The effects of symmetric center of pressure displacement training with feedback on the gait of stroke patients

Immediate augmented real-time forefoot weight bearing using visual feedback improves gait symmetry in chronic stroke

BACKGROUND

Symmetry of gait is an important component of rehabilitation in stroke patients. Insufficient weight-bearing causes gait asymmetry.

OBJECTIVE

This study aimed to identify the immediate effects of sufficient weight-bearing on the forefoot during the stance phase using visual feedback.

METHODS

Twenty-seven individuals with stroke enrolled in this study. All patients were evaluated for gait parameters with and without visual feedback. Visual feedback was provided through a smart application and a beam projector screen that showed a weight shift as a change in color. Spatiotemporal gait parameters were evaluated, resulting in values for a calculated symmetry index, in addition to heel % and toe % temporal values.

RESULTS

Velocity and cadence were significantly decreased when visual feedback was provided (p< 0.05). Spatiotemporal parameters, except for bilateral step length, swing time of affected side, and single-limb support of less affected side, showed significant improvement (p< 0.05). The gait pattern of subjects was more symmetrical with visual feedback compared to non-visual feedback (p< 0.05). The toe-on time significantly improved on the affected side with visual feedback (p< 0.05).

CONCLUSION

This study suggests that visual feedback aids in the improvement of gait symmetry, forefoot weight-bearing on the affected side, and spatiotemporal parameters.

The Effects of Short-Term Wearing of Customized 3D Printed Single-Sided Lateral Wedge Insoles on Lower Limbs in Healthy Males: A Randomized Controlled Trial

Background

Unbalanced standing and gait asymmetry are common in individuals with musculoskeletal disorders. Achieving symmetrical posture and gait is an important goal of rehabilitation. This study investigated the biomechanical differences in the lower extremities observed immediately after an insole was used and without the use of different one-sided insoles.

Material/Methods

Thirty young, healthy adult males received 3 different insole interventions: experimental group A had a customized 3-dimensional (3D)-printed single-sided lateral wedge insole (CLWI) inserted on the left side, and experimental group B had on the left side, a traditional single insert. The control had unilateral flat insoles; no insole inserted into the socks. Motion mechanics and gait parameters were collected at the 2-time points, after insertion of the insole and after 20 minutes of walking with the insole.

Results

Asymmetric posture and gait appeared immediately after using the 2 insoles (lower joint moment, P<0.05). Compared with the control group, the abnormal posture and gait of experimental group B after wearing the traditional insole for 20 minutes were not obvious (P>0.05). However, the asymmetrical posture and gait remained in experimental group A after wearing the CLWI for 20 minutes (P<0.05). The center of pressure (COP) trajectory of the left foot of experimental group A was significantly higher than that of experimental group B and the control group at the 2-time points (P<0.05).

Conclusions

The asymmetry of posture and gait can be observed in a short time using a customized 3D-printed single-sided lateral wedge insole. This experiment provides guidance for the application of customized 3D-printed single-sided lateral wedge insoles for gait rehabilitation.

Neuromuscular adaptations and sensorimotor integration following a unilateral transfemoral amputation

BACKGROUND

Following an amputation, the human postural control system develops neuromuscular adaptations to regain an effective postural control. We investigated the compensatory mechanisms behind these adaptations and how sensorimotor integration is affected after a lower-limb transfemoral amputation.

METHODS

Center of pressure (CoP) data of 12 unilateral transfemoral amputees and 12 age-matched able-bodied subjects were recorded during quiet standing with eyes open (EO) and closed (EC). CoP adjustments under each leg were recorded to study their contribution to posture control. The spatial structure of the CoP displacements was characterized by measuring the mean distance, the mean velocity of the CoP adjustments, and the sway area. The Entropic Half-Life (EnHL) quantifies the temporal structure of the CoP adjustments and was used to infer disrupted sensory feedback loops in amputees. We expanded the analysis with measures of weight-bearing imbalance and asymmetry, and with two standardized balance assessments, the Berg Balance Scale (BBS) and Timed Up-and-Go (TUG).

RESULTS

There was no difference in the EnHL values of amputees and controls when combining the contributions of both limbs (p = 0.754). However, amputees presented significant differences between the EnHL values of the intact and prosthetic limb (p <  0.001). Suppressing vision reduced the EnHL values of the intact (p = 0.001) and both legs (p = 0.028), but not in controls. Vision feedback in amputees also had a significant effect (increase) on the mean CoP distance (p <  0.001), CoP velocity (p <  0.001) and sway area (p = 0.007). Amputees presented an asymmetrical stance. The EnHL values of the intact limb in amputees were positively correlated to the BBS scores (EO: ρ = 0.43, EC: ρ = 0.44) and negatively correlated to the TUG times (EO: ρ = - 0.59, EC: ρ = - 0.69).

CONCLUSION

These results suggest that besides the asymmetry in load distribution, there exist neuromuscular adaptations after an amputation, possibly related to the loss of sensory feedback and an altered sensorimotor integration. The EnHL values suggest that the somatosensory system predominates in the control of the intact leg. Further, suppressing the visual system caused instability in amputees, but had a minimal impact on the CoP dynamics of controls. These findings points toward the importance of providing somatosensory feedback in lower-limb prosthesis to reestablish a normal postural control.

TRIAL REGISTRATION

DRKS00015254 , registered on September 20th, 2018.

Immediate and short-term effects of wearing a single textured insole on symmetry of stance and gait in healthy adults

Asymmetry of standing balance and gait are common in individuals with neurological or musculoskeletal disorders and achieving symmetrical stance and gait is an important goal of rehabilitation. The aim of the study was to investigate if asymmetry of stance and gait observed immediately after the start of using a single textured insole remains during longer use of the insole. Ten young healthy adults walked in two different conditions: with a textured insole positioned in the left shoe or without the insole. Weight bearing, gait, and perceived level of discomfort were evaluated before using a textured insole, immediately after being provided with the insole, and after walking for 10min with the insole. The center of pressure (COP) trajectory was calculated for the right and left foot in the insole and no-insole conditions. Asymmetry of stance and gait was present immediately after the start of using a textured insole (p<0.05) but was not evident after 10min of wearing the insole. The COP trajectory of the right foot after being provided with the left insole was significantly greater compared with walking with no insole (p<0.05). Gait velocity, cadence, and the COP trajectory of the left foot were not affected by the use of the insole. The outcome of the study provides a background for the investigation of the effect of using a textural insole in gait rehabilitation.

The effects of Pilates exercise training on static and dynamic balance in chronic stroke patients: a randomized controlled trial

[Purpose] The purpose of this study was to analyze the effects of Pilates exercise on static and dynamic balance in chronic stroke patients. [Subjects and Methods] Nineteen individuals with unilateral chronic hemiparetic stroke (age, 64.7 ± 6.9 years; height, 161.7 ± 7.9 cm; weight, 67.0 ± 11.1 kg) were randomly allocated to either a Pilates exercise group (PG, n=10) or a control group (CG, n=9). The PG attended 24 exercise sessions conducted over an 8-week period (3 sessions/week). Center of pressure (COP) sway and COP velocity were measured one week before and after the exercise program and compared to assess training effects. [Results] Pilates exercise positively affected both static and dynamic balance in patients with chronic stroke. For static balance, COP sway and velocity in the medial-lateral (M-L) and anterior-posterior (A-P) directions were significantly decreased in the PG after training while no significant differences were found in the CG. For dynamic balance, measured during treadmill walking, the PG showed significantly reduced COP sway and velocity in the M-L and A-P directions for both the paretic and non-paretic leg. [Conclusions] The findings provide initial evidence that Pilates exercise can enhance static and dynamic balance in patients with chronic stroke.