Rhythmic arm swing enhances patterned locomotor-like muscle activity in passively moved lower extremities

The Effects of Proprioceptive Neuromuscular Facilitation Pattern Kinesio Taping on Arm Swing, Balance, and Gait Parameters among Chronic Stroke Patients: A Randomized Controlled Trial

(1) Background: This study aimed to investigate the effects of proprioceptive neuromuscular facilitation pattern kinesio taping on arm swing, balance, and gait parameters among chronic stroke patients. (2) Methods: Twenty-eight participants were randomized into proprioceptive neuromuscular facilitation pattern kinesio taping during gait training (n = 14) and gait training (n = 14) groups. The proprioceptive neuromuscular facilitation pattern kinesio taping during gait training group employed proprioceptive neuromuscular facilitation pattern kinesio taping during 15 min treadmill-based gait training five times a week for four weeks, while the gait training group underwent the same gait training without proprioceptive neuromuscular facilitation pattern kinesio taping. Arm swing angle was measured using the Image J program, static balance was assessed with an AMTI force plate, dynamic balance was evaluated through the Timed Up and Go test, and gait parameters were recorded using the GAITRite system and the Dynamic Gait Index. (3) Results: After 4 weeks of training, the proprioceptive neuromuscular facilitation pattern kinesio taping during gait training group exhibited significant improvements in all variables compared to the baseline (p < 0.05), whereas the gait training group did not show statistically significant differences in any variables (p > 0.05). (4) Conclusions: This study demonstrates the effectiveness of proprioceptive neuromuscular facilitation pattern kinesio taping during gait training in enhancing arm swing angle, balance, and gait parameters.

Using a simple rope-pulley system that mechanically couples the arms, legs, and treadmill reduces the metabolic cost of walking

BACKGROUND

Emphasizing the active use of the arms and coordinating them with the stepping motion of the legs may promote walking recovery in patients with impaired lower limb function. Yet, most approaches use seated devices to allow coupled arm and leg movements. To provide an option during treadmill walking, we designed a rope-pulley system that physically links the arms and legs. This arm-leg pulley system was grounded to the floor and made of commercially available slotted square tubing, solid strut channels, and low-friction pulleys that allowed us to use a rope to connect the subject's wrist to the ipsilateral foot. This set-up was based on our idea that during walking the arm could generate an assistive force during arm swing retraction and, therefore, aid in leg swing.

METHODS

To test this idea, we compared the mechanical, muscular, and metabolic effects between normal walking and walking with the arm-leg pulley system. We measured rope and ground reaction forces, electromyographic signals of key arm and leg muscles, and rates of metabolic energy consumption while healthy, young subjects walked at 1.25 m/s on a dual-belt instrumented treadmill (n = 8).

RESULTS

With our arm-leg pulley system, we found that an assistive force could be generated, reaching peak values of 7% body weight on average. Contrary to our expectation, the force mainly coincided with the propulsive phase of walking and not leg swing. Our findings suggest that subjects actively used their arms to harness the energy from the moving treadmill belt, which helped to propel the whole body via the arm-leg rope linkage. This effectively decreased the muscular and mechanical demands placed on the legs, reducing the propulsive impulse by 43% (p < 0.001), which led to a 17% net reduction in the metabolic power required for walking (p = 0.001).

CONCLUSIONS

These findings provide the biomechanical and energetic basis for how we might reimagine the use of the arms in gait rehabilitation, opening the opportunity to explore if such a method could help patients regain their walking ability.

TRIAL REGISTRATION

 Study registered on 09/29/2018 in ClinicalTrials.gov (ID-NCT03689647).

Intermuscular coherence analysis in older adults reveals that gait-related arm swing drives lower limb muscles via subcortical and cortical pathways

KEY POINTS

Gait-related arm swing in humans supports efficient lower limb muscle activation, indicating a neural coupling between the upper and lower limbs during gait. Intermuscular coherence analyses of gait-related electromyography from upper and lower limbs in 20 healthy participants identified significant coherence in alpha and beta/gamma bands indicating that upper and lower limbs share common subcortical and cortical drivers that coordinate the rhythmic four-limb gait pattern. Additional directed connectivity analyses revealed that upper limb muscles drive and shape lower limb muscle activity during gait via subcortical and cortical pathways and to a lesser extent vice versa. The results provide a neural underpinning that arm swing may serve as an effective rehabilitation therapy concerning impaired gait in neurological diseases.

ABSTRACT

Human gait benefits from arm swing, as it enhances efficient lower limb muscle activation in healthy participants as well as patients suffering from neurological impairment. The underlying neuronal mechanisms of such coupling between upper and lower limbs remain poorly understood. The aim of the present study was to examine this coupling by intermuscular coherence analysis during gait. Additionally, directed connectivity analysis of this coupling enabled assessment of whether gait-related arm swing indeed drives lower limb muscles. To that end, electromyography recordings were obtained from four lower limb muscles and two upper limb muscles bilaterally, during gait, of 20 healthy participants (mean (SD) age 67 (6.8) years). Intermuscular coherence analysis revealed functional coupling between upper and lower limb muscles in the alpha and beta/gamma band during muscle specific periods of the gait cycle. These effects in the alpha and beta/gamma bands indicate involvement of subcortical and cortical sources, respectively, that commonly drive the rhythmic four-limb gait pattern in an efficiently coordinated fashion. Directed connectivity analysis revealed that upper limb muscles drive and shape lower limb muscle activity during gait via subcortical and cortical pathways and to a lesser extent vice versa. This indicates that gait-related arm swing reflects the recruitment of neuronal support for optimizing the cyclic movement pattern of the lower limbs. These findings thus provide a neural underpinning for arm swing to potentially serve as an effective rehabilitation therapy concerning impaired gait in neurological diseases.

Changes in Gait Performance in Stroke Patients after Taping with Scapular Setting Exercise

The purpose of this study was to investigate the effects of combined taping with scapular setting exercise on the gait performance of stroke patients. Twenty stroke patients were randomly allocated to two groups: the taping with scapular setting exercise (TSSE) group (n = 10) and scapular setting exercise (SSE) group (n = 10). Intervention was performed for one week, and pre- and postintervention results for TSSE and SSE were compared. Outcomes were determined using the inertia measurement unit, which can measure spatiotemporal gait parameters, and using the timed up-and-go test. Two-way repeated analysis was used to compare pre- and postintervention results. In the TSSE group, intervention significantly improved cadence, gait speed, stride length, step length, gait cycle, swing phase duration, double support duration, and timed up-and-go test results more than in the SSE group. TSSE was found to improve all spatiotemporal gait parameters examined; thus, we recommend TSSE be considered as an intervention to improve gait parameters in stroke patients.

Effects of integrating rhythmic arm swing into robot-assisted walking in patients with subacute stroke: a randomized controlled pilot study

This study aimed to identify the effects of rhythmic arm swing during robot-assisted walking training on balance, gait, motor function, and activities of daily living among patients with subacute stroke. Twenty patients with subacute stroke were recruited, and thereafter randomly allocated to either the experimental group that performed the robot-assisted walking training with rhythmic arm swing, or the control group that performed the training in arm fixation. In total, 30 training sessions were carried out. The outcome measures included the 10-m walk test, Berg balance scale, timed up-and-go test, fall index that was measured using the Tetrax system, motor function test of Fugl-Meyer assessment, and modified Barthel index. The patients of both groups showed significant improvement in all parameters after the intervention (P<0.05). The Berg balance scale, Fugl-Meyer assessment, and modified Barthel index scores at post-test appeared to be significantly higher for the experimental group than for the control group (P<0.05). These findings indicate that more favorable effects from robot-assisted walking training in patients with subacute stroke may be obtained by the use of rhythmic arm swing.

Non-gait-specific intervention for the rehabilitation of walking after SCI: role of the arms

Arm movements modulate leg activity and improve gait efficiency; however, current rehabilitation interventions focus on improving walking through gait-specific training and do not actively involve the arms. The goal of this project was to assess the effect of a rehabilitation strategy involving simultaneous arm and leg cycling on improving walking after incomplete spinal cord injury (iSCI). We investigated the effect of 1) non-gait-specific training and 2) active arm involvement during training on changes in over ground walking capacity. Participants with iSCI were assigned to simultaneous arm-leg cycling (A&L) or legs only cycling (Leg) training paradigms, and cycling movements were assisted with electrical stimulation. Overground walking speed significantly increased by 0.092 ± 0.022 m/s in the Leg group and 0.27 ± 0.072m/s in the A&L group after training. Whereas the increases in the Leg group were similar to those seen after current locomotor training strategies, increases in the A&L group were significantly larger than those in the Leg group. Walking distance also significantly increased by 32.12 ± 8.74 m in the Leg and 91.58 ± 36.24 m in the A&L group. Muscle strength, sensation, and balance improved in both groups; however, the A&L group had significant improvements in most gait measures and had more regulated joint kinematics and muscle activity after training compared with the Leg group. We conclude that electrical stimulation-assisted cycling training can produce significant improvements in walking after SCI. Furthermore, active arm involvement during training can produce greater improvements in walking performance. This strategy may also be effective in people with other neural disorders or diseases. NEW & NOTEWORTHY This work challenges concepts of task-specific training for the rehabilitation of walking and encourages coordinated training of the arms and legs after spinal cord injury. Cycling of the legs produced significant improvements in walking that were similar in magnitude to those reported with gait-specific training. Moreover, active engagement of the arms simultaneously with the legs generated nearly double the improvements obtained by leg training only. The cervico-lumbar networks are critical for the improvement of walking.

A Review of Classification Techniques of EMG Signals during Isotonic and Isometric Contractions

In recent years, there has been major interest in the exposure to physical therapy during rehabilitation. Several publications have demonstrated its usefulness in clinical/medical and human machine interface (HMI) applications. An automated system will guide the user to perform the training during rehabilitation independently. Advances in engineering have extended electromyography (EMG) beyond the traditional diagnostic applications to also include applications in diverse areas such as movement analysis. This paper gives an overview of the numerous methods available to recognize motion patterns of EMG signals for both isotonic and isometric contractions. Various signal analysis methods are compared by illustrating their applicability in real-time settings. This paper will be of interest to researchers who would like to select the most appropriate methodology in classifying motion patterns, especially during different types of contractions. For feature extraction, the probability density function (PDF) of EMG signals will be the main interest of this study. Following that, a brief explanation of the different methods for pre-processing, feature extraction and classifying EMG signals will be compared in terms of their performance. The crux of this paper is to review the most recent developments and research studies related to the issues mentioned above.

Active Hip Flexion is a predictor of mobility in Amyotrophic Lateral Sclerosis

BACKGROUND

Muscle Force (MF) and amplitude of active movement (AAM) are progressively affected in amyotrophic lateral sclerosis (ALS). These measurements are correlated with mobility but influence it in a distinct manner.

OBJECTIVE

To determine the influence of MF and AAM on the mobility of the subjects with ALS.

METHODS

The formula for identifying the covariables and scale of mobility of the Amyotrophic Lateral Sclerosis Assessment Questionnaire were applied to 23 subjects with ALS. The MF data of the knee and ankle flexors and extensors were collected in the most affected limb. In conjunction, the AAM of hip and knee flexion were captured. Multiple linear regressions were used, considering alpha ≤0.05.

RESULTS

MF and AAM interfered in mobility and are responsible for 63.6% of the variation in mobility. The variable that explained this variation was the AAM of hip flexion. The stage of disease was considered a covariable.

CONCLUSION

AAM of hip flexion is a safe predictor of mobility in ALS. Retarding loss of this AAM may maintain these subjects functional for a longer time. It was not possible to use MF of the muscles evaluated to predict mobility.