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Sterke B, Jabeen S, Baines P, Vallery H, Ribbers G, Heijenbrok-Kal M. Direct biomechanical manipulation of human gait stability: A systematic review. PLoS One 2024; 19:e0305564. [PMID: 38990959 PMCID: PMC11239080 DOI: 10.1371/journal.pone.0305564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 05/31/2024] [Indexed: 07/13/2024] Open
Abstract
People fall more often when their gait stability is reduced. Gait stability can be directly manipulated by exerting forces or moments onto a person, ranging from simple walking sticks to complex wearable robotics. A systematic review of the literature was performed to determine: What is the level of evidence for different types of mechanical manipulations on improving gait stability? The study was registered at PROSPERO (CRD42020180631). Databases Embase, Medline All, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, and Google Scholar were searched. The final search was conducted on the 1st of December, 2022. The included studies contained mechanical devices that influence gait stability for both impaired and non-impaired subjects. Studies performed with prosthetic devices, passive orthoses, and analysing post-training effects were excluded. An adapted NIH quality assessment tool was used to assess the study quality and risk of bias. Studies were grouped based on the type of device, point of application, and direction of forces and moments. For each device type, a best-evidence synthesis was performed to quantify the level of evidence based on the type of validity of the reported outcome measures and the study quality assessment score. Impaired and non-impaired study participants were considered separately. From a total of 4701 papers, 53 were included in our analysis. For impaired subjects, indicative evidence was found for medio-lateral pelvis stabilisation for improving gait stability, while limited evidence was found for hip joint assistance and canes. For non-impaired subjects, moderate evidence was found for medio-lateral pelvis stabilisation and limited evidence for body weight support. For all other device types, either indicative or insufficient evidence was found for improving gait stability. Our findings also highlight the lack of consensus on outcome measures amongst studies of devices focused on manipulating gait.
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Affiliation(s)
- Bram Sterke
- Rehabilitation Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Saher Jabeen
- Department of Biomechanical Engineering, Technical University of Delft, Delft, The Netherlands
| | - Patricia Baines
- Department of Biomechanical Engineering, Technical University of Delft, Delft, The Netherlands
| | - Heike Vallery
- Rehabilitation Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Biomechanical Engineering, Technical University of Delft, Delft, The Netherlands
| | - Gerard Ribbers
- Rehabilitation Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
- Rijndam Rehabilitation Center, Rotterdam, The Netherlands
| | - Majanka Heijenbrok-Kal
- Rehabilitation Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
- Rijndam Rehabilitation Center, Rotterdam, The Netherlands
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Ettema S, Pennink GH, Buurke TJW, David S, van Bennekom CAM, Houdijk H. Clinical indications and protocol considerations for selecting initial body weight support levels in gait rehabilitation: a systematic review. J Neuroeng Rehabil 2024; 21:97. [PMID: 38849899 PMCID: PMC11157893 DOI: 10.1186/s12984-024-01389-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 05/20/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Body weight support (BWS) training devices are frequently used to improve gait in individuals with neurological impairments, but guidance in selecting an appropriate level of BWS is limited. Here, we aim to describe the initial BWS levels used during gait training, the rationale for this selection and the clinical goals aligned with BWS training for different diagnoses. METHOD A systematic literature search was conducted in PubMed, Embase and Web of Science, including terms related to the population (individuals with neurological disorders), intervention (BWS training) and outcome (gait). Information on patient characteristics, type of BWS device, BWS level and training goals was extracted from the included articles. RESULTS Thirty-three articles were included, which described outcomes using frame-based (stationary or mobile) and unidirectional ceiling-mounted devices on four diagnoses (multiple sclerosis (MS), spinal cord injury (SCI), stroke, traumatic brain injury (TBI)). The BWS levels were highest for individuals with MS (median: 75%, IQR: 6%), followed by SCI (median: 40%, IQR: 35%), stroke (median: 30%, IQR: 4.75%) and TBI (median: 15%, IQR: 0%). The included studies reported eleven different training goals. Reported BWS levels ranged between 30 and 75% for most of the training goals, without a clear relationship between BWS level, diagnosis, training goal and rationale for BWS selection. Training goals were achieved in all included studies. CONCLUSION Initial BWS levels differ considerably between studies included in this review. The underlying rationale for these differences was not clearly motivated in the included studies. Variation in study designs and populations does not allow to draw a conclusion on the effectiveness of BWS levels. Hence, it remains difficult to formulate guidelines on optimal BWS settings for different diagnoses, BWS devices and training goals. Further efforts are required to establish clinical guidelines and to experimentally investigate which initial BWS levels are optimal for specific diagnoses and training goals.
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Affiliation(s)
- Sanne Ettema
- Research and Development, Heliomare Rehabilitation, Wijk aan Zee, the Netherlands.
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - Geertje H Pennink
- Research and Development, Heliomare Rehabilitation, Wijk aan Zee, the Netherlands
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Tom J W Buurke
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Sina David
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Coen A M van Bennekom
- Research and Development, Heliomare Rehabilitation, Wijk aan Zee, the Netherlands
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam, the Netherlands
| | - Han Houdijk
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Cowburn J, Serrancolí G, Colyer S, Cazzola D. Optimal fibre length and maximum isometric force are the most influential parameters when modelling muscular adaptations to unloading using Hill-type muscle models. Front Physiol 2024; 15:1347089. [PMID: 38694205 PMCID: PMC11061504 DOI: 10.3389/fphys.2024.1347089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/25/2024] [Indexed: 05/04/2024] Open
Abstract
Introduction: Spaceflight is associated with severe muscular adaptations with substantial inter-individual variability. A Hill-type muscle model is a common method to replicate muscle physiology in musculoskeletal simulations, but little is known about how the underlying parameters should be adjusted to model adaptations to unloading. The aim of this study was to determine how Hill-type muscle model parameters should be adjusted to model disuse muscular adaptations. Methods: Isokinetic dynamometer data were taken from a bed rest campaign and used to perform tracking simulations at two knee extension angular velocities (30°·s-1 and 180°·s-1). The activation and contraction dynamics were solved using an optimal control approach and direct collocation method. A Monte Carlo sampling technique was used to perturb muscle model parameters within physiological boundaries to create a range of theoretical and feasible parameters to model muscle adaptations. Results: Optimal fibre length could not be shortened by more than 67% and 61% for the knee flexors and non-knee muscles, respectively. Discussion: The Hill-type muscle model successfully replicated muscular adaptations due to unloading, and recreated salient features of muscle behaviour associated with spaceflight, such as altered force-length behaviour. Future researchers should carefully adjust the optimal fibre lengths of their muscle-models when trying to model adaptations to unloading, particularly muscles that primarily operate on the ascending and descending limbs of the force-length relationship.
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Affiliation(s)
- James Cowburn
- Department for Health, University of Bath, Bath, United Kingdom
- Centre for the Analysis of Motion, Entertainment Research and Applications, University of Bath, Bath, United Kingdom
| | - Gil Serrancolí
- Department of Mechanical Engineering, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Steffi Colyer
- Department for Health, University of Bath, Bath, United Kingdom
- Centre for the Analysis of Motion, Entertainment Research and Applications, University of Bath, Bath, United Kingdom
| | - Dario Cazzola
- Department for Health, University of Bath, Bath, United Kingdom
- Centre for the Analysis of Motion, Entertainment Research and Applications, University of Bath, Bath, United Kingdom
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Cowburn J, Serrancolí G, Pavei G, Minetti A, Salo A, Colyer S, Cazzola D. A novel computational framework for the estimation of internal musculoskeletal loading and muscle adaptation in hypogravity. Front Physiol 2024; 15:1329765. [PMID: 38384800 PMCID: PMC10880100 DOI: 10.3389/fphys.2024.1329765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 01/08/2024] [Indexed: 02/23/2024] Open
Abstract
Introduction: Spaceflight is associated with substantial and variable musculoskeletal (MSK) adaptations. Characterisation of muscle and joint loading profiles can provide key information to better align exercise prescription to astronaut MSK adaptations upon return-to-Earth. A case-study is presented of single-leg hopping in hypogravity to demonstrate the additional benefit computational MSK modelling has when estimating lower-limb MSK loading. Methods: A single male participant performed single-leg vertical hopping whilst attached to a body weight support system to replicate five gravity conditions (0.17, 0.25, 0.37, 0.50, 1 g). Experimental joint kinematics, joint kinetics and ground reaction forces were tracked in a data-tracking direct collocation simulation framework. Ground reaction forces, sagittal plane hip, knee and ankle net joint moments, quadriceps muscle forces (Rectus Femoris and three Vasti muscles), and hip, knee and ankle joint reaction forces were extracted for analysis. Estimated quadriceps muscle forces were input into a muscle adaptation model to predict a meaningful increase in muscle cross-sectional area, defined in (DeFreitas et al., 2011). Results: Two distinct strategies were observed to cope with the increase in ground reaction forces as gravity increased. Hypogravity was associated with an ankle dominant strategy with increased range of motion and net plantarflexor moment that was not seen at the hip or knee, and the Rectus Femoris being the primary contributor to quadriceps muscle force. At 1 g, all three joints had increased range of motion and net extensor moments relative to 0.50 g, with the Vasti muscles becoming the main muscles contributing to quadriceps muscle force. Additionally, hip joint reaction force did not increase substantially as gravity increased, whereas the other two joints increased monotonically with gravity. The predicted volume of exercise needed to counteract muscle adaptations decreased substantially with gravity. Despite the ankle dominant strategy in hypogravity, the loading on the knee muscles and joint also increased, demonstrating this provided more information about MSK loading. Discussion: This approach, supplemented with muscle-adaptation models, can be used to compare MSK loading between exercises to enhance astronaut exercise prescription.
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Affiliation(s)
- James Cowburn
- Department for Health, University of Bath, Bath, United Kingdom
- Centre for the Analysis of Motion, Entertainment Research and Applications, University of Bath, Bath, United Kingdom
| | - Gil Serrancolí
- Department of Mechanical Engineering, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Gaspare Pavei
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Alberto Minetti
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Aki Salo
- Department for Health, University of Bath, Bath, United Kingdom
- Centre for the Analysis of Motion, Entertainment Research and Applications, University of Bath, Bath, United Kingdom
| | - Steffi Colyer
- Department for Health, University of Bath, Bath, United Kingdom
- Centre for the Analysis of Motion, Entertainment Research and Applications, University of Bath, Bath, United Kingdom
| | - Dario Cazzola
- Department for Health, University of Bath, Bath, United Kingdom
- Centre for the Analysis of Motion, Entertainment Research and Applications, University of Bath, Bath, United Kingdom
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Pohlman C, Pardee A, Friedman M, Rutherford D, Vannatta CN, Kernozek TW. Effects of Body Weight Support in Running on Achilles Tendon Loading. Int J Sports Med 2023; 44:913-918. [PMID: 37336504 DOI: 10.1055/a-2113-1026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Achilles tendon (AT) tendinopathy is common in runners. Repetitive AT loading may play a role in etiology. Interventions such as body weight support (BWS) may reduce loading on the AT in running. Examine how ground reaction force, AT loading, foot strike, and cadence variables change in running with BWS. Twenty-four healthy female runners free from injury were examined. Participants ran on an instrumented treadmill with and without BWS using a harness-based system at a standardized speed. The system has 4 elastic cords affixed to a harness that is attached to a frame-like structure. Kinematic data and kinetic data were used in a musculoskeletal model (18 segments and 16 degrees of freedom) to determine AT loading variables, foot strike angle, and cadence. Paired t-tests were used to compare each variable between conditions. Ground reaction force was 9.0% lower with BWS (p<.05). Peak AT stress, force, and impulse were 9.4, 11.7%, and 14.8% lower when using BWS in running compared to no support (p<.05). Foot strike angle was similar (p<.05) despite cadence being reduced (p<.05). BWS may reduce AT loading and impulse variables during running. This may be important in rehabilitation efforts.
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Affiliation(s)
- Callie Pohlman
- Health Professions, Physical Therapy Program, University of Wisconsin-La Crosse, La Crosse, United States
- Sports Physical Therapy, Gundersen Health System, La Crosse, United States
| | - Andrew Pardee
- Health Professions, Physical Therapy Program, University of Wisconsin-La Crosse, La Crosse, United States
- Sports Physical Therapy, Gundersen Health System, La Crosse, United States
| | - Mikey Friedman
- Health Professions, Physical Therapy Program, University of Wisconsin-La Crosse, La Crosse, United States
- Sports Physical Therapy, Gundersen Health System, La Crosse, United States
| | - Drew Rutherford
- Health Professions, Physical Therapy Program, University of Wisconsin-La Crosse, La Crosse, United States
- Sports Physical Therapy, Gundersen Health System, La Crosse, United States
| | - Charles Nathan Vannatta
- La Crosse Institute for Movement Science, University of Wisconsin-La Crosse, La Crosse, United States
| | - Thomas W Kernozek
- Health Professions, La Crosse Institute for Movement Science (LIMS), La Crosse, United States
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Sterke BT, Poggensee KL, Ribbers GM, Lemus D, Vallery H. Light-Weight Wearable Gyroscopic Actuators Can Modulate Balance Performance and Gait Characteristics: A Proof-of-Concept Study. Healthcare (Basel) 2023; 11:2841. [PMID: 37957986 PMCID: PMC10647239 DOI: 10.3390/healthcare11212841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/13/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
Falling is a major cause of morbidity, and is often caused by a decrease in postural stability. A key component of postural stability is whole-body centroidal angular momentum, which can be influenced by control moment gyroscopes. In this proof-of-concept study, we explore the influence of our wearable robotic gyroscopic actuator "GyroPack" on the balance performance and gait characteristics of non-impaired individuals (seven female/eight male, 30 ± 7 years, 68.8 ± 8.4 kg). Participants performed a series of balance and walking tasks with and without wearing the GyroPack. The device displayed various control modes, which were hypothesised to positively, negatively, or neutrally impact postural control. When configured as a damper, the GyroPack increased mediolateral standing time and walking distance, on a balance beam, and decreased trunk angular velocity variability, while walking on a treadmill. When configured as a negative damper, both peak trunk angular rate and trunk angular velocity variability increased during treadmill walking. This exploratory study shows that gyroscopic actuators can influence balance and gait kinematics. Our results mirror the findings of our earlier studies; though, with more than 50% mass reduction of the device, practical and clinical applicability now appears within reach.
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Affiliation(s)
- Bram T. Sterke
- Department of Rehabilitation Medicine, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands; (K.L.P.); (G.M.R.); (H.V.)
- Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands;
| | - Katherine L. Poggensee
- Department of Rehabilitation Medicine, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands; (K.L.P.); (G.M.R.); (H.V.)
- Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands;
| | - Gerard M. Ribbers
- Department of Rehabilitation Medicine, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands; (K.L.P.); (G.M.R.); (H.V.)
- Rijndam Revalidatie, Westersingel 300, 3015 LJ Rotterdam, The Netherlands
| | - Daniel Lemus
- Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands;
| | - Heike Vallery
- Department of Rehabilitation Medicine, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands; (K.L.P.); (G.M.R.); (H.V.)
- Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands;
- Faculty of Mechanical Engineering, Rhine-Westphalia Technical University of Aachen, 52062 Aachen, Germany
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Kahaki ZR, Safarpour AR, Daneshmandi H. The spatiotemporal gait parameters among people with visual impairment: A literature review study. Oman J Ophthalmol 2023; 16:427-433. [PMID: 38059096 PMCID: PMC10697262 DOI: 10.4103/ojo.ojo_24_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 07/23/2023] [Accepted: 08/01/2023] [Indexed: 12/08/2023] Open
Abstract
Gait is an individual's walking pattern, and it is a significant part of daily living activities. Quantitative gait assessments, like spatiotemporal parameters (STPs), are related to the functional conditions to provide useful information. This study reviewed the comprehensive differences in spatiotemporal gait variability measures between visually impaired people and the sighted. The search strategy was performed in three databases (PubMed/MEDLINE, Web of Science, and Scopus) from the start date to October 2022, and the utilized keywords for this search are related to gait and blindness. This review considered only those studies that evaluated gait parameters in people with visual impairment and blind people without any limitations in age and gender. In this review, studies without a control group (sighted people) were excluded. The Newcastle-Ottawa Scale (NOS) was applied for critical appraisal. Six full manuscripts were included. The sample size ranged from 19 to 91. The mean modified NOS critical appraisal scores for cross-sectional studies were 6.0. In these studies, among nine STPs: stride length, walking speed, stance and swing phase, step width, cadence, step length, double support, and single support, at least five and at most seven factors were examined. The gait pattern of blind and low-vision people is characterized by a slower walking speed, shorter stride length, increased step width, decreased cadence, prolonged duration of double support, and reduced single support compared to the controls.
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Affiliation(s)
- Zeinab Rasouli Kahaki
- Department of Ergonomics, Student Research Committee, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Reza Safarpour
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hadi Daneshmandi
- Research Center for Health Sciences, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
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Malaya CA, Parikh PJ, Smith DL, Riaz A, Chandrasekaran S, Layne CS. Effects of simulated hypo-gravity on lower limb kinematic and electromyographic variables during anti-gravitational treadmill walking. Front Physiol 2023; 14:1141015. [PMID: 37362436 PMCID: PMC10285399 DOI: 10.3389/fphys.2023.1141015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 05/26/2023] [Indexed: 06/28/2023] Open
Abstract
Introduction: This study investigated kinematic and EMG changes in gait across simulated gravitational unloading levels between 100% and 20% of normal body weight. This study sought to identify if each level of unloading elicited consistent changes-particular to that percentage of normal body weight-or if the changes seen with unloading could be influenced by the previous level(s) of unloading. Methods: 15 healthy adult participants (26.3 ± 2.5 years; 53% female) walked in an Alter-G anti-gravity treadmill unloading system (mean speed: 1.49 ± 0.37 mph) for 1 min each at 100%, 80%, 60%, 40% and 20% of normal body weight, before loading back to 100% in reverse order. Lower-body kinematic data were captured by inertial measurement units, and EMG data were collected from the rectus femoris, biceps femoris, medial gastrocnemius, and anterior tibialis. Data were compared across like levels of load using repeated measures ANOVA and statistical parametric mapping. Difference waveforms for adjacent levels were created to examine the rate of change between different unloading levels. Results: This study found hip, knee, and ankle kinematics as well as activity in the rectus femoris, and medial gastrocnemius were significantly different at the same level of unloading, having arrived from a higher, or lower level of unloading. There were no significant changes in the kinematic difference waveforms, however the waveform representing the change in EMG between 100% and 80% load was significantly different from all other levels. Discussion: This study found that body weight unloading from 100% to 20% elicited distinct responses in the medial gastrocnemius, as well as partly in the rectus femoris. Hip, knee, and ankle kinematics were also affected differentially by loading and unloading, especially at 40% of normal body weight. These findings suggest the previous level of gravitational load is an important factor to consider in determining kinematic and EMG responses to the current level during loading and unloading below standard g. Similarly, the rate of change in kinematics from 100% to 20% appears to be linear, while the rate of change in EMG was non-linear. This is of particular interest, as it suggests that kinematic and EMG measures decouple with unloading and may react to unloading uniquely.
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Affiliation(s)
- Christopher A. Malaya
- Center for Neuromotor and Biomechanics Research, Department of Health and Human Performance, University of Houston, Houston, TX, United States
- Grail Laboratory, Parker University, Dallas, TX, United States
| | - Pranav J. Parikh
- Center for Neuromotor and Biomechanics Research, Department of Health and Human Performance, University of Houston, Houston, TX, United States
| | - Dean L. Smith
- Nutrition and Health, Department of Kinesiology, Miami University, Oxford, OH, United States
| | - Arshia Riaz
- Center for Neuromotor and Biomechanics Research, Department of Health and Human Performance, University of Houston, Houston, TX, United States
| | - Subhalakshmi Chandrasekaran
- Center for Neuromotor and Biomechanics Research, Department of Health and Human Performance, University of Houston, Houston, TX, United States
| | - Charles S. Layne
- Center for Neuromotor and Biomechanics Research, Department of Health and Human Performance, University of Houston, Houston, TX, United States
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Kikkawa T, Takashima A. Practice of gait training using lower-limb orthosis and body weight-supported walker for severe acute motor axonal neuropathy: a case report. JAPANESE JOURNAL OF COMPREHENSIVE REHABILITATION SCIENCE 2023; 14:49-53. [PMID: 37859787 PMCID: PMC10585010 DOI: 10.11336/jjcrs.14.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/01/2023] [Indexed: 10/21/2023]
Abstract
Kikkawa T, Takashima A. Practice of gait training using lower-limb orthosis and body weight-supported walker for severe acute motor axonal neuropathy: a case report. Jpn J Compr Rehabil Sci 2023; 14: 49-53. Introduction Acute motor axonal neuropathy (AMAN) requires aggressive gait rehabilitation from the early phase of its onset due to the long time required to achieve independent gait. In this report, we describe the progress of gait training using a combination of lower-limb orthosis and body weight-supported (BWS) walker in a patient with severe AMAN. Case A 30-year-olds man diagnosed with AMAN underwent two high-dose intravenous immunoglobulin treatments and combined steroid pulse therapy. The patient was admitted to the convalescent rehabilitation ward for 87 days with a Medical Research Council (MRC) score of 7 points for muscle strength and 13 points for Functional Independence Measure (FIM) motor items. He started gait training with a knee-ankle-foot orthosis on the 128th day. Thereafter, the distance of gait training increased with the use of lower-limb orthosis and BWS walker. At the time of discharge, the patient's MRC score had improved to 24 points and his FIM motor items score to 31 points. He was able to walk 90 m using ankle-foot orthosis and forearm walker and was transferred to a rehabilitation facility on day 237. Discussion Gait training with lower-limb orthosis and BWS walker was performed on a patient with severe AMAN. As a result, gait training distance increased without adverse events. Gait training can be performed safely and effectively by combining lower-limb orthosis and BWS walker when gait ability is expected to improve, even in severely ill patients.
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Affiliation(s)
- Taishi Kikkawa
- Department of Rehabilitation, Ushioda General Hospital, Kanagawa, Japan
| | - Akemi Takashima
- Department of Neurology, Ushioda General Hospital, Kanagawa, Japan
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Lyu T, Yan K, Lyu J, Zhao X, Wang R, Zhang C, Liu M, Xiong C, Liu C, Wei Y. Comparative efficacy of gait training for balance outcomes in patients with stroke: A systematic review and network meta-analysis. Front Neurol 2023; 14:1093779. [PMID: 37077566 PMCID: PMC10106590 DOI: 10.3389/fneur.2023.1093779] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/01/2023] [Indexed: 04/05/2023] Open
Abstract
BackgroundGrowing evidence suggests that gait training can improve stroke patients’ balance outcomes. However, it remains unclear which type of gait training is more effective in improving certain types of balance outcomes in patients with stroke. Thus, this network meta-analysis (NMA) included six types of gait training (treadmill, body-weight-supported treadmill, virtual reality gait training, robotic-assisted gait training, overground walking training, and conventional gait training) and four types of balance outcomes (static steady-state balance, dynamic steady-state balance, proactive balance, and balance test batteries), aiming to compare the efficacy of different gait training on specific types of balance outcomes in stroke patients and determine the most effective gait training.MethodWe searched PubMed, Embase, Medline, Web of Science, and Cochrane Library databases from inception until 25 April 2022. Randomized controlled trials (RCTs) of gait training for the treatment of balance outcomes after stroke were included. RoB2 was used to assess the risk of bias in the included studies. Frequentist random-effects network meta-analysis (NMA) was used to evaluate the effect of gait training on four categories of balance outcomes.ResultA total of 61 RCTs from 2,551 citations, encompassing 2,328 stroke patients, were included in this study. Pooled results showed that body-weight-support treadmill (SMD = 0.30, 95% CI [0.01, 0.58]) and treadmill (SMD = 0.25, 95% CI [0.00, 0.49]) could improve the dynamic steady-state balance. Virtual reality gait training (SMD = 0.41, 95% CI [0.10, 0.71]) and body-weight-supported treadmill (SMD = 0.41, 95% CI [0.02, 0.80]) demonstrated better effects in improving balance test batteries. However, none of included gait training showed a significant effect on static steady-state balance and proactive balance.ConclusionGait training is an effective treatment for improving stroke patients’ dynamic steady-state balance and balance test batteries. However, gait training had no significant effect on static steady-state balance and proactive balance. To achieve maximum efficacy, clinicians should consider this evidence when recommending rehabilitation training to stroke patients. Considering body-weight-supported treadmill is not common for chronic stroke patients in clinical practice, the treadmill is recommended for those who want to improve dynamic steady-state balance, and virtual reality gait training is recommended for those who want to improve balance test batteries.LimitationMissing evidence in relation to some types of gait training is supposed to be taken into consideration. Moreover, we fail to assess reactive balance in this NMA since few included trials reported this outcome.Systematic Review RegistrationPROSPERO, identifier CRD42022349965.
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Affiliation(s)
- Tianyi Lyu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Kang Yan
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Jiaxuan Lyu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Xirui Zhao
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Ruoshui Wang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Chaoyang Zhang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Meng Liu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Chao Xiong
- L3 & Maintenance Solutions, SUSE Software (Beijing) Co., Ltd., Beijing, China
| | - Chengjiang Liu
- Department of General Medicine, Affiliated Anqing First People’s Hospital of Anhui Medical University, HeFei, Anhui, China
| | - Yulong Wei
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
- *Correspondence: Yulong Wei,
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De Martino E, Green DA, Ciampi de Andrade D, Weber T, Herssens N. Human movement in simulated hypogravity-Bridging the gap between space research and terrestrial rehabilitation. Front Neurol 2023; 14:1062349. [PMID: 36815001 PMCID: PMC9939477 DOI: 10.3389/fneur.2023.1062349] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 01/18/2023] [Indexed: 02/09/2023] Open
Abstract
Human movement is optimized to Earth's gravity and based on highly complex interactions between sensory and neuro-muscular systems. Yet, humans are able to adapt-at least partially-to extreme environments upon and beyond Earth's surface. With upcoming Lunar Gateway and Artemis missions, it is crucial to increase our understanding of the impact of hypogravity-i.e., reduced vertical loading-on physiological and sensory-motor performances to improve countermeasure programs, and define crewmember's readiness to perform mission critical tasks. Several methodologies designed to reduce vertical loading are used to simulate hypogravity on Earth, including body weight support (BWS) devices. Countering gravity and offloading the human body is also used in various rehabilitation scenarios to improve motor recovery in neurological and orthopedic impairments. Thus, BWS-devices have the potential of advancing theory and practice of both space exploration and terrestrial rehabilitation by improving our understanding of physiological and sensory-motor adaptations to reduced vertical loading and sensory input. However, lack of standardization of BWS-related research protocols and reporting hinders the exchange of key findings and new advancements in both areas. The aim of this introduction paper is to review the role of BWS in understanding human movement in simulated hypogravity and the use of BWS in terrestrial rehabilitation, and to identify relevant research areas contributing to the optimization of human spaceflight and terrestrial rehabilitation. One of the main aims of this research topic is to facilitate standardization of hypogravity-related research protocols and outcome reporting, aimed at optimizing knowledge transfer between space research and BWS-related rehabilitation sciences.
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Affiliation(s)
- Enrico De Martino
- Department of Health Science and Technology, Center for Neuroplasticity and Pain, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - David A. Green
- Space Medicine Team, European Astronaut Centre, Cologne, Germany,KBR GmbH, Cologne, Germany,Centre of Human and Applied Physiological Sciences, King's College London, London, United Kingdom
| | - Daniel Ciampi de Andrade
- Department of Health Science and Technology, Center for Neuroplasticity and Pain, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Tobias Weber
- Space Medicine Team, European Astronaut Centre, Cologne, Germany,KBR GmbH, Cologne, Germany
| | - Nolan Herssens
- Space Medicine Team, European Astronaut Centre, Cologne, Germany,*Correspondence: Nolan Herssens ✉
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12
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Herssens N, Cowburn J, Albracht K, Braunstein B, Cazzola D, Colyer S, Minetti AE, Pavei G, Rittweger J, Weber T, Green DA. Movement in low gravity environments (MoLo) programme-The MoLo-L.O.O.P. study protocol. PLoS One 2022; 17:e0278051. [PMID: 36417480 PMCID: PMC9683620 DOI: 10.1371/journal.pone.0278051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 11/08/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Exposure to prolonged periods in microgravity is associated with deconditioning of the musculoskeletal system due to chronic changes in mechanical stimulation. Given astronauts will operate on the Lunar surface for extended periods of time, it is critical to quantify both external (e.g., ground reaction forces) and internal (e.g., joint reaction forces) loads of relevant movements performed during Lunar missions. Such knowledge is key to predict musculoskeletal deconditioning and determine appropriate exercise countermeasures associated with extended exposure to hypogravity. OBJECTIVES The aim of this paper is to define an experimental protocol and methodology suitable to estimate in high-fidelity hypogravity conditions the lower limb internal joint reaction forces. State-of-the-art movement kinetics, kinematics, muscle activation and muscle-tendon unit behaviour during locomotor and plyometric movements will be collected and used as inputs (Objective 1), with musculoskeletal modelling and an optimisation framework used to estimate lower limb internal joint loading (Objective 2). METHODS Twenty-six healthy participants will be recruited for this cross-sectional study. Participants will walk, skip and run, at speeds ranging between 0.56-3.6 m/s, and perform plyometric movement trials at each gravity level (1, 0.7, 0.5, 0.38, 0.27 and 0.16g) in a randomized order. Through the collection of state-of-the-art kinetics, kinematics, muscle activation and muscle-tendon behaviour, a musculoskeletal modelling framework will be used to estimate lower limb joint reaction forces via tracking simulations. CONCLUSION The results of this study will provide first estimations of internal musculoskeletal loads associated with human movement performed in a range of hypogravity levels. Thus, our unique data will be a key step towards modelling the musculoskeletal deconditioning associated with long term habitation on the Lunar surface, and thereby aiding the design of Lunar exercise countermeasures and mitigation strategies.
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Affiliation(s)
- Nolan Herssens
- Space Medicine Team, European Astronaut Centre, European Space Agency, Cologne, Germany
| | - James Cowburn
- Department for Health, University of Bath, Bath, United Kingdom
- Centre for the Analysis of Motion, Entertainment Research and Applications, University of Bath, Bath, United Kingdom
| | - Kirsten Albracht
- Centre for Health and Integrative Physiology in Space, German Sport University, Cologne, Germany
- Institute of Movement and Neuroscience, German Sport University, Cologne, Germany
- Department of Medical Engineering and Technomathematics, University of Applied Sciences Aachen, Aachen, Germany
| | - Bjoern Braunstein
- Centre for Health and Integrative Physiology in Space, German Sport University, Cologne, Germany
- Institute of Movement and Neuroscience, German Sport University, Cologne, Germany
- Institute of Biomechanics and Orthopaedics, German Sport University, Cologne, Germany
- German Research Centre of Elite Sport Cologne, Cologne, Germany
| | - Dario Cazzola
- Department for Health, University of Bath, Bath, United Kingdom
- Centre for the Analysis of Motion, Entertainment Research and Applications, University of Bath, Bath, United Kingdom
| | - Steffi Colyer
- Department for Health, University of Bath, Bath, United Kingdom
- Centre for the Analysis of Motion, Entertainment Research and Applications, University of Bath, Bath, United Kingdom
| | - Alberto E. Minetti
- Laboratory of Physiomechanics of Locomotion, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Gaspare Pavei
- Laboratory of Physiomechanics of Locomotion, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Jörn Rittweger
- Division of Muscle and Bone Metabolism, Institute of Aerospace Medicine DLR, Cologne, Germany
- Department of Pediatrics and Adolescent Medicine, University of Cologne, Cologne, Germany
| | - Tobias Weber
- Space Medicine Team, European Astronaut Centre, European Space Agency, Cologne, Germany
- KBR, Cologne, North Rhein-Westphalia, Germany
| | - David A. Green
- Space Medicine Team, European Astronaut Centre, European Space Agency, Cologne, Germany
- KBR, Cologne, North Rhein-Westphalia, Germany
- Centre of Human and Applied Physiological Sciences, King’s College London, London, United Kingdom
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13
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Ertman B, Dade R, Vannatta CN, Kernozek TW. Offloading Effects on Impact Forces and Patellofemoral Joint Loading During Running in Females. Gait Posture 2022; 93:212-217. [PMID: 35183838 DOI: 10.1016/j.gaitpost.2022.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 02/07/2022] [Accepted: 02/12/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Structure-specific loading is being increasingly recognized as playing a role in running related injuries. The use of interventions targeted at reducing patellofemoral joint loads have shown effectiveness in reducing symptoms of patellofemoral pain. Use of bodyweight support (BWS) has the potential to reduce loading on the patellofemoral joint during running to augment rehabilitation efforts. RESEARCH QUESTION How is patellofemoral joint loading different when using a harness-based BWS system during running? METHODS Twenty-five healthy females free from lower extremity injury were included. Participants completed four running trials on an instrumented treadmill with varying amounts of BWS using a commercially available harness system. Kinematic data from a 3D motion capture system and kinetic data from the treadmill were combined in a computer model to estimate measures of patellofemoral joint loading, knee kinematics, ground reaction force, and stride frequency. RESULTS Peak patellofemoral joint stress and time-integral were reduced when running under BWS conditions compared to control conditions. Incremental decreases in patellofemoral loading were not observed with incremental increases in BWS. Peak knee flexion angle was reduced in all BWS conditions compared to control but was not different between BWS conditions. Knee flexion excursion was reduced in only the high BWS condition. Peak ground reaction force and stride frequency incrementally decreased with increased amounts of BWS. SIGNIFICANCE Harness-based BWS systems may provide a simple means to reduce patellofemoral joint loading to assist in rehabilitation efforts, such as addressing patellofemoral pain.
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Affiliation(s)
- Bryce Ertman
- Department of Health Professions, Physical Therapy Program, University of Wisconsin, 1300 Badger Street, La Crosse, WI, United States; La Crosse Institute for Movement Science (LIMS), University of Wisconsin, 1300 Badger Street, La Crosse, WI, United States
| | - Renee Dade
- Department of Health Professions, Physical Therapy Program, University of Wisconsin, 1300 Badger Street, La Crosse, WI, United States; La Crosse Institute for Movement Science (LIMS), University of Wisconsin, 1300 Badger Street, La Crosse, WI, United States
| | - C N Vannatta
- La Crosse Institute for Movement Science (LIMS), University of Wisconsin, 1300 Badger Street, La Crosse, WI, United States; Gundersen Health System, Sports Medicine Department, 311 Gundersen Drive, Onalaska, WI, United States
| | - Thomas W Kernozek
- Department of Health Professions, Physical Therapy Program, University of Wisconsin, 1300 Badger Street, La Crosse, WI, United States; La Crosse Institute for Movement Science (LIMS), University of Wisconsin, 1300 Badger Street, La Crosse, WI, United States.
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14
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Bishnoi A, Lee R, Hu Y, Mahoney JR, Hernandez ME. Effect of Treadmill Training Interventions on Spatiotemporal Gait Parameters in Older Adults with Neurological Disorders: Systematic Review and Meta-Analysis of Randomized Controlled Trials. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052824. [PMID: 35270516 PMCID: PMC8909968 DOI: 10.3390/ijerph19052824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 12/07/2022]
Abstract
Objective: Treadmill interventions have been shown to promote ‘normal’ walking patterns, as they facilitate the proper movement and timing of the lower limbs. However, prior reviews have not examined which intervention provides the most effective treatment of specific gait impairments in neurological populations. The objective of this systematic review was to review and quantify the changes in gait after treadmill interventions in adults with neurological disorders. Data Sources: A keyword search was performed in four databases: PubMed, CINAHL, Scopus, and Web of Science (January 2000−December 2021). We performed the search algorithm including all possible combinations of keywords. Full-text articles were examined further using forward/backward search methods. Study Selection: Studies were thoroughly screened using the following inclusion criteria: study design: Randomized Controlled Trial (RCT); adults ≥55 years old with a neurological disorder; treadmill intervention; spatiotemporal gait characteristics; and language: English. Data Extraction: A standardized data extraction form was used to collect the following methodological outcome variables from each of the included studies: author, year, population, age, sample size, and spatiotemporal gait parameters including stride length, stride time, step length, step width, step time, stance time, swing time, single support time, double support time, or cadence. Data Synthesis: We found a total of 32 studies to be included in our systematic review through keyword search, out of which 19 studies included adults with stroke and 13 studies included adults with PD. We included 22 out of 32 studies in our meta-analysis that examined gait in adults with neurological disorders, which only yielded studies including Parkinson’s disease (PD) and stroke patients. A meta-analysis was performed among trials presenting with similar characteristics, including study population and outcome measure. If heterogeneity was >50% (denoted by I2), random plot analysis was used, otherwise, a fixed plot analysis was performed. All analyses used effect sizes and standard errors and a p < 0.05 threshold was considered statistically significant (denoted by *). Overall, the effect of treadmill intervention on cadence (z = 6.24 *, I2 = 11.5%) and step length (z = 2.25 *, I2 = 74.3%) in adults with stroke was significant. We also found a significant effect of treadmill intervention on paretic step length (z = 2.34 *, I2 = 0%) and stride length (z = 6.09 *, I2 = 45.5%). For the active control group, including adults with PD, we found that overground physical therapy training had the largest effect on step width (z = −3.75 *, I2 = 0%). Additionally, for PD adults in treadmill intervention studies, we found the largest significant effect was on step length (z = 2.73 *, I2 = 74.2%) and stride length (z = −2.54 *, I2 = 96.8%). Conclusion: Treadmill intervention with sensory stimulation and body weight support treadmill training were shown to have the largest effect on step length in adults with PD and stroke.
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Affiliation(s)
- Alka Bishnoi
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA; (A.B.); (Y.H.)
| | - Rachel Lee
- Department of Solid Organ Transplant, University of Chicago Medical Center, Chicago, IL 60637, USA;
| | - Yang Hu
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA; (A.B.); (Y.H.)
| | - Jeannette R. Mahoney
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY 10461, USA;
| | - Manuel E. Hernandez
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA; (A.B.); (Y.H.)
- Correspondence:
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15
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Saveko A, Brykov V, Kitov V, Shpakov A, Tomilovskaya E. Adaptation in Gait to Lunar and Martian Gravity Unloading During Long-Term Isolation in the Ground-Based Space Station Model. Front Hum Neurosci 2022; 15:742664. [PMID: 35095445 PMCID: PMC8790089 DOI: 10.3389/fnhum.2021.742664] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 12/08/2021] [Indexed: 11/25/2022] Open
Abstract
The aim of the experiment was to evaluate the adaptive responses of biomechanical and electromyographic parameters to vertical unloading (Lunar—0.15 G and Martian—0.35 G) when walking during the 4-month isolation experiment SIRIUS-19 in the ground-based space station model (GBI). The study involved 6 healthy international crew members of the SIRIUS-19 project aged 34 ± 6.2 years (3 women and 3 men). Body Weight Unloading (BWU) conditions was created by the h/p/cosmos airwalk system. The locomotor test included walking (3.5 ± 0.3 km/h) with a sequential change of BWU modes: 5-min walking with 0% BWU (1 G), 5-min walking with 65% BWU (0.35 G) and 5-min walking with 85% BWU (0.15 G). Ground Reaction Force was recorded by the h/p/cosmos treadmill device. Muscle Lab Model 4000e device was used to record the electromyographic signals of the hip and shin muscles. The locomotor test was performed twice before GBI, monthly during GBI and 1 week after leaving isolation. The results obtained before GBI demonstrate that the changes of support and proprioceptive afferentation signals play significant role in reorganizing of the biomechanical structure of motor acts and the development of new movement patterns. The results of the study are consistent with the previously obtained results of other studies in this direction. Despite the fact that during the GBI the participants of the experiment performed regular physical training, a decrease in the performance indicators values was detected, especially pronounced after 100 days of GBI. This is probably due to limited space of a space station model, as well as the development of a special motor stereotype in it. Noteworthy are the results obtained after the 4th session of the experiment, indicating the effect of sensorimotor learning. We think that the data obtained in this study will be useful in research both in gravitational physiology and in clinical medicine.
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Affiliation(s)
- Alina Saveko
- Russian Federation State Scientific Center, Institute of Biomedical Problems of the Russian Academy of Sciences, Moscow, Russia
| | - Vitaly Brykov
- Russian Federation State Scientific Center, Institute of Biomedical Problems of the Russian Academy of Sciences, Moscow, Russia
| | - Vladimir Kitov
- Russian Federation State Scientific Center, Institute of Biomedical Problems of the Russian Academy of Sciences, Moscow, Russia
| | - Alexey Shpakov
- Russian Federation State Scientific Center, Institute of Biomedical Problems of the Russian Academy of Sciences, Moscow, Russia.,Federal Science Center of Physical Culture and Sport (VNIIFK), Moscow, Russia
| | - Elena Tomilovskaya
- Russian Federation State Scientific Center, Institute of Biomedical Problems of the Russian Academy of Sciences, Moscow, Russia
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16
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Kerkman JN, Zandvoort CS, Daffertshofer A, Dominici N. Body Weight Control Is a Key Element of Motor Control for Toddlers' Walking. FRONTIERS IN NETWORK PHYSIOLOGY 2022; 2:844607. [PMID: 36926099 PMCID: PMC10013000 DOI: 10.3389/fnetp.2022.844607] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 02/10/2022] [Indexed: 01/21/2023]
Abstract
New-borns can step when supported for about 70-80% of their own body weight. Gravity-related sensorimotor information might be an important factor in developing the ability to walk independently. We explored how body weight support alters motor control in toddlers during the first independent steps and in toddlers with about half a year of walking experience. Sixteen different typically developing children were assessed during (un)supported walking on a running treadmill. Electromyography of 18-24 bilateral leg and back muscles and vertical ground reaction forces were recorded. Strides were grouped into four levels of body weight support ranging from no (<10%), low (10-35%), medium (35-55%), and high (55-95%) support. We constructed muscle synergies and muscle networks and assessed differences between levels of support and between groups. In both groups, muscle activities could be described by four synergies. As expected, the mean activity decreased with body weight support around foot strikes. The younger first-steps group showed changes in the temporal pattern of the synergies when supported for more than 35% of their body weight. In this group, the muscle network was dense with several interlimb connections. Apparently, the ability to process gravity-related information is not fully developed at the onset of independent walking causing motor control to be fairly disperse. Synergy-specific sensitivity for unloading implies distinct neural mechanisms underlying (the emergence of) these synergies.
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Affiliation(s)
- Jennifer N Kerkman
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Science Institute (AMS) and Institute for Brain and Behaviour Amsterdam (iBBA), Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Coen S Zandvoort
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Science Institute (AMS) and Institute for Brain and Behaviour Amsterdam (iBBA), Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Andreas Daffertshofer
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Science Institute (AMS) and Institute for Brain and Behaviour Amsterdam (iBBA), Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Nadia Dominici
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Science Institute (AMS) and Institute for Brain and Behaviour Amsterdam (iBBA), Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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17
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Plooij M, Apte S, Keller U, Baines P, Sterke B, Asboth L, Courtine G, von Zitzewitz J, Vallery H. Neglected physical human-robot interaction may explain variable outcomes in gait neurorehabilitation research. Sci Robot 2021; 6:eabf1888. [PMID: 34550719 DOI: 10.1126/scirobotics.abf1888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- M Plooij
- Department of Biomechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, Netherlands.,Demcon Advanced Mechatronics, Delfttechpark 23, Delft, Netherlands.,Motek, a DIH brand, Hogehilweg 18-C, 1101 CD Amsterdam, Netherlands
| | - S Apte
- Department of Biomechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, Netherlands.,Laboratory of Movement Analysis and Measurement, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - U Keller
- ONWARD, EPFL Innovation Park, Lausanne, Switzerland.,Center for Neuroprosthetics (CNP) Valais, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.,Swiss Children's Rehab, University Children's Hospital Zurich, Affoltern am Albis, Switzerland
| | - P Baines
- Department of Biomechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, Netherlands
| | - B Sterke
- Motek, a DIH brand, Hogehilweg 18-C, 1101 CD Amsterdam, Netherlands.,Department of Rehabilitation Medicine, Erasmus MC, Postbus 2040, 3000 CA Rotterdam, Netherlands
| | - L Asboth
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.,Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.,Defitech Center for Interventional Neurotherapies (NeuroRestore), EPFL/CHUV/UNIL, Lausanne, Switzerland
| | - G Courtine
- ONWARD, EPFL Innovation Park, Lausanne, Switzerland.,Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.,Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.,Defitech Center for Interventional Neurotherapies (NeuroRestore), EPFL/CHUV/UNIL, Lausanne, Switzerland
| | - J von Zitzewitz
- ONWARD, EPFL Innovation Park, Lausanne, Switzerland.,Center for Neuroprosthetics (CNP) Valais, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - H Vallery
- Department of Biomechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, Netherlands.,Department of Rehabilitation Medicine, Erasmus MC, Postbus 2040, 3000 CA Rotterdam, Netherlands
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18
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Barela A, Celestino M, Gama G, Russo-Junior D, Santana D, Barela J. Gait alterations induced by unloaded body weight in individuals with stroke while walking on moveable and fixed surfaces. Med Eng Phys 2021; 95:9-14. [PMID: 34479697 DOI: 10.1016/j.medengphy.2021.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 06/25/2021] [Accepted: 07/06/2021] [Indexed: 10/20/2022]
Abstract
This study examined the effects of the support surface (i.e., treadmill or ground) and the quantity of body weight unloading provided by a partial body weight support (PBWS) system on the spatiotemporal gait characteristics of individuals with stroke. Fifteen individuals, aged 57.2 ± 9.8 years, with chronic stroke walked on a treadmill and on the ground with 0%, 10%, and 20% of PBWS. Inertial sensors placed on the participants' feet registered 3-D acceleration and 3-D angular velocity during walking, and some gait parameters were calculated. Overall, individuals with stroke walked with shorter and slower strides and spent more time in contact with the support surface when walking on the treadmill compared to when walking on the ground. The duration of double limb support decreased when the percentage of PBWS increased. Stride length and speed were more variable in the paretic limb than in the non-paretic limb. Treadmill walking was more consistent and less similar to ordinary walking than walking on the ground. The gait pattern of individuals with stroke was modulated according to the support surface on which walking was performed, and the use of a PBWS system seems suitable to develop walking proficiencies on a daily basis.
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Affiliation(s)
- Ana Barela
- Institute of Physical Activity and Sport Sciences, Cruzeiro do Sul University, Rua Galvão Bueno, 868, São Paulo, SP 01506-000, Brazil.
| | - Melissa Celestino
- Institute of Physical Activity and Sport Sciences, Cruzeiro do Sul University, Rua Galvão Bueno, 868, São Paulo, SP 01506-000, Brazil
| | - Gabriela Gama
- Institute of Physical Activity and Sport Sciences, Cruzeiro do Sul University, Rua Galvão Bueno, 868, São Paulo, SP 01506-000, Brazil
| | - Douglas Russo-Junior
- Institute of Physical Activity and Sport Sciences, Cruzeiro do Sul University, Rua Galvão Bueno, 868, São Paulo, SP 01506-000, Brazil
| | - Dinah Santana
- Institute of Physical Activity and Sport Sciences, Cruzeiro do Sul University, Rua Galvão Bueno, 868, São Paulo, SP 01506-000, Brazil
| | - José Barela
- Department of Physical Education, Institute of Biosciences, São Paulo State University, Av. 24-A, 1515, Rio Claro, SP 13506-000, Brazil.
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A Clinically Interpretable Computer-Vision Based Method for Quantifying Gait in Parkinson's Disease. SENSORS 2021; 21:s21165437. [PMID: 34450879 PMCID: PMC8399017 DOI: 10.3390/s21165437] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/04/2021] [Accepted: 08/08/2021] [Indexed: 12/20/2022]
Abstract
Gait is a core motor function and is impaired in numerous neurological diseases, including Parkinson's disease (PD). Treatment changes in PD are frequently driven by gait assessments in the clinic, commonly rated as part of the Movement Disorder Society (MDS) Unified PD Rating Scale (UPDRS) assessment (item 3.10). We proposed and evaluated a novel approach for estimating severity of gait impairment in Parkinson's disease using a computer vision-based methodology. The system we developed can be used to obtain an estimate for a rating to catch potential errors, or to gain an initial rating in the absence of a trained clinician-for example, during remote home assessments. Videos (n=729) were collected as part of routine MDS-UPDRS gait assessments of Parkinson's patients, and a deep learning library was used to extract body key-point coordinates for each frame. Data were recorded at five clinical sites using commercially available mobile phones or tablets, and had an associated severity rating from a trained clinician. Six features were calculated from time-series signals of the extracted key-points. These features characterized key aspects of the movement including speed (step frequency, estimated using a novel Gamma-Poisson Bayesian model), arm swing, postural control and smoothness (or roughness) of movement. An ordinal random forest classification model (with one class for each of the possible ratings) was trained and evaluated using 10-fold cross validation. Step frequency point estimates from the Bayesian model were highly correlated with manually labelled step frequencies of 606 video clips showing patients walking towards or away from the camera (Pearson's r=0.80, p<0.001). Our classifier achieved a balanced accuracy of 50% (chance = 25%). Estimated UPDRS ratings were within one of the clinicians' ratings in 95% of cases. There was a significant correlation between clinician labels and model estimates (Spearman's ρ=0.52, p<0.001). We show how the interpretability of the feature values could be used by clinicians to support their decision-making and provide insight into the model's objective UPDRS rating estimation. The severity of gait impairment in Parkinson's disease can be estimated using a single patient video, recorded using a consumer mobile device and within standard clinical settings; i.e., videos were recorded in various hospital hallways and offices rather than gait laboratories. This approach can support clinicians during routine assessments by providing an objective rating (or second opinion), and has the potential to be used for remote home assessments, which would allow for more frequent monitoring.
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MacLean MK, Ferris DP. Human muscle activity and lower limb biomechanics of overground walking at varying levels of simulated reduced gravity and gait speeds. PLoS One 2021; 16:e0253467. [PMID: 34260611 PMCID: PMC8279339 DOI: 10.1371/journal.pone.0253467] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 06/04/2021] [Indexed: 12/03/2022] Open
Abstract
Reducing the mechanical load on the human body through simulated reduced gravity can reveal important insight into locomotion biomechanics. The purpose of this study was to quantify the effects of simulated reduced gravity on muscle activation levels and lower limb biomechanics across a range of overground walking speeds. Our overall hypothesis was that muscle activation amplitudes would not decrease proportionally to gravity level. We recruited 12 participants (6 female, 6 male) to walk overground at 1.0, 0.76, 0.55, and 0.31 G for four speeds: 0.4, 0.8, 1.2, and 1.6 ms-1. We found that peak ground reaction forces, peak knee extension moment in early stance, peak hip flexion moment, and peak ankle extension moment all decreased substantially with reduced gravity. The peak knee extension moment at late stance/early swing did not change with gravity. The effect of gravity on muscle activity amplitude varied considerably with muscle and speed, often varying nonlinearly with gravity level. Quadriceps (rectus femoris, vastus lateralis, & vastus medialis) and medial gastrocnemius activity decreased in stance phase with reduced gravity. Soleus and lateral gastrocnemius activity had no statistical differences with gravity level. Tibialis anterior and biceps femoris increased with simulated reduced gravity in swing and stance phase, respectively. The uncoupled relationship between simulated gravity level and muscle activity have important implications for understanding biomechanical muscle functions during human walking and for the use of bodyweight support for gait rehabilitation after injury.
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Affiliation(s)
- Mhairi K. MacLean
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida, United States of America
- * E-mail: (MKM); (DPF)
| | - Daniel P. Ferris
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida, United States of America
- * E-mail: (MKM); (DPF)
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21
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Maranesi E, Bevilacqua R, Di Rosa M, Pelliccioni G, Di Donna V, Luzi R, Morettini M, Sbrollini A, Casoni E, Rinaldi N, Baldoni R, Lattanzio F, Burattini L, Riccardi GR. An innovative training based on robotics for older people with subacute stroke: study protocol for a randomized controlled trial. Trials 2021; 22:400. [PMID: 34127032 PMCID: PMC8204575 DOI: 10.1186/s13063-021-05357-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 06/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stroke is a leading cause of disability, injury, and death in elderly people and represents a major public health problem with substantial medical and economic consequences. The incidence of stroke rapidly increases with age, doubling for each decade after age 55 years. Gait impairment is one of the most important problems after stroke, and improving walking function is often a key component of any rehabilitation program. To achieve this goal, a robotic gait trainer seems to be promising. In fact, some studies underline the efficacy of robotic gait training based on end-effector technology, for different diseases, in particular in stroke patients. In this randomized controlled trial, we verify the efficacy of the robotic treatment in terms of improving the gait and reducing the risk of falling and its long-term effects. METHODS In this single-blind randomized controlled trial, we will include 152 elderly subacute stroke patients divided in two groups to receive a traditional rehabilitation program or a robotic rehabilitation using G-EO system, an end-effector device for the gait rehabilitation, in addition to the traditional therapy. Twenty treatment sessions will be conducted, divided into 3 training sessions per week, for 7 weeks. The control group will perform traditional therapy sessions lasting 50 min. The technological intervention group, using the G-EO system, will carry out 30 min of traditional therapy and 20 min of treatment with a robotic system. The primary outcome of the study is the evaluation of the falling risk. Secondary outcomes are the assessment of the gait improvements and the fear of falling. Further evaluations, such as length and asymmetry of the step, walking and functional status, and acceptance of the technology, will be carried. DISCUSSION The final goal of the present study is to propose a new approach and an innovative therapeutic plan in the post-stroke rehabilitation, focused on the use of a robotic device, in order to obtain the beneficial effects of this treatment. TRIAL REGISTRATION ClinicalTrials.gov NCT04087083 . Registered on September 12, 2019.
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Affiliation(s)
- Elvira Maranesi
- Clinical Unit of Physical Rehabilitation, IRCCS INRCA, Ancona, Italy
- Scientific Direction, IRCCS INRCA, Ancona, Italy
| | | | - Mirko Di Rosa
- Unit of Geriatric Pharmacoepidemiology, IRCCS INRCA, Ancona, Italy
| | | | | | | | - Micaela Morettini
- Cardiovascular Bioengineering Lab, Department of Information Engineering, Università Politecnica delle Marche, Ancona, Italy
| | - Agnese Sbrollini
- Cardiovascular Bioengineering Lab, Department of Information Engineering, Università Politecnica delle Marche, Ancona, Italy
| | - Elisa Casoni
- Clinical Unit of Physical Rehabilitation, IRCCS INRCA, Ancona, Italy
| | - Nadia Rinaldi
- Clinical Unit of Physical Rehabilitation, IRCCS INRCA, Fermo, Italy
| | - Renato Baldoni
- Clinical Unit of Physical Rehabilitation, IRCCS INRCA, Ancona, Italy
| | | | - Laura Burattini
- Cardiovascular Bioengineering Lab, Department of Information Engineering, Università Politecnica delle Marche, Ancona, Italy
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22
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Gill ML, Linde MB, Hale RF, Lopez C, Fautsch KJ, Calvert JS, Veith DD, Beck LA, Garlanger KL, Sayenko DG, Lavrov IA, Thoreson AR, Grahn PJ, Zhao KD. Alterations of Spinal Epidural Stimulation-Enabled Stepping by Descending Intentional Motor Commands and Proprioceptive Inputs in Humans With Spinal Cord Injury. Front Syst Neurosci 2021; 14:590231. [PMID: 33584209 PMCID: PMC7875885 DOI: 10.3389/fnsys.2020.590231] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 12/11/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Regaining control of movement following a spinal cord injury (SCI) requires utilization and/or functional reorganization of residual descending, and likely ascending, supraspinal sensorimotor pathways, which may be facilitated via task-specific training through body weight supported treadmill (BWST) training. Recently, epidural electrical stimulation (ES) combined with task-specific training demonstrated independence of standing and stepping functions in individuals with clinically complete SCI. The restoration of these functions may be dependent upon variables such as manipulation of proprioceptive input, ES parameter adjustments, and participant intent during step training. However, the impact of each variable on the degree of independence achieved during BWST stepping remains unknown. Objective: To describe the effects of descending intentional commands and proprioceptive inputs, specifically body weight support (BWS), on lower extremity motor activity and vertical ground reaction forces (vGRF) during ES-enabled BWST stepping in humans with chronic sensorimotor complete SCI. Furthermore, we describe perceived changes in the level of assistance provided by clinicians when intent and BWS are modified. Methods: Two individuals with chronic, mid thoracic, clinically complete SCI, enrolled in an IRB and FDA (IDE G150167) approved clinical trial. A 16-contact electrode array was implanted in the epidural space between the T11-L1 vertebral regions. Lower extremity motor output and vertical ground reaction forces were obtained during clinician-assisted ES-enabled treadmill stepping with BWS. Consecutive steps were achieved during various experimentally-controlled conditions, including intentional participation and varied BWS (60% and 20%) while ES parameters remain unchanged. Results: During ES-enabled BWST stepping, the knee extensors exhibited an increase in motor activation during trials in which stepping was passive compared to active or during trials in which 60% BWS was provided compared to 20% BWS. As a result of this increased motor activation, perceived clinician assistance increased during the transition from stance to swing. Intentional participation and 20% BWS resulted in timely and purposeful activation of the lower extremities muscles, which improved independence and decreased clinician assistance. Conclusion: Maximizing participant intention and optimizing proprioceptive inputs through BWS during ES-enabled BWST stepping may facilitate greater independence during BWST stepping for individuals with clinically complete SCI. Clinical Trial Registration:ClinicalTrials.gov identifier: NCT02592668.
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Affiliation(s)
- Megan L Gill
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Margaux B Linde
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Rena F Hale
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Cesar Lopez
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Kalli J Fautsch
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Jonathan S Calvert
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN, United States
| | - Daniel D Veith
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Lisa A Beck
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Kristin L Garlanger
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Dimitry G Sayenko
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Hospital, Houston, TX, United States
| | - Igor A Lavrov
- Department of Neurology, Mayo Clinic, Rochester, MN, United States.,Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
| | - Andrew R Thoreson
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Peter J Grahn
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States.,Department of Neurosurgery, Mayo Clinic, Rochester, MN, United States.,Office for Education Diversity, Equity and Inclusion, Mayo Clinic, Rochester, MN, United States
| | - Kristin D Zhao
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, United States
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23
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Richter C, Braunstein B, Staeudle B, Attias J, Suess A, Weber T, Mileva KN, Rittweger J, Green DA, Albracht K. Gastrocnemius Medialis Contractile Behavior Is Preserved During 30% Body Weight Supported Gait Training. Front Sports Act Living 2021; 2:614559. [PMID: 33537667 PMCID: PMC7849151 DOI: 10.3389/fspor.2020.614559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 11/23/2020] [Indexed: 11/13/2022] Open
Abstract
Rehabilitative body weight supported gait training aims at restoring walking function as a key element in activities of daily living. Studies demonstrated reductions in muscle and joint forces, while kinematic gait patterns appear to be preserved with up to 30% weight support. However, the influence of body weight support on muscle architecture, with respect to fascicle and series elastic element behavior is unknown, despite this having potential clinical implications for gait retraining. Eight males (31.9 ± 4.7 years) walked at 75% of the speed at which they typically transition to running, with 0% and 30% body weight support on a lower-body positive pressure treadmill. Gastrocnemius medialis fascicle lengths and pennation angles were measured via ultrasonography. Additionally, joint kinematics were analyzed to determine gastrocnemius medialis muscle-tendon unit lengths, consisting of the muscle's contractile and series elastic elements. Series elastic element length was assessed using a muscle-tendon unit model. Depending on whether data were normally distributed, a paired t-test or Wilcoxon signed rank test was performed to determine if body weight supported walking had any effects on joint kinematics and fascicle-series elastic element behavior. Walking with 30% body weight support had no statistically significant effect on joint kinematics and peak series elastic element length. Furthermore, at the time when peak series elastic element length was achieved, and on average across the entire stance phase, muscle-tendon unit length, fascicle length, pennation angle, and fascicle velocity were unchanged with respect to body weight support. In accordance with unchanged gait kinematics, preservation of fascicle-series elastic element behavior was observed during walking with 30% body weight support, which suggests transferability of gait patterns to subsequent unsupported walking.
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Affiliation(s)
- Charlotte Richter
- Institute of Movement and Neurosciences, German Sport University Cologne, Cologne, Germany.,Department of Medical Engineering and Technomathematics, University of Applied Sciences Aachen, Aachen, Germany
| | - Bjoern Braunstein
- Institute of Movement and Neurosciences, German Sport University Cologne, Cologne, Germany.,Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany.,Centre for Health and Integrative Physiology in Space (CHIPS), Cologne, Germany.,German Research Centre of Elite Sport, Cologne, Germany
| | - Benjamin Staeudle
- Institute of Movement and Neurosciences, German Sport University Cologne, Cologne, Germany.,Department of Medical Engineering and Technomathematics, University of Applied Sciences Aachen, Aachen, Germany
| | - Julia Attias
- Centre of Human and Applied Physiological Sciences, King's College London, London, United Kingdom
| | - Alexander Suess
- European Astronaut Centre (EAC), European Space Agency, Space Medicine Team (HRE-OM), Cologne, Germany
| | - Tobias Weber
- European Astronaut Centre (EAC), European Space Agency, Space Medicine Team (HRE-OM), Cologne, Germany.,KBR GmbH, Cologne, Germany
| | - Katya N Mileva
- School of Applied Sciences, London South Bank University, London, United Kingdom
| | - Joern Rittweger
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany.,Department of Pediatrics and Adolescent Medicine, University of Cologne, Cologne, Germany
| | - David A Green
- Centre of Human and Applied Physiological Sciences, King's College London, London, United Kingdom.,European Astronaut Centre (EAC), European Space Agency, Space Medicine Team (HRE-OM), Cologne, Germany.,KBR GmbH, Cologne, Germany
| | - Kirsten Albracht
- Institute of Movement and Neurosciences, German Sport University Cologne, Cologne, Germany.,Department of Medical Engineering and Technomathematics, University of Applied Sciences Aachen, Aachen, Germany.,Institute for Bioengineering, University of Applied Sciences Aachen, Aachen, Germany
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24
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Pierce SR, Skorup J, Alcott M, Bochnak M, Paremski AC, Prosser LA. The Use of Dynamic Weight Support with Principles of Infant Learning in a Child with Cerebral Palsy: A Case Report. Phys Occup Ther Pediatr 2021; 41:166-175. [PMID: 32423264 DOI: 10.1080/01942638.2020.1766638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AIMS Typical infant movement is characterized by a high degree of motor exploration, error, and variability. However, children with cerebral palsy (CP) often cannot create these experiences due to their neuromotor impairments. The purpose of this case study is to describe a 6-month course of physical therapy (PT) incorporating principles of infant motor learning using dynamic weight support (DWS) in a child with CP. METHODS The child was a 27-month-old girl with diplegic CP who functioned at Gross Motor Function Classification System Level IV. The child received 68 PT sessions over a six-month period. DWS was used during therapy to encourage motor practice. The therapy area was arranged to encourage active exploration, motor variability, and error experience. Gross motor function, postural control, parent perception of performance, and parent satisfaction were measured before, during, and after the course of therapy. RESULTS Gross motor function increased during the treatment beyond the level predicted from natural progression. Postural control fluctuated and demonstrated no appreciable improvement. Parent-perceived performance and satisfaction improved on three of four goals. CONCLUSIONS Using DWS to incorporate principles of infant learning may have facilitated the development of gross motor skills in a child with diplegic CP.
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Affiliation(s)
- Samuel R Pierce
- Department of Physical Therapy, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Julie Skorup
- Department of Physical Therapy, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Morgan Alcott
- Department of Physical Therapy, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Meghan Bochnak
- Department of Physical Therapy, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Athylia C Paremski
- Division of Rehabilitation Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Laura A Prosser
- Division of Rehabilitation Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Pediatrics, University of Pennsylvania, Philadelphia, PA, USA
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25
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MacLean MK, Ferris DP. Design and Validation of a Low-Cost Bodyweight Support System for Overground Walking. J Med Device 2020; 14:045001. [PMID: 33442440 PMCID: PMC7580661 DOI: 10.1115/1.4047996] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 07/10/2020] [Indexed: 11/08/2022] Open
Abstract
Walking with bodyweight support is a vital tool for both gait rehabilitation and biomechanics research. There are few commercially available bodyweight support systems for overground walking that are able to provide a near constant lifting force of more than 50% bodyweight. The devices that do exist are expensive and are not often used outside of rehabilitation clinics. Our aim was to design, build, and validate a bodyweight support device for overground walking that: (1) cost less than $5000, (2) could support up to 75% of the users' bodyweight (BW), and (3) had small (±5% BW) fluctuations in force. We used pairs of constant force springs to provide the constant lifting force. To validate the force fluctuation, we recruited eight participants to walk at 0.4, 0.8, 1.2, and 1.6 m/s with 0%, 22%, 46%, and 69% of their bodyweight supported. We used a load cell to measure force through the system and motion capture data to create a vector of the supplied lifting force. The final prototype cost less than $4000 and was able to support 80% of the users' bodyweight. Fluctuations in vertical force increased with speed and bodyweight support, reaching a maximum of 10% at 1.6 m/s and 69% BW support.
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Affiliation(s)
- Mhairi K MacLean
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Building 1275 Center Drive, Gainesville, FL 32611
| | - Daniel P Ferris
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Building 1275 Center Drive, Gainesville, FL 32611
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26
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Bannwart M, Bayer SL, König Ignasiak N, Bolliger M, Rauter G, Easthope CA. Mediolateral damping of an overhead body weight support system assists stability during treadmill walking. J Neuroeng Rehabil 2020; 17:108. [PMID: 32778127 PMCID: PMC7418206 DOI: 10.1186/s12984-020-00735-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 07/28/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Body weight support systems with three or more degrees of freedom (3-DoF) are permissive and safe environments that provide unloading and allow unrestricted movement in any direction. This enables training of walking and balance control at an early stage in rehabilitation. Transparent systems generate a support force vector that is near vertical at all positions in the workspace to only minimally interfere with natural movement patterns. Patients with impaired balance, however, may benefit from additional mediolateral support that can be adjusted according to their capacity. An elegant solution for providing balance support might be by rendering viscous damping along the mediolateral axis via the software controller. Before use with patients, we evaluated if control-rendered mediolateral damping evokes the desired stability enhancement in able-bodied individuals. METHODS A transparent, cable-driven robotic body weight support system (FLOAT) was used to provide transparent body weight support with and without mediolateral damping to 21 able-bodied volunteers while walking at preferred gait velocity on a treadmill. Stability metrics reflecting resistance to small and large perturbations were derived from walking kinematics and compared between conditions and to free walking. RESULTS Compared to free walking, the application of body weight support per-se resulted in gait alterations typically associated with body weight support, namely increased step length and swing phase. Frontal plane dynamic stability, measured by kinematic variability and nonlinear dynamics of the center of mass, was increased under body weight support, indicating reduced balance requirements in both damped and undamped support conditions. Adding damping to the body weight support resulted in a greater increase of frontal plane stability. CONCLUSION Adding mediolateral damping to 3-DoF body weight support systems is an effective method of increasing frontal plane stability during walking in able-bodied participants. Building on these results, adjustable mediolateral damping could enable therapists to select combinations of unloading and stability specifically for each patient and to adapt this in a task specific manner. This could extend the impact of transparent 3-DoF body weight support systems, enabling training of gait and active balance from an early time point onwards in the rehabilitation process for a wide range of mobility activities of daily life.
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Affiliation(s)
- M. Bannwart
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Sensory Motor Systems Laboratory, Department of Health Sciences and Technology, Swiss Federal Institute of Technology, Zurich, Switzerland
| | - S. L. Bayer
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | | | - M. Bolliger
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - G. Rauter
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Sensory Motor Systems Laboratory, Department of Health Sciences and Technology, Swiss Federal Institute of Technology, Zurich, Switzerland
- BIROMED-Laboratory, Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - C. A. Easthope
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- cereneo Center for Interdisciplinary Research, Vitznau, Switzerland
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27
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Maranesi E, Riccardi GR, Di Donna V, Di Rosa M, Fabbietti P, Luzi R, Pranno L, Lattanzio F, Bevilacqua R. Effectiveness of Intervention Based on End-effector Gait Trainer in Older Patients With Stroke: A Systematic Review. J Am Med Dir Assoc 2020; 21:1036-1044. [DOI: 10.1016/j.jamda.2019.10.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 09/11/2019] [Accepted: 10/14/2019] [Indexed: 01/19/2023]
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28
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Influence of Body Weight Support Systems on the Abnormal Gait Kinematic. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10134685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
In recent years, the Body Weight Support system has been considered to be an indispensable component in gait training systems, which be used to improve the ability to walk of hemiplegic, stroke, and spinal cord injury patients. Previous studies investigated the influence of the Body Weight Support system on gait parameters were based on the implementation with healthy subjects or patients with high assistance. Consequently, the influences of the Body Weight Support systems on gait rehabilitation in clinical practice are still unclear and need further investigation. In this study, we investigated the effects of the two Body Weight Support systems, the active body weight support system and the Counter Weight system, on an abnormal gait, which was generated by restriction of the right knee joint and 3 kg-weight on the right ankle joint. Both Body Weight Support systems improve the gait parameters of the abnormal gait such as the center of mass, the center of pressure, margin of stability, and step parameters. The active Body Weight Support system with the unloading force modulation showed more advanced and better behavior in comparison with the Counter Weight system. The results suggested the applicability of two Body Weight Support systems in clinical practice as a recovered gait intervention.
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29
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Apte S, Plooij M, Vallery H. Simulation of human gait with body weight support: benchmarking models and unloading strategies. J Neuroeng Rehabil 2020; 17:81. [PMID: 32586398 PMCID: PMC7318415 DOI: 10.1186/s12984-020-00697-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 05/21/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Gait training with partial body weight support (BWS) has become an established rehabilitation technique. Besides passive unloading mechanisms such as springs or counterweights, also active systems that allow rendering constant or modulated vertical forces have been proposed. However, only pilot studies have been conducted to compare different unloading or modulation strategies, and conducting experimental studies is costly and time-consuming. Simulation models that predict the influence of unloading force on human walking may help select the most promising candidates for further evaluation. However, the reliability of simulation results depends on the chosen gait model. The purpose of this paper is two-fold: First, using human experimental data, we evaluate the accuracy of some of the most prevalent walking models in replicating human walking under the influence of Constant-Force BWS: The Simplest Walking model (SW), the Spring-Loaded Inverted Pendulum model (SLIP) and the Muscle-Reflex (MR) gait model. Second, three realizations of BWS, based on Constant-Force (CF), Counterweight (CW) and Tuned-Spring (TS) approaches, are compared to each other in terms of their influence on gait parameters. METHODS We conducted simulations in Matlab/Simulink to model the behaviour of each gait model under all three BWS conditions. Nine simulations were undertaken in total and gait parameter response was analysed in each case. Root mean square error (mrmse) w.r.t human data was used to compare the accuracy of gait models. The metrics of interest were spatiotemporal parameters and the vertical ground reaction forces. To scrutinize the BWS strategies, loss of dynamic similarity was calculated in terms of root mean square difference in gait dynamics (Δgd) with respect to the reference gait under zero unloading. The gait dynamics were characterized by a dimensionless number Modela-w. RESULTS SLIP model showed the lowest mrmse for 6 out of 8 gait parameters and for 1 other, the mrmse value were comparable to the MR model; SW model had the highest mrmse. Out of three BWS strategies, Tuned-Spring strategies led to the lowest Δgd values. CONCLUSIONS The results of this work demonstrate the usefulness of gait models for BWS simulation and suggest the SLIP model to be more suitable for BWS simulations than the Simplest Walker and the Muscle-reflex models. Further, the Tuned-Spring approach appears to cause less distortions to the gait pattern than the more established Counterweight and Constant-Force approaches and merits experimental verification.
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Affiliation(s)
- Salil Apte
- Department of Biomechanical Engineering, Delft University of Technology, Mekelweg 2, Delft, 2628 CD Netherlands
- Laboratory of Movement Analysis and Measurement (LMAM), École Polytechnique Fédérale de Lausanne, Station 9, Lausanne, CH-1015 Switzerland
| | - Michiel Plooij
- Motek Medical BV, Hogehilweg 18C, Amsterdam, 1101 CD Netherlands
| | - Heike Vallery
- Department of Biomechanical Engineering, Delft University of Technology, Mekelweg 2, Delft, 2628 CD Netherlands
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30
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Militskova A, Mukhametova E, Fatykhova E, Sharifullin S, Cuellar CA, Calvert JS, Grahn PJ, Baltina T, Lavrov I. Supraspinal and Afferent Signaling Facilitate Spinal Sensorimotor Network Excitability After Discomplete Spinal Cord Injury: A Case Report. Front Neurosci 2020; 14:552. [PMID: 32655351 PMCID: PMC7323764 DOI: 10.3389/fnins.2020.00552] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 05/04/2020] [Indexed: 12/25/2022] Open
Abstract
Objective In this study, we evaluated the role of residual supraspinal and afferent signaling and their convergence on the sublesional spinal network in subject diagnosed with complete paralysis (AIS-A). Methods A combination of electrophysiologic techniques with positional changes and subject-driven reinforcement maneuvers was implemented in this study. Electrical stimulation was applied transcutaneously at the T9-L2 vertebra levels and the spinal cord motor evoked potentials (SEMP) were recorded from leg muscles. To test the influence of positional changes, the subject was placed in (i) supine, (ii) upright with partial body weight bearing and (iii) vertically suspended without body weight bearing positions. Results Increase in amplitude of SEMP was observed during transition from supine to upright position, supporting the role of sensory input in lumbosacral network excitability. Additionally, amplitudes of SEMP were facilitated during reinforcement maneuvers, indicating a supralesional influence on sub-lesional network. After initial assessment, subject underwent rehabilitation therapy with following electrophysiological testing that reviled facilitation of SEMP. Conclusion These results demonstrate that combination of electrophysiological techniques with positional and reinforcement maneuvers can add to the diagnostics of discomplete SCI. These findings also support an idea that integration of supraspinal and afferent information on sub-lesional circuitry plays a critical role in facilitation of spinal sensorimotor network in discomplete SCI.
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Affiliation(s)
- Alena Militskova
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
| | - Elvira Mukhametova
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
| | - Elsa Fatykhova
- Children's Republican Clinical Hospital of the Ministry of Health of the Republic of Tatarstan, Kazan, Russia
| | | | - Carlos A Cuellar
- Centro de Investigación en Ciencias de la Salud, Universidad Anáhuac México, Huixquilucan, Mexico
| | - Jonathan S Calvert
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Peter J Grahn
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States.,Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, United States
| | - Tatiana Baltina
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
| | - Igor Lavrov
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia.,Department of Biomedical Engineering, Mayo Clinic, Rochester, MN, United States.,Department of Neurology, Mayo Clinic, Rochester, MN, United States
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31
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Calabrò RS, Billeri L, Andronaco VA, Accorinti M, Milardi D, Cannavò A, Aliberti E, Militi A, Bramanti P, Naro A. Walking on the Moon: A randomized clinical trial on the role of lower body positive pressure treadmill training in post-stroke gait impairment. J Adv Res 2020; 21:15-24. [PMID: 31641534 PMCID: PMC6796731 DOI: 10.1016/j.jare.2019.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/09/2019] [Accepted: 09/18/2019] [Indexed: 12/14/2022] Open
Abstract
The effects of LBPP on locomotion in neurologic patients are poorly predictable. The mechanisms through which LPBB acts on gait are partially unknown. Gait training using AlterG improves functional gait in post-stroke patients. AlterG increases muscle activation and/or phasic muscle activation in post-stroke. This knowledge may be useful to plan patient-tailored LBPP locomotor training.
Body weight–supported treadmill training (BWSTT) can be usefully employed to facilitate gait recovery in patients with neurological injuries. Specifically, lower body positive pressure support system (LBPPSS) decreases weight-bearing and ground reaction forces with potentially positive effects on qualitative gait indices. However, which gait features are being shaped by LBPPSS in post-stroke patients is yet poorly predictable. A pilot study on the effects of LBPPSS on qualitative and quantitative gait indices was carried out in patients with hemiparesis due to stroke in the chronic phase. Fifty patients, who suffered from a first, single, ischemic, supra-tentorial stroke that occurred at least 6 months before study inclusion, were enrolled in the study. They were provided with 24 daily sessions of gait training using either the AlterG device or conventional treadmill gait training (TGT). These patients were compared with 25 age-matched healthy controls (HC), who were provided with the same amount of AlterG. Qualitative and quantitative gait features, including Functional Ambulation Categories, gait cycle features, and muscle activation patterns were analyzed before and after the training. It was found that AlterG provided the patients with higher quantitative but not qualitative gait features, as compared to TGT. In particular, AlterG specifically shaped muscle activation phases and gait cycle features in patients, whereas it increased only overall muscle activation in HC. These data suggest that treadmill gait training equipped with LBPPSS specifically targets the gait features that are abnormal in chronic post-stroke patients. It is hypothesizable that the specificity of AlterG effects may depend on a selective reshape of gait rhythmogenesis elaborated by the locomotor spinal circuits receiving a deteriorated corticospinal drive. Even though further studies are warranted to clarify the role of treadmills equipped with LBPPSS in gait training of chronic post-stroke patients, the knowledge of the exact gait pattern during weight-relief is potentially useful to plan patient-tailored locomotor training.
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Affiliation(s)
- Rocco Salvatore Calabrò
- Robotic Neurorehabilitation Unit, IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
- Corresponding author at: Rocco Salvatore Calabrò, IRCCS Centro Neurolesi Bonino Pulejo; via Palermo, SS 113, ctr. Casazza, 98124 Messina, Italy.
| | - Luana Billeri
- Robotic Neurorehabilitation Unit, IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
| | | | - Maria Accorinti
- Robotic Neurorehabilitation Unit, IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
| | - Demetrio Milardi
- Robotic Neurorehabilitation Unit, IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
- Department of Biomorphology and Biotechnologies, University of Messina, Messina, Italy
| | - Antonino Cannavò
- Robotic Neurorehabilitation Unit, IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
| | - Enrico Aliberti
- Department of Motor Sciences, University of Messina, Messina, Italy
| | - Angela Militi
- Department of Motor Sciences, University of Messina, Messina, Italy
| | - Placido Bramanti
- Robotic Neurorehabilitation Unit, IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
| | - Antonino Naro
- Robotic Neurorehabilitation Unit, IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
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Bannwart M, Rohland E, Easthope CA, Rauter G, Bolliger M. Robotic body weight support enables safe stair negotiation in compliance with basic locomotor principles. J Neuroeng Rehabil 2019; 16:157. [PMID: 31870393 PMCID: PMC6929285 DOI: 10.1186/s12984-019-0631-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 12/11/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND After a neurological injury, mobility focused rehabilitation programs intensively train walking on treadmills or overground. However, after discharge, quite a few patients are not able to independently negotiate stairs, a real-world task with high physical and psychological demands and a high injury risk. To decrease fall risk and improve patients' capacity to navigate typical environments, early stair negotiation training can help restore competence and confidence in safe stair negotiation. One way to enable early training in a safe and permissive environment is to unload the patient with a body weight support system. We here investigated if unloaded stair negotiation complies with basic locomotor principles, in terms of enabling performance of a physiological movement pattern with minimal compensation. METHODS Seventeen able-bodied participants were unloaded with 0-50% bodyweight during self-paced ascent and descent of a 4-tread staircase. Spatio-temporal parameters, joint ranges of motion, ground reaction forces and myoelectric activity in the main lower limb muscles of participants were compared between unloading levels. Likelihood ratio tests of separated linear mixed models of the investigated outcomes assessed if unloading affects the parameters in general. Subsequent post-hoc testing revealed which levels of unloading differed from unsupported stair negotiation. RESULTS Unloading affected walking velocity, joint ranges of motion, vertical ground reaction force parameters and myoelectric activity in all investigated muscles for stair ascent and descent while step width and single support duration were only affected during ascent. A reduction with increasing levels of body weight support was seen in walking velocity (0.07-0.12 m/s), ranges of motion of the knee and hip (2-10°), vertical ground reaction force peaks (10-70%) and myoelectric activity (17-70%). An increase with unloading was only seen during ascent for ankle range of motion and tibialis anterior activity at substantial unloading. CONCLUSIONS Body weight support facilitates stair negotiation by providing safety and support against gravity. Although unloading effects are present in most parameters, up to 30% body weight support these changes are small, and no dysfunctional patterns are introduced. Body weight support therefore fulfills all the necessary requirements for early stair negotiation training.
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Affiliation(s)
- M. Bannwart
- Spinal Cord Injury Center, Balgrist University Hospital, Forchstrasse 340, CH-8008 Zurich, Switzerland
- Sensory Motor Systems Lab, Department of Health Sciences and Technology, Swiss Federal Institute of Technology, Zurich, Switzerland
| | - E. Rohland
- Spinal Cord Injury Center, Balgrist University Hospital, Forchstrasse 340, CH-8008 Zurich, Switzerland
| | - C. A. Easthope
- Spinal Cord Injury Center, Balgrist University Hospital, Forchstrasse 340, CH-8008 Zurich, Switzerland
- Cereneo Center for Interdisciplinary Research, Vitznau, Switzerland
| | - G. Rauter
- Spinal Cord Injury Center, Balgrist University Hospital, Forchstrasse 340, CH-8008 Zurich, Switzerland
- Sensory Motor Systems Lab, Department of Health Sciences and Technology, Swiss Federal Institute of Technology, Zurich, Switzerland
- BIROMED-Lab, Department of Biomedical Engineering, University Basel, Gewerbestrasse 14, CH-4123 Basel, Allschwil Switzerland
| | - M. Bolliger
- Spinal Cord Injury Center, Balgrist University Hospital, Forchstrasse 340, CH-8008 Zurich, Switzerland
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Barela AMF, Gama GL, Russo-Junior DV, Celestino ML, Barela JA. Gait alterations during walking with partial body weight supported on a treadmill and over the ground. Sci Rep 2019; 9:8139. [PMID: 31148585 PMCID: PMC6544641 DOI: 10.1038/s41598-019-44652-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 05/21/2019] [Indexed: 11/29/2022] Open
Abstract
Understanding the changes induced by body weight support (BWS) systems when non-disabled adults walk can help develop appropriate rehabilitation protocols. The purpose of this study was to investigate spatial-temporal gait alterations during walking with BWS on a treadmill and over the ground. Fourteen non-disabled young adults (including seven women) walked over the ground and on a treadmill with 0%, 10%, and 20% of BWS at 80% of their self-selected comfortable walking speed (baseline). The stride length and speed, step length, and stance and double-limb support durations were calculated and compared among the different conditions. The non-disabled adults modulated their spatial-temporal gait parameters according to the surface and percentage of BWS. They walked with shorter and slower strides and shorter steps and spent more time in contact with the support surface as they walked on the treadmill than as they did over the ground. Walking on the treadmill promoted less variability and a higher rate of change than did walking over the ground. Both the surface and amount of BWS should be taken into consideration when using BWS systems for (re)learning and/or reestablishing gait.
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Affiliation(s)
- Ana Maria F Barela
- Institute of Physical Activity and Sport Sciences, Cruzeiro do Sul University, Rua Galvão Bueno, 868, São Paulo, SP, Brazil.
| | - Gabriela L Gama
- Institute of Physical Activity and Sport Sciences, Cruzeiro do Sul University, Rua Galvão Bueno, 868, São Paulo, SP, Brazil
| | - Douglas V Russo-Junior
- Institute of Physical Activity and Sport Sciences, Cruzeiro do Sul University, Rua Galvão Bueno, 868, São Paulo, SP, Brazil
| | - Melissa L Celestino
- Institute of Physical Activity and Sport Sciences, Cruzeiro do Sul University, Rua Galvão Bueno, 868, São Paulo, SP, Brazil
| | - José A Barela
- Department of Physical Education, Institute of Biosciences, São Paulo State University, Av. 24-A, 1515, Rio Claro, SP, Brazil
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Lopes KA, Batista MM, Martins L, Kiihn AL, Queiroga MR, Tartaruga MP. Internal mechanical work and maximum subtalar joint pronation in different gradients. FISIOTERAPIA EM MOVIMENTO 2019. [DOI: 10.1590/1980-5918.032.ao03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Introduction: Some authors have described the importance of physiological intensity in the behavior of the biomechanical aspects of running (for example, subtalar pronation), but the complex relationships between these variables are not yet well understood. Objective: This study investigated the influence of positive gradients on internal mechanical work (Wint) and maximum subtalar pronation at a submaximal running speed. Method: Sixteen male, trained long-distance runners (age: 29 ± 7 yr; stature: 1.72 ± 0.07 m; body mass: 72.1 ± 10.6 kg), performed four running economy tests (gradients: +1%, +5%, +10% and +15%, respectively) for four minutes at a same submaximal running speed to quantify the maximum values of subtalar pronation and predict the Wint values. Data were analyzed using descriptive statistics, Student’s T-test, and one-way repeated-measures (ANOVA) along with the Statistical Package for the Social Sciences (SPSS) version 20.0. Results: Wint increased according to the gradient (p < 0.05). However, no significant differences were observed in the maximum values of maximum subtalar pronation corresponding to each gradient. Conclusion: Results show the maximum subtalar pronation during submaximal running depends on the speed rather than intensity of effort.
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Affiliation(s)
| | - Mayara Maciel Batista
- Universidade Estadual do Centro-Oeste do Paraná, Brazil; Universidade Federal do Paraná, Brazil
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Easthope CS, Traini LR, Awai L, Franz M, Rauter G, Curt A, Bolliger M. Overground walking patterns after chronic incomplete spinal cord injury show distinct response patterns to unloading. J Neuroeng Rehabil 2018; 15:102. [PMID: 30419945 PMCID: PMC6233558 DOI: 10.1186/s12984-018-0436-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 10/15/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Body weight support (BWS) is often provided to incomplete spinal cord injury (iSCI) patients during rehabilitation to enable gait training before full weight-bearing is recovered. Emerging robotic devices enable BWS during overground walking, increasing task-specificity of the locomotor training. However, in contrast to a treadmill setting, there is little information on how unloading is integrated into overground locomotion. We investigated the effect of a transparent multi-directional BWS system on overground walking patterns at different levels of unloading in individuals with chronic iSCI (CiSCI) compared to controls. METHODS Kinematics of 12 CiSCI were analyzed at six different BWS levels from 0 to 50% body weight unloading during overground walking at 2kmh- 1 and compared to speed-matched controls. RESULTS In controls, temporal parameters, single joint trajectories, and intralimb coordination responded proportionally to the level of unloading, while spatial parameters remained unaffected. In CiSCI, unloading induced similar changes in temporal parameters. CiSCI, however, did not adapt their intralimb coordination or single joint trajectories to the level of unloading. CONCLUSIONS The findings revealed that continuous, dynamic unloading during overground walking results in subtle and proportional gait adjustments corresponding to changes in body load. CiSCI demonstrated diminished responses in specific domains of gait, indicating that their altered neural processing impeded the adjustment to environmental constraints. CiSCI retain their movement patterns under overground unloading, indicating that this is a viable locomotor therapy tool that may also offer a potential window on the diminished neural control of intralimb coordination.
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Affiliation(s)
| | - Luca Renato Traini
- Spinal Cord Injury Center, Balgrist University Hospital, Forchstrasse 340, CH-8008, Zürich, Switzerland
| | - Lea Awai
- Spinal Cord Injury Center, Balgrist University Hospital, Forchstrasse 340, CH-8008, Zürich, Switzerland.,Sobell Department of Motor Neuroscience and Movement Disorders, University College London, London, UK
| | - Martina Franz
- Spinal Cord Injury Center, Balgrist University Hospital, Forchstrasse 340, CH-8008, Zürich, Switzerland
| | - Georg Rauter
- BIROMED-Lab, Department of Biomedical Engineering, University Basel, Basel, Switzerland
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, Forchstrasse 340, CH-8008, Zürich, Switzerland
| | - Marc Bolliger
- Spinal Cord Injury Center, Balgrist University Hospital, Forchstrasse 340, CH-8008, Zürich, Switzerland
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36
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Apte S, Plooij M, Vallery H. Correction to: Influence of body weight unloading on human gait characteristics: a systematic review. J Neuroeng Rehabil 2018; 15:73. [PMID: 30089522 PMCID: PMC6081899 DOI: 10.1186/s12984-018-0414-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 07/11/2018] [Indexed: 11/10/2022] Open
Abstract
The original article [1] contained a major error whereby Figure 1 mistakenly displayed a duplicate of Figure 5.
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Affiliation(s)
- Salil Apte
- 0000 0001 2097 4740grid.5292.cMechanical, Maritime and Materials Engineering (3mE), TU Delft, Mekelweg 2, 2628 Delft, CD Netherlands
| | - Michiel Plooij
- 0000 0001 2097 4740grid.5292.cMechanical, Maritime and Materials Engineering (3mE), TU Delft, Mekelweg 2, 2628 Delft, CD Netherlands ,Motekforce Link, Hogehilweg 18-C, 1101 Amsterdam, CD Netherlands
| | - Heike Vallery
- 0000 0001 2097 4740grid.5292.cMechanical, Maritime and Materials Engineering (3mE), TU Delft, Mekelweg 2, 2628 Delft, CD Netherlands
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