Walking Training with a Weight Support Feedback Cane Improves Lower Limb Muscle Activity and Gait Ability in Patients with Chronic Stroke: A Randomized Controlled Trial

Feedback Interventions in Motor Recovery of Lateropulsion after Stroke: A Literature Review and Case Series

Lateropulsion is a post-stroke phenomenon marked by an active push of the body across the midline towards the more affected side and/or a resistance of the weight shift towards the less affected side. Within the mechanisms of treatment, feedback systems have been shown to be effective. The aim of the present study was to create a body of knowledge by performing a literature review on the use of feedback mechanisms in the treatment of lateropulsion and to report two cases of lateropulsion patients who had undergone feedback-based treatment.

METHODS

The review was performed across five different databases (Embase, Medline/PubMed, Scopus, Web of Science, and PEDro) up to February 2024, and haptic feedback intervention was incorporated into the case series (with lateropulsion and ambulation capacity as the main variables).

RESULTS

In total, 211 records were identified and 6 studies were included after the review of the literature. The most used feedback modality was visual feedback. In the case series, positive results were observed from the intervention, particularly in the recovery of lateropulsion and balance, as well as in the improvement of gait for one patient. Patients demonstrated good adherence to the intervention protocol without adverse effects.

CONCLUSIONS

Visual feedback is the most commonly used feedback modality in lateropulsion patients but other mechanisms such as haptic feedback also are feasible and should be taken into account. Larger sample sizes, extended follow-up periods, and the isolation of feedback mechanisms must be established to clarify evidence.

Effects of cane use on the kinematic and kinetic of lower-extremity joints in inexperienced users

The cane is commonly prescribed for the elderly to maintain balance and enhance independent mobility. However, improper use of cane can increase the risk of falling. Understanding the characteristics of cane gait is critical for better establishing proper cane usage norms. The paper aimed to investigate effects of cane use on kinematics and kinetics of lower extremities in the elderly and the young to guide the development of adaptive cane gait. Twenty participants (10 elder and 10 young) were recruited and walked at a self-comfortable speed or with a cane in a two-point gait. The spatiotemporal gait parameters, hip/knee/ankle joint angles and ground reaction force (GRF) were statistically analyzed using MANOVAs to assess the effects of age and cane. Using the cane significantly decreased step length, cadence and speed and increased step time in both age groups. Age and cane had significant effects on ankle plantarflexion angle in initial swing phase (APA-ISw). In cane gait, the peaks of vertical GRF(V-GRF) and anterior-posterior GRF (AP-GRF) in bilateral lower extremities significantly decreased, and the troughs of right V-GRF significantly increased for both groups. These results suggest that using a cane does interfere with the natural gait of the user and insufficient ankle plantarflexion in initial swing phase (ISw) and reduced AP-GRF may be two key risk factors contributing to cane gait instability. Therefore, the users should consider actively increasing ankle plantarflexion in ISw to avoid deteriorating gait performance due to over-reliance on the cane.

Adjunct Non-Elastic Hip Taping Improves Gait Stability in Cane-Assisted Individuals with Chronic Stroke: A Randomized Controlled Trial

Cane-assisted individuals with chronic stroke may perform with an abnormal gait pattern. One of the important factors of gait training for cane-assisted individuals is inducing improvement in lower limb muscle activity of the paretic side. Non-elastic taping on the hip may be used as an adjunct therapy for improving gait. The objective of this study was to investigate effects of non-elastic hip taping combined with exercise on gait in cane-assisted individuals with chronic stroke. This study is a single-blinded, randomized controlled trial. A total of 21 cane-assisted ambulators with chronic stroke were enrolled. Participants in both groups received a therapeutic exercise program, with the experimental and control groups having adjunct non-elastic taping and sham taping on the hip, respectively. The gait, Berg Balance Scale, 6-min walk test, and Fall Efficacy Scale–International were measured at pre-intervention, post-intervention, and 1-month follow-up. The experimental group resulted in significantly better performance in double-support time compared with the control group. Furthermore, the experimental group showed a significant improvement in double-support time and spatial symmetry at post-intervention and 1-month follow-up compared with pre-intervention. This study demonstrated that non-elastic hip taping combined with exercise could improve gait stability in cane-assisted ambulators. Non-elastic hip taping would be a useful adjunct to rehabilitation strategies for individuals with chronic stroke.