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Meng L, Zhang T, Zhao X, Wang D, Xu R, Yang A, Ming D. A quantitative lower limb function assessment method based on fusion of surface EMG and inertial data in stroke patients during cycling task. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2023.104880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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Shima A, Miyake T, Tanaka K, Ogawa A, Omae E, Nagamori Y, Miyata Y, Ohata K, Maki T, Ono Y, Mima T, Takahashi R, Koganemaru S. Case report: A novel approach of closed-loop brain stimulation combined with robot gait training in post-stroke gait disturbance. Front Hum Neurosci 2023; 17:1082556. [PMID: 36778037 PMCID: PMC9911819 DOI: 10.3389/fnhum.2023.1082556] [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: 10/28/2022] [Accepted: 01/11/2023] [Indexed: 01/28/2023] Open
Abstract
Most post-stroke patients have long-lasting gait disturbances that reduce their daily activities. They often show impaired hip and knee joint flexion and ankle dorsiflexion of the lower limbs during the swing phase of gait, which is controlled by the corticospinal tract from the primary motor cortex (M1). Recently, we reported that gait-synchronized closed-loop brain stimulation targeting swing phase-related activity in the affected M1 can improve gait function in post-stroke patients. Subsequently, a gait-training robot (Orthobot®) was developed that could assist lower-limb joint movements during the swing phase of gait. Therefore, we investigated whether gait-synchronized closed-loop brain stimulation combined with robot-assisted training targeting the swing phase could enhance the recovery of post-stroke gait disturbance. A 57-year-old female patient with chronic post-stroke hemiparesis underwent closed-loop brain stimulation combined with robot-assisted training for 10 min 2 years after left pons infarction. For closed-loop brain stimulation, we used transcranial oscillatory electrical current stimulation over the lesioned M1 foot area with 1.5 mA of DC offset and 0-3 mA of sine-wave formed currents triggered by the paretic heel contact to set the maximum current just before the swing phase (intervention A; two times repeated, A1 and A2). According to the N-of-1 study design, we also performed sham stimulation (intervention B) and control stimulation not targeting the swing phase (intervention C) combined with robot-assisted training in the order of A1-B-A2-C interventions. As a result, we found larger improvements in gait speed, the Timed Up and Go test result, and muscle strength after the A1 and A2 interventions than after the B and C interventions. After confirming the short-term effects, we performed an additional long-term intervention twice a week for 5 weeks, for a total of 10 sessions. Gait parameters also largely improved after long-term intervention. Gait-synchronized closed-loop brain stimulation combined with robot-assisted training targeting the swing phase of gait may promote the recovery of gait function in post-stroke patients. Further studies with a larger number of patients are necessary.
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Affiliation(s)
- Atsushi Shima
- Department of Regenerative Systems Neuroscience, Human Brain Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tomoaki Miyake
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kazuki Tanaka
- Department of Regenerative Systems Neuroscience, Human Brain Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akari Ogawa
- Department of Regenerative Systems Neuroscience, Human Brain Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan,Department of Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Erika Omae
- Department of Regenerative Systems Neuroscience, Human Brain Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan,Department of Neuroscience, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yui Nagamori
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yusuke Miyata
- Department of Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Koji Ohata
- Department of Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takakuni Maki
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yumie Ono
- Department of Electronics and Bioinformatics, Meiji University, Kanagawa, Japan
| | - Tatsuya Mima
- The Graduate School of Core Ethics and Frontier Sciences, Ritsumeikan University, Kyoto, Japan
| | - Ryosuke Takahashi
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Satoko Koganemaru
- Department of Regenerative Systems Neuroscience, Human Brain Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan,Department of Rehabilitation Medicine, Hokkaido University Hospital, Hokkaido, Japan,*Correspondence: Satoko Koganemaru ✉
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Das R, Paul S, Mourya GK, Kumar N, Hussain M. Recent Trends and Practices Toward Assessment and Rehabilitation of Neurodegenerative Disorders: Insights From Human Gait. Front Neurosci 2022; 16:859298. [PMID: 35495059 PMCID: PMC9051393 DOI: 10.3389/fnins.2022.859298] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/01/2022] [Indexed: 12/06/2022] Open
Abstract
The study of human movement and biomechanics forms an integral part of various clinical assessments and provides valuable information toward diagnosing neurodegenerative disorders where the motor symptoms predominate. Conventional gait and postural balance analysis techniques like force platforms, motion cameras, etc., are complex, expensive equipment requiring specialist operators, thereby posing a significant challenge toward translation to the clinics. The current manuscript presents an overview and relevant literature summarizing the umbrella of factors associated with neurodegenerative disorder management: from the pathogenesis and motor symptoms of commonly occurring disorders to current alternate practices toward its quantification and mitigation. This article reviews recent advances in technologies and methodologies for managing important neurodegenerative gait and balance disorders, emphasizing assessment and rehabilitation/assistance. The review predominantly focuses on the application of inertial sensors toward various facets of gait analysis, including event detection, spatiotemporal gait parameter measurement, estimation of joint kinematics, and postural balance analysis. In addition, the use of other sensing principles such as foot-force interaction measurement, electromyography techniques, electrogoniometers, force-myography, ultrasonic, piezoelectric, and microphone sensors has also been explored. The review also examined the commercially available wearable gait analysis systems. Additionally, a summary of recent progress in therapeutic approaches, viz., wearables, virtual reality (VR), and phytochemical compounds, has also been presented, explicitly targeting the neuro-motor and functional impairments associated with these disorders. Efforts toward therapeutic and functional rehabilitation through VR, wearables, and different phytochemical compounds are presented using recent examples of research across the commonly occurring neurodegenerative conditions [viz., Parkinson's disease (PD), Alzheimer's disease (AD), multiple sclerosis, Huntington's disease (HD), and amyotrophic lateral sclerosis (ALS)]. Studies exploring the potential role of Phyto compounds in mitigating commonly associated neurodegenerative pathologies such as mitochondrial dysfunction, α-synuclein accumulation, imbalance of free radicals, etc., are also discussed in breadth. Parameters such as joint angles, plantar pressure, and muscle force can be measured using portable and wearable sensors like accelerometers, gyroscopes, footswitches, force sensors, etc. Kinetic foot insoles and inertial measurement tools are widely explored for studying kinematic and kinetic parameters associated with gait. With advanced correlation algorithms and extensive RCTs, such measurement techniques can be an effective clinical and home-based monitoring and rehabilitation tool for neuro-impaired gait. As evident from the present literature, although the vast majority of works reported are not clinically and extensively validated to derive a firm conclusion about the effectiveness of such techniques, wearable sensors present a promising impact toward dealing with neurodegenerative motor disorders.
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Affiliation(s)
- Ratan Das
- Department of Biomedical Engineering, North-Eastern Hill University, Shillong, India
| | - Sudip Paul
- Department of Biomedical Engineering, North-Eastern Hill University, Shillong, India
| | - Gajendra Kumar Mourya
- Department of Biomedical Engineering, North-Eastern Hill University, Shillong, India
| | - Neelesh Kumar
- Biomedical Applications Unit, Central Scientific Instruments Organisation, Chandigarh, India
| | - Masaraf Hussain
- Department of Neurology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, India
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Long J, Zhang Y, Liu X, Jin X. Effects of sling exercise therapy on post-stroke walking impairment: a systematic review and meta-analysis. Int J Rehabil Res 2022; 45:12-23. [PMID: 34726197 DOI: 10.1097/mrr.0000000000000505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Walking impairment is a common consequence of stroke, resulting in long-term disability. Trunk muscle strength has been proven to be associated with post-stroke walking performance. As a type of trunk training, sling exercise therapy (SET) has been widely used to improve the trunk function in stroke patients. The purpose of this systematic review was to investigate the efficacy of SET on post-stroke walking impairment. Seven databases were systematically searched for eligible studies from their inception to 1 August 2021. Review Manager 5.3 software was used for this meta-analysis. The overall quality of included studies was evaluated by the physiotherapy evidence database scale. Twenty-five randomized controlled trials involving 1504 patients were included (23 in China and two in South Korea). In summary, SET more effectively improved the walking ability of post-stroke patients than conventional physical therapy or trunk training. The pooled analysis demonstrated that SET had positive effects on the 10 m maximum walking speed, integrated electromyography value of rectus femoris, biceps femoris and gastrocnemius, functional ambulation category, timed up and go test, and step length. At least in East Asia, our findings support SET to manage the post-stroke walking impairment.
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Affiliation(s)
- Junzi Long
- School of Rehabilitation Medicine, Henan University of Chinese Medicine, Zhengzhou, Henan, China
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Necessity and Content of Swing Phase Gait Coordination Training Post Stroke; A Case Report. Brain Sci 2021; 11:brainsci11111498. [PMID: 34827497 PMCID: PMC8615654 DOI: 10.3390/brainsci11111498] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/28/2021] [Accepted: 11/05/2021] [Indexed: 11/17/2022] Open
Abstract
Background/Problem: Standard neurorehabilitation and gait training has not proved effective in restoring normal gait coordination for many stroke survivors. Rather, persistent gait dyscoordination occurs, with associated poor function, and progressively deteriorating quality of life. One difficulty is the array of symptoms exhibited by stroke survivors with gait deficits. Some researchers have addressed lower limb weakness following stroke with exercises designed to strengthen muscles, with the expectation of improving gait. However, gait dyscoordination in many stroke survivors appears to result from more than straightforward muscle weakness. PURPOSE Thus, the purpose of this case study is to report results of long-duration gait coordination training in an individual with initial good strength, but poor gait swing phase hip/knee and ankle coordination. METHODS Mr. X was enrolled at >6 months after a left hemisphere ischemic stroke. Gait deficits included a 'stiff-legged gait' characterized by the absence of hip and knee flexion during right mid-swing, despite the fact that he showed good initial strength in right lower limb quadriceps, hamstrings, and ankle dorsiflexors. Treatment was provided 4 times/week for 1.5 h, for 12 weeks. The combined treatment included the following: motor learning exercises designed for coordination training of the lower limb; functional electrical stimulation (FES) assisted practice; weight-supported coordination practice; and over-ground and treadmill walking. The FES was used as an adjunct to enhance muscle response during motor learning and prior to volitional recovery of motor control. Weight-supported treadmill training was administered to titrate weight and pressure applied at the joints and to the plantar foot surface during stance phase and pre-swing phase of the involved limb. Later in the protocol, treadmill training was administered to improve speed of movement during the gait cycle. Response to treatment was assessed through an array of impairment, functional mobility, and life role participation measures. RESULTS At post-treatment, Mr. X exhibited some recovery of hip, knee, and ankle coordination during swing phase according to kinematic measures, and the stiff-legged gait was resolved. Muscle strength measures remained essentially constant throughout the study. The modified Ashworth scale showed improved knee extensor tone from baseline of 1 to normal (0) at post-treatment. Gait coordination overall improved by 12 points according to the Gait Assessment and Intervention Tool, Six Minute Walk Test improved by 532', and the Stroke Impact Scale improved by 12 points, including changes in daily activities; mobility; and meaningful activities. DISCUSSION Through the combined use of motor learning exercises, FES, weight-support, and treadmill training, coordination of the right lower limb improved sufficiently to exhibit a more normal swing phase, reducing the probability of falls, and subsequent downwardly spiraling dysfunction. The recovery of lower limb coordination during swing phase illustrates what is possible when strength is sufficient and when coordination training is targeted in a carefully titrated, highly incrementalized manner. Conclusions/Contribution to the Field: This case study contributes to the literature in several ways: (1) illustrates combined interventions for gait training and response to treatment; (2) provides supporting case evidence of relationships among knee flexion coordination, swing phase coordination, functional mobility, and quality of life; (3) illustrates that strength is necessary, but not sufficient to restore coordinated gait swing phase after stroke in some stroke survivors; and (4) provides details regarding coordination training and progression of gait training treatment for stroke survivors.
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Matsuzawa Y, Miyazaki T, Takeshita Y, Higashi N, Hayashi H, Araki S, Nakatsuji S, Fukunaga S, Kawada M, Kiyama R. Effect of Leg Extension Angle on Knee Flexion Angle during Swing Phase in Post-Stroke Gait. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57111222. [PMID: 34833440 PMCID: PMC8625603 DOI: 10.3390/medicina57111222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/05/2021] [Accepted: 11/08/2021] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Leg extension angle is important for increasing the propulsion force during gait and is a meaningful indicator for evaluating gait quality in stroke patients. Although leg extension angle during late stance might potentially also affect lower limb kinematics during the swing phase, the relationship between these two remains unclear. This study aimed to investigate the relationship between leg extension angle and knee flexion angle during pre-swing and swing phase in post-stroke gait. Materials and Methods: Twenty-nine stroke patients walked along a 16 m walkway at a self-selected speed. Tilt angles and acceleration of pelvis and paretic lower limb segments were measured using inertial measurement units. Leg extension angle, consisting of a line connecting the hip joint with the ankle joint, hip and knee angles, and increments of velocity during pre-swing and swing phase were calculated. Correlation analysis was conducted to examine the relationships between these parameters. Partial correlation analysis adjusted by the Fugl-Meyer assessment-lower limb (FMA-LL) was also performed. Results: On the paretic side, leg extension angle was positively correlated with knee flexion angle during the swing phase (r = 0.721, p < 0.001) and knee flexion angle and increments of velocity during the pre-swing phase (r = 0.740–0.846, p < 0.001). Partial correlation analysis adjusted by the FMA-LL showed significant correlation between leg extension angle and knee flexion angle during the swing phase (r = 0.602, p = 0.001) and knee flexion angle and increments of velocity during the pre-swing phase (r = 0.655–0.886, p < 0.001). Conclusions: Leg extension angle affected kinematics during the swing phase in post-stroke gait regardless of the severity of paralysis, and was similar during the pre-swing phase. These results would guide the development of effective gait training programs that enable a safe and efficient gait for stroke patients.
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Affiliation(s)
- Yuta Matsuzawa
- Doctoral Department, Course of Health Sciences, Graduate School of Health Sciences, Kagoshima University, Kagoshima 890-8544, Japan; (Y.M.); (Y.T.); (S.N.)
- Miyakonojo Rehabilitation Academy, Miyazaki 885-0062, Japan
| | - Takasuke Miyazaki
- Course of Physical Therapy, Faculty of Medicine, School of Health Sciences, Kagoshima University, Kagoshima 890-8544, Japan; (S.A.); (M.K.); (R.K.)
- Correspondence: ; Tel.: +81-99-275-6774
| | - Yasufumi Takeshita
- Doctoral Department, Course of Health Sciences, Graduate School of Health Sciences, Kagoshima University, Kagoshima 890-8544, Japan; (Y.M.); (Y.T.); (S.N.)
| | - Naoto Higashi
- Master’s Department, Course of Health Sciences, Graduate School of Health Sciences, Kagoshima University, Kagoshima 890-8544, Japan; (N.H.); (H.H.)
| | - Hiroyuki Hayashi
- Master’s Department, Course of Health Sciences, Graduate School of Health Sciences, Kagoshima University, Kagoshima 890-8544, Japan; (N.H.); (H.H.)
| | - Sota Araki
- Course of Physical Therapy, Faculty of Medicine, School of Health Sciences, Kagoshima University, Kagoshima 890-8544, Japan; (S.A.); (M.K.); (R.K.)
| | - Shintaro Nakatsuji
- Doctoral Department, Course of Health Sciences, Graduate School of Health Sciences, Kagoshima University, Kagoshima 890-8544, Japan; (Y.M.); (Y.T.); (S.N.)
- Miyakonojo Rehabilitation Academy, Miyazaki 885-0062, Japan
| | | | - Masayuki Kawada
- Course of Physical Therapy, Faculty of Medicine, School of Health Sciences, Kagoshima University, Kagoshima 890-8544, Japan; (S.A.); (M.K.); (R.K.)
| | - Ryoji Kiyama
- Course of Physical Therapy, Faculty of Medicine, School of Health Sciences, Kagoshima University, Kagoshima 890-8544, Japan; (S.A.); (M.K.); (R.K.)
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Cruz-Montecinos C, Pérez-Alenda S, Cerda M, Maas H. Modular reorganization of gait in chronic but not in artificial knee joint constraint. J Neurophysiol 2021; 126:516-531. [PMID: 34133242 DOI: 10.1152/jn.00418.2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
It is currently unknown if modular reorganization does occur if not the central nervous system, but the musculoskeletal system is affected. The aims of this study were to investigate 1) the effects of an artificial knee joint constraint on the modular organization of gait in healthy subjects; and 2) the differences in modular organization between healthy subjects with an artificial knee joint constraint and people with a similar but chronic knee joint constraint. Eleven healthy subjects and eight people with a chronic knee joint constraint walked overground at 1 m/s. The healthy subjects also walked with a constraint limiting knee joint movement to 20°. The total variance accounted (tVAF) for one to four synergies and modular organization were assessed using surface electromyography from 11 leg muscles. The distribution of number of synergies were not significantly different between groups. The tVAF and the motor modules were not significantly affected by the artificial knee constraint. A higher tVAF for one and two synergies, as well as merging of motor modules were observed in the chronic knee constraint group. We conclude that in the short-term a knee constraint does not affect the modular organization of gait, but in the long-term a knee constraint results in modular reorganization. These results indicate that merging of motor modules may also occur when changes in the mechanics of the musculoskeletal system is the primary cause of the motor impairment.NEW & NOTEWORTHY It is currently unknown if modular reorganization does occur if not the central nervous system, but the musculoskeletal system is affected. This study showed that in the short-term a knee constraint does not affect the modular organization of gait, but in the long-term a knee constraint results in modular reorganization. These results indicate that modular reorganization may also occur when changes in the mechanics of the musculoskeletal system is the primary cause of the motor impairment.
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Affiliation(s)
- Carlos Cruz-Montecinos
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain.,Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Laboratory of Clinical Biomechanics, Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Sofía Pérez-Alenda
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Mauricio Cerda
- Integrative Biology Program, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, Santiago, Chile.,Center for Medical Informatics and Telemedicine, Faculty of Medicine, Universidad de Chile, Santiago, Chile.,Biomedical Neuroscience Institute, Santiago, Chile
| | - Huub Maas
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
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Effect of Functional Electrical Stimulation of the Gluteus Medius during Gait in Patients following a Stroke. BIOMED RESEARCH INTERNATIONAL 2020; 2020:8659845. [PMID: 35721669 PMCID: PMC9201370 DOI: 10.1155/2020/8659845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/12/2020] [Accepted: 10/28/2020] [Indexed: 11/25/2022]
Abstract
Many stroke patients rely on cane or ankle-foot orthosis during gait rehabilitation. The purpose of this study was to investigate the immediate effect of functional electrical stimulation (FES) to the gluteus medius (GMed) and tibialis anterior (TA) on gait performance in stroke patients, including those who needed assistive devices. Fourteen stroke patients were enrolled in this study (mean poststroke duration: 194.9 ± 189.6 d; mean age: 72.8 ± 10.7 y). Participants walked 14 m at a comfortable velocity with and without FES to the GMed and TA. After an adaptation period, lower-limb motion was measured using magnetic inertial measurement units attached to the pelvis and the lower limb of the affected side. Motion range of angle of the affected thigh and shank segments in the sagittal plane, motion range of the affected hip and knee extension-flexion angle, step time, and stride time were calculated from inertial measurement units during the middle ten walking strides. Gait velocity, cadence, and stride length were also calculated. These gait indicators, both with and without FES, were compared. Gait velocity was significantly faster with FES (p = 0.035). Similarly, stride length and motion range of the shank of the affected side were significantly greater with FES (stride length: p = 0.018; motion range of the shank: p = 0.026). Meanwhile, cadence showed no significant difference (p = 0.238) in gait with or without FES. Similarly, range of motion of the affected hip joint, knee joint, and thigh did not differ significantly depending on FES condition (p = 0.115‐0.529). FES to the GMed and TA during gait produced an improvement in gait velocity, stride length, and motion range of the shank. Our results will allow therapists to use FES on stroke patients with varying conditions.
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Noveletto F, Soares AV, Eichinger FLF, Domenech SC, Hounsell MDS, Filho PB. Biomedical Serious Game System for Lower Limb Motor Rehabilitation of Hemiparetic Stroke Patients. IEEE Trans Neural Syst Rehabil Eng 2020; 28:1481-1487. [PMID: 32305932 DOI: 10.1109/tnsre.2020.2988362] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Hemiparesis resulting from a stroke has a direct impact on patients' daily activities. New approaches for motor rehabilitation include Serious Games (SG) because they include (in a motivating way) the three fundamental elements for rehabilitation: intensive, repetitive and task-oriented training. This study aims to evaluate the therapeutic effects of a biomedical SG and a scoring system developed for lower limb motor rehabilitation of hemiparetic stroke patients. The SG was inspired by the classic videogame called Pong, where the goal is to control a tennis racquet, but using muscular strength. A knee extensor apparatus was adapted with a load cell and mechanical adjustments for measuring the muscular strength of the quadriceps femoris (QFG) and hamstrings (HSG). A scoring system was proposed to evaluate muscular control. Eleven hemiparetic stroke patients participated in an exercise program using the SG twice a week for ten weeks and only the paretic side was trained. Significant Effect Sizes ( d ) were found for QFG strength ( d=0.5;p=0.021 ), QFG control ( ), HSG strength ( d=1.1; p = 0.001 ), HSG control ( d=1.5; p = 0.003 ), functional mobility ( ), gait speed ( d=0.4; p=0.007 ) and motor recovery ( ). Results indicate that the intervention of a SG with both proper apparatus and evaluation system may effectively promote lower limb motor rehabilitation of hemiparetic stroke patients.
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Ambrosini E, Parati M, Peri E, De Marchis C, Nava C, Pedrocchi A, Ferriero G, Ferrante S. Changes in leg cycling muscle synergies after training augmented by functional electrical stimulation in subacute stroke survivors: a pilot study. J Neuroeng Rehabil 2020; 17:35. [PMID: 32106874 PMCID: PMC7047376 DOI: 10.1186/s12984-020-00662-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 02/13/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Muscle synergies analysis can provide a deep understanding of motor impairment after stroke and of changes after rehabilitation. In this study, the neuro-mechanical analysis of leg cycling was used to longitudinally investigate the motor recovery process coupled with cycling training augmented by Functional Electrical Stimulation (FES) in subacute stroke survivors. METHODS Subjects with ischemic subacute stroke participated in a 3-week training of FES-cycling with visual biofeedback plus usual care. Participants were evaluated before and after the intervention through clinical scales, gait spatio-temporal parameters derived from an instrumented mat, and a voluntary pedaling test. Biomechanical metrics (work produced by the two legs, mechanical effectiveness and symmetry indexes) and bilateral electromyography from 9 leg muscles were acquired during the voluntary pedaling test. To extract muscles synergies, the Weighted Nonnegative Matrix Factorization algorithm was applied to the normalized EMG envelopes. Synergy complexity was measured by the number of synergies required to explain more than 90% of the total variance of the normalized EMG envelopes and variance accounted for by one synergy. Regardless the inter-subject differences in the number of extracted synergies, 4 synergies were extracted from each patient and the cosine-similarity between patients and healthy weight vectors was computed. RESULTS Nine patients (median age of 75 years and median time post-stroke of 2 weeks) were recruited. Significant improvements in terms of clinical scales, gait parameters and work produced by the affected leg were obtained after training. Synergy complexity well correlated to the level of motor impairment at baseline, but it did not change after training. We found a significant improvement in the similarity of the synergy responsible of the knee flexion during the pulling phase of the pedaling cycle, which was the mostly compromised at baseline. This improvement may indicate the re-learning of a more physiological motor strategy. CONCLUSIONS Our findings support the use of the neuro-mechanical analysis of cycling as a method to assess motor recovery after stroke, mainly in an early phase, when gait evaluation is not yet possible. The improvement in the modular coordination of pedaling correlated with the improvement in motor functions and walking ability achieved at the end of the intervention support the role of FES-cycling in enhancing motor re-learning after stroke but need to be confirmed in a controlled study with a larger sample size. TRIAL REGISTRATION ClinicalTrial.gov, NCT02439515. Registered on May 8, 2015, .
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Affiliation(s)
- Emilia Ambrosini
- Department of Electronics, Information and Bioengineering, Neuroengineering and Medical Robotics Laboratory, Politecnico di Milano, Milan, Italy
| | - Monica Parati
- Istituti Clinici Scientifici Maugeri, IRCSS, Lissone, Italy.
| | - Elisabetta Peri
- Department of Electrical Engineering, Laboratory of Biomedical Diagnostics, Eindhoven University of Technology, Eindhoven, The Netherlands
| | | | - Claudia Nava
- Istituti Clinici Scientifici Maugeri, IRCSS, Lissone, Italy
| | - Alessandra Pedrocchi
- Department of Electronics, Information and Bioengineering, Neuroengineering and Medical Robotics Laboratory, Politecnico di Milano, Milan, Italy
| | | | - Simona Ferrante
- Department of Electronics, Information and Bioengineering, Neuroengineering and Medical Robotics Laboratory, Politecnico di Milano, Milan, Italy
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Li J, Zhang Y, Song S, Hou Y, Hong Y, Yue S, Li K. Dynamical Analysis of Standing Balance Control on Sloped Surfaces in Individuals with Lumbar Disc Herniation. Sci Rep 2020; 10:1676. [PMID: 32015370 PMCID: PMC6997405 DOI: 10.1038/s41598-020-58455-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 01/15/2020] [Indexed: 11/15/2022] Open
Abstract
The changes of balance control mechanism caused by lumbar disc herniation (LDH) has not been well understood. This study aimed to investigate the effects of LDH on the balance control during standing on sloped surfaces. Ten patients with LDH and 10 gender- and age-matched healthy subjects were instructed to stand quietly on a sloped surface at -5°, 0° or +5°, respectively. The trajectories of the center of pressure (COP) of each individual limb and the full-body were recorded. Cross recurrence quantification analysis (CRQA) was applied to assess the coordination of COP components at the anterior-posterior and medial-lateral directions. The patients with LDH presented magnified inter-limb load asymmetry and had more deterministic components in the COP coordination of the less-affected limb and the full-body than the healthy subjects. The LDH led to decreased dynamical degree of freedom and less flexibility in bidirectional controlling the center of mass simultaneously. The effects of sensorimotor deficits due to LDH could be more obviously exhibited as standing on a declined rather than an inclined surface. This study shed light on the effects of LDH on standing balance control and may facilitate to develop novel strategies for evaluation of LDH.
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Affiliation(s)
- Jinping Li
- Laboratory of Motor Control and Rehabilitation, Institute of Biomedical Engineering, School of Control Science and Engineering, Shandong University, Jinan, 250061, China
| | - Yang Zhang
- Department of Physical Medicine and Rehabilitation, Qilu Hospital, Shandong University, Jinan, 250012, China
| | - Shasha Song
- Department of Physical Medicine and Rehabilitation, Qilu Hospital, Shandong University, Jinan, 250012, China
| | - Ying Hou
- Department of Rehabilitation Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, 215002, China
| | - Yigen Hong
- Department of Physical Medicine and Rehabilitation, Qilu Hospital, Shandong University, Jinan, 250012, China
| | - Shouwei Yue
- Department of Physical Medicine and Rehabilitation, Qilu Hospital, Shandong University, Jinan, 250012, China.
| | - Ke Li
- Laboratory of Motor Control and Rehabilitation, Institute of Biomedical Engineering, School of Control Science and Engineering, Shandong University, Jinan, 250061, China.
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Li J, Wei N, Yue S, Zhang Y, Li K. Analysis of Standing Balance on Sloped Surfaces in Individuals with Lumbar Disc Herniation. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:5092-5095. [PMID: 31947004 DOI: 10.1109/embc.2019.8857918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The change of balance control mechanism caused by lumbar disc herniation (LDH) has not been well understood. The aim of the study was to investigate the effects of LDH on the dynamical coordinations of center of pressure (COP) during standing on sloped surfaces. Eight LDH patients and 8 gender- and age-matched healthy subjects were recruited to participant in the experiment. Three surface conditions (declining, level and inclining) were set up. Limb load asymmetry (LLA) and individual leg COP (COPmore-affected and COPless-affected) were calculated from the foot pressure distributions which recorded during quiet standing by a force plate. Cross recurrence quantification analysis (CRQA) was applied to assess the coordination of COP trajectories. Linear cross-correlation was applied to measure the correlation between CRQA parameters and COP area. LDH patients showed higher LLA and more deterministic structure of less-affected leg, especially on sloped surfaces, but there is not much difference in more-affected leg. CRQA parameters showed positive correlation with COP area on sloped surfaces. This study reveals that the LDH patients alter the postural control mechanism by magnifying the inter-limb asymmetry and reinforcing feedforward mechanism. The sloped surfaces magnified the changes of more deterministic and rigid patterns in less-affected side in the LDH. This study may provide a new strategy for clinical diagnosis and evaluation of LDH.
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Khan F, Anjamparuthikal H, Chevidikunnan MF. The Comparison between Isokinetic Knee Muscles Strength in the Ipsilateral and Contralateral Limbs and Correlating with Function of Patients with Stroke. J Neurosci Rural Pract 2019; 10:683-689. [PMID: 31831990 PMCID: PMC6906114 DOI: 10.1055/s-0039-1700612] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Objective The aim of this study is to compare the isokinetic knee muscles peak torque measurements and proprioception between the affected and intact limbs of patients with stroke, in addition to finding the correlation between knee muscles strength and lower limb function. Methods Twelve patients with stroke (mean age 64.33 ± 6.140 years), with 3 to 7 months poststroke who can walk 25 feet independently without using or using assistive devices and full passive range of motion were included in the study. Biodex isokinetic dynamometer was used for measuring isokinetic strength at 90°/s, 120°/s, and 150°/s and isometric strength at 60°/s in both flexors and extensors of the knee, whereas proprioception was measured at 45°/s knee flexion, all for affected and intact limbs. Functional measurements were assessed using the Fugl-Meyer Assessment for Lower Limb scale and Barthel Index (BI). Results The differences shown were found to be statistically significant between affected and intact limbs in isokinetic 90°/s flexion ( p = 0.005), extension ( p = 0.0013), and isometric at 60°/s flexion ( p < 0.0001) knee muscle strengths and also the proprioception ( p = 0.05). Significant positive correlation was found between isokinetic affected side knee flexion at 90°/s ( r = 0.903) with BI ( r = 0.704). Conclusion There is a significant difference in peak torque measurements between affected and normal lower limbs of poststroke patients, as well as a significant correlation between the knee strength and lower limb functions. Furthermore, it can also be concluded that the differences in knee proprioception between the affected and intact limbs were shown to be significant.
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Affiliation(s)
- Fayaz Khan
- Department of Physical Therapy, Faculty of Medical Rehabilitation Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Haris Anjamparuthikal
- Department of Physical Therapy, Faculty of Medical Rehabilitation Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohamed Faisal Chevidikunnan
- Department of Physical Therapy, Faculty of Medical Rehabilitation Science, King Abdulaziz University, Jeddah, Saudi Arabia
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Yuan H, Ge P, Du L, Xia Q. Co-Contraction of Lower Limb Muscles Contributes to Knee Stability During Stance Phase in Hemiplegic Stroke Patients. Med Sci Monit 2019; 25:7443-7450. [PMID: 31584038 PMCID: PMC6792518 DOI: 10.12659/msm.916154] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Knee stability has an important role in the gait of hemiplegic stroke patients. However, factors affecting knee stability have not been assessed concerning gait. The purpose of this study was to explore whether co-contraction of the lower limb muscles contributes to the knee stability during the stance phase of the gait cycle in hemiplegic stroke patients. Material/Methods A total of 30 hemiplegic stroke patients, ages 36–79 years, were instructed to walk at their natural speed. The root mean square of surface electromyography was used to measure activities of the biceps femoris and rectus femoris muscles, while the co-contraction ratio was computed based on the root mean squares. The peak angle of knee extension was acquired in the stance phase by 3D kinematic analyses. Lower limb function was evaluated using the Fugl-Meyer scale for lower limb motor assessment. Results A statistically significant increase of the muscle co-contraction ratio of the involved extremity was observed compared with that of the uninvolved extremity (t=−4.066, P<0.05). The muscle co-contraction ratio was significantly correlated with the peak angle of knee extension (r=0.387, P=0.035), Fugl-Meyer scale (r=−0.522, P=0.003), and Modified Ashworth Scale (r=0.404, P=0.027) during the stance phase of the gait cycle. Conclusions Our results showed that co-contraction of the rectus femoris muscle contributes to the stability of the knee and lower limb function in hemiplegic stroke patients, and suggests that co-contraction should be considered in the rehabilitation of knee stability during gait in hemiplegic stroke patients. Appropriate rehabilitation assessment planning with hemiplegic stroke patients, such as muscle co-contraction or knee stability of, might be created based on our results.
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Affiliation(s)
- Hai Yuan
- Department of Rehabilitation Medicine, The Second People's Hospital of Hefei City, Hefei, Anhui, China (mainland)
| | - Pingping Ge
- Department of Rehabilitation Medicine, The Second People's Hospital of Hefei City, Hefei, Anhui, China (mainland)
| | - Lingling Du
- Department of Rehabilitation Medicine, The Second People's Hospital of Hefei City, Hefei, Anhui, China (mainland)
| | - Qing Xia
- Department of Rehabilitation Medicine, The Second People's Hospital of Hefei City, Hefei, Anhui, China (mainland)
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Sánchez-Sánchez ML, Ruescas-Nicolau MA, Carrasco JJ, Espí-López GV, Pérez-Alenda S. Cross-sectional study of quadriceps properties and postural stability in patients with chronic stroke and limited vs. non-limited community ambulation. Top Stroke Rehabil 2019; 26:503-510. [PMID: 31246150 DOI: 10.1080/10749357.2019.1634360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Changes in the paretic-side metabolism post-stroke and quadriceps muscle mechanical properties favour muscle wasting, affecting postural instability and walking impairment. Further clarification is needed in subjects post-stroke who show limited or non-limited community ambulation. Objectives: To analyze between-limb differences in quadriceps muscle thickness, strength and thigh cutaneous temperature, as well as investigate postural stability in subjects with chronic stroke and limited vs. non-limited community ambulation and compared against healthy controls. Methods: In this controlled cross-sectional study, 26 participants with chronic hemiparesis post-stroke (divided in a slow gait group (SG<0.8 m/s) (n = 13) and a fast gait group with full community ambulation speed (FG≥0.8 m/s)) and 18 healthy people were recruited. Thigh surface temperature, rectus femoris (RF) and vastus intermedius (VI) muscles thickness, quadriceps' isometric maximal voluntary contraction and postural stability were measured. Results: The SG presented significantly lower RF (P = .019) and VI (P = .006) muscle thickness, less peak force (P < .001) and lower temperature (P = .002) in the paretic vs the non-paretic limb. The FG showed significantly lower VI thickness (P = .036) and peak force (P < .001) in the paretic vs the non-paretic limb. Regarding balance, all indices were worse in the SG versus the FG and CG. Conclusions: Subjects of the FG, despite showing full community ambulation speed, had less quadriceps strength and VI muscle thickness but not RF muscle wasting in the paretic limb. The paretic VI muscle wasting may be an important factor to reach normal walking. The SG showed between-limb differences in all the studied variables and the worst postural stability.
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Affiliation(s)
- Maria-Luz Sánchez-Sánchez
- Physiotherapy in Motion. Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia , Valencia , Spain
| | - Maria-Arantzazu Ruescas-Nicolau
- Physiotherapy in Motion. Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia , Valencia , Spain
| | - Juan J Carrasco
- Physiotherapy in Motion. Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia , Valencia , Spain.,Intelligent Data Analysis Laboratory, University of Valencia , Valencia , Spain
| | - Gemma-Victoria Espí-López
- Research Unit in Manual Locomotor Therapy. Faculty of Physiotherapy, University of Valencia , Valencia , Spain.,Department of Physiotherapy, University of Valencia , Valencia , Spain
| | - Sofia Pérez-Alenda
- Physiotherapy in Motion. Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia , Valencia , Spain
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Alcantara CC, Blanco J, De Oliveira LM, Ribeiro PFS, Herrera E, Nakagawa TH, Reisman DS, Michaelsen SM, Garcia LC, Russo TL. Cryotherapy reduces muscle hypertonia, but does not affect lower limb strength or gait kinematics post-stroke: a randomized controlled crossover study. Top Stroke Rehabil 2019; 26:267-280. [PMID: 31012824 DOI: 10.1080/10749357.2019.1593613] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Based on the premise that spasticity might affect gait post-stroke, cryotherapy is among the techniques used to temporarily reduce spasticity in neurological patients. This effective technique would enhance muscle performance, and ultimately, functional training, such as walking. However, understanding whether a decrease in spasticity level, if any, would lead to improving muscle performance and gait parameters is not based on evidence and needs to be clarified. OBJECTIVES to investigate the immediate effects of cryotherapy, applied to spastic plantarflexor muscles of subjects post-stroke, on tonus level, torque generation capacity of plantarflexors and dorsiflexors, and angular/spatiotemporal gait parameters. METHODS Sixteen chronic hemiparetic subjects participated in this randomized controlled crossover study. Cryotherapy (ice pack) or Control (room temperature sand pack) were applied to the calf muscles of the paretic limb. The measurements taken (before and immediately after intervention) were: 1) Tonus according to the Modified Ashworth Scale; 2) Torque assessments were performed using an isokinetic dynamometer; and 3) Spatiotemporal and angular kinematics of the hip, knee, and ankle (flexion/extension), obtained using a tridimensional movement analysis system (Qualisys). RESULTS Cryotherapy decreased plantarflexor tonus but did not change muscle torque generation capacity and did not affect spatiotemporal or angular parameters during gait compared to control application. These findings contribute to the evidence-based approach to clinical rehabilitation post-stroke. CONCLUSIONS The findings of this study suggest that cryotherapy applied to the calf muscles of subjects with chronic hemiparesis reduces muscle hypertonia but does not improve dorsiflexors and plantarflexors performance and gait parameters.
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Affiliation(s)
- Carolina Carmona Alcantara
- a Laboratory of Neurological Physiotherapy Research, Department of Physical Therapy , Federal University of São Carlos (UFSCar) , São Carlos , Brazil
| | - Julia Blanco
- a Laboratory of Neurological Physiotherapy Research, Department of Physical Therapy , Federal University of São Carlos (UFSCar) , São Carlos , Brazil
| | - Lucilene Maria De Oliveira
- a Laboratory of Neurological Physiotherapy Research, Department of Physical Therapy , Federal University of São Carlos (UFSCar) , São Carlos , Brazil
| | - Paula Fernanda Sávio Ribeiro
- a Laboratory of Neurological Physiotherapy Research, Department of Physical Therapy , Federal University of São Carlos (UFSCar) , São Carlos , Brazil
| | - Esperanza Herrera
- b Physical Therapy School , Universidad Industrial de Santander (UIS) , Bucaramanga , Colombia
| | - Theresa Helissa Nakagawa
- a Laboratory of Neurological Physiotherapy Research, Department of Physical Therapy , Federal University of São Carlos (UFSCar) , São Carlos , Brazil
| | - Darcy S Reisman
- c Department of Physical Therapy , University of Delaware , Newark , DE , USA
| | - Stella Maris Michaelsen
- d Department of Physical Therapy , Universidade do Estado de Santa Catarina , Florianópolis, SC , Brazil
| | - Luccas Cavalcanti Garcia
- a Laboratory of Neurological Physiotherapy Research, Department of Physical Therapy , Federal University of São Carlos (UFSCar) , São Carlos , Brazil
| | - Thiago Luiz Russo
- a Laboratory of Neurological Physiotherapy Research, Department of Physical Therapy , Federal University of São Carlos (UFSCar) , São Carlos , Brazil
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Measurement of electromyography during bobsleigh push-start: A comparison with world top-ranked athletes. Sci Sports 2019. [DOI: 10.1016/j.scispo.2018.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Fujita K, Hori H, Kobayashi Y. Contribution of muscle activity at different gait phases for improving walking performance in chronic stroke patients with hemiparesis. J Phys Ther Sci 2018; 30:1381-1385. [PMID: 30464370 PMCID: PMC6220099 DOI: 10.1589/jpts.30.1381] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 08/20/2018] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The aim of this study was to clarify the optimal timing for increasing muscle
activity in the paralyzed lower limb of stroke survivors by evaluating the relationship
between gait muscle activity patterns and gait parameters. [Participants and Methods]
Electromyography of the tibialis anterior, soleus, rectus femoris, and biceps femoris on
the paralyzed side and spatiotemporal gait parameters were evaluated in 40 chronic
post-stroke patients as they walked at a comfortable speed. The normalized average
amplitude and asymmetry indexes of each gait phase were calculated. The correlations
between gait velocity or asymmetry indexes and the activity amplitudes of various muscles
during each gait phase were analyzed. Multiple regression analysis was performed with gait
velocity or asymmetry indexes as the response variable and the muscle activity amplitudes
in the various gait phases as explanatory variables. [Results] The major determinants of
gait velocity were the tibialis anterior activity (β=−0.35) and biceps
femoris activity (β=0.45) during the swing phase. In addition, the biceps
femoris activity during the swing phase was the major determinant of the asymmetry index
for the swing phase duration (β=−0.41). [Conclusion] For patients with
hemiparesis, increasing the biceps femoris activity during the swing phase is considered
optimal, which may lead to improvement in walking performance.
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Affiliation(s)
- Kazuki Fujita
- Department of Rehabilitation Physical Therapy, Faculty of Health Science, Fukui Health Science University: 55-13-1 Egami, Fukui-city, Fukui 910-3190, Japan
| | - Hideaki Hori
- Department of Rehabilitation Physical Therapy, Faculty of Health Science, Fukui Health Science University: 55-13-1 Egami, Fukui-city, Fukui 910-3190, Japan
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