenty-four participants were assessed at T2. Outcome measures included Fugl-Meyer lower-extremity motor score, 14 temporospatial gait parameters, and symmetry indices of 5 step parameters. Except for step width, all temporospatial parameters improved from T0 to T1 (p ≤ 0.0001). Additionally, significant improvements in symmetry were found for the initial double-support time and single-support time (p ≤ 0.0001). As a group, no significant differences were found between T1 and T2 in any of the temporospatial measures. However, the individual analysis revealed that 42% (10/24) of the subsample showed a significant increase in gait speed (Welch’s t-test, p ≤ 0.002). Yet, only 5/24 (21%) of the participants improved speed from T1 to T2 according to speed-based minimum detectable change criteria. The increase in gait speed from T0 to T1 was negatively correlated with gait speed and stride length and positively correlated with the symmetry indices of stance and single-support times at T0 (p ≤ 0.002). Temporospatial gait parameters and stance time symmetry improved over the first 6 months after stroke with an apparent plateau thereafter. A greater increase in gait speed during the first 6 months post-stroke is associated with initially slower walking, shorter stride length, and more pronounced asymmetry in stance and single-support times. The improvement in lower-extremity motor function and bilateral improvements in step parameters collectively suggest that gait changes over the first 6 months after stroke are likely due to a combination of neurological recovery, compensatory strategies, and physical therapy received during that time.
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Elery T, Reznick E, Shearin S, McCain K, Gregg RD. Design and Initial Validation of a Multiple Degree-of-Freedom Joint for an Ankle-Foot Orthosis. J Med Device 2021. [DOI: 10.1115/1.4053200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Abstract
This paper presents the novel design of a Multi-Degree-Of-Freedom joint (M-DOF) for an Ankle-Foot Orthosis (AFO) that aims to improve upon the commercially available Double Action Joint (DAJ). The M-DOF is designed to maintain the functionality of the DAJ, while increasing dorsiflexion stiffness and introducing inversion/eversion. This increase in range of motion is designed to produce greater engagement from lower limb muscles during gait. The M-DOF was experimentally validated with one able-bodied and one stroke subject. Across walking speeds, the M-DOF AFO minimally affected the able-bodied subject's joint kinematics. The stroke subject's ankle dorsiflexion/plantarflexion and knee flexion were not heavily altered when wearing the M-DOF AFO, compared to the DAJ AFO. The new DOF allowed by the M-DOF AFO increased the inversion/eversion of the ankle by ~3°, without introducing any new compensations compared to their gait with the DAJ AFO.
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Affiliation(s)
- Toby Elery
- Department of Bioengineering, University of Texas at Dallas, Richardson, TX 75080
| | - Emma Reznick
- Robotics Institute, University of Michigan, Ann Arbor, MI 48109
| | - Staci Shearin
- School of Health Professions, UT Southwestern Medical Center, Dallas, TX 75390
| | - Karen McCain
- School of Health Professions, UT Southwestern Medical Center, Dallas, TX 75390
| | - Robert D. Gregg
- Department of Electrical and Computer Engineering, University of Michigan, Ann Arbor, MI, 48105
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Joubran K, Bar-Haim S, Shmuelof L. Dynamic balance recovery in chronic acquired brain injury participants following a perturbation training. Int J Rehabil Res 2021; 44:350-357. [PMID: 34739006 DOI: 10.1097/mrr.0000000000000485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Acquired brain injury (ABI) is defined as a damage to the brain that occurs after birth. Subjects post-ABI frequently suffer from dynamic balance impairments that persist years after the injury. This study aimed to investigate the effect of a perturbation method using mechatronic shoes that introduce unexpected balance perturbations on the recovery of dynamic balance and gait velocity in chronic ABI participants. In an intervention trial, 35 chronic ABI participants (stroke and traumatic brain injury) participated in 22 sessions of perturbation training, twice a week for 3 months. Dynamic balance was assessed pre- and post-training using Community Balance and Mobility Scale (CB&M). Gait velocity was also assessed in the stroke participants using the 10 Meter Walking Test (10MWT). Dynamic balance improved significantly post-training (P = 0.001). This improvement was greater than the improvement that was observed in a sub-group that was tested twice before training (P = 0.04). Sixteen participants (45.7%) out of 35 met or exceeded minimal detectable change (MDC) of the CB&M Scale. Self-paced velocity also improved significantly (P = 0.02) but only two participants (9.5%) out of 21 exceeded the MDC of 10MWT post-stroke. Our results suggest that unexpected balance perturbation training using mechatronic shoes leads to an improvement in dynamic balance and gait velocity in chronic ABI participants. The advantage of perturbation training using mechatronic shoes with respect to conventional balance training should be further examined.
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Affiliation(s)
- Katherin Joubran
- Department of Cognitive and Brain Sciences, Ben-Gurion University of the Negev
- Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev
| | - Simona Bar-Haim
- Department of Physical Therapy, Recanati School for Community Health Professions, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Lior Shmuelof
- Department of Cognitive and Brain Sciences, Ben-Gurion University of the Negev
- Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev
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Li Y, Fan T, Qi Q, Wang J, Qiu H, Zhang L, Wu X, Ye J, Chen G, Long J, Wang Y, Huang G, Li J. Efficacy of a Novel Exoskeletal Robot for Locomotor Rehabilitation in Stroke Patients: A Multi-center, Non-inferiority, Randomized Controlled Trial. Front Aging Neurosci 2021; 13:706569. [PMID: 34497506 PMCID: PMC8419710 DOI: 10.3389/fnagi.2021.706569] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/14/2021] [Indexed: 01/29/2023] Open
Abstract
Objective: To investigate the efficacy and safety of a novel lower-limb exoskeletal robot, BEAR-H1 (Shenzhen Milebot Robot Technology), in the locomotor function of subacute stroke patients. Methods: The present study was approved by the ethical committee of the First Affiliated Hospital of Nanjing Medical University (No. 2019-MD-43), and registration was recorded on the Chinese Clinical Trial Registry with a unique identifier: ChiCTR2100044475. A total of 130 patients within 6 months of stroke were randomly divided into two groups: the robot group and the control group. The control group received routine training for walking, while in the robot group, BEAR-H1 lower-limb exoskeletal robot was used for locomotor training. Both groups received two sessions daily, 5 days a week for 4 weeks consecutively. Each session lasted 30 min. Before treatment, after treatment for 2 weeks, and 4 weeks, the patients were assessed based on the 6-minute walking test (6MWT), functional ambulation scale (FAC), Fugl-Meyer assessment lower-limb subscale (FMA-LE), and Vicon gait analysis. Results: After a 4-week intervention, the results of 6MWT, FMA-LE, FAC, cadence, and gait cycle in the two groups significantly improved (P < 0.05), but there was no significant difference between the two groups (P > 0.05). The ratio of stance phase to that of swing phase, swing phase symmetry ratio (SPSR), and step length symmetry ratio (SLSR) was not significantly improved after 4 weeks of training in both the groups. Further analyses revealed that the robot group exhibited potential benefits, as the point estimates of 6MWT and Δ6MWT (post-pre) at 4 weeks were higher than those in the control group. Additionally, within-group comparison showed that patients in the robot group had a significant improvement in 6MWT earlier than their counterparts in the control group. Conclusions: The rehabilitation robot in this study could improve the locomotor function of stroke patients; however, its effect was no better than conventional locomotor training.
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Affiliation(s)
- Yongqiang Li
- Center of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Tao Fan
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Qi Qi
- Shanghai YangZhi Rehabilitation Hospital, (Shanghai Sunshine Rehabilitation Center), Shanghai, China
| | - Jun Wang
- Guangdong Work Injury Rehabilitation Hospital (Guangdong Work Injury Rehabilitation Center), Guangzhou, China
| | - Huaide Qiu
- Center of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lingye Zhang
- Center of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xixi Wu
- Jiangsu Zhongshan Geriatric Rehabilitation Hospital, Nanjing, China
| | - Jing Ye
- Shenzhen MileBot Robotics Co., Ltd., Shenzhen, China
| | - Gong Chen
- Shenzhen MileBot Robotics Co., Ltd., Shenzhen, China
| | - Jianjun Long
- Department of Rehabilitation Medicine, The Second People's Hospital of Shenzhen, Shenzhen, China
| | - Yulong Wang
- Department of Rehabilitation Medicine, The Second People's Hospital of Shenzhen, Shenzhen, China
| | - Guozhi Huang
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Jianan Li
- Center of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Costa P, De Jesus T, Torriani-Pasin C, Polese J. Functional capacity and walking speed reserve in individuals with chronic stroke: A cross-sectional study. Physiother Theory Pract 2021; 38:2563-2567. [PMID: 34399658 DOI: 10.1080/09593985.2021.1964660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Individuals with stroke experience residual walking disabilities, as the inability to increase walking speed (walking speed reserve - WSR), and frequently present decreasing in functional capacity. The relation between functional capacity and walking ability may contribute to more specific functional management of stroke. OBJECTIVE To investigate the association between WSR and functional capacity in individuals with chronic stroke and compare functional capacity between individuals who can increase walking speed or not. METHODS Cross-sectional study, where functional capacity was assessed with the Duke Activity Status Index (DASI), in metabolic equivalent (METS). WSR was assessed through the difference between fast and self-selected speed (in m/s). The individuals were assigned into two groups: able (WSR ≥ 0.2 m/s) and unable (WSR<0.2 m/s) to increase speed. Pearson's correlation and t test were used for analysis. RESULTS Fifty-five individuals (functional capacity 23 ± 13 METS and WSR 0.3 ± 0.2 m/s) were included. The association between functional capacity and WSR was positive and statistically significant, with moderate magnitude (r = 0.56) (p < .001). Individuals who were unable to increase their walking speed have less functional capacity (17.5 versus 31.3) (p = .003). CONCLUSION Functional capacity has a positive association with WSR in individuals with chronic stroke. The individuals who are unable to increase walking speed present lower functional capacity.
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Affiliation(s)
- Pollyana Costa
- Department Of Physical Therapy, Post Graduate Program Of Health Sciences, Faculdade Ciências Médicas De Minas Gerais, Belo Horizonte, Brazil
| | - Thainá De Jesus
- Department Of Physical Therapy, Post Graduate Program Of Health Sciences, Faculdade Ciências Médicas De Minas Gerais, Belo Horizonte, Brazil
| | - Camila Torriani-Pasin
- School Of Physical Education And Sports, University Of São Paulo. Av. Professor Mello Moraes, São Paulo, Brazil
| | - Janaine Polese
- Department Of Physical Therapy, Post Graduate Program Of Health Sciences, Faculdade Ciências Médicas De Minas Gerais, Belo Horizonte, Brazil
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Parker CJ, Guerin H, Buchanan B, Lewek MD. Targeted verbal cues can immediately alter gait following stroke. Top Stroke Rehabil 2021; 29:382-391. [PMID: 34027831 DOI: 10.1080/10749357.2021.1928840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Physical therapists use verbal cueing extensively during gait rehabilitation. Nevertheless, little is known about the ability of individuals post-stroke to make immediate changes to targeted spatiotemporal gait parameters from verbal commands. Additionally, adequate muscle strength may be necessary to promote positive alterations in gait.Objectives: To determine the influence of targeted verbal cues on spatiotemporal gait parameters for individuals with chronic stroke. Further, we assessed the potential of a relationship between cue-induced gait modifications and paretic lower limb strength.Methods: Using a within-subjects design, twenty-seven adults with chronic stroke walked over a pressure mat with verbal cues to walk at (1) comfortable and (2) fast speeds, with increased (3) arm swing, (4) foot height, (5) step length, (6) push off, and (7) cadence. We also assessed lower extremity strength using a hand-held dynamometer. We measured gait speed, step length, stance time, and cadence for comparisons between conditions and performed correlational analyses to assess the influence of strength on gait alterations.Results: Specific cues elicited increased walking speed, cadence, step lengths and paretic limb stance time. Only greater paretic hip and knee flexion strength was related to the ability to increase cadence when cued to do so (r > 0.41).Conclusion: With targeted verbal cueing, clinicians can improve step length, gait speed, stance time and cadence for individuals with chronic stroke. Lower extremity strength does not appear to be related to the ability to alter gait with verbal cueing in individuals with chronic stroke.
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Affiliation(s)
- Chelsea J Parker
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, United States
| | - Hailey Guerin
- Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, United States
| | - Ben Buchanan
- Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, United States
| | - Michael D Lewek
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, United States.,Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, United States
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Ankle Power Generation Has a Greater Influence on Walking Speed Reserve Than Balance Following Traumatic Brain Injury. J Head Trauma Rehabil 2021; 37:96-103. [PMID: 33935224 DOI: 10.1097/htr.0000000000000684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Reduced walking speed is common following traumatic brain injury (TBI). Walking speed reserve (WSR) refers to the ability to increase walking speed on demand and is calculated as the difference between self-selected and fast walking speeds. Walking speed reserve is important for adaptive functional mobility in the community. Predictors of WSR following TBI are yet to be determined. The aim of the study was to identify whether static balance or ankle power generation (APG) was a stronger predictor of WSR following TBI. SETTING A major metropolitan rehabilitation hospital. PARTICIPANTS A total of 92 individuals receiving inpatient physiotherapy for mobility limitations following TBI were recruited. DESIGN A cross-sectional study. METHODS Walking speed (self-selected and fast), APG, and a summed single-leg stance scores were measured. The ability to increase walking speed on demand by 0.20 m/s or more defined WSR. Correlations, logistic regression, and receiver operating characteristic (ROC) curve analyses were performed to investigate independent relationships between WSR, APG, and static balance. RESULTS Fifty participants (54.3%) had a WSR of 0.20 m/s or more. The strongest predictor of WSR was APG (odds ratio [OR] = 3.34; 95% CI, 1.50-7.43) when compared with static balance (OR = 1.03; 95% CI, 1.01-1.06). The ROC curve demonstrated that APG could accurately discriminate between individuals with a WSR from those without (AUC [area under the ROC curve] = 0.79; 95% CI, 0.70-0.88). The APG cutoff score identified on the curve that maximized combined sensitivity (92.0%) and specificity (54.8%) was 0.75 W/kg. CONCLUSION Following TBI, APG was a stronger predictor of WSR than static balance. Clinicians should consider interventions that preferentially target APG in order to increase WSR for community mobility.
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Cerebellar Transcranial Direct Current Stimulation for Motor Learning in People with Chronic Stroke: A Pilot Randomized Controlled Trial. Brain Sci 2020; 10:brainsci10120982. [PMID: 33327476 PMCID: PMC7764949 DOI: 10.3390/brainsci10120982] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/07/2020] [Accepted: 12/10/2020] [Indexed: 11/16/2022] Open
Abstract
Cerebellar transcranial direct current stimulation (ctDCS) is a non-invasive brain stimulation technique that alters neural plasticity through weak, continuous, direct currents delivered to the cerebellum. This study aimed to evaluate the feasibility of conducting a randomized controlled trial (RCT) delivering three consecutive days of ctDCS during split-belt treadmill training (SBTT) in people with chronic stroke. Using a double-blinded, parallel-group RCT design, eligible participants were randomly allocated to receive either active anodal ctDCS or sham ctDCS combined with SBTT on three consecutive days. Outcomes were assessed at one-week follow-up, using step length symmetry as a measure of motor learning and comfortable over-ground walking speed as a measure of walking capacity. The feasibility of the RCT protocol was evaluated based on recruitment, retention, protocol deviations and data completeness. The feasibility of the intervention was assessed based on safety, adherence and intervention fidelity. Of the 26 potential participants identified over four months, only four were enrolled in the study (active anodal ctDCS n = 1, sham ctDCS n = 3). Both the inclusion criteria and the fidelity of the SBTT relied upon the accurate estimation of step length asymmetry. The method used to determine the side of the step length asymmetry was unreliable and led to deviations in the protocol. The ctDCS intervention was well adhered to, safe, and delivered as per the planned protocol. Motor learning outcomes for individual participants revealed that treadmill step length symmetry remained unchanged for three participants but improved for one participant (sham ctDCS). Comfortable over-ground walking speed improved for two participants (sham ctDCS). The feasibility of the planned protocol and intervention was limited by intra-individual variability in the magnitude and side of the step length asymmetry. This limited the sample and compromised the fidelity of the SBTT intervention. To feasibly conduct a full RCT investigating the effect of ctDCS on locomotor adaptation, a reliable method of identifying and defining step length asymmetry in people with stroke is required. Future ctDCS research should either optimize the methods for SBTT delivery or utilize an alternative motor adaptation task.
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Walking test procedures influence speed measurements in individuals with chronic stroke. Clin Biomech (Bristol, Avon) 2020; 80:105197. [PMID: 33069966 PMCID: PMC7749042 DOI: 10.1016/j.clinbiomech.2020.105197] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 08/26/2020] [Accepted: 10/06/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Walking speed measurements are clinically important, but varying test procedures may influence measurements and impair clinical utility. This study assessed the concurrent validity of walking speed in individuals with chronic stroke measured during the 10-m walk test with variations in 1) the presence of an electronic mat, 2) the speed measurement device, and 3) the measurement distance relative to the total test distance. METHODS Twenty-five individuals with chronic stroke performed walking tests at comfortable and maximal walking speeds under three conditions: 1) 10-m walk test (without electronic mat) measured by stopwatch, 2) 10-m walk test (partially over an electronic mat) measured by software, and 3) 10-m walk test (partially over an electronic mat) measured by stopwatch. Analyses of systematic bias, proportional bias, and absolute agreement were performed to determine concurrent validity between conditions. FINDINGS Walking speeds were not different between measurements (P ≥ 0.11), except maximal walking speed was faster when speed was measured with software vs. stopwatch (P = 0.002). Absolute agreement between measurements was excellent (ICC ≥ 0.97, P < 0.001). There was proportional bias between software vs. stopwatch (R2 ≥ 0.19, P ≤ 0.03) and between tests with vs. without the electronic mat (R2 = 0.27, P = 0.008). Comparisons between conditions revealed that walking speed and concurrent validity may be influenced by walking test distance, presence of an electronic mat, speed measurement device, and relative measurement distance. INTERPRETATION Walking test procedures influence walking speed and concurrent validity between measurements. Waking test procedures should be as similar as possible with normative data or between repeated measurements to optimize validity.
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Improving Spatiotemporal Gait Asymmetry Has Limited Functional Benefit for Individuals Poststroke. J Neurol Phys Ther 2020; 44:197-204. [DOI: 10.1097/npt.0000000000000321] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Treadmill-Based Locomotor Training With Robotic Pelvic Assist and Visual Feedback: A Feasibility Study. J Neurol Phys Ther 2020; 44:205-213. [PMID: 32516301 DOI: 10.1097/npt.0000000000000317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Gait asymmetries are common after stroke, and often persist despite conventional rehabilitation. Robots provide training at a greater practice frequency than conventional approaches. However, prior studies of have found the transfer of learned skills outside of the device to be inadequate. The tethered pelvic assist device (TPAD) promotes weight shifting, yet allows users to independently navigate spatiotemporal aspects of gait. The purpose of this study was to evaluate feasibility and preliminary efficacy of a 5-day intervention combining TPAD training with visual feedback and task-specific overground training to promote improved force and stance symmetry in individuals after stroke. METHODS After baseline assessments, 11 participants chronically after stroke received 1 hour of practice for 5 consecutive days. Training sessions included visual feedback during TPAD treadmill training followed by overground gait training. Safety, perceived exertion, and adherence were recorded as measures of feasibility. Load and stance symmetry were reassessed after the intervention (posttraining) and again 1 week later. RESULTS No adverse events were reported. Mean (SD) perceived exertion (3.61 (0.23)) was low and did not significantly change throughout the intervention. Overall adherence was 96.4%. Load asymmetry was not significantly reduced on the treadmill from baseline to posttraining (P = 0.075). Overground stance symmetry significantly improved on posttraining (F = 8.498, P = 0.002), but was not sustained at follow-up. (See the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A311, which summarizes the study background, methods, and results.) DISCUSSION AND CONCLUSIONS:: Results demonstrate this combined interventional approach was feasible and improved stance symmetry overground, yet further work should consider increasing training intensity and/or duration to induce gains lasting through follow-up.
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Minimal Detectable Change for Gait Speed Depends on Baseline Speed in Individuals With Chronic Stroke. J Neurol Phys Ther 2020; 43:122-127. [PMID: 30702510 DOI: 10.1097/npt.0000000000000257] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Given the heterogeneity of mobility outcomes after stroke, the purpose of this study was to examine how the minimal detectable change (MDC) for gait speed varies based on an individual's baseline walking speed. METHODS Seventy-six participants with chronic stroke and able to walk without therapist assistance participated in 2 visits to record overground self-selected comfortable gait speed (CGS) and fast gait speed (FGS). Based on the CGS at visit 1, participants were assigned to 1 of 3 speed groups: low (<0.4 m/s; n = 32), moderate (0.4-0.8 m/s; n = 29), and high functioning group (>0.8 m/s; n = 15). Participants were then reclassified using updated gait speed cutoffs of 0.49 and 0.93 m/s. For each group, we determined test-retest reliability between visits, and the MDC for CGS and FGS. RESULTS Gait speed significantly increased from visit 1 to visit 2 for each group (P < 0.001). The reliability for CGS declined with increasing gait speed, and MDC95 values increased with increasing gait speed (low: 0.10 m/s; moderate: 0.15 m/s; and high: 0.18 m/s). Similar findings were observed for FGS, and when participants were recoded using alternative thresholds. DISCUSSION AND CONCLUSIONS Slower walkers demonstrated greater consistency in walking speed from day to day, which contributed to a smaller MDC95 than faster walkers. These data will help researchers and clinicians adjust their expectations and goals when working with individuals with chronic stroke. Expectations for changing gait speed should be based on baseline gait speed, and will allow for more appropriate assessments of intervention outcomes. AVAILABLE: for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A253).
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Use of real-time visual feedback during overground walking training on gait symmetry and velocity in patients with post-stroke hemiparesis: randomized controlled, single-blind study. Int J Rehabil Res 2020; 43:247-254. [PMID: 32459669 DOI: 10.1097/mrr.0000000000000419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study aimed to determine the efficacy of using real-time visual feedback during overground walking training to improve walking function in patients with post-stroke hemiparesis. Twenty-four patients with post-stroke hemiparesis who were able to walk independently under less impact of synergy pattern on the affected lower limbs (Brunnstrom stage IV or V) were randomly assigned to either the experimental group or the control group. All subjects performed overground walking for 30 min, three times a week for 6 weeks, with real-time visual feedback (weight load to the affected lower limb) provided during training for subjects in the experimental group. Outcome measures comprised the timed up-and-go test and gait parameters (step length, stride length, single and double support times, step and stride length ratios, and single support time ratio). In between-group comparison, the changes between pre-test and post-test scores in all parameters were significantly greater in the experimental group than in the control group (P < 0.05), except for double support time and step length ratio. Furthermore, post-test values of all parameters were significantly more improved in the experimental group than in the control group (P < 0.05). Our findings suggest that real-time visual feedback may be an advantageous therapeutic adjunct to reinforce the effects of overground walking training in patients with post-stroke hemiparesis.
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Aljuhni R, Cleland BT, Roth S, Madhavan S. Genetic polymorphisms for BDNF, COMT, and APOE do not affect gait or ankle motor control in chronic stroke: A preliminary cross-sectional study. Top Stroke Rehabil 2020; 28:72-80. [PMID: 32378476 DOI: 10.1080/10749357.2020.1762060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Motor deficits after stroke are a primary cause of long-term disability. The extent of functional recovery may be influenced by genetic polymorphisms. Objectives: Determine the effect of genetic polymorphisms for brain-derived neurotrophic factor (BDNF), catechol-O-methyltransferase (COMT), and apolipoprotein E (APOE) on walking speed, walking symmetry, and ankle motor control in individuals with chronic stroke. Methods: 38 participants with chronic stroke were compared based upon genetic polymorphisms for BDNF (presence [MET group] or absence [VAL group] of a Met allele), COMT (presence [MET group] or absence [VAL group] of a Met allele), and APOE (presence [ε4+ group] of absence [ε4- group] of ε4 allele). Comfortable and maximal walking speed were measured with the 10-m walk test. Gait spatiotemporal symmetry was measured with the GAITRite electronic mat; symmetry ratios were calculated for step length, step time, swing time, and stance time. Ankle motor control was measured as the accuracy of performing an ankle tracking task. Results: No significant differences were detected (p ≥ 0.11) between the BDNF, COMT, or APOE groups for any variables. Conclusions: In these preliminary findings, genetic polymorphisms for BDNF, COMT, and APOE do not appear to affect walking speed, walking symmetry, or ankle motor performance in chronic stroke.
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Affiliation(s)
- Rehab Aljuhni
- Brain Plasticity Lab, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago , Chicago, IL, USA
| | - Brice T Cleland
- Brain Plasticity Lab, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago , Chicago, IL, USA
| | - Stephen Roth
- Department of Kinesiology, School of Public Health, University of Maryland , College Park, MD, USA
| | - Sangeetha Madhavan
- Brain Plasticity Lab, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago , Chicago, IL, USA
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Donoghue OA, Savva GM, Börsch-Supan A, Kenny RA. Reliability, measurement error and minimum detectable change in mobility measures: a cohort study of community-dwelling adults aged 50 years and over in Ireland. BMJ Open 2019; 9:e030475. [PMID: 31719075 PMCID: PMC6858113 DOI: 10.1136/bmjopen-2019-030475] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE To estimate the effects of repeat assessments, rater and time of day on mobility measures and to estimate their variation between and within participants in a population-based sample of Irish adults aged ≥50 years. DESIGN Test-retest study in a population representative sample. SETTING Academic health assessment centre of The Irish Longitudinal Study on Ageing (TILDA). PARTICIPANTS 128 community-dwelling adults from the Survey for Health, Ageing and Retirement in Europe (SHARE) Ireland study who agreed to take part in the SHARE-Ireland/TILDA collaboration. INTERVENTIONS Not applicable. OUTCOME MEASURES Participants performed timed up-and-go (TUG), repeated chair stands (RCS) and walking speed tests administered by one of two raters. Repeat assessments were conducted 1-4 months later. Participants were randomised with respect to a change in time (morning, afternoon) and whether the rater was changed between assessments. Within and between-participant variance for each measure was estimated using mixed-effects models. Intraclass correlation (ICC), SE of measurement and minimum detectable change (MDC) were reported. RESULTS Average performance did not vary between baseline and repeat assessments in any test, except RCS. The rater significantly affected performance on all tests except one, but time of day did not. Reliability varied from ICC=0.66 (RCS) to ICC=0.88 (usual gait speed). MDC was 2.08 s for TUG, 4.52 s for RCS and ranged from 19.49 to 34.73 cm/s for walking speed tests. There was no evidence for lower reliability of gait parameters with increasing time between assessments. CONCLUSIONS Reliability varied for each test when measurements are obtained over 1-4 months with most variation due to rater effects. Usual and motor dual task gait speed demonstrated highest reliability.
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Affiliation(s)
- Orna A Donoghue
- The Irish Longitudinal Study on Ageing (TILDA), University of Dublin Trinity College, Dublin, Ireland
| | | | - Axel Börsch-Supan
- Munich Center for the Economics of Aging, Max Planck Institute for Social Law and Social Policy, Munchen, Germany
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing (TILDA), University of Dublin Trinity College, Dublin, Ireland
- Mercer's Institute for Successful Ageing, St. James' Hospital, Dublin, Ireland
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Effects of Load Addition During Gait Training on Weight-Bearing and Temporal Asymmetry After Stroke: A Randomized Clinical Trial. Am J Phys Med Rehabil 2019; 99:250-256. [PMID: 31584453 DOI: 10.1097/phm.0000000000001314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate the effects of adding load to restrain the nonparetic lower limb during gait training on weight-bearing and temporal asymmetry after stroke. DESIGN Thirty-eight subjects were randomized into treadmill training with load (5% of body weight) on the nonparetic limb (experimental group) and treadmill training without load (control group). Interventions lasted 30 mins/d for 2 wks (9 sessions). Both groups performed home-based exercises and were instructed to increase the use of paretic limb in daily life situations. Ground reaction force was obtained by a force plate during standing position (static) and gait (dynamic). Temporal gait parameters were assessed by a motion system analysis. Outcome measures were evaluated at baseline, posttraining, and after a 40-day follow-up. RESULTS The experimental group increased static ground reaction force of the paretic limb at posttraining (P = 0.037) and the control group increased dynamic ground reaction force of the paretic limb at posttraining (P = 0.021), both with maintenance at follow-up. Neither group showed a change in the swing time symmetry ratio after training (P = 0.190). CONCLUSIONS Treadmill training associated with behavioral strategies/home-based exercises seemed to be useful to minimize weight-bearing asymmetry, but not to improve temporal gait asymmetry. Load addition did not show additional benefits.
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Jarvis HL, Brown SJ, Price M, Butterworth C, Groenevelt R, Jackson K, Walker L, Rees N, Clayton A, Reeves ND. Return to Employment After Stroke in Young Adults: How Important Is the Speed and Energy Cost of Walking? Stroke 2019; 50:3198-3204. [PMID: 31554503 PMCID: PMC6824505 DOI: 10.1161/strokeaha.119.025614] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Supplemental Digital Content is available in the text. A quarter of individuals who experience a stroke are under the age of 65 years (defined as young adults), and up to 44% will be unable to return to work poststroke, predominantly because of walking difficulties. No research study has comprehensively analyzed walking performance in young adult’s poststroke. The primary aim of this study is to investigate how a stroke in young adults affects walking performance (eg, walking speed and metabolic cost) compared with healthy age-matched controls. The secondary aim is to determine the predictive ability of walking performance parameters for return to employment poststroke.
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Affiliation(s)
- Hannah L Jarvis
- From the Department of Life Sciences, Research Centre for Musculoskeletal Science and Sports Medicine, Faculty of Science and Engineering, Manchester Metropolitan University, United Kingdom (H.L.J., S.J.B., N.D.R.)
| | - Steven J Brown
- From the Department of Life Sciences, Research Centre for Musculoskeletal Science and Sports Medicine, Faculty of Science and Engineering, Manchester Metropolitan University, United Kingdom (H.L.J., S.J.B., N.D.R.)
| | - Michelle Price
- Powys Teaching Health Board, Neuro Rehabilitation, Newtown Hospital, United Kingdom (M.P.)
| | - Claire Butterworth
- Cardiff and Vale University Health Board, Physiotherapy, Llandough Hospital, United Kingdom (C.B.)
| | - Renee Groenevelt
- Hywel Dda University Health Board, Physiotherapy, Pembrokeshire, Wales, United Kingdom (R.G.)
| | - Karl Jackson
- Betsi Cadwaladr University Health Board, Physiotherapy, Ysbyty Gwynedd, Bangor, Wales, United Kingdom (K.J.)
| | - Louisa Walker
- Cwm Taf University Health Board, Physiotherapy Department, Keir Hardie Health Park, Merthyr Tydfil, Wales, United Kingdom (L.W., N.R.)
| | - Nia Rees
- Cwm Taf University Health Board, Physiotherapy Department, Keir Hardie Health Park, Merthyr Tydfil, Wales, United Kingdom (L.W., N.R.)
| | - Abigail Clayton
- Abertawe Bro Morgannwg University Health Board, Therapy Services, Heol Maes Eglwys, Swansea, Wales, United Kingdom (A.C.)
| | - Neil D Reeves
- From the Department of Life Sciences, Research Centre for Musculoskeletal Science and Sports Medicine, Faculty of Science and Engineering, Manchester Metropolitan University, United Kingdom (H.L.J., S.J.B., N.D.R.)
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Test-retest reliability and minimal detectable change for measures of balance and gait in adults with cerebral palsy. Gait Posture 2019; 72:96-101. [PMID: 31177021 DOI: 10.1016/j.gaitpost.2019.05.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 05/14/2019] [Accepted: 05/26/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Walking and balance often begin to deteriorate in ambulant adults with cerebral palsy (CP) in early adulthood. The decline in walking and balance imposes a more sedentary lifestyle, increases falls risk, negatively affects health, participation, and quality of life, and ultimately results in increased disability. Available research is not sufficient to guide interventions to improve walking and balance in this population. To advance research in this area, there is a need for measures of gait and balance with proven psychometrics for adults with CP. RESEARCH QUESTION The goal of this study was to determine test-retest reliability and minimal detectable change (MDC) values and to assess score distribution for the Balance Evaluation Systems Test (BESTest) and the Four Square Step Test (FSST) as measures of balance, for the Activities-specific Balance Confidence (ABC) Scale and the Modified Fall Efficacy Scale (MFES) as measures of balance confidence, and for over-ground spatiotemporal gait parameters at comfortable gait speed (CGS) and fast gait speed (FGS). METHODS Twenty ambulant adults with CP (mean age 32.7 years), GMFCS-E&R Levels I and II, were tested twice within an average of 10 days. Test-retest reliability was evaluated using intra-class correlation coefficients (ICC2,1), and MDC95 values were calculated using standard error of measurement values. RESULTS The test-retest reliability of most outcome measures was good to excellent. ICC values were: BESTest = 0.99, BESTest sections 0.88 to 0.98, FSST = 0.91, ABC=0.86, MFES = 0.9, CGS = 0.88, and FGS = 0.98. MDC values were: BESTest total = 4.9%, BESTest sections 8.7%-21.2%, FSST = 3.7 s, ABC = 18%, MFES = 1 point, CGS = 0.26 m/s, and FGS = 0.14 m/s. Most outcome scores were broadly distributed over scales ranges. SIGNIFICANCE Adults with CP demonstrated stable test-retest performance on the selected measures. These measures could be useful to assess balance and gait of adults with CP. The MDC values can help evaluate whether observed changes exceed the expected random test-retest variations.
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Arcolin I, Corna S, Giardini M, Giordano A, Nardone A, Godi M. Proposal of a new conceptual gait model for patients with Parkinson's disease based on factor analysis. Biomed Eng Online 2019; 18:70. [PMID: 31159825 PMCID: PMC6547597 DOI: 10.1186/s12938-019-0689-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 05/27/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Gait impairment is a risk factor for falls in patients with Parkinson's disease (PD). Gait can be conveniently assessed by electronic walkways, but there is need to select which spatiotemporal gait variables are useful for assessing gait in PD. Existing models for gait variables developed in healthy subjects and patients with PD show some methodological shortcomings in their validation through exploratory factor analysis (EFA), and were never confirmed by confirmatory factor analysis (CFA). The aims of this study were (1) to create a new model of gait for PD through EFA, (2) to analyze the factorial structure of our new model and compare it with existing models through CFA. RESULTS From the 37 variables initially considered in 250 patients with PD, 10 did not show good-to-excellent reliability and were eliminated, while further 19 were eliminated after correlation matrix and Kaiser-Meyer-Olkin measure. The remaining eight variables underwent EFA and three factors emerged: pace/rhythm, variability, and asymmetry. Structural validity of our new model was then examined with CFA, using the structural equation modeling. After some modifications, suggested by the Modification Indices, we obtained a final model that showed an excellent fit. In contrast, when the structure of previous models of gait was analyzed, no model achieved convergence with our sample of patients. CONCLUSIONS Our model for spatiotemporal gait variables of patients with PD is the first to be developed through an accurate EFA and confirmed by CFA. It contains eight gait variables divided into three factors and shows an excellent fit. Reasons for the non-convergence of other models could be their inclusion of highly inter-correlated or low-reliability variables or could be possibly due to the fact that they did not use more recent methods for determining the number of factors to extract.
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Affiliation(s)
- Ilaria Arcolin
- Istituti Clinici Scientifici Maugeri Spa SB (IRCCS), Pavia, Italy
| | - Stefano Corna
- Istituti Clinici Scientifici Maugeri Spa SB (IRCCS), Pavia, Italy
| | - Marica Giardini
- Istituti Clinici Scientifici Maugeri Spa SB (IRCCS), Pavia, Italy
| | - Andrea Giordano
- Istituti Clinici Scientifici Maugeri Spa SB (IRCCS), Pavia, Italy
| | - Antonio Nardone
- Istituti Clinici Scientifici Maugeri Spa SB (IRCCS), Pavia, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Marco Godi
- Istituti Clinici Scientifici Maugeri Spa SB (IRCCS), Pavia, Italy
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Huang WY, Tuan SH, Li MH, Liu XY, Hsu PT. Immediate effects of a novel walking assist device with auxiliary illuminator on patients after acute strokes. Hong Kong Physiother J 2019; 39:115-124. [PMID: 31889762 PMCID: PMC6900335 DOI: 10.1142/s1013702519500100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 04/02/2019] [Accepted: 04/08/2019] [Indexed: 11/18/2022] Open
Abstract
Background: Many patients after acute stage of stroke are present with abnormal gait pattern due to weakness or hypertonicity of the affected limbs. Facilitation of normal gait is a primary goal of rehabilitation on these patients. Objective: We aimed to investigate whether walking assist device with auxiliary illuminator (quad-cane with laser) providing visual feedback during ambulation could improve parameters of gait cycle immediately among patients with subacute and chronic stroke. Methods: This was a cross-sectional study and 30 participants (male 23, female 7, group 1) with mean age 60.20±11.12 years were recruited. Among them, 22 used ankle-foot orthosis [(AFO), group 2] and 8 did not use AFO (group 3) at usual walking. All the participants walked along a strait corridor with even surface for 20 m without and with using a quad-cane with laser, respectively. A gait analyzer (Reha-Watch1 system) was used to measure the changes of the parameters of gait cycle, including stride length, cadence, gait speed, stance phase, swing phase, duration of single support and double support, the angle between toes and the ground at the time of toe-off (the toe-off angle) and the angle between calcaneus and the ground at the time of heel-strike (the heel-strike angle), before and with the use of a quad-cane with laser. Results: The increase in the heel-strike angle reached a significant difference in groups 1 2, and 3 (p=0.02,<0.01, and =0.05, respectively). However, the stride length, the gait speed, the cadence, percentage of the stance phase, swing phase, single-support phase, and double-support phase in a gait cycle, and the toe-off angle showed no significant change with the use of quad-cane with laser. Conclusion: Patients after acute stroke had an immediate and significant increase in the heel-stroke angle by using a quad-cane with laser during ambulation, which might help the patients to reduce knee hyperextension moment and lessen the pressure of heel at loading phase.
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Affiliation(s)
- Wan-Yun Huang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,National Cheng Kung University, Institute of Allied Health Sciences, Tainan, Taiwan
| | - Sheng-Hui Tuan
- Department of Rehabilitation Medicine, Cishan Hospital, Ministry of Health and Welfare, Kaohsiung, Taiwan
| | - Min-Hui Li
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Graduate Institute of Aerospace and Undersea Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Xin-Yu Liu
- Department of Kinesiology, Health, and Leisure Studies, National University of Kaohsiung, Kaohsiung, Taiwan
| | - Pei-Te Hsu
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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Chen IH, Yang YR, Lu CF, Wang RY. Novel gait training alters functional brain connectivity during walking in chronic stroke patients: a randomized controlled pilot trial. J Neuroeng Rehabil 2019; 16:33. [PMID: 30819259 PMCID: PMC6396471 DOI: 10.1186/s12984-019-0503-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 02/22/2019] [Indexed: 01/08/2023] Open
Abstract
Background A recent study has demonstrated that a turning-based treadmill program yields greater improvements in gait speed and temporal symmetry than regular treadmill training in chronic stroke patients. However, it remains unknown how this novel and challenging gait training shapes the cortico-cortical network and cortico-spinal network during walking in chronic stroke patients. The purpose of this study was to examine how a novel type of gait training, which is an unfamiliar but effective task for people with chronic stroke, enhances brain reorganization. Methods Subjects in the experimental and control groups received 30 min of turning-based treadmill training and regular treadmill training, respectively. Cortico-cortical connectivity and cortico-muscular connectivity during walking and gait performance were assessed before and after completing the 12-session training. Results Eighteen subjects (n = 9 per group) with a mean age of 52.5 ± 9.7 years and an overground walking speed of 0.61 ± 0.26 m/s consented and participated in this study. There were significant group by time interactions for gait speed, temporal gait symmetry, and cortico-cortical connectivity as well as cortico-muscular connectivity in walk-related frequency (24–40 Hz) over the frontal-central-parietal areas. Compared with the regular treadmill training, the turning-based treadmill training resulted in greater improvements in these measures. Moreover, the increases in cortico-cortical connectivity and cortico-muscular connectivity while walking were associated with improvements in temporal gait symmetry. Conclusions Our findings suggest this novel turning-based treadmill training is effective for enhancing brain functional reorganization underlying cortico-cortical and corticomuscular mechanisms and thus may result in gait improvement in people with chronic stroke. Trial registration ACTRN12617000190303. Registered 3 February 2017, retrospectively registered.
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Affiliation(s)
- I-Hsuan Chen
- Department of Physical Therapy, Fooyin University, Kaohsiung, Taiwan
| | - Yea-Ru Yang
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, 155, Sec 2, Li Nong St., Shih-Pai, Taipei, 112, Taiwan
| | - Chia-Feng Lu
- Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Ray-Yau Wang
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, 155, Sec 2, Li Nong St., Shih-Pai, Taipei, 112, Taiwan.
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30
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Lewek MD, Raiti C, Doty A. The Presence of a Paretic Propulsion Reserve During Gait in Individuals Following Stroke. Neurorehabil Neural Repair 2019; 32:1011-1019. [PMID: 30558525 DOI: 10.1177/1545968318809920] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The residual hemiparesis after stroke results in a unilateral reduction in propulsive force during gait. Prior work has suggested the presence of a propulsive reserve in the paretic limb. OBJECTIVE The purpose of this study was to quantify the paretic propulsive reserve in individuals poststroke and to determine the biomechanical mechanism underlying the generation of additional paretic propulsive limb force. METHODS Ten individuals with chronic hemiparesis poststroke walked on a treadmill against an impeding force (ascending 0% to 10% body weight [BW], in 2.5% BW increments, followed by descending 10% to 0% BW, also in 2.5% BW increments) applied to the body's center of mass. The resulting propulsive forces were measured bilaterally and compared between impeding force levels. We then assessed potential mechanisms (trailing limb angle and plantarflexion moment) underlying the changes in propulsion. RESULTS Overall, peak paretic propulsive force increased by 92% and the paretic propulsive impulse increased by 225%, resulting in a significant increase in the paretic limb's contribution to propulsion. Participants continued to produce increased paretic propulsion on removal of the impeding force. The trailing limb angle contributed significantly to the increase in paretic propulsion, whereas the plantarflexion moment did not. CONCLUSIONS Participants exhibited a robust propulsive reserve on the paretic limb, suggesting that there is untapped potential that can be exploited through rehabilitation to improve gait recovery. The increase in propulsive symmetry indicates that a greater response was observed by the paretic limb rather than increased compensation by the nonparetic limb.
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Affiliation(s)
- Michael D Lewek
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Cristina Raiti
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Amanda Doty
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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31
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Faras TJ, Laporte MD, Sandoval R, Najjar F, Ade V, Stubbs P. The effect of unilateral blood flow restriction on temporal and spatial gait parameters. Heliyon 2019; 5:e01146. [PMID: 30723827 PMCID: PMC6350218 DOI: 10.1016/j.heliyon.2019.e01146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 12/05/2018] [Accepted: 01/15/2019] [Indexed: 12/15/2022] Open
Abstract
Blood flow restriction walking (BFR-W) is becoming more frequently used in aerobic and strength training and it has been proposed that BFR-W can be used in clinical populations. BFR-W may change gait stability yet few studies have assessed gait changes during or following BFR-W. The aim of this study was to assess if spatial-temporal gait parameters change during and following BFR-W. Twenty-four participants completed two walking sessions (>48-hours apart); 1) Unilateral BFR-W applied at the dominant thigh, 2) walking without BFR. In each session participants performed a 5-min warmup, 15-min walking intervention and 10-min active recovery. The warmup and active recovery were performed without BFR on both days. Measurements were attained at baseline, during the intervention and post-intervention using the GAITRite®. Linear mixed models were applied to each measured variable. Fixed factors were timepoint (warmup, intervention, and active recovery), condition (BFR-W and control walking) and condition × timepoint. Random factors were subject and subject × condition. Participants took shorter (3.2-cm (mean difference), CI95%: 0.8–5.6-cm) and wider strides (1.4-cm, CI95%: 0.9–1.9-cm) during BFR-W. For single leg measures, participants took shorter steps (2.8-cm, CI95%: 1.7–4.0-cm) with a faster single support time (7.5-ms, CI95%: 2.9–12.0-ms) on the non-dominant (unoccluded) leg during BFR-W compared to the non-dominant leg during control walking. There were no differences in step length and single support time between the dominant (occluded) leg during BFR-W compared to the dominant leg during control walking. There were no significant changes in velocity, cadence or double support time between BFR-W and control walking (P > 0.05). BFR-W caused small transient changes to several gait parameters. These changes should be considered when using BFR-W in clinical populations.
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Affiliation(s)
- Timothy John Faras
- Discipline of Physiotherapy, Department of Health Professions, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Michael David Laporte
- Discipline of Physiotherapy, Department of Health Professions, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Remi Sandoval
- Discipline of Physiotherapy, Department of Health Professions, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Fadi Najjar
- Discipline of Physiotherapy, Department of Health Professions, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Vanessa Ade
- Discipline of Physiotherapy, Department of Health Professions, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Peter Stubbs
- Discipline of Physiotherapy, Department of Health Professions, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.,Hammel Neurorehabilitation and Research Center, Aarhus University, Hammel, Denmark.,Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, Australia
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32
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Rozanski GM, Wong JS, Inness EL, Patterson KK, Mansfield A. Longitudinal change in spatiotemporal gait symmetry after discharge from inpatient stroke rehabilitation. Disabil Rehabil 2019; 42:705-711. [DOI: 10.1080/09638288.2018.1508508] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Gabriela M. Rozanski
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Jennifer S. Wong
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Elizabeth L. Inness
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Kara K. Patterson
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Avril Mansfield
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
- Evaluative Clinical Sciences, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
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33
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Betschart M, McFayden BJ, Nadeau S. Lower limb joint moments on the fast belt contribute to a reduction of step length asymmetry over ground after split-belt treadmill training in stroke: A pilot study. Physiother Theory Pract 2018; 36:989-999. [DOI: 10.1080/09593985.2018.1530708] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Martina Betschart
- Centre de Recherche Interdisciplinaire en Réadaptation (CRIR), Institut de Réadaptation Gingras-Lindsay de Montréal (IRGLM), CIUSSS Centre-Sud-de-l’Île-de-Montréal, Québec, Canada
- École de Réadaptation, Université de Montréal, Québec, Canada
| | - Bradford J. McFayden
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (CIRRIS), CIUSSS de la Capitale-Nationale, Québec, Canada
- Département de Réadaptation, Faculté de Médecine, Université de Laval, Québec, Canada
| | - Sylvie Nadeau
- Centre de Recherche Interdisciplinaire en Réadaptation (CRIR), Institut de Réadaptation Gingras-Lindsay de Montréal (IRGLM), CIUSSS Centre-Sud-de-l’Île-de-Montréal, Québec, Canada
- École de Réadaptation, Université de Montréal, Québec, Canada
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Washabaugh EP, Krishnan C. A wearable resistive robot facilitates locomotor adaptations during gait. Restor Neurol Neurosci 2018. [PMID: 29526856 DOI: 10.3233/rnn-170782] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Robotic-resisted treadmill walking is a form of task-specific training that has been used to improve gait function in individuals with neurological injury, such as stroke, spinal cord injury, or cerebral palsy. Traditionally, these devices use active elements (e.g., motors or actuators) to provide resistance during walking, making them bulky, expensive, and less suitable for overground or in-home rehabilitation. We recently developed a low-cost, wearable robotic brace that generates resistive torques across the knee joint using a simple magnetic brake. However, the possible effects of training with this device on gait function in a clinical population are currently unknown. OBJECTIVE The purpose of this study was to test the acute effects of resisted walking with this device on kinematics, muscle activation patterns, and gait velocity in chronic stroke survivors. METHODS Six stroke survivors wore the resistive brace and walked on a treadmill for 20 minutes (4×5 minutes) at their self-selected walking speed while simultaneously performing a foot trajectory-tracking task to minimize stiff-knee gait. Electromyography, sagittal plane gait kinematics, and overground gait velocity were collected to evaluate the acute effects of the device on gait function. RESULTS Robotic-resisted treadmill training resulted in a significant increase in quadriceps and hamstring EMG activity during walking. Significant aftereffects (i.e., improved joint excursions) were also observed on the hip and knee kinematics, which persisted for several steps after training. More importantly, training resulted in significant improvements in overground gait velocity. These results were consistent in all the subjects tested. CONCLUSION This study provides preliminary evidence indicating that robotic-resisted treadmill walking using our knee brace can result in meaningful biomechanical aftereffects that translate to overground walking.
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Affiliation(s)
- Edward P Washabaugh
- Department of Physical Medicine and Rehabilitation, NeuRRo Lab, Michigan Medicine, Ann Arbor, MI, USA.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Chandramouli Krishnan
- Department of Physical Medicine and Rehabilitation, NeuRRo Lab, Michigan Medicine, Ann Arbor, MI, USA.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
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35
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Yeung LF, Ockenfeld C, Pang MK, Wai HW, Soo OY, Li SW, Tong KY. Randomized controlled trial of robot-assisted gait training with dorsiflexion assistance on chronic stroke patients wearing ankle-foot-orthosis. J Neuroeng Rehabil 2018; 15:51. [PMID: 29914523 PMCID: PMC6006663 DOI: 10.1186/s12984-018-0394-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 06/11/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Robot-assisted ankle-foot-orthosis (AFO) can provide immediate powered ankle assistance in post-stroke gait training. Our research team has developed a novel lightweight portable robot-assisted AFO which is capable of detecting walking intentions using sensor feedback of wearer's gait pattern. This study aims to investigate the therapeutic effects of robot-assisted gait training with ankle dorsiflexion assistance. METHODS This was a double-blinded randomized controlled trial. Nineteen chronic stroke patients with motor impairment at ankle participated in 20-session robot-assisted gait training for about five weeks, with 30-min over-ground walking and stair ambulation practices. Robot-assisted AFO either provided active powered ankle assistance during swing phase in Robotic Group (n = 9), or torque impedance at ankle joint as passive AFO in Sham Group (n = 10). Functional assessments were performed before and after the 20-session gait training with 3-month Follow-up. Primary outcome measure was gait independency assessed by Functional Ambulatory Category (FAC). Secondary outcome measures were clinical scores including Fugl-Meyer Assessment (FMA), Modified Ashworth Scale (MAS), Berg Balance Scale (BBS), Timed 10-Meter Walk Test (10MWT), Six-minute Walk Test (SMWT), supplemented by gait analysis. All outcome measures were performed in unassisted gait after patients had taken off the robot-assisted AFO. Repeated-measures analysis of covariance was conducted to test the group differences referenced to clinical scores before training. RESULTS After 20-session robot-assisted gait training with ankle dorsiflexion assistance, the active ankle assistance in Robotic Group induced changes in gait pattern with improved gait independency (all patients FAC ≥ 5 post-training and 3-month follow-up), motor recovery, walking speed, and greater confidence in affected side loading response (vertical ground reaction force + 1.49 N/kg, peak braking force + 0.24 N/kg) with heel strike instead of flat foot touch-down at initial contact (foot tilting + 1.91°). Sham Group reported reduction in affected leg range of motion (ankle dorsiflexion - 2.36° and knee flexion - 8.48°) during swing. CONCLUSIONS Robot-assisted gait training with ankle dorsiflexion assistance could improve gait independency and help stroke patients developing confidence in weight acceptance, but future development of robot-assisted AFO should consider more lightweight and custom-fit design. TRIAL REGISTRATION ClinicalTrials.gov NCT02471248 . Registered 15 June 2015 retrospectively registered.
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Affiliation(s)
- Ling-Fung Yeung
- Department of Biomedical Engineering, The Chinese University of Hong Kong, ShaTin, Hong Kong
| | - Corinna Ockenfeld
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Man-Kit Pang
- Industrial Centre, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Hon-Wah Wai
- Industrial Centre, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Oi-Yan Soo
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Ma Liu Shui, Hong Kong
| | - Sheung-Wai Li
- Division of Rehabilitation, Department of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Kai-Yu Tong
- Department of Biomedical Engineering, The Chinese University of Hong Kong, ShaTin, Hong Kong
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36
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Patterson KK, Wong JS, Nguyen TU, Brooks D. A dance program to improve gait and balance in individuals with chronic stroke: a feasibility study. Top Stroke Rehabil 2018; 25:410-416. [DOI: 10.1080/10749357.2018.1469714] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Kara K. Patterson
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Jennifer S. Wong
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Thi-Ut Nguyen
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Dina Brooks
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada
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Peters DM, Fridriksson J, Stewart JC, Richardson JD, Rorden C, Bonilha L, Middleton A, Gleichgerrcht E, Fritz SL. Cortical disconnection of the ipsilesional primary motor cortex is associated with gait speed and upper extremity motor impairment in chronic left hemispheric stroke. Hum Brain Mapp 2017; 39:120-132. [PMID: 28980355 DOI: 10.1002/hbm.23829] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 09/14/2017] [Accepted: 09/18/2017] [Indexed: 12/11/2022] Open
Abstract
Advances in neuroimaging have enabled the mapping of white matter connections across the entire brain, allowing for a more thorough examination of the extent of white matter disconnection after stroke. To assess how cortical disconnection contributes to motor impairments, we examined the relationship between structural brain connectivity and upper and lower extremity motor function in individuals with chronic stroke. Forty-three participants [mean age: 59.7 (±11.2) years; time poststroke: 64.4 (±58.8) months] underwent clinical motor assessments and MRI scanning. Nonparametric correlation analyses were performed to examine the relationship between structural connectivity amid a subsection of the motor network and upper/lower extremity motor function. Standard multiple linear regression analyses were performed to examine the relationship between cortical necrosis and disconnection of three main cortical areas of motor control [primary motor cortex (M1), premotor cortex (PMC), and supplementary motor area (SMA)] and motor function. Anatomical connectivity between ipsilesional M1/SMA and the (1) cerebral peduncle, (2) thalamus, and (3) red nucleus were significantly correlated with upper and lower extremity motor performance (P ≤ 0.003). M1-M1 interhemispheric connectivity was also significantly correlated with gross manual dexterity of the affected upper extremity (P = 0.001). Regression models with M1 lesion load and M1 disconnection (adjusted for time poststroke) explained a significant amount of variance in upper extremity motor performance (R2 = 0.36-0.46) and gait speed (R2 = 0.46), with M1 disconnection an independent predictor of motor performance. Cortical disconnection, especially of ipsilesional M1, could significantly contribute to variability seen in locomotor and upper extremity motor function and recovery in chronic stroke. Hum Brain Mapp 39:120-132, 2018. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Denise M Peters
- Department of Exercise Science, Physical Therapy Program, University of South Carolina, 921 Assembly Street, Columbia, South Carolina
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina, 915 Greene Street, Columbia, South Carolina
| | - Jill C Stewart
- Department of Exercise Science, Physical Therapy Program, University of South Carolina, 921 Assembly Street, Columbia, South Carolina
| | - Jessica D Richardson
- Department of Communication Sciences and Disorders, University of South Carolina, 915 Greene Street, Columbia, South Carolina
| | - Chris Rorden
- Department of Psychology, University of South Carolina, 1512 Pendleton Street, Columbia, South Carolina
| | - Leonardo Bonilha
- Department of Neurology, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, South Carolina
| | - Addie Middleton
- Department of Exercise Science, Physical Therapy Program, University of South Carolina, 921 Assembly Street, Columbia, South Carolina
| | - Ezequiel Gleichgerrcht
- Department of Neurology, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, South Carolina
| | - Stacy L Fritz
- Department of Exercise Science, Physical Therapy Program, University of South Carolina, 921 Assembly Street, Columbia, South Carolina
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Betschart M, McFadyen BJ, Nadeau S. Repeated split-belt treadmill walking improved gait ability in individuals with chronic stroke: A pilot study. Physiother Theory Pract 2017; 34:81-90. [DOI: 10.1080/09593985.2017.1375055] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Martina Betschart
- Centre de recherche interdisciplinaire en réadaptation (CRIR), Institut de réadaptation Gingras-Lindsay de Montréal (IRGLM), CIUSSS Centre-Sud-de-l’Île-de-Montréal, Québec, Canada
- École de réadaptation, Université de Montréal, Québec, Canada
| | - Bradford J McFadyen
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), CIUSSS de la capitale-nationale, Québec, Canada
- Département de réadaptation, Faculté de médecine, Université de Laval, Québec, Québec, Canada
| | - Sylvie Nadeau
- Centre de recherche interdisciplinaire en réadaptation (CRIR), Institut de réadaptation Gingras-Lindsay de Montréal (IRGLM), CIUSSS Centre-Sud-de-l’Île-de-Montréal, Québec, Canada
- École de réadaptation, Université de Montréal, Québec, Canada
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Wright RL, Brownless SB, Pratt D, Sackley CM, Wing AM. Stepping to the Beat: Feasibility and Potential Efficacy of a Home-Based Auditory-Cued Step Training Program in Chronic Stroke. Front Neurol 2017; 8:412. [PMID: 28878730 PMCID: PMC5572237 DOI: 10.3389/fneur.2017.00412] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 07/31/2017] [Indexed: 11/24/2022] Open
Abstract
Background Hemiparesis after stroke typically results in a reduced walking speed, an asymmetrical gait pattern and a reduced ability to make gait adjustments. The purpose of this pilot study was to investigate the feasibility and preliminary efficacy of home-based training involving auditory cueing of stepping in place. Methods Twelve community-dwelling participants with chronic hemiparesis completed two 3-week blocks of home-based stepping to music overlaid with an auditory metronome. Tempo of the metronome was increased 5% each week. One 3-week block used a regular metronome, whereas the other 3-week block had phase shift perturbations randomly inserted to cue stepping adjustments. Results All participants reported that they enjoyed training, with 75% completing all training blocks. No adverse events were reported. Walking speed, Timed Up and Go (TUG) time and Dynamic Gait Index (DGI) scores (median [inter-quartile range]) significantly improved between baseline (speed = 0.61 [0.32, 0.85] m⋅s−1; TUG = 20.0 [16.0, 39.9] s; DGI = 14.5 [11.3, 15.8]) and post stepping training (speed = 0.76 [0.39, 1.03] m⋅s−1; TUG = 16.3 [13.3, 35.1] s; DGI = 16.0 [14.0, 19.0]) and was maintained at follow-up (speed = 0.75 [0.41, 1.03] m⋅s−1; TUG = 16.5 [12.9, 34.1] s; DGI = 16.5 [13.5, 19.8]). Conclusion This pilot study suggests that auditory-cued stepping conducted at home was feasible and well-tolerated by participants post-stroke, with improvements in walking and functional mobility. No differences were detected between regular and phase-shift training with the metronome at each assessment point.
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Affiliation(s)
- Rachel L Wright
- School of Psychology, University of Birmingham, Birmingham, United Kingdom.,School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | | | - David Pratt
- West Midlands Rehabilitation Centre, Birmingham Community Healthcare Trust, Birmingham, United Kingdom
| | - Catherine M Sackley
- Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Alan M Wing
- School of Psychology, University of Birmingham, Birmingham, United Kingdom
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Lewek MD, Braun CH, Wutzke C, Giuliani C. The role of movement errors in modifying spatiotemporal gait asymmetry post stroke: a randomized controlled trial. Clin Rehabil 2017; 32:161-172. [PMID: 28750549 DOI: 10.1177/0269215517723056] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Current rehabilitation to improve gait symmetry following stroke is based on one of two competing motor learning strategies: minimizing or augmenting symmetry errors. We sought to determine which of those motor learning strategies best improves overground spatiotemporal gait symmetry. DESIGN Randomized controlled trial. SETTING Rehabilitation research lab. SUBJECTS In all, 47 participants (59 ± 12 years old) with chronic hemiparesis post stroke and spatiotemporal gait asymmetry were randomized to error augmentation, error minimization, or conventional treadmill training (control) groups. INTERVENTIONS To augment or minimize asymmetry on a step-by-step basis, we developed a responsive, "closed-loop" control system, using a split-belt instrumented treadmill that continuously adjusted the difference in belt speeds to be proportional to the patient's current asymmetry. MAIN MEASURES Overground spatiotemporal asymmetries and gait speeds were collected prior to and following 18 training sessions. RESULTS Step length asymmetry reduced after training, but stance time did not. There was no group × time interaction. Gait speed improved after training, but was not affected by type of asymmetry, or group. Of those who trained to modify step length asymmetry, there was a moderately strong linear relationship between the change in step length asymmetry and the change in gait speed. CONCLUSION Augmenting errors was not superior to minimizing errors or providing only verbal feedback during conventional treadmill walking. Therefore, the use of verbal feedback to target spatiotemporal asymmetry, which was common to all participants, appears to be sufficient to reduce step length asymmetry. Alterations in stance time asymmetry were not elicited in any group.
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Affiliation(s)
- Michael D Lewek
- 1 Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Carty H Braun
- 2 UNC Health Care System, Chapel Hill, NC, USA.,3 Children's Hospital of Atlanta, Atlanta, GA, USA
| | - Clint Wutzke
- 4 Human Movement Science Program, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,5 Department of Rehabilitation Science, George Mason University, Fairfax, VA, USA
| | - Carol Giuliani
- 1 Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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41
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Lee ME, Jo GY, Do HK, Choi HE, Kim WJ. Efficacy of Aquatic Treadmill Training on Gait Symmetry and Balance in Subacute Stroke Patients. Ann Rehabil Med 2017; 41:376-386. [PMID: 28758074 PMCID: PMC5532342 DOI: 10.5535/arm.2017.41.3.376] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 09/09/2016] [Indexed: 11/24/2022] Open
Abstract
Objective To determine the efficacy of aquatic treadmill training (ATT) as a new modality for stroke rehabilitation, by assessing changes in gait symmetry, balance function, and subjective balance confidence for the paretic and non-paretic leg in stroke patients. Methods Twenty-one subacute stroke patients participated in 15 intervention sessions of aquatic treadmill training. The Comfortable 10-Meter Walk Test (CWT), spatiotemporal gait parameters, Berg Balance Scale (BBS), and Activities-specific Balance Confidence scale (ABC) were assessed pre- and post-interventions. Results From pre- to post-intervention, statistically significant improvements were observed in the CWT (0.471±0.21 to 0.558±0.23, p<0.001), BBS (39.66±8.63 to 43.80±5.21, p<0.001), and ABC (38.39±13.46 to 46.93±12.32, p<0.001). The step-length symmetry (1.017±0.25 to 0.990±0.19, p=0.720) and overall temporal symmetry (1.404±0.36 to 1.314±0.34, p=0.218) showed improvement without statistical significance. Conclusion ATT improves the functional aspects of gait, including CWT, BBS and ABC, and spatiotemporal gait symmetry, though without statistical significance. Further studies are required to examine and compare the potential benefits of ATT as a new modality for stroke therapy, with other modalities.
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Affiliation(s)
- Mi Eun Lee
- Department of Physical Medicine and Rehabilitation, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Geun Yeol Jo
- Department of Physical Medicine and Rehabilitation, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hwan Kwon Do
- Department of Physical Medicine and Rehabilitation, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hee Eun Choi
- Department of Physical Medicine and Rehabilitation, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Woo Jin Kim
- Department of Physical Medicine and Rehabilitation, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
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Kumar DS, Reisman DS, Galloway JC. Go baby go café: a case study on an immersive rehabilitation environment to improve functional outcomes and quality of life. Disabil Rehabil 2017; 40:2343-2350. [DOI: 10.1080/09638288.2017.1334235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Devina S. Kumar
- Biomechanics and Movement Science, Physical Therapy, University of Delaware, Newark, DE, USA
| | - Darcy S. Reisman
- Biomechanics and Movement Science, Physical Therapy, University of Delaware, Newark, DE, USA
| | - James C. Galloway
- Biomechanics and Movement Science, Physical Therapy, University of Delaware, Newark, DE, USA
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Washabaugh EP, Kalyanaraman T, Adamczyk PG, Claflin ES, Krishnan C. Validity and repeatability of inertial measurement units for measuring gait parameters. Gait Posture 2017; 55:87-93. [PMID: 28433867 PMCID: PMC5507609 DOI: 10.1016/j.gaitpost.2017.04.013] [Citation(s) in RCA: 198] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 04/07/2017] [Accepted: 04/10/2017] [Indexed: 02/02/2023]
Abstract
Inertial measurement units (IMUs) are small wearable sensors that have tremendous potential to be applied to clinical gait analysis. They allow objective evaluation of gait and movement disorders outside the clinic and research laboratory, and permit evaluation on large numbers of steps. However, repeatability and validity data of these systems are sparse for gait metrics. The purpose of this study was to determine the validity and between-day repeatability of spatiotemporal metrics (gait speed, stance percent, swing percent, gait cycle time, stride length, cadence, and step duration) as measured with the APDM Opal IMUs and Mobility Lab system. We collected data on 39 healthy subjects. Subjects were tested over two days while walking on a standard treadmill, split-belt treadmill, or overground, with IMUs placed in two locations: both feet and both ankles. The spatiotemporal measurements taken with the IMU system were validated against data from an instrumented treadmill, or using standard clinical procedures. Repeatability and minimally detectable change (MDC) of the system was calculated between days. IMUs displayed high to moderate validity when measuring most of the gait metrics tested. Additionally, these measurements appear to be repeatable when used on the treadmill and overground. The foot configuration of the IMUs appeared to better measure gait parameters; however, both the foot and ankle configurations demonstrated good repeatability. In conclusion, the IMU system in this study appears to be both accurate and repeatable for measuring spatiotemporal gait parameters in healthy young adults.
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Affiliation(s)
- Edward P Washabaugh
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Tarun Kalyanaraman
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Peter G Adamczyk
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Edward S Claflin
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Chandramouli Krishnan
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.
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Yoshikawa K, Mizukami M, Kawamoto H, Sano A, Koseki K, Sano K, Asakawa Y, Kohno Y, Nakai K, Gosho M, Tsurushima H. Gait training with Hybrid Assistive Limb enhances the gait functions in subacute stroke patients: A pilot study. NeuroRehabilitation 2017; 40:87-97. [PMID: 27814305 DOI: 10.3233/nre-161393] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The robotic Hybrid Assistive Limb (HAL) provides motion according to the wearer's voluntary activity. HAL training effects on walking speed and capacity have not been clarified in subacute stroke. OBJECTIVES To determine improvement in walking ability by HAL and the most effective improvement measure for use in future large-scale trials. METHODS Sixteen first-ever hemiplegic stroke patients completed at least 20 sessions over 5 weeks. Per session, the experimental group received no more than 20 min of gait training with HAL (HT) and 40 min of conventional physiotherapy, whereas the control group received at least 60 min of conventional physiotherapy. Primary outcome was maximum walking speed (MWS). RESULTS The change in MWS from baseline at week 5 was 11.6±10.6 m/min (HAL group) and 2.2±4.1 m/min (control group) (adjusted mean difference = 9.24 m/min, 95% confidence interval 0.48-18.01, P = 0.040). In HAL subjects there were significant increases in Self-selected walking speed (SWS; a secondary outcome) and in step length (a secondary outcome) at MWS and SWS compared with controls. CONCLUSIONS HT improved walking speed in hemiplegic sub-acute stroke patients. In future, randomized controlled trials are needed to confirm the utility of HT.
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Affiliation(s)
- Kenichi Yoshikawa
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ami Ibaraki, Japan
| | - Masafumi Mizukami
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Ami Ibaraki, Japan
| | - Hiroaki Kawamoto
- Faculty of Systems and Information Engineering, University of Tsukuba, Tsukuba Ibaraki, Japan
| | - Ayumu Sano
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ami Ibaraki, Japan
| | - Kazunori Koseki
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ami Ibaraki, Japan
| | - Kumiko Sano
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ami Ibaraki, Japan
| | - Yasutsugu Asakawa
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Ami Ibaraki, Japan
| | - Yutaka Kohno
- Department of Neurology, Ibaraki Prefectural University of Health Sciences Hospital, Ami Ibaraki, Japan
| | - Kei Nakai
- Department of Neurology, Ibaraki Prefectural University of Health Sciences Hospital, Ami Ibaraki, Japan.,Faculty of Medicine, University of Tsukuba, Tsukuba Ibaraki, Japan
| | - Masahiko Gosho
- Department of Clinical Trial and Clinical Epidemiology, Faculty of Medicine, University of Tsukuba, Tsukuba Ibaraki, Japan
| | - Hideo Tsurushima
- Faculty of Medicine, University of Tsukuba, Tsukuba Ibaraki, Japan
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Karakkattil P, Trudelle-Jackson E, Brown HH, Hammontree P, Okolo M. Outcomes of Botulinum Toxin Type A for equinovarus deformity in patients with CVA: A case series. Physiother Theory Pract 2017; 33:410-419. [PMID: 28481738 DOI: 10.1080/09593985.2017.1318420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND There is evidence that Botulinum Toxin-A (BTX-A) reduces focal spasticity associated with equinovarus to improve gait in patients poststroke. However, there is little research examining whether gait improvements are maintained after the effectiveness period of BTX-A injections. The purpose of this observational study was to determine whether there was a difference in gait parameters in three patients before BTX-A injection versus four and ten weeks after. CASE SERIES Three women, ages 63, 60, and 42 postischemic stroke with hemiparesis and equinovarus underwent measurements for: plantar flexor spasticity, ankle dorsiflexion ROM, temporal-spatial gait parameters, and gait endurance. All participants improved in ankle ROM. At week 10, spasticity had returned to initial measurement levels in participants A and C. Base of support and step length symmetry ratios did not improve following injections. Participants A and B, who received physical therapy during the study, showed modest gains in gait endurance and velocity. CONCLUSION Although BTX-A injections improved spasticity, this improvement did not translate to gait outcomes. Addition of physical therapy interventions appeared to improve gait outcomes in this case series. We suggest future randomized control studies to compare effects of physical therapy alone to BTX-A combined with physical therapy on gait outcomes.
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Affiliation(s)
- Priya Karakkattil
- a Baylor Institute for Rehabilitation , Outpatient Rehabilitation Services , Frisco , TX , USA.,b School of Physical Therapy , Texas Woman's University , Dallas , TX , USA
| | | | | | - Patrick Hammontree
- b School of Physical Therapy , Texas Woman's University , Dallas , TX , USA
| | - Mary Okolo
- b School of Physical Therapy , Texas Woman's University , Dallas , TX , USA
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46
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Gait Training With Visual Feedback and Proprioceptive Input to Reduce Gait Asymmetry in Adults With Cerebral Palsy: A Case Series. Pediatr Phys Ther 2017; 29:138-145. [PMID: 28350769 DOI: 10.1097/pep.0000000000000362] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this case series was to investigate the feasibility of using visual feedback on gait asymmetry during gait retraining and whether this leads to reduced asymmetry, improvement in gait speed, cost of walking, and dynamic balance in ambulant adults with cerebral palsy (CP). METHODS Five adults with CP, who were ambulatory and had step length or stance time asymmetry, trained for 18 sessions on a split-belt treadmill with concurrent visual feedback from a virtual environment. Training also included overground gait training to encourage transfer of learning. RESULTS All participants reduced gait asymmetry and improved on outcomes at posttest and follow-up. CONCLUSIONS Outcome measures and training protocols were feasible in this sample of convenience of adults with CP who were ambulatory and who did not have visual impairment. The adults with CP in this study demonstrated individual improvements in gait and balance following training.
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Cabral S, Fernandes R, Selbie WS, Moniz-Pereira V, Veloso AP. Inter-session agreement and reliability of the Global Gait Asymmetry index in healthy adults. Gait Posture 2017; 51:20-24. [PMID: 27693957 DOI: 10.1016/j.gaitpost.2016.09.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 08/18/2016] [Accepted: 09/13/2016] [Indexed: 02/02/2023]
Abstract
There has been a growing effort in restoring gait symmetry in clinical conditions associated with pronounced gait asymmetry. A prerequisite to achieve this is that the chosen approach can accurately assess symmetry and detect/impose changes that exceed the natural day to day variability. Global symmetry indices are superior to local and discrete indices because they capture the patient's overall gait symmetry. However, their repeatability is unknown. This study assessed the inter-session agreement and reliability of the Global Gait Asymmetry index. Twenty-three healthy individuals participated in two 3D gait analyses, performed approximately one week apart. The 95% limits of agreement, standard error of measurement, smallest detectable change, and intraclass correlation coefficient were analysed. The obtained values showed this index has poor agreement and reliability between sessions. Therefore, it cannot be used to assess the patient's progress overtime nor to compare symmetry levels among groups.
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Affiliation(s)
- Silvia Cabral
- U Lisboa, Fac Motricidade Humana, CIPER, LBMF, P-1499-002 Lisboa, Portugal.
| | - Rita Fernandes
- U Lisboa, Fac Motricidade Humana, CIPER, LBMF, P-1499-002 Lisboa, Portugal; Departamento de Fisioterapia, Escola Superior de Saúde, Instituto Politécnico de Setúbal, Campus do Instituto Politécnico de Setúbal, Estefanilha, Edifício ESCE, 2914-503 Setúbal, Portugal
| | | | - Vera Moniz-Pereira
- U Lisboa, Fac Motricidade Humana, CIPER, LBMF, P-1499-002 Lisboa, Portugal
| | - António P Veloso
- U Lisboa, Fac Motricidade Humana, CIPER, LBMF, P-1499-002 Lisboa, Portugal
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Morel C, Hauret I, Andant N, Bonnin A, Pereira B, Coudeyre E. Efficacy of two injection-site localisation techniques for botulinum toxin injections: a single-blind, crossover, randomised trial protocol among adults with hemiplegia due to stroke. BMJ Open 2016; 6:e011751. [PMID: 27852706 PMCID: PMC5129049 DOI: 10.1136/bmjopen-2016-011751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Botulinum toxin injections are an effective treatment for limb spasticity following stroke. Different tracking techniques are used for this purpose: palpation, electrostimulation, electromyography and ultrasound. Yet very few studies have compared these different techniques, and none has successfully proved the superior efficacy of ultrasound-guided injections compared to another tracking method. The primary objective of our study was therefore to compare the efficacy of botulinum toxin injections depending on the tracking technique used: ultrasound versus electrostimulation. METHODS AND ANALYSIS This is a clinical, single-centre, prospective, interventional, single-blind, crossover, randomised trial. In total, 30 patients aged between 18 and 80 years presenting with triceps surae spasticity (evaluated >1 on the modified Ashworth scale) associated with hemiplegia sequelae due to stroke will be included. The patients will be selected among those who attend for consultation the Physical Medicine and Rehabilitation Department of the Clermont-Ferrand University Hospital. One group will receive the abobotulinumtoxinA (BoNT-A) injection guided by electrostimulation then ultrasound, and the second group's botulinum toxin injections will be guided by ultrasound then electrostimulation. For each patient, the duration of study participation is 5 months. The primary end point is variation in passive ankle dorsiflexion range of motion at slow and high speeds (Tardieu scale) with the knee straight. ETHICS AND DISSEMINATION This study received ethics approval form the CPP of Rhônes-Alpes region. Results will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT01935544; pre-results.
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Affiliation(s)
- Claire Morel
- Service de Médecine Physique et de Réadaptation; CHU Clermont-Ferrand, Clermont-Ferrand, France
- Université Clermont Auvergne, Clermont-Ferrand, France
| | - Isabelle Hauret
- Service de Médecine Physique et de Réadaptation; CHU Clermont-Ferrand, Clermont-Ferrand, France
- Centre médical Etienne Clémentel, Enval, France
| | - Nicolas Andant
- Biostatistics Unit, Délégation Recherche Clinique & Innovation (DRCI), CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Armand Bonnin
- Service de Médecine Physique et de Réadaptation; CHU Clermont-Ferrand, Clermont-Ferrand, France
- Université Clermont Auvergne, Clermont-Ferrand, France
| | - Bruno Pereira
- Biostatistics Unit, Délégation Recherche Clinique & Innovation (DRCI), CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Emmanuel Coudeyre
- Service de Médecine Physique et de Réadaptation; CHU Clermont-Ferrand, Clermont-Ferrand, France
- Université Clermont Auvergne, Clermont-Ferrand, France
- INRA, Unité de Nutrition Humaine (UNH, UMR 1019), Clermont-Ferrand, France
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Byun S, Han JW, Kim TH, Kim KW. Test-Retest Reliability and Concurrent Validity of a Single Tri-Axial Accelerometer-Based Gait Analysis in Older Adults with Normal Cognition. PLoS One 2016; 11:e0158956. [PMID: 27427965 PMCID: PMC4948825 DOI: 10.1371/journal.pone.0158956] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 06/25/2016] [Indexed: 11/18/2022] Open
Abstract
Objective We investigated the concurrent validity and test-retest reliability of spatio-temporal gait parameters measured with a single tri-axial accelerometer (TAA), determined the optimal number of steps required for obtaining acceptable levels of reliability, and compared the validity and reliability of the estimated gait parameters across the three reference axes of the TAA. Methods A total of 82 cognitively normal elderly participants walked around a 40-m long round walkway twice wearing a TAA at their center of body mass. Gait parameters such as cadence, gait velocity, step time, step length, step time variability, and step time asymmetry were estimated from the low pass-filtered signal of the TAA. The test-retest reliability and concurrent validity with the GAITRite® system were evaluated for the estimated gait parameters. Results Gait parameters using signals from the vertical axis showed excellent reliability for all gait parameters; the intraclass correlation coefficient (ICC) was 0.79–0.90. A minimum of 26 steps and 14 steps were needed to achieve excellent reliability in step time variability and step time asymmetry, respectively. A strong level of agreement was seen for the basic gait parameters between the TAA and GAITRiteⓇ (ICC = 0.91–0.96). Conclusions The measurement of gait parameters of elderly individuals with normal cognition using a TAA placed on the body’s center of mass was reliable and showed superiority over the GAITRiteⓇ with regard to gait variability and asymmetry. The TAA system was a valid tool for measuring basic gait parameters. Considering its wearability and low price, the TAA system may be a promising alternative to the pressure sensor walkway system for measuring gait parameters.
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Affiliation(s)
- Seonjeong Byun
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Won Han
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Tae Hui Kim
- Department of Psychiatry, Yonsei University Wonju Severance Christian Hospital, Wonju, Korea
| | - Ki Woong Kim
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences, Seoul, Korea
- * E-mail:
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Sheikh M, Azarpazhooh MR, Hosseini HA. Randomized comparison trial of gait training with and without compelled weight-shift therapy in individuals with chronic stroke. Clin Rehabil 2016; 30:1088-1096. [DOI: 10.1177/0269215515611467] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To compare the effects of gait training combined with compelled weight-shift therapy and gait training alone on velocity and gait symmetry in patients with chronic stroke. Design: Single-blind randomized controlled trial. Participants: Patients ( N=28) with chronic stroke and stance asymmetry toward the non-paretic side. Interventions: Six weeks of gait training combined with compelled weight-shift therapy via a shoe lift applied under the non-paretic leg (experimental group, n=14) or gait training alone (control group, n=14). Main measures: Percentage of total body weight carried by the paretic limb, gait velocity and gait spatiotemporal symmetry ratios including step symmetry, stance symmetry, swing symmetry and overall temporal symmetry. Results: When comparing the two groups, weight bearing on the affected side increased more significantly in experimental group than in control group (40.14±3.77, 38.28±4.06) after the end of treatment and also after a three-month follow-up (44.42±3.5, 38.5±3.77) (P<0.05). Among the experimental and control groups, there were no significant differences of gait velocity (cm/s) after six weeks of treatment (49.82±16.82, 42.66±18.75) and also after a three-month follow-up (50.94±16.27, 41.66±17.58) ( P>0.05). There were no significant differences of gait spatiotemporal symmetry ratios including step symmetry, stance symmetry, swing symmetry and overall temporal symmetry between the two groups after six weeks of treatment and also at three-month follow-up ( P>0.05). Conclusions: This study did not confirm that the effect of gait training combined with compelled body weight shift therapy was better than gait training alone on improving velocity and gait symmetry in patients with chronic stroke.
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Affiliation(s)
- Mania Sheikh
- Department of Physical Therapy, School of Paramedical Sciences, Campus of Mashhad University of Medical Sciences, Azadi square, Mashhad, Iran
| | | | - Hossein Asghar Hosseini
- Department of Physical Therapy, School of Paramedical Sciences, Campus of Mashhad University of Medical Sciences, Azadi square, Mashhad, Iran
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