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Yan S, Park SH, Dee W, Keefer R, Rojas AM, Rymer WZ, Wu M. Motor adaptation to continuous lateral trunk support force during walking improves trunk postural control and walking in children with cerebral palsy: A pilot study. Hum Mov Sci 2024; 97:103258. [PMID: 39116509 PMCID: PMC11401758 DOI: 10.1016/j.humov.2024.103258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 06/22/2024] [Accepted: 07/30/2024] [Indexed: 08/10/2024]
Abstract
PURPOSE To determine whether the application of continuous lateral trunk support forces during walking would improve trunk postural control and improve gait performance in children with CP. MATERIALS AND METHODS Nineteen children with spastic CP participated in this study (8 boys; mean age 10.6 ± 3.4 years old). Fourteen of them were tested in the following sessions: 1) walking on a treadmill without force for 1-min (baseline), 2) with lateral trunk support force for 7-min (adaptation), and 3) without force for 1-min (post-adaptation). Overground walking pre/post treadmill walking. Five of them were tested using a similar protocol but without trunk support force (i.e., control). RESULTS Participants from the experimental group showed enhancement in gait phase dependent muscle activation of rectus abdominis in late adaptation period compared to baseline (P = 0.005), which was retained during the post-adaptation period (P = 0.036), reduced variability of the peak trunk oblique angle during the late post-adaptation period (P = 0.023), and increased overground walking speed after treadmill walking (P = 0.032). Participants from the control group showed modest changes in kinematics and EMG during treadmill and overground walking performance. These results suggest that applying continuous lateral trunk support during walking is likely to induce learning of improved trunk postural control in children with CP, which may partially transfer to overground walking, although we do not have a firm conclusion due to the small sample size in the control group.
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Affiliation(s)
- Shijun Yan
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, USA; Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Seoung Hoon Park
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, USA; Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Weena Dee
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Renee Keefer
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Ana-Marie Rojas
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, USA; Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - William Zev Rymer
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, USA; Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Ming Wu
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, USA; Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA; Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL, USA.
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Lim H, Yan S, Dee W, Pech V, Hameeduddin I, Roth EJ, Rymer WZ, Wu M. Motor interference on lateral pelvis shifting towards the paretic leg during walking and its cortical mechanisms in persons with stroke. Eur J Neurosci 2024. [PMID: 39143724 DOI: 10.1111/ejn.16507] [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: 02/07/2024] [Revised: 07/24/2024] [Accepted: 07/29/2024] [Indexed: 08/16/2024]
Abstract
Motor interference, where new skill acquisition disrupts the performance of a previously learned skill, is a critical yet underexplored factor in gait rehabilitation post-stroke. This study investigates the interference effects of two different practice schedules, applying interleaved (ABA condition) and intermittent (A-A condition) pulling force to the pelvis during treadmill walking, on lateral pelvis shifting towards the paretic leg in individuals with stroke. Task A involved applying resistive pelvis force (pulling towards the non-paretic side), and Task B applied assistive force (pulling towards the paretic side) at the stance phase of the paretic leg during walking. Sixteen individuals with chronic stroke were tested for gait pattern changes, including lateral pelvis shifting and spatiotemporal gait parameters, and neurophysiological changes, including muscle activity in the paretic leg and beta band absolute power in the lesioned cortical areas. A-A condition demonstrated increased lateral pelvis shifting towards the paretic side, extended paretic stance time and longer non-paretic step length after force release while ABA condition did not show any changes. These changes in gait pattern after A-A condition were accompanied by increased muscle activities of the ankle plantarflexors, and hip adductors/abductors. A-A condition demonstrated greater changes in beta band power in the sensorimotor regions compared to ABA condition. These findings suggest that while walking practice with external force to the pelvis can improve lateral pelvis shifting towards the paretic leg post-stroke, practicing a new pelvis shifting task in close succession may hinder the performance of a previously obtained lateral pelvis shifting pattern during walking.
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Affiliation(s)
- Hyosok Lim
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Shijun Yan
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Weena Dee
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Velarie Pech
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Iram Hameeduddin
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL, USA
| | - Elliot J Roth
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - William Z Rymer
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Ming Wu
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
- Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL, USA
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Darcy B, Rashford L, Tsai NT, Huizenga D, Reed KB, Bamberg SJM. One-year retention of gait speed improvement in stroke survivors after treatment with a wearable home-use gait device. Front Neurol 2024; 14:1089083. [PMID: 38274885 PMCID: PMC10808505 DOI: 10.3389/fneur.2023.1089083] [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: 11/03/2022] [Accepted: 12/07/2023] [Indexed: 01/27/2024] Open
Abstract
Background Gait impairments after stroke are associated with numerous physical and psychological consequences. Treatment with the iStride® gait device has been shown to facilitate improvements to gait function, including gait speed, for chronic stroke survivors with hemiparesis. This study examines the long-term gait speed changes up to 12 months after treatment with the gait device. Methods Eighteen individuals at least one-year post-stroke completed a target of 12, 30-minute treatment sessions with the gait device in their home environment. Gait speed was measured at baseline and five follow-up sessions after the treatment period: one week, one month, three months, six months, and 12 months. Gait speed changes were analyzed using repeated-measures ANOVA from baseline to each follow-up time frame. Additional analysis included comparison to the minimal clinically important difference (MCID), evaluation of gait speed classification changes, and review of subjective questionnaires. Results Participants retained an average gait speed improvement >0.21 m/s compared to baseline at all post-treatment time frames. Additionally, 94% of participants improved their gait speed beyond the MCID during one or more post-treatment measurements, and 88% subjectively reported a gait speed improvement. Conclusion Treatment with the gait device may result in meaningful, long-term gait speed improvement for chronic stroke survivors with hemiparetic gait impairments. Clinical trial registration https://clinicaltrials.gov/ct2/show/NCT03649217, identifier NCT03649217.
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Affiliation(s)
- Brianne Darcy
- Moterum Technologies, Inc., Salt Lake City, UT, United States
| | - Lauren Rashford
- Moterum Technologies, Inc., Salt Lake City, UT, United States
| | - Nancey T. Tsai
- Moterum Technologies, Inc., Salt Lake City, UT, United States
| | - David Huizenga
- Moterum Technologies, Inc., Salt Lake City, UT, United States
| | - Kyle B. Reed
- Department of Mechanical Engineering, University of South Florida, Tampa, FL, United States
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