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Liu X, Liang J, Liu Y. Effects of walking speeds on lower extremity kinematic synergy in toe vertical position control: An experimental study. Medicine (Baltimore) 2024; 103:e38024. [PMID: 38701268 PMCID: PMC11062729 DOI: 10.1097/md.0000000000038024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 04/05/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND This study aimed to investigate whether lower limb joints mutually compensate for each other, resulting in motor synergy that suppresses toe vertical position fluctuation, and whether walking speeds affect lower limb synergy. METHODS Seventeen male university students walked at slow (0.85 ± 0.04 m/s), medium (1.43 ± 0.05 m/s) and fast (1.99 ± 0.06 m/s) speeds on a 15-m walkway while lower limb kinematic data were collected. Uncontrolled manifold analysis was used to quantify the strength of synergy. Two-way (speed × phase) repeated-measures analysis of variance was used to analyze all dependent variables. RESULTS A significant speed-by-phase interaction was observed in the synergy index (SI) (P < .001). At slow walking speeds, subjects had greater SI during mid-swing (P < .001), while at fast walking speeds, they had greater SI during early-swing (P < .001). During the entire swing phase, fast walking exhibited lower SI values than medium (P = .005) and slow walking (P = .027). CONCLUSION Kinematic synergy plays a crucial role in controlling toe vertical position during the swing phase, and fast walking exhibits less synergy than medium and slow walking. These findings contribute to a better understanding of the role of kinematic synergy in gait stability and have implications for the development of interventions aimed at improving gait stability and reducing the risk of falls.
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Affiliation(s)
- Xuan Liu
- Beijing Sport University, Beijing, China
| | | | - Ye Liu
- Beijing Sport University, Beijing, China
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Lee SJ, Kim TY, Kim KM, Cho SR. Comparison between prefabricated ankle-foot orthoses, Dyna Ankle and UD Flex, in patients with hemiplegia. J Int Med Res 2024; 52:3000605241233514. [PMID: 38501996 PMCID: PMC10952991 DOI: 10.1177/03000605241233514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 01/29/2024] [Indexed: 03/20/2024] Open
Abstract
OBJECTIVE To compare the kinematic effects of two widely-used prefabricated ankle-foot orthoses (AFOs), the Dyna Ankle (DA) and UD Flex (UD), on the gait cycle of patients with hemiplegia due to cerebral palsy or acquired brain injury. METHODS This was a retrospective cohort study involving 29 patients. Gait analysis results were assessed under three conditions: barefoot, with the DA, and with the UD. Friedman tests and post hoc analysis with Bonferroni correction were performed to assess differences between the three conditions. RESULTS The DA significantly improved ankle dorsiflexion during the mid-swing phase, making it more effective in correcting foot drop compared with the UD (DA: 2.28°, UD: 0.44°). Conversely, the UD was more effective in preventing knee flexion during the loading response (DA: 28.11°, UD: 26.72°). CONCLUSIONS The DA improved ankle dorsiflexion during the swing phase significantly more than that with the UD in patients with hemiplegia. Compared with the DA, the UD more effectively prevented increased knee flexion during the loading response. The choice to prescribe these orthoses should consider individual patient characteristics.
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Affiliation(s)
- Su Ji Lee
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae Yong Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyung Min Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung-Rae Cho
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
- Graduate Program of Biomedical Engineering, Yonsei University College of Medicine, Seoul, Korea
- Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea
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3
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Avalos MA, Rosenblatt NJ. Can minimum toe clearance predict community-based trips by older adults? Gait Posture 2024; 107:189-193. [PMID: 37852886 PMCID: PMC10842081 DOI: 10.1016/j.gaitpost.2023.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 09/20/2023] [Accepted: 09/28/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Tripping is the leading cause of falls by older adults. While tripping theoretically occurs when minimum toe clearance (MTC) is insufficient to avoid an unseen obstacle, the relationship between MTC and community-based trips is unknown. RESEARCH QUESTION To what extent do MTC and its variability predict the number of community-based trips during gait by older adults? METHOD 51 older adults with normal or obese body mass index walked across an 8 m walkway. For each step, we identified MTC as the local minimum of the vertical trajectory of a toe marker during the swing phase. We calculated the across-steps mean, median, interquartile range, and standard deviation for MTC, and skewness and kurtosis of the distribution of all MTC values for an individual. Every two weeks for one year, participants reported on community-based trips. A series of negative binomial regressions were used to predict the number of trips over obstacles (with or without a fall) based on MTC measures. RESULTS 28 participants experienced at least one trip, with 14 experiencing two or more. In the absence of any covariates, only kurtosis and skewness significantly predicted the incidence rate of trips. However, neither remained significant after accounting for fall history. The model that included kurtosis and fall history predicted trips better than one with fall history alone, with the incidence rate of trips decreasing by 35% for every unit increase in kurtosis (incidence rate ratio of 0.64 with 95% confidence interval: 0.38 - 1.08; p = 0.09) SIGNIFICANCE: While MTC has the potential to provide insight into older adults more likely to trip over obstacles in the community, assessing MTC during level-ground walking within a lab environment may lack ecological validity to strongly describe the risk of community-based trips above and beyond fall history.
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Affiliation(s)
- Marco A Avalos
- Dr. William M. Scholl Colleg of Podiatric Medicine's Center for Lower Extremity Ambulatory Research (CLEAR), Rosalind Franklin Univerisity of Medicine and Science, 3333 Greenbay Road, North Chicago, IL 60604, USA.
| | - Noah J Rosenblatt
- Dr. William M. Scholl Colleg of Podiatric Medicine's Center for Lower Extremity Ambulatory Research (CLEAR), Rosalind Franklin Univerisity of Medicine and Science, 3333 Greenbay Road, North Chicago, IL 60604, USA.
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Areno G, Chantraine F, Schreiber C, Masson X, Classen T, Pereira JAC, Dierick F. CHECGAIT: A Functional Electrical Stimulation Clinical Pathway to Reduce Foot Drop during Walking in Adult Patients with Upper Motor Neuron Lesions. J Clin Med 2023; 12:5112. [PMID: 37568513 PMCID: PMC10419675 DOI: 10.3390/jcm12155112] [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: 06/21/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023] Open
Abstract
Foot drop during the swing phase of gait and at initial foot contact is a current kinematic abnormality that can occur following an upper motor neuron (UMN) lesion. Functional electrical stimulation (FES) of the common peroneal nerve through an assistive device is often used in neuro-rehabilitation to help patients regain mobility. Although there are FES-specific guideline recommendations, it remains a challenge for clinicians to appropriately select patients eligible for the daily use of FES devices, as very few health insurance systems cover its cost in Europe. In Luxembourg, since 2018, successfully completing an FES clinical pathway called CHECGAIT is a prerequisite to receiving financial coverage for FES devices from the national health fund (Caisse Nationale de Santé-CNS). This study describes the structure and steps of CHECGAIT and reports our experience with a cohort of 100 patients enrolled over a three-year period. The clinical and gait outcomes of all patients were retrospectively quantified, and a specific analysis was performed to highlight differences between patients with and without an FES device prescription at the end of a CHECGAIT. Several significant gait differences were found between these groups. These results and CHECGAIT may help clinicians to better select patients who can most benefit from this technology in their daily lives. In addition, CHECGAIT could provide significant savings to public health systems by avoiding unnecessary deliveries of FES devices.
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Affiliation(s)
- Gilles Areno
- Laboratoire d’Analyse du Mouvement et de la Posture (LAMP), Centre National de Rééducation Fonctionnelle et de Réadaptation—Rehazenter, Rue André Vésale 1, 2674 Luxembourg, Luxembourg
- Physiotherapy Department, Centre National de Rééducation Fonctionnelle et de Réadaptation—Rehazenter, Rue André Vésale 1, 2674 Luxembourg, Luxembourg
| | - Frédéric Chantraine
- Laboratoire d’Analyse du Mouvement et de la Posture (LAMP), Centre National de Rééducation Fonctionnelle et de Réadaptation—Rehazenter, Rue André Vésale 1, 2674 Luxembourg, Luxembourg
- Medical Department, Centre National de Rééducation Fonctionnelle et de Réadaptation—Rehazenter, Rue André Vésale 1, 2674 Luxembourg, Luxembourg
| | - Céline Schreiber
- Laboratoire d’Analyse du Mouvement et de la Posture (LAMP), Centre National de Rééducation Fonctionnelle et de Réadaptation—Rehazenter, Rue André Vésale 1, 2674 Luxembourg, Luxembourg
| | - Xavier Masson
- Laboratoire d’Analyse du Mouvement et de la Posture (LAMP), Centre National de Rééducation Fonctionnelle et de Réadaptation—Rehazenter, Rue André Vésale 1, 2674 Luxembourg, Luxembourg
- Päiperléck, Op Tomm 19, 5485 Wormeldange, Luxembourg
| | - Tanja Classen
- Laboratoire d’Analyse du Mouvement et de la Posture (LAMP), Centre National de Rééducation Fonctionnelle et de Réadaptation—Rehazenter, Rue André Vésale 1, 2674 Luxembourg, Luxembourg
- Physiotherapy Department, Centre National de Rééducation Fonctionnelle et de Réadaptation—Rehazenter, Rue André Vésale 1, 2674 Luxembourg, Luxembourg
| | - José Alexandre Carvalho Pereira
- Medical Department, Centre National de Rééducation Fonctionnelle et de Réadaptation—Rehazenter, Rue André Vésale 1, 2674 Luxembourg, Luxembourg
| | - Frédéric Dierick
- Laboratoire d’Analyse du Mouvement et de la Posture (LAMP), Centre National de Rééducation Fonctionnelle et de Réadaptation—Rehazenter, Rue André Vésale 1, 2674 Luxembourg, Luxembourg
- Faculté des Sciences de la Motricité, UCLouvain, Place Pierre de Coubertin 1-2, 1348 Ottignies-Louvain-la-Neuve, Belgium
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Martin S, Taylor SB, Shideler BL, Ogrin R, Begg R. Effects of diabetes mellitus on step length and minimum toe clearance adaptation. Biomed Eng Online 2023; 22:43. [PMID: 37165365 PMCID: PMC10170732 DOI: 10.1186/s12938-023-01082-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/15/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Adaptive gait involves the ability to adjust the leading foot in response to the requirement of dynamic environments during walking. Accurate adjustments of the minimum toe clearance (MTC) height and step length can prevent older people from falling when walking and responding to hazards. Although older people with diabetes fall more frequently than healthy older adults, no previous studies have quantified their adaptive gait abilities. This study aimed to investigate the effects of diabetes mellitus on step length and MTC height adjustments using a non-immersive virtual-reality system. METHODS Sixteen young adults (26 ± 5 years, 7 females), 16 healthy older adults (68 ± 5 years, 6 females), and 16 older adults with diabetes (70 ± 5 years, 6 females) completed adaptability tests while walking on a treadmill. A computer system visualised a continuous real-time signal of absolute step length and MTC on a monitor. Each person responded to four discrete participant-specific step length and MTC visual targets that were presented on the same signal. Tasks were to match the peaks of interest on each signal to presented targets. Targets were 10% longer or shorter than the mean baseline step length, and 2.5 cm, and 3.5 cm higher than the mean baseline MTC. When a target was displayed, it remained unchanged for 10 consecutive foot displacement adaptation attempts. Then, the target was removed and a new target or the same target was present after 10 consecutive steps and remained for 10 steps. Each target was randomly presented three times (3 × 10). Step length and MTC height adjustments in response to targets were measured and compared among groups. RESULTS Mean preferred walking speeds were not different among groups significantly when no targets were presented on the monitor in baseline walking. However, when participants walked on a treadmill while attempting to match step lengths or MTC heights to displayed targets on the monitor, the group with diabetes had reduced step length and MTC adjustments compared with other groups significantly. They showed greater errors (differences between their step lengths/MTC heights and presented targets) on the monitor. CONCLUSIONS This study quantified reduced abilities for older individuals with diabetes to adjust both step length and MTC in response to stimuli compared to healthy older counterparts. Reduced step length and MTC height adjustments can increase falls in at risk populations. The presented virtual-reality system has merits for assessing and training step and MTC adaptation.
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Affiliation(s)
- Suzanne Martin
- Institute for Health and Sport, Victoria University, Melbourne, VIC, 3011, Australia.
| | - Simon B Taylor
- Institute for Health and Sport, Victoria University, Melbourne, VIC, 3011, Australia
| | | | - Rajna Ogrin
- Bolton Clarke Research Institute, Melbourne, VIC, Australia
| | - Rezaul Begg
- Institute for Health and Sport, Victoria University, Melbourne, VIC, 3011, Australia
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Gambelli CN, Bredin J, Doix ACM, Garcia J, Tanant V, Fournier-Mehouas M, Desnuelle C, Sacconi S, Colson SS. The effect of tibialis anterior weakness on foot drop and toe clearance in patients with facioscapulohumeral dystrophy. Clin Biomech (Bristol, Avon) 2023; 102:105899. [PMID: 36738507 DOI: 10.1016/j.clinbiomech.2023.105899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 01/25/2023] [Accepted: 01/25/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND Facioscapulohumeral dystrophy is a genetic disease characterized by progressive muscle weakness leading to a complex combination of postural instability, foot drop during swing and compensatory strategies during gait that have been related to an increased risk of falling. The aim is to assess the effect of tibialis anterior muscle weakness on foot drop and minimum toe clearance of patients with facioscapulohumeral dystrophy during gait. METHODS Eight patients allocated to a subgroup depending on the severity of tibialis anterior muscle weakness, assessed by manual muscle testing (i.e., severe and mild weakness), and eight matched control participants underwent gait analysis at self-selected walking speeds. FINDINGS Walking speed, for all facioscapulohumeral dystrophy patients, and step length, for patients with severe weakness only, were significantly decreased compared to control participants. Minimum toe clearance was similar across all groups, but its variability was increased only for patients with severe weakness. A greater foot drop was systematically observed for patients with severe weakness during swing and only in late swing for patients with mild weakness. Individual strategies to compensate for foot drop remain unclear and may depend on other muscle impairment variability. INTERPRETATION Although all patients were able to control the average height of their foot trajectory during swing, patients with severe tibialis anterior muscle weakness exhibited increased foot drop and minimum toe clearance variability. Manual muscle testing is a simple, cheap and effective method to assess tibialis anterior muscle weakness and seems promising to identify facioscapulohumeral dystrophy patients with an increased risk of tripping.
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Affiliation(s)
- C N Gambelli
- Physical Activity, Sport and Recreation Research Focus Area (PhASRec), Potchefstroom Campus, North-West University (NWU), Potchefstroom, South Africa; Université Côte d'Azur, LAMHESS, France; Laboratory of Physiology and Biomechanics of Locomotion, Institute of Neuroscience (IoNS), Université catholique de Louvain (UCL), Louvain-la-Neuve, Belgium.
| | - J Bredin
- Université Côte d'Azur, LAMHESS, France; Centre de Santé Institut Rossetti-PEP06, Nice, France
| | | | - J Garcia
- Université Côte d'Azur, CHU, France
| | - V Tanant
- Université Côte d'Azur, CHU, France
| | - M Fournier-Mehouas
- Université Côte d'Azur, LAMHESS, France; Université Côte d'Azur, CHU, France
| | - C Desnuelle
- Université Côte d'Azur, CNRS, Inserm, iBV, France
| | - S Sacconi
- Université Côte d'Azur, CHU, France; Université Côte d'Azur, CHU, CNRS, Inserm, IRCAN, France
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Taping-induced cutaneous stimulation to the ankle tendons reduces minimum toe clearance variability. Heliyon 2023; 9:e12682. [PMID: 36685399 PMCID: PMC9850051 DOI: 10.1016/j.heliyon.2022.e12682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/21/2022] [Accepted: 12/22/2022] [Indexed: 01/07/2023] Open
Abstract
Large variability of minimum toe clearance (MTC) leads to a higher risk of tripping. Visual feedback-based gait training systems have been used to regulate MTC distribution, but these systems are expensive and bulky. Furthermore, the effect of such training lasts only for a short period of time. Considering the efficacy of elastic adhesive tape-induced cutaneous stimulation to the ankle tendons in improving proprioception and movement detection, we hypothesize that application of tapes to the ankle tendons as a practical method for modifying MTC distribution. To test this hypothesis, we recruited 13 young and healthy adults and instructed them to walk on a treadmill under four conditions: no taping, taping the tibialis anterior tendon, taping the Achilles tendon, and taping both tendons. We measured MTC distribution, lower limb joint angles and muscle activations of the tibialis anterior and gastrocnemius medialis, and compared these outcomes under the four conditions. The application of elastic adhesive tape to the ankle tendons had no significant effect on the average MTC height, but tapes applied to the Achilles tendon and both tendons significantly reduced MTC variability. Taping decreased the variability of some lower limb joint angles, but taping did not induce significant changes in the activation levels of the shank muscles. These results demonstrate that elastic adhesive tape applied to the shank can reduce MTC variability with minimal resistance, inertia and cumbersomeness.
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Asogwa CO, Nagano H, Wang K, Begg R. Using Deep Learning to Predict Minimum Foot-Ground Clearance Event from Toe-Off Kinematics. SENSORS (BASEL, SWITZERLAND) 2022; 22:6960. [PMID: 36146308 PMCID: PMC9502804 DOI: 10.3390/s22186960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 06/16/2023]
Abstract
Efficient, adaptive, locomotor function is critically important for maintaining our health and independence, but falls-related injuries when walking are a significant risk factor, particularly for more vulnerable populations such as older people and post-stroke individuals. Tripping is the leading cause of falls, and the swing-phase event Minimum Foot Clearance (MFC) is recognised as the key biomechanical determinant of tripping probability. MFC is defined as the minimum swing foot clearance, which is seen approximately mid-swing, and it is routinely measured in gait biomechanics laboratories using precise, high-speed, camera-based 3D motion capture systems. For practical intervention strategies designed to predict, and possibly assist, swing foot trajectory to prevent tripping, identification of the MFC event is essential; however, no technique is currently available to determine MFC timing in real-life settings outside the laboratory. One strategy has been to use wearable sensors, such as Inertial Measurement Units (IMUs), but these data are limited to primarily providing only tri-axial linear acceleration and angular velocity. The aim of this study was to develop Machine Learning (ML) algorithms to predict MFC timing based on the preceding toe-off gait event. The ML algorithms were trained using 13 young adults' foot trajectory data recorded from an Optotrak 3D motion capture system. A Deep Learning configuration was developed based on a Recurrent Neural Network with a Long Short-Term Memory (LSTM) architecture and Huber loss-functions to minimise MFC-timing prediction error. We succeeded in predicting MFC timing from toe-off characteristics with a mean absolute error of 0.07 s. Although further algorithm training using population-specific inputs are needed. The ML algorithms designed here can be used for real-time actuation of wearable active devices to increase foot clearance at critical MFC and reduce devastating tripping falls. Further developments in ML-guided actuation for active exoskeletons could prove highly effective in developing technologies to reduce tripping-related falls across a range of gait impaired populations.
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Affiliation(s)
- Clement Ogugua Asogwa
- Institute for Health and Sport (IHES), Victoria University, Melbourne, VIC 8001, Australia
| | - Hanatsu Nagano
- Institute for Health and Sport (IHES), Victoria University, Melbourne, VIC 8001, Australia
| | - Kai Wang
- University of Tsukuba, Tsukuba 305-8577, Japan
| | - Rezaul Begg
- Institute for Health and Sport (IHES), Victoria University, Melbourne, VIC 8001, Australia
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Shin J, Chung Y. The effects of treadmill training with visual feedback and rhythmic auditory cue on gait and balance in chronic stroke patients: A randomized controlled trial. NeuroRehabilitation 2022; 51:443-453. [DOI: 10.3233/nre-220099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
BACKGROUND: Many stroke patients show reduced walking abilities, characterized by asymmetric walking patterns. For such patients, restoration of walking symmetry is important. OBJECTIVE: This study investigates the effect of treadmill training with visual feedback and rhythmic auditory cue (VF+RAC) for walking symmetry on spatiotemporal gait parameters and balance abilities. METHODS: Thirty-two patients with chronic stroke participated in this study. Participants were randomized to either the VF+RAC (n = 16) or the Control (n = 16) group. The VF+RAC group received treadmill training with VF and RAC, and the Control group underwent treadmill training without any visual and auditory stimulation. VF+RAC and Control groups were trained three times per week for eight weeks. After eight weeks of training, the spatiotemporal gait parameters, Timed up and go test, and Berg balance scale were measured. RESULTS: The VF+RAC group significantly improved balance and spatiotemporal parameters except for non-paretic single limb support compared to the Control group. CONCLUSIONS: This study demonstrated that treadmill training with VF+RAC significantly improved spatiotemporal gait symmetry, including other gait parameters, and enhanced balance abilities in stroke patients. Therefore, treadmill training with VF+RAC could be a beneficial intervention in clinical settings for stroke patients who need improvement in their gait and balance abilities.
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Affiliation(s)
- Jin Shin
- Department of Physical Medicine and Rehabilitation, Gyeong-in Rehabilitation Center Hospital, Incheon, Republic of Korea
| | - Yijung Chung
- Department of Physical Therapy, College of Health and Welfare, Sahmyook University, Seoul, Republicof Korea
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Acute effect of traditional and adaptive metronomes on gait variability in older individuals with a history of falls. Aging Clin Exp Res 2022; 34:1349-1356. [PMID: 35020171 PMCID: PMC9151579 DOI: 10.1007/s40520-021-02066-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 12/26/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Metronome cueing has been shown to reduce gait variability and thereby potentially reduce falls risk in individuals with Parkinson's disease. It is unclear however, if metronome cueing has a similar effect in healthy older adults with a history of falls. AIM To investigate whether a traditional and/or an adaptive metronome, based on an individual's gait pattern, were effective in reducing gait variability in older adults with a history of falls. METHODS Twenty older adults (15 women, 71 ± 4.9 years) with a history of falls were included in this cross-over study. Participants received two types of cueing (adaptive and traditional metronome) 1 week apart. The variability of the participants' stride time, stride length, walking speed and duration of double leg support were recorded during three walking conditions (baseline, during feedback and post-feedback gait). Repeated-measures ANOVA was used to assess the possible effects of the two cueing strategies on gait variables. RESULTS Compared with the baseline condition, participants had significantly increased stride time variability during feedback (F (2) = 9.83, p < 0.001) and decreased double leg support time variability post-feedback (F (2) 3.69, p = 0.034). Increased stride time variability was observed with the adaptive metronome in comparison to the traditional metronome. CONCLUSION Metronome cueing strategies may reduce double leg support variability in older adults with a history of falls but seem to increase stride time variability. Further studies are needed to investigate if metronome cueing is more beneficial for individuals with greater baseline gait variability than those included in the current study.
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11
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Nagano H, Said CM, James L, Sparrow WA, Begg R. Biomechanical Correlates of Falls Risk in Gait Impaired Stroke Survivors. Front Physiol 2022; 13:833417. [PMID: 35330930 PMCID: PMC8940193 DOI: 10.3389/fphys.2022.833417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 02/11/2022] [Indexed: 12/03/2022] Open
Abstract
Increased falls risk is prevalent among stroke survivors with gait impairments. Tripping is the leading cause of falls and it is highly associated with mid-swing Minimum Foot Clearance (MFC), when the foot’s vertical margin from the walking surface is minimal. The current study investigated MFC characteristics of post-stroke individuals (n = 40) and healthy senior controls (n = 21) during preferred speed treadmill walking, using an Optotrak 3D motion capture system to record foot-ground clearance. In addition to MFC, bi-lateral spatio-temporal gait parameters, including step length, step width and double support time, were obtained for the post-stroke group’s Unaffected and Affected limb and the control group’s Dominant and Non-dominant limbs. Statistical analysis of MFC included central tendency (mean, median), step-to-step variability (standard deviation and interquartile range) and distribution (skewness and kurtosis). In addition, the first percentile, that is the lowest 1% of MFC values (MFC 1%) were computed to identify very high-risk foot trajectory control. Spatio-temporal parameters were described using the mean and standard deviation with a 2 × 2 (Group × Limb) Multivariate Analysis of Variance applied to determine significant Group and Limb effects. Pearson’s correlations were used to reveal any interdependence between gait variables and MFC control. The main finding of the current research was that post-stroke group’s affected limb demonstrated lower MFC 1% with higher variability and lower kurtosis. Post-stroke gait was also characterised by shorter step length, larger step width and increased double support time. Gait retraining methods, such as using real-time biofeedback, would, therefore, be recommended for post-stroke individuals, allowing them to acquire optimum swing foot control and reduce their tripping risk by elevating the swing foot and improving step-to-step consistency in gait control.
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Affiliation(s)
- Hanatsu Nagano
- Institute for Health and Sports (IHeS), Victoria University, Melbourne, VIC, Australia
- *Correspondence: Hanatsu Nagano,
| | - Catherine M. Said
- Department of Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Melbourne, VIC, Australia
- Department of Physiotherapy, Western Health, St. Albans, VIC, Australia
- Australian Institute for Musculoskeletal Science, St. Albans, VIC, Australia
- Department of Physiotherapy, Austin Health, Heidelberg, VIC, Australia
| | - Lisa James
- Institute for Health and Sports (IHeS), Victoria University, Melbourne, VIC, Australia
| | - William A. Sparrow
- Institute for Health and Sports (IHeS), Victoria University, Melbourne, VIC, Australia
| | - Rezaul Begg
- Institute for Health and Sports (IHeS), Victoria University, Melbourne, VIC, Australia
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12
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Pathak P, Moon J, Roh SG, Roh C, Shim Y, Ahn J. Application of vibration to the soles reduces minimum toe clearance variability during walking. PLoS One 2022; 17:e0261732. [PMID: 34982783 PMCID: PMC8726470 DOI: 10.1371/journal.pone.0261732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 12/07/2021] [Indexed: 12/18/2022] Open
Abstract
Minimum toe clearance (MTC) is an important indicator of the risk of tripping. Aging and neuromuscular diseases often decrease MTC height and increase its variability, leading to a higher risk of tripping. Previous studies have developed visual feedback-based gait training systems to modify MTC. However, these systems are bulky and expensive, and the effects of the training continue only for a short time. We paid attention to the efficacy of vibration in decreasing the variability of gait parameters, and hypothesized that proper vibration applied to soles can reduce the MTC variability. Using shoes embedded with active vibrating insoles, we assessed the efficacy of both sub- and supra-threshold vibration in affecting MTC distribution. Experiment results with 17 young and healthy adults showed that vibration applied throughout the walking task with constant intensity of 130% of sensory threshold significantly decreased MTC variability, whereas sub-threshold vibration yielded no significant effect. These results demonstrate that a properly designed tactile sensory input which is controlled and delivered by a simple wearable device, the active insole, can reduce the MTC variability during walking.
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Affiliation(s)
- Prabhat Pathak
- Department of Physical Education, Seoul National University, Seoul, Republic of Korea
| | - Jeongin Moon
- Department of Physical Education, Seoul National University, Seoul, Republic of Korea
| | - Se-gon Roh
- Robot Center in Samsung Seoul R&D Campus, Samsung Electronics Co., Ltd., Seoul, Republic of Korea
| | | | | | - Jooeun Ahn
- Department of Physical Education, Seoul National University, Seoul, Republic of Korea
- Institute of Sport Science, Seoul National University, Seoul, Republic of Korea
- * E-mail:
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Guzik A, Wolan-Nieroda A, Drużbicki M. Assessment of Agreement Between a New Application to Compute the Wisconsin Gait Score and 3-Dimensional Gait Analysis, and Reliability of the Application in Stroke Patients. Front Hum Neurosci 2022; 16:775261. [PMID: 35185497 PMCID: PMC8851887 DOI: 10.3389/fnhum.2022.775261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 01/13/2022] [Indexed: 11/13/2022] Open
Abstract
Currently, there are no computerized tools enabling objective interpretation of observational gait assessment based on Wisconsin Gait Scale (WGS), which is a reliable and well-tested tool. The solution envisaged by us may provide a practical tool for assessing gait deviations in patients with hemiparesis after stroke. The present study assessed agreement between a new application software for computerized WGS and 3-dimensional gait analysis (3DGA), and reliability of the application. The study involved 33 individuals with hemiparesis after stroke. The software was developed based on a model designed taking into account components of the WGS and incorporating auxiliary lines passing through the relevant anthropometric points on the patient’s body, as well as measurements of angular values, distances and duration of the specific gait phases, which make it possible to substantiate assessment based on this scale. Series of videos were made to record gait of the qualified patients. After the gait evaluation was carried out using the app, the data were retrieved from the software. The gait assessment was performed separately by three independent examiners who reviewed the video recording using the new app twice (two weeks apart). Additionally, 3DGA was carried out for all the subjects, and the results of the app-aided assessment were compared to those acquired using 3DGA. The findings show statistically significant correlations (p < 0.05) between majority of the WGS items measured using the new app, and the relevant spatiotemporal and kinematic parameters identified by 3DGA. Agreement between the scores reported by the three examiners was high in both measurements, as reflected by Cronbach’s alpha exceeding 0.8. The findings reflect very good intra-observer reliability (as reflected by kappa coefficients from 0.847 to 1) and inter-observer reliability (as reflected by kappa coefficients from 0.634 to 1) of the new application software for computerized WGS. The opportunities offered by the observational gait scale objectified through our new software for computerized WGS result from the fact that the tool provides a useful low-cost and time-effective feedback to monitor ongoing treatments or formulate hypotheses.
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Design of a Novel Wearable System for Foot Clearance Estimation. SENSORS 2021; 21:s21237891. [PMID: 34883901 PMCID: PMC8659772 DOI: 10.3390/s21237891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/18/2021] [Accepted: 11/19/2021] [Indexed: 11/24/2022]
Abstract
Trip-related falls are one of the major causes of injury among seniors in Canada and can be attributable to an inadequate Minimum Toe Clearance (MTC). Currently, motion capture systems are the gold standard for measuring MTC; however, they are expensive and have a restricted operating area. In this paper, a novel wearable system is proposed that can estimate different foot clearance parameters accurately using only two Time-of-Flight (ToF) sensors located at the toe and heel of the shoe. A small-scale preliminary study was conducted to investigate the feasibility of foot clearance estimation using the proposed wearable system. We recruited ten young, healthy females to walk at three self-selected speeds (normal, slow, and fast) while wearing the system. Our data analysis showed an average correlation coefficient of 0.94, 0.94, 0.92 for the normal, slow, and fast speed, respectively, when comparing the ToF signals with motion capture. The ANOVA analysis confirmed these results further by revealing no statistically significant differences between the ToF signals and motion capture data for most of the gait parameters after applying the newly proposed foot angle and offset compensation. In addition, the proposed system can measure the MTC with an average Mean Error (ME) of −0.08 ± 3.69 mm, −0.12 ± 4.25 mm, and −0.10 ± 6.57 mm for normal, slow, and fast walking speeds, respectively. The proposed affordable wearable system has the potential to perform real-time MTC estimation and contribute to future work focused on minimizing tripping risks.
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15
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Datta S, Begg R, Rao AS, Karmakar C, Bajelan S, Said C, Palaniswami M. Measures of Bipedal Toe-Ground Clearance Asymmetry to Characterize Gait in Stroke Survivors. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:6015-6018. [PMID: 34892488 DOI: 10.1109/embc46164.2021.9629740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Post-stroke hemiparesis often impairs gait and increases the risks of falls. Low and variable Minimum Toe Clearance (MTC) from the ground during the swing phase of the gait cycle has been identified as a major cause of such falls. In this paper, we study MTC characteristics in 30 chronic stroke patients, extracted from gait patterns during treadmill walking, using infrared sensors and motion analysis camera units. We propose objective measures to quantify MTC asymmetry between the paretic and non-paretic limbs using Poincaré analysis. We show that these subject independent Gait Asymmetry Indices (GAIs) represent temporal variations of relative MTC differences between the two limbs and can distinguish between healthy and stroke participants. Compared to traditional measures of cross-correlation between the MTC of the two limbs, these measures are better suited to automate gait monitoring during stroke rehabilitation. Further, we explore possible clusters within the stroke data by analysing temporal dispersion of MTC features, which reveals that the proposed GAIs can also be potentially used to quantify the severity of lower limb hemiparesis in chronic stroke.
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Jung J, Choi W, Lee S. Immediate augmented real-time forefoot weight bearing using visual feedback improves gait symmetry in chronic stroke. Technol Health Care 2021; 28:733-741. [PMID: 32444583 DOI: 10.3233/thc-192016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
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.
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Affiliation(s)
- Jihye Jung
- Department of Physical Therapy, The Graduate School of Sahmyook University, Seoul, Korea
| | - Wonjae Choi
- Institute of the SMART Rehabilitation, Sahmyook University, Seoul, Korea
| | - Seungwon Lee
- Department of Physical Therapy, Sahmyook University, Seoul, Korea
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17
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Tiwari A, Joshi D. Design and Validation of a Real-Time Visual Feedback System to Improve Minimum Toe Clearance (mTC) in Transfemoral Amputees. IEEE Trans Neural Syst Rehabil Eng 2021; 29:1711-1722. [PMID: 34398756 DOI: 10.1109/tnsre.2021.3105139] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Tripping is accompanied by reduced minimum toe clearance (mTC) during the swing phase of gait. The risk of fall due to tripping among transfemoral amputees is nearly 67% which is greater than the transtibial amputees. Therefore, intervention to improve mTC can potentially enhance the quality of life among transfemoral amputees. In this paper, we first develop a real-time visual feedback system with center of pressure (CoP) information. Next, we recruited six non-disabled and three transfemoral amputees to investigate the effect on mTC while participants were trained to shift the CoP anteriorly/posteriorly during heel strike. Finally, to assess the lasting effect of training on mTC, retention trials were conducted without feedback. During feedback, posterior shift in the CoP improved the mTC significantly from 4.68 ± 0.40 cm to 6.12 ± 0.68 cm (p < 0.025) in non-disabled participants. A similar significant improvement in mTC from 4.60 ± 0.55 cm to 5.62 ± 0.57 cm was observed in amputees during posterior shift of CoP. Besides mTC, maximal toe clearances, i.e., maxTC1 and maxTC2, also showed a significant increase (p < 0.025) during the posterior shift of CoP in both the participants. Moreover, during retention, mTC did not differ significantly (p > 0.05) from feedback condition in amputee, suggesting a positive effect of feedback training. The foot-to-ground angle (FGA) at mTC increased significantly (p < 0.025) during posterior shift feedback in non-disabled suggests active ankle dorsiflexion in increasing mTC. However, in amputees, FGA at mTC did not differ significantly during both anterior and posterior CoP shift feedback. The present findings suggest CoP feedback as a potential strategy during gait rehabilitation of transfemoral amputees.
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Wada Y, Otaka Y, Mukaino M, Tsujimoto Y, Shiroshita A, Kawate N, Taito S. The effect of ankle-foot orthosis on ankle kinematics in individuals after stroke: A systematic review and meta-analysis. PM R 2021; 14:828-836. [PMID: 34369101 DOI: 10.1002/pmrj.12687] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 07/28/2021] [Accepted: 08/02/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate whether ankle-foot orthosis (AFO) has a beneficial effect on dorsiflexion angle increase during the swing phase among individuals with stroke and patient-important outcomes in individuals with stroke. LITERATURE SURVEY Randomized controlled trials (RCTs), randomized crossover trials, and cluster RCTs until May 2020 were researched through CENTRAL, MEDLINE, EMBASE, PEDro, CINAHL, and REHABDATA databases. Studies reporting on AFO use to improve walking, functional mobility, quality of life, and activity limitations and reports of adverse events in individuals with stroke were included. METHODOLOGY Two independent reviewers extracted the data and assessed the risk of bias. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations approach. SYNTHESIS Fourteen trials that enrolled 282 individuals with stroke and compared AFO with no AFO were included. Compared with no AFO, AFO could increase the dorsiflexion angle of ankle joints during walking (mean difference [MD, 3.7°]; 95% confidence interval [CI], 2.0-5.3; low certainty of evidence). Furthermore, AFO could improve walking ability (walking speed) (MD, 0.09 [m/s]; 95% CI, 0.06-0.12; low certainty of evidence). No study had reported the effects of AFO on quality of life, adverse events, fall frequency, and activities of daily life. CONCLUSIONS Our findings suggest that AFO improved ankle kinematics and walking ability in the short term; nonetheless, the evidence was characterized by a low degree of certainty.
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Affiliation(s)
- Yoshitaka Wada
- Department of Rehabilitation Medicine, Showa University Fujigaoka Rehabilitation Hospital, Yokohama, Japan
| | - Yohei Otaka
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Masahiko Mukaino
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Yasushi Tsujimoto
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Nephrology and Dialysis, Kyoritsu Hospital, Himeji, Japan.,Systematic Review Workshop Peer Support Group (SRWS-PSG), Osaka, Japan
| | - Akihiro Shiroshita
- Systematic Review Workshop Peer Support Group (SRWS-PSG), Osaka, Japan.,Department of Respiratory Medicine, Ichinomiyanishi Hospital, Ichinomiya, Japan
| | - Nobuyuki Kawate
- Department of Rehabilitation Medicine, Showa University Fujigaoka Rehabilitation Hospital, Yokohama, Japan
| | - Shunsuke Taito
- Systematic Review Workshop Peer Support Group (SRWS-PSG), Osaka, Japan.,Division of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University Hospital, Hiroshima, Japan
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Mohan DM, Khandoker AH, Wasti SA, Ismail Ibrahim Ismail Alali S, Jelinek HF, Khalaf K. Assessment Methods of Post-stroke Gait: A Scoping Review of Technology-Driven Approaches to Gait Characterization and Analysis. Front Neurol 2021; 12:650024. [PMID: 34168608 PMCID: PMC8217618 DOI: 10.3389/fneur.2021.650024] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 05/07/2021] [Indexed: 12/26/2022] Open
Abstract
Background: Gait dysfunction or impairment is considered one of the most common and devastating physiological consequences of stroke, and achieving optimal gait is a key goal for stroke victims with gait disability along with their clinical teams. Many researchers have explored post stroke gait, including assessment tools and techniques, key gait parameters and significance on functional recovery, as well as data mining, modeling and analyses methods. Research Question: This study aimed to review and summarize research efforts applicable to quantification and analyses of post-stroke gait with focus on recent technology-driven gait characterization and analysis approaches, including the integration of smart low cost wearables and Artificial Intelligence (AI), as well as feasibility and potential value in clinical settings. Methods: A comprehensive literature search was conducted within Google Scholar, PubMed, and ScienceDirect using a set of keywords, including lower extremity, walking, post-stroke, and kinematics. Original articles that met the selection criteria were included. Results and Significance: This scoping review aimed to shed light on tools and technologies employed in post stroke gait assessment toward bridging the existing gap between the research and clinical communities. Conventional qualitative gait analysis, typically used in clinics is mainly based on observational gait and is hence subjective and largely impacted by the observer's experience. Quantitative gait analysis, however, provides measured parameters, with good accuracy and repeatability for the diagnosis and comparative assessment throughout rehabilitation. Rapidly emerging smart wearable technology and AI, including Machine Learning, Support Vector Machine, and Neural Network approaches, are increasingly commanding greater attention in gait research. Although their use in clinical settings are not yet well leveraged, these tools promise a paradigm shift in stroke gait quantification, as they provide means for acquiring, storing and analyzing multifactorial complex gait data, while capturing its non-linear dynamic variability and offering the invaluable benefits of predictive analytics.
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Affiliation(s)
- Dhanya Menoth Mohan
- Department of Biomedical Engineering, Health Engineering Innovation Center (HEIC), Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Ahsan Habib Khandoker
- Department of Biomedical Engineering, Health Engineering Innovation Center (HEIC), Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Sabahat Asim Wasti
- Neurological Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Sarah Ismail Ibrahim Ismail Alali
- Department of Biomedical Engineering, Health Engineering Innovation Center (HEIC), Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Herbert F Jelinek
- Department of Biomedical Engineering, Health Engineering Innovation Center (HEIC), Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Kinda Khalaf
- Department of Biomedical Engineering, Health Engineering Innovation Center (HEIC), Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
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20
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Real-time gait metric estimation for everyday gait training with wearable devices in people poststroke. ACTA ACUST UNITED AC 2021; 2. [PMID: 34396094 PMCID: PMC8360352 DOI: 10.1017/wtc.2020.11] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Hemiparetic walking after stroke is typically slow, asymmetric, and inefficient, significantly impacting activities of daily living. Extensive research shows that functional, intensive, and task-specific gait training is instrumental for effective gait rehabilitation, characteristics that our group aims to encourage with soft robotic exosuits. However, standard clinical assessments may lack the precision and frequency to detect subtle changes in intervention efficacy during both conventional and exosuit-assisted gait training, potentially impeding targeted therapy regimes. In this paper, we use exosuit-integrated inertial sensors to reconstruct three clinically meaningful gait metrics related to circumduction, foot clearance, and stride length. Our method corrects sensor drift using instantaneous information from both sides of the body. This approach makes our method robust to irregular walking conditions poststroke as well as usable in real-time applications, such as real-time movement monitoring, exosuit assistance control, and biofeedback. We validate our algorithm in eight people poststroke in comparison to lab-based optical motion capture. Mean errors were below 0.2 cm (9.9%) for circumduction, −0.6 cm (−3.5%) for foot clearance, and 3.8 cm (3.6%) for stride length. A single-participant case study shows our technique’s promise in daily-living environments by detecting exosuit-induced changes in gait while walking in a busy outdoor plaza.
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21
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Nagano H, Sparrow WA, Mizukami K, Sarashina E, Begg R. A cross-sectional study of foot-ground clearance in healthy community dwelling Japanese cohorts aged 50, 60 and 70 years. BMC Geriatr 2021; 21:166. [PMID: 33676395 PMCID: PMC7937319 DOI: 10.1186/s12877-021-02117-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 02/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Falls-related injuries are particularly serious for older people, causing pain, reduced community engagement and associated medical costs. Tripping is the leading cause of falls and the current study examined whether minimum ground clearance (MFC) of the swing foot, indicating high tripping risk, would be differentiated across cohorts of healthy 50-, 60- and 70-years old community residents in Japan. METHODS A cross-sectional population comprising the three groups (50s, 60s and 70s) of 123 Konosu City residents consented to be recorded when walking on an unobstructed surface at preferred speed. Gait biomechanics was measured using high speed (100 Hz) motion capture (OptiTrack - Natural Point Inc.), including step length and width, double support, foot contact angle and MFC (swing toe height above the ground). Multivariate Analysis of Variance (MANOVA) was used to confirm ageing effects on MFC and fundamental gait parameters. Pearson's correlations were performed to identify the relationships between mean MFC and other MFC characteristics (SD and SI), step length, step width, double support time and foot contact angle. RESULTS Compared to 50s, lower step length was seen (2.69 cm and 6.15 cm) for 60s and 70s, respectively. No other statistical effects were identified for spatio-temporal parameters between the three groups. The 50s cohort MFC was also significantly higher than 60s and 70s, while step-to-step MFC variability was greater in the 70s than 50s and 60s. Pearson's correlations demonstrated that more symmetrical gait patterns were associated with greater MFC height, as reflected in greater symmetry in step width (50s), MFC (60s) and foot contact angle (70s). In the 70s increased MFC height correlated with higher MFC variability and reduced foot contact angle. CONCLUSIONS MFC height reduces from 60 years but more variable MFC appears later, from 70 years. While symmetrical gait was accompanied by increased MFC height, in the 70s group attempts to increase MFC height may have caused more MFC variability and lower foot contact angles, compromising foot-ground clearance. Assessments of swing foot mechanics may be a useful component of community falls prevention.
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Affiliation(s)
- Hanatsu Nagano
- Institute for Health and Sport (IHeS), Victoria University, P.O. Box 14428, VIC, 8001, Melbourne, Australia.
| | - W A Sparrow
- Institute for Health and Sport (IHeS), Victoria University, P.O. Box 14428, VIC, 8001, Melbourne, Australia.,Graduate School of Comprehensive Human Sciences, Faculty of Health and Sport Sciences, University of Tsukuba, Ibaraki, 305-8574, Tsukuba, Japan
| | - Katsuyoshi Mizukami
- Graduate School of Comprehensive Human Sciences, Faculty of Health and Sport Sciences, University of Tsukuba, Ibaraki, 305-8574, Tsukuba, Japan
| | - Eri Sarashina
- Institute for Health and Sport (IHeS), Victoria University, P.O. Box 14428, VIC, 8001, Melbourne, Australia
| | - Rezaul Begg
- Institute for Health and Sport (IHeS), Victoria University, P.O. Box 14428, VIC, 8001, Melbourne, Australia
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22
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Nagano H, Said CM, James L, Begg RK. Feasibility of Using Foot-Ground Clearance Biofeedback Training in Treadmill Walking for Post-Stroke Gait Rehabilitation. Brain Sci 2020; 10:brainsci10120978. [PMID: 33322082 PMCID: PMC7764443 DOI: 10.3390/brainsci10120978] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/25/2020] [Accepted: 12/11/2020] [Indexed: 11/16/2022] Open
Abstract
Hemiplegic stroke often impairs gait and increases falls risk during rehabilitation. Tripping is the leading cause of falls, but the risk can be reduced by increasing vertical swing foot clearance, particularly at the mid-swing phase event, minimum foot clearance (MFC). Based on previous reports, real-time biofeedback training may increase MFC. Six post-stroke individuals undertook eight biofeedback training sessions over a month, in which an infrared marker attached to the front part of the shoe was tracked in real-time, showing vertical swing foot motion on a monitor installed in front of the subject during treadmill walking. A target increased MFC range was determined, and participants were instructed to control their MFC within the safe range. Gait assessment was conducted three times: Baseline, Post-training and one month from the final biofeedback training session. In addition to MFC, step length, step width, double support time and foot contact angle were measured. After biofeedback training, increased MFC with a trend of reduced step-to-step variability was observed. Correlation analysis revealed that MFC height of the unaffected limb had interlinks with step length and ankle angle. In contrast, for the affected limb, step width variability and MFC height were positively correlated. The current pilot-study suggested that biofeedback gait training may reduce tripping falls for post-stroke individuals.
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Affiliation(s)
- Hanatsu Nagano
- Institute for Health and Sport (IHES), Victoria University, Melbourne, VIC 3011, Australia; (L.J.); (R.K.B.)
- Correspondence:
| | - Catherine M. Said
- Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, Melbourne, VIC 3053, Australia;
- Physiotherapy Department, Western Health, St. Albans, VIC 3021, Australia
- Australian Institute for Musculoskeletal Science, St. Albans, VIC 3021, Australia
- Physiotherapy Department, Austin Health, Heidelberg, VIC 3084, Australia
| | - Lisa James
- Institute for Health and Sport (IHES), Victoria University, Melbourne, VIC 3011, Australia; (L.J.); (R.K.B.)
| | - Rezaul K. Begg
- Institute for Health and Sport (IHES), Victoria University, Melbourne, VIC 3011, Australia; (L.J.); (R.K.B.)
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Effect of an EMG-FES Interface on Ankle Joint Training Combined with Real-Time Feedback on Balance and Gait in Patients with Stroke Hemiparesis. Healthcare (Basel) 2020; 8:healthcare8030292. [PMID: 32846971 PMCID: PMC7551751 DOI: 10.3390/healthcare8030292] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 08/19/2020] [Accepted: 08/21/2020] [Indexed: 11/17/2022] Open
Abstract
This study evaluated the effects of an electromyography-functional electrical stimulation interface (EMG-FES interface) combined with real-time balance and gait feedback on ankle joint training in patients with stroke hemiplegia. Twenty-six stroke patients participated in this study. All subjects were randomly assigned to either the EMG-FES interface combined with real-time feedback on ankle joint training (RFEF) group (n = 13) or the EMG-FES interface on ankle joint training (EF) group (n = 13). Subjects in both groups were trained for 20 min a day, 5 times a week, for 4 weeks. Similarly, all participants underwent a standard rehabilitation physical therapy for 60 min a day, 5 times a week, for 4 weeks. The RFEF group showed significant increases in weight-bearing lunge test (WBLT), Tardieu Scale (TS), Timed Up and Go Test (TUG), Berg Balance Scale (BBS), velocity, cadence, step length, stride length, stance per, and swing per (p < 0.05). Likewise, the EF group showed significant increases in WBLT, TUG, BBS, velocity, and cadence (p < 0.05). Moreover, the RFEF group showed significantly greater improvements than the EF group in terms of WBLT, Tardieu Scale, TUG, BBS, velocity, step length, stride length, stance per, and swing per (p < 0.05). Ankle joint training using an EMG-FES interface combined with real-time feedback improved ankle range of motion (ROM), muscle tone, balance, and gait in stroke patients. These results suggest that an EMG-FES interface combined with real-time feedback is feasible and suitable for ankle joint training in individuals with stroke.
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24
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Age effects on step adaptation during treadmill walking with continuous step length biofeedback. Gait Posture 2020; 80:174-177. [PMID: 32521471 DOI: 10.1016/j.gaitpost.2020.04.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 01/21/2020] [Accepted: 04/21/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The inability to adjust step length can lead to falls in older people when navigating everyday terrain. Precisely targeted forward placement of the leading foot, constituting step length adjustment, is required for adaptive gait control, but this ability may reduce with ageing. The objective of this study was to investigate ageing effects on step length adaptation using real-time biofeedback. RESEARCH QUESTION Does ageing affect the ability to adapt step length to match a target using real-time biofeedback? METHODS Fifteen older adults (67 ± 3 years; 8 females) and 27 young adults (24 ± 4 years; 13 females) completed a step length adaptation test while walking at preferred speed on a treadmill. The test involved walking while viewing a monitor at the front of the treadmill that showed a real-time signal of absolute left-right foot displacement. The task was to match the local maxima of the signal (i.e. step length) to two target conditions, at 10 % longer or 10 % shorter than mean baseline step length. When the target was displayed, it remained unchanged for a set of 10 consecutive step attempts. Three sets of 10 attempts for each target condition were allocated in random order, for a total of 30 step attempts per target. Average absolute error and average error (bias) of step length accuracy was computed for each target condition and compared between groups. RESULTS The step adaptation test identified that older adults had greater mean absolute error for both short and long step targets and showed a step length-dependent bias significantly different to the young. SIGNIFICANCE Real-time foot position feedback could be a useful tool to train and evaluate step adaptation in older people.
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Fien S, Henwood T, Climstein M, Rathbone E, Keogh JWL. Gait Speed Characteristics and Their Spatiotemporal Determinants in Nursing Home Residents: A Cross-Sectional Study. J Geriatr Phys Ther 2020; 42:E148-E154. [PMID: 29200084 DOI: 10.1519/jpt.0000000000000160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Low and slowing gait speeds among nursing home residents are linked to a higher risk of disability, cognitive impairment, falls, and mortality. A better understanding of the spatiotemporal parameters of gait that influence declining mobility could lead to effective rehabilitation and preventative intervention. The aims of this study were to objectively quantify the spatiotemporal characteristics of gait in the nursing home setting and define the relationship between these parameters and gait speed. METHODS One hundred nursing home residents were enrolled into the study and completed 3 habitual gait speed trials over a distance of 3.66 m. Trials were performed using an instrumented gait analysis. The manner in which the spatiotemporal parameters predicted gait speed was examined by univariate and multivariable regression modeling. RESULTS The nursing home residents had a habitual mean (SD) gait speed of 0.63 (0.19) m/s, a stride length of 0.83 (0.15) m, a support base of 0.15 (0.06) m, and step time of 0.66 (0.12) seconds. Multivariable linear regression revealed stride length, support base, and step time predicted gait speed (R = 0.89, P < .05). Step time had the greatest influence on gait speed, with each 0.1-second decrease in step time resulting in a 0.09 m/s (95% confidence interval, 0.08-0.10) increase in habitual gait speed. CONCLUSIONS This study revealed step time, stride length, and support base are the strongest predictors of gait speed among nursing home residents. Future research should concentrate on developing and evaluating intervention programs that were specifically designed to focus on the strong predictors of gait speed in nursing home residents. We would also suggest that routine assessments of gait speed, and if possible their spatiotemporal characteristics, be done on all nursing home residents in an attempt to identify residents with low or slowing gait speed.
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Affiliation(s)
- Samantha Fien
- Faculty of Health Science and Medicine, Bond University, Robina, Australia
| | - Timothy Henwood
- Faculty of Health Science and Medicine, Bond University, Robina, Australia.,Southern Cross Care, North Plympton, Australia
| | - Mike Climstein
- Exercise, Health and Performance Faculty Research Group, The University of Sydney, Sydney, Australia.,Water-Based Research Unit, Faculty of Health Sciences, Bond University, Gold Coast, Australia
| | - Evelyne Rathbone
- Faculty of Health Science and Medicine, Bond University, Robina, Australia
| | - Justin William Leslie Keogh
- Faculty of Health Science and Medicine, Bond University, Robina, Australia.,Human Potential Centre, AUT University, Auckland, New Zealand.,Cluster for Health Improvement, Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Sippy Downs, Australia
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Yamamoto R, Akizuki K, Kanai Y, Nakano W, Kobayashi Y, Ohashi Y. Differences in skill level influence the effects of visual feedback on motor learning. J Phys Ther Sci 2019; 31:939-945. [PMID: 31871382 PMCID: PMC6879409 DOI: 10.1589/jpts.31.939] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 08/23/2019] [Indexed: 11/24/2022] Open
Abstract
[Purpose] No previous studies have confirmed whether the effects of visual feedback on motor learning vary according to learner skill level for a learning task. The purpose of this study was to clarify whether differences in skill influence the effects of visual feedback on motor learning. [Participants and Methods] Sixty-four participants were assigned to one of four different feedback groups (concurrent-100%, concurrent-50%, terminal-100%, or terminal-50%). The learning task was to adjust the load amount continuously to the left lower limb in accordance with sound stimulation at intervals of 1 Hz. The four groups performed a pretest, practice sessions, and a retention test 24 hours after practice. After completing these measurements, the participants were classified as either high- or low-skilled based on the results of the pretest. [Results] Only the groups of low-skilled participants who used concurrent feedback showed lower root mean square errors in the retention test compared to in the pretest. [Conclusion] Differences in skill level for the same task influenced the effects of visual feedback on motor learning. Furthermore, concurrent visual feedback can help improve motor learning in low-skilled learners for the same task.
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Affiliation(s)
- Ryohei Yamamoto
- Department of Rehabilitation, Kyushu University of Nursing and Social Welfare: 888 Tomio, Tamana, Kumamoto 865-0062, Japan
| | - Kazunori Akizuki
- Department of Physical Therapy, Kobe International University, Japan
| | - Yoshihide Kanai
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Japan
| | - Wataru Nakano
- Department of Shizuoka Physical Therapy, Tokoha University, Japan
| | - Yasuto Kobayashi
- Department of Sport Management, Sakushin Gakuin University, Japan
| | - Yukari Ohashi
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Japan
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Begg R, Galea MP, James L, Sparrow WAT, Levinger P, Khan F, Said CM. Real-time foot clearance biofeedback to assist gait rehabilitation following stroke: a randomized controlled trial protocol. Trials 2019; 20:317. [PMID: 31151480 PMCID: PMC6545011 DOI: 10.1186/s13063-019-3404-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 05/06/2019] [Indexed: 12/11/2022] Open
Abstract
Background The risk of falling is significantly higher in people with chronic stroke and it is, therefore, important to design interventions to improve mobility and decrease falls risk. Minimum toe clearance (MTC) is the key gait cycle event for predicting tripping-falls because it occurs mid-swing during the walking cycle where forward velocity of the foot is maximum. High forward velocity coupled with low MTC increases the probability of unanticipated foot-ground contacts. Training procedures to increase toe-ground clearance (MTC) have potential, therefore, as a falls-prevention intervention. The aim of this project is to determine whether augmented sensory information via real-time visual biofeedback during gait training can increase MTC. Methods Participants will be aged > 18 years, have sustained a single stroke (ischemic or hemorrhagic) at least six months previously, able to walk 50 m independently, and capable of informed consent. Using a secure web-based application (REDCap), 150 participants will be randomly assigned to either no-feedback (Control) or feedback (Experimental) groups; all will receive 10 sessions of treadmill training for up to 10 min at a self-selected speed over 5–6 weeks. The intervention group will receive real-time, visual biofeedback of MTC during training and will be asked to modify their gait pattern to match a required “target” criterion. Biofeedback is continuous for the first six sessions then progressively reduced (faded) across the remaining four sessions. Control participants will walk on the treadmill without biofeedback. Gait assessments are conducted at baseline, immediately following the final training session and then during follow-up, at one, three, and six months. The primary outcome measure is MTC. Monthly falls calendars will also be collected for 12 months from enrolment. Discussion The project will contribute to understanding how stroke-related changes to sensory and motor processes influence gait biomechanics and associated tripping risk. The research findings will guide our work in gait rehabilitation following stroke and may reduce falls rates. Treadmill training procedures incorporating continuous real-time feedback may need to be modified to accommodate stroke patients who have greater difficulties with treadmill walking. Trial registration Australia New Zealand Clinical Trials Registry, ACTRN12617000250336. Registered on 17 February 2017.
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Affiliation(s)
- Rezaul Begg
- Institute for Health and Sport (IHES), Victoria University, Footscray Park Campus (Room PB307), PO Box 14428, Melbourne, VIC, 8001, Australia.
| | - Mary P Galea
- Royal Melbourne Hospital, Australian Rehabilitation Research Centre, Parkville, Victoria, 3010, Australia.,The University of Melbourne, Department of Medicine, Melbourne, Australia
| | - Lisa James
- Institute for Health and Sport (IHES), Victoria University, Footscray Park Campus (Room PB307), PO Box 14428, Melbourne, VIC, 8001, Australia
| | - W A Tony Sparrow
- Institute for Health and Sport (IHES), Victoria University, Footscray Park Campus (Room PB307), PO Box 14428, Melbourne, VIC, 8001, Australia
| | - Pazit Levinger
- National Ageing Research Institute Ltd., Clinical Gerontology Division, Royal Melbourne Hospital, PO Box 2127, Melbourne, VIC, 3050, Australia
| | - Fary Khan
- Royal Melbourne Hospital, Australian Rehabilitation Research Centre, Parkville, Victoria, 3010, Australia
| | - Catherine M Said
- The University of Melbourne, Department of Physiotherapy, 34-54 Poplar Road, Parkville, Victoria, 3052, Australia.,Austin Health, Heidelberg Repatriation Hospital, PO Box 5444, Heidelberg West, Victoria, 3084, Australia.,Western Centre for Health Research and Education, Sunshine Hospital, Western Health, Furlong Rd, St Albans, VIC, 3021, Australia.,Australian Institute of Musculoskeletal Science, St Albans, Australia
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A Principal Components Analysis Approach to Quantifying Foot Clearance and Foot Clearance Variability. J Appl Biomech 2019; 35:116-122. [PMID: 30421634 DOI: 10.1123/jab.2018-0187] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Low foot clearance and high variability may be related to falls risk. Foot clearance is often defined as the local minimum in toe height during swing; however, not all strides have this local minimum. The primary purpose of this study was to identify a nondiscrete measure of foot clearance during all strides, and compare discrete and nondiscrete measures in ability to rank individuals on foot clearance and variability. Thirty-five participants (young adults [n = 10], older fallers [n = 10], older nonfallers [n = 10], and stroke survivors [n = 5]) walked overground while lower extremity 3D kinematics were recorded. Principal components analysis (PCA) of the toe height waveform yielded representation of toe height when it was closest to the ground. Spearman's rank order correlation assessed the association of foot clearance and variability between PCA and discrete variables, including the local minimum. PCA had significant (P < .05) moderate or strong associations with discrete measures of foot clearance and variability. An approximation of the discrete local minimum had a weak association with PCA and other discrete measures of foot clearance. A PCA approach to quantifying foot clearance can be used to identify the behavioral components of toe height when it is closest to the ground, even for strides without a local minimum.
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Pongpipatpaiboon K, Mukaino M, Matsuda F, Ohtsuka K, Tanikawa H, Yamada J, Tsuchiyama K, Saitoh E. The impact of ankle-foot orthoses on toe clearance strategy in hemiparetic gait: a cross-sectional study. J Neuroeng Rehabil 2018; 15:41. [PMID: 29792211 PMCID: PMC5966858 DOI: 10.1186/s12984-018-0382-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 05/03/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Ankle-foot orthoses (AFOs) are frequently used to improve gait stability, toe clearance, and gait efficiency in individuals with hemiparesis. During the swing phase, AFOs enhance lower limb advancement by facilitating the improvement of toe clearance and the reduction of compensatory movements. Clinical monitoring via kinematic analysis would further clarify the changes in biomechanical factors that lead to the beneficial effects of AFOs. The purpose of this study was to investigate the actual impact of AFOs on toe clearance, and determine the best strategy to achieve toe clearance (including compensatory movements) during the swing phase. METHODS This study included 24 patients with hemiparesis due to stroke. The gait performance of these patients with and without AFOs was compared using three-dimensional treadmill gait analysis. A kinematic analysis of the paretic limb was performed to quantify the contribution of the extent of lower limb shortening and compensatory movements (such as hip elevation and circumduction) to toe clearance. The impact of each movement related to toe clearance was assessed by analyzing the change in the vertical direction. RESULTS Using AFOs significantly increased toe clearance (p = 0.038). The quantified limb shortening and pelvic obliquity significantly differed between gaits performed with versus without AFOs. Among the movement indices related to toe clearance, limb shortening was increased by the use of AFOs (p < 0.0001), while hip elevation due to pelvic obliquity (representing compensatory strategies) was diminished by the use of AFOs (p = 0.003). The toe clearance strategy was not significantly affected by the stage of the hemiparetic condition (acute versus chronic) or the type of AFO (thermoplastic AFOs versus adjustable posterior strut AFOs). CONCLUSIONS Simplified three-dimensional gait analysis was successfully used to quantify and visualize the impact of AFOs on the toe clearance strategy of hemiparetic patients. AFO use increased the extent of toe clearance and limb shortening during the swing phase, while reducing compensatory movements. This approach to visualization of the gait strategy possibly contributes to clinical decision-making in the real clinical settings. TRIAL REGISTRATION UMIN000028946 . Registered 31 August 2017 (retrospectively registered).
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Affiliation(s)
- Kannit Pongpipatpaiboon
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi 470-1192 Japan
| | - Masahiko Mukaino
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi 470-1192 Japan
| | - Fumihiro Matsuda
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi Japan
| | - Kei Ohtsuka
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi Japan
| | - Hiroki Tanikawa
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi Japan
| | - Junya Yamada
- Department of Rehabilitation, Fujita Health University Hospital, Toyoake, Aichi Japan
| | - Kazuhiro Tsuchiyama
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi Japan
| | - Eiichi Saitoh
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi 470-1192 Japan
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Shin J, Chung Y. Influence of visual feedback and rhythmic auditory cue on walking of chronic stroke patient induced by treadmill walking in real-time basis. NeuroRehabilitation 2018; 41:445-452. [PMID: 28946580 DOI: 10.3233/nre-162139] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Many patients who have suffered from a stroke show decreased walking ability, characterized by asymmetric gait. For such patients, the recovery of symmetry in walking is important. OBJECTIVES The purpose of this study is to investigate the effect of visual feedback with rhythmic auditory cue on treadmill gait in persons with chronic stroke. METHODS Seventeen chronic subjects who have been diagnosed at least six months or before were recruited in G Hospital, located in Incheon. The subjects who were enrolled in this study were instructed to walk randomly on a treadmill: treadmill with visual feedback and rhythmic auditory cue (VF+RAC), treadmill with visual feedback (VF), general treadmill (Control; non-feedback). Three factors were observed and estimated: paretic step length, non-paretic step length, spatial asymmetry ratio at comfortable speed. Also, in VF and VF+RAC, calibration of feedback accuracy was measured. RESULTS Results showed that paretic step length and spatial asymmetry ratio were significantly improved in VF+RAC compared to that of the VF and control (p < 0.05). Accuracies of paretic and non-paretic leg were significantly increased in VF+RAC than that of the VF (p < 0.05). CONCLUSIONS According to this result, it seems that application of VF+RAC in treadmill gait significantly improved gait of these patients. Also, we can conclude that VF+RAC in treadmill gait is thought to be useful in clinical settings where there are many chronic patients who are in need of improvement in their gait ability.
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Affiliation(s)
- Jin Shin
- Department of Physical Therapy, The Graduate School, Sahmyook University, Seoul, Republic of Korea
| | - Yijung Chung
- Department of Physical Therapy, College of Health Science and Social Welfare, Sahmyook University, Seoul, Republic of Korea
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31
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Trinh T, Shiner CT, Thompson-Butel AG, McNulty PA. Targeted upper-limb Wii-based Movement Therapy also improves lower-limb muscle activation and functional movement in chronic stroke. Disabil Rehabil 2016; 39:1939-1949. [DOI: 10.1080/09638288.2016.1213892] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Terry Trinh
- Neuroscience Research Australia, Sydney, NSW, Australia
- Faculty of Medicine, School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Christine T. Shiner
- Neuroscience Research Australia, Sydney, NSW, Australia
- Faculty of Medicine, School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Angelica G. Thompson-Butel
- Neuroscience Research Australia, Sydney, NSW, Australia
- Faculty of Medicine, School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Penelope A. McNulty
- Neuroscience Research Australia, Sydney, NSW, Australia
- Faculty of Medicine, School of Medical Sciences, University of New South Wales, Sydney, Australia
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Martinez CA, Mintz E, Ecsedy AE, Fisher BE. Constraining movement reveals motor capability in chronic stroke: an initial study. Clin Rehabil 2016; 31:1126-1133. [PMID: 27587329 DOI: 10.1177/0269215516665452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine if persons with chronic stroke and decreased hip and knee flexion during swing can walk with improved swing-phase kinematics when the task demands constrained gait to the sagittal plane. DESIGN A one-day, within-subject design comparing gait kinematics under two conditions: Unconstrained treadmill walking and a constrained condition in which the treadmill walking space is reduced to limit limb advancement to occur in the sagittal plane. SETTING Outpatient physical therapy clinic. SUBJECTS Eight individuals (mean age, 64.1 ±9.3, 2 F) with mild-moderate paresis were enrolled. MAIN MEASURES Spatiotemporal gait characteristics and swing-phase hip and knee range of motion during unconstrained and constrained treadmill walking were compared using paired t-test and Cohen's d ( d) to determine effect size. RESULTS There was a significant, moderate-to-large effect of the constraint on hip flexion ( p < 0.001, d = -1.1) during initial swing, and hip ( p < 0.05, d = -0.8) and knee ( p < 0.001, d = -1.1) flexion during midswing. There was a moderate effect of constraint on terminal swing knee flexion ( p = 0.238, d = -0.6). Immediate and significant changes in step width ( p < 0.05, d = 0.9) and paretic step length ( p < 0.05, d = -0.5) were noted in the constrained condition compared with unconstrained. CONCLUSION Constraining the treadmill walking path altered the gait patterns among the study's participants. The immediate change during constrained walking suggests that patients with chronic stroke may have underlying movement capability that they do not preferentially utilize.
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Affiliation(s)
- Clarisa A Martinez
- 1 Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | | | | | - Beth E Fisher
- 1 Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
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Khandoker AH, Sparrow WA, Begg RK. Tone Entropy Analysis of Augmented Information Effects on Toe-Ground Clearance When Walking. IEEE Trans Neural Syst Rehabil Eng 2016; 24:1218-1224. [PMID: 27071178 DOI: 10.1109/tnsre.2016.2538294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Minimum toe clearance (MTC) is an event approximately mid-swing in the walking cycle that is critical for preventing unintended foot contact with surface irregularities ("tripping"). Treadmill-based gait training for older adults was undertaken using real-time augmented information to increase foot-ground clearance at MTC (MTC height). Ten young (Y) (Age: 23±2 year) and ten older (O) (Age: 76±9 year) participants undertook 10 min preferred speed treadmill walking (baseline) followed by 20 min with MTC height information (training) and 10 min without augmented information (retention). Three-dimensional lower limb position was sampled at 100 Hz from which MTC height was computed for each step cycle. MTC height data were analyzed using traditional descriptive statistics (mean and SD) and by computing tone (T) and entropy (E) to show, respectively, cycle-to-cycle changes to MTC height and the informational content of the MTC height time-series. There were significant ( ) age-group differences in T-E values of MTC height; Baseline ( Older=-5.40±2.00 (T); 6.63±0.23 (E); Young = -3.00±0.89 (T); 6.20±0.51 (E)), Training ( Older=-5.05±3.45 (T); 6.46±0.42 (E); Young = -2.55±0.67 (T); 6.75±0.39 (E)) Retention ( Older=-3.77±2.59 (T); 6.38±0.46 (E); Young = -2.55±0.67 (T); 6.26±0.39 (E)). Relative to baseline, tone value was significantly ( ) reduced and entropy was elevated in training and vice versa in retention phase for the young group but no significant trends were observed for older group. T and E measures of MTC height considered separately discriminated the age groups only in baseline but distinctive "clusters" were observed in tone versus entropy plots indicating characteristically different patterns of MTC adjustment over step cycles. Treadmill training with MTC height augmented information is a practical intervention for reducing tripping in older people and others with gait impairments. T-E analysis is useful for identifying characteristics of lower limb control with ageing that have not been previously recognized in studies employing traditional statistical analysis of the MTC event.
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MacLellan MJ, Richards CL, Fung J, McFadyen BJ. Comparison of kinetic strategies for avoidance of an obstacle with either the paretic or non-paretic as leading limb in persons post stroke. Gait Posture 2015. [PMID: 26195252 DOI: 10.1016/j.gaitpost.2015.06.191] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The task of stepping over obstacles is known to be particularly risky for persons post stroke. A kinetic analysis informing on the movement strategies used to ensure clearance of the leading limb over an obstacle is, however, lacking. We examined obstacle avoidance strategies in six community dwelling stroke survivors comparing the use of paretic and non-paretic limb as the leading limb for clearance over obstacles measuring 7.5% and 15% of their total leg length. Subjects were able to increase foot clearance height in both limbs in order to avoid the two obstacles. Obstacle clearance with the non-paretic limb leading was associated with positive knee flexor work that increased when stepping over each obstacle, thus showing a normal knee strategy that flexes both the knee and the hip for foot clearance. There was also slightly increased hip flexor contribution for non-paretic obstacle clearance that was the same for both obstacle heights. When the paretic limb led during obstacle clearance, there was also evidence of an increased knee flexor moment, suggesting a residual knee strategy, but it was less pronounced than for the non-paretic limb and was assisted by greater vertical hip elevation and additional positive hip flexor work that both gained greater importance with increased obstacle height. These findings suggest that rehabilitation should explore the ability to improve the residual, but less powerful, knee flexor strategy in the paretic limb in specific patients, with further promotion of a hip flexor and limb elevation strategy depending on patient deficits and obstacle height.
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Affiliation(s)
- Michael J MacLellan
- School of Kinesiology, College of Human Sciences and Education, Louisiana State University, USA.
| | - Carol L Richards
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Canada; Department of Rehabilitation, Faculty of Medicine, Laval University, Canada
| | - Joyce Fung
- Feil & Oberfeld/CRIR Research Centre, Jewish Rehabilitation Hospital, and School of Physical and Occupational Therapy, McGill University, Canada
| | - Bradford J McFadyen
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Canada; Department of Rehabilitation, Faculty of Medicine, Laval University, Canada
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35
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Khoury MN, Missios S, Edwin N, Sakruti S, Barnett G, Stevens G, Peereboom DM, Khorana AA, Ahluwalia MS. Intracranial hemorrhage in setting of glioblastoma with venous thromboembolism. Neurooncol Pract 2015; 3:87-96. [PMID: 31386010 DOI: 10.1093/nop/npv028] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Indexed: 02/02/2023] Open
Abstract
Background Venous thromboembolism (VTE) is a complication of glioblastoma. Anticoagulating patients with glioblastoma carries a theoretical risk of intracranial hemorrhage (ICH). Methods We performed a retrospective cohort study of consecutive glioblastoma patients (2007-2013) diagnosed with VTE. Results The study population comprised of 523 glioblastoma patients of whom 173 (33%) had VTE events. Seventeen (10%) had ICH: 6 (35%) subdural hematomas and 11 (65%) intratumoral hemorrhages. In total, 4 patients with ICH required neurosurgical intervention. Enhancement in the area of subsequent intratumoral hemorrhage was noted in 9 of 10 with available pre-ICH scans. Multivariable regression did not show associations between ICH and tumor enhancement diameter or use of vascular-endothelial-growth-factor inhibitor. Fifteen (16%) patients receiving anticoagulation had ICH compared with 2 (2.6%) not receiving anticoagulation (P = .005). The method of anticoagulation was not associated with development of ICH. Median survival times from nondistal VTE diagnosis to death were 8.0 and 3.5 months (P = .05) in patients receiving anticoagulation and those not on anticoagulation, respectively. Conclusion Patients with glioblastoma and VTE on anticoagulation have increased incidence of ICH. However, development of ICH was not associated with lower median survival from time of VTE. Intratumoral hemorrhage occurred within the enhancing portion of tumor; however, no relationship was identified between the development of ICH and (i) the median diameter of enhancement or (ii) type of anticoagulant used. However, patients with absence of enhancing tumor did not have intratumoral bleed, suggesting gross total resection may limit this adverse outcome. It is appropriate to initiate anticoagulation in glioblastoma patients with VTEs.
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Affiliation(s)
- Michael Nabil Khoury
- Department of Neurooncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, Florida (M.N.K.); Department of Oncological Sciences, University of South Florida, Tampa, Florida (M.N.K.); Department of Neurosurgery, Louisiana State University, 1501 Kings Hwy, Shreveport, Louisiana (S.M.); Department of Internal Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (N.E.); Department of Hematology/Oncology, University Hospital, 11100 Euclid Avenue, Cleveland, Ohio (S.S.); Department of Neurosurgery,Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (G.B.); Department of Neurology,Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (G.S.); Department of Hematology and Oncology,Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (D.M.P., A.A.K., M.S.A.); Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (G.B., G.S., D.M.P., M.S.A.)
| | - Symeon Missios
- Department of Neurooncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, Florida (M.N.K.); Department of Oncological Sciences, University of South Florida, Tampa, Florida (M.N.K.); Department of Neurosurgery, Louisiana State University, 1501 Kings Hwy, Shreveport, Louisiana (S.M.); Department of Internal Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (N.E.); Department of Hematology/Oncology, University Hospital, 11100 Euclid Avenue, Cleveland, Ohio (S.S.); Department of Neurosurgery,Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (G.B.); Department of Neurology,Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (G.S.); Department of Hematology and Oncology,Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (D.M.P., A.A.K., M.S.A.); Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (G.B., G.S., D.M.P., M.S.A.)
| | - Natasha Edwin
- Department of Neurooncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, Florida (M.N.K.); Department of Oncological Sciences, University of South Florida, Tampa, Florida (M.N.K.); Department of Neurosurgery, Louisiana State University, 1501 Kings Hwy, Shreveport, Louisiana (S.M.); Department of Internal Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (N.E.); Department of Hematology/Oncology, University Hospital, 11100 Euclid Avenue, Cleveland, Ohio (S.S.); Department of Neurosurgery,Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (G.B.); Department of Neurology,Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (G.S.); Department of Hematology and Oncology,Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (D.M.P., A.A.K., M.S.A.); Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (G.B., G.S., D.M.P., M.S.A.)
| | - Susmita Sakruti
- Department of Neurooncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, Florida (M.N.K.); Department of Oncological Sciences, University of South Florida, Tampa, Florida (M.N.K.); Department of Neurosurgery, Louisiana State University, 1501 Kings Hwy, Shreveport, Louisiana (S.M.); Department of Internal Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (N.E.); Department of Hematology/Oncology, University Hospital, 11100 Euclid Avenue, Cleveland, Ohio (S.S.); Department of Neurosurgery,Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (G.B.); Department of Neurology,Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (G.S.); Department of Hematology and Oncology,Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (D.M.P., A.A.K., M.S.A.); Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (G.B., G.S., D.M.P., M.S.A.)
| | - Gene Barnett
- Department of Neurooncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, Florida (M.N.K.); Department of Oncological Sciences, University of South Florida, Tampa, Florida (M.N.K.); Department of Neurosurgery, Louisiana State University, 1501 Kings Hwy, Shreveport, Louisiana (S.M.); Department of Internal Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (N.E.); Department of Hematology/Oncology, University Hospital, 11100 Euclid Avenue, Cleveland, Ohio (S.S.); Department of Neurosurgery,Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (G.B.); Department of Neurology,Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (G.S.); Department of Hematology and Oncology,Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (D.M.P., A.A.K., M.S.A.); Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (G.B., G.S., D.M.P., M.S.A.)
| | - Glen Stevens
- Department of Neurooncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, Florida (M.N.K.); Department of Oncological Sciences, University of South Florida, Tampa, Florida (M.N.K.); Department of Neurosurgery, Louisiana State University, 1501 Kings Hwy, Shreveport, Louisiana (S.M.); Department of Internal Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (N.E.); Department of Hematology/Oncology, University Hospital, 11100 Euclid Avenue, Cleveland, Ohio (S.S.); Department of Neurosurgery,Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (G.B.); Department of Neurology,Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (G.S.); Department of Hematology and Oncology,Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (D.M.P., A.A.K., M.S.A.); Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (G.B., G.S., D.M.P., M.S.A.)
| | - David M Peereboom
- Department of Neurooncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, Florida (M.N.K.); Department of Oncological Sciences, University of South Florida, Tampa, Florida (M.N.K.); Department of Neurosurgery, Louisiana State University, 1501 Kings Hwy, Shreveport, Louisiana (S.M.); Department of Internal Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (N.E.); Department of Hematology/Oncology, University Hospital, 11100 Euclid Avenue, Cleveland, Ohio (S.S.); Department of Neurosurgery,Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (G.B.); Department of Neurology,Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (G.S.); Department of Hematology and Oncology,Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (D.M.P., A.A.K., M.S.A.); Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (G.B., G.S., D.M.P., M.S.A.)
| | - Alok A Khorana
- Department of Neurooncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, Florida (M.N.K.); Department of Oncological Sciences, University of South Florida, Tampa, Florida (M.N.K.); Department of Neurosurgery, Louisiana State University, 1501 Kings Hwy, Shreveport, Louisiana (S.M.); Department of Internal Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (N.E.); Department of Hematology/Oncology, University Hospital, 11100 Euclid Avenue, Cleveland, Ohio (S.S.); Department of Neurosurgery,Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (G.B.); Department of Neurology,Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (G.S.); Department of Hematology and Oncology,Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (D.M.P., A.A.K., M.S.A.); Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (G.B., G.S., D.M.P., M.S.A.)
| | - Manmeet S Ahluwalia
- Department of Neurooncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, Florida (M.N.K.); Department of Oncological Sciences, University of South Florida, Tampa, Florida (M.N.K.); Department of Neurosurgery, Louisiana State University, 1501 Kings Hwy, Shreveport, Louisiana (S.M.); Department of Internal Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (N.E.); Department of Hematology/Oncology, University Hospital, 11100 Euclid Avenue, Cleveland, Ohio (S.S.); Department of Neurosurgery,Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (G.B.); Department of Neurology,Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (G.S.); Department of Hematology and Oncology,Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (D.M.P., A.A.K., M.S.A.); Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (G.B., G.S., D.M.P., M.S.A.)
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Modulation of reactive response to slip-like perturbations: effect of explicit cues on paretic versus non-paretic side stepping and fall-risk. Exp Brain Res 2015; 233:3047-58. [PMID: 26289480 DOI: 10.1007/s00221-015-4367-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 06/20/2015] [Indexed: 10/23/2022]
Abstract
This study aimed to examine the effect of explicit cuing on reactive stepping with the paretic limb during slip-like perturbations in stroke survivors and to identify differences in postural stability and fall-risk while stepping with either limb. Eleven chronic hemiparetic stroke survivors received slip-like stance perturbations in no-cue (implicit, no instructions) and cued (explicit, instructions to step with paretic limb) conditions. Frequency of stepping with the paretic limb was recorded. Differences between non-paretic and paretic steps for falls, number of compensatory steps, relative center-of-mass position (X COM/BOS), and velocity (Ẋ(COM/BOS)), and vertical limb support (hip descent-Z hip) were analyzed. Stepping with the paretic limb increased from 6% in no-cue condition to 42% in cued condition with no significant difference in number of falls and steps regardless of stepping limb. At liftoff of the compensatory step, stability was greater (anterior X COM/BOS) with paretic than non-paretic limb stepping whereas, at touchdown (TD) of the step, stability with paretic limb reduced (posterior X COM/BOS and Ẋ(COM/BOS)) due to a smaller compensatory step taken with the paretic versus non-paretic limb. There was no significant difference in peak Z hip regardless of stepping limb; however, the timing of peak Z hip differed (occuring prior to TD during non-paretic stepping and post-TD during paretic stepping). Thus, fall onset was earlier with non-paretic versus paretic stepping. The results support that explicit cueing can facilitate initiation of reactive step from the paretic limb as compared with the no-cue condition. Stepping with the paretic limb in the cued condition however altered time of fall onset. Regardless of the stepping side, individuals demonstrated a fall risk suggesting the need for interventions focusing on reactive step training with both the limbs.
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Xu X, McGorry RW, Chou LS, Lin JH, Chang CC. Accuracy of the Microsoft Kinect for measuring gait parameters during treadmill walking. Gait Posture 2015; 42:145-51. [PMID: 26002604 DOI: 10.1016/j.gaitpost.2015.05.002] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 05/05/2015] [Accepted: 05/06/2015] [Indexed: 02/02/2023]
Abstract
The measurement of gait parameters normally requires motion tracking systems combined with force plates, which limits the measurement to laboratory settings. In some recent studies, the possibility of using the portable, low cost, and marker-less Microsoft Kinect sensor to measure gait parameters on over-ground walking has been examined. The current study further examined the accuracy level of the Kinect sensor for assessment of various gait parameters during treadmill walking under different walking speeds. Twenty healthy participants walked on the treadmill and their full body kinematics data were measured by a Kinect sensor and a motion tracking system, concurrently. Spatiotemporal gait parameters and knee and hip joint angles were extracted from the two devices and were compared. The results showed that the accuracy levels when using the Kinect sensor varied across the gait parameters. Average heel strike frame errors were 0.18 and 0.30 frames for the right and left foot, respectively, while average toe off frame errors were -2.25 and -2.61 frames, respectively, across all participants and all walking speeds. The temporal gait parameters based purely on heel strike have less error than the temporal gait parameters based on toe off. The Kinect sensor can follow the trend of the joint trajectories for the knee and hip joints, though there was substantial error in magnitudes. The walking speed was also found to significantly affect the identified timing of toe off. The results of the study suggest that the Kinect sensor may be used as an alternative device to measure some gait parameters for treadmill walking, depending on the desired accuracy level.
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Affiliation(s)
- Xu Xu
- Liberty Mutual Research Institute for Safety, 71 Frankland Road, Hopkinton, MA 01748, USA.
| | - Raymond W McGorry
- Liberty Mutual Research Institute for Safety, 71 Frankland Road, Hopkinton, MA 01748, USA
| | - Li-Shan Chou
- Department of Human Physiology, University of Oregon, Eugene, OR 97403, USA
| | - Jia-Hua Lin
- Safety and Health Assessment and Research for Prevention (SHARP) Program, Washington State Department of Labor and Industries, Olympia, WA 98504, USA
| | - Chien-Chi Chang
- Department of Industrial Engineering and Engineering Management, National Tsing Hua University, Hsinchu, Taiwan, ROC
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Iosa M, Gizzi L, Tamburella F, Dominici N. Editorial: Neuro-motor control and feed-forward models of locomotion in humans. Front Hum Neurosci 2015; 9:306. [PMID: 26082704 PMCID: PMC4451353 DOI: 10.3389/fnhum.2015.00306] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 05/12/2015] [Indexed: 12/31/2022] Open
Affiliation(s)
- Marco Iosa
- Clinical Laboratory of Experimental Neurorehabilitation, Fondazione Santa Lucia I.R.C.C.S. Rome, Italy
| | - Leonardo Gizzi
- Department of Neurorehabilitation Engineering, Bernstein Focus Neurotechnology Göttingen - Bernstein Center for Computational Neuroscience Göttingen, Germany
| | - Federica Tamburella
- SPInal REhabilitation Lab (SPIRE), Fondazione Santa Lucia I.R.C.C.S. Rome, Italy
| | - Nadia Dominici
- Faculty of Human Movement Sciences, MOVE Research Institute, VU University Amsterdam Amsterdam, Netherlands
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