1
|
Minelli C, Luvizutto GJ, Cacho RDO, Neves LDO, Magalhães SCSA, Pedatella MTA, de Mendonça LIZ, Ortiz KZ, Lange MC, Ribeiro PW, de Souza LAPS, Milani C, da Cruz DMC, da Costa RDM, Conforto AB, Carvalho FMM, Ciarlini BS, Frota NAF, Almeida KJ, Schochat E, Oliveira TDP, Miranda C, Piemonte MEP, Lopes LCG, Lopes CG, Tosin MHDS, Oliveira BC, de Oliveira BGRB, de Castro SS, de Andrade JBC, Silva GS, Pontes-Neto OM, de Carvalho JJF, Martins SCO, Bazan R. Brazilian practice guidelines for stroke rehabilitation: Part II. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:741-758. [PMID: 36254447 PMCID: PMC9685826 DOI: 10.1055/s-0042-1757692] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/18/2022] [Indexed: 10/14/2022]
Abstract
The Brazilian Practice Guidelines for Stroke Rehabilitation - Part II, developed by the Scientific Department of Neurological Rehabilitation of the Brazilian Academy of Neurology (Academia Brasileira de Neurologia, in Portuguese), focuses on specific rehabilitation techniques to aid recovery from impairment and disability after stroke. As in Part I, Part II is also based on recently available evidence from randomized controlled trials, systematic reviews, meta-analyses, and other guidelines. Part II covers disorders of communication, dysphagia, postural control and balance, ataxias, spasticity, upper limb rehabilitation, gait, cognition, unilateral spatial neglect, sensory impairments, home rehabilitation, medication adherence, palliative care, cerebrovascular events related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the future of stroke rehabilitation, and stroke websites to support patients and caregivers. Our goal is to provide health professionals with more recent knowledge and recommendations for better rehabilitation care after stroke.
Collapse
Affiliation(s)
- Cesar Minelli
- Hospital Carlos Fernando Malzoni, Matão SP, Brazil
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil
- Instituto Você sem AVC, Matão SP, Brazil
| | - Gustavo José Luvizutto
- Universidade Federal do Triângulo Mineiro, Departamento de Fisioterapia Aplicada, Uberaba MG, Brazil
| | - Roberta de Oliveira Cacho
- Universidade Federal do Rio Grande do Norte, Faculdade de Ciências da Saúde do Trairi, Santa Cruz RN, Brazil
| | | | | | - Marco Túlio Araújo Pedatella
- Hospital Israelita Albert Einstein, Unidade Goiânia, Goiânia GO, Brazil
- Hospital Santa Helena, Goiânia GO, Brazil
- Hospital Encore, Goiânia GO, Brazil
- Hospital Estadual Geral de Goiânia Dr. Alberto Rassi, Goiânia GO, Brazil
- Hospital de Urgência de Goiânia, Goiânia, GO, Brazil
| | - Lucia Iracema Zanotto de Mendonça
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Divisão de Neurologia, São Paulo SP, Brazil
- Pontíficia Universidade Católica de São Paulo, Faculdade de Ciências Humanas e da Saúde, São Paulo SP, Brazil
| | - Karin Zazo Ortiz
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Fala, Linguagem e Ciências Auditivas, São Paulo SP, Brazil
| | | | | | | | - Cristiano Milani
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Serviço de Neurologia Vascular e Emergências Neurológicas, Ribeirão Preto SP, Brazil
| | | | | | - Adriana Bastos Conforto
- Universidade de São Paulo, Hospital das Clínicas, Divisão de Neurologia Clínica, São Paulo SP, Brazil
- Hospital Israelita Albert Einstein, São Paulo SP, Brazil
| | | | - Bruna Silva Ciarlini
- Universidade de Fortaleza, Programa de Pos-Graduação em Ciências Médicas, Fortaleza CE, Brazil
| | | | | | - Eliane Schochat
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo SP, Brazil
| | - Tatiana de Paula Oliveira
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo SP, Brazil
| | - Camila Miranda
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo SP, Brazil
| | - Maria Elisa Pimentel Piemonte
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo SP, Brazil
| | - Laura Cardia Gomes Lopes
- Universidade Estadual de São Paulo, Faculdade de Medicina de Botucatu, Hospital das Clínicas, Departamento de Neurologia, Psicologia e Psiquiatria, São Paulo SP, Brazil
| | | | | | | | | | | | | | | | - Octávio Marques Pontes-Neto
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil
| | | | - Sheila C. Ouriques Martins
- Rede Brasil AVC, Porto Alegre RS, Brazil
- Hospital Moinhos de Vento, Departamento de Neurologia, Porto Alegre RS, Brazil
- Hospital de Clínicas de Porto Alegre, Departamento de Neurologia, Porto Alegre RS, Brazil
| | - Rodrigo Bazan
- Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu SP, Brazil
| |
Collapse
|
2
|
Avelino PR, Nascimento LR, Menezes KKP, Ada L, Teixeira-Salmela LF. Canes may not improve spatiotemporal parameters of walking after stroke: a systematic review of cross-sectional within-group experimental studies. Disabil Rehabil 2022; 44:1758-1765. [PMID: 32857674 DOI: 10.1080/09638288.2020.1808088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To examine whether using a cane would improve spatiotemporal parameters of walking, i.e., speed, stride length, cadence, and symmetry after stroke. MATERIAL AND METHODS Searches were conducted in eight databases. The experimental condition was walking with a cane. Four outcomes were of interest: walking speed, stride length, cadence, and symmetry. RESULTS Twelve studies were included. Results from nine studies suggested that individuals with stroke walked 0.01 m/s (SD 0.06) slower with a single-point cane, compared with no cane. Two studies suggested a reduction in cadence (MD-5 steps/min, SD2) and an increase in stride length (MD 0.08 m, SD 0.01). Three studies suggested that individuals walked 0.06 m/s (SD 0.07) slower with a four-point cane, compared with no cane. Four studies suggested that individuals walked 0.06 m/s (SD 0.04) faster with a single- point cane compared with a four-point cane. Results regarding other outcomes were inconclusive. CONCLUSIONS Results showed no worthwhile improvements in spatiotemporal parameters of walking with a single-point cane and a slight reduction with a four-point cane, compared with no cane. Individuals walked slightly faster with a single-point cane compared with a four-point cane, but the evidence is insufficient to support this superiority.IMPLICATIONS FOR REHABILITATIONA single-point cane may not improve spatiotemporal parameters of walking after stroke.Walking with a four-point cane may slightly decrease spatiotemporal parameters of walking.Canes may be prescribed without the fear of negatively impairing walking kinematics.
Collapse
Affiliation(s)
- Patrick R Avelino
- NeuroGroup, Discipline of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Lucas R Nascimento
- NeuroGroup, Discipline of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Center of Health Sciences, Discipline of Physiotherapy, Universidade Federal do Espírito Santo, Espírito Santo, Brazil
| | - Kênia K P Menezes
- NeuroGroup, Discipline of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Louise Ada
- Discipline of Physiotherapy, The University of Sydney, Sydney, Australia
| | - Luci F Teixeira-Salmela
- NeuroGroup, Discipline of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| |
Collapse
|
3
|
A Systematic Review of Non-Pharmacological Interventions to Improve Gait Asymmetries in Neurological Populations. Symmetry (Basel) 2022. [DOI: 10.3390/sym14020281] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Gait asymmetries are commonly observed in neurological populations and linked to decreased gait velocity, balance decrements, increased fall risk, and heightened metabolic cost. Interventions designed to improve gait asymmetries have varying methods and results. The purpose of this systematic review was to investigate non-pharmacological interventions to improve gait asymmetries in neurological populations. Keyword searches were conducted using PubMed, CINAHL, and Academic Search Complete. The search yielded 14 studies for inclusion. Gait was assessed using 3D motion capture systems (n = 7), pressure-sensitive mats (e.g., GAITRite; n = 5), and positional sensors (n = 2). The gait variables most commonly analyzed for asymmetry were step length (n = 11), stance time (n = 9), and swing time (n = 5). Interventions to improve gait asymmetries predominantly used gait training techniques via a split-belt treadmill (n = 6), followed by insoles/orthoses (n = 3). The literature suggests that a wide range of methods can be used to improve spatiotemporal asymmetries. However, future research should further examine kinematic and kinetic gait asymmetries. Additionally, researchers should explore the necessary frequency and duration of various intervention strategies to achieve the greatest improvement in gait asymmetries, and to determine the best symmetry equation for quantifying gait asymmetries.
Collapse
|
4
|
Kang YS, Cho KH. Changes in lower limb muscle activation and gait function according to cane dependence in chronic stroke patients. Technol Health Care 2021; 29:133-141. [PMID: 32444585 DOI: 10.3233/thc-192075] [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: 11/15/2022]
Abstract
BACKGROUND Few quantitative analyses have been performed on muscle activation and gait function according to cane dependence. OBJECTIVE The purpose of this study was to measure changes in the lower limb muscle activation and gait function according to reduced cane dependence using a weight-bearing feedback cane (WBFC) that had been designed to quantitatively measure cane dependence in stroke patients during walking. METHODS Twenty-four subjects were recruited from a local rehabilitation hospital. The WBFC measured the average weight support (AWS, kg) loaded on the cane during walking through a Bluetooth connection to laptop software. All subjects walked 20 m using a WBFC set in the three levels of weight support (WSR, 100%, 60%, and 20%) based on the measured AWS. Paretic lower limb muscle activation and gait function (velocity, cadence, paretic side stride length, and symmetry index) were measured using wireless surface EMG and a 3-axis accelerometer during walking. RESULTS The paretic side lower limb muscle activation of the 20% WSR on the cane was significantly higher than that of the 100% WSR on the cane (p< 0.05). Gait functions of the 20% WSR on the cane were significantly lower than those of the 100% WSR on the cane (p< 0.05). CONCLUSION These findings suggest that indiscreet weight support on the cane during walking can interfere with lower limb muscle activation and gait function. Therefore, in a clinical setting, reducing cane dependence during stroke gait training should be carefully considered.
Collapse
Affiliation(s)
- Young Sic Kang
- Department of Physical Therapy, Graduate School, Korea National University of Transportation, Republic of Korea
| | - Ki Hun Cho
- Department of Physical Therapy, Korea National University of Transportation, Republic of Korea
| |
Collapse
|
5
|
Huang WY, Tuan SH, Li MH, Hsu PT. Efficacy of a novel walking assist device with auxiliary laser illuminator in stroke Patients~ a randomized control trial. J Formos Med Assoc 2021; 121:592-603. [PMID: 34247893 DOI: 10.1016/j.jfma.2021.06.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 05/18/2021] [Accepted: 06/21/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND/PURPOSE Task-oriented functional walking is important in stroke patients. We aimed to investigate effects of a quad-cane with auxiliary laser illuminator (laser-cane) among stroke patients. METHODS This was a randomized-prospective study. Patients in the experimental group (EG) received 15-min of walking training with laser-cane and 15-min of traditional physical therapy. Patients in the control group (CG) received the same rehabilitation without laser-cane. The rehabilitation lasted for 4 weeks, twice per week. Primary outcome were gait parameters. Secondary outcomes were Berg Balance Scale (BBS), Timed Up and Go Test (TUG), and Barthel index (BI). Outcomes were measured at baseline, at the end of the rehabilitation (visit-1), and 4 weeks later (visit-2). RESULTS Both the groups (both n = 15) showed improvement of cadence, relative stance and swing phase duration of non-paretic side, BBS, and TUG at both visits. In the intragroup comparison, the EG additionally improved at stride length, relative stance and swing phase duration of paretic side, and gait speed at both visits; temporal swing symmetry, and toe-off angle of non-paretic side at the visit-2. Intergroup comparing for changing of outcomes with the CG, stride length and gait speed increased, relative stance phase duration of the non-paretic site decreased, and the temporal swing symmetry improved at the visit-1; relative stance phase duration of the paretic side decreased and the temporal stance symmetry improved at the visit-2 in the EG. CONCLUSION Rehabilitation with laser-cane improved the balance, activity of daily living, gait symmetry and gait parameters of stroke patients.
Collapse
Affiliation(s)
- Wan-Yun Huang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Institute of Allied Health Sciences, National Cheng Kung University, Tainan, Taiwan
| | - Sheng-Hui Tuan
- Department of Rehabilitation Medicine, Cishan Hospital, Ministry of Health and Welfare, Kaohsiung, Taiwan; Department of Physical Therapy, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan
| | - Min-Hui Li
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
| | - Pei-Te Hsu
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
| |
Collapse
|
6
|
Avelino PR, Nascimento LR, Ada L, de Menezes KKP, Teixeira-Salmela LF. Using a cane for one month does not improve walking or social participation in chronic stroke: An attention-controlled randomized trial. Clin Rehabil 2021; 35:1590-1598. [PMID: 34053229 DOI: 10.1177/02692155211020864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To examine the effects of the provision of a cane, delivered to ambulatory people with chronic stroke, for improving walking and social participation. DESIGN Two-arm, randomized trial. SETTING Community-based. PARTICIPANTS Ambulatory individuals with chronic stroke. INTERVENTIONS The experimental intervention was the provision of a single-point cane during one month. The control group received a placebo intervention. OUTCOME MEASURES Walking speed, step length, cadence, walking capacity, and walking confidence were measured without the cane to examine its rehabilitative effect. Walking speed was also measured with the cane for inclusiveness, and social participation was measured for examining carry over effects. Outcomes were measured at baseline, and after one and two months. RESULTS Fifty individuals were included. In the experimental group, mean age was 69 years (SD 14), and walking speed was 0.58 m/s (SD 0.17). In the control group, mean age was 68 years (SD 13), and walking speed was 0.63 m/s (SD 0.15). When walking without the cane, after one and after two months, there were no between-group differences in any measures. When walking with the cane, after one month, the experimental group walked 0.14 m/s (95% CI 0.05-0.23) faster than the control group and after two months, they were still walking 0.18 m/s (95% CI 0.06-0.30) faster. CONCLUSION Use of a cane improved walking speed, only when participants walked with the cane. Use of cane for one month did not improve walking outcomes, when walking without the cane. People with stroke would need to continue to use the cane to maintain any benefits in walking speed.
Collapse
Affiliation(s)
| | - Lucas Rodrigues Nascimento
- Department of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Discipline of Physiotherapy, Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Louise Ada
- Discipline of Physiotherapy, University of Sydney, Sydney, NSW, Australia
| | | | | |
Collapse
|
7
|
Kang YS, Oh GB, Cho KH. Walking Training with a Weight Support Feedback Cane Improves Lower Limb Muscle Activity and Gait Ability in Patients with Chronic Stroke: A Randomized Controlled Trial. Med Sci Monit 2021; 27:e931565. [PMID: 34052826 PMCID: PMC8174088 DOI: 10.12659/msm.931565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background Induction of proper weight transfer to the affected lower limb should be considered the most essential factor for successful stroke cane gait training. This study aimed to investigate the effect of walking training with a weight support feedback cane on lower limb muscle activity and gait ability of chronic stroke patients. Material/Methods Thirty stroke patients were randomized into 2 groups: a weight support feedback cane gait training group (WSFC group, n=15) and a conventional cane gait training group (CC group, n=15). All subjects were enrolled in standard rehabilitation programs for 4 weeks. Additionally, the WSFC group participated in WSFC gait training and the CC group participated in conventional cane gait training for 4 weeks. During WSFC gait training, the weight support rate loaded on the cane was reduced by 10% every week from 60% to 30% based on the measured initial cane dependence, while the CC group participated in conventional cane gait training with verbal instruction to reduce cane dependence. Lower limb muscle activity and gait ability were measured using wireless surface electromyography and a 3-axis accelerometer during walking. Results The WSFC group showed significantly greater improvement than the CC group in lower limb muscle activity and gait ability (P<0.05). Conclusions Cane gait training significantly improved lower limb muscle activity and gait ability in stroke regardless of the training method; however, the addition of real-time weight support feedback to cane gait training appears to provide further benefit compared with conventional cane gait training in chronic stroke patients.
Collapse
Affiliation(s)
- Young Sic Kang
- Department of Physical Therapy, Korea National University of Transportation, Jeungpyeong-gun, South Korea
| | - Gku Bin Oh
- Department of Physical Therapy, Korea National University of Transportation, Jeungpyeong-gun, South Korea
| | - Ki Hun Cho
- Department of Physical Therapy, Korea National University of Transportation, Jeungpyeong-gun, South Korea
| |
Collapse
|
8
|
Maguire CC, Sieben JM, Lutz N, van der Wijden G, Scheidhauer H, de Bie R. Replacing canes with an elasticated orthotic-garment in chronic stroke patients - The influence on gait and balance. A series of N-of-1 trials. J Bodyw Mov Ther 2020; 24:203-214. [PMID: 33218513 DOI: 10.1016/j.jbmt.2020.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 03/02/2020] [Accepted: 06/07/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To investigate the effect of replacing canes with an elasticated orthotic-garment on balance and gait-function in chronic stroke survivors. DESIGN Experimental, N-of-1 series with a replicated, ABC design with randomised phase duration in a home setting. PARTICIPANTS Four cane using chronic stroke survivors (P1-4). INTERVENTIONS Phase A (9-12 weeks) cane-walking "as usual" to establish baseline values; Phase B (9-16 weeks) intervention: orthotic-garment worn throughout the day with maximal cane-use reduction; Phase C (9-10 weeks) participant-determined follow-up: either no walking-aid, orthotic-garment or cane. OUTCOME MEASURES Primary: Functional-Gait-Assessment (FGA), Secondary: Trunk-sway during walking measured as Total-Angle-Area (TAA°2) in frontal and sagittal-planes, both measured weekly. RESULTS Visual and statistical analysis of results showed significant improvements in FGA from phase A to B in all participants. Improvement continued in phase C in P2, stabilized in P1 and P4 and deteriorated in P3. A Minimal-Clinical-Important-Difference of 6 points-change was achieved in P2 & P4. Trunk-sway reduced during walking, indicating increased stability, in two participants from phase A to B and in three participants from A to C but no TAA changes were statistically significant. In phase C participant-selected walking-aids were: P1 cane-usage reduced by 25%, P2 independent-walking with no assistive-device, S3 usual cane-usage, P4 orthotic-garment with reduced cane-usage 2-3 days-a-week, usual cane-usage 4-5 days. CONCLUSIONS Although walking ability is multifactorial these results indicate that the choice of walking-aids can have a specific and clinically relevant impact on gait following stroke. "Hands-free" assistive-devices may be more effective than canes in improving gait-function in some patients. CLINICALTRIALS. GOV ID NCT03642444.
Collapse
Affiliation(s)
- Clare C Maguire
- Department of Physiotherapy, Bildungszentrum Gesundheit Basel-Stadt, 4142, Muenchenstein, Switzerland; Caphri School for Public Health and Primary Care Research, Maastricht University, 6200, MD, Maastricht, the Netherlands; Department of Physiotherapy, REHAB, Clinic for Neurorehabilitation and Paraplegiology, Basel, Switzerland; Department of Health, Bern University of Applied Science, Schwarztorstrasse 48, 3007, Bern, Switzerland.
| | - Judith M Sieben
- Caphri School for Public Health and Primary Care Research, Maastricht University, 6200, MD, Maastricht, the Netherlands; Department of Anatomy and Embryology, Maastricht University, 6200, MD, Maastricht, the Netherlands
| | - Nathanael Lutz
- Department of Physiotherapy, Bildungszentrum Gesundheit Basel-Stadt, 4142, Muenchenstein, Switzerland
| | - Gisela van der Wijden
- Department of Physiotherapy, REHAB, Clinic for Neurorehabilitation and Paraplegiology, Basel, Switzerland
| | - Heike Scheidhauer
- Department of Physiotherapy, Bildungszentrum Gesundheit Basel-Stadt, 4142, Muenchenstein, Switzerland
| | - RobertA de Bie
- Caphri School for Public Health and Primary Care Research, Maastricht University, 6200, MD, Maastricht, the Netherlands; Department of Epidemiology, Maastricht University, 6200, MD, Maastricht, the Netherlands
| |
Collapse
|
9
|
Soler B, Ramari C, Valet M, Dalgas U, Feys P. Clinical assessment, management, and rehabilitation of walking impairment in MS: an expert review. Expert Rev Neurother 2020; 20:875-886. [PMID: 32729742 DOI: 10.1080/14737175.2020.1801425] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION One of the most common and life-altering consequences of Multiple Sclerosis (MS) is walking impairment. The distance, speed, and Gait pattern functions are components of the International Classification of Functioning, Disability, and Health (ICF) and are also predictors of dependency in terms of daily living activities in patients with MS (pwMS). AREAS COVERED This article provides an overview of walking impairment in pwMS, with focus on the assessment of gait and the rehabilitation approaches. EXPERT OPINION The authors recommend that pwMS undergo gait assessment integrating the ICF perspective using validated clinical outcome measures that cover spatiotemporal gait parameters. Moreover, assessment of walking speed with short walking capacity tests such as the timed 25-foot walk (T25FW) or the 10-m walk test (10 MWT) and tests for walking distance with middle distance tests such as the 2-min walk test (2MWT) and the 6-min walk test (6MWT). This review further highlights strategies that may restore walking function including pharmacological symptomatic treatment and non-pharmacological rehabilitation approaches such as exercise and task-specific training providing an appraisal of mobility targeted therapies to be considered when planning multidisciplinary comprehensive-care of pwMS. Finally, new and novel strategies such as motor imagery and rhythmic auditory stimulation have been developed to improve walking speed and distance in pwMS.
Collapse
Affiliation(s)
- Bernardita Soler
- Neurology Service, Hospital Doctor Sótero Del Río , Santiago, Chile.,Neurology Department, Pontificia Universidad Católica De Chile , Santiago, Chile
| | - Cintia Ramari
- Faculty of Physical Education, University of Brasília , Brasília, Brazil
| | - Maxime Valet
- Cliniques universitaires Saint-Luc, Service de Médecine Physique et Réadaptation , Brussels, Belgium.,Université catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuromusculoskeletal lab (NMSK) , Brussels, Belgium
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University , Aarhus, Denmark
| | - Peter Feys
- REVAL, Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University , Hasselt, Belgium
| |
Collapse
|
10
|
Short-term cane use in subacute stroke patients affects the nonparetic upper extremity nerves. Int J Rehabil Res 2020; 43:148-153. [DOI: 10.1097/mrr.0000000000000397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
11
|
Buurke TJW, Lamoth CJC, van der Woude LHV, den Otter R. Handrail Holding During Treadmill Walking Reduces Locomotor Learning in Able-Bodied Persons. IEEE Trans Neural Syst Rehabil Eng 2019; 27:1753-1759. [PMID: 31425041 DOI: 10.1109/tnsre.2019.2935242] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Treadmills used for gait training in clinical rehabilitation and experimental settings are commonly fitted with handrails to assist or support persons in locomotor tasks. However, the effects of balance support through handrail holding on locomotor learning are unknown. Locomotor learning can be studied on split-belt treadmills, where participants walk on two parallel belts with asymmetric left and right belt speeds, to which they adapt their stepping pattern within a few minutes. The aim of this study was to determine how handrail holding affects the walking pattern during split-belt adaptation and after-effects in able-bodied persons. Fifty healthy young participants in five experimental groups were instructed to hold handrails, swing arms freely throughout the experiment or hold handrails during adaptation and swing arms freely during after-effects. Step length asymmetry and double support asymmetry were measured to assess the spatiotemporal walking pattern. The results showed that holding handrails during split-belt adaptation reduces magnitude of initial perturbation of step length asymmetry and reduces after-effects in step length asymmetry upon return to symmetric belt speeds. The findings of this study imply that balance support during gait training reduces locomotor learning, which should be considered in daily clinical gait practice and future research on locomotor learning.
Collapse
|
12
|
Pyo S, Cho K, Kwon S, Lee D, Song S, Lee G. Gait analysis in hemiplegic stroke survivors who used the one-arm motorized walker. Technol Health Care 2019; 28:135-142. [PMID: 31306144 DOI: 10.3233/thc-191595] [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: 11/15/2022]
Abstract
OBJECTIVE A high number of stroke survivors experience limitations in balance and gait abilities. Thus, an improvement in gait ability is an important goal in the rehabilitation of hemiplegic stroke survivors. This study aimed to investigate the effect of using the one-arm motorized walker, a hemi-walker developed to assist hemiplegic stroke survivors in gait training and activities of daily living, on the improvement in gait ability in hemiplegic stroke survivors. METHODS Eleven hemiplegic stroke survivors who met the inclusion criteria were included. The participants were instructed to walk thrice using traditional walking aids on a gait mat and then to walk thrice using the one-arm motorized walker. During each walk, spatiotemporal gait parameters, including velocity, cadence, step length, stride length, single support time, and double support time, were evaluated using a gait analysis system. RESULTS Velocity and cadence significantly increased when the participants walked using the one-arm motorized walker compared to those who used traditional walking aids (p< 0.05), whereas double support time significantly decreased for both the more affected and less affected sides (p< 0.05). However, no significant difference was observed in terms of step length and single support time. CONCLUSION The one-arm motorized walker may have a positive effect on the improvement of gait ability in hemiplegic stroke survivors. It can be an effective walking aid for hemiplegic stroke survivors who experience difficulties in independent walking.
Collapse
Affiliation(s)
- Seunghyeon Pyo
- Department of Physical Therapy, Graduate School of Kyungnam University, Changwon, Korea
| | - Kihun Cho
- Department of Physical Therapy, Korea National University of Transportation, Jeungpyeong, Korea
| | - Suncheol Kwon
- Department of Rehabilitative and Assistive Technology, National Rehabilitation Research Institute, National Rehabilitation Center, Seoul, Korea
| | - Donggeon Lee
- Department of Physical Therapy, Graduate School of Kyungnam University, Changwon, Korea
| | - Sunhae Song
- Department of Physical Therapy, Graduate School of Kyungnam University, Changwon, Korea
| | - Gyuchang Lee
- Department of Physical Therapy, Kyungnam University, Changwon, Korea
| |
Collapse
|
13
|
Huang WY, Tuan SH, Li MH, Liu XY, Hsu PT. Immediate effects of a novel walking assist device with auxiliary illuminator on patients after acute strokes. Hong Kong Physiother J 2019; 39:115-124. [PMID: 31889762 PMCID: PMC6900335 DOI: 10.1142/s1013702519500100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 04/02/2019] [Accepted: 04/08/2019] [Indexed: 11/18/2022] Open
Abstract
Background: Many patients after acute stage of stroke are present with abnormal gait pattern due to weakness or hypertonicity of the affected limbs. Facilitation of normal gait is a primary goal of rehabilitation on these patients. Objective: We aimed to investigate whether walking assist device with auxiliary illuminator (quad-cane with laser) providing visual feedback during ambulation could improve parameters of gait cycle immediately among patients with subacute and chronic stroke. Methods: This was a cross-sectional study and 30 participants (male 23, female 7, group 1) with mean age 60.20±11.12 years were recruited. Among them, 22 used ankle-foot orthosis [(AFO), group 2] and 8 did not use AFO (group 3) at usual walking. All the participants walked along a strait corridor with even surface for 20 m without and with using a quad-cane with laser, respectively. A gait analyzer (Reha-Watch1 system) was used to measure the changes of the parameters of gait cycle, including stride length, cadence, gait speed, stance phase, swing phase, duration of single support and double support, the angle between toes and the ground at the time of toe-off (the toe-off angle) and the angle between calcaneus and the ground at the time of heel-strike (the heel-strike angle), before and with the use of a quad-cane with laser. Results: The increase in the heel-strike angle reached a significant difference in groups 1 2, and 3 (p=0.02,<0.01, and =0.05, respectively). However, the stride length, the gait speed, the cadence, percentage of the stance phase, swing phase, single-support phase, and double-support phase in a gait cycle, and the toe-off angle showed no significant change with the use of quad-cane with laser. Conclusion: Patients after acute stroke had an immediate and significant increase in the heel-stroke angle by using a quad-cane with laser during ambulation, which might help the patients to reduce knee hyperextension moment and lessen the pressure of heel at loading phase.
Collapse
Affiliation(s)
- Wan-Yun Huang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,National Cheng Kung University, Institute of Allied Health Sciences, Tainan, Taiwan
| | - Sheng-Hui Tuan
- Department of Rehabilitation Medicine, Cishan Hospital, Ministry of Health and Welfare, Kaohsiung, Taiwan
| | - Min-Hui Li
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Graduate Institute of Aerospace and Undersea Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Xin-Yu Liu
- Department of Kinesiology, Health, and Leisure Studies, National University of Kaohsiung, Kaohsiung, Taiwan
| | - Pei-Te Hsu
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| |
Collapse
|
14
|
Chow JW, Stokic DS. Gait Impairments in Patients Without Lower Limb Hypertonia Early Poststroke Are Related to Weakness of Paretic Knee Flexors. Arch Phys Med Rehabil 2018; 100:1091-1101. [PMID: 30447195 DOI: 10.1016/j.apmr.2018.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 10/12/2018] [Accepted: 10/16/2018] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To describe gait characteristics of patients without clinical evidence of lower limb hypertonia within 2 months of stroke and explore the relationship between gait and residual motor function. DESIGN Cohort study. SETTING Motion analysis laboratory in a tertiary-care free-standing rehabilitation hospital. PARTICIPANTS Consecutive sample of 73 eligible inpatients (first-known stroke <2 months postonset, walking independently, modified Ashworth score of 0 in the paretic lower limb) and 27 healthy controls (N=100). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Gait speed, stride and step lengths and cadences, stance time, single-support and double-support times, and associated symmetry measures in patients at self-selected normal speed and controls at very slow speed (51.1±32.6 cm/s and 61.9±21.8 cm/s, respectively, P=.115); Fugl-Meyer lower extremity motor score (FM-LE) and isometric knee flexion and extension strength in patients. RESULTS Except the stride/step cadence, all temporospatial parameters significantly differed between the stroke and control participants. Furthermore, significantly greater asymmetries were found in the patients for the overall stance time, initial double-support and single-support times, and step cadence, reflecting smaller values in the paretic than nonparetic limb. Most temporospatial parameters moderately to strongly correlated with the gait speed (|r|: .72-.94, P<.0001), FM-LE (|r|: .42-.62, P≤.0005), and paretic knee flexor strength (|r|: .47-.57, P≤.0004). CONCLUSIONS Gait of patients without clinical evidence of lower limb hypertonia within 2 months of stroke is characterized by many temporospatial deviations and asymmetries. The self-selected normal gait speed, FM-LE, and paretic knee flexor strength can discriminate gait impairments in these patients shortly before inpatient discharge. It remains to be determined whether the observed relationships between paretic knee flexor strength and gait measures warrant the development of interventions for strengthening of the paretic knee flexors in order to improve gait early poststroke.
Collapse
Affiliation(s)
- John W Chow
- Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, Jackson, MS.
| | - Dobrivoje S Stokic
- Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, Jackson, MS
| |
Collapse
|
15
|
Kamono A, Kato M, Ogihara N. Accuracy evaluation of a method to partition ground reaction force and center of pressure in cane-assisted gait using an instrumented cane with a triaxial force sensor. Gait Posture 2018; 60:141-147. [PMID: 29207289 DOI: 10.1016/j.gaitpost.2017.11.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 11/05/2017] [Accepted: 11/27/2017] [Indexed: 02/02/2023]
Abstract
Clarifying the biomechanics of cane-assisted gait in elderly individuals and patients with gait disorders is important for developing better therapeutic interventions in the fields of rehabilitation and orthopedics. However, if the foot and the cane in the ipsilateral hand are placed on the same force plate simultaneously, the force plate cannot separate the forces as it records the sum of the forces. To overcome this indeterminacy problem of the ground reaction force (GRF) and the center of pressure (COP) in cane-assisted gait analysis, a method to partition the GRF and COP using an instrumented cane with a force transducer has been proposed. However, the accuracy and precision of the estimated GRF and COP has not been evaluated previously. We therefore reestablished a framework to partition the foot and cane forces during walking using an instrumented cane with a triaxial force sensor and evaluated the accuracy and precision of the method using a force plate array. Cane-assisted gait of healthy adults and hemiplegic patients were measured. Mean accuracy and precision associated with the GRF and COP measurements were approximately 0.4±1.4N and 0.2±2.7mm, respectively, indicating that the separations of the GRF and COP were sufficiently accurate for kinetic gait analysis. Although some methodological limitations certainly apply, this system will serve as a useful tool for improved therapeutic interventions.
Collapse
Affiliation(s)
- Arinori Kamono
- School of Nursing and Rehabilitation Sciences, Showa University, Kanagawa, Japan; Department of Mechanical Engineering, Keio University, Yokohama, Japan.
| | - Mizuki Kato
- Department of Mechanical Engineering, Keio University, Yokohama, Japan
| | - Naomichi Ogihara
- Department of Mechanical Engineering, Keio University, Yokohama, Japan
| |
Collapse
|
16
|
Abstract
Stroke, or cerebrovascular accident, involves injury to the central nervous system as a result of a vascular cause, and is a leading cause of disability worldwide. People with stroke often experience sensory, cognitive, and motor sequelae that can lead to difficulty walking, controlling balance in standing and voluntary tasks, and reacting to prevent a fall following an unexpected postural perturbation. This chapter discusses the interrelationships between stroke-related impairments, problems with control of balance and gait, fall risk, fear of falling, and participation in daily physical activity. Rehabilitation can improve balance and walking function, and consequently independence and quality of life, for those with stroke. This chapter also describes effective interventions for improving balance and walking function poststroke, and identifies some areas for further research in poststroke rehabilitation.
Collapse
Affiliation(s)
- Avril Mansfield
- Toronto Rehabilitation Institute, University Health Network and Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.
| | - Elizabeth L Inness
- Toronto Rehabilitation Institute, University Health Network and Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - William E Mcilroy
- Department of Kinesiology, University of Waterloo and Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Waterloo, ON, Canada
| |
Collapse
|
17
|
Effect of the provision of a cane on walking and social participation in individuals with stroke: protocol for a randomized trial. Braz J Phys Ther 2017; 22:168-173. [PMID: 29246455 PMCID: PMC5883961 DOI: 10.1016/j.bjpt.2017.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 11/20/2017] [Accepted: 11/21/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Canes are usually prescribed for individuals with stroke with the purpose of improving walking and increasing safety. However, there is no consensus regarding the clinical effects of these aids on walking and participation. OBJECTIVE This study will examine the efficacy of the provision of a cane to improve walking and increase participation after stroke. METHODS This is a two-arm, prospectively registered, randomized trial with concealed allocation, blinded measurers, and intention-to-treat analysis. Fifty individuals with chronic stroke, categorized as slow or intermediate walkers (walking speeds ≤0.8m/s), will participate. The experimental group will receive a single-point cane and instructions to use the cane anytime they need to walk. The control group will receive a placebo intervention, consisting of self-stretching exercises of the lower limb muscles and instructions to not use assistive devices. The primary outcome will be comfortable walking speed. Secondary outcomes will include walking step length, walking cadence, walking capacity, walking confidence, and participation. Outcomes will be collected by a researcher blinded to group allocation at baseline (Week 0), after intervention (Week 4), and one month beyond intervention (Week 8). CONCLUSION The provision of a single-point cane may help improving walking of slow and intermediate walkers after stroke. If walking is enhanced, the benefits may be carried over to participation, and individuals may experience greater free-living physical activity at home and in the community.
Collapse
|
18
|
Peterson LJ, Meng H, Dobbs D, Hyer K. Gender Differences in Mobility Device Use Among U.S. Older Adults. J Gerontol B Psychol Sci Soc Sci 2017; 72:827-835. [PMID: 27495837 DOI: 10.1093/geronb/gbw081] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 06/24/2016] [Indexed: 11/14/2022] Open
Abstract
Objectives Research has shown greater mobility limitations among women than men. We aimed to examine (a) gender differences in the use of canes for mobility and (b) what factors contribute to these differences under the frameworks of the disablement model and the Theory of Planned Behavior. Method Using National Health and Aging Trends Study data, we estimated hierarchical logistic regression models to predict the likelihood of cane use among older adults who completed performance-based measures (n = 5,503). We tested the interactions between gender and selected variables to further understand gender difference. Results In unadjusted analysis, 22% of women and 16% of men used canes. In models adjusted in steps for sociodemographics, health, physical impairments, capacity, psychosocial, and social environment factors, women were progressively less likely to use canes, significantly so at the last step. Suppression effect analyses showed the influence of living alone and receiving mobility help variables. Interaction analyses showed that women reporting poor health or balance were less likely to use canes; obese women were more likely. Discussion Significant gender differences exist in cane use among older community-living adults. Findings suggest that health and function partly account for these differences. Future research is needed to understand social/cultural factors involved.
Collapse
Affiliation(s)
- Lindsay J Peterson
- Florida Policy Exchange Center on Aging, School of Aging Studies, University of South Florida, Tampa
| | - Hongdao Meng
- Florida Policy Exchange Center on Aging, School of Aging Studies, University of South Florida, Tampa
| | - Debra Dobbs
- Florida Policy Exchange Center on Aging, School of Aging Studies, University of South Florida, Tampa
| | - Kathryn Hyer
- Florida Policy Exchange Center on Aging, School of Aging Studies, University of South Florida, Tampa
| |
Collapse
|
19
|
Ma CC, Rao N, Muthukrishnan S, Aruin AS. A textured insole improves gait symmetry in individuals with stroke. Disabil Rehabil 2017; 40:2798-2802. [PMID: 28783984 DOI: 10.1080/09638288.2017.1362477] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Gait asymmetry is a common consequence of stroke and improving gait symmetry is an important goal of rehabilitation. We investigated the effect of a single textured insole in improving gait symmetry in individuals with stroke. METHOD Seventeen individuals with stroke who had asymmetrical gait were recruited and required to walk with a textured insole positioned in the shoe on the unaffected side or without the insole. Gait parameters were evaluated using the instrumented walkway. Gait velocity, cadence, and symmetry indices for the spatial and temporal parameters of gait and center of pressure displacements were obtained. RESULTS When walking with a textured insole, symmetry indexes for stance, single support phases of gait, as well as center of pressure displacements improved significantly. While using a textured insole, the duration of the stance phase and a single support phase decreased on the unaffected side and increased on the affected side significantly. Gait velocity and cadence were not affected by the use of the insole. CONCLUSIONS Individuals with stroke walking with a textured insole placed in the shoe on the unaffected side improved the symmetry of their gait. The outcome provides a foundation for future investigations of the efficacy of using a single textured insole in gait rehabilitation of individuals with unilateral impairment. Implications for Rehabilitation A single textured insole positioned in the shoe on the unaffected side improved gait symmetry in individuals with stroke. Gait velocity and cadence were not affected by the use of the insole.
Collapse
Affiliation(s)
- Charlie C Ma
- a PhD Program in Rehabilitation Sciences, College of Applied Health Sciences , University of Illinois at Chicago , Chicago , IL , USA
| | - Noel Rao
- b Marianjoy Rehabilitation Hospital , Wheaton , IL , USA
| | - Sriranjini Muthukrishnan
- c Department of Neurology and Rehabilitation , University of Illinois at Chicago , Chicago , IL , USA
| | - Alexander S Aruin
- d Department of Physical Therapy , University of Illinois at Chicago , Chicago , IL , USA
| |
Collapse
|
20
|
Hematopoietic Stem Cell Transplantation: A Bioethical Lens. Stem Cells Int 2017; 2017:1286246. [PMID: 28740510 PMCID: PMC5504964 DOI: 10.1155/2017/1286246] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 03/22/2017] [Accepted: 05/15/2017] [Indexed: 01/03/2023] Open
Abstract
Hematopoietic stem cell transplantation (HSCT) is one of a range of therapeutic options available to patients suffering from various diseases. HSCT procedure involves important ethical and legal aspects that can occur at every phase of the procedure: the clinical choice of whether to perform the procedure, pretransplantation preparation regimens, donor selection, stem cell harvest procedure, transplantation phase, and short-term and long-term follow-up care. In this discussion paper, we outline the ethical issue-facing physicians involved in HSCT. Currently, HSCT is a widely accepted treatment for many life-threatening diseases. It thus represents a real therapeutic hope for many patients. It does, however, carry a burden of possible morbidity and mortality. Consequently, there are substantial information and communication issues involved in the consent process for HSCT. In the final decision, the judgements of different parties, such as patients, family members, and healthcare professionals, intersect and overlap and this is particularly true when the patient is a minor. Finally, HSCT is a very expensive procedure. The social and economic concerns of HSCT are discussed within the actual contextual framework of the dramatic increase in healthcare costs and inequalities in healthcare in relation to socioeconomic status, educational status, and ethnicity.
Collapse
|
21
|
Choi YK, Kim K, Choi JU. Effects of stair task training on walking ability in stroke patients. J Phys Ther Sci 2017; 29:235-237. [PMID: 28265147 PMCID: PMC5332978 DOI: 10.1589/jpts.29.235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 11/02/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The aim of this study was to determine the effect of stair task training on
gait abilities by conducting stair task training. In this training, step training is
applied in various directions with hemiplegia patients. [Subjects and Methods] Thirty-six
patients with stroke were selected on the basis of inclusion and exclusion criteria, and
they were randomly divided into eighteen patients in the experimental group and eighteen
patients in the control group via draw. [Results] In this study, the Dartfish program was
used to measure gait capabilities. Experiment group showed a statistically significant
improvement in the swing phase time of the affected lower extremity compared to control
group. [Conclusion] It was found that the stair task training group had effective results
in the swing phase time of the affected lower extremity compared with the group that
applied weight support on the affected lower extremity and balance training.
Collapse
Affiliation(s)
- Yong-Kyu Choi
- Department of Physical Therapy, Graduate School of Physical Therapy, Daegu Universityo, Republic of Korea
| | - Kyoung Kim
- Department of Physical Therapy, Graduate School of Physical Therapy, Daegu Universityo, Republic of Korea
| | - Jin-Uk Choi
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University, Republic of Korea
| |
Collapse
|
22
|
Aoki O, Otani Y, Morishita S, Domen K. The effects of various visual conditions on trunk control during ambulation in chronic post stroke patients. Gait Posture 2017; 52:301-307. [PMID: 28033576 DOI: 10.1016/j.gaitpost.2016.12.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 12/03/2016] [Accepted: 12/18/2016] [Indexed: 02/02/2023]
Abstract
Downward gazing is commonly observed among patients after a stroke during standing or walking as they struggle to maintain equilibrium. In this study, we aimed to evaluate the effects of fixed gazing and downward gazing on trunk control ability during gait. Sixteen subjects after a stroke (age: 51.3±4.9years) and seven healthy subjects (age: 65.1±3.4years) participated in this study. Participants walked 10m at a comfortable speed while they faced forward (no gaze point), gazed forward (with a fixed gaze point), gazed downward, and gazed downward while concealing their legs. Trunk acceleration was measured using tri-axial accelerometers attached to the back of the upper (C7 spinous process) and lower (L3 spinous process) trunk. The coefficient of attenuation (CoA) of acceleration at the trunk was computed to assess trunk control ability. Results in the stroke group showed that the CoA during fixed-point and downward gazing was better than that while facing forward with no gaze point (p<0.001). In the stroke group, the CoA during gazing downward with their legs concealed was worse than that during downward gazing. Our findings indicate that patients after a stroke might use visual information for reducing their neck oscillation (C7) during fixed-point and downward gazing. Our results indicate that the visual information during downward gazing might work the same as during fixed-point gazing.
Collapse
Affiliation(s)
- Osamu Aoki
- Faculty of Rehabilitation, Shijonawate Gakuen University, 5-11-10 Houjo, Daito, Osaka, 574-0011, Japan.
| | - Yoshitaka Otani
- Faculty of Rehabilitation, Kobe International University, 9-1-6 Kouyocho-naka, Higashinada, Kobe, Hyogo, 658-0032, Japan.
| | - Shinichiro Morishita
- Faculty of Medical Technology, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata-shi, Niigata, 950-3198, Japan.
| | - Kazuhisa Domen
- Department of Physical Medicine and Rehabilitation, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
| |
Collapse
|
23
|
Dogru E, Kizilci H, Balci NC, Korkmaz NC, Canbay O, Katayifci N. The effect of walking sticks on balance in geriatric subjects. J Phys Ther Sci 2016; 28:3267-3271. [PMID: 28174431 PMCID: PMC5276740 DOI: 10.1589/jpts.28.3267] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 03/31/2016] [Indexed: 12/03/2022] Open
Abstract
[Purpose] Guidelines and clarity regarding the information for deciding the need for
walking sticks and the suitability of these sticks is insufficient. This study aimed to
evaluate the suitability of walking stick and its effects on the balance in the elderly.
[Subjects and Methods] A total of 39 elderly subjects aged between 65–95 years (mean age,
76.15 ± 8.35 years) and living in the Residential Aged Care and Rehabilitation Center were
included. Sociodemographic data of the individuals, the material of the walking stick, who
made the decision of usage and length of walking sticks were questioned. The Berg Balance
Scale (BBS) scores were used to evaluate balance. [Results] Subjects’ BBS scores while
using the walking stick were higher than that without the walking stick. A significant
difference was observed in BBS scores obtained with the stick and without the stick,
according to body mass index parameters. Majority of the subjects also started to use
walking sticks by themselves. No significant difference was observed between the ideal
length and actual length of the walking stick was used. [Conclusion] Our study
demonstrated that the elderly generally decide to use walking stick by themselves and
chose the appropriate materials; which improves their balance.
Collapse
Affiliation(s)
- Esra Dogru
- School of Physical Therapy and Rehabilitation, Mustafa Kemal University, Turkey
| | - Harun Kizilci
- Department of Physiotherapy and Rehabilitation, Inonu University, Turkey
| | - Nilay Comuk Balci
- Department of Physiotherapy and Rehabilitation, Baskent University, Turkey
| | | | - Ozden Canbay
- School of Physical Therapy and Rehabilitation, Mustafa Kemal University, Turkey
| | - Nihan Katayifci
- School of Physical Therapy and Rehabilitation, Mustafa Kemal University, Turkey
| |
Collapse
|
24
|
Nascimento LR, Ada L, Teixeira-Salmela LF. The provision of a cane provides greater benefit to community-dwelling people after stroke with a baseline walking speed between 0.4 and 0.8 metres/second: an experimental study. Physiotherapy 2016; 102:351-356. [DOI: 10.1016/j.physio.2015.10.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 10/07/2015] [Indexed: 10/22/2022]
|
25
|
Chisholm AE, Qaiser T, Lam T. Neuromuscular control of curved walking in people with stroke: Case report. ACTA ACUST UNITED AC 2016; 52:775-83. [PMID: 26745877 DOI: 10.1682/jrrd.2014.08.0189] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 06/01/2015] [Indexed: 11/05/2022]
Abstract
People are required to adapt their basic walking pattern to turn and change directions safely for activities of daily living. This case study describes the changes in neuromuscular control among individuals with stroke on walking paths of different curvatures. Two men with hemiparetic stroke and one control subject walked along a straight, wide curved, and tight curved pathway while muscle activation of the medial and lateral gastrocnemius was recorded, along with the trajectory of the center of pressure (COP) during the single support phase. Balance, sensorimotor control, and functional ambulation were also evaluated. The subject with greater lower-limb sensorimotor impairment displayed a larger difference in the anterior-posterior COP displacement between limbs, which exacerbated as the path curvature increased. In addition, while the control subject demonstrated a lateral shift in the medial-lateral COP position, this person was unable to adapt the COP position on the nonparetic side. The second participant with a stroke demonstrated better balance and lateral shifting of the COP position. Modulation of the COP trajectory is required to safely perform curved walking. Further study is required to confirm the role of stroke-related gait deficits in the ability to adapt to curved walking.
Collapse
|
26
|
IJmker T, Lamoth CJ, Houdijk H, Tolsma M, van der Woude LHV, Daffertshofer A, Beek PJ. Effects of handrail hold and light touch on energetics, step parameters, and neuromuscular activity during walking after stroke. J Neuroeng Rehabil 2015; 12:70. [PMID: 26298647 PMCID: PMC4546819 DOI: 10.1186/s12984-015-0051-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 06/26/2015] [Indexed: 11/11/2022] Open
Abstract
Background Holding a handrail or using a cane may decrease the energy cost of walking in stroke survivors. However, the factors underlying this decrease have not yet been previously identified. The purpose of the current study was to fill this void by investigating the effect of physical support (through handrail hold) and/or somatosensory input (through light touch contact with a handrail) on energy cost and accompanying changes in both step parameters and neuromuscular activity. Elucidating these aspects may provide useful insights into gait recovery post stroke. Methods Fifteen stroke survivors participated in this study. Participants walked on a treadmill under three conditions: no handrail contact, light touch of the handrail, and firm handrail hold. During the trials we recorded oxygen consumption, center of pressure profiles, and bilateral activation of eight lower limb muscles. Effects of the three conditions on energy cost, step parameters and neuromuscular activation were compared statistically using conventional ANOVAs with repeated measures. In order to examine to which extent energy cost and step parameters/muscle activity are associated, we further employed a partial least squares regression analysis. Results Handrail hold resulted in a significant reduction in energy cost, whereas light touch contact did not. With handrail hold subjects took longer steps with smaller step width and improved step length symmetry, whereas light touch contact only resulted in a small but significant decrease in step width. The EMG analysis indicated a global drop in muscle activity, accompanied by an increased constancy in the timing of this activity, and a decreased co-activation with handrail hold, but not with light touch. The regression analysis revealed that increased stride time and length, improved step length symmetry, and decreased muscle activity were closely associated with the decreased energy cost during handrail hold. Conclusion Handrail hold, but not light touch, altered step parameters and was accompanied by a global reduction in muscle activity, with improved timing constancy. This suggests that the use of a handrail allows for a more economic step pattern that requires less muscular activation without resulting in substantial neuromuscular re-organization. Handrail use may thus have beneficial effects on gait economy after stroke, which cannot be accomplished through enhanced somatosensory input alone. Electronic supplementary material The online version of this article (doi:10.1186/s12984-015-0051-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- T IJmker
- MOVE Research Institute Amsterdam, Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, VU University Amsterdam, van der Boechorststraat 9, 1081 BT, Amsterdam, The Netherlands. .,Heliomare Rehabilitation, Research and Development, Relweg 51, 1949 EC, Wijk aan Zee, The Netherlands.
| | - C J Lamoth
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Center for Rehabilitation, Antonius Deusinglaan 1, 9713AV, Groningen, The Netherlands
| | - H Houdijk
- MOVE Research Institute Amsterdam, Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, VU University Amsterdam, van der Boechorststraat 9, 1081 BT, Amsterdam, The Netherlands.,Heliomare Rehabilitation, Research and Development, Relweg 51, 1949 EC, Wijk aan Zee, The Netherlands
| | - M Tolsma
- Heliomare Rehabilitation, Research and Development, Relweg 51, 1949 EC, Wijk aan Zee, The Netherlands
| | - L H V van der Woude
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Center for Rehabilitation, Antonius Deusinglaan 1, 9713AV, Groningen, The Netherlands
| | - A Daffertshofer
- MOVE Research Institute Amsterdam, Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, VU University Amsterdam, van der Boechorststraat 9, 1081 BT, Amsterdam, The Netherlands
| | - P J Beek
- MOVE Research Institute Amsterdam, Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, VU University Amsterdam, van der Boechorststraat 9, 1081 BT, Amsterdam, The Netherlands
| |
Collapse
|
27
|
Iosa M, Paradisi F, Brunelli S, Delussu AS, Pellegrini R, Zenardi D, Paolucci S, Traballesi M. Assessment of gait stability, harmony, and symmetry in subjects with lower-limb amputation evaluated by trunk accelerations. ACTA ACUST UNITED AC 2015; 51:623-34. [PMID: 25144175 DOI: 10.1682/jrrd.2013.07.0162] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 12/05/2013] [Indexed: 11/05/2022]
Abstract
Analysis of upper-body accelerations is a promising and simple technique for quantitatively assessing some general features of gait such as stability, harmony, and symmetry. Despite the growing literature on elderly healthy populations and neurological patients, few studies have used accelerometry to investigate these features in subjects with lower-limb amputation. We enrolled four groups of subjects: subjects with transfemoral amputation who walked with a locked knee prosthesis, subjects with transfemoral amputation who walked with an unlocked knee prosthesis, subjects with transtibial amputation, and age-matched nondisabled subjects. We found statistically significant differences for stability (p < 0.001), harmony (p < 0.001), and symmetry (p < 0.001) of walking, with general trends following the noted order of subjects, but with the lowest laterolateral harmony in subjects with transtibial amputation. This study is the first to investigate upper-body acceleration of subjects with unilateral lower-limb amputation during walking who were evaluated upon dismissal from a rehabilitation hospital; it is also the first study to differentiate the sample in terms of level of amputation and type of prosthesis used.
Collapse
Affiliation(s)
- Marco Iosa
- Santa Lucia Foundation, Scientific Institute for Research, Hospitalization and Health Care, Via Ardeatina 306, 00179 Roma, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
28
|
Jung K, Kim Y, Cha Y, In TS, Hur YG, Chung Y. Effects of gait training with a cane and an augmented pressure sensor for enhancement of weight bearing over the affected lower limb in patients with stroke: a randomized controlled pilot study. Clin Rehabil 2014; 29:135-42. [PMID: 25009199 DOI: 10.1177/0269215514540923] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the effect of gait training when using a cane with an augmented pressure sensor for enhancement of weight-bearing over the affected lower limb on the peak pressure force of the cane, muscle activation, and gait in patients with stroke. DESIGN Randomized controlled pilot study. SETTING Inpatient rehabilitation center. PARTICIPANTS A total of 22 hemiparetic stroke patients were recruited and randomly divided into an experimental group (n = 11) and control group, which later had a drop-out (n = 10). INTERVENTIONS Subjects in the experimental group participated in gait training with auditory feedback for 30 minutes, five times a week for four weeks, whereas those in the control group received gait training without auditory feedback for the same amount of time. MAIN MEASURES The peak force of cane, muscle activation of gluteus medius, and vastus medialis oblique, single limb support phase of the affected leg, and gait speed before and after training were collected. RESULTS Significant improvement in the peak force of cane, muscle activation of gluteus medius and vastus medialis oblique, single limb support phase of the affected leg, and gait speed were observed in the experimental group (13.5 ±9.5 cm/s) compared with the control group (3.7 ±8.4 cm/s) (p < 0.05). CONCLUSION Gait training using a cane with an augmented pressure sensor to enhance weight bearing over the affected lower limb is beneficial and effective in improving the peak force of cane, muscle activation, and gait in stroke patients.
Collapse
Affiliation(s)
- Kyoungsim Jung
- Department of Physical Therapy, The Graduate School, Sahmyook University, Seoul, Republic of Korea
| | - Young Kim
- Department of Physical Therapy, The Graduate School, Sahmyook University, Seoul, Republic of Korea
| | - Yuri Cha
- Department of Physical Therapy, The Graduate School, Sahmyook University, Seoul, Republic of Korea
| | - Tae-Sung In
- Department of Physical Therapy, Shin-Hwa Rehabilitation Hospital, Seoul, Republic of Korea
| | - Young-Goo Hur
- Department of Physical Therapy, School of Health Sciences, Cheju Halla University, Jeju, Republic of Korea
| | - Yijung Chung
- Department of Physical Therapy, College of Health and Welfare, Sahmyook University, Seoul, Republic of Korea
| |
Collapse
|
29
|
Salbach NM, O'Brien K, Evans C, Yoshida K. Dissemination of student research in a canadian master of science in physical therapy programme. Physiother Can 2014; 65:154-7. [PMID: 24403678 DOI: 10.3138/ptc.2012-18] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine the extent of presentation and publication, as well as time to publication, of student research completed as a component of a Master of Science in Physical Therapy (MScPT) degree at a Canadian university. METHOD The authors conducted a retrospective cross-sectional study of MScPT research projects completed between 2003 and 2009, each undertaken by a group of MScPT students who carried out protocol development, ethics submission, data collection, analysis, and manuscript and poster preparation under the supervision of research advisors. Research advisors were e-mailed a request for citations of presentations and publications. RESULTS Advisors from 102 of 113 research projects completed from 2003 through 2009 provided information, for a response rate of 90.3%. Of the 102 groups, 53.9% disseminated findings through publication or presentation, 33.3% presented at one or more conferences, and 30.4% published at least one peer-reviewed journal article. Median time to publication was 21 months. Almost half the journal articles (47%) were published in Physiotherapy Canada. CONCLUSIONS MScPT student research groups are disseminating their findings through publication or presentation at a moderate rate. Investigation of factors influencing dissemination is needed to develop strategies to facilitate knowledge transfer.
Collapse
Affiliation(s)
- Nancy M Salbach
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto
| | - Kelly O'Brien
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto
| | - Cathy Evans
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto
| | - Karen Yoshida
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto
| |
Collapse
|
30
|
Abstract
Multiple sclerosis (MS) is an immune-mediated disease that causes demyelination and degeneration within the brain and spinal cord. This may result in many impairments, including impaired ambulation, muscle weakness, abnormal tone, visual disturbances, decreased sensation, and fatigue. Rehabilitation helps patients with MS maximize independence by helping to manage and minimize impairments. Deficits seen in ambulation should be addressed to improve energy efficiency and reduce falls. Compensation through appropriate prescription of assistive devices, bracing, and wheelchairs will help improve safety. Rehabilitation can make a significant impact on achieving and maintaining quality of life and independence.
Collapse
|
31
|
Chen IH, Yang YR, Chan RC, Wang RY. Turning-Based Treadmill Training Improves Turning Performance and Gait Symmetry After Stroke. Neurorehabil Neural Repair 2013; 28:45-55. [DOI: 10.1177/1545968313497102] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Turning is a challenging task for stroke patients. Programs that effectively target turning, however, have not been established. Objective. This study examined the effects of a novel turning-based treadmill training on turning performance, gait symmetry, balance, and muscle strength in patients with chronic stroke. Methods. Thirty participants were randomly assigned to the experimental group that received 30 minutes of turning-based treadmill training or to the control group that received 30 minutes of regular treadmill training, followed by a 10-minute general exercise program for 12 sessions over 4 weeks. Primary outcomes (overground turning speed and temporal–spatial characteristics of straight walking) and secondary outcomes (balance and muscle strength) were assessed at baseline, after training, and at 1-month follow-up. Results. Fifteen participants per group were 54.2 ± 9.6 years old, poststroke 2.6 ± 1.9 years, and walked overground at 0.59 ± 0.28 m/s. Sixteen had an ischemic and 14 a hemorrhagic stroke. There were significant interaction effects between groups and time on turning speed regardless of turning direction, straight-walking performance (speed and temporal symmetry), strength of hip muscles and ankle dorsiflexors, and balance control (Berg Balance Scale, weight shifting in the forward direction and vestibular function). Compared with the control group, the experimental group showed greater improvements in these measures following training. These improvements persisted at the 1-month follow-up evaluation. Conclusions. Turning-based treadmill training may be a feasible and effective strategy to improve turning ability, gait symmetry, muscle strength, and balance control for individuals with chronic stroke.
Collapse
Affiliation(s)
| | - Yea-Ru Yang
- National Yang-Ming University, Taipei, Taiwan
- Taipei City Hospital, Taipei, Taiwan
| | - Rai-Chi Chan
- Taipei Veterans General Hospital, Taipei, Taiwan
| | | |
Collapse
|
32
|
Abstract
Interacting with other people and the environment is fundamental to quality of life. Canes, walkers, and crutches increase, maintain, or improve functional capabilities of many individuals with neurologic disorders. Canes offer a choice of handle, shaft, and base. Walkers have various types of base, uprights, handgrips, platforms, and accessories. Crutch designs include underarm, triceps, forearm, and platform. Orthoses, particularly ankle foot orthoses and knee ankle foot orthoses, are often used to stabilize or immobilize lower limb segments while walking. Studies have shown the benefits of traditional assistive devices on gait, when prescribed and used properly.
Collapse
|
33
|
Use of visual and proprioceptive feedback to improve gait speed and spatiotemporal symmetry following chronic stroke: a case series. Phys Ther 2012; 92:748-56. [PMID: 22228605 PMCID: PMC3345339 DOI: 10.2522/ptj.20110206] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE Persistent deficits in gait speed and spatiotemporal symmetry are prevalent following stroke and can limit the achievement of community mobility goals. Rehabilitation can improve gait speed, but has shown limited ability to improve spatiotemporal symmetry. The incorporation of combined visual and proprioceptive feedback regarding spatiotemporal symmetry has the potential to be effective at improving gait. CASE DESCRIPTION A 60-year-old man (18 months poststroke) and a 53-year-old woman (21 months poststroke) each participated in gait training to improve gait speed and spatiotemporal symmetry. Each patient performed 18 sessions (6 weeks) of combined treadmill-based gait training followed by overground practice. To assist with relearning spatiotemporal symmetry, treadmill-based training for both patients was augmented with continuous, real-time visual and proprioceptive feedback from an immersive virtual environment and a dual belt treadmill, respectively. OUTCOMES Both patients improved gait speed (patient 1: 0.35 m/s improvement; patient 2: 0.26 m/s improvement) and spatiotemporal symmetry. Patient 1, who trained with step-length symmetry feedback, improved his step-length symmetry ratio, but not his stance-time symmetry ratio. Patient 2, who trained with stance-time symmetry feedback, improved her stance-time symmetry ratio. She had no step-length asymmetry before training. DISCUSSION Both patients made improvements in gait speed and spatiotemporal symmetry that exceeded those reported in the literature. Further work is needed to ascertain the role of combined visual and proprioceptive feedback for improving gait speed and spatiotemporal symmetry after chronic stroke.
Collapse
|
34
|
Patterson KK, Nadkarni NK, Black SE, McIlroy WE. Gait symmetry and velocity differ in their relationship to age. Gait Posture 2012; 35:590-4. [PMID: 22300728 PMCID: PMC3914537 DOI: 10.1016/j.gaitpost.2011.11.030] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Revised: 10/14/2011] [Accepted: 11/27/2011] [Indexed: 02/02/2023]
Abstract
UNLABELLED Measurement of gait is essential for identifying underlying deficits contributing to gait dysfunction, guiding clinical decisions and measuring rehabilitation outcomes. Velocity is commonly used to measure gait, however, its interpretation in patient populations is complicated by the confound of age. Gait symmetry may be an additional and valuable measure since it may not feature the same age-related changes as velocity. The purpose of this study was to determine if gait symmetry is related to age. METHODS Spatiotemporal gait parameters were recorded for 172 individuals with stroke and 81 healthy adults walking across a pressure sensitive mat at their preferred speed. Swing time, stance time and step length symmetry ratios were calculated. The relationship of age to velocity and symmetry was examined using Pearson correlations. RESULTS There was a significant negative association between velocity and age in the healthy group (r=-0.57, p<0.01). There were no significant relationships between age and any of the three symmetry ratios for either the stroke or healthy groups. CONCLUSIONS The main finding of the current study is that gait symmetry ratios are not significantly associated with age in either a healthy or a post-stroke group. Gait symmetry ratios may therefore, allow the clinician and the researcher to make judgments about the effects of disease (such as stroke) on the control of an individual's gait without the confound of age.
Collapse
|
35
|
Reliability of spatiotemporal asymmetry during overground walking for individuals following chronic stroke. J Neurol Phys Ther 2012; 35:116-21. [PMID: 21934372 DOI: 10.1097/npt.0b013e318227fe70] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Rehabilitation research for individuals with chronic stroke is increasingly addressing spatiotemporal asymmetries (STA). Understanding the reliability of STA between sessions is essential for determining whether treatment responses exceed day-to-day variation. The purpose of this study was to determine the minimal detectable change (MDC) and test-retest reliability in STA and gait speed measures for individuals with chronic stroke. METHODS Twenty-six individuals with chronic (>6 months) stroke participated in 2 visits. At each visit, participants walked across a 14-ft (4.3-m) GAITRite mat at comfortable gait speed (CGS) and fast gait speed (FGS). Spatiotemporal asymmetries ratios (paretic/nonparetic limb) were calculated for step length, stance time, and swing time. Intraclass correlation coefficients (ICC, 2,1) were calculated to determine reliability between sessions. Minimal detectable change values were calculated to determine the smallest change that is considered "real." RESULTS Spatiotemporal asymmetry measures were consistent between sessions, with ICCs ranging from 0.93 to 0.98. Asymmetry ratio MDC values were calculated for step length (CGS: 0.15; FGS: 0.19), swing time (CGS: 0.26; FGS: 0.20), and stance time (CGS: 0.09; FGS: 0.10). Gait speed MDC was 0.20 m/s and 0.22 m/s, respectively, for the CGS and FGS walking conditions. DISCUSSION AND CONCLUSION There were considerable differences among MDC values for the various STA measures, suggesting that larger changes will be necessary to show improvement for certain measures (eg, swing time asymmetry). These data will assist with setting clinical goals for patients with chronic stroke and will be useful for evaluating interventions designed to minimize temporal and spatial interlimb asymmetries during walking.
Collapse
|
36
|
Guillebastre B, Rougier PR, Sibille B, Chrispin A, Detante O, Pérennou DA. When might a cane be necessary for walking following a stroke? Neurorehabil Neural Repair 2011; 26:173-7. [PMID: 21734069 DOI: 10.1177/1545968311412786] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND For individuals with lateral postural imbalance after stroke, the decision to adopt a cane for walking often is not based on objective findings. OBJECTIVE The authors investigated the explanatory value of 2 posturographic criteria for lateral postural imbalance on the walking abilities of poststroke subjects. METHODS Indices of postural asymmetry (percentage of body weight on the less loaded lower limb) and instability (mediolateral variance of center-of-pressure displacements) were measured in 40 healthy individuals and 52 patients (mean 94.2 days after first hemispheric stroke), who stood still on a double force platform. Cut-off values (mean ± 2 standard deviations) were calculated and compared. The predictive value of both postural indices on walking abilities with or without a cane was analyzed. RESULTS Of the patients, 34.6% were unstable along the mediolateral axis (variance >7 mm(2)), and 44.2% were asymmetrical (body weight <40%); 30% needed a technical aid and 35% walked without a cane. The probability of being able to walk without a cane was less than 5% if the paretic lower limb was not loaded more than 40%. The postural instability index was less informative. CONCLUSIONS This study suggests that patients who do not load more than 40% of their body weight on their paretic lower limb may benefit from the prescription of a cane.
Collapse
Affiliation(s)
- Bastien Guillebastre
- Université de Savoie, Domaine Universitaire du Bourget-du-Lac, Bourget-du-Lac, France
| | | | | | | | | | | |
Collapse
|
37
|
Chisholm AE, Perry SD, McIlroy WE. Inter-limb centre of pressure symmetry during gait among stroke survivors. Gait Posture 2011; 33:238-43. [PMID: 21167716 DOI: 10.1016/j.gaitpost.2010.11.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Revised: 09/17/2010] [Accepted: 11/14/2010] [Indexed: 02/02/2023]
Abstract
The purpose of the present study was to describe the spatial-temporal parameters of the centre of pressure (COP) trajectory during the single-support phase of gait among stroke survivors and relate these parameters to the severity of sensorimotor impairment. Fifty-seven participants were asked to walk at their preferred and fast speed over a pressure sensitive mat. Outcome measures included anterior-posterior (AP) COP displacement, AP-COP velocity, medial-lateral (ML) COP variability and foot region COP time. The results demonstrated an asymmetrical AP-COP displacement in favour of the non-paretic limb for the majority of participants. The inter-limb difference scores for AP-COP displacement and AP-COP velocity were related to the severity of sensorimotor impairment and greater among gait aid users. ML-COP variability was greater under the non-paretic limb, possibly suggesting difficulty with paretic limb swing phase. Reduced or absent forefoot COP time suggests difficulty with forward progression and modified foot function during push-off. The inter-limb difference in COP parameters highlights the asymmetrical nature of post-stroke gait and the challenge of maintaining single limb support. We view this information as potentially important to clinicians as an outcome measure for gait rehabilitation.
Collapse
|
38
|
Verma R, Arya KN, Sharma P, Garg RK. Understanding gait control in post-stroke: implications for management. J Bodyw Mov Ther 2010; 16:14-21. [PMID: 22196422 DOI: 10.1016/j.jbmt.2010.12.005] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Revised: 12/02/2010] [Accepted: 12/03/2010] [Indexed: 10/18/2022]
Abstract
The role of the brain in post-stroke gait is not understood properly, although the ability to walk becomes impaired in more than 80% of post-stroke patients. Most, however, regain some ability to walk with either limited mobility or inefficient, asymmetrical or unsafe gait. Conventional intervention focuses on support of weak muscles or body part by use of foot orthosis and walking aids. This review provides an overview of available evidence of neuro-kinesiology & neurophysiology of normal and post-stroke gait. The role of the spinal cord has been explored, more in animals than humans. Mammalian locomotion is based on a rhythmic, "pacemaker" activity of the spinal stepping generators. Bipedal human locomotion is different from quadripedal animal locomotion. However, knowledge derived from the spinal cord investigation of animals, is being applied for management of human gait dysfunction. The potential role of the brain is now recognized in the independent activation of muscles during walking. The brain modifies the gait pattern during the complex demands of daily activities. Though the exact role of the motor cortex in control of gait is unclear, available evidence may be applied to gait rehabilitation of post-stroke patients.
Collapse
Affiliation(s)
- Rajesh Verma
- Department of Neurology, CSM Medical University (KGMU), Lucknow 226003, UP, India
| | | | | | | |
Collapse
|
39
|
Affiliation(s)
- Kara K Patterson
- PhD candidate Graduate Department of Rehabilitation Science University of Toronto Toronto, ON
| |
Collapse
|