1
|
Vecchio M, Chiaramonte R, De Sire A, Buccheri E, Finocchiaro P, Scaturro D, Letizia Mauro G, Cioni M. Do proprioceptive training strategies with dual-task exercises positively influence gait parameters in chronic stroke? A systematic review. J Rehabil Med 2024; 56:jrm18396. [PMID: 39145519 PMCID: PMC11337222 DOI: 10.2340/jrm.v56.18396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 04/09/2024] [Indexed: 08/16/2024] Open
Abstract
OBJECTIVE This study aims to assess the impact of proprioceptive training strategies with dual-task exercises on gait in people with chronic stroke. STUDY DESIGN Systematic review. PATIENTS Chronic stroke. METHODS Searches were conducted in accordance with PRISMA guidelines and PICOS criteria. PubMed, Web of Science, and Scopus databases were systematically searched from November 2020 to February 2022, for eligible clinical trials. Two independent reviewers thoroughly screened potential articles for relevance and assessed the methodology quality. In accordance with the GRADE, PICOS criteria, and Cochrane risk of bias tools, the authors included articles concerning the effectiveness of dual-task in proprioceptive training on gait parameters in people with chronic stroke. RESULTS Of 3075 identified studies, 11 articles met the inclusion criteria: 7 were randomized clinical trials, 1 was not randomized, and 3 were observational studies. The overall quality of evidence, assessed using the GRADE framework, was high, indicating a high level of confidence in the systematic review's findings. The papers involved 393 stroke patients; 241 underwent dual-task in proprioceptive training, with 152 participants in other stroke rehabilitation; within the dual-task group, 71 engaged in cognitive tasks, and 170 participated in motor tasks. dual-task in proprioceptive training improved gait speed, cadence, stride time, stride length, and step length. The best effects were observed with training 3 times a week for 4 weeks, with each session lasting 30 minutes, on speed, cadence, stride length, and step length. CONCLUSION Current evidence suggests that proprioceptive training strategies with dual-task exercises improved walking abilities in people with chronic stroke. Specifically, it enhanced gait speed, a key indicator of clinical severity.
Collapse
Affiliation(s)
- Michele Vecchio
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy; Rehabilitation Unit, "AOU Policlinico G. Rodolico-San Marco", Catania, Italy
| | - Rita Chiaramonte
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy.
| | - Alessandro De Sire
- Physical and Rehabilitative Medicine, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy; Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Enrico Buccheri
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Patrizia Finocchiaro
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Dalila Scaturro
- Department of Surgery, Oncology and Stomatology, University of Palermo, Palermo, Italy
| | - Giulia Letizia Mauro
- Department of Surgery, Oncology and Stomatology, University of Palermo, Palermo, Italy
| | - Matteo Cioni
- Laboratory of Neuro-Biomechanics, Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| |
Collapse
|
2
|
Ma J, Qian S, Ma N, Zhang L, Xu L, Liu X, Meng G. Effect of short-term 10 Hz repeated transcranial magnetic stimulation on postural control ability in patients with mild hemiparesis in acute ischemic stroke: a single-blinded randomized controlled trial. Front Neurol 2024; 15:1439904. [PMID: 39206286 PMCID: PMC11350563 DOI: 10.3389/fneur.2024.1439904] [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: 05/31/2024] [Accepted: 07/26/2024] [Indexed: 09/04/2024] Open
Abstract
Background Previous studies have demonstrated that repetitive transcranial magnetic stimulation (rTMS) can improve postural control in subacute and chronic ischemic stroke, but further research is needed to investigate the effect of rTMS on acute ischemic stroke. Objective We compared the therapeutic effects of rTMS plus conventional rehabilitation and conventional rehabilitation on postural control in patients with mild hemiparesis in acute ischemic stroke. Methods Eighty-six patients with acute ischemic stroke were randomly assigned to either the experimental group or the control group within 1-7 days of onset. Patients in both groups received conventional rehabilitation for 2 weeks. Patients in the experimental group received rTMS treatments lasting for 2 weeks. Before and after the 2-week treatment, patients were assessed based on the Timed up and Go (TUG) test, Dual-Task Walking (DTW) test, Functional Ambulation Category (FAC), Tinetti Performance Oriented Mobility Assessment (POMA), gait kinematic parameters, Barthel Index (BI), Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and National Institutes of Health Stroke Scale (NIHSS). Additionally, TUG and single-task gait velocity were assessed at 2 months after the start of treatment, and independent walking recovery was also followed up. Results After 2 weeks of treatment, compared to conventional rehabilitation, participants who underwent rTMS treatment plus conventional rehabilitation exhibited notable enhancements in TUG, FAC, POMA, and some gait parameters [single-task gait velocity, gait stride length, gait cadence, gait cycle]. Changes in cognitive function partially mediated the improvement in single-task gait velocity and gait stride length by rTMS plus conventional rehabilitation. Generalized Estimating Equation (GEE) analysis showed that the trend of improvement in single-task gait velocity over time was more pronounced in the experimental group than in the control group. The results of the Kaplan-Meier curve indicated a median gait recovery time of 90 days for patients in the experimental group and 100 days for the control group. Multifactorial Cox regression analyses showed that rTMS plus conventional rehabilitation promoted faster recovery of independent walking compared with conventional rehabilitation. Conclusion rTMS plus conventional rehabilitation outperformed conventional rehabilitation in improving postural control in patients with acute ischemic stroke. Improvements in cognitive function may serve as a mediating factor in the favorable treatment outcome of rTMS plus conventional rehabilitation for improving postural control. Clinical trial registration https://www.chictr.org.cn, identifier ChiCTR1900026225.
Collapse
Affiliation(s)
- Jiangping Ma
- Department of Neurology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Neurology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Siyu Qian
- Department of Neurology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Neurology, Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai, China
| | - Nuo Ma
- Department of Neurology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lu Zhang
- Department of Neurology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Linghao Xu
- Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xueyuan Liu
- Department of Neurology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Guilin Meng
- Department of Neurology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| |
Collapse
|
3
|
Le Roy A, Dubois F, Roche N, Brunel H, Bonnyaud C. Cautious Gait during Navigational Tasks in People with Hemiparesis: An Observational Study. SENSORS (BASEL, SWITZERLAND) 2024; 24:4241. [PMID: 39001018 PMCID: PMC11244485 DOI: 10.3390/s24134241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 06/25/2024] [Accepted: 06/26/2024] [Indexed: 07/16/2024]
Abstract
Locomotor and balance disorders are major limitations for subjects with hemiparesis. The Timed Up and Go (TUG) test is a complex navigational task involving oriented walking and obstacle circumvention. We hypothesized that subjects with hemiparesis adopt a cautious gait during complex locomotor tasks. The primary aim was to compare spatio-temporal gait parameters, indicators of cautious gait, between the locomotor subtasks of the TUG (Go, Turn, Return) and a Straight-line walk in people with hemiparesis. Our secondary aim was to analyze the relationships between TUG performance and balance measures, compare spatio-temporal gait parameters between fallers and non-fallers, and identify the biomechanical determinants of TUG performance. Biomechanical parameters during the TUG and Straight-line walk were analyzed using a motion capture system. A repeated measures ANOVA and two stepwise ascending multiple regressions (with performance variables and biomechanical variables) were conducted. Gait speed, step length, and % single support phase (SSP) of the 29 participants were reduced during Turn compared to Go and Return and the Straight-line walk, and step width and % double support phase were increased. TUG performance was related to several balance measures. Turn performance (R2 = 63%) and Turn trajectory deviation followed by % SSP on the paretic side and the vertical center of mass velocity during Go (R2 = 71%) determined TUG performance time. People with hemiparesis adopt a cautious gait during complex navigation at the expense of performance.
Collapse
Affiliation(s)
- Albane Le Roy
- APHP, GHU Paris-Saclay, Raymond Poincaré Hospital, Physical Medicine and Rehabilitation Department, 92380 Garches, France
- IFMK Saint-Michel, 75015 Paris, France
| | - Fabien Dubois
- APHP, GHU Paris-Saclay, Raymond Poincaré Hospital, Motion Analysis Laboratory, Functional Explorations Department, 92380 Garches, France
- Université Paris-Saclay, UVSQ, Research Unit ERPHAN, 78000 Versailles, France
| | - Nicolas Roche
- APHP, GHU Paris-Saclay, Raymond Poincaré Hospital, Motion Analysis Laboratory, Functional Explorations Department, 92380 Garches, France
- Université Paris-Saclay, UVSQ, Inserm Unit 1179, END-ICAP Laboratory, 78000 Versailles, France
| | | | - Céline Bonnyaud
- IFMK Saint-Michel, 75015 Paris, France
- APHP, GHU Paris-Saclay, Raymond Poincaré Hospital, Motion Analysis Laboratory, Functional Explorations Department, 92380 Garches, France
- Université Paris-Saclay, UVSQ, Research Unit ERPHAN, 78000 Versailles, France
| |
Collapse
|
4
|
Ghrouz A, Guillen-Sola A, Morgado-Perez A, Muñoz-Redondo E, Ramírez-Fuentes C, Curbelo Peña Y, Duarte E. The effect of a motor relearning on balance and postural control in patients after stroke: An open-label randomized controlled trial. Eur Stroke J 2024; 9:303-311. [PMID: 38158722 PMCID: PMC11318422 DOI: 10.1177/23969873231220218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 11/24/2023] [Indexed: 01/03/2024] Open
Abstract
INTRODUCTION Balance and postural control impairments are common in stroke patients, increasing fall risk and limiting their daily and social activities. Current research lacks comprehensive studies evaluating the efficacy and long-term effects of task-specific training on balance and postural control among stroke patients, especially when considering biomechanical and posturographic assessments. PATIENTS AND METHODS A randomized controlled trial included 63 subacute stroke patients recruited from the outpatient rehabilitation department. Participants were randomly assigned to the MRP group (n=32), receiving task-specific training based on MRP, or the CPT group (n=31), receiving conventional physical therapy. Both groups completed an 8-week intervention (3 sessions/week; 1 h./session). Balance and postural control were assessed at baseline, post-intervention, and 3-month follow-up using the Berg Balance Scale (BBS) and posturography. RESULTS The MRP group exhibited significantly larger improvements than the CPT group in both BBS scores (p=0.001, d=2.98, 95% CI [2.25, 3.70]) and Balance Index scores (p=0.001, d=2.83, 95% CI [2.12, 3.53]) after the intervention. These improvements were sustained at 3-month follow-up. DISCUSSION The findings suggest that task-specific training based on MRP is more effective than CPT for improving balance and postural control. The MRP intervention may enhance the motor learning and neural plasticity of the patients, leading to better functional outcomes. However, the study's open-label design represents a limitation, and further research with adequate blinding is needed. CONCLUSION Task-specific training based on MRP was superior to CPT for improving balance and postural control in subacute stroke patients. Participants undergoing MRP exhibited significant and clinically relevant improvements that were sustained at follow-up.
Collapse
Affiliation(s)
- Amer Ghrouz
- Department of Physical Medicine and Rehabilitation, Hospitals del Mar i l’Esperança, Parc de Salut Mar, Barcelona, Spain
- Rehabilitation Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Applied Medical Sciences, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Anna Guillen-Sola
- Rehabilitation Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Neurorehabilitation Unit, Physical Medicine and Rehabilitation Department, Hospital del Mar, Barcelona, Spain
| | - Andrea Morgado-Perez
- Department of Physical Medicine and Rehabilitation, Hospitals del Mar i l’Esperança, Parc de Salut Mar, Barcelona, Spain
- Rehabilitation Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Elena Muñoz-Redondo
- Department of Physical Medicine and Rehabilitation, Hospitals del Mar i l’Esperança, Parc de Salut Mar, Barcelona, Spain
- Rehabilitation Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Cindry Ramírez-Fuentes
- Department of Physical Medicine and Rehabilitation, Hospitals del Mar i l’Esperança, Parc de Salut Mar, Barcelona, Spain
- Rehabilitation Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Yulibeth Curbelo Peña
- Department of Physical Medicine and Rehabilitation, Hospitals del Mar i l’Esperança, Parc de Salut Mar, Barcelona, Spain
| | - Esther Duarte
- Department of Physical Medicine and Rehabilitation, Hospitals del Mar i l’Esperança, Parc de Salut Mar, Barcelona, Spain
- Rehabilitation Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| |
Collapse
|
5
|
Peters J, Lauinger A, Mayr M, Ginell K, Abou L. Dual-Task Assessments for Predicting Future Falls in Neurologic Conditions: A Systematic Review. Am J Phys Med Rehabil 2024; 103:554-560. [PMID: 38466165 DOI: 10.1097/phm.0000000000002452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
ABSTRACT This review investigated the ability of dual-task tests to predict falls in people with neurological disorders. Databases were searched to identify prospective cohort studies that analyzed dual-task testing and falls in people with neurological disorders. Reviewers screened studies for eligibility and extracted key information like participant characteristics, intervention details, outcome measures, and significant outcomes. Reviewers assessed methodological quality of eligible studies using the Standard Quality Assessment Criteria. Eighteen studies of strong methodological qualified with 1750 participants were included in the review. Dual-task performances were predictive of future falls in people with Huntington's disease, spinal cord injury, and moderate cognitive impairment, although only one independent study was included for each disability type. In people with stroke, 37% of eligible studies showed dual-task assessments to be predictive of future falls. No dual-task tests predicted prospective falling in people with Alzheimer's or Parkinson's disease. Complex dual tasks seemed to be more predictive of fall risk than simpler dual tasks. Results suggest that disability type, severity of disability, and task complexity play a role in the predictive ability of dual-task assessments and future falling in neurological disorders. Future studies may benefit from using this review to guide the design of effective dual-task assessments and fall interventions.
Collapse
Affiliation(s)
- Joseph Peters
- From the Kansas City University College of Osteopathic Medicine, Kansas City University, Kansas City, Missouri (JP, MM); Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois (AL); and Department of Physical Medicine & Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan (KG, LA)
| | | | | | | | | |
Collapse
|
6
|
Abdelfadil HMG, Fahmy EM, Abdelmegeed SM, Zakaria HM, Darwesh AA, Kadry AM, Elsayed SH, Aboeleneen AM, Alshimy AM. Effect of adding systematic desensitization to goal-directed paradigm on risk of falling in patients with stroke: a randomized controlled trial. Front Neurol 2024; 15:1285420. [PMID: 38784906 PMCID: PMC11111878 DOI: 10.3389/fneur.2024.1285420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 04/19/2024] [Indexed: 05/25/2024] Open
Abstract
Background Improvement in rehabilitation outcomes for patients suffering from chronic stroke can be attained through systematic desensitization of their fear of falling, which in turn reduces the risk of falling. Purpose This study aimed to examine the effect of adding systematic desensitization to a goal-directed paradigm on functional performance, balance, risk of falling, and fear of falling among chronic ischemic stroke patients. Methodology Two equally sized groups, each comprising 40 stroke patients of both sexes, were randomly divided. For 8 weeks, Group A received three sessions per week of combined treatment consisting of systematic desensitization and a goal-directed paradigm, while Group B received only the goal-directed paradigm. The Timed Up and Go (TUG) test and Dynamic Gait Index (DGI) were used to assess function performance; the Berg Balance Scale (BBS) and the Biodex Fall Risk Index (FRI) were used to evaluate balance; and the 16-item Fall Efficacy Scale-International (FES-I) was used to evaluate fear of falling. At baseline and after the treatment, all measurements were obtained. Results Both groups (A and B) revealed a substantial increase in functional performance through a decrease in TUG scores and an increase in DGI. Additionally, there was a decrease in the risk of falling through an increase in the BBS scores and a decrease in the FRI. Furthermore, there was a decrease in the fear of falling, as measured using the FES-I, after treatment, with superior improvement in Group A with a p-value of <0.001. Conclusion Systematic desensitization combined with a goal-directed paradigm has a superior effect on improving functional performance and reducing the risk of falling and the fear of falling in patients with stroke compared to a goal-directed paradigm alone.
Collapse
Affiliation(s)
- Heba Mohammed Gaber Abdelfadil
- Department of Physical Therapy for Neuromuscular Disorders and its Surgery, Faculty of Physical Therapy, October 6 University, Giza, Egypt
| | | | - Shimaa Mohamed Abdelmegeed
- Department of Physical Therapy for Neurology and Neurosurgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Hoda Mohammed Zakaria
- Department of Physical Therapy for Neurology and Neurosurgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Ashraf Ahmed Darwesh
- Department of Physical Therapy for Neurology and Neurosurgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | | | - Shereen Hamed Elsayed
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Ahmed M. Aboeleneen
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Basic Science, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Ahmed Magdy Alshimy
- Department of Physical Therapy for Neurology and Its Surgery, Faculty of Physical Therapy, Al Ryada University for Science and Technology, Sadat City, Menoufia, Egypt
| |
Collapse
|
7
|
Kline PW, Shaikh FD, Tennant JE, Hamel R, Zukowski LA. Global Cognition, Gender, and Level of Education Predict Dual-Task Gait Speed Variability Metrics in Older Adults. Gerontology 2024; 70:724-731. [PMID: 38643764 DOI: 10.1159/000537720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 02/05/2024] [Indexed: 04/23/2024] Open
Abstract
INTRODUCTION The purpose of this study was to determine if demographic variables and measures of cognitive function, functional mobility, self-reported balance self-efficacy, and self-reported physical activity can predict gait speed variability during single-task walking (STGSCV), during cognitive-motor dual-tasking (DTGSCV), and dual-task effect on gait speed variability (DTEGSCV) in older adults. METHODS In 62 older adults, demographics were recorded and cognitive function (including the Montreal Cognitive Assessment, MoCA), functional mobility, balance self-efficacy (Activities-specific Balance Confidence Scale, ABC), and self-reported physical activity (Physical Activity Scale for the Elderly, PASE) were assessed. Three linear regression models were used to determine whether the functional mobility tests, PASE score, ABC score, and tests of cognitive function predicted gait speed variability outcomes (STGSCV, DTGSCV, DTEGSCV), with demographics included as covariates. RESULTS MoCA score (p = 0.003), gender (p = 0.040), and years of education (p = 0.010) significantly predicted DTGSCV (R2 = 0.297, p = 0.002). MoCA score (p = 0.008) and years of education (p < 0.001) also significantly predicted DTEGSCV. Despite a significant regression model (R2 = 0.316, p = 0.001), there were no significant individual predictors of STGSCV. CONCLUSION Older adults with lower cognitive function scores, according to the MoCA, and higher levels of education demonstrate larger gait speed variability during dual-tasking and may be at increased risk of real-world mobility issues or falling.
Collapse
Affiliation(s)
- Paul W Kline
- Department of Physical Therapy, High Point University, High Point, North Carolina, USA
- Department of Physical Therapy, College of Health Professions, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Faisal D Shaikh
- Department of Physical Therapy, High Point University, High Point, North Carolina, USA
| | | | - Renee Hamel
- Department of Physical Therapy, High Point University, High Point, North Carolina, USA
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Lisa A Zukowski
- Department of Physical Therapy, High Point University, High Point, North Carolina, USA
| |
Collapse
|
8
|
Wu F, Meng Z, Yang K, Li J. Effects of ankle-foot orthoses on gait parameters in post-stroke patients with different Brunnstrom stages of the lower limb: a single-center crossover trial. Eur J Med Res 2024; 29:235. [PMID: 38622742 PMCID: PMC11017542 DOI: 10.1186/s40001-024-01835-2] [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: 02/21/2024] [Accepted: 04/08/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Ankle-foot orthoses (AFO) can improve gait posture and walking ability in post-stroke patients. However, the effect of AFO on gait parameters in post-stroke patients according to the Brunnstrom stage of stroke recovery of the lower limbs remains unclear. The study aimed to investigate whether stroke patients with different Brunnstrom stages benefit from wearing AFO. METHODS Twenty-five post-stroke participants included 18 men (50 ± 13 years) and 7 women (60 ± 15 years). The patients were divided based on Brunnstrom stage III or IV of the lower limbs. All patients underwent the gait and timed up and go (TUG) test using a gait analysis system while walking barefoot or with an AFO. The spatiotemporal and asymmetric parameters were analyzed. RESULTS All 25 patients completed the study. Significant differences were observed between barefoot and AFO use in TUG time (P < 0.001) but not walking velocity (P > 0.05). The main effect of the swing time ratio was significant in both groups (P < 0.05); however, the main effects of stride length, stance time, and gait asymmetry ratio were nonsignificant (P > 0.05). For barefoot versus AFO, the main effects of stride length (P < 0.05) and swing time (P < 0.01) ratios were significant, whereas those of stance time and gait asymmetry ratio were nonsignificant (P > 0.05). CONCLUSIONS Post-stroke patients with lower Brunnstrom stages benefitted more from AFO, particularly in gait asymmetry.
Collapse
Affiliation(s)
- Fangchao Wu
- Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3, Qingchun East Road, Shangcheng District, Hangzhou, People's Republic of China
| | - Zhe Meng
- Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3, Qingchun East Road, Shangcheng District, Hangzhou, People's Republic of China
| | - Kezhen Yang
- Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3, Qingchun East Road, Shangcheng District, Hangzhou, People's Republic of China
| | - Jianhua Li
- Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3, Qingchun East Road, Shangcheng District, Hangzhou, People's Republic of China.
| |
Collapse
|
9
|
Abdollahi M, Rashedi E, Kuber PM, Jahangiri S, Kazempour B, Dombovy M, Azadeh-Fard N. Post-Stroke Functional Changes: In-Depth Analysis of Clinical Tests and Motor-Cognitive Dual-Tasking Using Wearable Sensors. Bioengineering (Basel) 2024; 11:349. [PMID: 38671771 PMCID: PMC11048064 DOI: 10.3390/bioengineering11040349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/26/2024] [Accepted: 03/28/2024] [Indexed: 04/28/2024] Open
Abstract
Clinical tests like Timed Up and Go (TUG) facilitate the assessment of post-stroke mobility, but they lack detailed measures. In this study, 21 stroke survivors and 20 control participants underwent TUG, sit-to-stand (STS), and the 10 Meter Walk Test (10MWT). Tests incorporated single tasks (STs) and motor-cognitive dual-task (DTs) involving reverse counting from 200 in decrements of 10. Eight wearable motion sensors were placed on feet, shanks, thighs, sacrum, and sternum to record kinematic data. These data were analyzed to investigate the effects of stroke and DT conditions on the extracted features across segmented portions of the tests. The findings showed that stroke survivors (SS) took 23% longer for total TUG (p < 0.001), with 31% longer turn time (p = 0.035). TUG time increased by 20% (p < 0.001) from STs to DTs. In DTs, turning time increased by 31% (p = 0.005). Specifically, SS showed 20% lower trunk angular velocity in sit-to-stand (p = 0.003), 21% longer 10-Meter Walk time (p = 0.010), and 18% slower gait speed (p = 0.012). As expected, turning was especially challenging and worsened with divided attention. The outcomes of our study demonstrate the benefits of instrumented clinical tests and DTs in effectively identifying motor deficits post-stroke across sitting, standing, walking, and turning activities, thereby indicating that quantitative motion analysis can optimize rehabilitation procedures.
Collapse
Affiliation(s)
- Masoud Abdollahi
- Department of Industrial and Systems Engineering, Rochester Institute of Technology, Rochester, NY 14623, USA; (M.A.); (P.M.K.); (S.J.); (B.K.); (N.A.-F.)
| | - Ehsan Rashedi
- Department of Industrial and Systems Engineering, Rochester Institute of Technology, Rochester, NY 14623, USA; (M.A.); (P.M.K.); (S.J.); (B.K.); (N.A.-F.)
| | - Pranav Madhav Kuber
- Department of Industrial and Systems Engineering, Rochester Institute of Technology, Rochester, NY 14623, USA; (M.A.); (P.M.K.); (S.J.); (B.K.); (N.A.-F.)
| | - Sonia Jahangiri
- Department of Industrial and Systems Engineering, Rochester Institute of Technology, Rochester, NY 14623, USA; (M.A.); (P.M.K.); (S.J.); (B.K.); (N.A.-F.)
| | - Behnam Kazempour
- Department of Industrial and Systems Engineering, Rochester Institute of Technology, Rochester, NY 14623, USA; (M.A.); (P.M.K.); (S.J.); (B.K.); (N.A.-F.)
| | - Mary Dombovy
- Department of Rehabilitation and Neurology, Unity Hospital, Rochester, NY 14626, USA;
| | - Nasibeh Azadeh-Fard
- Department of Industrial and Systems Engineering, Rochester Institute of Technology, Rochester, NY 14623, USA; (M.A.); (P.M.K.); (S.J.); (B.K.); (N.A.-F.)
| |
Collapse
|
10
|
Howard KE, Reimold NK, Knight HL, Embry AE, Knapp HA, Agne AA, Jacobs CJ, Dean JC. Relationships between mediolateral step modulation and clinical balance measures in people with chronic stroke. Gait Posture 2024; 109:9-14. [PMID: 38237508 PMCID: PMC10939767 DOI: 10.1016/j.gaitpost.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 12/18/2023] [Accepted: 01/13/2024] [Indexed: 03/16/2024]
Abstract
BACKGROUND Many people with chronic stroke (PwCS) exhibit walking balance deficits linked to increased fall risk and decreased balance confidence. One potential contributor to these balance deficits is a decreased ability to modulate mediolateral stepping behavior based on pelvis motion. This behavior, hereby termed mediolateral step modulation, is thought to be an important balance strategy but can be disrupted in PwCS. RESEARCH QUESTION Are biomechanical metrics of mediolateral step modulation related to common clinical balance measures among PwCS? METHODS In this cross-sectional study, 93 PwCS walked on a treadmill at their self-selected speed for 3-minutes. We quantified mediolateral step modulation for both paretic and non-paretic steps by calculating partial correlations between mediolateral pelvis displacement at the start of each step and step width (ρSW), mediolateral foot placement relative to the pelvis (ρFP), and final mediolateral location of the pelvis (ρPD) at the end of the step. We also assessed several common clinical balance measures (Functional Gait Assessment [FGA], Activities-specific Balance Confidence scale [ABC], self-reported fear of falling and fall history). We performed Spearman correlations to relate each biomechanical metric of step modulation to FGA and ABC scores. We performed Wilcoxon rank sum tests to compare each biomechanical metric between individuals with and without a fear of falling and a history of falls. RESULTS Only ρFP for paretic steps was significantly related to all four clinical balance measures; higher paretic ρFP values tended to be observed in participants with higher FGA scores, with higher ABC scores, without a fear of falling and without a history of falls. However, the strength of each of these relationships was only weak to moderate. SIGNIFICANCE While the present results do not provide insight into causality, they justify future work investigating whether interventions designed to increase ρFP can improve clinical measures of post-stroke balance in parallel.
Collapse
Affiliation(s)
- Keith E Howard
- College of Health Professions; Medical University of South Carolina, USA
| | - Nicholas K Reimold
- College of Health Professions; Medical University of South Carolina, USA
| | - Heather L Knight
- College of Health Professions; Medical University of South Carolina, USA
| | - Aaron E Embry
- College of Health Professions; Medical University of South Carolina, USA; Ralph H. Johnson Veterans Affairs Health Care System, Charleston, SC, USA
| | - Holly A Knapp
- College of Health Professions; Medical University of South Carolina, USA
| | - Alexa A Agne
- College of Health Professions; Medical University of South Carolina, USA
| | - Camden J Jacobs
- College of Health Professions; Medical University of South Carolina, USA
| | - Jesse C Dean
- College of Health Professions; Medical University of South Carolina, USA; Ralph H. Johnson Veterans Affairs Health Care System, Charleston, SC, USA.
| |
Collapse
|
11
|
Peng X, Srivastava S, Sutton F, Zhang Y, Badran BW, Kautz SA. Compensatory increase in ipsilesional supplementary motor area and premotor connectivity is associated with greater gait impairments: a personalized fMRI analysis in chronic stroke. Front Hum Neurosci 2024; 18:1340374. [PMID: 38487103 PMCID: PMC10937543 DOI: 10.3389/fnhum.2024.1340374] [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: 11/23/2023] [Accepted: 02/16/2024] [Indexed: 03/17/2024] Open
Abstract
Background Balance and mobility impairments are prevalent post-stroke and a large number of survivors require walking assistance at 6 months post-stroke which diminishes their overall quality of life. Personalized interventions for gait and balance rehabilitation are crucial. Recent evidence indicates that stroke lesions in primary motor pathways, such as corticoreticular pathways (CRP) and corticospinal tract (CST), may lead to reliance on alternate motor pathways as compensation, but the current evidence lacks comprehensive knowledge about the underlying neural mechanisms. Methods In this study, we investigate the functional connectivity (FC) changes within the motor network derived from an individualized cortical parcellation approach in 33 participants with chronic stroke compared to 17 healthy controls. The correlations between altered motor FC and gait deficits (i.e., walking speed and walking balance) were then estimated in the stroke population to understand the compensation mechanism of the motor network in motor function rehabilitation post-stroke. Results Our results demonstrated significant FC increases between ipsilesional medial supplementary motor area (SMA) and premotor in stroke compared to healthy controls. Furthermore, we also revealed a negative correlation between ipsilesional SMA-premotor FC and self-selected walking speed, as well as the Functional Gait Assessment (FGA) scores. Conclusion The increased FC between the ipsilesional SMA and premotor regions could be a compensatory mechanism within the motor network following a stroke when the individual can presumably no longer rely on the more precise CST modulation of movements to produce a healthy walking pattern. These findings enhance our understanding of individualized motor network FC changes and their connection to gait and walking balance impairments post-stroke, improving stroke rehabilitation interventions.
Collapse
Affiliation(s)
- Xiaolong Peng
- Department of Psychiatry and Behavioral Sciences, Neuro-X Lab, Medical University of South Carolina, Charleston, SC, United States
| | - Shraddha Srivastava
- Ralph H. Johnson VA Medical Center, Charleston, SC, United States
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, United States
| | - Falon Sutton
- Department of Psychiatry and Behavioral Sciences, Neuro-X Lab, Medical University of South Carolina, Charleston, SC, United States
| | - Yongkuan Zhang
- Department of Psychiatry and Behavioral Sciences, Neuro-X Lab, Medical University of South Carolina, Charleston, SC, United States
| | - Bashar W. Badran
- Department of Psychiatry and Behavioral Sciences, Neuro-X Lab, Medical University of South Carolina, Charleston, SC, United States
| | - Steven A. Kautz
- Ralph H. Johnson VA Medical Center, Charleston, SC, United States
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, United States
- Division of Physical Therapy, Department of Rehabilitation Sciences, College of Health Professions, Medical University of South Carolina, Charleston, SC, United States
| |
Collapse
|
12
|
Teodoro J, Fernandes S, Castro C, Fernandes JB. Current Trends in Gait Rehabilitation for Stroke Survivors: A Scoping Review of Randomized Controlled Trials. J Clin Med 2024; 13:1358. [PMID: 38592172 PMCID: PMC10932333 DOI: 10.3390/jcm13051358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 02/23/2024] [Accepted: 02/24/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Stroke stands as a significant global health concern, constituting a leading cause of disability worldwide. Rehabilitation interventions are crucial in aiding the recovery of stroke patients, contributing to an overall enhancement in their quality of life. This scoping review seeks to identify current trends in gait rehabilitation for stroke survivors. METHODS The review followed the methodological framework suggested by Arksey and O'Malley. Electronic databases, such as CINAHL Complete, MEDLINE Complete, and Nursing & Allied Health Collection, were systematically searched in November 2023. Inclusion criteria comprised papers published in either English or Portuguese from 2013 to 2023. RESULTS From the initial search, a total of 837 papers were identified; twenty-one papers were incorporated into this review. Thirteen distinct categories of gait rehabilitation interventions were identified, encompassing diverse approaches. These categories comprise conventional rehabilitation exercises, traditional gait training with integrated technology, and gait training supported by modern technologies. CONCLUSIONS Although traditional rehabilitation exercises have historically proven effective in aiding stroke survivors, a recent trend has emerged, emphasizing the development and integration of innovative therapeutic approaches that harness modern technologies.
Collapse
Affiliation(s)
- Joana Teodoro
- Department of Nursing, Hospital Garcia de Orta, 2805-267 Almada, Portugal;
- Nurs* Lab, 2829-511 Almada, Portugal; (S.F.); (C.C.)
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal
| | - Sónia Fernandes
- Nurs* Lab, 2829-511 Almada, Portugal; (S.F.); (C.C.)
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal
| | - Cidália Castro
- Nurs* Lab, 2829-511 Almada, Portugal; (S.F.); (C.C.)
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal
| | - Júlio Belo Fernandes
- Nurs* Lab, 2829-511 Almada, Portugal; (S.F.); (C.C.)
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal
| |
Collapse
|
13
|
Leszczak J, Pyzińska J, Baran J, Baran R, Bylicki K, Pop T. Assessment of functional fitness impacted by hospital rehabilitation in post-stroke patients who additionally contracted COVID-19. PeerJ 2024; 12:e16710. [PMID: 38192599 PMCID: PMC10773450 DOI: 10.7717/peerj.16710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/01/2023] [Indexed: 01/10/2024] Open
Abstract
Background The aim of the study was to assess the effects of rehabilitation in post-stroke patients, or post-stroke patients with simultaneous COVID-19 infection, in relation to: improved locomotion efficiency, improved balance, reduced risk of falling as well as the patients' more effective performance in everyday activities. Methods The study involved 60 patients in the early period (2-3 months) after a stroke. Group I consisted of 18 patients (30.0%) who, in addition to a stroke, also contracted COVID-19. Group II consisted of 42 patients (70%) post-stroke, with no SARS-CoV2 infection. The effects were assessed on the basis of: Tinetti test, Timed Up & Go test and Barthel scale. Results Both groups achieved a statistically significant improvement in their Barthel score after therapy (p < 0.001). The Tinetti test, assessing gait and balance, showed that participants in Group I improved their score by an average of 4.22 points. ±4.35, and in Group II, on average, by 3.48 points ± 3.45 points. In the Timed Up & Go test over a distance of 3 m, significant improvement was achieved in both groups, as well but the effect was higher in Group I (p < 0.001). Conclusions Hospital rehabilitation in the early period after stroke improved locomotion efficiency and balance, and reduced the risk of falls in post-stroke patients, both with and without COVID-19 infection.
Collapse
Affiliation(s)
- Justyna Leszczak
- Institute of Health Sciences, Medical Faculty, University of Rzeszów, Rzeszów, Poland
| | - Joanna Pyzińska
- Institute of Health Sciences, Medical Faculty, University of Rzeszów, Rzeszów, Poland
| | - Joanna Baran
- Institute of Health Sciences, Medical Faculty, University of Rzeszów, Rzeszów, Poland
| | - Rafał Baran
- Institute of Health Sciences, Medical Faculty, University of Rzeszów, Rzeszów, Poland
| | - Krzysztof Bylicki
- Institute of Health Sciences, Medical Faculty, University of Rzeszów, Rzeszów, Poland
| | - Teresa Pop
- Institute of Health Sciences, Medical Faculty, University of Rzeszów, Rzeszów, Poland
| |
Collapse
|
14
|
Gregg E, Beggs C, Bissas A, Nicholson G. A machine learning approach to identify important variables for distinguishing between fallers and non-fallers in older women. PLoS One 2023; 18:e0293729. [PMID: 37906588 PMCID: PMC10617741 DOI: 10.1371/journal.pone.0293729] [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] [Received: 06/08/2023] [Accepted: 10/17/2023] [Indexed: 11/02/2023] Open
Abstract
Falls are a significant ongoing public health concern for older adults. At present, few studies have concurrently explored the influence of multiple measures when seeking to determine which variables are most predictive of fall risks. As such, this cross-sectional study aimed to identify those functional variables (i.e. balance, gait and clinical measures) and physical characteristics (i.e. strength and body composition) that could best distinguish between older female fallers and non-fallers, using a machine learning approach. Overall, 60 community-dwelling older women (≥65 years), retrospectively classified as fallers (n = 21) or non-fallers (n = 39), attended three data collection sessions. Data (281 variables) collected from tests in five separate domains (balance, gait, clinical measures, strength and body composition) were analysed using random forest (RF) and leave-one-variable-out partial least squares correlation analysis (LOVO PLSCA) to assess variable importance. The strongest discriminators from each domain were then aggregated into a multi-domain dataset, and RF, LOVO PLSCA, and logistic regression models were constructed to identify the important variables in distinguishing between fallers and non-fallers. These models were used to classify participants as either fallers or non-fallers, with their performance evaluated using receiver operating characteristic (ROC) analysis. The study found that it is possible to classify fallers and non-fallers with a high degree of accuracy (e.g. logistic regression: sensitivity = 90%; specificity = 87%; AUC = 0.92; leave-one-out cross-validation accuracy = 63%) using a combination of 18 variables from four domains, with the gait and strength domains being particularly informative for screening programmes aimed at assessing falls risk.
Collapse
Affiliation(s)
- Emily Gregg
- Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom
- York Health Economics Consortium, University of York, York, United Kingdom
| | - Clive Beggs
- Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom
- Department of Medicine for the Elderly, Cambridge University Hospitals, Cambridge, United Kingdom
| | - Athanassios Bissas
- School of Sport and Exercise, University of Gloucestershire, Gloucester, United Kingdom
| | - Gareth Nicholson
- Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom
| |
Collapse
|
15
|
Xia Y, Wang M, Zhu Y. The Effect of Cerebellar rTMS on Modulating Motor Dysfunction in Neurological Disorders: a Systematic Review. CEREBELLUM (LONDON, ENGLAND) 2023; 22:954-972. [PMID: 36018543 DOI: 10.1007/s12311-022-01465-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/18/2022] [Indexed: 06/15/2023]
Abstract
The effectiveness of cerebellar repetitive transcranial magnetic stimulation (rTMS) on motor dysfunction in patients with neurological disorders has received increasing attention because of its potential for neuromodulation. However, studies on the neuromodulatory effects, parameters, and safety of rTMS implementation in the cerebellum to alleviate motor dysfunction are limited. This systematic review aimed to evaluate the effectiveness and safety of cerebellar rTMS treatment for motor dysfunction caused by neurological disorders and to review popular stimulation parameters. Five electronic databases-Medline, Web of Science, Scopus, Cochrane Library, and Embase-were searched for relevant research published from inception to July 2022. All randomized controlled trials (RCTs) that reported the effects of cerebellar rTMS combined with behavioral rating scales on motor dysfunction were eligible for enrollment. Additionally, reference lists of the enrolled studies were manually checked. Among 1156 articles screened, 21 RCTs with 666 subjects were included. rTMS conducted on the cerebellum showed an improvement in stroke (spasticity, balance, and gait), cervical dystonia, Parkinson's disease (tremor), cerebellar ataxia, and essential tremor but not in multiple sclerosis. The 8-shaped coil with a diameter of 70 mm was determined as the most common therapeutic choice. None of the studies reported severe adverse events except mild side effects in three. Therefore, rTMS appears to be a promising and safe technique for the treatment of motor dysfunction, targeting the cerebellum to induce motor behavioral improvement. Further rigorous RCTs, including more samples and longer follow-up periods, are required to precisely explore the effective stimulation parameters and possible mechanisms.
Collapse
Affiliation(s)
- Yifei Xia
- School of Kinesiology, Shanghai University of Sport, Yangpu District, No. 200 Hengren Road, Shanghai, China
| | - Mingqi Wang
- School of Kinesiology, Shanghai University of Sport, Yangpu District, No. 200 Hengren Road, Shanghai, China
| | - Yulian Zhu
- School of Kinesiology, Shanghai University of Sport, Yangpu District, No. 200 Hengren Road, Shanghai, China.
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Jing'an District, No. 12 Wulumuqi road, Shanghai, 200040, China.
| |
Collapse
|
16
|
Paterson J, Trevenen M, Hill K, Almeida OP, Yeap BB, Golledge J, Hankey GJ, Flicker L. Balance and Strength Measures are Associated With Mortality in Older Men. J Am Med Dir Assoc 2023; 24:1527-1532.e2. [PMID: 37187326 DOI: 10.1016/j.jamda.2023.03.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 03/30/2023] [Accepted: 03/30/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVES As people age, rates of morbidity and mortality are heterogenous. Balance and strength performance may contribute to this, offering modifiable risk factors for mortality. We aimed to compare relationships of balance and strength performance with all-cause and cause-specific mortality. DESIGN The Health in Men Study, a cohort study, using wave 4 as baseline for analyses (2011-2013). SETTING AND PARTICIPANTS 1335 older men (>65 years old), initially recruited April 1996-January 1999 in Western Australia, were included. METHODS Physical tests included a strength (knee extension test) and balance measure (modified Balance Outcome Measure for Elder Rehabilitation (mBOOMER) Score), derived from baseline physical assessments. Outcome measures included all-cause, cardiovascular, and cancer mortality, ascertained via the WADLS death registry. Data were analyzed using Cox proportional hazards regression models (age as analysis time, adjusted for sociodemographic data, health behaviors, and conditions). RESULTS Four hundred seventy-three participants died before the end of follow-up (December 17, 2017). Better performance on both the mBOOMER score and knee extension test was associated with lower likelihood of all-cause [hazard ratio (HR) 0.83, 95% CI 0.80-0.87, and HR 0.96, 95% CI 0.95-0.98, respectively] and cardiovascular mortality (HR 0.82, 95% CI 0.77-0.87, and HR 0.96, 95% CI 0.94-0.98, respectively). Better mBOOMER score performance was associated with lower likelihood of cancer mortality (HR 0.90, 95% CI 0.83-0.98) only when including participants with prior cancer. CONCLUSIONS AND IMPLICATIONS In summary, this study demonstrates an association of poorer performance in both strength and balance with future all-cause and cardiovascular mortality. Notably, these results clarify the relationship of balance with cause-specific mortality, with balance equaling strength as a modifiable risk factor for mortality.
Collapse
Affiliation(s)
- Jack Paterson
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Michelle Trevenen
- Western Australian Centre for Health & Ageing, Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Keith Hill
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University, School of Primary and Allied Health Care, Peninsula Campus, Frankston, Victoria, Australia
| | - Osvaldo P Almeida
- Western Australian Centre for Health & Ageing, Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Bu B Yeap
- Medical School, University of Western Australia, Perth, Western Australia, Australia; Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, James Cook University, Townsville, Queensland, Australia; Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Queensland, Australia
| | - Graeme J Hankey
- Medical School, University of Western Australia, Nedlands, Western Australia, Australia; Perron Institute for Neurological and Translational Science, Nedlands, Western Australia, Australia
| | - Leon Flicker
- Western Australian Centre for Health & Ageing, Medical School, University of Western Australia, Perth, Western Australia, Australia.
| |
Collapse
|
17
|
Saraiva J, Rosa G, Fernandes S, Fernandes JB. Current Trends in Balance Rehabilitation for Stroke Survivors: A Scoping Review of Experimental Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6829. [PMID: 37835099 PMCID: PMC10572981 DOI: 10.3390/ijerph20196829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/15/2023] [Accepted: 09/23/2023] [Indexed: 10/15/2023]
Abstract
Balance impairment is a common consequence of a stroke, which can significantly hinder individuals' participation in daily activities, social interactions, and leisure pursuits and their ability to return to work. Rehabilitation is vital for minimizing post-stroke sequelae and facilitating the recovery of patients. This review aims to identify current trends in balance rehabilitation of stroke survivors. This Scoping review followed Arksey and O'Malley's methodological framework. The literature search was conducted in electronic databases, including CINAHL Complete, MEDLINE Complete, and Nursing & Allied Health Collection. The search was performed in March 2023, and the inclusion criteria were articles published in English or Portuguese between 2013 and 2023. A total of 446 articles were identified. After selecting and analyzing the reports, fourteen publications were included in this review. Seven distinct categories of balance rehabilitation interventions were identified, covering various approaches. These categories included conventional rehabilitation exercises, gym-based interventions, vibration therapy, rhythmic auditory stimulation training, boxing therapy, dual-task training, and technology-based rehabilitation interventions. Each of these methods presents unique benefits and can significantly impact the recovery of balance in stroke survivors, enhancing their overall well-being and functional capacity.
Collapse
Affiliation(s)
- Júlia Saraiva
- Department of Nursing, Hospital Garcia de Orta, 2805-267 Almada, Portugal;
- Nurs* Lab, Caparica, 2829-511 Almada, Portugal; (S.F.); (J.B.F.)
| | - Gonçalo Rosa
- Department of Nursing, Hospital Garcia de Orta, 2805-267 Almada, Portugal;
- Nurs* Lab, Caparica, 2829-511 Almada, Portugal; (S.F.); (J.B.F.)
| | - Sónia Fernandes
- Nurs* Lab, Caparica, 2829-511 Almada, Portugal; (S.F.); (J.B.F.)
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Caparica, 2829-511 Almada, Portugal
| | - Júlio Belo Fernandes
- Nurs* Lab, Caparica, 2829-511 Almada, Portugal; (S.F.); (J.B.F.)
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Caparica, 2829-511 Almada, Portugal
| |
Collapse
|
18
|
Jiménez-Lupión D, Chirosa-Ríos L, Martínez-García D, Rodríguez-Pérez M, Jerez-Mayorga D. Effects of Power Training on Functional Capacity Related to Fall Risk in Older Adults: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2023; 104:1514-1525. [PMID: 36868491 DOI: 10.1016/j.apmr.2023.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 01/12/2023] [Accepted: 01/27/2023] [Indexed: 03/05/2023]
Abstract
OBJECTIVE Functional capacity is 1 of the main risk factors for falls among older adults. The aim of this systematic review and meta-analysis was to determine the effect of power training on functional capacity test (FCT) related to fall risk in older adults. DATA SOURCES Systematic searches were conducted in 4 databases, including PubMed, Web of Science, Scopus, and SPORTDiscus, from inception to November 2021. STUDY SELECTION Randomized controlled trials (RCTs) assessing the effect of power training on functional capacity compared with another type of training program or control group in older adults with the ability to exercise independently. DATA EXTRACTION Two independent researchers evaluated eligibility and used the PEDro scale to assess risk of bias. The information extracted was related to article identification (authors, country and year of publication), participant characteristics (sample, sex, and age), strength training protocols (exercises/intensity/weeks), and the outcome of the FCT used related to fall risk. The Cochran Q statistic and I2 statistics was used to assess heterogeneity. Random-effects model were conducted to pool the effect sizes expressed as mean differences (MD). DATA SYNTHESIS Twelve studies (478 subjects) were selected for systematic review. A meta-analysis comprised 6 studies (217 subjects) where the outcome measure was the 30-second Sit to Stand (30s-STS) test, and another comprised 4 studies (142 subjects) where the outcome measure was the timed Up and Go (TUG) test. There was an improvement in performance in favor of the experimental group in both the TUG subgroup (MD -0.31 s; 95% CI -0.63, 0.00 s; P=.05), and the 30s-STS subgroup (MD 1.71 reps; 95% CI -0.26, 3.67 reps; P=.09). CONCLUSIONS In conclusion, power training increases functional capacity related to fall risk further than other types of exercise in older adults.
Collapse
Affiliation(s)
- Daniel Jiménez-Lupión
- Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Luis Chirosa-Ríos
- Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Darío Martínez-García
- Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Manuel Rodríguez-Pérez
- Department of Education, Faculty of Education Sciences, University of Almería, Almería, Spain; SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería, Almería, Spain
| | - Daniel Jerez-Mayorga
- Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain; Exercise and Rehabilitation Sciences Laboratory, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile.
| |
Collapse
|
19
|
Mori L, Collino F, Marzi A, Pellegrino L, Ponzano M, Chiaro DD, Maestrini S, Caneva S, Pardini M, Fiaschi P, Zona G, Trompetto C. Useful outcome measures in INPH patients evaluation. Front Neurol 2023; 14:1201932. [PMID: 37609661 PMCID: PMC10441237 DOI: 10.3389/fneur.2023.1201932] [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: 04/11/2023] [Accepted: 07/11/2023] [Indexed: 08/24/2023] Open
Abstract
Introduction Idiopathic normal pressure hydrocephalus (INPH) is a neurological disorder that is potentially reversible and clinically characterized by a specific triad of symptoms, including gait disturbance, cognitive disorders, and urinary incontinence. In INPH assessment, the most commonly used test is the Timed Up and Go test (TUG), but a more comprehensive assessment would be necessary. The first aim of the present study is to verify the sensitivity of a protocol with both clinical and instrumental outcome measures for gait and balance in recognizing INPH patients. The second aim is to verify the most important spatio-temporal parameters in INPH assessment and their possible correlations with clinical outcome measures. Methods Between January 2019 and June 2022, we evaluated 70 INPH subjects. We assessed balance performances with the Berg Balance Scale (BBS), Short Physical Performance Battery (SPPB), and TUG, both single (ST) and dual task (DT). We also performed an instrumental gait assessment with the GAITRite electronic walkway system, asking the patients to walk on the carpet for one minute at normal speed, fast speed, and while performing a dual task. We compared the results with those of 20 age-matched healthy subjects (HS). Results INPH patients obtained statistically significant lower scores at the BBS, SPPB, and TUG DT but not at the TUG ST, likely because the DT involves cognitive factors altered in these subjects. Concerning instrumental gait evaluation, we found significant differences between HS and INPH patients in almost all spatio-temporal parameters except cadence, which is considered a relevant factor in INPH guidelines. We also found significant correlations between balance outcome measures and gait parameters. Discussion Our results confirm the usefulness of BBS and suggest improving the assessment with SPPB. Although the TUG ST is the most commonly used test in the literature to evaluate INPH performances, it does not identify INPH; the TUG DT, instead, might be more useful. The GAITRite system is recognized as a quick and reliable tool to assess walking abilities and spatio-temporal parameters in INPH patients, and the most useful parameters are stride length, stride width, speed, and the percentage of double support. Both clinical and instrumental evaluation may be useful in recognizing subjects at risk for falls.
Collapse
Affiliation(s)
- Laura Mori
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Federica Collino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Annalisa Marzi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Lucia Pellegrino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Marta Ponzano
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Davide Del Chiaro
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Sara Maestrini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Stefano Caneva
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Matteo Pardini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Pietro Fiaschi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Gianluigi Zona
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Carlo Trompetto
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| |
Collapse
|
20
|
Swier VJ, White KA, Johnson TB, Wang X, Han J, Pearce DA, Singh R, Drack AV, Pfeifer W, Rogers CS, Brudvig JJ, Weimer JM. A novel porcine model of CLN3 Batten disease recapitulates clinical phenotypes. Dis Model Mech 2023; 16:dmm050038. [PMID: 37305926 PMCID: PMC10434985 DOI: 10.1242/dmm.050038] [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: 12/09/2022] [Accepted: 05/10/2023] [Indexed: 06/13/2023] Open
Abstract
Mouse models of CLN3 Batten disease, a rare lysosomal storage disorder with no cure, have improved our understanding of CLN3 biology and therapeutics through their ease of use and a consistent display of cellular pathology. However, the translatability of murine models is limited by disparities in anatomy, body size, life span and inconsistent subtle behavior deficits that can be difficult to detect in CLN3 mutant mouse models, thereby limiting their use in preclinical studies. Here, we present a longitudinal characterization of a novel miniswine model of CLN3 disease that recapitulates the most common human pathogenic variant, an exon 7-8 deletion (CLN3Δex7/8). Progressive pathology and neuron loss is observed in various regions of the CLN3Δex7/8 miniswine brain and retina. Additionally, mutant miniswine present with retinal degeneration and motor abnormalities, similar to deficits seen in humans diagnosed with the disease. Taken together, the CLN3Δex7/8 miniswine model shows consistent and progressive Batten disease pathology, and behavioral impairment mirroring clinical presentation, demonstrating its value in studying the role of CLN3 and safety/efficacy of novel disease-modifying therapeutics.
Collapse
Affiliation(s)
- Vicki J. Swier
- Pediatrics and Rare Diseases Group, Sanford Research, Sioux Falls, SD 57104, USA
| | - Katherine A. White
- Pediatrics and Rare Diseases Group, Sanford Research, Sioux Falls, SD 57104, USA
| | - Tyler B. Johnson
- Pediatrics and Rare Diseases Group, Sanford Research, Sioux Falls, SD 57104, USA
| | | | - Jimin Han
- Department of Ophthalmology, Center for Visual Science, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - David A. Pearce
- Pediatrics and Rare Diseases Group, Sanford Research, Sioux Falls, SD 57104, USA
| | - Ruchira Singh
- Department of Ophthalmology, Center for Visual Science, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Arlene V. Drack
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA 52242, USA
- University of Iowa Institute for Vision Research, Iowa City, IA 52242, USA
| | - Wanda Pfeifer
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA 52242, USA
| | | | - Jon J. Brudvig
- Pediatrics and Rare Diseases Group, Sanford Research, Sioux Falls, SD 57104, USA
- Department of Pediatrics, Sanford School of Medicine, University of South Dakota, Sioux Falls, SD 57105, USA
| | - Jill M. Weimer
- Pediatrics and Rare Diseases Group, Sanford Research, Sioux Falls, SD 57104, USA
- Department of Pediatrics, Sanford School of Medicine, University of South Dakota, Sioux Falls, SD 57105, USA
| |
Collapse
|
21
|
Wang Y, Li Y, Liu S, Liu P, Zhu Z, Wu J. Gait characteristics related to fall risk in patients with cerebral small vessel disease. Front Neurol 2023; 14:1166151. [PMID: 37346167 PMCID: PMC10279878 DOI: 10.3389/fneur.2023.1166151] [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: 02/14/2023] [Accepted: 05/15/2023] [Indexed: 06/23/2023] Open
Abstract
Background Falls and gait disturbance are significant clinical manifestations of cerebral small vessel disease (CSVD). However, few relevant studies are reported at present. We aimed to investigate gait characteristics and fall risk in patients with CSVD. Methods A total of 119 patients with CSVD admitted to the Department of Neurology at Tianjin Huanhu Hospital between 17 August 2018 and 7 November 2018 were enrolled in this study. All patients underwent cerebral magnetic resonance imaging scanning and a 2-min walking test using an OPAL wearable sensor and Mobility Lab software. Relevant data were collected using the gait analyzer test system to further analyze the time-space and kinematic parameters of gait. All patients were followed up, and univariate and multivariate logistic regression analyses were conducted to analyze the gait characteristics and relevant risk factors in patients with CSVD at an increased risk of falling. Results All patients were grouped according to the presence or absence of falling and fear of falling and were divided into a high-fall risk group (n = 35) and a low-fall risk group (n = 72). Logistic multivariate regression analysis showed that the toe-off angle [odds ratio (OR) = 0.742, 95% confidence interval (CI) 0.584-0.942, p < 0.05], toe-off angle coefficient of variation (CV) (OR = 0.717, 95% CI: 0.535-0.962, p < 0.05), stride length CV (OR = 1.256, 95% CI: 1.017-1.552, p < 0.05), and terminal double support CV (OR = 1.735, 95% CI: 1.271-2.369, p < 0.05) were statistically significant (p < 0.05) and were independent risk factors for high-fall risk in patients with CSVD. Conclusion CSVD patients with seemingly normal gait and ambulation independently still have a high risk of falling, and gait spatiotemporal-kinematic parameters, gait symmetry, and gait variability are important indicators to assess the high-fall risk. The decrease in toe-off angle, in particular, and an increase in related parameters of CV, can increase the fall risk of CSVD patients.
Collapse
Affiliation(s)
- Yajing Wang
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Neurosurgical Institute, Tianjin, China
| | - Yanna Li
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Neurosurgical Institute, Tianjin, China
| | - Shoufeng Liu
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Neurosurgical Institute, Tianjin, China
| | - Peipei Liu
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Neurosurgical Institute, Tianjin, China
| | - Zhizhong Zhu
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
- Department of Rehabilitation, Tianjin Huanhu Hospital, Tianjin, China
| | - Jialing Wu
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Neurosurgical Institute, Tianjin, China
| |
Collapse
|
22
|
Bonilla Yanez M, Kettlety SA, Finley JM, Schweighofer N, Leech KA. Gait speed and individual characteristics are related to specific gait metrics in neurotypical adults. Sci Rep 2023; 13:8069. [PMID: 37202435 PMCID: PMC10195830 DOI: 10.1038/s41598-023-35317-y] [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: 11/23/2022] [Accepted: 05/16/2023] [Indexed: 05/20/2023] Open
Abstract
Gait biofeedback is a well-studied strategy to reduce gait impairments such as propulsion deficits or asymmetric step lengths. With biofeedback, participants alter their walking to reach the desired magnitude of a specific parameter (the biofeedback target) with each step. Biofeedback of anterior ground reaction force and step length is commonly used in post-stroke gait training as these variables are associated with self-selected gait speed, fall risk, and the energy cost of walking. However, biofeedback targets are often set as a function of an individual's baseline walking pattern, which may not reflect the ideal magnitude of that gait parameter. Here we developed prediction models based on speed, leg length, mass, sex, and age to predict anterior ground reaction force and step length of neurotypical adults as a possible method for personalized biofeedback. Prediction of these values on an independent dataset demonstrated strong agreement with actual values, indicating that neurotypical anterior ground reaction forces can be estimated from an individual's leg length, mass, and gait speed, and step lengths can be estimated from individual's leg length, mass, age, sex, and gait speed. Unlike approaches that rely on an individual's baseline gait, this approach provides a standardized method to personalize gait biofeedback targets based on the walking patterns exhibited by neurotypical individuals with similar characteristics walking at similar speeds without the risk of over- or underestimating the ideal values that could limit feedback-mediated reductions in gait impairments.
Collapse
Affiliation(s)
- Maryana Bonilla Yanez
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Sarah A Kettlety
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - James M Finley
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
- Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, USA
| | - Nicolas Schweighofer
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
- Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, USA
| | - Kristan A Leech
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA.
- Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, USA.
| |
Collapse
|
23
|
Zhu YH, Ruan M, Yun RS, Zhong YX, Zhang YX, Wang YJ, Sun YL, Cui JW. Is Leg-Driven Treadmill-Based Exoskeleton Robot Training Beneficial to Poststroke Patients: A Systematic Review and Meta-analysis. Am J Phys Med Rehabil 2023; 102:331-339. [PMID: 36075885 DOI: 10.1097/phm.0000000000002098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of the study is to systematically review the effects of leg-driven treadmill-based exoskeleton robot training on balance and walking ability in poststroke patients. DESIGN The PubMed, Cochrane Library, Embase, Web of Science, Medline, CNKI, VIP, and Wanfang databases were searched from inception to August 2021. The literature quality was evaluated using Cochrane Handbook. Primary outcomes include the Functional Ambulation Category Scale and Berg Balance Scale, and secondary outcomes include the 10 meter walk test, 6 minute walk test, and gait assessment cadence were analyzed. RESULTS Seventeen randomized controlled trials were included in the systematic review, 15 studies in meta-analysis. Primary outcomes showed no significant difference in the Functional Ambulation Category Scale score; subgroup with the exoskeleton robot + conventional therapy of the Berg Balance Scale score was significantly increased; secondary outcomes showed no significance in 6 minute walk test or 10 meter walk test. The cadence score increased for the subgroup with an onset of more than 6 mos in the treatment group. The control group performed better than the subgroup with an onset of less than 6 mos. CONCLUSIONS Leg-driven treadmill-based exoskeleton robot training can improve balance function in poststroke patients and is beneficial for patients with an onset of greater than 6 mos. However, there is no evidence to support the efficacy of walking ability.
Collapse
Affiliation(s)
- Ying-Hui Zhu
- From the School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China (Y-HZ, MR, R-SY, Y-X Zhong, Y-X Zhang, Y-JW, J-WC); and Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China (Y-JW, Y-LS)
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Liu S, Yu H, Wang Z, Dai P. Correlation analysis of balance function with plantar pressure distribution and gait parameters in patients with cerebral infarction in the basal ganglia region. Front Neurosci 2023; 17:1099843. [PMID: 36908774 PMCID: PMC9998687 DOI: 10.3389/fnins.2023.1099843] [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: 11/16/2022] [Accepted: 02/13/2023] [Indexed: 03/14/2023] Open
Abstract
Objective To analyze the correlation between balance function and gait parameters of patients with basal ganglia infarction. And to observe the influence of balance function on plantar pressure and hemiplegia gait based on the Berg Balance Scale (BBS) score. Methods One hundred and forty patients with cerebral infarction hemiplegia in the basal ganglia region (a study group, n = 140) and healthy people (a control group, n = 140) were enrolled. The study group was evaluated with the BBS, the 10 m walking test (10MWT), and the timed up-and-go test (TUGT). The gait parameters and the peak plantar pressure were measured in both groups while walking, and the differences between the groups were compared. In addition, the characteristics of the plantar pressure curve of the hemiplegic and non-hemiplegic sides during walking and the correlation between the 10MWT, the TUGT, the plantar pressure peak, the gait parameters,and the BBS score were analyzed in the study group. Results The peak plantar pressure of the forefoot and heel, stride length, lateral symmetry, stand phase, swing phase, and dual stand phase of both sides in the study group were significantly lower than those in the control group (P < 0.05). The BBS score negatively correlated with the 10MWT, the TUGT, the peak plantar pressure of the hemiplegic forefoot, midfoot, and the non-hemiplegic midfoot, the anterior to posterior position (ant/post position), hemiplegic stand phase, and the dual stand phase (P < 0.05). The BBS score positively correlated with the hemiplegic swing phase and stride length (P < 0.05). Conclusion A correlation was found between the forefoot plantar pressure and the stand phase of the hemiplegic limbs, the ant/post position, and the balance function after basal ganglion cerebral infarction. This association can be used in walking and balance assessment for stroke rehabilitation. Correcting forefoot pressure or the front and ant/post position can improve balance function.
Collapse
Affiliation(s)
| | - Huixian Yu
- Department of Rehabilitation Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | | | | |
Collapse
|
25
|
The contribution of walking speed versus recent stroke to temporospatial gait variability. Gait Posture 2023; 100:216-221. [PMID: 36621194 DOI: 10.1016/j.gaitpost.2022.12.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/25/2022] [Accepted: 12/26/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Inconsistent results have been reported for temporospatial gait variability after stroke. Given the large differences in gait speed across stroke subjects and relative to healthy controls, it is not clear which changes in temporospatial gait variability can be ascribed to the walking speed during gait evaluation versus the consequences of stroke. RESEARCH QUESTIONS Does temporospatial gait variability differ between (1) stroke subjects grouped in clinically-relevant functional ambulation classes, (2) the paretic and non-paretic legs within each class, and (3) stroke and healthy subjects after controlling for gait speed? METHODS Stroke subjects were evaluated at their comfortable speed < 2 months post-onset and classified into the household (<40 cm/s, n = 38), limited-community (40-80 cm/s, n = 35), and full-community (>80 cm/s, n = 14) walkers. Coefficients of variation (CVs) for paretic and non-paretic stance, initial double-support, and single-support times, step length, step cadence, and step width were compared across the stroke ambulation classes and between the two legs. For the parameters with significantly different CVs between stroke subjects and 33 age-matched controls walking at very-slow and free speeds, a 1-way ANCOVA was used with the gait speed as a covariate. RESULTS For most step parameters, CVs were greater in slower stroke ambulation classes except for the smaller step width CV. The differences between the paretic and non-paretic legs emerged in slower walkers only. After controlling for the gait speed, CVs of stroke subjects no longer significantly differed from controls walking at very-slow speed. With controls walking at free speed, however, CVs for the paretic and non-paretic single-support times and the non-paretic step time remained significantly different. SIGNIFICANCE Gait is more variable at slower speeds both in stroke subjects and healthy controls. After accounting for the free gait speed, the increased variability of only a few temporal parameters may be attributed to a recent stroke.
Collapse
|
26
|
Bartsch B, Faulkner J, Moore JB, Stoner L. Exercise prescription, intervention, dissemination, and implementation following transient ischemic attack or stroke: advancing the field through interdisciplinary science. Transl Behav Med 2023; 13:309-315. [PMID: 36694928 DOI: 10.1093/tbm/ibac107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Lay Summary
Research has demonstrated that both exercise, and a reduction in cardiovascular disease (CVD) risk factors (i.e., high blood sugar, blood lipids, and blood pressure), following a stroke or transient ischemic attack (TIA) are beneficial for reducing risk of recurrent stroke or TIA and for improving overall quality of life. Despite this evidence, many stroke and TIA survivors remain inactive and sedentary and present with multiple CVD risk factors. The purpose of this commentary is to highlight gaps in the current literature in regard to exercise and behavior interventions for the stroke and TIA populations, present ideas for intervention design, and discuss the dissemination and implementation of research findings. The future research ideas presented in this commentary are based on current research findings, as well as the professional experience of the article authors. Professional experience spans occupational therapy in neurorehabilitation, clinical exercise physiology in rehabilitation, creation and implementation of stroke rehabilitation clinics, stroke and TIA research, and behavioral and implementation science.
Collapse
Affiliation(s)
- Bria Bartsch
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA
| | - James Faulkner
- Department of Sport, Exercise and Health, University of Winchester, Winchester, UK
| | - Justin B Moore
- Department of Implementation Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Lee Stoner
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, NC, USA.,Department of Epidemiology, The Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| |
Collapse
|
27
|
Jonsdottir J, Mestanza Mattos FG, Torchio A, Corrini C, Cattaneo D. Fallers after stroke: a retrospective study to investigate the combination of postural sway measures and clinical information in faller's identification. Front Neurol 2023; 14:1157453. [PMID: 37181569 PMCID: PMC10174247 DOI: 10.3389/fneur.2023.1157453] [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: 02/02/2023] [Accepted: 04/14/2023] [Indexed: 05/16/2023] Open
Abstract
Background Falls can have devastating effects on quality of life. No clear relationships have been identified between clinical and stabilometric postural measures and falling in persons after stroke. Objective This cross-sectional study investigates the value of including stabilometric measures of sway with clinical measures of balance in models for identification of faller chronic stroke survivors, and the relations between variables. Methods Clinical and stabilometric data were collected from a convenience sample of 49 persons with stroke in hospital care. They were categorized as fallers (N = 21) or non-fallers (N = 28) based on the occurrence of falls in the previous 6 months. Logistic regression (model 1) was performed with clinical measures, including the Berg Balance scale (BBS), Barthel Index (BI), and Dynamic Gait Index (DGI). A second model (model 2) was run with stabilometric measures, including mediolateral (SwayML) and anterior-posterior sway (SwayAP), velocity of antero-posterior (VelAP) and medio-lateral sway (VelML), and absolute position of center of pressure (CopX abs). A third stepwise regression model was run including all variables, resulting in a model with SwayML, BBS, and BI (model 3). Finally, correlations between independent variables were analyzed. Results The area under the curve (AUC) for model 1 was 0.68 (95%CI: 0.53-0.83, sensitivity = 95%, specificity = 39%) with prediction accuracy of 63.3%. Model 2 resulted in an AUC of 0.68 (95%CI: 0.53-0.84, sensitivity = 76%, specificity = 57%) with prediction accuracy of 65.3%. The AUC of stepwise model 3 was 0.74 (95%CI: 0.60-0.88, sensitivity = 57%, specificity = 81%) with prediction accuracy of 67.4%. Finally, statistically significant correlations were found between clinical variables (p < 0.05), only velocity parameters were correlated with balance performance (p < 0.05). Conclusion A model combining BBS, BI, and SwayML was best at identifying faller status in persons in the chronic phase post stroke. When balance performance is poor, a high SwayML may be part of a strategy protecting from falls.
Collapse
Affiliation(s)
- Johanna Jonsdottir
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
- *Correspondence: Johanna Jonsdottir,
| | | | | | | | - Davide Cattaneo
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| |
Collapse
|
28
|
Khan F, Abusharha S, Alfuraidy A, Nimatallah K, Almalki R, Basaffar R, Mirdad M, Chevidikunnan MF, Basuodan R. Prediction of Factors Affecting Mobility in Patients with Stroke and Finding the Mediation Effect of Balance on Mobility: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16612. [PMID: 36554493 PMCID: PMC9779513 DOI: 10.3390/ijerph192416612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 12/04/2022] [Accepted: 12/07/2022] [Indexed: 06/17/2023]
Abstract
(1) Background: Regaining mobility after stroke is essential to facilitate patient independency in activities of daily living. Predicting post-stroke mobility is clinically important and plays a significant part in rehabilitation programs. The purpose of this study is to find the factors affecting mobility in patients with stroke and to analyze the mediation effect of balance on mobility. (2) Methods: This cross-sectional study included forty-one patients with stroke averaging an age of 57.2 ± 88.6. The Rivermead Mobility Index (RMI) was used for measuring the mobility, Timed Up and Go (TUG) to measure the walking speed, Berg Balance Scale (BBS) to assess the balance and a handheld dynamometer (HHD) was used for measuring the isometric strength of the ankle and knee. (3) Results: In regression analysis balance (β=0.58; p≤ 0.0001) and walking speed (β=-0.27; p=0.04) were the significant factors predicting mobility. (4) Conclusions: Balance and gait speed were the factors that influenced mobility in stroke patients, indicating the utility of measuring these aspects in order to provide appropriate rehabilitation programs.
Collapse
Affiliation(s)
- Fayaz Khan
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Sami Abusharha
- Department of Occupational Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Aljowhara Alfuraidy
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Khadeeja Nimatallah
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Raghad Almalki
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Rafa’a Basaffar
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Mawada Mirdad
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Mohamed Faisal Chevidikunnan
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Reem Basuodan
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
| |
Collapse
|
29
|
Psychometric Evaluation of the Narrow Corridor Walk Test (NCWT) on Advanced Walking Balance in People with Stroke. BIOMED RESEARCH INTERNATIONAL 2022; 2022:1436715. [DOI: 10.1155/2022/1436715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/27/2022] [Accepted: 10/31/2022] [Indexed: 11/21/2022]
Abstract
Objectives. To investigate (i) the interrater and test-retest reliabilities of completion time and number of steps in the Narrow Corridor Walking Test (NCWT); (ii) the minimal detectable changes (MDCs) in NCWT results; (iii) the correlations between NCWT results and stroke-specific outcome measures; and (iv) the optimal cut-off values of NCWT results for discriminating the difference in advanced balance ability between people with stroke and healthy older adults. Design. Cross-sectional. Subjects. Thirty people with stroke and 30 healthy older adults. Methods. People with stroke completed the NCWT on two separate days with a 7- to 10-day interval. The Fugl-Meyer Assessment (FMA), ankle dorsiflexor and plantarflexor muscle strength, Berg Balance Scale (BBS), Timed Up and Go (TUG) test, and the Chinese version of the Community Integration Measure (CIM) were used to assess. The healthy older adults completed the NCWT once. Results. The NCWT completion time and NCWT steps showed excellent interrater reliability and test-retest reliability and significant correlations with FMA, affected ankle dorsiflexor muscle strength, BBS score, and TUG completion time. A cut-off value of 7.40 s for NCWT completion time and 13.33 for the NCWT steps distinguished people with stroke from healthy older adults. The MDCs of the NCWT completion time and NCWT steps were 6.87 s and 5.50, respectively. Conclusion. The NCWT is a reliable clinical measurement tool for the assessment of advanced balance ability in people with stroke.
Collapse
|
30
|
Balta D, Kuo H, Wang J, Porco IG, Morozova O, Schladen MM, Cereatti A, Lum PS, Della Croce U. Characterization of Infants' General Movements Using a Commercial RGB-Depth Sensor and a Deep Neural Network Tracking Processing Tool: An Exploratory Study. SENSORS (BASEL, SWITZERLAND) 2022; 22:7426. [PMID: 36236525 PMCID: PMC9572717 DOI: 10.3390/s22197426] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 06/16/2023]
Abstract
Cerebral palsy, the most common childhood neuromotor disorder, is often diagnosed through visual assessment of general movements (GM) in infancy. This skill requires extensive training and is thus difficult to implement on a large scale. Automated analysis of GM performed using low-cost instrumentation in the home may be used to estimate quantitative metrics predictive of movement disorders. This study explored if infants' GM may be successfully evaluated in a familiar environment by processing the 3D trajectories of points of interest (PoI) obtained from recordings of a single commercial RGB-D sensor. The RGB videos were processed using an open-source markerless motion tracking method which allowed the estimation of the 2D trajectories of the selected PoI and a purposely developed method which allowed the reconstruction of their 3D trajectories making use of the data recorded with the depth sensor. Eight infants' GM were recorded in the home at 3, 4, and 5 months of age. Eight GM metrics proposed in the literature in addition to a novel metric were estimated from the PoI trajectories at each timepoint. A pediatric neurologist and physiatrist provided an overall clinical evaluation from infants' video. Subsequently, a comparison between metrics and clinical evaluation was performed. The results demonstrated that GM metrics may be meaningfully estimated and potentially used for early identification of movement disorders.
Collapse
Affiliation(s)
- Diletta Balta
- Department of Electronics and Telecommunications, Politecnico di Torino, 10129 Torino, Italy
| | - HsinHung Kuo
- Department of Biomedical Engineering, The Catholic University of America, Washington, DC 20064, USA
| | - Jing Wang
- Department of Biomedical Engineering, The Catholic University of America, Washington, DC 20064, USA
| | | | - Olga Morozova
- Children’s National Hospital, Washington, DC 20010, USA
| | - Manon Maitland Schladen
- Department of Biomedical Engineering, The Catholic University of America, Washington, DC 20064, USA
- Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC 20057, USA
| | - Andrea Cereatti
- Department of Electronics and Telecommunications, Politecnico di Torino, 10129 Torino, Italy
| | - Peter Stanley Lum
- Department of Biomedical Engineering, The Catholic University of America, Washington, DC 20064, USA
| | - Ugo Della Croce
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy
| |
Collapse
|
31
|
Giardini M, Arcolin I, Godi M, Guglielmetti S, Maretti A, Capelli A, Corna S. The Coronavirus Footprint on Dual-Task Performance in Post-Acute Patients after Severe COVID-19: A Future Challenge for Rehabilitation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10644. [PMID: 36078366 PMCID: PMC9518102 DOI: 10.3390/ijerph191710644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/12/2022] [Accepted: 08/23/2022] [Indexed: 06/15/2023]
Abstract
Recent studies suggest that also the non-critical form of COVID-19 infection may be associated with executive function impairments. However, it is not clear if they result from cognitive impairments or by COVID-19 infection per se. We aimed to investigate if patients in the post-acute stage of severe COVID-19 (PwCOVID), without manifest cognitive deficits, reveal impairments in performing dual-task (DT) activities compared to healthy controls (HS). We assessed balance in 31 PwCOVID vs. 30 age-matched HS by stabilometry and the Timed Up and Go (TUG) test with/without a cognitive DT. The DT cost (DTC), TUG test time and sway oscillations were recorded; correct cognitive responses (CCR) were calculated to evaluate cognitive performance. Results show a significant difference in overall DT performance between PwCOVID and HS in both stabilometry (p < 0.01) and the TUG test (p < 0.0005), although with similar DTCs. The main difference in the DTs between groups emerged in the CCR (effect size > 0.8). Substantially, PwCOVID gave priority to the motor task, leaving out the cognitive one, while HS performed both tasks simultaneously. Our findings suggest that PwCOVID, even without a manifest cognitive impairment, may present a deficit in executive function during DTs. These results encourage the use of DTs and CCR in PwCOVID.
Collapse
Affiliation(s)
- Marica Giardini
- Istituti Clinici Scientifici Maugeri IRCCS, Division of Physical Medicine and Rehabilitation of Veruno Institute, 28013 Gattico, Italy
| | - Ilaria Arcolin
- Istituti Clinici Scientifici Maugeri IRCCS, Division of Physical Medicine and Rehabilitation of Veruno Institute, 28013 Gattico, Italy
| | - Marco Godi
- Istituti Clinici Scientifici Maugeri IRCCS, Division of Physical Medicine and Rehabilitation of Veruno Institute, 28013 Gattico, Italy
| | - Simone Guglielmetti
- Istituti Clinici Scientifici Maugeri IRCCS, Division of Physical Medicine and Rehabilitation of Veruno Institute, 28013 Gattico, Italy
| | - Alessandro Maretti
- Istituti Clinici Scientifici Maugeri IRCCS, Division of Physical Medicine and Rehabilitation of Veruno Institute, 28013 Gattico, Italy
| | - Armando Capelli
- Istituti Clinici Scientifici Maugeri IRCCS, Division of Pulmonary Rehabilitation of Veruno Institute, 28013 Gattico, Italy
| | - Stefano Corna
- Istituti Clinici Scientifici Maugeri IRCCS, Division of Physical Medicine and Rehabilitation of Veruno Institute, 28013 Gattico, Italy
| |
Collapse
|
32
|
Effect of Different Ankle-Foot Immobility on Lateral Gait Stability in the Stance Phase. Appl Bionics Biomech 2022; 2022:7135040. [PMID: 35965839 PMCID: PMC9365579 DOI: 10.1155/2022/7135040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/15/2022] [Accepted: 07/21/2022] [Indexed: 11/17/2022] Open
Abstract
Background This study aimed to investigate the effect of limited foot and ankle mobility on the lateral stability of gait through the observation of the mediolateral margin of stability and related kinematic parameters. Methods Thirty young, healthy participants walked at a fixed gait velocity on a level surface. Participants achieved different degrees of restricted mobility by wearing soft-soled shoes (S), an ankle-foot orthosis with unrestricted dorsiflexion-plantarflexion activity only (A), and an ankle-foot orthosis with unrestricted dorsiflexion-plantarflexion and adjustable horizontal rotation of the foot (OU/OR). Furthermore, the spatiotemporal parameters, mediolateral margin of stability, center of pressure, angle of the fore and hind foot relative to the tibia, and correlation coefficients of the factors were analyzed. Regression analysis was also performed. Results At right heel strike, group A had a significantly lower mediolateral margin of stability than group S and group OU. Meanwhile, forefoot adduction (0.2 < |r| <0.4) and plantarflexion (0.2 < |r| <0.4), as well as hindfoot internal rotation (0.2 < |r| <0.6) and inversion (0.2 < |r| <0.4), correlated negatively with lateral stability. Regression analysis revealed forefoot dorsiflexion and supination were the main independent variables for group A. At right heel off, groups OU and OR had a significantly lower mediolateral margin of stability than those in groups A and S. Forefoot adduction (0.2 < |r| <0.4) and dorsiflexion (0.4 < |r| <0.6) were correlated with lateral stability, as were hindfoot dorsiflexion (0.2 < |r| <0.4) and inversion (0.2 < |r| <0.4). Regression analysis revealed forefoot abduction and plantarflexion were the main independent variables for groups OU and OR. Conclusions The present study verified from gait data that forefoot dorsiflexion and supination at the initial contact of the stance phase were relevant factors for the differences in lateral gait stability, whereas abduction and plantar flexion of the forefoot at the terminal stance phase were the main influencing factors of lateral gait stability.
Collapse
|
33
|
Ares-Benitez I, Billot M, Rigoard P, Cano-Bravo F, David R, Luque-Moreno C. Feasibility, acceptability and effects of dance therapy in stroke patients: A systematic review. Complement Ther Clin Pract 2022; 49:101662. [DOI: 10.1016/j.ctcp.2022.101662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 08/06/2022] [Accepted: 08/18/2022] [Indexed: 11/03/2022]
|
34
|
Chow JW, Stokic DS. Reply to Daly, J.J. Comment on "Chow, J.W.; Stokic, D.S. Longitudinal Changes in Temporospatial Gait Characteristics during the First Year Post-Stroke. Brain Sci. 2021, 11, 1648". Brain Sci 2022; 12:997. [PMID: 36009060 PMCID: PMC9405753 DOI: 10.3390/brainsci12080997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 07/07/2022] [Indexed: 02/01/2023] Open
Abstract
This commentary [...].
Collapse
Affiliation(s)
- John W. Chow
- Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, Jackson, MS 39216, USA;
| | | |
Collapse
|
35
|
Su C, Yang X, Wei S, Zhao R. Periventricular white matter hyperintensities are associated with gait and balance in patients with minor stroke. Front Neurol 2022; 13:941668. [PMID: 35937058 PMCID: PMC9355320 DOI: 10.3389/fneur.2022.941668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveCerebral small vessel disease (CSVD) is associated with gait and balance deficits in older adults. However, the effect of CSVD-related brain injury on post-stroke mobility is unknown. This study aimed to investigate the association of CSVD with gait and balance impairment after a minor stroke.MethodsA total of 273 patients with a minor stroke (NIHSS ≤ 5 points) who were hospitalized at the Affiliated Hospital of Qingdao University were enrolled. The manifestations of white matter hyperintensities (WMH), lacunes, enlarged perivascular spaces (EPVS), and cerebral microbleeds (CMB) were statistically analyzed according to magnetic resonance imaging results, and the total burden score of CSVD was calculated. Gait function was assessed by a 6-m walking speed test, and balance function was assessed by the timed-up-and-go (TUG) test. Linear regression analysis was applied to determine the association after adjusting for key variables.ResultsThe correlation results showed that in patients with minor stroke, age, sex, smoking history, and the infarct site were associated with gait speed, and age and the infarct site were associated with the TUG test. In the univariate linear regression model, periventricular white matter hyperintensities (PVWMH), deep white matter hyperintensities (DWMH), and the total burden of CSVD were correlated with gait speed, while only PVWMH correlated with the TUG test. After adjusting for confounders, only PVWMH were independent predictors of gait speed (β = −0.089, p < 0.05) and the TUG test (β = 0.517, p < 0.05).ConclusionsOur study confirmed that CSVD is associated with gait and balance disorders after a minor stroke. PVWMH are independent predictors of gait and balance disorders in patients with minor stroke. These findings should be confirmed in larger prospective studies.
Collapse
|
36
|
Su C, Yang X, Wei S, Zhao R. Association of Cerebral Small Vessel Disease With Gait and Balance Disorders. Front Aging Neurosci 2022; 14:834496. [PMID: 35875801 PMCID: PMC9305071 DOI: 10.3389/fnagi.2022.834496] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 06/14/2022] [Indexed: 12/27/2022] Open
Abstract
Cerebral small vessel disease (CSVD) is a common cerebrovascular disease and an important cause of gait and balance disorders. Gait and balance disorders can further lead to an increased risk of falls and a decreased quality of life. CSVD can damage gait and balance function by affecting cognitive function or directly disrupting motor pathways, and different CSVD imaging features have different characteristics of gait and balance impairment. In this article, the correlation between different imaging features of sporadic CSVD and gait and balance disorders has been reviewed as follows, which can provide beneficial help for standardized management of CSVD.
Collapse
Affiliation(s)
| | | | | | - Renliang Zhao
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China
| |
Collapse
|
37
|
Mobbs RJ, Natarajan P, Fonseka RD, Betteridge C, Ho D, Mobbs R, Sy L, Maharaj M. Walking orientation randomness metric (WORM) score: pilot study of a novel gait parameter to assess walking stability and discriminate fallers from non-fallers using wearable sensors. BMC Musculoskelet Disord 2022; 23:304. [PMID: 35351090 PMCID: PMC8966274 DOI: 10.1186/s12891-022-05211-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 03/04/2022] [Indexed: 05/31/2023] Open
Abstract
Background Musculoskeletal disorders can contribute to injurious falls and incur significant societal and healthcare burdens. Identification of fallers from non-fallers through wearable-based gait analysis can facilitate timely intervention to assist mobility and prevent falls whilst improving care and attention for high fall-risk patients. In this study, we use wearable sensor-based gait analysis to introduce a novel variable to assess walking stability in fallers and non-fallers – the Walking Orientation Randomness Metric. The WORM score quantifies the stability, or ‘figure-of-eight’ motion of a subject’s trunk during walking as an indicator of a falls-predictive (pathological) gait. Methods WORM is calculated as the ‘figure-of-eight’ oscillation mapped out in the transverse-plane by the upper body’s centre-point during a walking bout. A sample of patients presenting to the Prince of Wales Hospital (Sydney, Australia) with a primary diagnosis of “falls for investigation” and age-matched healthy controls (non-fallers) from the community were recruited. Participants were fitted at the sternal angle with the wearable accelerometer, MetaMotionC (Mbientlab Inc., USA) and walked unobserved (at self-selected pace) for 5-50 m along an obstacle-free, carpeted hospital corridor. Results Participants comprised of 16 fallers (mean age: 70 + 17) and 16 non-fallers (mean age: 70 + 9) based on a recent fall(s) history. The (median) WORM score was 17-fold higher (p < 0.001) in fallers (3.64 cm) compared to non-fallers (0.21 cm). ROC curve analyses demonstrate WORM can discriminate fallers from non-fallers (AUC = 0.97). Diagnostic analyses (cut-off > 0.51 cm) show high sensitivity (88%) and specificity (94%). Conclusion In this pilot study we have introduced the WORM score, demonstrating its discriminative performance in a preliminary sample size of 16 fallers. WORM is a novel gait metric assessing walking stability as measured by truncal way during ambulation and shows promise for objective and clinical evaluation of fallers. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05211-1.
Collapse
Affiliation(s)
- Ralph Jasper Mobbs
- Faculty of Medicine, University of New South Wales, Sydney, Australia. .,NeuroSpine Surgery Research Group (NSURG), Sydney, Australia. .,Wearables and Gait Analysis Research Group (WAGAR), Sydney, Australia. .,Department of Neurosurgery, Prince of Wales Hospital, Sydney, Australia. .,Neuro Spine Clinic, Prince of Wales Private Hospital, 320-346 Barker St, Randwick, NSW, 2031, Australia.
| | - Pragadesh Natarajan
- Faculty of Medicine, University of New South Wales, Sydney, Australia.,NeuroSpine Surgery Research Group (NSURG), Sydney, Australia.,Wearables and Gait Analysis Research Group (WAGAR), Sydney, Australia
| | - R Dineth Fonseka
- Faculty of Medicine, University of New South Wales, Sydney, Australia.,NeuroSpine Surgery Research Group (NSURG), Sydney, Australia.,Wearables and Gait Analysis Research Group (WAGAR), Sydney, Australia
| | - Callum Betteridge
- Faculty of Medicine, University of New South Wales, Sydney, Australia.,NeuroSpine Surgery Research Group (NSURG), Sydney, Australia.,Wearables and Gait Analysis Research Group (WAGAR), Sydney, Australia
| | - Daniel Ho
- Faculty of Medicine, University of New South Wales, Sydney, Australia.,NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
| | - Redmond Mobbs
- School of Mathematics and Computer Science, University of New South Wales (UNSW), Sydney, Australia
| | - Luke Sy
- School of Mathematics and Computer Science, University of New South Wales (UNSW), Sydney, Australia
| | - Monish Maharaj
- Faculty of Medicine, University of New South Wales, Sydney, Australia.,NeuroSpine Surgery Research Group (NSURG), Sydney, Australia.,Wearables and Gait Analysis Research Group (WAGAR), Sydney, Australia.,Department of Neurosurgery, Prince of Wales Hospital, Sydney, Australia.,Neuro Spine Clinic, Prince of Wales Private Hospital, 320-346 Barker St, Randwick, NSW, 2031, Australia
| |
Collapse
|
38
|
Cimolin V, Vismara L, Ferraris C, Amprimo G, Pettiti G, Lopez R, Galli M, Cremascoli R, Sinagra S, Mauro A, Priano L. Computation of Gait Parameters in Post Stroke and Parkinson's Disease: A Comparative Study Using RGB-D Sensors and Optoelectronic Systems. SENSORS 2022; 22:s22030824. [PMID: 35161570 PMCID: PMC8839392 DOI: 10.3390/s22030824] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/07/2022] [Accepted: 01/20/2022] [Indexed: 02/04/2023]
Abstract
The accurate and reliable assessment of gait parameters is assuming an important role, especially in the perspective of designing new therapeutic and rehabilitation strategies for the remote follow-up of people affected by disabling neurological diseases, including Parkinson’s disease and post-stroke injuries, in particular considering how gait represents a fundamental motor activity for the autonomy, domestic or otherwise, and the health of neurological patients. To this end, the study presents an easy-to-use and non-invasive solution, based on a single RGB-D sensor, to estimate specific features of gait patterns on a reduced walking path compatible with the available spaces in domestic settings. Traditional spatio-temporal parameters and features linked to dynamic instability during walking are estimated on a cohort of ten parkinsonian and eleven post-stroke subjects using a custom-written software that works on the result of a body-tracking algorithm. Then, they are compared with the “gold standard” 3D instrumented gait analysis system. The statistical analysis confirms no statistical difference between the two systems. Data also indicate that the RGB-D system is able to estimate features of gait patterns in pathological individuals and differences between them in line with other studies. Although they are preliminary, the results suggest that this solution could be clinically helpful in evolutionary disease monitoring, especially in domestic and unsupervised environments where traditional gait analysis is not usable.
Collapse
Affiliation(s)
- Veronica Cimolin
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milano, Italy; (V.C.); (R.L.); (M.G.)
| | - Luca Vismara
- Istituto Auxologico Italiano, IRCCS, Department of Neurology and Neurorehabilitation, S. Giuseppe Hospital, 28824 Piancavallo, Italy; (L.V.); (R.C.); (S.S.); (A.M.)
- Department of Neurosciences, University of Turin, Via Cherasco 15, 10100 Torino, Italy
| | - Claudia Ferraris
- Institute of Electronics, Computer and Telecommunication Engineering, National Research Council, Corso Duca degli Abruzzi 24, 10129 Torino, Italy; (C.F.); (G.A.); (G.P.)
| | - Gianluca Amprimo
- Institute of Electronics, Computer and Telecommunication Engineering, National Research Council, Corso Duca degli Abruzzi 24, 10129 Torino, Italy; (C.F.); (G.A.); (G.P.)
- Department of Control and Computer Engineering, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129 Torino, Italy
| | - Giuseppe Pettiti
- Institute of Electronics, Computer and Telecommunication Engineering, National Research Council, Corso Duca degli Abruzzi 24, 10129 Torino, Italy; (C.F.); (G.A.); (G.P.)
| | - Roberto Lopez
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milano, Italy; (V.C.); (R.L.); (M.G.)
- Department of Electrical Engineering, Universidad de Concepción, Víctor Lamas 1290, Concepción 4030000, Chile
| | - Manuela Galli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milano, Italy; (V.C.); (R.L.); (M.G.)
| | - Riccardo Cremascoli
- Istituto Auxologico Italiano, IRCCS, Department of Neurology and Neurorehabilitation, S. Giuseppe Hospital, 28824 Piancavallo, Italy; (L.V.); (R.C.); (S.S.); (A.M.)
- Department of Neurosciences, University of Turin, Via Cherasco 15, 10100 Torino, Italy
| | - Serena Sinagra
- Istituto Auxologico Italiano, IRCCS, Department of Neurology and Neurorehabilitation, S. Giuseppe Hospital, 28824 Piancavallo, Italy; (L.V.); (R.C.); (S.S.); (A.M.)
| | - Alessandro Mauro
- Istituto Auxologico Italiano, IRCCS, Department of Neurology and Neurorehabilitation, S. Giuseppe Hospital, 28824 Piancavallo, Italy; (L.V.); (R.C.); (S.S.); (A.M.)
- Department of Neurosciences, University of Turin, Via Cherasco 15, 10100 Torino, Italy
| | - Lorenzo Priano
- Istituto Auxologico Italiano, IRCCS, Department of Neurology and Neurorehabilitation, S. Giuseppe Hospital, 28824 Piancavallo, Italy; (L.V.); (R.C.); (S.S.); (A.M.)
- Department of Neurosciences, University of Turin, Via Cherasco 15, 10100 Torino, Italy
- Correspondence: ; Tel.: +39-0323-514-392
| |
Collapse
|
39
|
Rhyu HS, Rhi SY. THE EFFECTS OF TRAINING ON DIFFERENT SURFACES, ON BALANCE AND GAIT PERFORMANCE IN STROKE HEMIPLEGIA. REV BRAS MED ESPORTE 2021. [DOI: 10.1590/1517-8692202127062020_0089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Although many studies have focused on balance exercises for elderly or stroke patients, no comprehensive studies have investigated the use of training on different surfaces (TDS) with analysis of gait performance in elderly male stroke patients. The active properties of balance and subjective reporting of functional gait ability were used to identify the effects of TDS. Static balance (SB), dynamic balance (DB) and gait analysis was measured in 30 elderly stroke patients. The patients were divided into the TDS group (n=15) and a control group (CG, n=15). Fifteen elderly stroke patients underwent TDS five times a week for 12 weeks. The data was analyzed using repeated measures analysis of variance. Significant differences were observed between the two groups (TDS and Control): SB (p < 0.0001), DB (OSI: p < 0.0001, APSI: p < 0.001, MLSI: p < 0.004) and gait analysis (right: temporal step time: p < 0.0001, temporal cycle time: p < 0.001, temporal double support time: p < 0.0001; left: temporal step time: p < 0.0001, temporal cycle time: p < 0.0001, temporal double support time: p < 0.0001). TDS in elderly male stroke patients suggests that the characteristics of gait performance in these patients may be improved by increasing static balance, dynamic balance and gait velocity. It is hoped that the results of this trial will provide new information on the effects of TDS on balance stability and gait ability in stroke patients, through changes in stability of the lower extremities. Level III, Case-control Study.
Collapse
|
40
|
Luque-Moreno C, Kiper P, Solís-Marcos I, Agostini M, Polli A, Turolla A, Oliva-Pascual-Vaca A. Virtual Reality and Physiotherapy in Post-Stroke Functional Re-Education of the Lower Extremity: A Controlled Clinical Trial on a New Approach. J Pers Med 2021; 11:1210. [PMID: 34834562 PMCID: PMC8622451 DOI: 10.3390/jpm11111210] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/13/2021] [Accepted: 11/15/2021] [Indexed: 01/10/2023] Open
Abstract
Numerous Virtual Reality (VR) systems address post-stroke functional recovery of the lower extremity (LE), most of them with low early applicability due to the gait autonomy they require. The aim of the present study was to evaluate the feasibility of a specific VR treatment and its clinical effect on LE functionality, gait, balance, and trunk control post-stroke. A controlled, prospective, clinical trial was carried out with 20 stroke patients, who were divided into two groups: the first group (VR + CP; n = 10) received combined therapy of 1 h VR and 1 h of conventional physiotherapy (CP) and the second group (CP; n = 10) received 2 h of CP (5 days/week, for 3 weeks). The following pre-post-intervention measuring scales were used: Functional Ambulatory Scale (FAC), Functional Independence Measure (FIM), Fugl-Meyer Assessment (FM), Berg Balance Scale (BBS), and Trunk Control Test (TCT). Only VR + CP showed a significant improvement in FAC. In FIM, CP presented a tendency to significance, whereas VR + CP showed significance. Both groups improved significantly in FM (especially in amplitude/pain in VR + CP and in sensitivity in CP) and in BBS. In TCT, there was a non-significant improvement in both groups. The results indicate that the intervention with VR is a feasible treatment in the post-stroke functional re-education of the LE, with the potential to be an optimal complement of CP.
Collapse
Affiliation(s)
- Carlos Luque-Moreno
- Department of Physiotherapy, University of Seville, 41009 Seville, Spain;
- Laboratory of Neurorehabilitation Technologies, San Camillo IRCCS, 30126 Venezia, Italy;
| | - Pawel Kiper
- Physical Medicine and Rehabilitation Unit, Azienda ULSS 3 Serenissima, 30126 Venice, Italy;
| | - Ignacio Solís-Marcos
- Unit of Humans in the Transport System, Swedish National Road and Transport Research Institute (VTI), Linköping University, 58330 Linköping, Sweden;
| | - Michela Agostini
- Department of Neuroscience, Section of Rehabilitation, University-General Hospital of Padova, 35128 Padova, Italy;
| | - Andrea Polli
- Pain in Motion International Research Group, Department of Physiotherapy, Vrije University Brussel, 1050 Brussel, Belgium;
| | - Andrea Turolla
- Laboratory of Neurorehabilitation Technologies, San Camillo IRCCS, 30126 Venezia, Italy;
| | | |
Collapse
|
41
|
Handelzalts S, Steinberg-Henn F, Farquhar J, Shkedy Rabani A, Levy S, Riemer R, Soroker N, Melzer I. Temporal But Not Spatial Gait Parameters Associated With Lower Balance Capacity in Moderate-High Functioning Persons With Stroke. J Neurol Phys Ther 2021; 45:301-309. [PMID: 34369447 DOI: 10.1097/npt.0000000000000368] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE Falls are a major health concern after stroke. Spatial and temporal gait asymmetry and variability can contribute to instability and increased fall risk in persons with stroke (PwS). We aimed to quantify gait spatiotemporal symmetry and variability parameters in PwS undergoing rehabilitation in the subacute stage of the disease, by comparison to healthy participants, and to examine the associations between these parameters and patients' reactive and proactive balance capacity. METHODS Twenty-two PwS and 12 healthy adults walked over a computerized treadmill system at their self-selected walking speed. Symmetry and variability of gait parameters (step length, swing time, and stance time) as well as upper extremity and lower extremity angular range of motion in the sagittal plane were extracted. In addition, the Berg Balance Scale (BBS) and the fall threshold in response to sudden surface translations at increasing intensities were assessed. RESULTS PwS demonstrated significantly higher asymmetry in all gait parameters in comparison to controls. Also, PwS demonstrated increased stance time variability in comparison to healthy controls and increased swing time variability in the paretic lower extremity. Significant negative associations were found between fall threshold and stance time asymmetry in PwS (r = -0.48, P = 0.022), between the BBS and swing time asymmetry (r = -0.50, P = 0.018), and between the BBS and stance time variability of the paretic lower extremity (r = -0.56, P = 0.006). DISCUSSION AND CONCLUSIONS Findings highlight the importance of gait temporal symmetry and variability measures for dynamic balance control after stroke. These parameters should be considered when assessing gait recovery and safety in PwS.Video Abstract available for more insight from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A355).
Collapse
Affiliation(s)
- Shirley Handelzalts
- Departments of Physical Therapy (S.H., J.F., I.M.) and Industrial Engineering and Management (A.S.R., R.R.), Ben-Gurion University of the Negev, Beer Sheva, Israel; Departments of Physical Therapy (S.H., F.S.H.) and Neurological Rehabilitation (N.S.), Loewenstein Rehabilitation Hospital, Ra'anana, Israel; Department of Statistics Education, The Academic College of Tel-Aviv-Yaffo, Tel-Aviv-Yaffo, Israel (S.L.); and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel (N.S.)
| | | | | | | | | | | | | | | |
Collapse
|
42
|
Zaborova V, Fesyun A, Gurevich K, Oranskaya A, Rylsky A, Kryuchkova K, Malakhovskiy V, Shestakov D. Changes in kinesiostabilogram parameters and movement speed of stroke patients while increasing their physical activity due to the use of biofeedback method. Eur J Transl Myol 2021; 31. [PMID: 34595898 PMCID: PMC8758953 DOI: 10.4081/ejtm.2021.9360] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 08/13/2021] [Indexed: 11/23/2022] Open
Abstract
Balance disorders are complications of stroke survivors. Aim of this study was the establish effectiveness of the biofeedback approach. In this intervention study 245 patients with early diagnosis of acute disturbance of cerebral circulation (ADCC) were examined. Patients able to move independently were treated by standard conservative ADCC therapy on an outpatient approach, but they continued to have problems with coordination of movement in upright position. Then they were submitted to an increasing physical activity based on five sessions of biofeedback, i.e., a complex rehabilitation of patients with motor pathology "Trust-M" according to TU 9442-001-63704475-2010. Mobility rates were assessed using a web camera. Patients' quality of life was evaluated by SF-36 questionnaire and the Hospital Anxiety and Depression Scale (HADS). All parameters were recorded before and after 5 sessions of biofeedback. After treatment, the stability indicators improved and all patients showed a significant increase in motion rate and quality of life. At the same time, the severity of pain and of depression and anxiety decreased. Negative correlations of average strength between the quadrant and patient HADS scaling rates were obtained. In conclusion, our work shows effectiveness of the biofeedback technique for correcting coordination in stroke survivors.
Collapse
Affiliation(s)
- Victoria Zaborova
- Department of Sports Medicine and Medical Rehabilitation, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; Sports Adaptology Laboratory, Moscow Institute of Physics and Technology (National Research University), Moscow Region, Dolgoprudniy.
| | - Anatoly Fesyun
- FSBI "National Medical Research Center for Rehabilitation and Resortology" Ministry of Public Health of Russia, Moscow.
| | - Konstantin Gurevich
- FSBI "National Medical Research Center for Rehabilitation and Resortology" Ministry of Public Health of Russia, Moscow, Russia; UNESCO chair "Healthy life style for sustainable development" "Moscow State University of Medicine and Dentistry. A.I. Evdokimov", Ministry of Health of the Russian Federation, Moscow, Russia; Research Institute of Healthcare Organization and Medical Management of the Moscow Department of Healthcare, Moscow .
| | - Alevtina Oranskaya
- UNESCO chair "Healthy life style for sustainable development" "Moscow State University of Medicine and Dentistry. A.I. Evdokimov", Ministry of Health of the Russian Federation, Moscow.
| | - Alexey Rylsky
- Moscow scientific and practical center for medical rehabilitation, rehabilitation and sports medicine, Department of Health of Moscow, Moscow.
| | - Kira Kryuchkova
- Department of Sports Medicine and Medical Rehabilitation, Sechenov First Moscow State Medical University (Sechenov University), Moscow.
| | - Vladimir Malakhovskiy
- Department of Sports Medicine and Medical Rehabilitation, Sechenov First Moscow State Medical University (Sechenov University), Moscow.
| | - Dmitry Shestakov
- Department of Orthopedics and Complex Trauma of the Moscow Clinical Research Center A.S. Loginov, Moscow.
| |
Collapse
|
43
|
Monitoring of Gait Parameters in Post-Stroke Individuals: A Feasibility Study Using RGB-D Sensors. SENSORS 2021; 21:s21175945. [PMID: 34502836 PMCID: PMC8434660 DOI: 10.3390/s21175945] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/31/2021] [Accepted: 09/02/2021] [Indexed: 11/17/2022]
Abstract
Stroke is one of the most significant causes of permanent functional impairment and severe motor disability. Hemiplegia or hemiparesis are common consequences of the acute event, which negatively impacts daily life and requires continuous rehabilitation treatments to favor partial or complete recovery and, consequently, to regain autonomy, independence, and safety in daily activities. Gait impairments are frequent in stroke survivors. The accurate assessment of gait anomalies is therefore crucial and a major focus of neurorehabilitation programs to prevent falls or injuries. This study aims to estimate, using a single RGB-D sensor, gait patterns and parameters on a short walkway. This solution may be suitable for monitoring the improvement or worsening of gait disorders, including in domestic and unsupervised scenarios. For this purpose, some of the most relevant spatiotemporal parameters, estimated by the proposed solution on a cohort of post-stroke individuals, were compared with those estimated by a gold standard system for a simultaneous instrumented 3D gait analysis. Preliminary results indicate good agreement, accuracy, and correlation between the gait parameters estimated by the two systems. This suggests that the proposed solution may be employed as an intermediate tool for gait analysis in environments where gold standard systems are impractical, such as home and ecological settings in real-life contexts.
Collapse
|
44
|
Traxler K, Schinabeck F, Baum E, Klotz E, Seebacher B. Feasibility of a specific task-oriented training versus its combination with manual therapy on balance and mobility in people post stroke at the chronic stage: study protocol for a pilot randomised controlled trial. Pilot Feasibility Stud 2021; 7:146. [PMID: 34311772 PMCID: PMC8313417 DOI: 10.1186/s40814-021-00886-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 07/09/2021] [Indexed: 11/28/2022] Open
Abstract
Background Large studies have shown that stroke is among the most relevant causes of acquired adult disability. Walking and balance impairment in stroke survivors often contribute to a restriction in daily activities and social participation. Task-oriented training (TOT) is an effective treatment strategy and manual therapy (MT) is used successfully to enhance ankle joint flexibility in this population. No study, however, has compared TOT against its combination with MT in a randomised controlled trial. Aims of this pilot study are therefore to explore the feasibility of a full-scale RCT using predefined feasibility criteria. Secondary aims are to explore the preliminary effects of specific TOT with a combined specific TOT-MT versus a control group in people post stroke. Methods This is a protocol of a 4-week prospective randomised controlled parallel pilot trial in people post stroke at the chronic stage with limited upper ankle joint mobility and an impairment in balance and mobility. At a German outpatient therapy centre using 1:1:1 allocation, 36 patients will be randomised into one of three groups: 15-min talocrural joint MT plus 30-min specific TOT (group A), 45-min specific TOT (group B), and controls (group C). Training will be goal-oriented including tasks that are based on daily activities and increased in difficulty utilising predefined progression criteria based on patients’ skill levels. Interventions will be provided face-to-face 2 times per week, for 4 weeks, in addition to 20-min concurrent x4 weekly home-based training sessions. Data will be collected by blinded assessors at baseline, post-intervention and 4-week follow-up. The primary outcome will be feasibility assessed by recruitment, retention and adherence rates, compliance, adverse events, falls and the acceptability of the intervention. Secondary outcomes will be walking speed, single and dual tasking functional mobility, ankle range of motion, disability and health-related quality of life. Discussion Feasibility provided, results from this study will be used to calculate the sample size of a larger randomised controlled trial to investigate the effects of specific TOT and specific TOT-MT compared to a post stroke control group. Trial registration German Clinical Trials Register, DRKS00023068. Registered on 21.09.2020, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00023068. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-021-00886-0.
Collapse
Affiliation(s)
- Kristina Traxler
- Therapiezentrum "Kinema", Neukirchen b. hl. Blut, Germany.,Department for Health Sciences, Medicine and Research, Faculty of Health and Medicine, Danube University Krems, Krems an der Donau, Austria
| | - Franz Schinabeck
- Überörtliche Gemeinschaftspraxis Hohenwarth/ Lam, Hohenwarth, Germany
| | - Eva Baum
- Therapiezentrum "Kinema", Neukirchen b. hl. Blut, Germany
| | - Edith Klotz
- Praxis Mittelpunkt Mensch, Furth im Wald, Germany
| | - Barbara Seebacher
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria. .,VASCAGE GmbH, Research Centre on Vascular Ageing and Stroke, Innsbruck, Austria.
| |
Collapse
|
45
|
Effect of the Wii Sports Resort on Mobility and Health-Related Quality of Life in Moderate Stroke. Behav Neurol 2021; 2021:6635298. [PMID: 34257740 PMCID: PMC8261187 DOI: 10.1155/2021/6635298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 05/27/2021] [Accepted: 06/08/2021] [Indexed: 11/18/2022] Open
Abstract
Background Stroke is a common cerebral circulatory disorder that has several sequelae that affect the daily life of patients as well as their quality of life and the lives of people close to them. Video games are being used in the rehabilitation process to address these sequelae and their benefits are shown on physical activity and in the cognition area. However, their effects on daily life activities and quality of life are not known. This study was aimed to test the effect of the Nintendo Wii Sports Resort on mobility and health-related quality of life among patients who have suffered a moderate stroke. Methods A prepost design study was conducted with 30 moderately impaired stroke patients aged 65 ± 15. The study lasted eight weeks. 15 participated in the intervention group and the others belong to the control group. They were assessed in mobility (Timed Get Up and Go Test—TUG) and health-related quality of life (SF-36 Health Questionnaire). Parametric test and effect sizes were used to analyze the change in outcomes and to compare groups. Results There were no differences at baseline between the groups. After the intervention, the intervention group had experienced a greater change according to the size of the effect on the variables concerning TUG (d = 1.32), physical function (d = 1.32), social function (d = 0.71), and Physical Component Summary (d = 0.75). On the other hand, the control group had a significant change in mental health according to effect size; however, this effect is not statistically relevant (d = 0.88; CI 95% = −3.74 to 5.50). Conclusions The results on mobility and health-related quality of life indicate an improvement in both groups. However, according to the effect sizes and its confidence of interval, the intervention group achieved better results than the control group. Although more studies are needed in this area, the results are encouraging for improving mobility and health-related quality of life after stroke.
Collapse
|
46
|
Effect of arm sling application on gait and balance in patients with post-stroke hemiplegia: a systematic review and meta-analysis. Sci Rep 2021; 11:11161. [PMID: 34045541 PMCID: PMC8160322 DOI: 10.1038/s41598-021-90602-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/12/2021] [Indexed: 12/03/2022] Open
Abstract
Hemiplegic shoulder pain and impairment are common poststroke outcomes, for which arm slings constitute long-used treatments. Although multiple studies have suggested association between gait pattern and sling application, results have varied. Accordingly, we conducted this meta-analysis to determine how arm sling use affects the gait and balance of patients with poststroke hemiplegia. The PubMed, Embase, and Cochrane Library databases were searched until April 21, 2021, for randomized or quasi-randomized controlled trials evaluating the effect of arm slings on gait or balance in patients with poststroke hemiplegia. The primary outcome was walking speed; the secondary outcomes were functional balance tests or walking evaluation parameters for which sufficient analytical data were available in three or more studies. Nine studies with a total of 235 patients were included, all of which were within-patient comparisons. Six studies reported significant between-group differences in walking speed with and without the use of arm slings. Patients wearing arm slings had higher walking speed (standardized mean difference = − 0.31, 95% confidence interval [CI] = − 0.55 to − 0.07, P = 0.01, n = 159; weighted mean difference = − 0.06, 95% CI − 0.10 to − 0.02, P = 0.001, n = 159). Our findings suggest that arm sling use improves gait performance, particularly walking speed, in patients with poststroke hemiplegia.
Collapse
|
47
|
Thilarajah S, Bower KJ, Williams G, Clark RA, Tan D, Pua YH. Paretic and Nonparetic Step Tests Are Noninterchangeable in Stroke: A Prospective Cohort Study. Phys Ther 2021; 101:6134189. [PMID: 33587141 DOI: 10.1093/ptj/pzab060] [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: 05/15/2020] [Revised: 11/20/2020] [Accepted: 12/31/2020] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The step test (ST) is a common clinical assessment of dynamic balance among survivors of stroke. The ST assesses a person's ability to place their paretic (paretic ST) or nonparetic (nonparetic ST) foot rapidly and repeatedly on and off a standardized block while standing. No study has formally explored if the 2 tests are interchangeable. Our study aimed to: (1) differentiate the correlates of paretic and nonparetic ST, and (2) compare their associations with physical function and falls. METHODS Eighty-one survivors of stroke were consecutively recruited from inpatient rehabilitation units (n = 4) and were assessed within 1 week prior to discharge. In addition to the ST, a handheld dynamometer and computerized posturography were used to measure lower limb muscle strength and standing balance, respectively. Self-selected gait speed and Timed Up and Go test were also assessed as measures of physical function. Falls data were monitored for 12 months post discharge using monthly calendars. Multivariable regression analyses were used to differentiate (1) the correlates of paretic and nonparetic STs, and (2) their associations with physical function and falls. RESULTS The median score for the paretic and nonparetic STs were 8 and 9 steps, respectively. Paretic ankle plantar-flexor and dorsiflexor strength were the strongest correlates of nonparetic ST, whereas both paretic ankle and knee extensor strength were the strongest correlates of paretic ST. In multivariable analyses adjusting for each other, both STs were independently associated with gait speed and Timed Up and Go scores. Paretic ST (odds ratio = 0.37; 95% CI = 0.22 to 0.62) was a stronger predictor than nonparetic ST (odds ratio = 0.51; 95% CI = 0.34 to 0.78) in predicting future falls. CONCLUSION This study confirmed that the paretic and nonparetic STs are noninterchangeable. ST scores should be assessed separately to achieve a more complete interpretation. IMPACT To our knowledge, this study is the first to objectively evaluate the similarities and differences between paretic and nonparetic STs. This information may refine the use and interpretation of the 2 STs for survivors of stroke.
Collapse
Affiliation(s)
| | - Kelly J Bower
- Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Gavin Williams
- Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia.,Epworth HealthCare, Richmond, Melbourne, Victoria, Australia
| | - Ross A Clark
- School of Health and Exercise Science, The University of the Sunshine Coast, Queensland, Australia
| | - Dawn Tan
- Department of Physiotherapy, Singapore General Hospital, Singapore
| | - Yong-Hao Pua
- Department of Physiotherapy, Singapore General Hospital, Singapore
| |
Collapse
|
48
|
Chen SC, Lin CH, Su SW, Chang YT, Lai CH. Feasibility and effect of interactive telerehabilitation on balance in individuals with chronic stroke: a pilot study. J Neuroeng Rehabil 2021; 18:71. [PMID: 33902646 PMCID: PMC8077813 DOI: 10.1186/s12984-021-00866-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/14/2021] [Indexed: 11/30/2022] Open
Abstract
Background Stroke survivors need continuing exercise intervention to maintain functional status. This study assessed the feasibility and efficacy of an interactive telerehabilitation exergaming system to improve balance in individuals with chronic stroke, compared to conventional one-on-one rehabilitation. Methods In this prospective case–control pilot study, 30 Taiwanese individuals with chronic stroke were enrolled and randomly allocated to an experimental group and a control group. All participants received intervention 3 times per week for 4 weeks in the study hospital. The experiment group underwent telerehabilitation using a Kinect camera-based interactive telerehabilitation system in an independent room to simulate home environment. In contrast, the control group received conventional one-on-one physiotherapy in a dedicated rehabilitation area. The effectiveness of interactive telerehabilitation in improving balance in stroke survivors was evaluated by comparing outcomes between the two groups. The primary outcome was Berg Balance Scale (BBS) scores. Secondary outcomes were performance of the Timed Up and Go (TUG) test, Modified Falls Efficacy Scale, Motricity Index, and Functional Ambulation Category. Results Comparison of outcomes between experimental and control groups revealed no significant differences between groups at baseline and post-intervention for all outcome measures. However, BBS scores improved significantly in both groups (control group: p = 0.01, effect size = 0.49; experimental group: p = 0.01, effect size = 0.70). Completion times of TUG tests also improved significantly in the experimental group (p = 0.005, effect size = 0.70). Conclusion The Kinect camera-based interactive telerehabilitation system demonstrates superior or equal efficacy compared to conventional one-on-one physiotherapy for improving balance in individuals with chronic stroke. Trial registration ClinicalTrials.gov. NCT03698357. Registered October 4, 2018, retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12984-021-00866-8.
Collapse
Affiliation(s)
- Shih-Ching Chen
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, No. 252, Wu-Hsing St., Taipei City, 110, Taiwan.,Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan.,Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan
| | - Chueh-Ho Lin
- Masters Program in Long-Term Care & School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Sheng-Wen Su
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan
| | - Yu-Tai Chang
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chien-Hung Lai
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, No. 252, Wu-Hsing St., Taipei City, 110, Taiwan. .,Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan. .,Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan.
| |
Collapse
|
49
|
Kinect V2-Based Gait Analysis for Children with Cerebral Palsy: Validity and Reliability of Spatial Margin of Stability and Spatiotemporal Variables. SENSORS 2021; 21:s21062104. [PMID: 33802731 PMCID: PMC8002565 DOI: 10.3390/s21062104] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/15/2021] [Accepted: 03/13/2021] [Indexed: 12/17/2022]
Abstract
Children with cerebral palsy (CP) have high risks of falling. It is necessary to evaluate gait stability for children with CP. In comparison to traditional motion capture techniques, the Kinect has the potential to be utilised as a cost-effective gait stability assessment tool, ensuring frequent and uninterrupted gait monitoring. To evaluate the validity and reliability of this measurement, in this study, ten children with CP performed two testing sessions, of which gait data were recorded by a Kinect V2 sensor and a referential Motion Analysis system. The margin of stability (MOS) and gait spatiotemporal metrics were examined. For the spatiotemporal parameters, intraclass correlation coefficient (ICC2,k) values were from 0.83 to 0.99 between two devices and from 0.78 to 0.88 between two testing sessions. For the MOS outcomes, ICC2,k values ranged from 0.42 to 0.99 between two devices and 0.28 to 0.69 between two test sessions. The Kinect V2 was able to provide valid and reliable spatiotemporal gait parameters, and it could also offer accurate outcome measures for the minimum MOS. The reliability of the Kinect V2 when assessing time-specific MOS variables was limited. The Kinect V2 shows the potential to be used as a cost-effective tool for CP gait stability assessment.
Collapse
|
50
|
Short-Term Effect of Kinesio Taping of Lower-Leg Proprioceptive Neuromuscular Facilitation Pattern on Gait Parameter and Dynamic Balance in Chronic Stroke with Foot Drop. Healthcare (Basel) 2021; 9:healthcare9030271. [PMID: 33802448 PMCID: PMC7999191 DOI: 10.3390/healthcare9030271] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 02/24/2021] [Accepted: 02/26/2021] [Indexed: 11/16/2022] Open
Abstract
The aim of this study is to identify the effectiveness of proprioceptive neuromuscular facilitation (PNF) leg Kinesio taping on gait parameters and dynamic balance in chronic stroke patients with foot drop. A total 22 chronic stroke patients were randomly assigned to experimental (n = 11) and control groups (n = 11). All subjects underwent conventional therapy and gait training for 50 min. The experimental group additionally received KT of tibialis anterior muscle (TA) and hamstring muscles according to the PNF pattern. The control group received KT of only TA. The primary outcome measures that the gait parameter are gait velocity, cadence, step length, and stride length. Dynamic balance was measured by the timed up-and-go test (TUG) time and activity-specific balance confidence scale (ABC) as the secondary outcomes. All of the measurements were performed baseline and 24 h after intervention. Our results showed that the experimental group showed significant improvements in gait velocity, cadence, step length, stride length and TUG, and ABC score compared with the control group. We conclude that the short term effect of application of lower-leg KT according to the PNF pattern increased the gait ability and dynamic balance of chronic stroke patients with foot drop.
Collapse
|