1
|
Tomita Y, Sekiguchi Y, Mayo NE. Efficacy of a Single-Bout of Auditory Feedback Training on Gait Performance and Kinematics in Healthy Young Adults. SENSORS (BASEL, SWITZERLAND) 2024; 24:3206. [PMID: 38794060 PMCID: PMC11125153 DOI: 10.3390/s24103206] [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: 02/27/2024] [Revised: 04/25/2024] [Accepted: 05/17/2024] [Indexed: 05/26/2024]
Abstract
This study investigated the immediate effects of auditory feedback training on gait performance and kinematics in 19 healthy young adults, focusing on bilateral changes, despite unilateral training. Baseline and post-training kinematic measurements, as well as the feedback training were performed on a treadmill with a constant velocity. Significant improvements were seen in step length (trained: 590.7 mm to 611.1 mm, 95%CI [7.609, 24.373]; untrained: 591.1 mm to 628.7 mm, 95%CI [10.698, 30.835]), toe clearance (trained: 13.9 mm to 16.5 mm, 95%CI [1.284, 3.503]; untrained: 11.8 mm to 13.7 mm, 95%CI [1.763, 3.612]), ankle dorsiflexion angle at terminal stance (trained: 8.3 deg to 10.5 deg, 95%CI [1.092, 3.319]; untrained: 9.2 deg to 12.0 deg, 95%CI [1.676, 3.573]), hip flexion angular velocity, (trained: -126.5 deg/s to -131.0 deg/s, 95%CI [-9.054, -2.623]; untrained: -130.2 deg/s to -135.3 deg/s, 95%CI [-10.536, -1.675]), ankle angular velocity at terminal stance (trained: -344.7 deg/s to -359.1 deg/s, 95%CI [-47.540, -14.924]; untrained: -340.3 deg/s to -376.9 deg/s, 95%CI [-37.280, -13.166s]), and gastrocnemius EMG activity (trained: 0.60 to 0.66, 95%CI [0.014, 0.258]; untrained: 0.55 to 0.65, 95%CI [0.049, 0.214]). These findings demonstrate the efficacy of auditory feedback training in enhancing key gait parameters, highlighting the bilateral benefits from unilateral training.
Collapse
Affiliation(s)
- Yosuke Tomita
- Department of Physical Therapy, Faculty of Health Care, Takasaki University of Health and Welfare, Takasaki 370-0033, Japan; (Y.T.); (Y.S.)
| | - Yoshihiro Sekiguchi
- Department of Physical Therapy, Faculty of Health Care, Takasaki University of Health and Welfare, Takasaki 370-0033, Japan; (Y.T.); (Y.S.)
| | - Nancy E. Mayo
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC H3G 1Y5, Canada
| |
Collapse
|
2
|
Cotinat M, Celerier M, Arquillière C, Flipo M, Prieur-Blanc N, Viton JM, Bensoussan L. Robotic gait training and botulinum toxin injection improve gait in the chronic post-stroke phase: A randomized controlled trial. Ann Phys Rehabil Med 2024; 67:101785. [PMID: 38118342 DOI: 10.1016/j.rehab.2023.101785] [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: 09/19/2022] [Revised: 05/17/2023] [Accepted: 05/23/2023] [Indexed: 12/22/2023]
Abstract
BACKGROUND Improving walking ability is one of the main goals of rehabilitation after stroke. When lower limb spasticity increases walking difficulty, botulinum toxin type A (BTx-A) injections can be combined with non-pharmacologic interventions such as intensive rehabilitation using a robotic approach. To the best of our knowledge, no comparisons have been made between the efficacy of robotic gait training and conventional physical therapy in combination with BTx-A injections. OBJECTIVE To conduct a randomized controlled trial to compare the efficacy on gait of robotic gait training versus conventional physiotherapy after BTx-A injection into the spastic triceps surae in people after stroke. METHOD Thirty-three participants in the chronic stroke phase with triceps surae spasticity inducing gait impairment were included. After BTx-A injection, participants were randomized into 2 groups. Group A underwent robotic gait training (Lokomat®) for 2 weeks, followed by conventional physiotherapy for 2 weeks (n = 15) and Group B underwent the same treatment in reverse order (n = 18). The efficacy of these methods was tested using the 6-minute walk test (6MWT), comparing post-test 1 and post-test 2 with the pre-test. RESULTS After the first period, the 6MWT increased significantly more in Group A than in Group B: the mean difference between the interventions was 33 m (95%CI 9; 58 p = 0.007; g = 0.95), in favor of Group A; after the second period, the 6MWT increased in both groups, but the 30 m difference between the groups still remained (95%CI 5; 55 p = 0.019; g = 0.73). CONCLUSION Two weeks of robotic gait training performed 2 weeks after BTx-A injections improved walking performance more than conventional physiotherapy. Large-scale studies are now required on the timing of robotic rehabilitation after BTx-A injection.
Collapse
Affiliation(s)
- Maëva Cotinat
- Aix Marseille Université, CNRS, INT UMR 7289, Marseille, France; Department of Physical and Rehabilitation Medicine, Marseille University Hospital, France.
| | - Mathilde Celerier
- Department of Physical and Rehabilitation Medicine, Marseille University Hospital, France
| | - Clelia Arquillière
- Department of Physical and Rehabilitation Medicine, Marseille University Hospital, France
| | - Margot Flipo
- Department of Physical and Rehabilitation Medicine, Marseille University Hospital, France
| | - Nicolas Prieur-Blanc
- Department of Physical and Rehabilitation Medicine, Marseille University Hospital, France
| | - Jean-Michel Viton
- Aix Marseille Université, CNRS, INT UMR 7289, Marseille, France; Department of Physical and Rehabilitation Medicine, Marseille University Hospital, France
| | - Laurent Bensoussan
- Aix Marseille Université, CNRS, INT UMR 7289, Marseille, France; Department of Physical and Rehabilitation Medicine, Marseille University Hospital, France; UGECAM Institut Universitaire de Réadaptation de Valmante Sud
| |
Collapse
|
3
|
Emmery L, Hackney ME, Kesar T, McKay JL, Rosenberg MC. An integrated review of music cognition and rhythmic stimuli in sensorimotor neurocognition and neurorehabilitation. Ann N Y Acad Sci 2023; 1530:74-86. [PMID: 37917153 PMCID: PMC10841443 DOI: 10.1111/nyas.15079] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
This work reviews the growing body of interdisciplinary research on music cognition, using biomechanical, kinesiological, clinical, psychosocial, and sociological methods. The review primarily examines the relationship between temporal elements in music and motor responses under varying contexts, with considerable relevance for clinical rehabilitation. After providing an overview of the terminology and approaches pertinent to theories of rhythm and meter from the musical-theoretical and cognitive fields, this review focuses on studies on the effects of rhythmic sensory stimulation on gait, rhythmic cues' effect on the motor system, reactions to rhythmic stimuli attempting to synchronize mobility (i.e., musical embodiment), and the application of rhythm for motor rehabilitation for individuals with Parkinson's disease, stroke, mild cognitive impairment, Alzheimer's disease, and other neurodegenerative or neurotraumatic diseases. This work ultimately bridges the gap between the musical-theoretical and cognitive science fields to facilitate innovative research in which each discipline informs the other.
Collapse
Affiliation(s)
- Laura Emmery
- Department of Music, Emory College of Arts and Sciences, Emory University, Atlanta, Georgia, USA
| | - Madeleine E. Hackney
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA HealthCare System, Decatur, Georgia, USA
- Department of Medicine, Division of Geriatrics and Gerontology, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Veterans Affairs Birmingham/Atlanta Geriatric Research Education and Clinical Center
- Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University School of Medicine, Atlanta, Georgia, USA
- Emory University School of Nursing, Atlanta, Georgia, USA
| | - Trisha Kesar
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - J. Lucas McKay
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Michael C. Rosenberg
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, Georgia, USA
| |
Collapse
|
4
|
Porciuncula F, Arumukhom Revi D, Baker TC, Sloutsky R, Walsh CJ, Ellis TD, Awad LN. Effects of high-intensity gait training with and without soft robotic exosuits in people post-stroke: a development-of-concept pilot crossover trial. J Neuroeng Rehabil 2023; 20:148. [PMID: 37936135 PMCID: PMC10629136 DOI: 10.1186/s12984-023-01267-9] [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: 03/14/2023] [Accepted: 10/11/2023] [Indexed: 11/09/2023] Open
Abstract
INTRODUCTION High-intensity gait training is widely recognized as an effective rehabilitation approach after stroke. Soft robotic exosuits that enhance post-stroke gait mechanics have the potential to improve the rehabilitative outcomes achieved by high-intensity gait training. The objective of this development-of-concept pilot crossover study was to evaluate the outcomes achieved by high-intensity gait training with versus without soft robotic exosuits. METHODS In this 2-arm pilot crossover study, four individuals post-stroke completed twelve visits of speed-based, high-intensity gait training: six consecutive visits of Robotic Exosuit Augmented Locomotion (REAL) gait training and six consecutive visits without the exosuit (CONTROL). The intervention arms were counterbalanced across study participants and separated by 6 + weeks of washout. Walking function was evaluated before and after each intervention using 6-minute walk test (6MWT) distance and 10-m walk test (10mWT) speed. Moreover, 10mWT speeds were evaluated before each training visit, with the time-course of change in walking speed computed for each intervention arm. For each participant, changes in each outcome were compared to minimal clinically-important difference (MCID) thresholds. Secondary analyses focused on changes in propulsion mechanics and associated biomechanical metrics. RESULTS Large between-group effects were observed for 6MWT distance (d = 1.41) and 10mWT speed (d = 1.14). REAL gait training resulted in an average pre-post change of 68 ± 27 m (p = 0.015) in 6MWT distance, compared to a pre-post change of 30 ± 16 m (p = 0.035) after CONTROL gait training. Similarly, REAL training resulted in a pre-post change of 0.08 ± 0.03 m/s (p = 0.012) in 10mWT speed, compared to a pre-post change of 0.01 ± 06 m/s (p = 0.76) after CONTROL. For both outcomes, 3 of 4 (75%) study participants surpassed MCIDs after REAL training, whereas 1 of 4 (25%) surpassed MCIDs after CONTROL training. Across the training visits, REAL training resulted in a 1.67 faster rate of improvement in walking speed. Similar patterns of improvement were observed for the secondary gait biomechanical outcomes, with REAL training resulting in significantly improved paretic propulsion for 3 of 4 study participants (p < 0.05) compared to 1 of 4 after CONTROL. CONCLUSION Soft robotic exosuits have the potential to enhance the rehabilitative outcomes produced by high-intensity gait training after stroke. Findings of this development-of-concept pilot crossover trial motivate continued development and study of the REAL gait training program.
Collapse
Affiliation(s)
- Franchino Porciuncula
- Department of Physical Therapy, Center for Neurorehabilitation, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA
- Department of Physical Therapy, Neuromotor Recovery Lab, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA
- Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Dheepak Arumukhom Revi
- Department of Physical Therapy, Neuromotor Recovery Lab, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA
- Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
- Department of Mechanical Engineering, Boston University, Boston, MA, USA
| | - Teresa C Baker
- Department of Physical Therapy, Center for Neurorehabilitation, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA
- Department of Physical Therapy, Neuromotor Recovery Lab, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA
| | - Regina Sloutsky
- Department of Physical Therapy, Neuromotor Recovery Lab, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA
| | - Conor J Walsh
- Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Terry D Ellis
- Department of Physical Therapy, Center for Neurorehabilitation, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA
| | - Louis N Awad
- Department of Physical Therapy, Neuromotor Recovery Lab, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA.
- Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA.
- Department of Mechanical Engineering, Boston University, Boston, MA, USA.
| |
Collapse
|
5
|
Browne MG, Stenum J, Padmanabhan P, Roemmich RT. Simple within-stride changes in treadmill speed can drive selective changes in human gait symmetry. PLoS One 2023; 18:e0287568. [PMID: 37883477 PMCID: PMC10602355 DOI: 10.1371/journal.pone.0287568] [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: 07/18/2022] [Accepted: 06/08/2023] [Indexed: 10/28/2023] Open
Abstract
Millions of people walk with asymmetric gait patterns, highlighting a need for customizable rehabilitation approaches that can flexibly target different aspects of gait asymmetry. Here, we studied how simple within-stride changes in treadmill speed could drive selective changes in gait symmetry. In Experiment 1, healthy adults (n = 10) walked on an instrumented treadmill with and without a closed-loop controller engaged. This controller changed the treadmill speed to 1.50 or 0.75 m/s depending on whether the right or left leg generated propulsive ground reaction forces, respectively. Participants walked asymmetrically when the controller was engaged: the leg that accelerated during propulsion (right) showed smaller leading limb angles, larger trailing limb angles, and smaller propulsive forces than the leg that decelerated (left). In Experiment 2, healthy adults (n = 10) walked on the treadmill with and without an open-loop controller engaged. This controller changed the treadmill speed to 1.50 or 0.75 m/s at a prescribed time interval while a metronome guided participants to step at different time points relative to the speed change. Different patterns of gait asymmetry emerged depending on the timing of the speed change: step times, leading limb angles, and peak propulsion were asymmetric when the speed changed early in stance while step lengths, step times, and propulsion impulses were asymmetric when the speed changed later in stance. In sum, we show that simple manipulations of treadmill speed can drive selective changes in gait symmetry. Future work will explore the potential for this technique to restore gait symmetry in clinical populations.
Collapse
Affiliation(s)
- Michael G. Browne
- Center for Movement Studies, Kennedy Krieger Institute, Baltimore, MD, United States of America
- Dept of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- Dept of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Jan Stenum
- Center for Movement Studies, Kennedy Krieger Institute, Baltimore, MD, United States of America
- Dept of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Purnima Padmanabhan
- Center for Movement Studies, Kennedy Krieger Institute, Baltimore, MD, United States of America
- Dept of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Ryan T. Roemmich
- Center for Movement Studies, Kennedy Krieger Institute, Baltimore, MD, United States of America
- Dept of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| |
Collapse
|
6
|
Cataldo AVR, Collimore AN, Spangler J, Ribeirinha-Braga L, Hutchinson K, Wang QM, Thompson L, Awad LN. Enhancing Neuroplasticity in the Chronic Phase After Stroke: Effects of a Soft Robotic Exosuit on Training Intensity and Brain-Derived Neurotrophic Factor. IEEE OPEN JOURNAL OF ENGINEERING IN MEDICINE AND BIOLOGY 2023; 4:284-291. [PMID: 38196979 PMCID: PMC10776098 DOI: 10.1109/ojemb.2023.3313396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/21/2023] [Accepted: 09/03/2023] [Indexed: 01/11/2024] Open
Abstract
Objective: High intensity training may enhance neuroplasticity after stroke; however, gait deficits limit the ability to achieve and sustain high walking training intensities. We hypothesize that soft robotic exosuits can facilitate speed-based gait training at higher intensities and longer durations, resulting in a corresponding increase in circulating brain-derived neurotrophic factor (BDNF). Results: Eleven individuals >6-mo post-stroke completed a two-session, pilot randomized crossover trial (NCT05138016). Maximum training speed (Δ: 0.07 ± 0.03 m/s), duration (Δ: 2.07 ± 0.88 min), and intensity (VO2 peak, Δ: 1.75 ± 0.60 ml-O2/kg/min) significantly increased (p < 0.05) during exosuit-augmented training compared to no-exosuit training. Post-session increases in BDNF (Δ: 5.96 ± 2.27 ng/ml, p = 0.03) were observed only after exosuit-augmented training. Biomechanical changes were not observed after exosuit-augmented training; however, a deterioration in gait propulsion symmetry (%Δ: -5 ± 2 %) and an increase in nonparetic propulsion (Δ: 0.9 ± 0.3 %bw) were observed (p < 0.05) after no-exosuit training. Conclusion: Soft robotic exosuits facilitate faster, longer duration, and higher intensity walking training associated with enhanced neuroplasticity.
Collapse
Affiliation(s)
- Anna V. Roto Cataldo
- Boston University, College of Health and Rehabilitation Sciences: SargentBostonMA02215USA
| | - Ashley N. Collimore
- Boston University, College of Health and Rehabilitation Sciences: SargentBostonMA02215USA
| | - Johanna Spangler
- Boston University, College of Health and Rehabilitation Sciences: SargentBostonMA02215USA
| | | | - Karen Hutchinson
- Boston University, College of Health and Rehabilitation Sciences: SargentBostonMA02215USA
| | - Qing Mei Wang
- Spaulding Rehabilitation HospitalCharlestownMA02129USA
| | - LaDora Thompson
- Boston University, College of Health and Rehabilitation Sciences: SargentBostonMA02215USA
| | - Louis N. Awad
- Boston University, College of Health and Rehabilitation Sciences: SargentBostonMA02215USA
| |
Collapse
|
7
|
Sloot LH, Baker LM, Bae J, Porciuncula F, Clément BF, Siviy C, Nuckols RW, Baker T, Sloutsky R, Choe DK, O'Donnell K, Ellis TD, Awad LN, Walsh CJ. Effects of a soft robotic exosuit on the quality and speed of overground walking depends on walking ability after stroke. J Neuroeng Rehabil 2023; 20:113. [PMID: 37658408 PMCID: PMC10474762 DOI: 10.1186/s12984-023-01231-7] [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: 01/18/2023] [Accepted: 08/04/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Soft robotic exosuits can provide partial dorsiflexor and plantarflexor support in parallel with paretic muscles to improve poststroke walking capacity. Previous results indicate that baseline walking ability may impact a user's ability to leverage the exosuit assistance, while the effects on continuous walking, walking stability, and muscle slacking have not been evaluated. Here we evaluated the effects of a portable ankle exosuit during continuous comfortable overground walking in 19 individuals with chronic hemiparesis. We also compared two speed-based subgroups (threshold: 0.93 m/s) to address poststroke heterogeneity. METHODS We refined a previously developed portable lightweight soft exosuit to support continuous overground walking. We compared five minutes of continuous walking in a laboratory with the exosuit to walking without the exosuit in terms of ground clearance, foot landing and propulsion, as well as the energy cost of transport, walking stability and plantarflexor muscle slacking. RESULTS Exosuit assistance was associated with improvements in the targeted gait impairments: 22% increase in ground clearance during swing, 5° increase in foot-to-floor angle at initial contact, and 22% increase in the center-of-mass propulsion during push-off. The improvements in propulsion and foot landing contributed to a 6.7% (0.04 m/s) increase in walking speed (R2 = 0.82). This enhancement in gait function was achieved without deterioration in muscle effort, stability or cost of transport. Subgroup analyses revealed that all individuals profited from ground clearance support, but slower individuals leveraged plantarflexor assistance to improve propulsion by 35% to walk 13% faster, while faster individuals did not change either. CONCLUSIONS The immediate restorative benefits of the exosuit presented here underline its promise for rehabilitative gait training in poststroke individuals.
Collapse
Affiliation(s)
- Lizeth H Sloot
- Harvard John A. Paulson School of Engineering and Applied Sciences, Cambridge, MA, USA
- Wyss Institute for Biologically Inspired Engineering, Boston, MA, USA
- ZITI Institute of Computer Engineering, Heidelberg University, Heidelberg, Germany
| | - Lauren M Baker
- Harvard John A. Paulson School of Engineering and Applied Sciences, Cambridge, MA, USA
- Wyss Institute for Biologically Inspired Engineering, Boston, MA, USA
| | - Jaehyun Bae
- Harvard John A. Paulson School of Engineering and Applied Sciences, Cambridge, MA, USA
- Wyss Institute for Biologically Inspired Engineering, Boston, MA, USA
| | - Franchino Porciuncula
- Harvard John A. Paulson School of Engineering and Applied Sciences, Cambridge, MA, USA
- Wyss Institute for Biologically Inspired Engineering, Boston, MA, USA
| | - Blandine F Clément
- Harvard John A. Paulson School of Engineering and Applied Sciences, Cambridge, MA, USA
- Wyss Institute for Biologically Inspired Engineering, Boston, MA, USA
- Institute for Biomedical Engineering, ETH Zürich, Zürich, Schweiz
| | - Christopher Siviy
- Harvard John A. Paulson School of Engineering and Applied Sciences, Cambridge, MA, USA
- Wyss Institute for Biologically Inspired Engineering, Boston, MA, USA
| | - Richard W Nuckols
- Harvard John A. Paulson School of Engineering and Applied Sciences, Cambridge, MA, USA
- Wyss Institute for Biologically Inspired Engineering, Boston, MA, USA
| | - Teresa Baker
- Wyss Institute for Biologically Inspired Engineering, Boston, MA, USA
- Department of Physical Therapy, Boston University, Boston, MA, USA
| | - Regina Sloutsky
- Wyss Institute for Biologically Inspired Engineering, Boston, MA, USA
- Department of Physical Therapy, Boston University, Boston, MA, USA
| | - Dabin K Choe
- Harvard John A. Paulson School of Engineering and Applied Sciences, Cambridge, MA, USA
- Wyss Institute for Biologically Inspired Engineering, Boston, MA, USA
| | - Kathleen O'Donnell
- Harvard John A. Paulson School of Engineering and Applied Sciences, Cambridge, MA, USA
- Wyss Institute for Biologically Inspired Engineering, Boston, MA, USA
| | - Terry D Ellis
- Department of Physical Therapy, Boston University, Boston, MA, USA
| | - Louis N Awad
- Wyss Institute for Biologically Inspired Engineering, Boston, MA, USA.
- Department of Physical Therapy, Boston University, Boston, MA, USA.
| | - Conor J Walsh
- Harvard John A. Paulson School of Engineering and Applied Sciences, Cambridge, MA, USA.
- Wyss Institute for Biologically Inspired Engineering, Boston, MA, USA.
| |
Collapse
|
8
|
Bergamo G, Swaminathan K, Kim D, Chin A, Siviy C, Novillo I, Baker TC, Wendel N, Ellis TD, Walsh CJ. Individualized Learning-Based Ground Reaction Force Estimation in People Post-Stroke Using Pressure Insoles. IEEE Int Conf Rehabil Robot 2023; 2023:1-6. [PMID: 37941269 DOI: 10.1109/icorr58425.2023.10304695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
Stroke is a leading cause of gait disability that leads to a loss of independence and overall quality of life. The field of clinical biomechanics aims to study how best to provide rehabilitation given an individual's impairments. However, there remains a disconnect between assessment tools used in biomechanical analysis and in clinics. In particular, 3-dimensional ground reaction forces (3D GRFs) are used to quantify key gait characteristics, but require lab-based equipment, such as force plates. Recent efforts have shown that wearable sensors, such as pressure insoles, can estimate GRFs in real-world environments. However, there is limited understanding of how these methods perform in people post-stroke, where gait is highly heterogeneous. Here, we evaluate three subject-specific machine learning approaches to estimate 3D GRFs with pressure insoles in people post-stroke across varying speeds. We find that a Convolutional Neural Network-based approach achieves the lowest estimation errors of 0.75 ± 0.24, 1.13 ± 0.54, and 4.79 ± 3.04 % bodyweight for the medio-lateral, antero-posterior, and vertical GRF components, respectively. Estimated force components were additionally strongly correlated with the ground truth measurements ( ). Finally, we show high estimation accuracy for three clinically relevant point metrics on the paretic limb. These results suggest the potential for an individualized machine learning approach to translate to real-world clinical applications.
Collapse
|
9
|
Lee J, Akbas T, Sulzer J. Hip and Knee Joint Kinematics Predict Quadriceps Hyperreflexia in People with Post-stroke Stiff-Knee Gait. Ann Biomed Eng 2023; 51:1965-1974. [PMID: 37133540 PMCID: PMC11003447 DOI: 10.1007/s10439-023-03217-x] [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: 11/11/2022] [Accepted: 04/20/2023] [Indexed: 05/04/2023]
Abstract
Wearable assistive technology for the lower extremities has shown great promise towards improving gait function in people with neuromuscular injuries. But common secondary impairments, such as hypersensitive stretch reflexes or hyperreflexia, have been often neglected. Incorporation of biomechanics into the control loop could improve individualization and avoid hyperreflexia. However, adding hyperreflexia prediction to the control loop would require expensive or complex measurement of muscle fiber characteristics. In this study, we explore a clinically accessible biomechanical predictor set that can accurately predict rectus femoris (RF) reaction after knee flexion assistance in pre-swing by a powered orthosis. We examined a total of 14 gait parameters based on gait kinematic, kinetic, and simulated muscle-tendon states from 8 post-stroke individuals with Stiff-Knee gait (SKG) wearing a knee exoskeleton robot. We independently performed both parametric and non-parametric variable selection approaches using machine learning regression techniques. Both models revealed the same four kinematic variables relevant to knee and hip joint motions were sufficient to effectively predict RF hyperreflexia. These results suggest that control of knee and hip kinematics may be a more practical method of incorporating quadriceps hyperreflexia into the exoskeleton control loop than the more complex acquisition of muscle fiber properties.
Collapse
Affiliation(s)
- Jeonghwan Lee
- Walker Department of Mechanical Engineering, University of Texas at Austin, Austin, TX, USA
| | | | - James Sulzer
- Department of Physical Medicine and Rehabilitation, MetroHealth Medical Center and Case Western Reserve University, Cleveland, OH, USA.
| |
Collapse
|
10
|
Abdullahi A, Wong TWL, Ng SSM. Variation in the rate of recovery in motor function between the upper and lower limbs in patients with stroke: some proposed hypotheses and their implications for research and practice. Front Neurol 2023; 14:1225924. [PMID: 37602245 PMCID: PMC10435271 DOI: 10.3389/fneur.2023.1225924] [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: 05/20/2023] [Accepted: 07/24/2023] [Indexed: 08/22/2023] Open
Abstract
Background Stroke results in impairment of motor function of both the upper and lower limbs. However, although it is debatable, motor function of the lower limb is believed to recover faster than that of the upper limb. The aim of this paper is to propose some hypotheses to explain the reasons for that, and discuss their implications for research and practice. Method We searched PubMED, Web of Science, Scopus, Embase and CENTRAL using the key words, stroke, cerebrovascular accident, upper extremity, lower extremity, and motor recovery for relevant literature. Result The search generated a total of 2,551 hits. However, out of this number, 51 duplicates were removed. Following review of the relevant literature, we proposed four hypotheses: natural instinct for walking hypothesis, bipedal locomotion hypothesis, central pattern generators (CPGs) hypothesis and role of spasticity hypothesis on the subject matter. Conclusion We opine that, what may eventually account for the difference, is the frequency of use of the affected limb or intensity of the rehabilitation intervention. This is because, from the above hypotheses, the lower limb seems to be used more frequently. When limbs are used frequently, this will result in use-dependent plasticity and eventual recovery. Thus, rehabilitation techniques that involve high repetitive tasks practice such as robotic rehabilitation, Wii gaming and constraint induced movement therapy should be used during upper limb rehabilitation.
Collapse
|
11
|
Kesar T. The Effects of Stroke and Stroke Gait Rehabilitation on Behavioral and Neurophysiological Outcomes:: Challenges and Opportunities for Future Research. Dela J Public Health 2023; 9:76-81. [PMID: 37701480 PMCID: PMC10494801 DOI: 10.32481/djph.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023] Open
Abstract
Stroke continues to be a leading cause of adult disability, contributing to immense healthcare costs. Even after discharge from rehabilitation, post-stroke individuals continue to have persistent gait impairments, which in turn adversely affect functional mobility and quality of life. Multiple factors, including biomechanics, energy cost, psychosocial variables, as well as the physiological function of corticospinal neural pathways influence stroke gait function and training-induced gait improvements. As a step toward addressing this challenge, the objective of the current perspective paper is to outline knowledge gaps pertinent to the measurement and retraining of stroke gait dysfunction. The paper also has recommendations for future research directions to address important knowledge gaps, especially related to the measurement and rehabilitation-induced modulation of biomechanical and neural processes underlying stroke gait dysfunction. We posit that there is a need for leveraging emerging technologies to develop innovative, comprehensive, methods to measure gait patterns quantitatively, to provide clinicians with objective measure of gait quality that can supplement conventional clinical outcomes of walking function. Additionally, we posit that there is a need for more research on how the stroke lesion affects multiple parts of the nervous system, and to understand the neuroplasticity correlates of gait training and gait recovery. Multi-modal clinical research studies that can combine clinical, biomechanical, neural, and computational modeling data provide promise for gaining new information about stroke gait dysfunction as well as the multitude of factors affecting recovery and treatment response in people with post-stroke hemiparesis.
Collapse
Affiliation(s)
- Trisha Kesar
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine
| |
Collapse
|
12
|
Swaminathan K, Porciuncula F, Park S, Kannan H, Erard J, Wendel N, Baker T, Ellis TD, Awad LN, Walsh CJ. Ankle-targeted exosuit resistance increases paretic propulsion in people post-stroke. J Neuroeng Rehabil 2023; 20:85. [PMID: 37391851 PMCID: PMC10314463 DOI: 10.1186/s12984-023-01204-w] [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: 04/03/2023] [Accepted: 06/15/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND Individualized, targeted, and intense training is the hallmark of successful gait rehabilitation in people post-stroke. Specifically, increasing use of the impaired ankle to increase propulsion during the stance phase of gait has been linked to higher walking speeds and symmetry. Conventional progressive resistance training is one method used for individualized and intense rehabilitation, but often fails to target paretic ankle plantarflexion during walking. Wearable assistive robots have successfully assisted ankle-specific mechanisms to increase paretic propulsion in people post-stroke, suggesting their potential to provide targeted resistance to increase propulsion, but this application remains underexamined in this population. This work investigates the effects of targeted stance-phase plantarflexion resistance training with a soft ankle exosuit on propulsion mechanics in people post-stroke. METHODS We conducted this study in nine individuals with chronic stroke and tested the effects of three resistive force magnitudes on peak paretic propulsion, ankle torque, and ankle power while participants walked on a treadmill at their comfortable walking speeds. For each force magnitude, participants walked for 1 min while the exosuit was inactive, 2 min with active resistance, and 1 min with the exosuit inactive, in sequence. We evaluated changes in gait biomechanics during the active resistance and post-resistance sections relative to the initial inactive section. RESULTS Walking with active resistance increased paretic propulsion by more than the minimal detectable change of 0.8 %body weight at all tested force magnitudes, with an average increase of 1.29 ± 0.37 %body weight at the highest force magnitude. This improvement corresponded to changes of 0.13 ± 0.03 N m kg- 1 in peak biological ankle torque and 0.26 ± 0.04 W kg- 1 in peak biological ankle power. Upon removal of resistance, propulsion changes persisted for 30 seconds with an improvement of 1.49 ± 0.58 %body weight after the highest resistance level and without compensatory involvement of the unresisted joints or limb. CONCLUSIONS Targeted exosuit-applied functional resistance of paretic ankle plantarflexors can elicit the latent propulsion reserve in people post-stroke. After-effects observed in propulsion highlight the potential for learning and restoration of propulsion mechanics. Thus, this exosuit-based resistive approach may offer new opportunities for individualized and progressive gait rehabilitation.
Collapse
Affiliation(s)
- Krithika Swaminathan
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, 02134, USA
| | - Franchino Porciuncula
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, 02134, USA
- Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, 02215, USA
| | - Sungwoo Park
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, 02134, USA
| | - Harini Kannan
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, 02134, USA
| | - Julien Erard
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, 02134, USA
| | - Nicholas Wendel
- Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, 02215, USA
| | - Teresa Baker
- Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, 02215, USA
| | - Terry D Ellis
- Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, 02215, USA
| | - Louis N Awad
- Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, 02215, USA
| | - Conor J Walsh
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, 02134, USA.
| |
Collapse
|
13
|
Bansal K, Vistamehr A, Conroy CL, Fox EJ, Rose DK. The influence of backward versus forward locomotor training on gait speed and balance control post-stroke: Recovery or compensation? J Biomech 2023; 155:111644. [PMID: 37229888 DOI: 10.1016/j.jbiomech.2023.111644] [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: 05/12/2022] [Revised: 04/25/2023] [Accepted: 05/16/2023] [Indexed: 05/27/2023]
Abstract
Backward walking training has been reported to improve gait speed and balance post-stroke. However, it is not known if gains are achieved through recovery of the paretic limb or compensations from the nonparetic limb. The purpose of this study was to compare the influence of backward locomotor training (BLT) versus forward locomotor training (FLT) on gait speed and dynamic balance control, and to quantify the underlying mechanisms used to achieve any gains. Eighteen participants post chronic stroke were randomly assigned to receive 18 sessions of either FLT (n = 8) or BLT (n = 10). Pre- and post-intervention outcomes included gait speed (10-meter Walk Test) and forward propulsion (time integral of anterior-posterior ground-reaction-forces during late stance for each limb). Dynamic balance control was assessed using clinical (Functional Gait Assessment) and biomechanical (peak-to-peak range of whole-body angular-momentum in the frontal plane) measures. Balance confidence was assessed using the Activities-Specific Balance Confidence scale. While gait speed and balance confidence improved significantly within the BLT group, these improvements were associated with an increased nonparetic limb propulsion generation, suggesting use of compensatory mechanisms. Although there were no improvements in gait speed within the FLT group, paretic limb propulsion generation significantly improved post-FLT, suggesting recovery of the paretic limb. Neither training group improved in dynamic balance control, implying the need of balance specific training along with locomotor training to improve balance control post-stroke. Despite the within-group differences, there were no significant differences between the FLT and BLT groups in the achieved gains in any of the outcomes.
Collapse
Affiliation(s)
- Kanika Bansal
- Department of Physical Therapy, University of Mount Union, Alliance, OH, USA.
| | - Arian Vistamehr
- Motion Analysis Center & Clinical Research Center, Brooks Rehabilitation, Jacksonville, FL, USA
| | - Christy L Conroy
- Motion Analysis Center & Clinical Research Center, Brooks Rehabilitation, Jacksonville, FL, USA
| | - Emily J Fox
- Motion Analysis Center & Clinical Research Center, Brooks Rehabilitation, Jacksonville, FL, USA; Department of Physical Therapy, University of Florida, Gainesville, FL, USA
| | - Dorian K Rose
- Motion Analysis Center & Clinical Research Center, Brooks Rehabilitation, Jacksonville, FL, USA; Department of Physical Therapy, University of Florida, Gainesville, FL, USA; Brain Rehabilitation Research Center, Malcolm Randall Veterans Affair Medical Center, Gainesville, FL, USA
| |
Collapse
|
14
|
Awad LN, Knarr BA, Kudzia P, Buchanan TS. The Interplay Between Walking Speed, Economy, and Stability After Stroke. J Neurol Phys Ther 2023; 47:75-83. [PMID: 36867550 PMCID: PMC10033356 DOI: 10.1097/npt.0000000000000431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
BACKGROUND AND PURPOSE Energy minimization is thought to underlie the naturally selected, preferred walking speed; however, people post-stroke walk slower than their most economical speed, presumably to optimize other objectives, such as stability. The purpose of this study was to examine the interplay between walking speed, economy, and stability. METHODS Seven individuals with chronic hemiparesis walked on a treadmill at 1 of 3 randomized speeds: slow, preferred, and fast. Concurrent measurements of speed-induced changes in walking economy (ie, the energy needed to move 1 kg of bodyweight 1 ml O 2 /kg/m) and stability were made. Stability was quantified as the regularity and divergence of the mediolateral motion of the pelvic center of mass (pCoM) during walking, as well as pCoM motion relative to the base of support. RESULTS Slower walking speeds were more stable (ie, pCoM motion was 10% ± 5% more regular and 26% ± 16% less divergent) but 12% ± 5% less economical. Conversely, faster walking speeds were 9% ± 8% more economical, but also less stable (ie, pCoM motion was 17% ± 5% more irregular). Individuals with slower walking speeds had an enhanced energetic benefit when walking faster ( rs = 0.96, P < 0.001). Individuals with greater neuromotor impairment had an enhanced stability benefit when walking slower ( rs = 0.86, P = 0.01). DISCUSSION AND CONCLUSIONS People post-stroke appear to prefer walking speeds that are faster than their most stable speed but slower than their most economical speed. The preferred walking speed after stroke appears to balance stability and economy. To encourage faster and more economical walking, deficits in the stable control of the mediolateral motion of the pCoM may need to be addressed.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A416 ).
Collapse
Affiliation(s)
- Louis N Awad
- Department of Physical Therapy, Boston University, Boston, Massachusetts, and Department of PM&R, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, Massachusetts (L.N.A.); Department of Biomechanics, University of Nebraska at Omaha, Omaha (B.A.K.); Department of Engineering Science, Simon Fraser University, Burnaby, British Columbia, Canada (P.K.); and Department of Mechanical Engineering, University of Delaware, Newark (T.S.B.)
| | | | | | | |
Collapse
|
15
|
Kettlety SA, Finley JM, Reisman DS, Schweighofer N, Leech KA. Speed-dependent biomechanical changes vary across individual gait metrics post-stroke relative to neurotypical adults. J Neuroeng Rehabil 2023; 20:14. [PMID: 36703214 PMCID: PMC9881336 DOI: 10.1186/s12984-023-01139-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 01/17/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Gait training at fast speeds is recommended to reduce walking activity limitations post-stroke. Fast walking may also reduce gait kinematic impairments post-stroke. However, it is unknown if differences in gait kinematics between people post-stroke and neurotypical adults decrease when walking at faster speeds. OBJECTIVE To determine the effect of faster walking speeds on gait kinematics post-stroke relative to neurotypical adults walking at similar speeds. METHODS We performed a secondary analysis with data from 28 people post-stroke and 50 neurotypical adults treadmill walking at multiple speeds. We evaluated the effects of speed and group on individual spatiotemporal and kinematic metrics and performed k-means clustering with all metrics at self-selected and fast speeds. RESULTS People post-stroke decreased step length asymmetry and trailing limb angle impairment, reducing between-group differences at fast speeds. Speed-dependent changes in peak swing knee flexion, hip hiking, and temporal asymmetries exaggerated between-group differences. Our clustering analyses revealed two clusters. One represented neurotypical gait behavior, composed of neurotypical and post-stroke participants. The other characterized stroke gait behavior-comprised entirely of participants post-stroke with smaller lower extremity Fugl-Meyer scores than the post-stroke participants in the neurotypical gait behavior cluster. Cluster composition was largely consistent at both speeds, and the distance between clusters increased at fast speeds. CONCLUSIONS The biomechanical effect of fast walking post-stroke varied across individual gait metrics. For participants within the stroke gait behavior cluster, walking faster led to an overall gait pattern more different than neurotypical adults compared to the self-selected speed. This suggests that to potentiate the biomechanical benefits of walking at faster speeds and improve the overall gait pattern post-stroke, gait metrics with smaller speed-dependent changes may need to be specifically targeted within the context of fast walking.
Collapse
Affiliation(s)
- Sarah A Kettlety
- Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 E Alcazar St, CHP 155, Los Angeles, CA, 90033, USA
| | - James M Finley
- Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 E Alcazar St, CHP 155, Los Angeles, CA, 90033, USA
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA
- Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, USA
| | - Darcy S Reisman
- Department of Physical Therapy, University of Delaware, 540 S College Ave, Suite 160, Newark, DE, 19713, USA
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA
| | - Nicolas Schweighofer
- Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 E Alcazar St, CHP 155, Los Angeles, CA, 90033, USA
- Department of Biomedical Engineering, 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, 1540 E Alcazar St, CHP 155, Los Angeles, CA, 90033, USA.
| |
Collapse
|
16
|
Effects of Bilateral Assistance for Hemiparetic Gait Post-Stroke Using a Powered Hip Exoskeleton. Ann Biomed Eng 2023; 51:410-421. [PMID: 35963920 PMCID: PMC9867666 DOI: 10.1007/s10439-022-03041-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 07/28/2022] [Indexed: 01/26/2023]
Abstract
Hemiparetic gait due to stroke is characterized by an asymmetric gait due to weakness in the paretic lower limb. These inter-limb asymmetries increase the biomechanical demand and reduce walking speed, leading to reduced community mobility and quality of life. With recent progress in the field of wearable technologies, powered exoskeletons have shown great promise as a potential solution for improving gait post-stroke. While previous studies have adopted different exoskeleton control methodologies for restoring gait post-stroke, the results are highly variable due to limited understanding of the biomechanical effect of exoskeletons on hemiparetic gait. In this study, we investigated the effect of different hip exoskeleton assistance strategies on gait function and gait biomechanics of individuals post-stroke. We found that, compared to walking without a device, powered assistance from hip exoskeletons improved stroke participants' self-selected overground walking speed by 17.6 ± 2.5% and 11.1 ± 2.7% with a bilateral and unilateral assistance strategy, respectively (p < 0.05). Furthermore, both bilateral and unilateral assistance strategies significantly increased the paretic and non-paretic step length (p < 0.05). Our findings suggest that powered assistance from hip exoskeletons is an effective means to increase walking speed post-stroke and tuning the balance of assistance between non-paretic and paretic limbs (i.e., a bilateral strategy) may be most effective to maximize performance gains.
Collapse
|
17
|
Conner BC, Fang Y, Lerner ZF. Under pressure: design and validation of a pressure-sensitive insole for ankle plantar flexion biofeedback during neuromuscular gait training. J Neuroeng Rehabil 2022; 19:135. [PMID: 36482447 PMCID: PMC9732996 DOI: 10.1186/s12984-022-01119-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 11/23/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Electromyography (EMG)-based audiovisual biofeedback systems, developed and tested in research settings to train neuromuscular control in patient populations such as cerebral palsy (CP), have inherent implementation obstacles that may limit their translation to clinical practice. The purpose of this study was to design and validate an alternative, plantar pressure-based biofeedback system for improving ankle plantar flexor recruitment during walking in individuals with CP. METHODS Eight individuals with CP (11-18 years old) were recruited to test both an EMG-based and a plantar pressure-based biofeedback system while walking. Ankle plantar flexor muscle recruitment, co-contraction at the ankle, and lower limb kinematics were compared between the two systems and relative to baseline walking. RESULTS Relative to baseline walking, both biofeedback systems yielded significant increases in mean soleus (43-58%, p < 0.05), and mean (68-70%, p < 0.05) and peak (71-82%, p < 0.05) medial gastrocnemius activation, with no differences between the two systems and strong relationships for all primary outcome variables (R = 0.89-0.94). Ankle co-contraction significantly increased relative to baseline only with the EMG-based system (52%, p = 0.03). CONCLUSION These findings support future research on functional training with this simple, low-cost biofeedback modality.
Collapse
Affiliation(s)
- Benjamin C. Conner
- grid.134563.60000 0001 2168 186XCollege of Medicine–Phoenix, University of Arizona, Phoenix, AZ USA
| | - Ying Fang
- grid.261120.60000 0004 1936 8040Department of Mechanical Engineering, Northern Arizona University, 15600 S McConnell Drive, NAU EGR Bldg 69, Flagstaff, AZ 86011 USA
| | - Zachary F. Lerner
- grid.134563.60000 0001 2168 186XCollege of Medicine–Phoenix, University of Arizona, Phoenix, AZ USA ,grid.261120.60000 0004 1936 8040Department of Mechanical Engineering, Northern Arizona University, 15600 S McConnell Drive, NAU EGR Bldg 69, Flagstaff, AZ 86011 USA
| |
Collapse
|
18
|
Linking gait mechanics with perceived quality of life and participation after stroke. PLoS One 2022; 17:e0274511. [PMID: 36129881 PMCID: PMC9491527 DOI: 10.1371/journal.pone.0274511] [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: 03/11/2022] [Accepted: 08/26/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Individuals with hemiparesis following stroke often experience a decline in the paretic limb’s anteriorly directed ground reaction force during walking (i.e., limb propulsive force). Gait speed and walking capacity have been independently associated with paretic limb propulsion, quality of life, and participation in people with stroke. However, it is unclear as to the extent that underlying limb mechanics (i.e., propulsion) play in influencing perceptions of quality of life and participation. We therefore sought to determine the role of limb propulsion during gait on the perception of quality of life and participation in people following stroke.
Methods
This study is a secondary analysis of individuals involved in a gait retraining randomized control trial. Gait speed, walking capacity, limb propulsion, Stroke Impact Scale, and average daily step counts were assessed prior to and following 6 weeks of training. The pre-training data from 40 individuals were analyzed cross-sectionally using Pearson and Spearman correlations, to evaluate the potential relationship between limb propulsion (ratio of paretic limb propulsion to total propulsion) with gait speed, gait capacity, perceived quality of life domains, and average daily step counts. Partial correlations were used to control for gait speed. Thirty-one individuals were assessed longitudinally for the same relationships.
Results
We observed a training effect for gait speed, walking capacity, and some quality of life measures. However, after controlling for gait speed, we observed no significant (p≤0.05) correlations in the cross-sectional and longitudinal analyses.
Significance
After controlling for the influence of gait speed, paretic limb propulsion is not directly related to perceived quality of life or participation. Although limb propulsion may not have a direct effect on participant’s perceived quality of life, it appears to be an important factor to enhance gait performance, and therefore may be important to target in rehabilitation, when feasible.
Collapse
|
19
|
Gao W, Cui Z, Yu Y, Mao J, Xu J, Ji L, Kan X, Shen X, Li X, Zhu S, Hong Y. Application of a Brain–Computer Interface System with Visual and Motor Feedback in Limb and Brain Functional Rehabilitation after Stroke: Case Report. Brain Sci 2022; 12:brainsci12081083. [PMID: 36009146 PMCID: PMC9405856 DOI: 10.3390/brainsci12081083] [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: 06/27/2022] [Revised: 08/05/2022] [Accepted: 08/10/2022] [Indexed: 11/25/2022] Open
Abstract
(1) Objective: To investigate the feasibility, safety, and effectiveness of a brain–computer interface (BCI) system with visual and motor feedback in limb and brain function rehabilitation after stroke. (2) Methods: First, we recruited three hemiplegic stroke patients to perform rehabilitation training using a BCI system with visual and motor feedback for two consecutive days (four sessions) to verify the feasibility and safety of the system. Then, we recruited five other hemiplegic stroke patients for rehabilitation training (6 days a week, lasting for 12–14 days) using the same BCI system to verify the effectiveness. The mean and Cohen’s w were used to compare the changes in limb motor and brain functions before and after training. (3) Results: In the feasibility verification, the continuous motor state switching time (CMSST) of the three patients was 17.8 ± 21.0s, and the motor state percentages (MSPs) in the upper and lower limb training were 52.6 ± 25.7% and 72.4 ± 24.0%, respectively. The effective training revolutions (ETRs) per minute were 25.8 ± 13.0 for upper limb and 24.8 ± 6.4 for lower limb. There were no adverse events during the training process. Compared with the baseline, the motor function indices of the five patients were improved, including sitting balance ability, upper limb Fugel–Meyer assessment (FMA), lower limb FMA, 6 min walking distance, modified Barthel index, and root mean square (RMS) value of triceps surae, which increased by 0.4, 8.0, 5.4, 11.4, 7.0, and 0.9, respectively, and all had large effect sizes (Cohen’s w ≥ 0.5). The brain function indices of the five patients, including the amplitudes of the motor evoked potentials (MEP) on the non-lesion side and lesion side, increased by 3.6 and 3.7, respectively; the latency of MEP on the non-lesion side was shortened by 2.6 ms, and all had large effect sizes (Cohen’s w ≥ 0.5). (4) Conclusions: The BCI system with visual and motor feedback is applicable in active rehabilitation training of stroke patients with hemiplegia, and the pilot results show potential multidimensional benefits after a short course of treatment.
Collapse
Affiliation(s)
- Wen Gao
- Department of Rehabilitation Medicine, The Second Hospital of Anhui Medical University, No. 678 Furong Road, Economic and Technological Development Zone, Hefei 230601, China
| | - Zhengzhe Cui
- Zhejiang Laboratory, Department of Intelligent Robot, Keji Avenue, Yuhang Zone, Hangzhou 311100, China
| | - Yang Yu
- Department of Rehabilitation Medicine, The Second Hospital of Anhui Medical University, No. 678 Furong Road, Economic and Technological Development Zone, Hefei 230601, China
| | - Jing Mao
- Department of Rehabilitation Medicine, The Second Hospital of Anhui Medical University, No. 678 Furong Road, Economic and Technological Development Zone, Hefei 230601, China
| | - Jun Xu
- Department of Rehabilitation Medicine, The Second Hospital of Anhui Medical University, No. 678 Furong Road, Economic and Technological Development Zone, Hefei 230601, China
| | - Leilei Ji
- Department of Rehabilitation Medicine, The Second Hospital of Anhui Medical University, No. 678 Furong Road, Economic and Technological Development Zone, Hefei 230601, China
| | - Xiuli Kan
- Department of Rehabilitation Medicine, The Second Hospital of Anhui Medical University, No. 678 Furong Road, Economic and Technological Development Zone, Hefei 230601, China
| | - Xianshan Shen
- Department of Rehabilitation Medicine, The Second Hospital of Anhui Medical University, No. 678 Furong Road, Economic and Technological Development Zone, Hefei 230601, China
| | - Xueming Li
- Department of Rehabilitation Medicine, The Second Hospital of Anhui Medical University, No. 678 Furong Road, Economic and Technological Development Zone, Hefei 230601, China
| | - Shiqiang Zhu
- Zhejiang Laboratory, Department of Intelligent Robot, Keji Avenue, Yuhang Zone, Hangzhou 311100, China
- Ocean College, Zhejiang University, No. 866 Yuhangtang Road, Xihu Zone, Hangzhou 310030, China
- Correspondence: (S.Z.); (Y.H.); Tel.: +86-0571-56390588 (S.Z.); +86-0551-65997012 (Y.H.)
| | - Yongfeng Hong
- Department of Rehabilitation Medicine, The Second Hospital of Anhui Medical University, No. 678 Furong Road, Economic and Technological Development Zone, Hefei 230601, China
- Correspondence: (S.Z.); (Y.H.); Tel.: +86-0571-56390588 (S.Z.); +86-0551-65997012 (Y.H.)
| |
Collapse
|
20
|
de Miguel-Fernandez J, Pescatore C, Mesa-Garrido A, Rikhof C, Prinsen E, Font-Llagunes JM, Lobo-Prat J. Immediate Biomechanical Effects of Providing Adaptive Assistance With an Ankle Exoskeleton in Individuals After Stroke. IEEE Robot Autom Lett 2022. [DOI: 10.1109/lra.2022.3183799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jesus de Miguel-Fernandez
- Biomechanical Engineering Lab, Department of Mechanical Engineering and Research Centre for Biomedical Engineering, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Camille Pescatore
- ABLE Human Motion, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Alba Mesa-Garrido
- Biomechanical Engineering Lab, Department of Mechanical Engineering and Research Centre for Biomedical Engineering, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Cindy Rikhof
- Roessingh Research and Development, Enschede, AH, Netherlands
| | - Erik Prinsen
- Roessingh Research and Development, Enschede, AH, Netherlands
| | - Josep M. Font-Llagunes
- Biomechanical Engineering Lab, Department of Mechanical Engineering and Research Centre for Biomedical Engineering, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Joan Lobo-Prat
- ABLE Human Motion, Universitat Politècnica de Catalunya, Barcelona, Spain
| |
Collapse
|
21
|
Muscle contributions to pre-swing biomechanical tasks influence swing leg mechanics in individuals post-stroke during walking. J Neuroeng Rehabil 2022; 19:55. [PMID: 35659252 PMCID: PMC9166530 DOI: 10.1186/s12984-022-01029-z] [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: 11/01/2021] [Accepted: 05/18/2022] [Indexed: 11/16/2022] Open
Abstract
Background Successful walking requires the execution of the pre-swing biomechanical tasks of body propulsion and leg swing initiation, which are often impaired post-stroke. While excess rectus femoris activity during swing is often associated with low knee flexion, previous work has suggested that deficits in propulsion and leg swing initiation may also contribute. The purpose of this study was to determine underlying causes of propulsion, leg swing initiation and knee flexion deficits in pre-swing and their link to stiff knee gait in individuals post-stroke. Methods Musculoskeletal models and forward dynamic simulations were developed for individuals post-stroke (n = 15) and healthy participants (n = 5). Linear regressions were used to evaluate the relationships between peak knee flexion, braking and propulsion symmetry, and individual muscle contributions to braking, propulsion, knee flexion in pre-swing, and leg swing initiation. Results Four out of fifteen of individuals post-stroke had higher plantarflexor contributions to propulsion and seven out of fifteen had higher vasti contributions to braking on their paretic leg relative to their nonparetic leg. Higher gastrocnemius contributions to propulsion predicted paretic propulsion symmetry (p = 0.005) while soleus contributions did not. Higher vasti contributions to braking in pre-swing predicted lower knee flexion (p = 0.022). The rectus femoris had minimal contributions to lower knee flexion acceleration in pre-swing compared to contributions from the vasti. However, for some individuals with low knee flexion, during pre-swing the rectus femoris absorbed more power and the iliopsoas contributed less power to the paretic leg. Total musculotendon work done on the paretic leg in pre-swing did not predict knee flexion during swing. Conclusions These results emphasize the multiple causes of propulsion asymmetry in individuals post-stroke, including low plantarflexor contributions to propulsion, increased vasti contributions to braking and reliance on compensatory mechanisms. The results also show that the rectus femoris is not a major contributor to knee flexion in pre-swing, but absorbs more power from the paretic leg in pre-swing in some individuals with stiff knee gait. These results highlight the need to identify individual causes of propulsion and knee flexion deficits to design more effective rehabilitation strategies. Supplementary Information The online version contains supplementary material available at 10.1186/s12984-022-01029-z.
Collapse
|
22
|
Tynterova A, Perepelitsa S, Golubev A. Personalized Neurophysiological and Neuropsychological Assessment of Patients with Left and Right Hemispheric Damage in Acute Ischemic Stroke. Brain Sci 2022; 12:brainsci12050554. [PMID: 35624940 PMCID: PMC9139366 DOI: 10.3390/brainsci12050554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/12/2022] [Accepted: 04/23/2022] [Indexed: 02/04/2023] Open
Abstract
The leading factors of post-stroke disability are motor disorders and cognitive dysfunctions. The aim of the study was to identify and provide a rationale for the variable early cognitive dysfunction in right and left hemispheric damage in patients with acute stroke. The study included 80 patients diagnosed with ischemic stroke. All patients were assessed for cognitive status, depression, fatigue and anxiety. For objectification, the method of evoked potentials (P300) and neuroimaging were used. Our findings revealed distinguishing features of cognitive dysfunction and identified a combination of the most informative markers characteristic of right and left hemispheric damage in patients with acute ischemic stroke. In patients with damage to the left hemisphere, a predominance of dysregulation syndrome (decrease in executive function and attention) was revealed, accompanied by various disorders such as severe anxiety and fatigue. The causes of this cognitive dysfunction may be directly related to stroke (damage to subcortical structures), as well as to a preexisting reduction in higher mental functions associated with age and vascular conditions. Cognitive impairments in patients with lesions of the right hemisphere were characterized by polymorphism and observed in the mental praxis, speech (with predominant semantic component) and abstract thinking domains. They are closely linked to each other and are more related to the lateralization of the lesion and preexisting neurodegeneration than to the localization of the ischemic lesion. The study of P300-evoked potentials is a good tool for confirming cognitive dysfunction. The latent period of the P300 wave is more sensitive to neurodegeneration, while the amplitude factor characterizes vascular pathology to a greater extent. The results of the study provide a rationale for a comprehensive assessment of lateralization, stroke localization, underlying diseases, neurophysiological parameters and identified cognitive impairments when developing a plan of rehabilitation and neuropsychological measures aimed at cognitive and emotional recovery of patients both in the acute phase of ischemic stroke and when selecting further personalized rehabilitation programs.
Collapse
Affiliation(s)
- Anastasia Tynterova
- Immanuel Kant Baltic Federal University, 14 Alexander Nevsky St., 236041 Kaliningrad, Kaliningrad Oblast, Russia;
- Correspondence:
| | - Svetlana Perepelitsa
- Immanuel Kant Baltic Federal University, 14 Alexander Nevsky St., 236041 Kaliningrad, Kaliningrad Oblast, Russia;
- V. A. Negovsky Research Institute of General Reanimatology, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 25 Petrovka Str., Build. 2, 107031 Moscow, Moskovskaya Oblast, Russia;
| | - Arкady Golubev
- V. A. Negovsky Research Institute of General Reanimatology, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 25 Petrovka Str., Build. 2, 107031 Moscow, Moskovskaya Oblast, Russia;
| |
Collapse
|
23
|
Wang R, An Q, Yang N, Kogami H, Yoshida K, Yamakawa H, Hamada H, Shimoda S, Yamasaki HR, Yokoyama M, Alnajjar F, Hattori N, Takahashi K, Fujii T, Otomune H, Miyai I, Yamashita A, Asama H. Clarify Sit-to-Stand Muscle Synergy and Tension Changes in Subacute Stroke Rehabilitation by Musculoskeletal Modeling. Front Syst Neurosci 2022; 16:785143. [PMID: 35359620 PMCID: PMC8963921 DOI: 10.3389/fnsys.2022.785143] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 02/15/2022] [Indexed: 12/01/2022] Open
Abstract
Post-stroke patients exhibit distinct muscle activation electromyography (EMG) features in sit-to-stand (STS) due to motor deficiency. Muscle activation amplitude, related to muscle tension and muscle synergy activation levels, is one of the defining EMG features that reflects post-stroke motor functioning and motor impairment. Although some qualitative findings are available, it is not clear if and how muscle activation amplitude-related biomechanical attributes may quantitatively reflect during subacute stroke rehabilitation. To better enable a longitudinal investigation into a patient's muscle activation changes during rehabilitation or an inter-subject comparison, EMG normalization is usually applied. However, current normalization methods using maximum voluntary contraction (MVC) or within-task peak/mean EMG may not be feasible when MVC cannot be obtained from stroke survivors due to motor paralysis and the subject of comparison is EMG amplitude. Here, focusing on the paretic side, we first propose a novel, joint torque-based normalization method that incorporates musculoskeletal modeling, forward dynamics simulation, and mathematical optimization. Next, upon method validation, we apply it to quantify changes in muscle tension and muscle synergy activation levels in STS motor control units for patients in subacute stroke rehabilitation. The novel method was validated against MVC-normalized EMG data from eight healthy participants, and it retained muscle activation amplitude differences for inter- and intra-subject comparisons. The proposed joint torque-based method was also compared with the common static optimization based on squared muscle activation and showed higher simulation accuracy overall. Serial STS measurements were conducted with four post-stroke patients during their subacute rehabilitation stay (137 ± 22 days) in the hospital. Quantitative results of patients suggest that maximum muscle tension and activation level of muscle synergy temporal patterns may reflect the effectiveness of subacute stroke rehabilitation. A quality comparison between muscle synergies computed with the conventional within-task peak/mean EMG normalization and our proposed method showed that the conventional was prone to activation amplitude overestimation and underestimation. The contributed method and findings help recapitulate and understand the post-stroke motor recovery process, which may facilitate developing more effective rehabilitation strategies for future stroke survivors.
Collapse
Affiliation(s)
- Ruoxi Wang
- Department of Precision Engineering, The University of Tokyo, Tokyo, Japan
| | - Qi An
- Department of Information Science and Electrical Engineering, Kyushu University, Fukuoka, Japan
- *Correspondence: Qi An
| | | | - Hiroki Kogami
- Department of Precision Engineering, The University of Tokyo, Tokyo, Japan
| | - Kazunori Yoshida
- Department of Precision Engineering, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Yamakawa
- Department of Precision Engineering, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Hamada
- Department of Precision Engineering, The University of Tokyo, Tokyo, Japan
| | | | - Hiroshi R. Yamasaki
- Department of Physical Therapy, Saitama Prefectural University, Saitama, Japan
| | | | - Fady Alnajjar
- RIKEN Center for Brain Science, Aichi, Japan
- College of Information Technology, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Noriaki Hattori
- Department of Rehabilitation, University of Toyama, Toyama, Japan
| | | | | | | | | | - Atsushi Yamashita
- Department of Precision Engineering, The University of Tokyo, Tokyo, Japan
| | - Hajime Asama
- Department of Precision Engineering, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
24
|
Pariser KM, Donlin MC, Downer KE, Higginson JS. Adaptive treadmill control can be manipulated to increase propulsive impulse while maintaining walking speed. J Biomech 2022; 133:110971. [PMID: 35121382 PMCID: PMC8891055 DOI: 10.1016/j.jbiomech.2022.110971] [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: 08/10/2021] [Revised: 01/20/2022] [Accepted: 01/21/2022] [Indexed: 11/18/2022]
Abstract
Adaptive treadmills (ATM) designed to promote increased propulsion may be an effective tool for gait training since propulsion is often impaired post-stroke. Our lab developed a novel ATM controller that adjusts belt speed via real-time changes in step length, propulsive impulse, and position. This study modified the relative importance of propulsion to step length in the controller to determine the effect of increased propulsive feedback gain on measures of propulsion and walking speed. Twenty-two participants completed five trials at their self-selected speed, each with a unique ATM controller. Walking speed, peak AGRF and PGRF, and AGRF, PGRF, and net impulse were compared between the modifications using one-way repeated measures ANOVAs at a significance level of 0.05. Participants chose similar walking speeds across all conditions (all p > 0.2730). There were no significant differences in peak AGRF (p = 0.1956) or PGRF (p = 0.5159) between conditions. AGRF impulse significantly increased as the gain on the propulsive impulse term was increased relative to the gain on step length (p < 0.0001) while PGRF and net impulse were similar across all conditions (p = 0.5487). Increasing the propulsive impulse gain essentially alters the treadmill environment by providing a controlled amount of resistance to increases in propulsive forces. Our findings demonstrate that the ATM can be modified to promote increased propulsive impulse while maintaining a consistent walking speed. Since increasing propulsion is a common goal of post-stroke gait training, these ATM modifications may improve the efficacy of the ATM for gait rehabilitation.
Collapse
Affiliation(s)
- Kayla M Pariser
- Department of Mechanical Engineering, University of Delaware, Newark, DE, USA.
| | - Margo C Donlin
- Department of Biomedical Engineering, University of Delaware, Newark, DE, USA
| | - Kaitlyn E Downer
- Department of Mechanical Engineering, University of Delaware, Newark, DE, USA
| | - Jill S Higginson
- Department of Mechanical Engineering, University of Delaware, Newark, DE, USA; Department of Biomedical Engineering, University of Delaware, Newark, DE, USA
| |
Collapse
|
25
|
Donlin MC, Pariser KM, Downer KE, Higginson JS. Adaptive treadmill walking encourages persistent propulsion. Gait Posture 2022; 93:246-251. [PMID: 35190317 PMCID: PMC8930561 DOI: 10.1016/j.gaitpost.2022.02.017] [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: 11/04/2021] [Revised: 02/10/2022] [Accepted: 02/14/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Adaptive treadmills allow real-time changes in walking speed by responding to changes in step length, propulsion, or position on the treadmill. The stride-to-stride variability, or persistence, of stride time during overground, fixed-speed, and adaptive treadmill walking has been studied, but persistence of propulsion during adaptive treadmill walking remains unknown. Because increased propulsion is often a goal of post-stroke rehabilitation, knowledge of the stride-to-stride variability may aid rehabilitation protocol design. RESEARCH QUESTION How do spatiotemporal and propulsive gait variables vary from stride to stride during adaptive treadmill walking, and how do they compare to fixed-speed treadmill walking? METHODS Eighteen young healthy subjects walked on an instrumented split-belt treadmill in the adaptive and fixed-speed modes for 10 minutes at their comfortable speed. Kinetic data was collected from the treadmill. Detrended fluctuation analysis was applied to the time series data. Shapiro-Wilk tests assessed normality and one-way repeated measures ANOVAs compared between adaptive, fixed-speed, and randomly shuffled conditions at a Bonferroni-corrected significance level of 0.0055. RESULTS Stride time, stride length, step length, and braking impulse were persistent (α > 0.5) in the adaptive and fixed-speed conditions. Adaptive and fixed-speed were different from each other. Stride speed was persistent in the adaptive condition and anti-persistent (α < 0.5) in the fixed-speed condition. Peak propulsive force, peak braking force, and propulsive impulse were persistent in the adaptive condition but not the fixed-speed condition (α ≈ 0.5). Net impulse was non-persistent in the adaptive and fixed-speed conditions. All variables were non-persistent in the shuffled condition. SIGNIFICANCE During adaptive treadmill walking, increases in propulsive force and impulse persist for multiple strides. Persistence was stronger on the adaptive treadmill, where increased propulsion translates into increased walking speed. For post-stroke gait rehabilitation where increasing propulsion and speed are goals, the stronger persistence of adaptive treadmill walking may be beneficial.
Collapse
Affiliation(s)
- Margo C. Donlin
- Department of Biomedical Engineering, University of Delaware, Newark, DE, USA,Corresponding author at: University of Delaware, 540 S. College Ave., STAR Health Sciences Complex, Rm. 201, Newark, DE, USA. (Margo Donlin)
| | - Kayla M. Pariser
- Department of Mechanical Engineering, University of Delaware, Newark, DE, USA
| | - Kaitlyn E. Downer
- Department of Mechanical Engineering, University of Delaware, Newark, DE, USA
| | - Jill S. Higginson
- Department of Biomedical Engineering, University of Delaware, Newark, DE, USA,Department of Mechanical Engineering, University of Delaware, Newark, DE, USA
| |
Collapse
|
26
|
Tomc M, Matjačić Z. Harnessing Energy of a Treadmill for Push-Off Assistance During Walking: In-Silico Feasibility Study. Front Bioeng Biotechnol 2022; 10:832087. [PMID: 35252141 PMCID: PMC8889039 DOI: 10.3389/fbioe.2022.832087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
Regaining efficient push-off is a crucial step in restitution of walking ability in impaired individuals. Inspired by the elastic nature of ankle plantarflexor muscle-tendon complex, we propose a novel rehabilitation device: Ankle Exoskeleton using Treadmill Actuation for Push-off assistance (AN-EXTRA-Push). Using a brake and an elastic tendon, it harnesses energy of a moving treadmill during stance phase, then releases it during push-off to aid with plantarflexion torque generation. We studied the feasibility of such a device and explored some key design and control parameters. A parameter sweep of three key parameters (brake engagement timing, brake disengagement timing and elastic tendon stiffness) was conducted in-silico. Results suggest that such a device is feasible and might inherently possess some features that simplify its control. Brake engagement timing and elastic tendon stiffness values determine the level of exoskeleton assistance. Our study affirms that timing of assistive torque is crucial, especially the timing of assistance termination which is determined by brake disengagement timing. Insights acquired by this study should serve as a basis for designing an experimental device and conducting studies on effects of AN-EXTRA-Push in humans.
Collapse
Affiliation(s)
- Matej Tomc
- Research and Development Unit, University Rehabilitation Institute Republic of Slovenia, Ljubljana, Slovenia
- Laboratory of Robotics, Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia
- *Correspondence: Matej Tomc,
| | - Zlatko Matjačić
- Research and Development Unit, University Rehabilitation Institute Republic of Slovenia, Ljubljana, Slovenia
- Laboratory of Robotics, Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
27
|
Sanjeevi N, Singh Y, Vashista V. Recent advances in lower-extremity exoskeletons in promoting performance restoration. CURRENT OPINION IN BIOMEDICAL ENGINEERING 2021. [DOI: 10.1016/j.cobme.2021.100338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
|
28
|
Haruyama K, Kawakami M, Okada K, Okuyama K, Tsuzuki K, Liu M. Pelvis-Toe Distance: 3-Dimensional Gait Characteristics of Functional Limb Shortening in Hemiparetic Stroke. SENSORS 2021; 21:s21165417. [PMID: 34450859 PMCID: PMC8401521 DOI: 10.3390/s21165417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/06/2021] [Accepted: 08/09/2021] [Indexed: 12/17/2022]
Abstract
We aimed to investigate whether a newly defined distance in the lower limb can capture the characteristics of hemiplegic gait compared to healthy controls. Three-dimensional gait analyses were performed on 42 patients with chronic stroke and 10 age-matched controls. Pelvis-toe distance (PTD) was calculated as the absolute distance between an anterior superior iliac spine marker and a toe marker during gait normalized by PTD in the bipedal stance. The shortening peak during the swing phase was then quantified as PTDmin. The sagittal clearance angle, the frontal compensatory angle, gait speed, and the observational gait scale were also collected. PTDmin in the stroke group showed less shortening on the affected side and excessive shortening on the non-affected side compared to controls. PTDmin on the affected side correlated negatively with the sagittal clearance peak angle and positively with the frontal compensatory peak angle in the stroke group. PTDmin in stroke patients showed moderate to high correlations with gait speed and observational gait scale. PTDmin adequately reflected gait quality without being affected by apparent improvements due to frontal compensatory patterns. Our results showed that various impairments and compensations were included in the inability to shorten PTD, which can provide new perspectives on gait rehabilitation in stroke patients.
Collapse
|
29
|
Time-integrated propulsive and braking impulses do not depend on walking speed. Gait Posture 2021; 88:258-263. [PMID: 34139632 PMCID: PMC8316424 DOI: 10.1016/j.gaitpost.2021.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/24/2021] [Accepted: 06/09/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Enhancing propulsion during walking is often a focus in physical therapy for those with impaired gait. However, there is no consensus in the literature for assessing braking and propulsion. Both are typically measured from the anterior-posterior ground reaction force (AP-GRF). While normalization of AP-GRF force by bodyweight is commonly done in the analysis, different methods for AP-GRF time axis normalization are used. RESEARCH QUESTION Does walking speed affect propulsion and/or braking, and how do different methods for calculating propulsion and braking impact the conclusion, in both healthy adults and those with lower limb impairment? METHODS We investigated three different analysis methods for assessing propulsion. 1. BW-TimeIntegration: Bodyweight (BW) normalized time integration of AP-GRF (units of BWs). 2. BW-%StanceIntegration: BW normalized AP-GRF is resampled to percent stance phase prior to integration (units of BW%Stance). 3. BW-Peak: BW normalized peak force (units of BW). We applied these methods to two data sets. One data set included AP-GRFs from trials of slow, self-selected, and fast walking speeds for 203 healthy controls (HCs); a second data set included subjects with lower limb orthopedic injuries. RESULTS Using the BW-TimeIntegration method, we found no effect of walking speed on propulsion for HCs. Time integration over the longer stance phase of slower walking balanced the lower magnitude AP-GRFs of slower walking, resulting in a time-integrated impulse that was the same regardless of walking speed. In contrast, the other two methods that are not time integration methods found that propulsion increased with walking speed. Similarly, in the gait pathology data set, differences in results were found depending on the analysis method used. SIGNIFICANCE For many gait studies concerning propulsion and/or braking, the impulse measure used should be related to the body's change of momentum, necessitating an analysis method with a time integration of the AP-GRF.
Collapse
|
30
|
Alingh JF, Groen BE, Kamphuis JF, Geurts ACH, Weerdesteyn V. Task-specific training for improving propulsion symmetry and gait speed in people in the chronic phase after stroke: a proof-of-concept study. J Neuroeng Rehabil 2021; 18:69. [PMID: 33892754 PMCID: PMC8062933 DOI: 10.1186/s12984-021-00858-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/22/2021] [Indexed: 12/21/2022] Open
Abstract
Background After stroke, some individuals have latent, propulsive capacity of the paretic leg, that can be elicited during task-specific gait training. The aim of this proof-of-concept study was to investigate the effect of five-week robotic gait training for improving propulsion symmetry by increasing paretic propulsion in chronic stroke survivors. Methods Twenty-nine individuals with chronic stroke and impaired paretic propulsion (≥ 8% difference in paretic vs. non-paretic propulsive impulse) were enrolled. Participants received ten 60-min sessions of individual robotic gait training targeting paretic propulsion (five weeks, twice a week), complemented with home exercises (15 min/day) focusing on increasing strength and practicing learned strategies in daily life. Propulsion measures, gait kinematics and kinetics, self-selected gait speed, performance of functional gait tasks, and daily-life mobility and physical activity were assessed five weeks (T0) and one week (T1) before the start of intervention, and one week (T2) and five weeks (T3) after the intervention period. Results Between T0 and T1, no significant differences in outcomes were observed, except for a marginal increase in gait speed (+ 2.9%). Following the intervention, propulsion symmetry (+ 7.9%) and paretic propulsive impulse had significantly improved (+ 8.1%), whereas non-paretic propulsive impulse remained unchanged. Larger gains in propulsion symmetry were associated with more asymmetrical propulsion at T0. In addition, following the intervention significantly greater paretic trailing limb angles (+ 6.6%) and ankle plantarflexion moments (+ 7.1%) were observed. Furthermore, gait speed (+ 7.2%), 6-Minute Walk Test (+ 6.4%), Functional Gait Assessment (+ 6.5%), and daily-life walking intensity (+ 6.9%) had increased following the intervention. At five-week follow-up (T3), gains in all outcomes were retained, and gait speed had further increased (+ 3.6%). Conclusions The post-intervention gain in paretic propulsion did not only translate into improved propulsion symmetry and gait speed, but also pertained to performance of functional gait tasks and daily-life walking activity levels. These findings suggest that well-selected chronic stroke survivors may benefit from task-specific targeted training to utilize the residual propulsive capacity of the paretic leg. Future research is recommended to establish simple baseline measures for identification of individuals who may benefit from such training and confirm benefits of the used training concepts in a randomized controlled trial. Trial registration: Registry number ClinicalTrials.gov (www.clinicaltrials.gov): NCT04650802, retrospectively registered 3 December 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s12984-021-00858-8.
Collapse
Affiliation(s)
- J F Alingh
- Sint Maartenskliniek Research, PO Box 9011, 6500 GM, Nijmegen, The Netherlands.,Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - B E Groen
- Sint Maartenskliniek Research, PO Box 9011, 6500 GM, Nijmegen, The Netherlands.,Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - J F Kamphuis
- Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - A C H Geurts
- Sint Maartenskliniek Research, PO Box 9011, 6500 GM, Nijmegen, The Netherlands.,Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - V Weerdesteyn
- Sint Maartenskliniek Research, PO Box 9011, 6500 GM, Nijmegen, The Netherlands. .,Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands.
| |
Collapse
|
31
|
Sánchez N, Winstein CJ. Lost in Translation: Simple Steps in Experimental Design of Neurorehabilitation-Based Research Interventions to Promote Motor Recovery Post-Stroke. Front Hum Neurosci 2021; 15:644335. [PMID: 33958994 PMCID: PMC8093777 DOI: 10.3389/fnhum.2021.644335] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 03/30/2021] [Indexed: 01/02/2023] Open
Abstract
Stroke continues to be a leading cause of disability. Basic neurorehabilitation research is necessary to inform the neuropathophysiology of impaired motor control, and to develop targeted interventions with potential to remediate disability post-stroke. Despite knowledge gained from basic research studies, the effectiveness of research-based interventions for reducing motor impairment has been no greater than standard of practice interventions. In this perspective, we offer suggestions for overcoming translational barriers integral to experimental design, to augment traditional protocols, and re-route the rehabilitation trajectory toward recovery and away from compensation. First, we suggest that researchers consider modifying task practice schedules to focus on key aspects of movement quality, while minimizing the appearance of compensatory behaviors. Second, we suggest that researchers supplement primary outcome measures with secondary measures that capture emerging maladaptive compensations at other segments or joints. Third, we offer suggestions about how to maximize participant engagement, self-direction, and motivation, by embedding the task into a meaningful context, a strategy more likely to enable goal-action coupling, associated with improved neuro-motor control and learning. Finally, we remind the reader that motor impairment post-stroke is a multidimensional problem that involves central and peripheral sensorimotor systems, likely influenced by chronicity of stroke. Thus, stroke chronicity should be given special consideration for both participant recruitment and subsequent data analyses. We hope that future research endeavors will consider these suggestions in the design of the next generation of intervention studies in neurorehabilitation, to improve translation of research advances to improved participation and quality of life for stroke survivors.
Collapse
Affiliation(s)
- Natalia Sánchez
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States
| | - Carolee J Winstein
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States.,Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| |
Collapse
|