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Li X, Li H, Liu Y, Liang W, Zhang L, Zhou F, Zhang Z, Yuan X. The effect of electromyographic feedback functional electrical stimulation on the plantar pressure in stroke patients with foot drop. Front Neurosci 2024; 18:1377702. [PMID: 38629052 PMCID: PMC11018889 DOI: 10.3389/fnins.2024.1377702] [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: 01/28/2024] [Accepted: 03/22/2024] [Indexed: 04/19/2024] Open
Abstract
Purpose The purpose of this study was to observe, using Footscan analysis, the effect of electromyographic feedback functional electrical stimulation (FES) on the changes in the plantar pressure of drop foot patients. Methods This case-control study enrolled 34 stroke patients with foot drop. There were 17 cases received FES for 20 min per day, 5 days per week for 4 weeks (the FES group) and the other 17 cases only received basic rehabilitations (the control group). Before and after 4 weeks, the walking speed, spatiotemporal parameters and plantar pressure were measured. Results After 4 weeks treatments, Both the FES and control groups had increased walking speed and single stance phase percentage, decreased step length symmetry index (SI), double stance phase percentage and start time of the heel after 4 weeks (p < 0.05). The increase in walking speed and decrease in step length SI in the FES group were more significant than the control group after 4 weeks (p < 0.05). The FES group had an increased initial contact phase, decreased SI of the maximal force (Max F) and impulse in the medial heel after 4 weeks (p < 0.05). Conclusion The advantages of FES were: the improvement of gait speed, step length SI, and the enhancement of propulsion force were more significant. The initial contact phase was closer to the normal range, which implies that the control of ankle dorsiflexion was improved. The plantar dynamic parameters between the two sides of the foot were more balanced than the control group. FES is more effective than basic rehabilitations for stroke patients with foot drop based on current spatiotemporal parameters and plantar pressure results.
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Affiliation(s)
| | | | | | | | | | | | - Zhiqiang Zhang
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiangnan Yuan
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, China
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Sekiguchi Y, Owaki D, Honda K, Izumi SI, Ebihara S. Differences in kinetic factors affecting gait speed between lesion sides in patients with stroke. Front Bioeng Biotechnol 2024; 12:1240339. [PMID: 38567085 PMCID: PMC10985198 DOI: 10.3389/fbioe.2024.1240339] [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: 06/14/2023] [Accepted: 03/06/2024] [Indexed: 04/04/2024] Open
Abstract
The differences in kinetic mechanisms of decreased gait speed across brain lesion sides have not been elucidated, including the arrangement of motor modules reflected by kinetic interjoint coordination. The purpose of this study was to elucidate the differences in the kinetic factors of slow gait speed in patients with stroke on the lesion sides. A three-dimensional motion analysis system was employed to assess joint moment in the lower limb and representative gait parameters in 32 patients with right hemisphere brain damage (RHD) and 38 patients with left hemisphere brain damage (LHD) following stroke as well as 20 healthy controls. Motor module composition and timing were determined using principal component analysis based on the three joint moments in the lower limb in the stance phase, which were the variances accounted for principal components (PCs) and the peak timing in the time series of PCs. A stepwise multiple linear regression analysis was performed to identify the most significant joint moment and PC-associated parameter in explaining gait speed. A negligible difference was observed in age, weight, height, and gait speed among patients with RHD and LHD and controls. The following factors contributed to gait speed: in patients with RHD, larger ankle plantarflexion moment on the paretic (p = 0.001) and nonparetic (p = 0.002) sides and ankle dorsiflexion moment on the nonparetic side (p = 0.004); in patients with LHD, larger ankle plantarflexion moment (p < 0.001) and delayed peak timing of the first PC (p = 0.012) on the paretic side as well as ankle dorsiflexion moment on the nonparetic side (p < 0.001); in the controls, delayed peak timing of the first PC (p = 0.002) on the right side and larger ankle dorsiflexion moment (p = 0.001) as well as larger hip flexion moment on the left side (p = 0.023). The findings suggest that the kinetic mechanisms of gait speed may differ among patients with RHD following patients with stroke with LHD, and controls.
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Affiliation(s)
- Yusuke Sekiguchi
- Department of Physical Medicine and Rehabilitation, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Dai Owaki
- Department of Robotics, Graduate School of Engineering, Tohoku University, Sendai, Japan
| | - Keita Honda
- Department of Physical Medicine and Rehabilitation, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Shin-Ichi Izumi
- Department of Physical Medicine and Rehabilitation, Graduate School of Medicine, Tohoku University, Sendai, Japan
- Department of Physical Medicine and Rehabilitation, Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan
| | - Satoru Ebihara
- Department of Internal Medicine & Rehabilitation Science, Disability Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
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Shih PC, Steele CJ, Hoepfel D, Muffel T, Villringer A, Sehm B. The impact of lesion side on bilateral upper limb coordination after stroke. J Neuroeng Rehabil 2023; 20:166. [PMID: 38093308 PMCID: PMC10717693 DOI: 10.1186/s12984-023-01288-4] [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: 07/30/2022] [Accepted: 11/29/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND A stroke frequently results in impaired performance of activities of daily life. Many of these are highly dependent on effective coordination between the two arms. In the context of bimanual movements, cyclic rhythmical bilateral arm coordination patterns can be classified into two fundamental modes: in-phase (bilateral homologous muscles contract simultaneously) and anti-phase (bilateral muscles contract alternately) movements. We aimed to investigate how patients with left (LHS) and right (RHS) hemispheric stroke are differentially affected in both individual-limb control and inter-limb coordination during bilateral movements. METHODS We used kinematic measurements to assess bilateral coordination abilities of 18 chronic hemiparetic stroke patients (9 LHS; 9 RHS) and 18 age- and sex-matched controls. Using KINARM upper-limb exoskeleton system, we examined individual-limb control by quantifying trajectory variability in each hand and inter-limb coordination by computing the phase synchronization between hands during anti- and in-phase movements. RESULTS RHS patients exhibited greater impairment in individual- and inter-limb control during anti-phase movements, whilst LHS patients showed greater impairment in individual-limb control during in-phase movements alone. However, LHS patients further showed a swap in hand dominance during in-phase movements. CONCLUSIONS The current study used individual-limb and inter-limb kinematic profiles and showed that bilateral movements are differently impaired in patients with left vs. right hemispheric strokes. Our results demonstrate that both fundamental bilateral coordination modes are differently controlled in both hemispheres using a lesion model approach. From a clinical perspective, we suggest that lesion side should be taken into account for more individually targeted bilateral coordination training strategies. TRIAL REGISTRATION the current experiment is not a health care intervention study.
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Affiliation(s)
- Pei-Cheng Shih
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Sony Computer Science Laboratories, Inc, Tokyo, Japan
| | - Christopher J Steele
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Department of Psychology, Concordia University, Montreal, QC, Canada
| | - Dennis Hoepfel
- Clinic and Polyclinic for Psychiatry and Psychotherapy, Leipzig, Germany
| | - Toni Muffel
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Arno Villringer
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Cognitive Neurology, University Hospital Leipzig, Leipzig, Germany
| | - Bernhard Sehm
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.
- Department of Cognitive Neurology, University Hospital Leipzig, Leipzig, Germany.
- Department of Neurology, University Hospital Halle (Saale), Halle, Germany.
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Tripathi S, Verghese J, Callisaya M, Mahoney JR, Srikanth V, Blumen HM. Brain patterns of pace - but not rhythm - are associated with vascular disease in older adults. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2022; 3:100154. [PMID: 36389342 PMCID: PMC9646823 DOI: 10.1016/j.cccb.2022.100154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 11/01/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022]
Abstract
Background Distinct domains of gait such as pace and rhythm are linked to an increased risk for cognitive decline, falls, and dementia in aging. The brain substrates supporting these domains and underlying diseases, however, remain relatively unknown. The current study aimed to identify patterns of gray matter volume (GMV) associated with pace and rhythm, and whether these patterns vary as a function of vascular and non-vascular comorbidities. Methods A cross-sectional sample of 297 older adults (M Age = 72.5 years ± 7.2 years, 43% women) without dementia was drawn from the Tasmanian Study of Cognition and Gait (TASCOG). Factor analyses were used to reduce eight quantitative gait variables into two domains. The "pace" domain was primarily composed of gait speed, stride length, and double support time. The "rhythm" domain was composed of swing time, stance time, and cadence. Multivariate covariance-based analyses adjusted for age, sex, education, total intracranial volume, and presence of mild cognitive impairment identified gray matter volume (GMV) patterns associated with pace and rhythm, as well as participant-specific expression (or factor) scores for each pattern. Results Pace was positively associated with GMV in the right superior temporal sulcus, bilateral supplementary motor areas (SMA), and bilateral cerebellar regions. Rhythm was positively associated with GMV in bilateral SMA, prefrontal, cingulate, and paracingulate cortices. The GMV pattern associated with pace was less expressed in participants with any vascular disease; this association was also found independently with hypertension, diabetes, and myocardial infarction. Conclusion Both pace and rhythm domains of gait were associated with the volume of brain structures that have been linked to controlled and automatic aspects of gait control, as well as with structures involved in multisensory integration. Only the brain structures associated with pace, however, were associated with vascular disease.
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Affiliation(s)
- Susmit Tripathi
- Department of Neurology, Weill Cornell Medicine, New York, NY 10065, USA
| | - Joe Verghese
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA,Department of Neurology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Michele Callisaya
- Peninsula Clinical School, Central Clinical School, Monash University, Victoria, Australia,Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia
| | - Jeannette R. Mahoney
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Velandai Srikanth
- Peninsula Clinical School, Central Clinical School, Monash University, Victoria, Australia,Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia
| | - Helena M. Blumen
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA,Department of Neurology, Albert Einstein College of Medicine, Bronx, NY 10461, USA,Corresponding author at: Department of Medicine (Geriatrics), Department of Neurology (Cognitive & Motor Aging), Albert Einstein College of Medicine, 1225 Morris Park Avenue, Van Etten Building, Room 319 Bronx, NY 10461, USA.
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Sekiguchi Y, Honda K, Izumi SI. Effect of Walking Adaptability on an Uneven Surface by a Stepping Pattern on Walking Activity After Stroke. Front Hum Neurosci 2022; 15:762223. [PMID: 35058764 PMCID: PMC8764227 DOI: 10.3389/fnhum.2021.762223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 11/16/2021] [Indexed: 11/24/2022] Open
Abstract
Real-world walking activity is important for poststroke patients because it leads to their participation in the community and physical activity. Walking activity may be related to adaptability to different surface conditions of the ground. The purpose of this study was to clarify whether walking adaptability on an uneven surface by step is related to daily walking activity in patients after stroke. We involved 14 patients who had hemiparesis after stroke (age: 59.4 ± 8.9 years; post-onset duration: 70.7 ± 53.5 months) and 12 healthy controls (age: 59.5 ± 14.2 years). The poststroke patients were categorized as least limited community ambulators or unlimited ambulators. For the uneven surface, the study used an artificial grass surface (7 m long, 2-cm leaf length). The subjects repeated even surface walking and the uneven surface walking trials at least two times at a comfortable speed. We collected spatiotemporal and kinematic gait parameters on both the even and uneven surfaces using a three-dimensional motion analysis system. After we measured gait, the subjects wore an accelerometer around the waist for at least 4 days. We measured the number of steps per day using the accelerometer to evaluate walking activity. Differences in gait parameters between the even and uneven surfaces were calculated to determine how the subjects adapted to an uneven surface while walking. We examined the association between the difference in parameter measurements between the two surface properties and walking activity (number of steps per day). Walking activity significantly and positively correlated with the difference in paretic step length under the conditions of different surface properties in the poststroke patients (r = 0.65, p = 0.012) and step width in the healthy controls (r = 0.68, p = 0.015). The strategy of increasing the paretic step length, but not step width, on an uneven surface may lead to a larger base of support, which maintains stability during gait on an uneven surface in poststroke patients, resulting in an increased walking activity. Therefore, in poststroke patients, an increase in paretic step length during gait on an uneven surface might be more essential for improving walking activity.
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Affiliation(s)
- Yusuke Sekiguchi
- Department of Physical Medicine and Rehabilitation, Graduate School of Medicine, Tohoku University, Sendai, Japan
- *Correspondence: Yusuke Sekiguchi,
| | - Keita Honda
- Department of Physical Medicine and Rehabilitation, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Shin-Ichi Izumi
- Department of Physical Medicine and Rehabilitation, Graduate School of Medicine, Tohoku University, Sendai, Japan
- Department of Physical Medicine and Rehabilitation, Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan
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Integrity of the Inferior Cerebellar Peduncle Correlates with Ambulatory Function after Hemorrhagic Stroke. J Stroke Cerebrovasc Dis 2021; 30:106164. [PMID: 34655972 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106164] [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: 07/13/2021] [Revised: 09/28/2021] [Accepted: 10/03/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Cerebro-cerebellar connectivity plays a critical role in motor recovery after stroke; however, the underlying mechanism of walking recovery is unclear. The dorsal spinocerebellar pathway has been suggested as a biomarker of poststroke ambulatory function. We aimed to explore the association between ambulatory function and the dorsal spinocerebellar pathway's integrity after intracerebral hemorrhage (ICH). MATERIALS AND METHODS Twenty-seven patients with ICH who were admitted for inpatient rehabilitation during the subacute phase of stroke and 27 age-matched healthy controls were included retrospectively. Ambulatory function was assessed using the Berg Balance Scale and Mobility score. We measured the fractional anisotropy (FA) values of the corticospinal tract (CST) and inferior cerebellar peduncle (ICP) as the final route of the dorsal spinocerebellar pathway. The FA laterality indices, representing the degree of degeneration, were calculated. A Spearman correlation analysis and multivariate linear regression models were used to determine the associations between the FA laterality indices and ambulatory function. RESULTS An FA reduction was found in both the ipsilesional CST and contralesional ICP of the patients. The ICP FA laterality index exhibited a moderate correlation with ambulatory function (Berg Balance Scale, ρBBS=0.589; Mobility score, ρMS=0.619). On dividing the patient group into the moderate (mRS 3, 4) and severe disability (mRS 5) groups, a stronger correlation was found (ρBBS=0.777, ρMS=0.856, moderate disability; ρBBS=0.732, ρMS=0.797, severe disability). The ICP FA laterality index and age were independently associated with the Mobility score (R2=0.525). CONCLUSIONS ICP degeneration occurs after ICH, and its degree is associated with ambulatory function after ICH.
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Fabre M, Antoine M, Robitaille MG, Ribot-Ciscar E, Ackerley R, Aimonetti JM, Chavet P, Blouin J, Simoneau M, Mouchnino L. Large Postural Sways Prevent Foot Tactile Information From Fading: Neurophysiological Evidence. Cereb Cortex Commun 2021; 2:tgaa094. [PMID: 34296149 PMCID: PMC8152841 DOI: 10.1093/texcom/tgaa094] [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: 11/25/2020] [Revised: 11/25/2020] [Accepted: 12/15/2020] [Indexed: 11/15/2022] Open
Abstract
Cutaneous foot receptors are important for balance control, and their activation during quiet standing depends on the speed and the amplitude of postural oscillations. We hypothesized that the transmission of cutaneous input to the cortex is reduced during prolonged small postural sways due to receptor adaptation during continued skin compression. Central mechanisms would trigger large sways to reactivate the receptors. We compared the amplitude of positive and negative post-stimulation peaks (P50N90) somatosensory cortical potentials evoked by the electrical stimulation of the foot sole during small and large sways in 16 young adults standing still with their eyes closed. We observed greater P50N90 amplitudes during large sways compared with small sways consistent with increased cutaneous transmission during large sways. Postural oscillations computed 200 ms before large sways had smaller amplitudes than those before small sways, providing sustained compression within a small foot sole area. Cortical source analyses revealed that during this interval, the activity of the somatosensory areas decreased, whereas the activity of cortical areas engaged in motor planning (supplementary motor area, dorsolateral prefrontal cortex) increased. We concluded that large sways during quiet standing represent self-generated functional behavior aiming at releasing skin compression to reactivate mechanoreceptors. Such balance motor commands create sensory reafference that help control postural sway.
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Affiliation(s)
- Marie Fabre
- Laboratoire de Neurosciences Cognitives, Aix Marseille Université, CNRS, FR 3C, Marseille 13331, France
| | - Marine Antoine
- Département de kinésiologie, Faculté de médecine, Université Laval, Québec, QC G1V 0A6, Canada
| | | | - Edith Ribot-Ciscar
- LNSC (Laboratoire de Neurosciences Sensorielles et Cognitives - UMR 7260, FR3C), Aix Marseille Université, CNRS, Marseille 13331, France
| | - Rochelle Ackerley
- LNSC (Laboratoire de Neurosciences Sensorielles et Cognitives - UMR 7260, FR3C), Aix Marseille Université, CNRS, Marseille 13331, France
| | - Jean-Marc Aimonetti
- LNSC (Laboratoire de Neurosciences Sensorielles et Cognitives - UMR 7260, FR3C), Aix Marseille Université, CNRS, Marseille 13331, France
| | - Pascale Chavet
- Institut des Sciences du Mouvement, Aix Marseille Université, CNRS, Marseille 13288, France
| | - Jean Blouin
- Laboratoire de Neurosciences Cognitives, Aix Marseille Université, CNRS, FR 3C, Marseille 13331, France
| | - Martin Simoneau
- Département de kinésiologie, Faculté de médecine, Université Laval, Québec, QC G1V 0A6, Canada
| | - Laurence Mouchnino
- Laboratoire de Neurosciences Cognitives, Aix Marseille Université, CNRS, FR 3C, Marseille 13331, France
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Frenkel-Toledo S, Ofir-Geva S, Mansano L, Granot O, Soroker N. Stroke Lesion Impact on Lower Limb Function. Front Hum Neurosci 2021; 15:592975. [PMID: 33597852 PMCID: PMC7882502 DOI: 10.3389/fnhum.2021.592975] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 01/12/2021] [Indexed: 12/13/2022] Open
Abstract
The impact of stroke on motor functioning is analyzed at different levels. ‘Impairment’ denotes the loss of basic characteristics of voluntary movement. ‘Activity limitation’ denotes the loss of normal capacity for independent execution of daily activities. Recovery from impairment is accomplished by ‘restitution’ and recovery from activity limitation is accomplished by the combined effect of ‘restitution’ and ‘compensation.’ We aimed to unravel the long-term effects of variation in lesion topography on motor impairment of the hemiparetic lower limb (HLL), and gait capacity as a measure of related activity limitation. Gait was assessed by the 3 m walk test (3MWT) in 67 first-event chronic stroke patients, at their homes. Enduring impairment of the HLL was assessed by the Fugl–Meyer Lower Extremity (FMA-LE) test. The impact of variation in lesion topography on HLL impairment and on walking was analyzed separately for left and right hemispheric damage (LHD, RHD) by voxel-based lesion-symptom mapping (VLSM). In the LHD group, HLL impairment tended to be affected by damage to the posterior limb of the internal capsule (PLIC). Walking capacity tended to be affected by a larger array of structures: PLIC and corona radiata, external capsule and caudate nucleus. In the RHD group, both HLL impairment and walking capacity were sensitive to damage in a much larger number of brain voxels. HLL impairment was affected by damage to the corona radiata, superior longitudinal fasciculus and insula. Walking was affected by damage to the same areas, plus the internal and external capsules, putamen, thalamus and parts of the perisylvian cortex. In both groups, voxel clusters have been found where damage affected FMA-LE and also 3MWT, along with voxels where damage affected only one of the measures (mainly 3MWT). In stroke, enduring ‘activity limitation’ is affected by damage to a much larger array of brain structures and voxels within specific structures, compared to enduring ‘impairment.’ Differences between the effects of left and right hemisphere damage are likely to reflect variation in motor-network organization and post-stroke re-organization related to hemispheric dominance. Further studies with larger sample size are required for the validation of these results.
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Affiliation(s)
- Silvi Frenkel-Toledo
- Department of Physical Therapy, Faculty of Health Sciences, Ariel University, Ariel, Israel.,Department of Neurological Rehabilitation, Loewenstein Rehabilitation Medical Center, Ra'anana, Israel
| | - Shay Ofir-Geva
- Department of Neurological Rehabilitation, Loewenstein Rehabilitation Medical Center, Ra'anana, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lihi Mansano
- Department of Neurological Rehabilitation, Loewenstein Rehabilitation Medical Center, Ra'anana, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Osnat Granot
- Department of Neurological Rehabilitation, Loewenstein Rehabilitation Medical Center, Ra'anana, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nachum Soroker
- Department of Neurological Rehabilitation, Loewenstein Rehabilitation Medical Center, Ra'anana, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Lin YY, Guo SJ, Quan H, Zhao YX, Huang DY. Donepezil Improves Gait Performance in Patients with an Acute Cerebral Infarction: A Prospective Observational Cohort Study. Curr Neurovasc Res 2020; 17:304-311. [PMID: 32282302 DOI: 10.2174/1567202617666200413130101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 03/11/2020] [Accepted: 03/14/2020] [Indexed: 12/18/2022]
Abstract
Background:
Hemiplegia is a common symptom after acute cerebral infarction.
Objective:
This study aimed to explore the influence factors of gait performance and investigate
whether donepezil could improve gait performance in patients with an acute cerebral infarction.
Methods:
A total of 107 patients who experienced unilateral paresis after an acute cerebral infarction
incident were enrolled in this prospectively observational study. Participants underwent a 3-
month assessment. At the study's conclusion, patients were divided into 2 groups-those who received
donepezil daily (observation Group) and those who did not (Control Group).
Results:
There was a significant difference (t=3.269, P=0.001) of Wisconsin Gait Scale (WGS)
score between single site infarction (27.11±6.65) and multiple sites infarction (31.54±6.42). For
gender, smoking, drinking, hypertension, hyperlipidemia and diabetes, there was no difference in
WGS scores between subgroups (P>0.05), respectively. The patient's admission National Institute
of Health Stroke Scale(NIHSS) score had a strongly positive correlation with WGS score (r=0.850,
P<0.001). Besides, age (r=0.218, P=0.024), glycosylated hemoglobin (r=0.274, P=0.004), MMSE
(r=-0.261, P=0.007) and Montreal Cognitive Assessment (MoCA) (r=-0.272, P=0.005) had a weak
correlation with WGS scores. Multivariate analysis showed age (95% CI: 0.042~0.188, P=0.002),
admission NIHSS score (95% CI: 2.405~3.137, P<0.001) and multiple sites infarction (95% CI:
0.044~2.983, P=0.044) were independent risk factors of WGS scores. WGS scores of both observation
and control groups gradually decreased after admission (P<0.001). At 3 months after admission,
WGS score of the observation group was significantly lower than the control group
(t=2.468, P=0.015). There were no significant differences between observation and control group
at admission and 1 month after admission (P>0.05) and WGS scores of both single site and multiple
sites infarction gradually decreased at one month and three months after admission (P<0.001),
while there was no significant difference between two groups (P>0.05).
Conclusion:
Admission NIHSS score, age and multiple sites infarction were independent risk factors
of WGS score. Donepezil could improve gait performance in patients with acute cerebral infarction.
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Affiliation(s)
- Ying-Ying Lin
- Department of Neurology, Tongji University School of Medicine, Shanghai Tenth People’s Hospital, 301 Middle Yanchang Road, Shanghai 200072, China
| | - Shi-Jie Guo
- Department of Neurology, Tongji University School of Medicine, Shanghai Tenth People’s Hospital, 301 Middle Yanchang Road, Shanghai 200072, China
| | - Hui Quan
- Department of Neurology, Tongji University School of Medicine, Shanghai Tenth People’s Hospital, 301 Middle Yanchang Road, Shanghai 200072, China
| | - Yan-Xin Zhao
- Department of Neurology, Tongji University School of Medicine, Shanghai Tenth People’s Hospital, 301 Middle Yanchang Road, Shanghai 200072, China
| | - Dong-Ya Huang
- Department of Neurology, Tongji University School of Medicine, East Hospital, 150 Jimo Road, Shanghai 200120, China
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Center of mass in analysis of dynamic stability during gait following stroke: A systematic review. Gait Posture 2019; 72:154-166. [PMID: 31202025 DOI: 10.1016/j.gaitpost.2019.06.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 05/27/2019] [Accepted: 06/07/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The Center of mass (CoM) analysis reveals important aspects of gait dynamic stability of stroke patients, but the variety of methods and measures represents a challenge for planning new studies. RESEARCH QUESTION How have the CoM measures been calculated and employed to investigate gait stability after a stroke? Three issues were addressed: (i) the methodological aspects of the calculation of CoM measures; (ii) the purposes and (iii) the conclusions of the studies on gait stability that employed those measures. METHODS PubMed and Science Direct databases have been searched to collect original articles produced until July 2017. A set of 26 studies were selected according to criteria involving their methodological quality. RESULTS A compromise between accuracy and feasibility in CoM calculation could be reached using the segmental method with 7-9 segments. Regarding their purposes, two types of studies were identified: clinical and research oriented. From the first ones, we highlighted: the margin of stability (MoS) in the mediolateral (ML) direction, and the angular momentum in the frontal plane could be indicators of dynamical stability; the MoS in the anteroposterior (AP) direction might be able to detect the risk of falls and the symmetry of vertical CoM displacement could be used to analyze energy expenditure during gait. These and other CoM measures are potentially useful in clinical settings, but their psychometric properties are still to be determined. The research oriented studies allowed to clarify that stability is not improved by widening the step in stroke patients and that the impaired control of the non-paretic limb might be the main source of instability. SIGNIFICANCE This review provides recommendations on the methods for estimating CoM and its measures, identifies the potential usefulness of CoM parameters and indicates issues that could be addressed in future studies.
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Yeo SS, Jang SH, Kwon JW. Central vestibular disorder due to ischemic injury on the parieto-insular vestibular cortex in patients with middle cerebral artery territory infarction: Observational study. Medicine (Baltimore) 2017; 96:e9349. [PMID: 29390518 PMCID: PMC5758220 DOI: 10.1097/md.0000000000009349] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Central vestibular disorder is common after middle cerebral artery (MCA) territory infarction. The MCA supplies blood to the parieto-insular vestibular cortex (PIVC), a core region of central vestibular symptoms. We report on patients that sustained injuries of the core vestibular pathway to the PIVC with central vestibular disorder following MCA territory infarction, demonstrated on diffusion tensor imaging (DTI). Nineteen patients with MCA territory infarction and 12 control subjects were recruited. To reconstruct the core vestibular pathway to the PIVC, we defined seed region of interest (ROI) as vestibular nuclei of pons and target ROI as the PIVC. Fractional anisotropy (FA), mean diffusivity, and tract volume were measured. In the affected hemisphere, FA value of the core vestibular pathway to the PIVC revealed significant difference between all patient groups and the control group (P < .05). In contrast, patients with symptoms of ataxia only revealed significant decrement of tract volume compared with the control group (P < .05). Additionally, subgroup B revealed significant decrement of tract volume compared with that of subgroup A and the control group (P < .05). In the unaffected hemisphere, there was no significant difference in all DTI parameters between all patient groups and the control group (P < .05). Injury to the core vestibular pathway to the PIVC was demonstrated in patients that revealed typical central vestibular disorder following MCA territory infarction. Analysis of the core vestibular pathway to the PIVC using DTI would be beneficial in clinical evaluation and management of patients with MCA territory infarction.
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Affiliation(s)
- Sang Seok Yeo
- Department of Physical Therapy, College of Health Sciences, Dankook University, Republic of Korea
| | - Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, South Korea
| | - Jung Won Kwon
- Assistant professor, Department of Physical Therapy, College of Health Sciences, Dankook University, Dandae-ro, Dongnam-gu, Cheonan-si, Chungnam, Republic of Korea
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12
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Ezeugwu VE, Manns PJ. Sleep Duration, Sedentary Behavior, Physical Activity, and Quality of Life after Inpatient Stroke Rehabilitation. J Stroke Cerebrovasc Dis 2017; 26:2004-2012. [PMID: 28669653 DOI: 10.1016/j.jstrokecerebrovasdis.2017.06.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 05/29/2017] [Accepted: 06/03/2017] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE The aim of this study was to describe accelerometer-derived sleep duration, sedentary behavior, physical activity, and quality of life and their association with demographic and clinical factors within the first month after inpatient stroke rehabilitation. MATERIALS AND METHODS Thirty people with stroke (mean ± standard deviation, age: 63.8 ± 12.3 years, time since stroke: 3.6 ± 1.1 months) wore an activPAL3 Micro accelerometer (PAL Technologies, Glasgow, Scotland) continuously for 7 days to measure whole-day activity behavior. The Stroke Impact Scale and the Functional Independence Measure were used to assess quality of life and function, respectively. RESULTS Sleep duration ranged from 6.6 to 11.6 hours/day. Fifteen participants engaged in long sleep greater than 9 hours/day. Participants spent 74.8% of waking hours in sedentary behavior, 17.9% standing, and 7.3% stepping. Of stepping time, only a median of 1.1 (interquartile range: .3-5.8) minutes were spent walking at a moderate-to-vigorous intensity (≥100 steps/minute). The time spent sedentary, the stepping time, and the number of steps differed significantly by the hemiparetic side (P < .05), but not by sex or the type of stroke. There were moderate to strong correlations between the stepping time and the number of steps with gait speed (Spearman r = .49 and .61 respectively, P < .01). Correlations between accelerometer-derived variables and age, time since stroke, and cognition were not significant. CONCLUSIONS People with stroke sleep for longer than the normal duration, spend about three quarters of their waking hours in sedentary behaviors, and engage in minimal walking following stroke rehabilitation. Our findings provide a rationale for the development of behavior change strategies after stroke.
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Affiliation(s)
- Victor E Ezeugwu
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada.
| | - Patricia J Manns
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
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13
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Gama GL, de Lucena LC, Brasileiro ACDAL, Silva EMGDS, Galvão ÉRVP, Maciel ÁC, Lindquist ARR. Post-stroke hemiparesis: Does chronicity, etiology, and lesion side are associated with gait pattern? Top Stroke Rehabil 2017; 24:388-393. [PMID: 28399777 DOI: 10.1080/10749357.2017.1304865] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Studies that evaluate gait rehabilitation programs for individuals with stroke often consider time since stroke of more than six months. In addition, most of these studies do not use lesion etiology or affected cerebral hemisphere as study factors. However, it is unknown whether these factors are associated with post-stroke motor performance after the spontaneous recovery period. OBJECTIVE To investigate whether time since stroke onset, etiology, and lesion side is associated with spatiotemporal and angular gait parameters of individuals with chronic stroke. METHODS Fifty individuals with chronic hemiparesis (20 women) were evaluated. The sample was stratified according to time since stroke (between 6 and 12 months, between 13 and 36 months, and over 36 months), affected cerebral hemisphere (left or right) and lesion etiology (ischemic and hemorrhagic). The participants were evaluated during overground walking at self-selected gait speed, and spatiotemporal and angular gait parameters were calculated. Results Differences between gait speed, stride length, hip flexion, and knee flexion were observed in subgroups stratified based on lesion etiology. Survivors of a hemorrhagic stroke exhibited more severe gait impairment. Subgroups stratified based on time since stroke only showed intergroup differences for stride length, and subgroups stratified based on affected cerebral hemisphere displayed between-group differences for swing time symmetry ratio. CONCLUSION In order to recruit a more homogeneous sample, more accurate results were obtained and an appropriate rehabilitation program was offered, researchers and clinicians should consider that gait pattern might be associated with time since stroke, affected cerebral hemisphere and lesion etiology.
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Affiliation(s)
- Gabriela Lopes Gama
- a Institute of Physical Activity and Sport Sciences , Cruzeiro do Sul University , São Paulo , Brazil
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14
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Yang HE, Kyeong S, Lee SH, Lee WJ, Ha SW, Kim SM, Kang H, Lee WM, Kang CS, Kim DH. Structural and functional improvements due to robot-assisted gait training in the stroke-injured brain. Neurosci Lett 2016; 637:114-119. [PMID: 27884739 DOI: 10.1016/j.neulet.2016.11.039] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 10/28/2016] [Accepted: 11/20/2016] [Indexed: 12/18/2022]
Abstract
Robot-assisted gait training (RAGT) can improve walking ability after stroke. Because the underlying mechanisms are still unknown, we analyzed changes in post-stroke injured brains after RAGT. Ten non-ambulatory patients receiving inpatient rehabilitation were examined within 3 months of stroke onset. RAGT consisted of 45min of training, 3days per week. We acquired diffusion tensor imaging (DTI) data before and after 20 sessions of RAGT. Fractional anisotropy (FA) maps were then used to determine neural changes after RAGT. Fugl-Meyer motor assessment of the lower extremity, motricity index of the lower extremity, functional ambulation category, and trunk control tests were also conducted before training, after 10 and 20 RAGT sessions, and at the 1-month follow-up. After RAGT, the supplementary motor area of the unaffected hemisphere showed increased FA, but the internal capsule, substantia nigra, and pedunculopontine nucleus of the affected hemisphere showed decreased FA. All clinical outcome measures improved after 20 sessions of RAGT. Our findings indicate that RAGT can facilitate plasticity in the intact supplementary motor area, but not the injured motor-related areas, in the affected hemisphere.
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Affiliation(s)
- Hea Eun Yang
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, South Korea
| | - Sunghyon Kyeong
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Seung Hwa Lee
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, South Korea
| | - Won-Jae Lee
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, South Korea
| | - Sang Won Ha
- Department of Neurology, Veterans Health Service Medical Center, Seoul, South Korea
| | - Seung Min Kim
- Department of Neurology, Veterans Health Service Medical Center, Seoul, South Korea
| | - Hyunkoo Kang
- Department of Radiology, Veterans Health Service Medical Center, Seoul, South Korea
| | - Won Min Lee
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, South Korea
| | - Chang Soon Kang
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, South Korea
| | - Dae Hyun Kim
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, South Korea.
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15
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Schaapsmeerders P, van Uden IWM, Tuladhar AM, Maaijwee NAM, van Dijk EJ, Rutten-Jacobs LCA, Arntz RM, Schoonderwaldt HC, Dorresteijn LDA, de Leeuw FE, Kessels RPC. Ipsilateral hippocampal atrophy is associated with long-term memory dysfunction after ischemic stroke in young adults. Hum Brain Mapp 2015; 36:2432-42. [PMID: 25757914 DOI: 10.1002/hbm.22782] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 01/16/2015] [Accepted: 02/24/2015] [Indexed: 11/06/2022] Open
Abstract
Memory impairment after stroke in young adults is poorly understood. In elderly stroke survivors memory impairments and the concomitant loss of hippocampal volume are usually explained by coexisting neurodegenerative disease (e.g., amyloid pathology) in interaction with stroke. However, neurodegenerative disease, such as amyloid pathology, is generally absent at young age. Accumulating evidence suggests that infarction itself may cause secondary neurodegeneration in remote areas. Therefore, we investigated the relation between long-term memory performance and hippocampal volume in young patients with first-ever ischemic stroke. We studied all consecutive first-ever ischemic stroke patients, aged 18-50 years, admitted to our academic hospital center between 1980 and 2010. Episodic memory of 173 patients was assessed using the Rey Auditory Verbal Learning Test and the Rey Complex Figure and compared with 87 stroke-free controls. Hippocampal volume was determined using FSL-FIRST, with manual correction. On average 10 years after stroke, patients had smaller ipsilateral hippocampal volumes compared with controls after left-hemispheric stroke (5.4%) and right-hemispheric stroke (7.7%), with most apparent memory dysfunctioning after left-hemispheric stroke. A larger hemispheric stroke was associated with a smaller ipsilateral hippocampal volume (b=-0.003, P<0.0001). Longer follow-up duration was associated with smaller ipsilateral hippocampal volume after left-hemispheric stroke (b=-0.028 ml, P=0.002) and right-hemispheric stroke (b=-0.015 ml, P=0.03). Our results suggest that infarction is associated with remote injury to the hippocampus, which may lower or expedite the threshold for cognitive impairment or even dementia later in life.
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Affiliation(s)
- Pauline Schaapsmeerders
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Inge W M van Uden
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Anil M Tuladhar
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Noortje A M Maaijwee
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Ewoud J van Dijk
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Loes C A Rutten-Jacobs
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Renate M Arntz
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Hennie C Schoonderwaldt
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Frank-Erik de Leeuw
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Roy P C Kessels
- Centre for Neuroscience and Centre for Cognition, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands.,Department of Medical Psychology, Radboud University Medical Centre, Nijmegen, The Netherlands
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16
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Milne SC, Hocking DR, Georgiou-Karistianis N, Murphy A, Delatycki MB, Corben LA. Sensitivity of spatiotemporal gait parameters in measuring disease severity in Friedreich ataxia. CEREBELLUM (LONDON, ENGLAND) 2014; 13:677-88. [PMID: 25022367 DOI: 10.1007/s12311-014-0583-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Friedreich ataxia (FRDA) is an autosomal recessive disease with gait ataxia being the main source of morbidity. Mobility progressively declines, from initial symptom onset at approximately 10-15 years of age to being unable to ambulate 10-15 years later. Here, we sought to investigate the relationship between spatiotemporal gait parameters and clinical markers of disease severity. Thirteen people with FRDA walked along an 8.3-m GAITRite® mat six times each at their preferred fast and slow speeds. Relationships between spatiotemporal gait parameters and a range of clinical and disease characteristics were examined. Significant correlations were found between spatiotemporal gait characteristics at each of the walking speeds and Friedreich Ataxia Rating Scale (FARS) score and disease duration. During the fast-walking condition, gait speed and cadence decreased with an increase in disease duration and the FARS score. GAA1 repeat expansion negatively correlated with double-support percentage of the gait cycle in all speed conditions demonstrating a relationship between the genetic mutation and compensatory strategies for impaired dynamic balance. In all speed conditions, there were correlations between a range of spatiotemporal gait characteristics and the timed 25-ft walk test, a well-established measure of gait mobility. These findings suggest that spatiotemporal gait parameters are a sensitive measure of gait decline in individuals with FRDA and should be considered for inclusion in intervention studies whilst participants are still ambulant.
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Affiliation(s)
- Sarah C Milne
- Physiotherapy Department, Kingston Centre, Monash Health, Cheltenham, VIC, Australia
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