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Tomita Y, Mullick AA, Feldman AG, Levin MF. Altered Anticipatory Postural Adjustments During Whole-Body Reaching in Subjects With Stroke. Neurorehabil Neural Repair 2024; 38:176-186. [PMID: 38347695 DOI: 10.1177/15459683241231528] [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] [Indexed: 03/16/2024]
Abstract
BACKGROUND Coordination between arm movements and postural adjustments is crucial for reaching-while-stepping tasks involving both anticipatory postural adjustments (APAs) and compensatory movements to effectively propel the whole-body forward so that the hand can reach the target. Stroke impairs the ability to coordinate the action of multiple body segments but the underlying mechanisms are unclear. Objective. To determine the effects of stroke on reaching performance and APAs during whole-body reaching. METHODS We tested arm reaching in standing (stand-reach) and reaching-while-stepping (step-reach; 15 trials/condition) in individuals with chronic stroke (n = 18) and age-matched healthy subjects (n = 13). Whole-body kinematics and kinetic data were collected during the tasks. The primary outcome measure for step-reach was "gain" (g), defined as the extent to which the hip displacement contributing to hand motion was neutralized by appropriate changes in upper limb movements (g = 1 indicates complete compensation) and APAs measured as spatio-temporal profiles of the center-of-pressure shifts preceding stepping. RESULTS Individuals with stroke had lower gains and altered APAs compared to healthy controls. In addition, step onset was delayed, and the timing of endpoint, trunk, and foot movement offset was prolonged during step-reach compared to healthy controls. Those with milder sensorimotor impairment and better balance function had higher gains. Altered APAs were also related to reduced balance function. CONCLUSIONS Altered APAs and prolonged movement offset in stroke may lead to a greater reliance on compensatory arm movements. Altered APAs in individuals with stroke may be associated with a reduced shift of referent body configuration during the movement.
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Affiliation(s)
- Yosuke Tomita
- Department of Physical Therapy, Faculty of Health Care, Takasaki University of Health and Welfare, Gunma, Japan
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Jewish Rehabilitation Hospital Site, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
| | - Aditi A Mullick
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Jewish Rehabilitation Hospital Site, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
| | - Anatol G Feldman
- Jewish Rehabilitation Hospital Site, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
- Department of Neuroscience, University of Montreal, Montreal, QC, Canada
| | - Mindy F Levin
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Jewish Rehabilitation Hospital Site, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
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Tseng SC, Cherry D, Ko M, Fisher SR, Furtado M, Chang SH. The effects of combined transcranial brain stimulation and a 4-week visuomotor stepping training on voluntary step initiation in persons with chronic stroke-a pilot study. Front Neurol 2024; 15:1286856. [PMID: 38450075 PMCID: PMC10915046 DOI: 10.3389/fneur.2024.1286856] [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: 08/31/2023] [Accepted: 02/02/2024] [Indexed: 03/08/2024] Open
Abstract
Purpose Evidence suggests that transcranial direct current stimulation (tDCS) can enhance motor performance and learning of hand tasks in persons with chronic stroke (PCS). However, the effects of tDCS on the locomotor tasks in PCS are unclear. This pilot study aimed to: (1) determine aggregate effects of anodal tDCS combined with step training on improvements of the neural and biomechanical attributes of stepping initiation in a small cohort of persons with chronic stroke (PCS) over a 4-week training program; and (2) assess the feasibility and efficacy of this novel approach for improving voluntary stepping initiation in PCS. Methods A total of 10 PCS were randomly assigned to one of two training groups, consisting of either 12 sessions of VST paired with a-tDCS (n = 6) or sham tDCS (s-tDCS, n = 4) over 4 weeks, with step initiation (SI) tests at pre-training, post-training, 1-week and 1-month follow-ups. Primary outcomes were: baseline vertical ground reaction force (B-vGRF), response time (RT) to initiate anticipatory postural adjustment (APA), and the retention of B-VGRF and RT. Results a-tDCS paired with a 4-week VST program results in a significant increase in paretic weight loading at 1-week follow up. Furthermore, a-tDCS in combination with VST led to significantly greater retention of paretic BWB compared with the sham group at 1 week post-training. Clinical implications The preliminary findings suggest a 4-week VST results in improved paretic limb weight bearing (WB) during SI in PCS. Furthermore, VST combined with a-tDCS may lead to better retention of gait improvements (NCT04437251) (https://classic.clinicaltrials.gov/ct2/show/NCT04437251).
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Affiliation(s)
- Shih-Chiao Tseng
- Neuromechanics Laboratory, Department of Physical Therapy, University of Texas Medical Branch, Galveston, TX, United States
| | - Dana Cherry
- Neuromechanics Laboratory, Department of Physical Therapy, University of Texas Medical Branch, Galveston, TX, United States
| | - Mansoo Ko
- Neuromechanics Laboratory, Department of Physical Therapy, University of Texas Medical Branch, Galveston, TX, United States
| | - Steven R. Fisher
- Neuromechanics Laboratory, Department of Physical Therapy, University of Texas Medical Branch, Galveston, TX, United States
| | - Michael Furtado
- Department of Physical Therapy, University of North Texas Health Science Center at Fort Worth, Fort Worth, TX, United States
| | - Shuo-Hsiu Chang
- Neuromuscular Plasticity Laboratory, Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, Houston, TX, United States
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Osada Y, Motojima N, Kobayashi Y, Yamamoto S. Differences in mediolateral dynamic stability during gait initiation according to whether the non-paretic or paretic leg is used as the leading limb. PLoS One 2022; 17:e0267577. [PMID: 35476702 PMCID: PMC9045617 DOI: 10.1371/journal.pone.0267577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 04/11/2022] [Indexed: 11/24/2022] Open
Abstract
We investigated mediolateral dynamic stability at first foot off and first initial contact during gait initiation according to whether the paretic or non-paretic leg was used as the leading limb. Thirty-eight individuals with stroke initiated gait with the paretic and non-paretic legs as the leading limb, and their movements were measured using a 3D motion analysis system. Margin of stability (i.e., the length between the extrapolated center of mass and lateral border of the stance foot) was used as an index of dynamic stability, with a large value indicating dynamic stability in the lateral direction. However, an excessively large margin of stability value (i.e., when the extrapolated center of mass is outside the medial border of the stance foot) indicates dynamic instability in the medial direction. Differences in the margin of stability between tasks were compared using the Wilcoxon signed-rank test. The minimum margin of stability was observed just before first foot off. When the non-paretic leg was used as the leading limb, the margin of stability tended to be excessively large at first foot off compared with when the paretic leg was used (p < 0.001). In other words, the extrapolated center of mass was outside the medial border of the paretic stance foot. In conclusion, lateral stability was achieved when using the non-paretic leading limb because the extrapolated center of mass was located outside the medial border of the stance foot. However, medial dynamic stability was lower for the non-paretic leading limb compared with the paretic leading limb.
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Affiliation(s)
- Yuji Osada
- Department of Health and Welfare Tokushima Bunri University, Tokushima, Japan
- * E-mail:
| | - Naoyuki Motojima
- Showa University School of Nursing and rehabilitation Science, Kanagawa, Japan
| | | | - Sumiko Yamamoto
- Graduate School, International University of Health & Welfare, Tokyo, Japan
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Osada Y, Motojima N, Kobayashi Y, Yamamoto S. Differences in paretic lower limb loading and fluidity in sit-to-walk according to selection of the leading limb in individuals with stroke. Clin Biomech (Bristol, Avon) 2022; 94:105639. [PMID: 35390670 DOI: 10.1016/j.clinbiomech.2022.105639] [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: 10/01/2021] [Revised: 03/23/2022] [Accepted: 03/29/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Sit-to-walk is an asymmetric task that is challenging for individuals with stroke, and paretic limb loading at seat-off and movement fluidity may change according to whether the non-paretic or paretic leg is used as the leading limb. This study aimed to investigate differences in paretic limb loading and fluidity depending on whether the non-paretic limb or paretic limb was used as the leading limb. METHODS Thirty-eight individuals with stroke performed sit-to-walk with each leg as the leading limb, and their movements were measured using a 3D motion analysis system. The paired t-test or Wilcoxon signed-rank test was used to assess differences according to limb selection in paretic limb loading ratio at seat-off and fluidity (Fluidity Index: ratio of the lowest to peak forward velocity before first initial contact). FINDINGS Twenty-two of 38 participants preferred to use the paretic limb as the leading limb. When leading with the paretic limb, the paretic limb loading ratio was significantly larger (p = 0.002), and the Fluidity Index was lower (p = 0.007). INTERPRETATION Sit-to-walk with the paretic leading limb seems to be an adaptive movement because many participants preferred leading with the paretic limb. However, selection of the leading limb in sit-to-walk involves a biomechanical tradeoff between paretic limb loading at seat-off and movement fluidity in individuals with stroke. Use of the paretic leading limb requires loading capacity of this limb, and the non-paretic leading limb must have high balance ability to merge sit-to-stand and gait initiation.
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Affiliation(s)
- Yuji Osada
- Department of Health and Welfare, Tokushima Bunri University, 180 Nishihamahoji, Tokushima 770-8514, Japan.
| | - Naoyuki Motojima
- Showa University, School of Nursing and rehabilitation Science, 1865 Tokaichibacho, Midoriku, Yokohama, Kanagawa 226-8555, Japan
| | - Yosuke Kobayashi
- Nakaizu Rehabilitation Center, 1523-108 Hiekawa, Izu, Shizuoka 410-2507, Japan
| | - Sumiko Yamamoto
- Graduate School, International University of Health and Welfare, 4-1-26 Akasaka, Minato-ku, Tokyo 107-8402, Japan.
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Delafontaine A, Vialleron T, Hussein T, Yiou E, Honeine JL, Colnaghi S. Anticipatory Postural Adjustments During Gait Initiation in Stroke Patients. Front Neurol 2019; 10:352. [PMID: 31057474 PMCID: PMC6478808 DOI: 10.3389/fneur.2019.00352] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 03/22/2019] [Indexed: 12/03/2022] Open
Abstract
Prior to gait initiation (GI), anticipatory postural adjustments (GI-APA) are activated in order to reorganize posture, favorably for gait. In healthy subjects, the center of pressure (CoP) is displaced backward during GI-APA, bilaterally by reducing soleus activities and activating the tibialis anterior (TA) muscles, and laterally in the direction of the leading leg, by activating hip abductors. In post-stroke hemiparetic patients, TA, soleus and hip abductor activities are impaired on the paretic side. Reduction in non-affected triceps surae activity can also be observed. These may result in a decreased ability to execute GI-APA and to generate propulsion forces during step execution. A systematic review was conducted to provide an overview of the reorganization which occurs in GI-APA following stroke as well as of the most effective strategies for tailoring gait-rehabilitation to these patients. Sixteen articles were included, providing gait data from a total of 220 patients. Stroke patients show a decrease in the TA activity associated with difficulties in silencing soleus muscle activity of the paretic leg, a decreased CoP shift, lower propulsive anterior forces and a longer preparatory phase. Regarding possible gait-rehabilitation strategies, the selected studies show that initiating gait with the paretic leg provides poor balance. The use of the non-paretic as the leading leg can be a useful exercise to stimulate the paretic postural muscles.
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Affiliation(s)
- Arnaud Delafontaine
- CIAMS, Université Paris-Sud, Université Paris-Saclay, Orsay, France.,CIAMS, Université d'Orléans, Orléans, France
| | - Thomas Vialleron
- CIAMS, Université Paris-Sud, Université Paris-Saclay, Orsay, France.,CIAMS, Université d'Orléans, Orléans, France
| | | | - Eric Yiou
- CIAMS, Université Paris-Sud, Université Paris-Saclay, Orsay, France.,CIAMS, Université d'Orléans, Orléans, France
| | | | - Silvia Colnaghi
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy.,Laboratory of Neuro-otology and Neuro-ophthalmology, IRCCS Mondino Foundation, Pavia, Italy
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Lee YJ. Changes in the symmetry of external perturbations affect patterns of muscle activity during gait initiation. Gait Posture 2019; 67:57-64. [PMID: 30286317 DOI: 10.1016/j.gaitpost.2018.09.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 08/10/2018] [Accepted: 09/24/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Gait initiation is associated with changes in the steady state and experiencing an external perturbation during initiation of gait could further threaten balance stability. RESEARCH QUESTION The aim of the study was to investigate if changes in the symmetry of the perturbations affect patterns of muscle activity during gait initiation. METHODS Eleven young health participants were instructed to stand on the force platform and wait for the instruction of taking a right step, left step or stand still while experiencing a pendulum perturbation applied to the back of both shoulders (symmetric), back of the right shoulder (asymmetric) or no perturbations. Bilateral electromyographic activity (EMG) of dorsal and ventral muscles, moments of the pendulum release and perturbation impact, center of pressure (COP) displacements and pelvic movements were recorded and analyzed before and after the onset of the perturbation. RESULTS Taking the right/left step in presence of symmetric perturbation did not affect the temporal sequence of COP and pelvic movements. The onset of COP and pelvic movement occurred before the perturbation impact at the shoulder levels. The factors of step and perturbation did not significantly affect integrals of bilateral muscles at the pendulum release. After the pendulum release, ventral and dorsal EMG integrals of the trunk, thigh, and shank segments increased or decreased corresponding to the swing and stance leg. Changes in muscle activities were also associated with the symmetric or asymmetric perturbations before and after the perturbation impact. SIGNIFICANCE The outcome of the study provides information about strategies used to coordinate the activity of muscles while body perturbations are induced during gait initiation.
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Affiliation(s)
- Yun-Ju Lee
- Department of Industrial Engineering and Engineering Management (R924), College of Engineering, National Tsing Hua University, No. 101, Sec. 2, Kuang-Fu Rd., Hsinchu City, 30013, Taiwan.
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Abstract
Kinematic and kinetic outcome measures are tightly linked in walking. Although altering motor output is a major goal of gait rehabilitation, little is understood regarding the relationship between altering a single kinematic variable and kinetic outcome changes. We designed a strategy to isolate hip extension alterations during walking on a treadmill to assess the change in kinetic outcomes. Ten healthy individuals walked on an instrumented split-belt treadmill with motion capture to calculate hip extension and kinetic outcomes at the following five different randomized cadences: self-selected cadence, self-selected ± 10%, and self-selected ± 20%. The treadmill speed was held constant at the individual's self-selected walking speed, forcing cadence changes to result in successful alterations to hip extension, varying 8.3 degrees from the self-selected -20% to +20% cadence conditions. Kinetic outcomes demonstrated similar alterations. Hip extension changes at each cadence significantly correlated with kinetic changes in propulsive impulse (r = 0.852, P < 0.001), peak ankle power (r = 0.473, P = 0.002), and ankle plantarflexion work (r = 0.762, P < 0.001). These results demonstrate that kinetic outcomes are highly alterable in response to a kinematic gait change. This clinically relevant finding highlights the potential to improve motor output in individuals during rehabilitation by altering gait patterns to achieve more optimal limb positions.
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Khanmohammadi R, Talebian S, Hadian MR, Olyaei G, Bagheri H. Characteristic muscle activity patterns during gait initiation in the healthy younger and older adults. Gait Posture 2016; 43:148-53. [PMID: 26497801 DOI: 10.1016/j.gaitpost.2015.09.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 09/06/2015] [Accepted: 09/17/2015] [Indexed: 02/02/2023]
Abstract
It is thought that gait initiation (GI) might be an optimal task for identifying postural control deficiencies. Thus, the aim of this study was to clarify the strategies adopted by older subjects during this task. 16 healthy younger and 15 healthy older adults participated in the study. Subjects were instructed to begin forward stepping with their dominant limb in response to an auditory stimulus. The mean muscle activity, co-contraction index, and intra-subject coefficients of variation (intra-subject CVs) of dominant limb muscles in different phases of GI were measured. The level of association between the co-contraction index and intra-subject CV of muscles was also explored. This study showed that in the anticipatory phase, the younger group had larger amplitudes and more intra-subject CVs than older the group, particularly for the tibialis anterior muscle. However, the co-contraction index was greater in older subjects relative to younger subjects. During the weight transition phase, tibialis anterior, semitendinosus and vastus lateralis muscles of older adults had a lower amplitude as compared to younger adults. However, during the locomotor phase, the activity of tibialis anterior was greater in comparison to younger adults. Also, during this phase, similar to the anticipatory phase, the co-contraction index between tibialis anterior and gastrocnemius muscles was greater in older subjects relative to younger subjects. Additionally, the larger co-contraction index of some muscles was associated with smaller intra-subject CV. These findings suggest that muscle behaviors are altered with aging and older adults employ different strategies in the different phases of GI as compared to younger adults.
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Affiliation(s)
- Roya Khanmohammadi
- Physical Therapy Department, Tehran university of Medical Sciences, Tehran, Iran.
| | - Saeed Talebian
- Physical Therapy Department, Tehran university of Medical Sciences, Tehran, Iran.
| | - Mohammad Reza Hadian
- Physical Therapy Department, Tehran university of Medical Sciences, Tehran, Iran.
| | - Gholamreza Olyaei
- Physical Therapy Department, Tehran university of Medical Sciences, Tehran, Iran.
| | - Hossein Bagheri
- Physical Therapy Department, Tehran university of Medical Sciences, Tehran, Iran.
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Preparatory postural adjustments during gait initiation in healthy younger and older adults: Neurophysiological and biomechanical aspects. Brain Res 2015; 1629:240-9. [DOI: 10.1016/j.brainres.2015.09.039] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 08/28/2015] [Accepted: 09/30/2015] [Indexed: 11/22/2022]
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Sousa ASP, Silva A, Santos R. Ankle anticipatory postural adjustments during gait initiation in healthy and post-stroke subjects. Clin Biomech (Bristol, Avon) 2015. [PMID: 26220907 DOI: 10.1016/j.clinbiomech.2015.07.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Anticipatory postural adjustments during gait initiation have an important role in postural stability but also in gait performance. However, these first phase mechanisms of gait initiation have received little attention, particularly in subcortical post-stroke subjects, where bilateral postural control pathways can be impaired. This study aims to evaluate ankle anticipatory postural adjustments during gait initiation in chronic post-stroke subjects with lesion in the territory of middle cerebral artery. METHODS Eleven subjects with post-stroke hemiparesis with the ability to walk independently and twelve healthy controls participated in this study. Bilateral electromyographic activity of tibialis anterior, soleus and medial gastrocnemius was collected during gait initiation to assess the muscle onset timing, period of activation/deactivation and magnitude of muscle activity during postural phase of gait initiation. This phase was identified through centre of pressure signal. FINDINGS Post-stroke group presented only half of the tibialis anterior relative magnitude observed in healthy subjects in contralesional limb (t=2.38, P=0.027) and decreased soleus deactivation period (contralesional limb, t=2.25, P=0.04; ipsilesional limb, t=3.67, P=0.003) as well its onset timing (contralesional limb, t=3.2. P=0.005; ipsilesional limb, t=2.88, P=0.033) in both limbs. A decreased centre of pressure displacement backward (t=3.45, P=0.002) and toward the first swing limb (t=3.29, P=0.004) was observed in post-stroke subjects. INTERPRETATION These findings indicate that chronic post-stroke subjects with lesion at middle cerebral artery territory present dysfunction in ankle anticipatory postural adjustments in both limbs during gait initiation.
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Affiliation(s)
- Andreia S P Sousa
- Escola Superior da Tecnologia de Saúde do Instituto Politécnico do Porto, Área Científica de Fisioterapia, Centro de Estudos de Movimento e Actividade Humana, Rua Valente Perfeito, 322, 4400-330 Vila Nova de Gaia, Portugal.
| | - Augusta Silva
- Escola Superior da Tecnologia de Saúde do Instituto Politécnico do Porto, Área Científica de Fisioterapia, Centro de Estudos de Movimento e Actividade Humana, Rua Valente Perfeito, 322, 4400-330 Vila Nova de Gaia, Portugal.
| | - Rubim Santos
- Escola Superior da Tecnologia de Saúde do Porto, Área Científica de Física, Centro de Estudos de Movimento e Actividade Humana, Rua Valente Perfeito, 322, 4400-330 Vila Nova de Gai, Portugal.
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Ko M, Hilgenberg S, Hasson SM, Braden HJ. Effect of bilateral step-up and -down training on motor function in a person with hemiparesis: a case report. Physiother Theory Pract 2014; 30:597-602. [PMID: 24697729 DOI: 10.3109/09593985.2014.904959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Gait training to facilitate the use of the paretic limb for persons with hemiparesis continues to be of interest to those in the clinical research domain. The purpose of this case report was to assess the outcomes of a repeated step-up and -down treatment, initiating with the paretic limb, on functional mobility, endurance and gait kinematic parameters in a person with hemiparesis. The participant was an 85-year-old female 3 years status post left hemiparesis, who reported overall good health. The participant was asked to step up on a 1-inch height wood box with her paretic limb. Once both feet were on top of the box, the participant initiated descent also with her paretic limb. The height of the box gradually progressed to 5 inches based on the participant's performance and tolerance. A metronome was used to facilitate rhythmic lower extremity movement patterns. The training duration for each treatment session was 7-15 min/day. The participant completed nine sessions spanning over 3 weeks. The outcome measure used to identify motor recovery was the Fugl-Myer (lower extremity). In addition, the timed up and go (TUG), the 6-min walk test (6 MWT) and gait kinematics were assessed to examine mobility and gait. The Fugl-Myer score and 6 MWT did not reflect a meaningful change (0% and +2.6%, respectively). However, TUG scores did show a meaningful change (+31.9%). With respect to gait kinematics, hip flexion on the paretic limb was improved from 11° to 18°, which indicates the normal range of hip motion during the initial swing phase in post-test.
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Affiliation(s)
- Mansoo Ko
- Physical Therapy Program, Angelo State University , San Angelo, TX , USA
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