Effect of insole on postural control and gait of stroke patients: a systematic review and meta-analysis

This systematic review aims to examine the evidence of adding postural insole to traditional physical therapy to improve weight distribution, gait, mobility, balance, and postural control in stroke survivors. Five databases were searched to retrieve all related randomized controlled trials examining the effect of insole on stroke patients. Two independent authors checked the potential articles against eligibility criteria according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A meta-analysis was conducted for available outcomes and the statistical heterogeneity was examined using the I2 test. Of 762 articles, only 15 with 448 patients were included after they met the inclusion criteria with most of them including participants exceeding 6 months of stroke incidence. When insole was used as compelled body weight shifting method, pooled statistical analysis revealed significant improvement in gait velocity [standardized mean difference (SMD) = 0.67; 95% confidence interval (CI): 0.31, 1.02; P  = 0.0003], cadence (SMD = 0.67; 95% CI: 0.16, 1.18; P  = 0.01] and stride length (SMD = 1.11; 95% CI: 0.57, 1.65; P  < 0.0001), while no significant effect on step length (SMD = 0.48; 95% CI: -0.37, 1.33; P  = 0.27). Pooled statistical analysis of balance outcomes revealed significant improvement in weight-bearing symmetry balance (SMD = 0.82; 95% CI: 0.25, 1.39; P  = 0.005) and long-term improvement in Berg Balance Scale (SMD = 1.19; 95% CI: 0.19, 2.20; P  = 0.02), while no difference was observed in balance confidence (SMD = 0.44; 95% CI: -0.15, 1.04; P  = 0.14) and sensorimotor functions (SMD = 0.36; 95% CI -0.39, 1.11; P  = 0.35). Insoles significantly improved spatiotemporal gait parameters, gait symmetry, and static balance compared with traditional physical therapy alone.

Differentiation in theta and gamma activation in weight-shifting learning between people with parkinson's disease of different anxiety severities

Anxiety and postural control deficits may be related in people with Parkinson's disease (PwPD). However, the association between anxiety levels and weight-shifting control remains ambiguous. This study investigated whether 1) weight-shifting control differed between PwPD with and without anxiety, and 2) the learning effect of weight-shifting differed between the two populations. Additionally, we evaluated cortical activities to investigate neural mechanisms underlying weight-shifting control. Twenty-eight PwPD (14 anxiety, 14 nonanxiety) participated in a 5-day weight-shifting study by coupling the bearing weight of their more-affected leg to a sinusoidal target at 0.25 Hz. We tested the weight-shifting control on day 1 (pretest), day 3 (posttest), and day 5 (retention test) with a learning session on day 3. The error and jerk of weight-shifting trajectory and the theta and gamma powers of electroencephalography in prefrontal, frontal, sensorimotor and parietal-occipital areas were measured. At the pretest, the anxiety group showed larger error and smaller jerk of weight-shifting with greater prefrontal theta, frontal gamma, and sensorimotor gamma powers than the nonanxiety group. Anxiety intensity was correlated positively with weight-shifting error and theta power but negatively with weight-shifting jerk. Reduced weight-shifting error with increased theta power after weight-shifting learning was observed in the nonanxiety group. However, the anxiety group showed decreased gamma power after weight-shifting learning without behavior change. Our findings suggest differential weight-shifting control and associated cortical activation between PwPD with and without anxiety. In addition, anxiety would deteriorate weight-shifting control and hinder weight-shifting learning benefits in PwPD, leading to less weight-shifting accuracy and correction.

Application of the participatory design in the testing of a baropodometric insole prototype for weight-bearing asymmetry after a stroke: A qualitative study

Introduction

Currently studies indicate the need to incorporate the user`s perspective in the testing of new assistive technologies. The objective of this paper is to test a baropodometric insole prototype for monitoring and treatment weight-bearing asymmetry, according to the Participatory Design.

Methods

We used a qualitative case study approach during the testing phase of the baropodometric insole prototype. The focus group approach addressed topics related to the experience and accessibility of the potential user in conjunction with professionals, researchers, and physiotherapy students. Facilitators, barriers, and requirements for the device were collected through audio recordings of the discussions during and after prototype testing.

Results

Key steps in the prototype testing process were divided into (1) Test of the prototype according to the Participatory Design, divided into Who, When, How, and Why the potential user was involved in the study; and (2) Facilitators, barriers and requirements to improve the prototype.

Conclusions

The baropodometric insole prototype can be seen as a promising device for monitoring and treating weight-bearing asymmetry.

Effect of Anterioposterior Weight-Shift Training with Visual Biofeedback in Patients with Step Length Asymmetry after Subacute Stroke

Step length asymmetry is a characteristic feature of gait in post-stroke patients. A novel anterioposterior weight-shift training method with visual biofeedback (AP training) was developed to improve the forward progression of the trunk. This study aimed to investigate the effect of AP training on gait asymmetries, patterns, and gait-related function in subacute stroke patients. Forty-six subacute stroke patients were randomly assigned to the AP training group or the control group. The AP training group received conventional gait training and AP training five times per week for 4 weeks. The control group received the same intensity of conventional gait training with patient education for self-anterior weight shifting. Plantar pressure analysis, gait analysis, energy consumption, and gait-related behavioral parameters were assessed before and after training. The AP training group showed significant improvement in step length asymmetry, forefoot contact area and pressure, Berg balance scale score, and Fugl-Meyer assessment scale of lower extremity score compared to the control group (p < 0.05). However, there was no significant between-group difference with respect to energy cost and kinetic and kinematic gait parameters. In conclusion, AP training may help improve the asymmetric step length in stroke patients, and also improve anterior weight shifting, balance, and motor function in subacute stroke survivors.

Asymmetric shoe height induces reactive changes in gait kinematics but not kinetics in healthy young adults

BACKGROUND

Footwear interventions are a potential avenue to correct walking asymmetry in neurologic populations, such as stroke. However, the motor learning mechanisms that underlie the changes in walking imposed by asymmetric footwear are unclear.

RESEARCH QUESTION

The objectives of this study were to examine symmetry changes during and after an asymmetric shoe height intervention in (1) vertical impulse and (2) spatiotemporal gait parameters and (3) joint kinematics, in healthy young adults METHODS: Eleven healthy young adults (3 males, 8 females; 21.2 ± 3.1 years old) participated in this study. Participants walked on an instrumented treadmill at 1.3 m/s for four conditions: (1) a 5-minute familiarization with equal shoe height, (2) a 5-minute baseline with equal shoe height, (3) a 10-minute intervention, where participants walked with asymmetric shoe height with a 10 mm shoe insert in one shoe, and (4) a 10-minute post-intervention, where participants walked with equal shoe height. Asymmetry in kinetics and kinematics were used to identify changes during intervention and aftereffects, a hallmark of feedforward adaptation RESULTS: Participants did not alter vertical impulse asymmetry (p = 0.667) nor stance time asymmetry (p = 0.228). During the intervention, step time asymmetry (p = 0.003) and double support asymmetry (p < 0.001) were greater compared to baseline. Leg joint asymmetry during stance (Ankle plantarflexion: p < 0.001; Knee flexion: p < 0.001; Hip extension: p = 0.011) was greater during the intervention compared to baseline. However, changes in spatiotemporal gait variables and joint mechanics did not demonstrate aftereffects.

SIGNIFICANCE

Our results show that healthy human adults change gait kinematics, but not weight-bearing symmetry with asymmetrical footwear. This suggests that healthy humans prioritize maintaining vertical impulse by changing their kinematics. Further, the changes in gait kinematics are short-lived, suggesting feedback-based control, and a lack of feedforward motor adaptations.

Neuromechanical control of impact absorption during induced lower limb loading in individuals post-stroke

Decreased loading of the paretic lower limb and impaired weight transfer between limbs negatively impact balance control and forward progression during gait in individuals post-stroke. However, the biomechanical and neuromuscular control mechanisms underlying such impaired limb loading remain unclear, partly due to their tendency of avoiding bearing weight on the paretic limb during voluntary movement. Thus, an approach that forces individuals to more fully and rapidly load the paretic limb has been developed. The primary purpose of this study was to compare the neuromechanical responses at the ankle and knee during externally induced limb loading in people with chronic stroke versus able-bodied controls, and determine whether energy absorption capacity, measured during induced limb loading of the paretic limb, was associated with walking characteristics in individuals post-stroke. Results revealed reduced rate of energy absorption and dorsiflexion velocity at the ankle joint during induced limb loading in both the paretic and non-paretic side in individuals post-stroke compared to healthy controls. The co-contraction index was higher in the paretic ankle and knee joints compared to the non-paretic side. In addition, the rate of energy absorption at the paretic ankle joint during the induced limb loading was positively correlated with maximum walking speed and negatively correlated with double limb support duration. These findings demonstrated that deficits in ankle dorsiflexion velocity may limit the mechanical energy absorption capacity of the joint and thereby affect the lower limb loading process during gait following stroke.

Clinical Practice Guideline to Improve Locomotor Function Following Chronic Stroke, Incomplete Spinal Cord Injury, and Brain Injury

BACKGROUND

Individuals with acute-onset central nervous system (CNS) injury, including stroke, motor incomplete spinal cord injury, or traumatic brain injury, often experience lasting locomotor deficits, as quantified by decreases in gait speed and distance walked over a specific duration (timed distance). The goal of the present clinical practice guideline was to delineate the relative efficacy of various interventions to improve walking speed and timed distance in ambulatory individuals greater than 6 months following these specific diagnoses.

METHODS

A systematic review of the literature published between 1995 and 2016 was performed in 4 databases for randomized controlled clinical trials focused on these specific patient populations, at least 6 months postinjury and with specific outcomes of walking speed and timed distance. For all studies, specific parameters of training interventions including frequency, intensity, time, and type were detailed as possible. Recommendations were determined on the basis of the strength of the evidence and the potential harm, risks, or costs of providing a specific training paradigm, particularly when another intervention may be available and can provide greater benefit.

RESULTS

Strong evidence indicates that clinicians should offer walking training at moderate to high intensities or virtual reality-based training to ambulatory individuals greater than 6 months following acute-onset CNS injury to improve walking speed or distance. In contrast, weak evidence suggests that strength training, circuit (ie, combined) training or cycling training at moderate to high intensities, and virtual reality-based balance training may improve walking speed and distance in these patient groups. Finally, strong evidence suggests that body weight-supported treadmill training, robotic-assisted training, or sitting/standing balance training without virtual reality should not be performed to improve walking speed or distance in ambulatory individuals greater than 6 months following acute-onset CNS injury to improve walking speed or distance.

DISCUSSION

The collective findings suggest that large amounts of task-specific (ie, locomotor) practice may be critical for improvements in walking function, although only at higher cardiovascular intensities or with augmented feedback to increase patient's engagement. Lower-intensity walking interventions or impairment-based training strategies demonstrated equivocal or limited efficacy.

LIMITATIONS

As walking speed and distance were primary outcomes, the research participants included in the studies walked without substantial physical assistance. This guideline may not apply to patients with limited ambulatory function, where provision of walking training may require substantial physical assistance.

SUMMARY

The guideline suggests that task-specific walking training should be performed to improve walking speed and distance in those with acute-onset CNS injury although only at higher intensities or with augmented feedback. Future studies should clarify the potential utility of specific training parameters that lead to improved walking speed and distance in these populations in both chronic and subacute stages following injury.

DISCLAIMER

These recommendations are intended as a guide for clinicians to optimize rehabilitation outcomes for persons with chronic stroke, incomplete spinal cord injury, and traumatic brain injury to improve walking speed and distance.

The Effect of Exercise Training on Gait, Balance, and Physical Fitness Asymmetries in Persons With Chronic Neurological Conditions: A Systematic Review of Randomized Controlled Trials

Background: Persons with chronic neurological conditions (CNCs) often present with asymmetrical impairments, creating significant differences between contralateral limbs in body functions. These asymmetries have been associated with reduced mobility and balance, and are often targeted for reduction during rehabilitation. Exercise training has established benefits for persons with CNCs, and may have positive effects on asymmetry outcomes.

Objectives: The purpose of this review was to summarize the current evidence for the effects exercise training on gait, balance, and physical fitness asymmetry in randomized control trials (RCTs) of persons with CNCs.

Methods: A search of four electronic databases (EMBASE, CINAHL, SPORTdiscus, and ovidMEDLINE) was conducted following the structured Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Results: The search retrieved 3,493 articles, with 465 articles assessed for eligibly, and nine articles meeting the criteria for inclusion. Of the included articles, five incorporated resistance exercise, three incorporated aerobic exercise, and one incorporated combined exercise (i.e., resistance and aerobic exercise). Gait asymmetry improved significantly in four studies after resistance, aerobic, and combined exercise. Significant improvements in weight bearing asymmetry were reported in three studies after resistance exercise. One study reported significant improvements in both gait and balance asymmetry after resistance exercise.

Conclusions: Preliminary evidence suggests that exercise training, as a component of rehabilitation, may have positive effects on gait and balance asymmetry in persons with CNCs. Several limitations of the current literature were noted, including a limited number of studies, combination of exercise with other rehabilitation modalities, a lack of reporting on exercise prescriptions (e.g., number of repetitions, intensity), and variability in the calculation of asymmetry outcomes. These limitations prevent definitive conclusions on the effects of exercise training on asymmetry outcomes. Future trials are needed to determine the potential of exercise training for reducing asymmetry in persons with CNCs.

Persons post-stroke improve step length symmetry by walking asymmetrically

BACKGROUND AND PURPOSE

Restoration of step length symmetry is a common rehabilitation goal after stroke. Persons post-stroke often retain the ability to walk with symmetric step lengths ("symmetric steps"); however, the resulting walking pattern remains effortful. Two key questions with direct implications for rehabilitation have emerged: 1) how do persons post-stroke generate symmetric steps, and 2) why do symmetric steps remain so effortful? Here, we aimed to understand how persons post-stroke generate symmetric steps and explored how the resulting gait pattern may relate to the metabolic cost of transport.

METHODS

We recorded kinematic, kinetic, and metabolic data as nine persons post-stroke walked on an instrumented treadmill under two conditions: preferred walking and symmetric stepping (using visual feedback).

RESULTS

Gait kinematics and kinetics remained markedly asymmetric even when persons post-stroke improved step length symmetry. Impaired paretic propulsion and aberrant movement of the center of mass were evident during both preferred walking and symmetric stepping. These deficits contributed to diminished positive work performed by the paretic limb on the center of mass in both conditions. Within each condition, decreased positive paretic work correlated with increased metabolic cost of transport and decreased walking speed across participants.

CONCLUSIONS

It is critical to consider the mechanics used to restore symmetric steps when designing interventions to improve walking after stroke. Future research should consider the many dimensions of asymmetry in post-stroke gait, and additional within-participant manipulations of gait parameters are needed to improve our understanding of the elevated metabolic cost of walking after stroke.

A Randomized Controlled Study Assessing the Effects of a Shoe Lift Under the Nonparetic Leg on Balance Performance in Individuals With Chronic Stroke

BACKGROUND AND PURPOSE

Improvement of balance and postural stability is an important goal in stroke rehabilitation. The purpose of this study was to investigate the effects of a shoe lift under the nonparetic leg on balance function and balance confidence in persons with chronic stroke.

METHODS

Thirty-six individuals with chronic stroke (21 males and 15 females), who were able to walk independently and showed stance asymmetry, were randomized to a shoe insert and a control group. The interventions included a 6-week balance training program, in conjunction with a shoe lift under the nonaffected leg (shoe insert group, n = 18), or balance training alone (control group, n = 18). The outcome measures were weight-bearing asymmetry (WBA), root mean square (RMS) of anterior-posterior (AP) and medial-lateral (ML) center-of-pressure (COP) velocity asymmetry, Berg Balance Scale (BBS), and Activities-specific Balance Confidence (ABC) Scale. These were measured in both groups at baseline, after the intervention, and at a 3-month follow-up. A repeated-measure multivariate analysis of variance was conducted to evaluate the impact of 2 different interventions on balance measures, across the 3 periods.

RESULTS AND DISCUSSION

No significant between-group differences were found for demographics and stroke-related characteristics of participants (P > .05). The outcome measures between the 2 groups were not significantly different at baseline (P > .05). There were between-group differences for WBA and the RMS of AP COP velocity asymmetry after the intervention and at the 3-month follow-up (P < .05). No significant difference in the RMS of ML COP velocity asymmetry, BBS, and ABC was identified between the 2 groups after the intervention and at the 3-month follow-up (P > .05).

CONCLUSION

The results indicated that the use of a shoe lift under the nonaffected leg in the context of a balance training program could result in a greater improvement in static standing balance as compared with balance training alone in an individual with chronic stroke.

TRIAL REGISTRATION

The study was retrospectively registered in the Iranian Registry of Clinical Trials (IRCT20190603043808N1).

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

INTRODUCTION

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Effects of Load Addition During Gait Training on Weight-Bearing and Temporal Asymmetry After Stroke: A Randomized Clinical Trial

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.

Simulating Hemiparetic Gait in Healthy Subjects Using TPAD With a Closed-Loop Controller

Hemiparetic gait is abnormal asymmetric walking, often observed among patients with cerebral palsy or stroke. One of the major features of asymmetric gait is excessive reliance on the healthy leg, which results in improper load shift, slow walking speed, higher metabolic cost, and weakness of the unused leg. Hence, clinically it is desirable to promote gait symmetry to improve walking. While there are no clear methods to achieve this goal, we are exploring new methods where we guide the pelvis to change the gait symmetry. This controller is designed to mimic the hands of a physical therapist holding the pelvis and guiding it to promote the usage of both legs during walking. In this paper, we show that the essence of this method can be demonstrated by promoting asymmetry in the gait of healthy subjects when walking with the device. The results showed that their kinematics and kinetics changed asymmetrically during the intervention. Subjects demonstrated asymmetric lateral ground reaction force to compensate for the lateral forces applied on the pelvis. Muscle activities increased on the targeted leg show the forced use of the leg which can be used for rehabilitation of patients with an asymmetric gait.

Difference between individuals with left and right hemiparesis in the effect of gluteus medius vibration on body weight shifting

OBJECTIVE

To test the effect of gluteus medius (GM) vibration on the reduction of asymmetric body weight distribution in individuals with hemiparesis (HP) at two stages of postural recovery.

METHODS

The effects of GM vibration according to the shift of the body weight (%Shift) onto the paretic leg during GM vibration were registered while standing on a force-platform in 40 HP (19 left and 21 right; mean age 54.7±10.6years, mean time after stroke 2.0±1.3months), as soon as they could stand without assistance and 4 to 6 weeks later, and in 40 control subjects (mean age 54.7±10.5years).

RESULTS

Without vibration, baseline body weight (BW) distribution was characterized by underloading of the paretic limb (mean BW on the paretic limb 37.2%±13.1%). At the early stage of balance recovery, % shift toward the paretic limb induced by GM vibration differed significantly between left and right HP (P=0.049) and between left HP and controls (C) (P=0.022) and was related to BW asymmetry (r=0.437, P=0.004). Later, GM vibration reduced asymmetric BW distribution in most HP and no difference was found between left and right HP and between left and C.

CONCLUSION

At an advanced stage of postural recovery, GM vibration could help encourage HP to put weight on the affected limb. Interestingly, a behavioral difference was initially observed between right and left HP that could probably be explained by a different strategy due to the baseline severity of the BW asymmetry.

Exploration of Two Training Paradigms Using Forced Induced Weight Shifting With the Tethered Pelvic Assist Device to Reduce Asymmetry in Individuals After Stroke: Case Reports

Many robotic devices in rehabilitation incorporate an assist-as-needed haptic guidance paradigm to promote training. This error reduction model, while beneficial for skill acquisition, could be detrimental for long-term retention. Error augmentation (EA) models have been explored as alternatives. A robotic Tethered Pelvic Assist Device has been developed to study force application to the pelvis on gait and was used here to induce weight shift onto the paretic (error reduction) or nonparetic (error augmentation) limb during treadmill training. The purpose of these case reports is to examine effects of training with these two paradigms to reduce load force asymmetry during gait in two individuals after stroke (>6 mos). Participants presented with baseline gait asymmetry, although independent community ambulators. Participants underwent 1-hr trainings for 3 days using either the error reduction or error augmentation model. Outcomes included the Borg rating of perceived exertion scale for treatment tolerance and measures of force and stance symmetry. Both participants tolerated training. Force symmetry (measured on treadmill) improved from pretraining to posttraining (36.58% and 14.64% gains), however, with limited transfer to overground gait measures (stance symmetry gains of 9.74% and 16.21%). Training with the Tethered Pelvic Assist Device device proved feasible to improve force symmetry on the treadmill irrespective of training model. Future work should consider methods to increase transfer to overground gait.

The effect of immediate decreasing of weight bearing asymmetry on quiet standing postural control in individuals with chronic stroke

The main patterns characterizing standing posture of hemiparetic patients include: weight-bearing asymmetry (WBA), larger postural sway, asymmetrical contribution of lower limbs to balance control, and increased visual dependency to balance control. The aim of this study was to evaluate the effect of decreasing WBA with the use of a shoe lift, on quiet standing postural control in patients with chronic stroke. Twenty-seven patients participated in this study. Patients completed two tests: 1) quiet standing; and 2) quiet standing while a lift was placed under the non-paretic limb. The following tests were completed on force plates for evaluation: asymmetry of the balance measures (weight bearing, root mean square (RMS) of anterior-posterior (AP) and medial-lateral (ML) center of pressure (COP) velocity), RMS of total AP and ML COP velocity, and AP and ML Romberg quotients. Paired t-tests were used to analyze the data. The mean value of WBA index decreased significantly after using a lift (p < 0.05). However, the changes of the mean value of other postural control parameters were not significant (p > 0.05). The results indicate that there may not be an association between decreased WBA and improved postural control during quiet standing in patients with stroke.

A textured insole improves gait symmetry in individuals with stroke

PURPOSE

Gait asymmetry is a common consequence of stroke and improving gait symmetry is an important goal of rehabilitation. We investigated the effect of a single textured insole in improving gait symmetry in individuals with stroke.

METHOD

Seventeen individuals with stroke who had asymmetrical gait were recruited and required to walk with a textured insole positioned in the shoe on the unaffected side or without the insole. Gait parameters were evaluated using the instrumented walkway. Gait velocity, cadence, and symmetry indices for the spatial and temporal parameters of gait and center of pressure displacements were obtained.

RESULTS

When walking with a textured insole, symmetry indexes for stance, single support phases of gait, as well as center of pressure displacements improved significantly. While using a textured insole, the duration of the stance phase and a single support phase decreased on the unaffected side and increased on the affected side significantly. Gait velocity and cadence were not affected by the use of the insole.

CONCLUSIONS

Individuals with stroke walking with a textured insole placed in the shoe on the unaffected side improved the symmetry of their gait. The outcome provides a foundation for future investigations of the efficacy of using a single textured insole in gait rehabilitation of individuals with unilateral impairment. Implications for Rehabilitation A single textured insole positioned in the shoe on the unaffected side improved gait symmetry in individuals with stroke. Gait velocity and cadence were not affected by the use of the insole.