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Garcia SA, Johnson AK, Orzame M, Palmieri-Smith RM. Biomechanical Effects of Manipulating Preferred Cadence During Treadmill Walking in Patients With ACL Reconstruction. Sports Health 2024; 16:420-428. [PMID: 37021815 PMCID: PMC11025515 DOI: 10.1177/19417381231163181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Abnormal gait is common after anterior cruciate ligament reconstruction (ACLR) which may influence osteoarthritis risk in this population. Yet few gait retraining options currently exist in ACLR rehabilitation. Cueing cadence changes is a simple, low-cost method that can alter walking mechanics in healthy adults, but few studies have tested its effectiveness in an ACLR population. Here, we evaluated the acute effects of altering cadence on knee mechanics in patients 9 to 12 months post ACLR. HYPOTHESIS Cueing larger steps will facilitate larger knee angles and moments, while cueing smaller steps would induce smaller knee angles and moments. STUDY DESIGN Randomized cross-sectional design. LEVEL OF EVIDENCE Level 3. METHODS Twenty-eight patients with unilateral ACLR underwent gait assessments on a treadmill at preferred pace. Preferred walking gait was assessed first to obtain preferred cadence. Participants then completed trials while matching an audible beat set to 90% and 110% of preferred cadence in a randomized order. Three-dimensional sagittal and frontal plane biomechanics were evaluated bilaterally. RESULTS Compared with preferred cadence, cueing larger steps induced larger peak knee flexion moments (KFMs) and knee extension excursions bilaterally (P < 0.01), whereas cueing smaller steps only reduced knee flexion excursions (P < 0.01). Knee adduction moments remain unchanged across conditions and were similar between limbs (P > 0.05). Peak KFMs and excursions were smaller in the injured compared with uninjured limb (P < 0.01). CONCLUSION Frontal plane gait outcomes were unchanged across conditions suggesting acute cadence manipulations result in mainly sagittal plane adaptations. Follow-up studies using a longitudinal cadence biofeedback paradigm may be warranted to elucidate the utility of this gait retraining strategy after ACLR. CLINICAL RELEVANCE Cueing changes in walking cadence can target sagittal plane knee loading and joint range of motion in ACLR participants. This strategy may offer high clinical translatability given it requires relatively minimal equipment (ie, free metronome app) outside of a treadmill.
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Affiliation(s)
- Steven A. Garcia
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan
- Orthopedic Rehabilitation and Biomechanics (ORB) Laboratory, University of Michigan, Ann Arbor, Michigan
| | - Alexa K. Johnson
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan
- Orthopedic Rehabilitation and Biomechanics (ORB) Laboratory, University of Michigan, Ann Arbor, Michigan
| | - Marissa Orzame
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan
- Orthopedic Rehabilitation and Biomechanics (ORB) Laboratory, University of Michigan, Ann Arbor, Michigan
| | - Riann M. Palmieri-Smith
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan
- Orthopedic Rehabilitation and Biomechanics (ORB) Laboratory, University of Michigan, Ann Arbor, Michigan
- Department of Orthopedic Surgery, Michigan Medicine, Ann Arbor, Michigan
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2
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Sánchez N, Schweighofer N, Mulroy SJ, Roemmich RT, Kesar TM, Torres-Oviedo G, Fisher BE, Finley JM, Winstein CJ. Multi-Site Identification and Generalization of Clusters of Walking Behaviors in Individuals With Chronic Stroke and Neurotypical Controls. Neurorehabil Neural Repair 2023; 37:810-822. [PMID: 37975184 PMCID: PMC10872629 DOI: 10.1177/15459683231212864] [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] [Indexed: 11/19/2023]
Abstract
BACKGROUND Walking patterns in stroke survivors are highly heterogeneous, which poses a challenge in systematizing treatment prescriptions for walking rehabilitation interventions. OBJECTIVES We used bilateral spatiotemporal and force data during walking to create a multi-site research sample to: (1) identify clusters of walking behaviors in people post-stroke and neurotypical controls and (2) determine the generalizability of these walking clusters across different research sites. We hypothesized that participants post-stroke will have different walking impairments resulting in different clusters of walking behaviors, which are also different from control participants. METHODS We gathered data from 81 post-stroke participants across 4 research sites and collected data from 31 control participants. Using sparse K-means clustering, we identified walking clusters based on 17 spatiotemporal and force variables. We analyzed the biomechanical features within each cluster to characterize cluster-specific walking behaviors. We also assessed the generalizability of the clusters using a leave-one-out approach. RESULTS We identified 4 stroke clusters: a fast and asymmetric cluster, a moderate speed and asymmetric cluster, a slow cluster with frontal plane force asymmetries, and a slow and symmetric cluster. We also identified a moderate speed and symmetric gait cluster composed of controls and participants post-stroke. The moderate speed and asymmetric stroke cluster did not generalize across sites. CONCLUSIONS Although post-stroke walking patterns are heterogenous, these patterns can be systematically classified into distinct clusters based on spatiotemporal and force data. Future interventions could target the key features that characterize each cluster to increase the efficacy of interventions to improve mobility in people post-stroke.
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Affiliation(s)
- Natalia Sánchez
- Department of Physical Therapy, Chapman University, Irvine, CA
- Fowler School of Engineering, Chapman University, Orange, CA
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA
| | - Nicolas Schweighofer
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA
- Neuroscience Graduate Program, University of Southern California, Los Angeles, CA
| | - Sara J. Mulroy
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA
- Pathokinesiology Lab, Rancho Los Amigos National Rehabilitation Center, Downey, CA
| | - Ryan T. Roemmich
- Center for Movement Studies, Kennedy Krieger Institute, Baltimore, Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Trisha M. Kesar
- Department of Rehabilitation Medicine, Emory University School of Medicine. Atlanta GA
| | | | - Beth E. Fisher
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA
- Department of Neurology Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - James M. Finley
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA
- Neuroscience Graduate Program, University of Southern California, Los Angeles, CA
| | - Carolee J. Winstein
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA
- Department of Neurology Keck School of Medicine, University of Southern California, Los Angeles, CA
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3
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Sánchez N, Schweighofer N, Mulroy SJ, Roemmich RT, Kesar TM, Torres-Oviedo G, Fisher BE, Finley JM, Winstein CJ. Multi-site identification and generalization of clusters of walking behaviors in individuals with chronic stroke and neurotypical controls. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.05.11.540385. [PMID: 37214916 PMCID: PMC10197630 DOI: 10.1101/2023.05.11.540385] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Background Walking patterns in stroke survivors are highly heterogeneous, which poses a challenge in systematizing treatment prescriptions for walking rehabilitation interventions. Objective We used bilateral spatiotemporal and force data during walking to create a multi-site research sample to: 1) identify clusters of walking behaviors in people post-stroke and neurotypical controls, and 2) determine the generalizability of these walking clusters across different research sites. We hypothesized that participants post-stroke will have different walking impairments resulting in different clusters of walking behaviors, which are also different from control participants. Methods We gathered data from 81 post-stroke participants across four research sites and collected data from 31 control participants. Using sparse K-means clustering, we identified walking clusters based on 17 spatiotemporal and force variables. We analyzed the biomechanical features within each cluster to characterize cluster-specific walking behaviors. We also assessed the generalizability of the clusters using a leave-one-out approach. Results We identified four stroke clusters: a fast and asymmetric cluster, a moderate speed and asymmetric cluster, a slow cluster with frontal plane force asymmetries, and a slow and symmetric cluster. We also identified a moderate speed and symmetric gait cluster composed of controls and participants post-stroke. The moderate speed and asymmetric stroke cluster did not generalize across sites. Conclusions Although post-stroke walking patterns are heterogenous, these patterns can be systematically classified into distinct clusters based on spatiotemporal and force data. Future interventions could target the key features that characterize each cluster to increase the efficacy of interventions to improve mobility in people post-stroke.
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Affiliation(s)
- Natalia Sánchez
- Department of Physical Therapy, Chapman University, Irvine, CA
- Fowler School of Engineering, Chapman University, Orange, CA
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA
| | - Nicolas Schweighofer
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA
- Neuroscience Graduate Program, University of Southern California, Los Angeles, CA
| | - Sara J. Mulroy
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA
- Pathokinesiology Lab, Rancho Los Amigos National Rehabilitation Center, Downey, CA
| | - Ryan T. Roemmich
- Center for Movement Studies, Kennedy Krieger Institute, Baltimore, Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Trisha M. Kesar
- Department of Rehabilitation Medicine, Emory University School of Medicine. Atlanta GA
| | | | - Beth E. Fisher
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA
- Department of Neurology Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - James M. Finley
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA
- Neuroscience Graduate Program, University of Southern California, Los Angeles, CA
| | - Carolee J. Winstein
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA
- Department of Neurology Keck School of Medicine, University of Southern California, Los Angeles, CA
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Kesar T. The Effects of Stroke and Stroke Gait Rehabilitation on Behavioral and Neurophysiological Outcomes:: Challenges and Opportunities for Future Research. Dela J Public Health 2023; 9:76-81. [PMID: 37701480 PMCID: PMC10494801 DOI: 10.32481/djph.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023] Open
Abstract
Stroke continues to be a leading cause of adult disability, contributing to immense healthcare costs. Even after discharge from rehabilitation, post-stroke individuals continue to have persistent gait impairments, which in turn adversely affect functional mobility and quality of life. Multiple factors, including biomechanics, energy cost, psychosocial variables, as well as the physiological function of corticospinal neural pathways influence stroke gait function and training-induced gait improvements. As a step toward addressing this challenge, the objective of the current perspective paper is to outline knowledge gaps pertinent to the measurement and retraining of stroke gait dysfunction. The paper also has recommendations for future research directions to address important knowledge gaps, especially related to the measurement and rehabilitation-induced modulation of biomechanical and neural processes underlying stroke gait dysfunction. We posit that there is a need for leveraging emerging technologies to develop innovative, comprehensive, methods to measure gait patterns quantitatively, to provide clinicians with objective measure of gait quality that can supplement conventional clinical outcomes of walking function. Additionally, we posit that there is a need for more research on how the stroke lesion affects multiple parts of the nervous system, and to understand the neuroplasticity correlates of gait training and gait recovery. Multi-modal clinical research studies that can combine clinical, biomechanical, neural, and computational modeling data provide promise for gaining new information about stroke gait dysfunction as well as the multitude of factors affecting recovery and treatment response in people with post-stroke hemiparesis.
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Affiliation(s)
- Trisha Kesar
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine
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5
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Livolsi C, Conti R, Guanziroli E, Friðriksson Þ, Alexandersson Á, Kristjánsson K, Esquenazi A, Molino Lova R, Romo D, Giovacchini F, Crea S, Molteni F, Vitiello N. An impairment-specific hip exoskeleton assistance for gait training in subjects with acquired brain injury: a feasibility study. Sci Rep 2022; 12:19343. [PMID: 36369462 PMCID: PMC9652374 DOI: 10.1038/s41598-022-23283-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 10/27/2022] [Indexed: 11/13/2022] Open
Abstract
This study was designed to investigate the feasibility and the potential effects on walking performance of a short gait training with a novel impairment-specific hip assistance (iHA) through a bilateral active pelvis orthosis (APO) in patients with acquired brain injury (ABI). Fourteen subjects capable of independent gait and exhibiting mild-to-moderate gait deficits, due to an ABI, were enrolled. Subjects presenting deficit in hip flexion and/or extension were included and divided into two groups based on the presence (group A, n = 6) or absence (group B, n = 8) of knee hyperextension during stance phase of walking. Two iHA-based profiles were developed for the groups. The protocol included two overground gait training sessions using APO, and two evaluation sessions, pre and post training. Primary outcomes were pre vs. post-training walking distance and steady-state speed in the 6-min walking test. Secondary outcomes were self-selected speed, joint kinematics and kinetics, gait symmetry and forward propulsion, assessed through 3D gait analysis. Following the training, study participants significantly increased the walked distance and average steady-state speed in the 6-min walking tests, both when walking with and without the APO. The increased walked distance surpassed the minimal clinically important difference for groups A and B, (respectively, 42 and 57 m > 34 m). In group A, five out of six subjects had decreased knee hyperextension at the post-training session (on average the peak of the knee extension angle was reduced by 36%). Knee flexion during swing phase increased, by 16% and 31%, for A and B groups respectively. Two-day gait training with APO providing iHA was effective and safe in improving walking performance and knee kinematics in ABI survivors. These preliminary findings suggest that this strategy may be viable for subject-specific post-ABI gait rehabilitation.
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Affiliation(s)
- Chiara Livolsi
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Pisa, Italy.
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy.
| | | | - Eleonora Guanziroli
- Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Lecco, Italy
| | | | | | | | - Alberto Esquenazi
- Department of PM&R, MossRehab and Einstein Healthcare Network, Elkins Park, PA, USA
| | | | | | | | - Simona Crea
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Pisa, Italy
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Florence, Italy
| | - Franco Molteni
- Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Lecco, Italy
| | - Nicola Vitiello
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Pisa, Italy
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Florence, Italy
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6
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Earley EJ, Zbinden J, Munoz-Novoa M, Mastinu E, Smiles A, Ortiz-Catalan M. Competitive motivation increased home use and improved prosthesis self-perception after Cybathlon 2020 for neuromusculoskeletal prosthesis user. J Neuroeng Rehabil 2022; 19:47. [PMID: 35578249 PMCID: PMC9112467 DOI: 10.1186/s12984-022-01024-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 05/03/2022] [Indexed: 11/30/2022] Open
Abstract
Background Assistive technologies, such as arm prostheses, are intended to improve the quality of life of individuals with physical disabilities. However, certain training and learning is usually required from the user to make these technologies more effective. Moreover, some people can be encouraged to train more through competitive motivation. Methods In this study, we investigated if the training for and participation in a competitive event (Cybathlon 2020) could promote behavioral changes in an individual with upper limb amputation (the pilot). We defined behavioral changes as the active time while his prosthesis was actuated, ratio of opposing and simultaneous movements, and the pilot’s ability to finely modulate his movement speeds. The investigation was based on extensive home-use data from the period before, during and after the Cybathlon 2020 competition. Results Relevant behavioral changes were found from both quantitative and qualitative analyses. The pilot’s home use of his prosthesis nearly doubled in the period before the Cybathlon, and remained 66% higher than baseline after the competition. Moreover, he improved his speed modulation when controlling his prosthesis, and he learned and routinely operated new movements in the prosthesis (wrist rotation) at home. Additionally, as confirmed by semi-structured interviews, his self-perception of the prosthetic arm and its functionality also improved. Conclusions An event like the Cybathlon may indeed promote behavioral changes in how competitive individuals with amputation use their prostheses. Provided that the prosthesis is suitable in terms of form and function for both competition and at-home daily use, daily activities can become opportunities for training, which in turn can improve prosthesis function and create further opportunities for daily use. Moreover, these changes appeared to remain even well after the event, albeit relevant only for individuals who continue using the technology employed in the competition. Supplementary Information The online version contains supplementary material available at 10.1186/s12984-022-01024-4.
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Affiliation(s)
- Eric J Earley
- Center for Bionics and Pain Research, Mölndal, Sweden.,Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Jan Zbinden
- Center for Bionics and Pain Research, Mölndal, Sweden.,Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Maria Munoz-Novoa
- Center for Bionics and Pain Research, Mölndal, Sweden.,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Enzo Mastinu
- Center for Bionics and Pain Research, Mölndal, Sweden.,Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Andrew Smiles
- Center for Bionics and Pain Research, Mölndal, Sweden.,Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden.,Waterloo Engineering Bionics Lab, University of Waterloo, Waterloo, Canada
| | - Max Ortiz-Catalan
- Center for Bionics and Pain Research, Mölndal, Sweden. .,Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden. .,Operational Area 3, Sahlgrenska University Hospital, Gothenburg, Sweden. .,Department of Orthopedics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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7
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Alingh JF, Groen BE, Kamphuis JF, Geurts ACH, Weerdesteyn V. Task-specific training for improving propulsion symmetry and gait speed in people in the chronic phase after stroke: a proof-of-concept study. J Neuroeng Rehabil 2021; 18:69. [PMID: 33892754 PMCID: PMC8062933 DOI: 10.1186/s12984-021-00858-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/22/2021] [Indexed: 12/21/2022] Open
Abstract
Background After stroke, some individuals have latent, propulsive capacity of the paretic leg, that can be elicited during task-specific gait training. The aim of this proof-of-concept study was to investigate the effect of five-week robotic gait training for improving propulsion symmetry by increasing paretic propulsion in chronic stroke survivors. Methods Twenty-nine individuals with chronic stroke and impaired paretic propulsion (≥ 8% difference in paretic vs. non-paretic propulsive impulse) were enrolled. Participants received ten 60-min sessions of individual robotic gait training targeting paretic propulsion (five weeks, twice a week), complemented with home exercises (15 min/day) focusing on increasing strength and practicing learned strategies in daily life. Propulsion measures, gait kinematics and kinetics, self-selected gait speed, performance of functional gait tasks, and daily-life mobility and physical activity were assessed five weeks (T0) and one week (T1) before the start of intervention, and one week (T2) and five weeks (T3) after the intervention period. Results Between T0 and T1, no significant differences in outcomes were observed, except for a marginal increase in gait speed (+ 2.9%). Following the intervention, propulsion symmetry (+ 7.9%) and paretic propulsive impulse had significantly improved (+ 8.1%), whereas non-paretic propulsive impulse remained unchanged. Larger gains in propulsion symmetry were associated with more asymmetrical propulsion at T0. In addition, following the intervention significantly greater paretic trailing limb angles (+ 6.6%) and ankle plantarflexion moments (+ 7.1%) were observed. Furthermore, gait speed (+ 7.2%), 6-Minute Walk Test (+ 6.4%), Functional Gait Assessment (+ 6.5%), and daily-life walking intensity (+ 6.9%) had increased following the intervention. At five-week follow-up (T3), gains in all outcomes were retained, and gait speed had further increased (+ 3.6%). Conclusions The post-intervention gain in paretic propulsion did not only translate into improved propulsion symmetry and gait speed, but also pertained to performance of functional gait tasks and daily-life walking activity levels. These findings suggest that well-selected chronic stroke survivors may benefit from task-specific targeted training to utilize the residual propulsive capacity of the paretic leg. Future research is recommended to establish simple baseline measures for identification of individuals who may benefit from such training and confirm benefits of the used training concepts in a randomized controlled trial. Trial registration: Registry number ClinicalTrials.gov (www.clinicaltrials.gov): NCT04650802, retrospectively registered 3 December 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s12984-021-00858-8.
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Affiliation(s)
- J F Alingh
- Sint Maartenskliniek Research, PO Box 9011, 6500 GM, Nijmegen, The Netherlands.,Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - B E Groen
- Sint Maartenskliniek Research, PO Box 9011, 6500 GM, Nijmegen, The Netherlands.,Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - J F Kamphuis
- Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - A C H Geurts
- Sint Maartenskliniek Research, PO Box 9011, 6500 GM, Nijmegen, The Netherlands.,Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - V Weerdesteyn
- Sint Maartenskliniek Research, PO Box 9011, 6500 GM, Nijmegen, The Netherlands. .,Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands.
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Sombric CJ, Torres-Oviedo G. Augmenting propulsion demands during split-belt walking increases locomotor adaptation of asymmetric step lengths. J Neuroeng Rehabil 2020; 17:69. [PMID: 32493440 PMCID: PMC7268294 DOI: 10.1186/s12984-020-00698-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 05/21/2020] [Indexed: 11/30/2022] Open
Abstract
Background Promising studies have shown that the gait symmetry of individuals with hemiparesis due to brain lesions, such as stroke, can improve through motor adaptation protocols forcing patients to use their affected limb more. However, little is known about how to facilitate this process. Here we asked if increasing propulsion demands during split-belt walking (i.e., legs moving at different speeds) leads to more motor adaptation and more symmetric gait in survivors of a stroke, as we previously observed in subjects without neurological disorders. Methods We investigated the effect of propulsion forces on locomotor adaptation during and after split-belt walking in the asymmetric motor system post-stroke. To test this, 12 subjects in the chronic phase post-stroke experienced a split-belt protocol in a flat and incline session so as to contrast the effects of two different propulsion demands. Step length asymmetry and propulsion forces were used to compare the motor behavior between the two sessions because these are clinically relevant measures that are altered by split-belt walking. Results The incline session resulted in more symmetric step lengths during late split-belt walking and larger after-effects following split-belt walking. In both testing sessions, subjects who have had a stroke adapted to regain speed and slope-specific leg orientations similarly to young, intact adults. Importantly, leg orientations, which were set by kinetic demands, during baseline walking were predictive of those achieved during split-belt walking, which in turn predicted each individual’s post-adaptation behavior. These results are relevant because they provide evidence that survivors of a stroke can generate the leg-specific forces to walk more symmetrically, but also because we provide insight into factors underlying the therapeutic effect of split-belt walking. Conclusions Individuals post-stroke at a chronic stage can adapt more during split-belt walking and have greater after-effects when propulsion demands are augmented by inclining the treadmill surface. Our results are promising since they suggest that increasing propulsion demands during paradigms that force patients to use their paretic side more could correct gait asymmetries post-stroke more effectively.
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Affiliation(s)
- Carly J Sombric
- Department of Bioengineering, University of Pittsburgh, 4420 Bayard Street, Suite 110, Pitt, Pittsburgh, PA, USA
| | - Gelsy Torres-Oviedo
- Department of Bioengineering, University of Pittsburgh, 4420 Bayard Street, Suite 110, Pitt, Pittsburgh, PA, USA.
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9
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Arlinghaus KR, Johnston CA. Identifying and Addressing Individuals Resistant to Behavioral Lifestyle Treatment. Am J Lifestyle Med 2019; 13:354-358. [PMID: 31285716 PMCID: PMC6600621 DOI: 10.1177/1559827619843117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
The prevention and treatment of lifestyle disease involves overlapping factors. Those at the highest risk for the development of lifestyle disease are also at the highest risk for poor treatment outcomes. Although behavioral treatment of lifestyle disease has demonstrated efficacy on average, considerable individual variation exists in treatment response. In clinical settings, individuals unresponsive to treatment are typically provided escalated care. Community-based care is designed to reach high-risk populations unlikely to seek medical care. However, in community settings escalated treatment options are not usually available for individuals unresponsive to treatment. Addressing this gap is imperative to improve health outcomes of high-risk populations and to identify individuals who may be resistant to behavioral lifestyle treatment.
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Affiliation(s)
| | - Craig A. Johnston
- Department of Health and Human Performance,
University of Houston, Houston, Texas
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10
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Sánchez-Sánchez ML, Ruescas-Nicolau MA, Carrasco JJ, Espí-López GV, Pérez-Alenda S. Cross-sectional study of quadriceps properties and postural stability in patients with chronic stroke and limited vs. non-limited community ambulation. Top Stroke Rehabil 2019; 26:503-510. [PMID: 31246150 DOI: 10.1080/10749357.2019.1634360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Changes in the paretic-side metabolism post-stroke and quadriceps muscle mechanical properties favour muscle wasting, affecting postural instability and walking impairment. Further clarification is needed in subjects post-stroke who show limited or non-limited community ambulation. Objectives: To analyze between-limb differences in quadriceps muscle thickness, strength and thigh cutaneous temperature, as well as investigate postural stability in subjects with chronic stroke and limited vs. non-limited community ambulation and compared against healthy controls. Methods: In this controlled cross-sectional study, 26 participants with chronic hemiparesis post-stroke (divided in a slow gait group (SG<0.8 m/s) (n = 13) and a fast gait group with full community ambulation speed (FG≥0.8 m/s)) and 18 healthy people were recruited. Thigh surface temperature, rectus femoris (RF) and vastus intermedius (VI) muscles thickness, quadriceps' isometric maximal voluntary contraction and postural stability were measured. Results: The SG presented significantly lower RF (P = .019) and VI (P = .006) muscle thickness, less peak force (P < .001) and lower temperature (P = .002) in the paretic vs the non-paretic limb. The FG showed significantly lower VI thickness (P = .036) and peak force (P < .001) in the paretic vs the non-paretic limb. Regarding balance, all indices were worse in the SG versus the FG and CG. Conclusions: Subjects of the FG, despite showing full community ambulation speed, had less quadriceps strength and VI muscle thickness but not RF muscle wasting in the paretic limb. The paretic VI muscle wasting may be an important factor to reach normal walking. The SG showed between-limb differences in all the studied variables and the worst postural stability.
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Affiliation(s)
- Maria-Luz Sánchez-Sánchez
- Physiotherapy in Motion. Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia , Valencia , Spain
| | - Maria-Arantzazu Ruescas-Nicolau
- Physiotherapy in Motion. Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia , Valencia , Spain
| | - Juan J Carrasco
- Physiotherapy in Motion. Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia , Valencia , Spain.,Intelligent Data Analysis Laboratory, University of Valencia , Valencia , Spain
| | - Gemma-Victoria Espí-López
- Research Unit in Manual Locomotor Therapy. Faculty of Physiotherapy, University of Valencia , Valencia , Spain.,Department of Physiotherapy, University of Valencia , Valencia , Spain
| | - Sofia Pérez-Alenda
- Physiotherapy in Motion. Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia , Valencia , Spain
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11
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Roelker SA, Bowden MG, Kautz SA, Neptune RR. Paretic propulsion as a measure of walking performance and functional motor recovery post-stroke: A review. Gait Posture 2019; 68:6-14. [PMID: 30408710 PMCID: PMC6657344 DOI: 10.1016/j.gaitpost.2018.10.027] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 09/25/2018] [Accepted: 10/19/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Although walking speed is the most common measure of gait performance post-stroke, improved walking speed following rehabilitation does not always indicate the recovery of paretic limb function. Over the last decade, the measure paretic propulsion (Pp, defined as the propulsive impulse generated by the paretic leg divided by the sum of the propulsive impulses of both legs) has been established as a measure of paretic limb output and recently targeted in post-stroke rehabilitation paradigms. However, the literature lacks a detailed synthesis of how paretic propulsion, walking speed, and other biomechanical and neuromuscular measures collectively relate to post-stroke walking performance and motor recovery. OBJECTIVE The aim of this review was to assess factors associated with the ability to generate Pp and identify rehabilitation targets aimed at improving Pp and paretic limb function. METHODS Relevant literature was collected in which paretic propulsion was used to quantify and assess propulsion symmetry and function in hemiparetic gait. RESULTS Paretic leg extension during terminal stance is strongly associated with Pp. Both paretic leg extension and propulsion are related to step length asymmetry, revealing an interaction between spatiotemporal, kinematic and kinetic metrics that underlies hemiparetic walking performance. The importance of plantarflexor function in producing propulsion is highlighted by the association of an independent plantarflexor excitation module with increased Pp. Furthermore, the literature suggests that although current rehabilitation techniques can improve Pp, these improvements depend on the patient's baseline plantarflexor function. SIGNIFICANCE Pp provides a quantitative measure of propulsion symmetry and should be a primary target of post-stroke gait rehabilitation. The current literature suggests rehabilitation techniques that target both plantarflexor function and leg extension may restore paretic limb function and improve gait asymmetries in individuals post stroke.
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Affiliation(s)
- Sarah A. Roelker
- Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Mark G. Bowden
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA.,Division of Physical Therapy, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA,Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - Steven A. Kautz
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA.,Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - Richard R. Neptune
- Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX, USA
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12
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Allen JL, Ting LH, Kesar TM. Gait Rehabilitation Using Functional Electrical Stimulation Induces Changes in Ankle Muscle Coordination in Stroke Survivors: A Preliminary Study. Front Neurol 2018; 9:1127. [PMID: 30619077 PMCID: PMC6306420 DOI: 10.3389/fneur.2018.01127] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 12/07/2018] [Indexed: 11/23/2022] Open
Abstract
Background: Previous studies have demonstrated that post-stroke gait rehabilitation combining functional electrical stimulation (FES) applied to the ankle muscles during fast treadmill walking (FastFES) improves gait biomechanics and clinical walking function. However, there is considerable inter-individual variability in response to FastFES. Although FastFES aims to sculpt ankle muscle coordination, whether changes in ankle muscle activity underlie observed gait improvements is unknown. The aim of this study was to investigate three cases illustrating how FastFES modulates ankle muscle recruitment during walking. Methods: We conducted a preliminary case series study on three individuals (53–70 y; 2 M; 35–60 months post-stroke; 19–22 lower extremity Fugl-Meyer) who participated in 18 sessions of FastFES (3 sessions/week; ClinicalTrials.gov: NCT01668602). Clinical walking function (speed, 6-min walk test, and Timed-Up-and-Go test), gait biomechanics (paretic propulsion and ankle angle at initial-contact), and plantarflexor (soleus)/dorsiflexor (tibialis anterior) muscle recruitment were assessed pre- and post-FastFES while walking without stimulation. Results:Two participants (R1, R2) were categorized as responders based on improvements in clinical walking function. Consistent with heterogeneity of clinical and biomechanical changes commonly observed following gait rehabilitation, how muscle activity was altered with FastFES differed between responders. R1 exhibited improved plantarflexor recruitment during stance accompanied by increased paretic propulsion. R2 exhibited improved dorsiflexor recruitment during swing accompanied by improved paretic ankle angle at initial-contact. In contrast, the third participant (NR1), classified as a non-responder, demonstrated increased ankle muscle activity during inappropriate phases of the gait cycle. Across all participants, there was a positive relationship between increased walking speeds after FastFES and reduced SOL/TA muscle coactivation. Conclusion:Our preliminary case series study is the first to demonstrate that improvements in ankle plantarflexor and dorsiflexor muscle recruitment (muscles targeted by FastFES) accompanied improvements in gait biomechanics and walking function following FastFES in individuals post-stroke. Our results also suggest that inducing more appropriate (i.e., reduced) ankle plantar/dorsi-flexor muscle coactivation may be an important neuromuscular mechanism underlying improvements in gait function after FastFES training, suggesting that pre-treatment ankle muscle status could be used for inclusion into FastFES. The findings of this case-series study, albeit preliminary, provide the rationale and foundations for larger-sample studies using similar methodology.
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Affiliation(s)
- Jessica L Allen
- Department of Chemical and Biomedical Engineering, West Virginia University, Morgantown, WV, United States
| | - Lena H Ting
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, United States.,Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, GA, United States
| | - Trisha M Kesar
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, United States
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13
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Ray NT, Knarr BA, Higginson JS. Walking speed changes in response to novel user-driven treadmill control. J Biomech 2018; 78:143-149. [PMID: 30078637 DOI: 10.1016/j.jbiomech.2018.07.035] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 05/29/2018] [Accepted: 07/20/2018] [Indexed: 11/28/2022]
Abstract
Implementing user-driven treadmill control in gait training programs for rehabilitation may be an effective means of enhancing motor learning and improving functional performance. This study aimed to determine the effect of a user-driven treadmill control scheme on walking speeds, anterior ground reaction forces (AGRF), and trailing limb angles (TLA) of healthy adults. Twenty-three participants completed a 10-m overground walking task to measure their overground self-selected (SS) walking speeds. Then, they walked at their SS and fastest comfortable walking speeds on an instrumented split-belt treadmill in its fixed speed and user-driven control modes. The user-driven treadmill controller combined inertial-force, gait parameter, and position based control to adjust the treadmill belt speed in real time. Walking speeds, peak AGRF, and TLA were compared among test conditions using paired t-tests (α = 0.05). Participants chose significantly faster SS and fast walking speeds in the user-driven mode than the fixed speed mode (p > 0.05). There was no significant difference between the overground SS walking speed and the SS speed from the user-driven trials (p < 0.05). Changes in AGRF and TLA were caused primarily by changes in walking speed, not the treadmill controller. Our findings show the user-driven treadmill controller allowed participants to select walking speeds faster than their chosen speeds on the fixed speed treadmill and similar to their overground speeds. Since user-driven treadmill walking increases cognitive activity and natural mobility, these results suggest user-driven treadmill control would be a beneficial addition to current gait training programs for rehabilitation.
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Affiliation(s)
- Nicole T Ray
- Department of Mechanical Engineering, University of Delaware, Newark, DE, United States.
| | - Brian A Knarr
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, United States
| | - Jill S Higginson
- Department of Mechanical Engineering, University of Delaware, Newark, DE, United States
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14
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Awad LN, Bae J, O'Donnell K, De Rossi SMM, Hendron K, Sloot LH, Kudzia P, Allen S, Holt KG, Ellis TD, Walsh CJ. A soft robotic exosuit improves walking in patients after stroke. Sci Transl Med 2018; 9:9/400/eaai9084. [PMID: 28747517 DOI: 10.1126/scitranslmed.aai9084] [Citation(s) in RCA: 248] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 04/21/2016] [Accepted: 07/07/2017] [Indexed: 12/22/2022]
Abstract
Stroke-induced hemiparetic gait is characteristically slow and metabolically expensive. Passive assistive devices such as ankle-foot orthoses are often prescribed to increase function and independence after stroke; however, walking remains highly impaired despite-and perhaps because of-their use. We sought to determine whether a soft wearable robot (exosuit) designed to supplement the paretic limb's residual ability to generate both forward propulsion and ground clearance could facilitate more normal walking after stroke. Exosuits transmit mechanical power generated by actuators to a wearer through the interaction of garment-like, functional textile anchors and cable-based transmissions. We evaluated the immediate effects of an exosuit actively assisting the paretic limb of individuals in the chronic phase of stroke recovery during treadmill and overground walking. Using controlled, treadmill-based biomechanical investigation, we demonstrate that exosuits can function in synchrony with a wearer's paretic limb to facilitate an immediate 5.33 ± 0.91° increase in the paretic ankle's swing phase dorsiflexion and 11 ± 3% increase in the paretic limb's generation of forward propulsion (P < 0.05). These improvements in paretic limb function contributed to a 20 ± 4% reduction in forward propulsion interlimb asymmetry and a 10 ± 3% reduction in the energy cost of walking, which is equivalent to a 32 ± 9% reduction in the metabolic burden associated with poststroke walking. Relatively low assistance (~12% of biological torques) delivered with a lightweight and nonrestrictive exosuit was sufficient to facilitate more normal walking in ambulatory individuals after stroke. Future work will focus on understanding how exosuit-induced improvements in walking performance may be leveraged to improve mobility after stroke.
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Affiliation(s)
- Louis N Awad
- Wyss Institute for Biologically Inspired Engineering, Harvard University, 3 Blackfan Circle, Boston, MA 02115, USA.,Department of Physical Therapy and Athletic Training, Boston University, 635 Commonwealth Avenue, Boston, MA 02215, USA.,Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, 60 Oxford Street, Suite 403, Cambridge, MA 02138, USA
| | - Jaehyun Bae
- Wyss Institute for Biologically Inspired Engineering, Harvard University, 3 Blackfan Circle, Boston, MA 02115, USA.,Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, 60 Oxford Street, Suite 403, Cambridge, MA 02138, USA
| | - Kathleen O'Donnell
- Wyss Institute for Biologically Inspired Engineering, Harvard University, 3 Blackfan Circle, Boston, MA 02115, USA.,Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, 60 Oxford Street, Suite 403, Cambridge, MA 02138, USA
| | - Stefano M M De Rossi
- Wyss Institute for Biologically Inspired Engineering, Harvard University, 3 Blackfan Circle, Boston, MA 02115, USA.,Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, 60 Oxford Street, Suite 403, Cambridge, MA 02138, USA
| | - Kathryn Hendron
- Department of Physical Therapy and Athletic Training, Boston University, 635 Commonwealth Avenue, Boston, MA 02215, USA
| | - Lizeth H Sloot
- Wyss Institute for Biologically Inspired Engineering, Harvard University, 3 Blackfan Circle, Boston, MA 02115, USA
| | - Pawel Kudzia
- Wyss Institute for Biologically Inspired Engineering, Harvard University, 3 Blackfan Circle, Boston, MA 02115, USA
| | - Stephen Allen
- Wyss Institute for Biologically Inspired Engineering, Harvard University, 3 Blackfan Circle, Boston, MA 02115, USA
| | - Kenneth G Holt
- Department of Physical Therapy and Athletic Training, Boston University, 635 Commonwealth Avenue, Boston, MA 02215, USA
| | - Terry D Ellis
- Department of Physical Therapy and Athletic Training, Boston University, 635 Commonwealth Avenue, Boston, MA 02215, USA.
| | - Conor J Walsh
- Wyss Institute for Biologically Inspired Engineering, Harvard University, 3 Blackfan Circle, Boston, MA 02115, USA. .,Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, 60 Oxford Street, Suite 403, Cambridge, MA 02138, USA
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15
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Genthe K, Schenck C, Eicholtz S, Zajac-Cox L, Wolf S, Kesar TM. Effects of real-time gait biofeedback on paretic propulsion and gait biomechanics in individuals post-stroke. Top Stroke Rehabil 2018; 25:186-193. [PMID: 29457532 DOI: 10.1080/10749357.2018.1436384] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objectives Gait training interventions that target paretic propulsion induce improvements in walking speed and function in individuals post-stroke. Previously, we demonstrated that able-bodied individuals increase propulsion unilaterally when provided real-time biofeedback targeting anterior ground reaction forces (AGRF). The purpose of this study was to, for the first time, investigate short-term effects of real-time AGRF gait biofeedback training on post-stroke gait. Methods Nine individuals with post-stroke hemiparesis (6 females, age = 54 ± 12.4 years 39.2 ± 24.4 months post-stroke) completed three 6-minute training bouts on an instrumented treadmill. During training, visual and auditory biofeedback were provided to increase paretic AGRF during terminal stance. Gait biomechanics were evaluated before training, and during retention tests conducted 2, 15, and 30 minutes post-training. Primary dependent variables were paretic and non-paretic peak AGRF; secondary variables included paretic and non-paretic peak trailing limb angle, plantarflexor moment, and step length. In addition to evaluating the effects of biofeedback training on these dependent variables, we compared effects of a 6-minute biofeedback training bout to a non-biofeedback control condition. Results Compared to pre-training, significantly greater paretic peak AGRFs were generated during the 2, 15, and 30-minute retention tests conducted after the 18-minute biofeedback training session. Biofeedback training induced no significant effects on the non-paretic leg. Comparison of a 6-minute biofeedback training bout with a speed-matched control bout without biofeedback demonstrated a main effect for training type, with greater peak AGRF generation during biofeedback. Discussion Our results suggest that AGRF biofeedback may be a feasible and promising gait training strategy to target propulsive deficits in individuals post-stroke.
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Affiliation(s)
- Katlin Genthe
- a Division of Physical Therapy, Department of Rehabilitation Medicine , Emory University , Atlanta , GA , USA
| | - Christopher Schenck
- b Department of Biomedical Engineering , Georgia Institute of Technology , Atlanta , GA , USA
| | - Steven Eicholtz
- a Division of Physical Therapy, Department of Rehabilitation Medicine , Emory University , Atlanta , GA , USA
| | - Laura Zajac-Cox
- a Division of Physical Therapy, Department of Rehabilitation Medicine , Emory University , Atlanta , GA , USA
| | - Steven Wolf
- a Division of Physical Therapy, Department of Rehabilitation Medicine , Emory University , Atlanta , GA , USA.,c Center for Visual and Neuro-cognitive Rehabilitation , Atlanta Veterans Affairs , Atlanta , GA , USA
| | - Trisha M Kesar
- a Division of Physical Therapy, Department of Rehabilitation Medicine , Emory University , Atlanta , GA , USA
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16
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Franck JA, Smeets RJEM, Seelen HAM. Evaluation of a functional hand orthosis combined with electrical stimulation adjunct to arm-hand rehabilitation in subacute stroke patients with a severely to moderately affected hand function. Disabil Rehabil 2018; 41:1160-1168. [PMID: 29316821 DOI: 10.1080/09638288.2017.1423400] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE To investigate the usability and effectiveness of a functional hand orthosis, combined with electrical stimulation adjunct to therapy-as-usual, on functional use of the moderately/severely impaired hand in sub-acute stroke patients. MATERIALS AND METHODS Single case experiment (A-B-A'-design) involving eight sub-acute stroke patients. The functional hand orthosis and electrical stimulation were used for six weeks, four days/week, 45'/day. OUTCOME MEASURES Action_Research_Arm_Test, Intrinsic_Motivation_Inventory. RESULTS At group level, patients improved 19.2 points (median value) (interquartile range: [8.8, 29.5] points) on the Action_Research_Arm_Test (p = 0.001). After correcting for spontaneous recovery and/or therapy-as-usual effects Action_Research_Arm_Test scores still improved significantly (median: 17.2 points; interquartile range: [5.1, 29.2] points) (p = 0.002). At individual level, six patients had improved as to arm-hand skill performance at follow-up (p < = 0.010). In one patient, arm-hand skill performance improvement did not attain statistical significance. In another patient, no arm-hand skill performance improvement was observed. Average Intrinsic_Motivation_Inventory sub-scores were between 4.6 and 6.3 (maximum: 7), except for 'perceived pressure/tension' (3.3). CONCLUSION Sub-acute stroke patients who display only little/modest improvement on their capacity to perform daily activities, seem to benefit from training with a dynamic arm orthosis in combination with electrical stimulation. Patients' perceived intrinsic motivation and sense of self-regulation was high. Implications for rehabilitation Arm-hand training featuring the dynamic hand orthosis in combination with electrical stimulation shows a shift from no dexterity to dexterity. As to the users' experience regarding the dynamic hand orthosis, patients perceive a high-intrinsic motivation and sense of self-regulation. Combining the orthosis with electrical stimulation creates opportunities for a nonfunctional hand towards task-oriented training.
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Affiliation(s)
- Johan Anton Franck
- a Department of Brain Injury Rehabilitation , Adelante Rehabilitation Centre , Hoensbroek , the Netherlands.,b Adelante Centre of Expertise in Rehabilitation and Audiology , Hoensbroek , the Netherlands
| | | | - Henk Alexander Maria Seelen
- b Adelante Centre of Expertise in Rehabilitation and Audiology , Hoensbroek , the Netherlands.,c Department of Rehabilitation Medicine , Maastricht University, Research School CAPHRI , Maastricht , the Netherlands
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17
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Casco S, Fuster I, Galeano R, Moreno JC, Pons JL, Brunetti F. Towards an ankle neuroprosthesis for hybrid robotics: Concepts and current sources for functional electrical stimulation. IEEE Int Conf Rehabil Robot 2017; 2017:1660-1665. [PMID: 28814058 DOI: 10.1109/icorr.2017.8009486] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Hybrid rehabilitation robotics combine neuro-prosthetic devices (close-loop functional electrical stimulation systems) and traditional robotic structures and actuators to explore better therapies and promote a more efficient motor function recovery or compensation. Although hybrid robotics and ankle neuroprostheses (NPs) have been widely developed over the last years, there are just few studies on the use of NPs to electrically control both ankle flexion and extension to promote ankle recovery and improved gait patterns in paretic limbs. The aim of this work is to develop an ankle NP specifically designed to work in the field of hybrid robotics. This article presents early steps towards this goal and makes a brief review about motor NPs and Functional Electrical Stimulation (FES) principles and most common devices used to aid the ankle functioning during the gait cycle. It also shows a current sources analysis done in this framework, in order to choose the best one for this intended application.
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18
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Schenck C, Kesar TM. Effects of unilateral real-time biofeedback on propulsive forces during gait. J Neuroeng Rehabil 2017; 14:52. [PMID: 28583196 PMCID: PMC5460355 DOI: 10.1186/s12984-017-0252-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 05/12/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In individuals with post-stroke hemiparesis, reduced push-off force generation in the paretic leg negatively impacts walking function. Gait training interventions that increase paretic push-off can improve walking function in individuals with neurologic impairment. During normal locomotion, push-off forces are modulated with variations in gait speed and slope. However, it is unknown whether able-bodied individuals can selectively modulate push-off forces from one leg in response to biofeedback. Here, in a group of young, neurologically-unimpaired individuals, we determined the effects of a real-time visual and auditory biofeedback gait training paradigm aimed at unilaterally increasing anteriorly-directed ground reaction force (AGRF) in the targeted leg. METHODS Ground reaction force data during were collected from 7 able-bodied individuals as they walked at a self-selected pace on a dual-belt treadmill instrumented with force platforms. During 11-min of gait training, study participants were provided real-time AGRF biofeedback encouraging a 20-30% increase in peak AGRF generated by their right (targeted) leg compared to their baseline (pre-training) AGRF. AGRF data were collected before, during, and after the biofeedback training period, as well as during two retention tests performed without biofeedback and after standing breaks. RESULTS Compared to AGRFs generated during the pre-training gait trials, participants demonstrated a significantly greater AGRF in the targeted leg during and immediately after training, indicating that biofeedback training was successful at inducing increased AGRF production in the targeted leg. Additionally, participants continued to demonstrate greater AGRF production in the targeted leg after two standing breaks, showing short-term recall of the gait pattern learned during the biofeedback training. No significant effects of training were observed on the AGRF in the non-targeted limb, showing the specificity of the effects of biofeedback toward the targeted limb. CONCLUSIONS These results demonstrate the short-term effects of using unilateral AGRF biofeedback to target propulsion in a specific leg, which may have utility as a training tool for individuals with gait deficits such as post-stroke hemiparesis. Future studies are needed to investigate the effects of real-time AGRF biofeedback as a gait training tool in neurologically-impaired individuals.
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Affiliation(s)
- Christopher Schenck
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Trisha M Kesar
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, 1441 Clifton Rd NE, Atlanta, GA, 30322, USA.
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19
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Awad LN, Reisman DS, Pohlig RT, Binder-Macleod SA. Identifying candidates for targeted gait rehabilitation after stroke: better prediction through biomechanics-informed characterization. J Neuroeng Rehabil 2016; 13:84. [PMID: 27663199 PMCID: PMC5035477 DOI: 10.1186/s12984-016-0188-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 08/26/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Walking speed has been used to predict the efficacy of gait training; however, poststroke motor impairments are heterogeneous and different biomechanical strategies may underlie the same walking speed. Identifying which individuals will respond best to a particular gait rehabilitation program using walking speed alone may thus be limited. The objective of this study was to determine if, beyond walking speed, participants' baseline ability to generate propulsive force from their paretic limbs (paretic propulsion) influences the improvements in walking speed resulting from a paretic propulsion-targeting gait intervention. METHODS Twenty seven participants >6 months poststroke underwent a 12-week locomotor training program designed to target deficits in paretic propulsion through the combination of fast walking with functional electrical stimulation to the paretic ankle musculature (FastFES). The relationship between participants' baseline usual walking speed (UWSbaseline), maximum walking speed (MWSbaseline), and paretic propulsion (propbaseline) versus improvements in usual walking speed (∆UWS) and maximum walking speed (∆MWS) were evaluated in moderated regression models. RESULTS UWSbaseline and MWSbaseline were, respectively, poor predictors of ΔUWS (R 2 = 0.24) and ΔMWS (R 2 = 0.01). Paretic propulsion × walking speed interactions (UWSbaseline × propbaseline and MWSbaseline × propbaseline) were observed in each regression model (R 2 s = 0.61 and 0.49 for ∆UWS and ∆MWS, respectively), revealing that slower individuals with higher utilization of the paretic limb for forward propulsion responded best to FastFES training and were the most likely to achieve clinically important differences. CONCLUSIONS Characterizing participants based on both their walking speed and ability to generate paretic propulsion is a markedly better approach to predicting walking recovery following targeted gait rehabilitation than using walking speed alone.
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Affiliation(s)
- Louis N Awad
- Department of Physical Therapy and Athletic Training, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, 02215, USA. .,Wyss Institute For Biologically Inspired Engineering, Harvard University, Cambridge, MA, 02138, USA.
| | - Darcy S Reisman
- Department of Physical Therapy, University of Delaware, Newark, DE, 19713, USA.,Graduate Program in Biomechanics and Movement Science, University of Delaware, Newark, DE, 19713, USA
| | - Ryan T Pohlig
- Delaware Clinical and Translational Research ACCEL Program, Newark, DE, 19713, USA.,Biostatistics Core Facility, University of Delaware, Newark, DE, 19713, USA
| | - Stuart A Binder-Macleod
- Department of Physical Therapy, University of Delaware, Newark, DE, 19713, USA.,Graduate Program in Biomechanics and Movement Science, University of Delaware, Newark, DE, 19713, USA.,Delaware Clinical and Translational Research ACCEL Program, Newark, DE, 19713, USA
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