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Tsai CY, Weinrauch WJ, Manente N, Huang V, Bryce TN, Spungen AM. Exoskeletal-Assisted Walking During Acute Inpatient Rehabilitation Enhances Recovery for Persons with Spinal Cord Injury-A Pilot Randomized Controlled Trial. J Neurotrauma 2024. [PMID: 38661533 DOI: 10.1089/neu.2023.0667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
Spinal cord injury (SCI) negatively impacts individuals' functional independence, and motor and sensory function. Intense walking training has been shown to facilitate recovery for individuals with chronic SCI. Powered robotic exoskeletons provide therapists with a tool that allows them to conduct walking training with less therapist effort as compared to conventional walking training. Exoskeletal-assisted walking (EAW) has been studied in the chronic SCI population with preliminary reports showing benefits in mobility, health, and quality-of-life outcomes. However, few reports have studied EAW's benefits in the acute (<90 days post) SCI population at a time when neural plasticity is most dynamic and modifiable. The purpose of the study was to conduct a pilot randomized controlled trial (RCT) to understand the effects of incorporated EAW in acute inpatient rehabilitation (AIR) for individuals with SCI on functional, motor, and sensory recovery. The study outcomes included the Spinal Cord Independence Measure (SCIM) III and International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) motor and sensory scores that were assessed by unblinded assessors. We also recorded EAW session data, including adverse events, walking and up time, step counts, Borg Rating of Perceived Exertion (RPE), and compliance with scheduled EAW training. From August 2019 to July 2022, 16 participants completed the AIR with incorporated EAW, and 12 completed the standard AIR, all with SCI and preserved leg function within 90 days post-injury. During each session, the AIR with incorporated EAW group averaged 34.3 (±9.4) min of up time, 25.4 (±7.7) min of walk time, and 536 (±157) steps. Analysis via two-by-two mixed-effects models showed significant increases in the SCIM total score and ISNCSCI total motor and sensory scores over time for the AIR with incorporated EAW group [SCIM total score: F(1, 26) = 5.59, p = 0.03; total motor score: F(1, 26) = 8.06, p < 0.01; total sensory score: F(1, 19.2) = 5.08, p = 0.04], outperforming the standard AIR group. The AIR with incorporated EAW group showed 13, 14, and 22 points higher changes in the SCIM total score, total motor score, and total sensory score (respectively) by discharge compared with the standard AIR group. Incorporating EAW into AIR may facilitate functional, motor, and sensory recovery for individuals with SCI during AIR better than standard AIR. However, the study had a limited sample size. Further studies are needed to clarify the effects of EAW in AIR.
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Affiliation(s)
- Chung-Ying Tsai
- Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Spinal Cord Damage Research Center, James J. Peters VA Medical Center, Bronx, New York, USA
| | - William J Weinrauch
- Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Nicholas Manente
- Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Vincent Huang
- Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Thomas N Bryce
- Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ann M Spungen
- Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Spinal Cord Damage Research Center, James J. Peters VA Medical Center, Bronx, New York, USA
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Moon Y, Yang C, Veit NC, McKenzie KA, Kim J, Aalla S, Yingling L, Buchler K, Hunt J, Jenz S, Shin SY, Kishta A, Edgerton VR, Gerasimenko YP, Roth EJ, Lieber RL, Jayaraman A. Noninvasive spinal stimulation improves walking in chronic stroke survivors: a proof-of-concept case series. Biomed Eng Online 2024; 23:38. [PMID: 38561821 PMCID: PMC10986021 DOI: 10.1186/s12938-024-01231-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 03/21/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND After stroke, restoring safe, independent, and efficient walking is a top rehabilitation priority. However, in nearly 70% of stroke survivors asymmetrical walking patterns and reduced walking speed persist. This case series study aims to investigate the effectiveness of transcutaneous spinal cord stimulation (tSCS) in enhancing walking ability of persons with chronic stroke. METHODS Eight participants with hemiparesis after a single, chronic stroke were enrolled. Each participant was assigned to either the Stim group (N = 4, gait training + tSCS) or Control group (N = 4, gait training alone). Each participant in the Stim group was matched to a participant in the Control group based on age, time since stroke, and self-selected gait speed. For the Stim group, tSCS was delivered during gait training via electrodes placed on the skin between the spinous processes of C5-C6, T11-T12, and L1-L2. Both groups received 24 sessions of gait training over 8 weeks with a physical therapist providing verbal cueing for improved gait symmetry. Gait speed (measured from 10 m walk test), endurance (measured from 6 min walk test), spatiotemporal gait symmetries (step length and swing time), as well as the neurophysiological outcomes (muscle synergy, resting motor thresholds via spinal motor evoked responses) were collected without tSCS at baseline, completion, and 3 month follow-up. RESULTS All four Stim participants sustained spatiotemporal symmetry improvements at the 3 month follow-up (step length: 17.7%, swing time: 10.1%) compared to the Control group (step length: 1.1%, swing time 3.6%). Additionally, 3 of 4 Stim participants showed increased number of muscle synergies and/or lowered resting motor thresholds compared to the Control group. CONCLUSIONS This study provides promising preliminary evidence that using tSCS as a therapeutic catalyst to gait training may increase the efficacy of gait rehabilitation in individuals with chronic stroke. Trial registration NCT03714282 (clinicaltrials.gov), registration date: 2018-10-18.
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Affiliation(s)
- Yaejin Moon
- Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
- Department of Exercise Science, Syracuse University, Syracuse, NY, 13057, USA
| | - Chen Yang
- Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Nicole C Veit
- Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA
- Biomedical Engineering Department, McCormick School of Engineering, Northwestern University, Evanston, IL, 60208, USA
| | - Kelly A McKenzie
- Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA
| | - Jay Kim
- Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA
| | - Shreya Aalla
- Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA
| | - Lindsey Yingling
- Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA
| | - Kristine Buchler
- Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA
| | - Jasmine Hunt
- Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA
| | - Sophia Jenz
- Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Sung Yul Shin
- Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Ameen Kishta
- Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA
| | - V Reggie Edgerton
- Rancho Los Amigos National Rehabilitation Center, Broccoli Impossible-to-Possible Lab, Rancho Research Institute, Downy, CA, 90242, USA
- Neurorestoration Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, USA
| | - Yury P Gerasimenko
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, 40202, USA
- Pavlov Institute of Physiology, St. Petersburg, Russia
| | - Elliot J Roth
- Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Richard L Lieber
- Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
- Hines VA Medical Center, Maywood, IL, 60141, USA
| | - Arun Jayaraman
- Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA.
- Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA.
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Amin RM, Phillips JJ, Humbert AT, Cholerton BA, Short VD, Smith MJ, Zabetian CP, Mata IF, Kelly VE. Associations between baseline cognitive status and motor outcomes after treadmill training in people with Parkinson's disease: a pilot study. Disabil Rehabil 2024; 46:1082-1091. [PMID: 37010072 PMCID: PMC10545807 DOI: 10.1080/09638288.2023.2189318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 01/27/2023] [Accepted: 03/05/2023] [Indexed: 04/04/2023]
Abstract
PURPOSE To determine the effect of baseline cognition on gait outcomes after a treadmill training program for people with Parkinson's disease (PD). METHODS This pilot clinical trial involved people with PD who were classified as having no cognitive impairment (PD-NCI) or mild cognitive impairment (PD-MCI). Baseline executive function and memory were assessed. The intervention was a 10-week gait training program (twice-weekly treadmill sessions), with structured speed and distance progression and verbal cues for gait quality. Response to intervention was assessed by gait speed measured after week 2 (short-term) and week 10 (long-term). RESULTS Participants (n = 19; 12 PD-NCI, 7 PD-MCI) had a mean (standard deviation) age of 66.5 (6.3) years, disease duration of 8.8 (6.3) years, and MDS-UPDRS III score of 21.3 (10.7). Gait speed increased at short-term and long-term assessments. The response did not differ between PD-NCI and PD-MCI groups; however, better baseline memory performance and milder PD motor severity were independently associated with greater improvements in gait speed in unadjusted and adjusted models. CONCLUSIONS These findings suggest that memory impairments and more severe motor involvement can influence the response to gait rehabilitation in PD and highlight the need for treatments optimized for people with greater cognitive and motor impairment.IMPLICATIONS FOR REHABILITATIONCognitive deficits in Parkinson's disease (PD) could impact motor learning and gait rehabilitation, yet little is known about the effects of cognitive impairments on the response to rehabilitation in people with PD.This study demonstrates that the response to gait rehabilitation did not differ between people with PD who had no cognitive impairment and those with mild cognitive impairment.Across all participants, better baseline memory was associated with greater improvements in gait speed.Rehabilitation professionals should be mindful of PD severity, as those with more substantial memory and motor impairments may require additional dosing or support to maximize gait training benefits.
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Affiliation(s)
- Raima M. Amin
- Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
- Department of Neurology, University of Washington, Seattle, WA, USA
| | | | - Andrew T. Humbert
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Brenna A. Cholerton
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Valerie D. Short
- Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Melissa J. Smith
- Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Cyrus P. Zabetian
- Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
- Department of Neurology, University of Washington, Seattle, WA, USA
| | - Ignacio F. Mata
- Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
- Department of Neurology, University of Washington, Seattle, WA, USA
- Lerner Research Institute, Genomic Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Valerie E. Kelly
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
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Tarihci Cakmak E, Yaliman A, Torna G, Sen EI. The effectiveness of bodyweight-supported treadmill training in stroke patients: randomized controlled trial. Neurol Sci 2024:10.1007/s10072-024-07385-z. [PMID: 38363446 DOI: 10.1007/s10072-024-07385-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 02/01/2024] [Indexed: 02/17/2024]
Abstract
OBJECTIVE This study aimed to assess the impact of conventional rehabilitation (CR) and the combination of bodyweight-supported treadmill training (BWSTT) with CR on walking speed, endurance, balance, mobility, and the quality of life in stroke survivors. METHOD In this prospective, randomized, controlled, and single-blind study, 30 stroke patients were included (ClinicalTrials.gov registration number: NCT04597658 date: October 22, 2020). These patients were divided into two groups: (1) CR only (control group, n = 14) and (2) CR with BWSTT (experimental group, n = 16). Both groups received CR for 3 consecutive weeks, 5 days a week, for 30 min each day. The experimental group received an additional 30 min of BWSTT per session. Patients were evaluated using the 10-m walk test (10MWT), the six-minute walk test (6MWT), the Tinetti Balance and Gait Assessment Score, the Timed Up and Go (TUG) test, the Rivermead Mobility Index (RMI), and the Stroke-Specific Quality of Life Scale (SS-QOL) before and after the intervention. RESULTS Both groups showed significant improvements across all scales after the intervention. The BWSTT group exhibited particularly noteworthy enhancements in comfortable 10MWT and TUG scores (p = 0.043 and p = 0.025, respectively) compared to the CR group post-intervention. CONCLUSION In conclusion, a holistic approach combining conventional physiotherapy with overground gait training can enhance various aspects of mobility. This approach offers a cost-effective and equipment-free alternative to BWSTT and necessitates specialized treadmill and bodyweight support systems, incurring higher costs. However, using BWSTT as a co-therapy therapy can be costly but provides additional benefits for enhancing functional mobility.
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Affiliation(s)
- Elif Tarihci Cakmak
- Department of Physical Medicine and Rehabilitation, University of Health Sciences Türkiye, Bagcilar Training and Research Hospital, Istanbul, Türkiye.
| | - Ayse Yaliman
- Department of Physical Medicine and Rehabilitation, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Gaye Torna
- Department of Physical Medicine and Rehabilitation, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Ekin Ilke Sen
- Department of Physical Medicine and Rehabilitation, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
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Dean RS, Farley KX, Waterman BR, Guettler J, Bicos J. Chronic exertional compartment syndrome is frequently diagnosed through static compartment pressure measurements and managed with fasciotomy: A systematic review. J ISAKOS 2024; 9:71-78. [PMID: 37778507 DOI: 10.1016/j.jisako.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/30/2023] [Accepted: 09/22/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVES Chronic exertional compartment syndrome (CECS) can be diagnosed either clinically or with intra-compartmental pressure monitor measurements and can be treated surgically or conservatively. METHODS A systematic review was performed on diagnostic and treatment modalities for CECS. Included studies were those that reported both their specific diagnostic modality and treatment regimens. Both surgical and conservative treatment strategies were considered. Demographic variables, diagnostic modalities, patient satisfaction and return to sport, the number of surgical incisions used for the anterior compartment fasciotomy, and the specific conservative treatment regimens were also recorded. Diagnostic modalities were grouped into one of three groups: 1) static compartment pressure monitor, 2) dynamic pressure monitoring, and 3) strictly clinical diagnosis. RESULTS The literature search identified 373 studies, of which 29 were included for final analysis. In total, there were 1270 total patients. Twenty-four studies used static compartment pressure monitors, 5 studies used dynamic pressure monitors and 2 studies used a strictly clinical diagnosis. Surgical management with fasciotomy was performed in 25 studies with a total of 1018 patients, while conservative management was used in 252 patients in 9 studies (5 studies included surgical and conservative treatments). Among surgical studies, 15 used a single-incision technique for anterior compartment fasciotomy, while 6 used a 2-incision technique. The reported satisfaction after fasciotomy was 42-94% while the return to sport was 26-100%. The reported return to sport in conservative management studies was 25-35%. CONCLUSION This systematic review found that the majority of clinical reports utilize static compartment pressure measurements to diagnose CECS, with fewer studies using dynamic intra-compartment pressure monitors. Additionally, surgical fasciotomy using a single-incision technique was the most common treatment strategy for anterior compartment CECC, with some studies reporting success with the two-incision technique. STUDY DESIGN Systematic review, level 4.
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Affiliation(s)
| | | | - Brian R Waterman
- Wake Forest University School of Medicine, Winston-Salem, NC, 27103 USA
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Gigonzac M, Terrier P. Restoring walking ability in older adults with arm-in-arm gait training: study protocol for the AAGaTT randomized controlled trial. BMC Geriatr 2023; 23:542. [PMID: 37674129 PMCID: PMC10481504 DOI: 10.1186/s12877-023-04255-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 08/24/2023] [Indexed: 09/08/2023] Open
Abstract
CONTEXT Falls are a significant problem among older adults. While balance and functional exercises have been shown to be effective, it remains unclear whether regular walking has specific effects on reducing the risk of falls. RATIONALE Older people who fall frequently have impaired gait patterns. Recent studies have suggested using interpersonal synchronization: while walking arm-in-arm, an older person synchronizes steps with a younger person to reinstate a better gait pattern. This method of gait training may reduce the risk of falls. OBJECTIVE The aim is to assess the efficacy of an arm-in-arm gait-training program in older people. DESIGN The arm-in-arm gait training trial (AAGaTT) is a single-site, open label, two-arm, randomized controlled trial. PARTICIPANTS We will enroll 66 dyads of older people and their younger "gait instructors". The older participants must be > 70 years old with adequate walking ability. They must have experienced a fall in the year prior to study entry. INTERVENTION Dyads will walk an indoor course for 30 min either side-by-side without contact (control group) or arm-in-arm while synchronizing their gait (intervention group). The gait training will be repeated three times a week for four weeks. OUTCOMES The main outcome will be the walking speed measured in five-minute walking trials performed at baseline and at the end of each intervention week (week 1 - week 4), and at week 7. Gait quality will be assessed using accelerometers. We will also assess perceived physical activity and health using questionnaires. Finally, we will monitor fall incidence over 18 months. We will evaluate whether outcomes are more improved in the intervention group compared to the control group. In addition, interviews will be conducted to assess the perception of the gait training. EXPECTED RESULTS Recent advances in the neurophysiology of motor control have shown that synchronizing gait to external cues or to a human partner can increase the efficiency of gait training. The expected benefits of arm-in-arm gait training are: reduced risk of falls, safe treatment with no adverse effects, and high adherence. This gait training program could be a low-cost intervention with positive effects on the health and well-being of seniors. TRIAL REGISTRATION ClinicalTrials.gov NCT05627453. Date of registration: 11.25.2022.
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Affiliation(s)
- Mathilde Gigonzac
- Haute Ecole Arc Santé, HES-SO University of Applied Sciences and Arts Western Switzerland, Neuchâtel, Switzerland
| | - Philippe Terrier
- Haute Ecole Arc Santé, HES-SO University of Applied Sciences and Arts Western Switzerland, Neuchâtel, Switzerland.
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Flux E, Bar-On L, Buizer AI, Harlaar J, van der Krogt MM. Electromyographic biofeedback-driven gaming to alter calf muscle activation during gait in children with spastic cerebral palsy. Gait Posture 2023; 102:10-7. [PMID: 36870265 DOI: 10.1016/j.gaitpost.2023.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/20/2023] [Accepted: 02/18/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND Children with cerebral palsy often show deviating calf muscle activation patterns during gait, with excess activation during early stance and insufficient activation during push-off. RESEARCH QUESTION Can children with cerebral palsy improve their calf muscle activation patterns during gait using one session of biofeedback-driven gaming? METHODS Eighteen children (6-17 y) with spastic cerebral palsy received implicit game-based biofeedback on electromyographic activity of the calf muscle (soleus or gastrocnemius medialis) while walking on a treadmill during one session. Biofeedback alternately aimed to reduce early stance activity, increase push-off activity, and both combined. Early stance and push-off activity and the double-bump-index (early stance divided by push-off activity) were determined during baseline and walking with feedback. Changes were assessed at group level using repeated measures ANOVA with simple contrast or Friedman test with post-hoc Wilcoxon signed rank test, as well as individually using independent t-tests or Wilcoxon rank sum tests. Perceived competence and interest-enjoyment were assessed through a questionnaire. RESULTS Children successfully decreased their electromyographic activity during early stance feedback trials (relative decrease of 6.8 ± 12.2 %, P = 0.025), with a trend during the combined feedback trials (6.5 ± 13.9 %, P = 0.055), and increased their electromyographic activity during push-off feedback trials (8.1 ± 15.8 %, P = 0.038). Individual improvements were seen in twelve of eighteen participants. All children experienced high levels of interest-enjoyment (8.4/10) and perceived competence (8.1/10). SIGNIFICANCE This exploratory study suggests that children with cerebral palsy can achieve small within-session improvements of their calf muscle activation pattern when provided with implicit biofeedback-driven gaming in an enjoyable manner. Follow-up gait training studies can incorporate this method to assess retention and long-term functional benefits of electromyographic biofeedback-driven gaming.
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Yokota C, Tanaka K, Omae K, Kamada M, Nishikawa H, Koga M, Ihara M, Fujimoto Y, Sankai Y, Nakajima T, Minami M. Effect of cyborg-type robot Hybrid Assistive Limb on patients with severe walking disability in acute stroke: A randomized controlled study. J Stroke Cerebrovasc Dis 2023; 32:107020. [PMID: 36701853 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/20/2022] [Accepted: 01/19/2023] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES To investigate whether early gait training using Hybrid Assistive Limb (HAL) is feasible and improves walking and independency compared with conventional physical therapy (CPT) in patients with severe walking disability after stroke. METHODS We conducted a single-center, randomized controlled study. Patients with first-ever stroke who had severe walking disability were included. All patients started gait training within 10 days post-stroke onset. Twenty-four patients were randomly assigned into HAL or CPT groups. Outcome measures were collected at three time points, at baseline, completion of 20 sessions of gait training (second assessment), and 3 months after the initiation of gait training. The primary outcomes were changes in motor sub-scores of the Functional Independence Measure or Functional Ambulation Category at the completion of the second assessment from baseline. RESULTS Twenty-two patients (median age, 68 years; 12 patients in the HAL group and 10 patients in the CPT group) completed the study. There were no significant differences in primary outcomes. Apathy scale, one of the secondary outcomes, showed a decreasing trend in the HAL group (mean change of -3.8, 95% CI -8.14 to 0.475), and a slight increasing trend in the CPT group (mean change of 1.2, 95% CI -2.66 to 5.06) at the second assessment. Patients in the HAL group experienced no adverse events. CONCLUSIONS Early gait training in patients with severe walking disability after stroke using HAL was feasible. Walking ability and independency were not improved at the completion of 20 sessions of gait training.
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Affiliation(s)
- Chiaki Yokota
- Department of Stroke Rehabilitation, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan.
| | - Kenta Tanaka
- Department of Data Science, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan
| | - Katsuhiro Omae
- Department of Data Science, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan
| | - Masatoshi Kamada
- Department of Stroke Rehabilitation, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan
| | - Hiroyasu Nishikawa
- Department of Stroke Rehabilitation, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan
| | - Yasuyuki Fujimoto
- Department of Stroke Rehabilitation, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan
| | - Yoshiyuki Sankai
- Center for Cybernics Research, University of Tsukuba, Tsukuba 305-8573, Japan, CYBERDYNE Inc
| | - Takashi Nakajima
- Niigata National Hospital, National Hospital Organization, 3-52 Akasaka, Kashiwazaki City 945-8585, Japan
| | - Manabu Minami
- Department of Data Science, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan
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Degami A, Taki S, Imura T, Iwamoto Y, Imada N, Tanaka R, Urakawa S, Inagawa T, Araki H, Araki O. Early Initiation of Exoskeletal Robotic Gait Training Improves Functional Outcomes in the Patients with Stroke: A Retrospective Observational Study. Eur Neurol 2023; 86:121-127. [PMID: 36516790 DOI: 10.1159/000527710] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 10/07/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The effect of early initiation of gait training using hybrid assistive limb (HAL) remains unclear. This observational study aimed to investigate whether early initiation of gait training using HAL improves functional outcomes in patients with stroke. METHODS We retrospectively analyzed patients with acute stroke admitted to our facility. HAL was used for exoskeletal robotic gait training. Study participants were median split into an early group and a late group based on the days from stroke onset to initiation of gait training using HAL. The functional outcomes, defined by the Brunnstrom recovery stage (BRS), modified Rankin Scale (mRS), and Functional Independence Measure (FIM) at discharge, were compared using propensity score-matched analysis. RESULTS We performed a propensity score-matched analysis in 63 patients with stroke (31 from the early group and 32 from the late group), and 17 pairs were matched. There were no significant differences in discharge in the BRS of the upper limb and finger in the post-matched cohort. On the other hand, the BRS of the lower limb in the early group was significantly higher than that in the late group. In addition, the mRS, but not FIM scores, was significantly better in the early group than that in the late group. CONCLUSIONS In conclusion, early initiation of gait training using HAL might improve the motor function of the paralyzed lower limb and disability in patients with stroke.
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Affiliation(s)
- Akira Degami
- Department of Rehabilitation, Araki Neurosurgical Hospital, Hiroshima, Japan
| | - Shingo Taki
- Department of Rehabilitation, Araki Neurosurgical Hospital, Hiroshima, Japan
- Graduate School of Humanities and Social Sciences, Hiroshima University, Hiroshima, Japan
| | - Takeshi Imura
- Graduate School of Humanities and Social Sciences, Hiroshima University, Hiroshima, Japan
- Department of Rehabilitation, Faculty of Health Sciences, Hiroshima Cosmopolitan University, Hiroshima, Japan
| | - Yuji Iwamoto
- Department of Rehabilitation, Araki Neurosurgical Hospital, Hiroshima, Japan
- Graduate School of Humanities and Social Sciences, Hiroshima University, Hiroshima, Japan
| | - Naoki Imada
- Department of Rehabilitation, Araki Neurosurgical Hospital, Hiroshima, Japan
| | - Ryo Tanaka
- Graduate School of Humanities and Social Sciences, Hiroshima University, Hiroshima, Japan
| | - Susumu Urakawa
- Department of Musculoskeletal Functional Research and Regeneration, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tetsuji Inagawa
- Department of Neurosurgery, Araki Neurosurgical Hospital, Hiroshima, Japan
| | - Hayato Araki
- Department of Neurosurgery, Araki Neurosurgical Hospital, Hiroshima, Japan
| | - Osamu Araki
- Department of Neurosurgery, Araki Neurosurgical Hospital, Hiroshima, Japan
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10
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Jayaraman C, Embry KR, Mummidisetty CK, Moon Y, Giffhorn M, Prokup S, Lim B, Lee J, Lee Y, Lee M, Jayaraman A. Modular hip exoskeleton improves walking function and reduces sedentary time in community-dwelling older adults. J Neuroeng Rehabil 2022; 19:144. [PMID: 36585676 PMCID: PMC9801566 DOI: 10.1186/s12984-022-01121-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 12/16/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Despite the benefits of physical activity for healthy physical and cognitive aging, 35% of adults over the age of 75 in the United States are inactive. Robotic exoskeleton-based exercise studies have shown benefits in improving walking function, but most are conducted in clinical settings with a neurologically impaired population. Emerging technology is starting to enable easy-to-use, lightweight, wearable robots, but their impact in the otherwise healthy older adult population remains mostly unknown. For the first time, this study investigates the feasibility and efficacy of using a lightweight, modular hip exoskeleton for in-community gait training in the older adult population to improve walking function. METHODS Twelve adults over the age of 65 were enrolled in a gait training intervention involving twelve 30-min sessions using the Gait Enhancing and Motivating System for Hip in their own senior living community. RESULTS Performance-based outcome measures suggest clinically significant improvements in balance, gait speed, and endurance following the exoskeleton training, and the device was safe and well tolerated. Gait speed below 1.0 m/s is an indicator of fall risk, and two out of the four participants below this threshold increased their self-selected gait speed over 1.0 m/s after intervention. Time spent in sedentary behavior also decreased significantly. CONCLUSIONS This intervention resulted in greater improvements in speed and endurance than traditional exercise programs, in significantly less time. Together, our results demonstrated that exoskeleton-based gait training is an effective intervention and novel approach to encouraging older adults to exercise and reduce sedentary time, while improving walking function. Future work will focus on whether the device can be used independently long-term by older adults as an everyday exercise and community-use personal mobility device. Trial registration This study was retrospectively registered with ClinicalTrials.gov (ID: NCT05197127).
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Affiliation(s)
- Chandrasekaran Jayaraman
- grid.280535.90000 0004 0388 0584Max Näder Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL USA
| | - Kyle R. Embry
- grid.280535.90000 0004 0388 0584Max Näder Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL USA ,grid.16753.360000 0001 2299 3507Departments of Physical Medicine and Rehabilitation, Medical Social Sciences and Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL USA
| | - Chaithanya K. Mummidisetty
- grid.280535.90000 0004 0388 0584Max Näder Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL USA
| | - Yaejin Moon
- grid.280535.90000 0004 0388 0584Max Näder Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL USA
| | - Matt Giffhorn
- grid.280535.90000 0004 0388 0584Max Näder Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL USA
| | - Sara Prokup
- grid.280535.90000 0004 0388 0584Max Näder Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL USA
| | | | - Jusuk Lee
- grid.266102.10000 0001 2297 6811Department of Radiology, University of California, San Francisco, USA
| | | | - Minhyung Lee
- grid.419666.a0000 0001 1945 5898Samsung Electronics Co, Suwon, South Korea
| | - Arun Jayaraman
- grid.280535.90000 0004 0388 0584Max Näder Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL USA ,grid.16753.360000 0001 2299 3507Departments of Physical Medicine and Rehabilitation, Medical Social Sciences and Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL USA
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11
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Saeedpour-Parizi MR, Date SS, Dominguez L, Baniasadi T, Shea JB. Simulated practice effects on the transfer and retention of gait sequences from the upper to the lower extremity. Exp Brain Res 2022; 240:2401-2411. [PMID: 35833953 DOI: 10.1007/s00221-022-06410-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/29/2022] [Indexed: 11/04/2022]
Abstract
This study investigated transfer of training from upper extremity limbs (the index fingers) to the lower extremity limbs (the legs) for performance of three gait sequences of different difficulty. Fifteen subjects participated in the study. Subjects in an iPad training group practiced by sequentially moving their left-and right-hand index fingers across tiles to each of three targets displayed on an iPad for 20 trials. Subjects in a gait training group practiced by sequentially walking across tiles to each of the 3 targets displayed on a screen for 20 trials. A no practice group did not receive practice trials. Immediately following practice of each level of difficulty, a transfer test (20 trials) was given for which subjects walked to the target just practiced. A retention test of 36 trials (12 trials at each difficulty level) was administered 20 min following performance of the last transfer test trial. The retention test showed that reaction times were shorter for the iPad training than gait training and no training groups; anticipatory postural adjustment times were equivalent for the iPad and gait training groups, but shorter than for the no training group; and movement times were shorter for the iPad training group than for the gait training and no training groups. These results suggest that iPad training (upper extremity) followed by performance of gait training (lower extremity) had greater benefits for learning (as measured by the delayed retention test) the gait sequences than practicing the actual gait sequences themselves.
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Affiliation(s)
- Mohammad R Saeedpour-Parizi
- Department of Kinesiology, School of Public Health, Indiana University Bloomington, 1025 E 7th Street, Bloomington, IN, 47405, USA. .,Department of Intelligent Systems Engineering, Luddy School of Informatics, Computing, and Engineering, Indiana University Bloomington, Bloomington, IN, USA.
| | - Surabhi Shripad Date
- Department of Kinesiology, School of Public Health, Indiana University Bloomington, 1025 E 7th Street, Bloomington, IN, 47405, USA
| | - Luis Dominguez
- Department of Kinesiology, School of Public Health, Indiana University Bloomington, 1025 E 7th Street, Bloomington, IN, 47405, USA
| | - Tayebeh Baniasadi
- Department of Kinesiology, School of Public Health, Indiana University Bloomington, 1025 E 7th Street, Bloomington, IN, 47405, USA
| | - John B Shea
- Department of Kinesiology, School of Public Health, Indiana University Bloomington, 1025 E 7th Street, Bloomington, IN, 47405, USA
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12
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Alam Z, Rendos NK, Vargas AM, Makanjuola J, Kesar TM. Timing of propulsion-related biomechanical variables is impaired in individuals with post-stroke hemiparesis. Gait Posture 2022; 96:275-278. [PMID: 35716486 DOI: 10.1016/j.gaitpost.2022.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 05/16/2022] [Accepted: 05/18/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND In individuals with post-stroke hemiparesis, reduced paretic leg propulsion, measured through anterior ground reaction forces (AGRF), is a common and functionally-relevant gait impairment. Deficits in other biomechanical variables such as plantarflexor moment, ankle power, and ankle excursion contribute to reduced propulsion. While reduction in the magnitude of propulsion post-stroke is well studied, here, our objective was to compare the timing of propulsion-related biomechanical variables. RESEARCH QUESTION Are there differences in the timing of propulsion and propulsion-related biomechanical variables between able-bodied individuals, the paretic leg, and non-paretic leg of post-stroke individuals? METHODS Nine able-bodied and 13 post-stroke individuals completed a gait analysis session comprising treadmill walking trials at each participant's self-selected speed. Two planned independent sample t-tests were conducted to detect differences in the timing of dependent variables between the paretic versus non-paretic leg post-stroke and paretic leg versus the dominant leg of able-bodied individuals. RESULTS Post-stroke individuals demonstrated significantly earlier timing of peak AGRF of their paretic leg versus their non-paretic leg and able-bodied individuals. Post-stroke participants displayed earlier timing of peak power of their paretic leg versus their non-paretic leg and able-bodied individuals, and earlier timing of peak ankle moment of the paretic leg versus able-bodied. No significant differences were detected in the timing of peak ankle angle. SIGNIFICANCE The earlier onset of peak AGRF, peak ankle power, and peak ankle moment may be an important, under-studied biomechanical factor underlying stroke gait impairments, and a potential therapeutic target for stroke gait retraining. Future investigations can explore the use of interventions such as gait biofeedback to normalize the timing of these peaks, thereby improving propulsion and walking function post-stroke.
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Affiliation(s)
- Zahin Alam
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, United States
| | - Nicole K Rendos
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, United States
| | - Alex M Vargas
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, United States
| | - Joseph Makanjuola
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, United States
| | - Trisha M Kesar
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, United States.
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13
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Fang Y, Orekhov G, Lerner ZF. Adaptive ankle exoskeleton gait training demonstrates acute neuromuscular and spatiotemporal benefits for individuals with cerebral palsy: A pilot study. Gait Posture 2022; 95:256-263. [PMID: 33248858 PMCID: PMC8110598 DOI: 10.1016/j.gaitpost.2020.11.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 10/05/2020] [Accepted: 11/04/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Gait abnormalities from neuromuscular conditions like cerebral palsy (CP) limit mobility and negatively affect quality of life. Increasing walking speed and stride length are essential clinical goals in the treatment of gait disorders from CP. RESEARCH QUESTION How does over-ground gait training with an untethered ankle exoskeleton providing adaptive assistance affect mobility-related spatiotemporal outcomes and lower-extremity muscle activity in people with CP? METHODS A diverse cohort of individuals with CP (n = 6, age 9-31, Gross Motor Function Classification System Level I - III) completed four over-ground training sessions (98 ± 17 min of assisted walking) and received pre- and post-training assessments. On both assessments, participants walked over-ground with and without the exoskeleton while we recorded spatiotemporal outcomes and muscle activity. We used two-tailed paired t-tests to compare all parameters pre- and post-training, and between assisted and unassisted conditions. RESULTS Following training, walking speed increased 0.24 m/s (p = 0.006) and stride length increased 0.17 m (p = 0.013) during unassisted walking, while walking speed increased 0.28 m/s (p = 0.023) and stride length increased 0.15 m (p = 0.002) during exoskeleton-assisted walking. Exoskeleton training improved stride-to-stride repeatability of soleus and vastus lateralis muscle activation by up to 51 % (p ≤ 0.046), while the amount of integrated stance-phase muscle activity was similar across visits and conditions. Relative to baseline, post-training walking with the exoskeleton resulted in a soleus activity pattern that was 39 % more similar to the typical pattern from unimpaired individuals (p < 0.001). SIGNIFICANCE This study demonstrates acute spatiotemporal and neuromuscular benefits from over-ground training with adaptive ankle exoskeleton assistance, and provides rationale for completion of a longer randomized controlled training protocol.
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Affiliation(s)
- Ying Fang
- Department of Mechanical Engineering, Northern Arizona University, Flagstaff, AZ 86011, USA
| | - Greg Orekhov
- Department of Mechanical Engineering, Northern Arizona University, Flagstaff, AZ 86011, USA
| | - Zachary F. Lerner
- Department of Mechanical Engineering, Northern Arizona University, Flagstaff, AZ 86011, USA,Department of Orthopedics, the University of Arizona College of Medicine-Phoenix, Phoenix, AZ 85004, USA
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Thimabut N, Yotnuengnit P, Charoenlimprasert J, Sillapachai T, Hirano S, Saitoh E, Piravej K. Effects of the robot-assisted gait training device plus physiotherapy in improving ambulatory functions in subacute stroke patients with hemiplegia: An assessor-blinded, randomized controlled trial. Arch Phys Med Rehabil 2022; 103:843-850. [PMID: 35143747 DOI: 10.1016/j.apmr.2022.01.146] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 01/05/2022] [Accepted: 01/08/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To investigate the effects of the robot-assisted gait training device (RAGTD) plus physiotherapy versus physiotherapy alone, in improving ambulatory functions in subacute stroke patients with hemiplegia. DESIGN A prospective, assessor-blinded, randomized controlled trial. SETTING Subacute stroke patients with hemiplegia admitted at the Rehabilitation Center. PARTICIPANTS Twenty-six subacute stroke patients with hemiplegia. INTERVENTION All patients received 30 training sessions (five days/week for six weeks) which included conventional physiotherapy training (60 min) and ambulation training (60 min). In the ambulation training session, the RAGTD group received robotic training (40 min) and ground ambulation training (20 min). The control group received only ground ambulation training (60 min). The outcomes were assessed at the initial session, the end of the 15th and the 30th sessions. Comparisons within group and between the groups were conducted. MAIN OUTCOME MEASURES Primary outcome variables were the Functional Independence Measure (FIM)-walk score and the efficacy of FIM-walk. RESULTS The RAGTD group showed greater improvements from baseline than control in: (1) the FIM-walk score, at the end of the 15th session (p = 0.012), (2) the efficacy of FIM-walk, at the end of the 15th session (p = 0.008), (3) walking distance in the 6-minute walk test (6MWT), at the end of the 15th session (p = 0.018), (4) the Barthel Index for Activities of Daily Living (ADL), at the end of the 30th session (p < 0.001), and (5) gait symmetry ratio, at the end of the 30th session (p = 0.044). Other gait parameters showed tendencies of improvement in the RAGTD group, but there were no significant differences. CONCLUSION RAGTD plus physiotherapy showed early improvements in walking ability and Barthel ADL index compared to the ground level training plus physiotherapy in subacute stroke patients with hemiplegia.
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Affiliation(s)
- Natapatchakrid Thimabut
- Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, THAILAND
| | - Pattarapol Yotnuengnit
- Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, THAILAND
| | | | | | - Satoshi Hirano
- Department of Rehabilitation Medicine Ι, School of Medicine, Fujita Health University, Japan
| | - Eiichi Saitoh
- Department of Rehabilitation Medicine Ι, School of Medicine, Fujita Health University, Japan
| | - Krisna Piravej
- Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, THAILAND.
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15
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Son C, Lee A, Lee J, Kim D, Kim SJ, Chun MH, Choi J. The effect of pelvic movements of a gait training system for stroke patients: a single blind, randomized, parallel study. J Neuroeng Rehabil 2021; 18:185. [PMID: 34961541 DOI: 10.1186/s12984-021-00964-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 11/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aging societies lead to higher demand for gait rehabilitation as age-related neurological disorders such as stroke and spinal cord injury increase. Since conventional methods for gait rehabilitation are physically and economically burdensome, robotic gait training systems have been studied and commercialized, many of which provided movements confined in the sagittal plane. For better outcomes of gait rehabilitation with more natural gait patterns, however, it is desirable to provide pelvic movements in the transverse plane. In this study, a robotic gait training system capable of pelvic motions in the transverse plane was used to evaluate the effect of the pelvic motions on stroke patients. METHOD Healbot T, which is a robotic gait training system and capable of providing pelvic movements in the transverse plane as well as flexion/extension of the hip and knee joints and adduction/abduction of the hip joints, is introduced and used to evaluate the effect of the pelvic movement on gait training of stroke patients. Gait trainings in Healbot T with and without pelvic movements are carried out with stroke patients having hemiparesis. EXPERIMENT Twenty-four stroke patients with hemiparesis were randomly assigned into two groups and 23 of them successfully completed the experiment except one subject who had dropped out due to personal reasons. Pelvis-on group was provided with pelvic motions whereas no pelvic movement was allowed for pelvis-off group during 10 sessions of gait trainings in Healbot T. Electromyography (EMG) signals and interaction forces as well as the joint angles of the robot were measured. Gait parameters such as stride length, cadence, and walking speed were measured while walking on the ground without assistance of Healbot T after gait training on 1st, 5th, and 10th day. RESULT Stride length significantly increased in both groups. Furthermore, cadence and walking speed of the pelvis-on group were increased by 10.6% and 11.8%. Although interaction forces of both groups except the thighs showed no differences, EMG signals from gluteus medius of the pelvis-on group increased by 88.6% during stance phase. In addition, EMG signals of biceps femoris, gastrocnemius medial, and gastrocnemius lateral of the pelvis-on group increased whereas EMG signals of the pelvis-off group except gastrocnemius lateral showed no difference after gait trainings. CONCLUSION Gait training using a robotic gait training system with pelvic movements was conducted to investigate the effects of lateral and rotational pelvic movements in gait training of stroke patients. The pelvic movements affected to increase voluntary muscle activation during the stance phase as well as cadence and walking speed. CLINICAL TRIAL REGISTRATION KCT0003762, 2018-1254, Registered 28 October 2018, https://cris.nih.go.kr/cris/search/search_result_st01_kren.jsp?seq=14310<ype=&rtype=.
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16
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Sanz-Morère CB, Martini E, Meoni B, Arnetoli G, Giffone A, Doronzio S, Fanciullacci C, Parri A, Conti R, Giovacchini F, Friðriksson Þ, Romo D, Crea S, Molino-Lova R, Vitiello N. Robot-mediated overground gait training for transfemoral amputees with a powered bilateral hip orthosis: a pilot study. J Neuroeng Rehabil 2021; 18:111. [PMID: 34217307 PMCID: PMC8254913 DOI: 10.1186/s12984-021-00902-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 06/23/2021] [Indexed: 02/06/2023] Open
Abstract
Background Transfemoral amputation is a serious intervention that alters the locomotion pattern, leading to secondary disorders and reduced quality of life. The outcomes of current gait rehabilitation for TFAs seem to be highly dependent on factors such as the duration and intensity of the treatment and the age or etiology of the patient. Although the use of robotic assistance for prosthetic gait rehabilitation has been limited, robotic technologies have demonstrated positive rehabilitative effects for other mobility disorders and may thus offer a promising solution for the restoration of healthy gait in TFAs. This study therefore explored the feasibility of using a bilateral powered hip orthosis (APO) to train the gait of community-ambulating TFAs and the effects on their walking abilities. Methods Seven participants (46–71 years old with different mobility levels) were included in the study and assigned to one of two groups (namely Symmetry and Speed groups) according to their prosthesis type, mobility level, and prior experience with the exoskeleton. Each participant engaged in a maximum of 12 sessions, divided into one Enrollment session, one Tuning session, two Assessment sessions (conducted before and after the training program), and eight Training sessions, each consisting of 20 minutes of robotically assisted overground walking combined with additional tasks. The two groups were assisted by different torque-phase profiles, aiming at improving symmetry for the Symmetry group and at maximizing the net power transferred by the APO for the Speed group. During the Assessment sessions, participants performed two 6-min walking tests (6mWTs), one with (Exo) and one without (NoExo) the exoskeleton, at either maximal (Symmetry group) or self-selected (Speed group) speed. Spatio-temporal gait parameters were recorded by commercial measurement equipment as well as by the APO sensors, and metabolic efficiency was estimated via the Cost of Transport (CoT). Additionally, kinetic and kinematic data were recorded before and after treatment in the NoExo condition.
Results The one-month training protocol was found to be a feasible strategy to train TFAs, as all participants smoothly completed the clinical protocol with no relevant mechanical failures of the APO. The walking performance of participants improved after the training. During the 6mWT in NoExo, participants in the Symmetry and Speed groups respectively walked 17.4% and 11.7% farther and increased walking speed by 13.7% and 17.9%, with improved temporal and spatial symmetry for the former group and decreased energetic expenditure for the latter. Gait analysis showed that ankle power, step width, and hip kinematics were modified towards healthy reference levels in both groups. In the Exo condition metabolic efficiency was reduced by 3% for the Symmetry group and more than 20% for the Speed group. Conclusions This study presents the first pilot study to apply a wearable robotic orthosis (APO) to assist TFAs in an overground gait rehabilitation program. The proposed APO-assisted training program was demonstrated as a feasible strategy to train TFAs in a rehabilitation setting. Subjects improved their walking abilities, although further studies are required to evaluate the effectiveness of the APO compared to other gait interventions. Future protocols will include a lighter version of the APO along with optimized assistive strategies.
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Affiliation(s)
| | - Elena Martini
- The BioRobotics Institute, Scuola Superiore Sant'Anna, 56025, Pontedera, Pisa, Italy
| | - Barbara Meoni
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143, Florence, Italy
| | | | | | - Stefano Doronzio
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143, Florence, Italy
| | | | - Andrea Parri
- IUVO S.R.L, Via Puglie, 9, 56025, Pontedera, Pisa, Italy
| | - Roberto Conti
- IUVO S.R.L, Via Puglie, 9, 56025, Pontedera, Pisa, Italy
| | | | | | - Duane Romo
- Össur, Grjótháls 5, 110, Reykjavík, Iceland
| | - Simona Crea
- The BioRobotics Institute, Scuola Superiore Sant'Anna, 56025, Pontedera, Pisa, Italy.,IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143, Florence, Italy.,Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, 56127, Pisa, Italy
| | | | - Nicola Vitiello
- The BioRobotics Institute, Scuola Superiore Sant'Anna, 56025, Pontedera, Pisa, Italy.,IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143, Florence, Italy.,Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, 56127, Pisa, Italy
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17
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Maranesi E, Bevilacqua R, Di Rosa M, Pelliccioni G, Di Donna V, Luzi R, Morettini M, Sbrollini A, Casoni E, Rinaldi N, Baldoni R, Lattanzio F, Burattini L, Riccardi GR. An innovative training based on robotics for older people with subacute stroke: study protocol for a randomized controlled trial. Trials 2021; 22:400. [PMID: 34127032 PMCID: PMC8204575 DOI: 10.1186/s13063-021-05357-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 06/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stroke is a leading cause of disability, injury, and death in elderly people and represents a major public health problem with substantial medical and economic consequences. The incidence of stroke rapidly increases with age, doubling for each decade after age 55 years. Gait impairment is one of the most important problems after stroke, and improving walking function is often a key component of any rehabilitation program. To achieve this goal, a robotic gait trainer seems to be promising. In fact, some studies underline the efficacy of robotic gait training based on end-effector technology, for different diseases, in particular in stroke patients. In this randomized controlled trial, we verify the efficacy of the robotic treatment in terms of improving the gait and reducing the risk of falling and its long-term effects. METHODS In this single-blind randomized controlled trial, we will include 152 elderly subacute stroke patients divided in two groups to receive a traditional rehabilitation program or a robotic rehabilitation using G-EO system, an end-effector device for the gait rehabilitation, in addition to the traditional therapy. Twenty treatment sessions will be conducted, divided into 3 training sessions per week, for 7 weeks. The control group will perform traditional therapy sessions lasting 50 min. The technological intervention group, using the G-EO system, will carry out 30 min of traditional therapy and 20 min of treatment with a robotic system. The primary outcome of the study is the evaluation of the falling risk. Secondary outcomes are the assessment of the gait improvements and the fear of falling. Further evaluations, such as length and asymmetry of the step, walking and functional status, and acceptance of the technology, will be carried. DISCUSSION The final goal of the present study is to propose a new approach and an innovative therapeutic plan in the post-stroke rehabilitation, focused on the use of a robotic device, in order to obtain the beneficial effects of this treatment. TRIAL REGISTRATION ClinicalTrials.gov NCT04087083 . Registered on September 12, 2019.
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Affiliation(s)
- Elvira Maranesi
- Clinical Unit of Physical Rehabilitation, IRCCS INRCA, Ancona, Italy. .,Scientific Direction, IRCCS INRCA, Ancona, Italy.
| | | | - Mirko Di Rosa
- Unit of Geriatric Pharmacoepidemiology, IRCCS INRCA, Ancona, Italy
| | | | | | | | - Micaela Morettini
- Cardiovascular Bioengineering Lab, Department of Information Engineering, Università Politecnica delle Marche, Ancona, Italy
| | - Agnese Sbrollini
- Cardiovascular Bioengineering Lab, Department of Information Engineering, Università Politecnica delle Marche, Ancona, Italy
| | - Elisa Casoni
- Clinical Unit of Physical Rehabilitation, IRCCS INRCA, Ancona, Italy
| | - Nadia Rinaldi
- Clinical Unit of Physical Rehabilitation, IRCCS INRCA, Fermo, Italy
| | - Renato Baldoni
- Clinical Unit of Physical Rehabilitation, IRCCS INRCA, Ancona, Italy
| | | | - Laura Burattini
- Cardiovascular Bioengineering Lab, Department of Information Engineering, Università Politecnica delle Marche, Ancona, Italy
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Liu J, Kim HB, Wolf SL, Kesar TM. Comparison of the Immediate Effects of Audio, Visual, or Audiovisual Gait Biofeedback on Propulsive Force Generation in Able-Bodied and Post-stroke Individuals. Appl Psychophysiol Biofeedback 2021; 45:211-220. [PMID: 32347399 DOI: 10.1007/s10484-020-09464-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Real-time biofeedback is a promising post-stroke gait rehabilitation strategy that can target specific gait deficits preferentially in the paretic leg. Our previous work demonstrated that the use of an audiovisual biofeedback interface designed to increase paretic leg propulsion, measured via anterior ground reaction force (AGRF) generation during late stance phase of gait, can induce improvements in peak AGRF production of the targeted and paretic limb of able-bodied and post-stroke individuals, respectively. However, whether different modes of biofeedback, such as visual, auditory, or a combination of both, have differential effects on AGRF generation is unknown. The present study investigated the effects of audio only, visual only, or audiovisual AGRF biofeedback in able-bodied and post-stroke individuals. Seven able-bodied (6 females, 27 ± 2 years) and nine post-stroke individuals (6 females, 54 ± 12 years, 42 ± 26 months post-stroke) completed four 30-s walking trials on a treadmill under 4 conditions: no biofeedback, audio biofeedback, visual biofeedback, or audiovisual biofeedback. Compared to walking without biofeedback, all three biofeedback modes significantly increased peak AGRF in the targeted and paretic leg. There was no significant difference in peak AGRF between the three biofeedback modes. Able-bodied individuals demonstrated greater feedback-induced increase in stride-to-stride variation of AGRF generation during audio biofeedback compared to visual biofeedback; however, similar results were not observed in the post-stroke group. The present findings may inform future development of real-time gait biofeedback interfaces for use in clinical or community environments.
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Affiliation(s)
- Justin Liu
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, 1441 Clifton Rd NE, Atlanta, GA, 30322, USA
| | - Hyun Bin Kim
- Emory College of Arts & Sciences, Emory University, Atlanta, GA, USA
| | - Steven L Wolf
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, 1441 Clifton Rd NE, Atlanta, GA, 30322, USA.,Center for Visual and Neurocognitive Rehabilitation, Atlanta Veterans Affair Health Care System, Decatur, GA, USA
| | - Trisha M Kesar
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, 1441 Clifton Rd NE, Atlanta, GA, 30322, USA.
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Miura K, Tsuda E, Kogawa M, Ishiyama H, Maeda K, Kuzuhara K, Ito I, Masuno N, Urita K, Saito Y, Yokoyama H, Henmi R, Ishibashi Y. Effects of gait training with a voluntary-driven wearable cyborg, Hybrid Assistive Limb (HAL), on quality of life in patients with neuromuscular disease, able to walk independently with aids. J Clin Neurosci 2021; 89:211-215. [PMID: 34119269 DOI: 10.1016/j.jocn.2021.04.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/11/2021] [Accepted: 04/27/2021] [Indexed: 11/15/2022]
Abstract
Robot-assisted gait training using a voluntary-driven wearable cyborg, Hybrid Assistive Limb (HAL), has been shown to improve the mobility of patients with neurological disorders; however, its effect on the quality of life (QOL) of patients is not clear. The aim of this study was to assess the effects of HAL-assisted gait training on QOL and mobility in patients with neuromuscular diseases (NMDs). Ten patients with NMDs (seven men and three women, mean age: 57 ± 11 years), with impairment in mobility but could walk alone with aids underwent two courses of gait training with HAL over 6 months, and the single course consisted of nine sessions of training for 4 weeks. We compared the findings of the 2 min walk test, 10 m walk test, the Short Form-36 (SF-36) questionnaire, and the Hospital Anxiety and Depression Scale at baseline, after the 1st training, before the 2nd training, and after the 2nd training using the Friedman test. A significant improvement was observed in the 2 min walking distance from baseline (93 ± 50 m) to after the 2nd training (115 ± 48 m, P = 0.034), as well as in the domains of vitality (P = 0.019) and mental component summary score (P = 0.019) of SF-36. The improvement in 10 m walking speed was significantly correlated with that in the physical functioning (R = 0.831, P = 0.003) and role physical (R = 0.697, P = 0.025) domains in the SF-36. Our findings suggest that HAL-assisted gait training is effective in improving QOL associated with mental health as well as gait ability in selected patients with NMDs.
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Affiliation(s)
- Kazutomo Miura
- Department of Rehabilitation Medicine, Hirosaki University, Graduate School of Medicine, Japan.
| | - Eiichi Tsuda
- Department of Rehabilitation Medicine, Hirosaki University, Graduate School of Medicine, Japan
| | - Masakazu Kogawa
- Department of Rehabilitation Medicine, Hirosaki University, Graduate School of Medicine, Japan
| | - Hiroaki Ishiyama
- Department of Rehabilitation Medicine, Hirosaki University, Graduate School of Medicine, Japan
| | - Kazushi Maeda
- Department of Rehabilitation Medicine, Hirosaki University, Graduate School of Medicine, Japan
| | - Kosuke Kuzuhara
- Department of Rehabilitation Medicine, Hirosaki University, Graduate School of Medicine, Japan
| | - Ikue Ito
- Department of Rehabilitation Medicine, Hirosaki University, Graduate School of Medicine, Japan
| | - Natsuka Masuno
- Department of Rehabilitation Medicine, Hirosaki University, Graduate School of Medicine, Japan
| | - Kazutaka Urita
- Department of Rehabilitation Medicine, Hirosaki University, Graduate School of Medicine, Japan
| | - Yuki Saito
- Department of Rehabilitation Medicine, Hirosaki University, Graduate School of Medicine, Japan
| | - Hiroko Yokoyama
- Department of Rehabilitation Medicine, Hirosaki University, Graduate School of Medicine, Japan
| | - Rui Henmi
- Department of Rehabilitation Medicine, Hirosaki University, Graduate School of Medicine, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University, Graduate School of Medicine, Japan
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Oh K, Park J, Jo SH, Hong SJ, Kim WS, Paik NJ, Park HS. Improved cortical activity and reduced gait asymmetry during poststroke self-paced walking rehabilitation. J Neuroeng Rehabil 2021; 18:60. [PMID: 33849557 PMCID: PMC8042685 DOI: 10.1186/s12984-021-00859-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/24/2021] [Indexed: 11/30/2022] Open
Abstract
Background For patients with gait impairment due to neurological disorders, body weight-supported treadmill training (BWSTT) has been widely used for gait rehabilitation. On a conventional (passive) treadmill that runs at a constant speed, however, the level of patient engagement and cortical activity decreased compared with gait training on the ground. To increase the level of cognitive engagement and brain activity during gait rehabilitation, a self-paced (active) treadmill is introduced to allow patients to actively control walking speed, as with overground walking. Methods To validate the effects of self-paced treadmill walking on cortical activities, this paper presents a clinical test with stroke survivors. We hypothesized that cortical activities on the affected side of the brain would also increase during active walking because patients have to match the target walking speed with the affected lower limbs. Thus, asymmetric gait patterns such as limping or hobbling might also decrease during active walking. Results Although the clinical test was conducted in a short period, the patients showed higher cognitive engagement, improved brain activities assessed by electroencephalography (EEG), and decreased gait asymmetry with the self-paced treadmill. As expected, increases in the spectral power of the low γ and β bands in the prefrontal cortex (PFC), premotor cortex (PMC), and supramarginal gyrus (SG) were found, which are possibly related to processing sensory data and planning voluntary movements. In addition, these changes in cortical activities were also found with the affected lower limbs during the swing phase. Since our treadmill controller tracked the swing speed of the leg to control walking speed, such results imply that subjects made substantial effort to control their affected legs in the swing phase to match the target walking speed. Conclusions The patients also showed reduced gait asymmetry patterns. Based on the results, the self-paced gait training system has the potential to train the symmetric gait and to promote the related cortical activities after stroke. Trial registration Not applicable
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Affiliation(s)
- Keonyoung Oh
- Arms & Hands Lab, Shirley Ryan AbilityLab, Chicago, IL, USA.,Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology (KAIST), 291 Daehak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea
| | - Jihong Park
- Department of Rehabilitation, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Seong Hyeon Jo
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology (KAIST), 291 Daehak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea
| | - Seong-Jin Hong
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology (KAIST), 291 Daehak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea
| | - Won-Seok Kim
- Department of Rehabilitation, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Nam-Jong Paik
- Department of Rehabilitation, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea.
| | - Hyung-Soon Park
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology (KAIST), 291 Daehak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea.
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Nishikawa Y, Watanabe K, Orita N, Maeda N, Kimura H, Tanaka S, Hyngstrom A. Influence of hybrid assistive limb gait training on spatial muscle activation patterns in spinal muscular atrophy type III. F1000Res 2021; 10:214. [PMID: 34249338 PMCID: PMC8258705 DOI: 10.12688/f1000research.50951.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Despite the potential benefits, the effects of Hybrid Assistive Limb (HAL) gait training on changes in neuromuscular activation that accompany functional gains in individuals with spinal muscular atrophy (SMA) type III is not well known. In this article, we quantify the effects of HAL gait training on spatial muscle activity patterns in a patient with SMA type III using multi-channel surface electromyography (SEMG). Methods: A 21-years old male (168 cm, 47.8 kg) with spinal muscular atrophy type III, when diagnosed at 18-years old by genetic screening, participated in this case study. Although he presented with forearm distal muscle weakness, atrophy of the intrinsic muscles of the hand, and neuromuscular fatigue, his activities of daily living is independent. The patient underwent a separate, single 33-minute session of both HAL and treadmill gait training. To evaluate the coefficient of variation (CoV) of force and alterations in the SEMG spatial distribution patterns, modified entropy and CoV of root mean square (RMS) were calculated from the vastus lateralis (VL) muscle before and after the intervention of HAL and treadmill gait training. Each training session was separated by a period of one month to avoid cross-over effects. Results: There was a greater decrease in the ΔCoV of force and an increase in the magnitude of whole VL muscle activation from pre-intervention to post-intervention with the HAL gait training as compared to the treadmill gait training. In response to only HAL gait training, the CoV of RMS was higher, and the modified entropy was lower post-intervention than pre-intervention. Conclusions: Our results support the notion that HAL gait training has a positive benefit on motor output not only in the magnitude of SEMG generated but also the patterns of neural activation.
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Affiliation(s)
- Yuichi Nishikawa
- Faculty of Frontier Engineering, Institute of Science and Engineering, Kanazawa University, Kanazawa, Ishikawa, 920-1192, Japan
| | - Kohei Watanabe
- Laboratory of Neuromuscular Biomechanics, School of Health and Sports Sciences, Chukyo University, Nagoya, Aichi, 470-0393, Japan
| | - Naoya Orita
- Division of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University Hospital, Hiroshima, Hiroshima, 734-8551, Japan
| | - Noriaki Maeda
- Division of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Hiroshima, 734-8551, Japan
| | - Hiroaki Kimura
- Department of Rehabilitation Medicine, Hiroshima University Hospital, Hiroshima, Hiroshima, 734-8551, Japan
| | - Shinobu Tanaka
- Faculty of Frontier Engineering, Institute of Science and Engineering, Kanazawa University, Kanazawa, Ishikawa, 920-1192, Japan
| | - Allison Hyngstrom
- Department of Physical Therapy, Marquette University, Milwaukee, Wisconsin, 53233, USA
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22
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Hwang YI, Park DJ. Effects of elastic neutral ankle-foot orthoses on 3 dimensional parameters during gait training in patients with stroke: A pilot study. J Bodyw Mov Ther 2021; 27:300-306. [PMID: 34391249 DOI: 10.1016/j.jbmt.2021.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 01/28/2021] [Accepted: 02/28/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND General ankle-foot orthosis (AFO) cannot be flexibly adjusted to volumetric change in the lower leg because the molding is custom-fit. Thus, we developed a flexible assistive device called elastic neutral AFO (EN-AFO) to help stroke patients hold a neutral ankle position. The purpose of this study was to investigate the effects of EN-AFO and improve gait patterns in stroke patients with rearfoot varus deformity. METHODS Fifteen stroke patients with a varus deformity of the foot performed a walking test with and without the use of EN-AFO. Kinematic data were measured with a 3D motion analysis system with inertial measurement unit (IMU) sensors. RESULTS In the stance phase, maximal pelvic tilt and maximal ankle dorsiflexion in the affected side changed, and maximal and minimal pelvic tilts and maximal hip abduction in the less-affected limb effectively changed, as well. During the swing phase, minimal pelvic tilt and minimal ankle abduction in the affective limb greatly changed; particularly, the reduction of maximal ankle inversion was significantly cleared. CONCLUSIONS The EN-AFO was effective in controlling the tendency of foot inversion in patients with varus deformities. This is suitable for gait training, as it can adjust the orthosis stiffness according to the foot condition.
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Affiliation(s)
- Young-In Hwang
- Department of Physical Therapy, College of Life and Health Science, Hoseo University, Republic of Korea
| | - Du-Jin Park
- Department of Physical Therapy, College of Health Sciences, Catholic University of Pusan, Republic of Korea.
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23
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Bensoussan C, Champclou A, Galarraga O, Letellier G, Rahmani A, Riochet D, De-Sèze M. Assessing the contribution of lower limb mobilization, in the supine position, on shoulder-pelvis girdles dissociation. Gait Posture 2021; 85:224-231. [PMID: 33618166 DOI: 10.1016/j.gaitpost.2020.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 11/18/2020] [Accepted: 12/09/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Several articular, muscular and neurological diseases generate mobility loss in the shoulder and pelvis girdles. Joint mobilization contributes to improving shoulder-pelvis girdles dissociation, but current mobilization techniques are not always successful and standardized. A robotic medical device, DPA Med®, by inducing trunk mobilization through lower limb oscillation has been developed for producing such a shoulder-pelvis girdles dissociation and is already used worldwide in rehabilitation hospitals. RESEARCH QUESTION To determine the optimal lower limb oscillation frequency that generated the best shoulder-pelvis girdles dissociation using the DPA Med® device. METHODS Thirty healthy adult volunteers (mean age: 38.6 [SD 15.2] years, mean height: 174 [SD 11.9] cm, mean body mass: 70.3 [SD 14.7] kg) participated in this prospective study. A kinematic analysis quantified pelvic and shoulder girdle mobility (rotation and lateral tilt) at different DPA Med® frequencies, from 0.5 Hz to 1 Hz. A visual analysis of the lower limb movement was also performed, using video sensors, to better understand the kinematics involved. RESULTS All DPA Med® frequencies have shown significant shoulder-pelvis girdles dissociation (p < 0.05). This study established an optimal oscillation frequency with the minimal interindividual variability at 0.808 Hz. It induced pelvic mobility similar to that of normal gait, in the transverse and frontal planes (10.3°, SD 2.9°, and 12.0°, SD 2.2°, respectively). This trunk mobility was achieved by producing a lemniscate-shaped motion in the lower limbs (an eight-shaped motion in the transverse plane). SIGNIFICANCE This study has shown that the DPA Med® device is able to induce shoulder-pelvis girdles dissociation similar to that of normal gait and allowed to establish the existence of an optimal DPA Med® oscillation frequency for lower limb mobility at 0.808 Hz. Further studies are required to evaluate its potentially benefits on gait disorders.
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Affiliation(s)
| | | | - Omar Galarraga
- Movement Analysis Laboratory, Rehabilitation Center of Coubert, France
| | - Guy Letellier
- Pediatric Rehabilitation Center (ESEAN-APF), Nantes, France
| | | | - David Riochet
- Pediatric Rehabilitation Center (ESEAN-APF), Nantes, France; Movement Analysis Laboratory, Le Mans University, France; Nantes University Hospital, France
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Yeung LF, Lau CCY, Lai CWK, Soo YOY, Chan ML, Tong RKY. Effects of wearable ankle robotics for stair and over-ground training on sub-acute stroke: a randomized controlled trial. J Neuroeng Rehabil 2021; 18:19. [PMID: 33514393 PMCID: PMC7847008 DOI: 10.1186/s12984-021-00814-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 01/12/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Wearable ankle robotics could potentially facilitate intensive repetitive task-specific gait training on stair environment for stroke rehabilitation. A lightweight (0.5 kg) and portable exoskeleton ankle robot was designed to facilitate over-ground and stair training either providing active assistance to move paretic ankle augmenting residual motor function (power-assisted ankle robot, PAAR), or passively support dropped foot by lock/release ankle joint for foot clearance in swing phase (swing-controlled ankle robot, SCAR). In this two-center randomized controlled trial, we hypothesized that conventional training integrated with robot-assisted gait training using either PAAR or SCAR in stair environment are more effective to enhance gait recovery and promote independency in early stroke, than conventional training alone. METHODS Sub-acute stroke survivors (within 2 months after stroke onset) received conventional training integrated with 20-session robot-assisted training (at least twice weekly, 30-min per session) on over-ground and stair environments, wearing PAAR (n = 14) or SCAR (n = 16), as compared to control group receiving conventional training only (CT, n = 17). Clinical assessments were performed before and after the 20-session intervention, including functional ambulatory category as primary outcome measure, along with Berg balance scale and timed 10-m walk test. RESULTS After the 20-session interventions, all three groups showed statistically significant and clinically meaningful within-group functional improvement in all outcome measures (p < 0.005). Between-group comparison showed SCAR had greater improvement in functional ambulatory category (mean difference + 0.6, medium effect size 0.610) with more than 56% independent walkers after training, as compared to only 29% for CT. Analysis of covariance results showed PAAR had greater improvement in walking speed than SCAR (mean difference + 0.15 m/s, large effect size 0.752), which was in line with the higher cadence and speed when wearing the robot during the 20-session robot-assisted training over-ground and on stairs. CONCLUSIONS Robot-assisted stair training would lead to greater functional improvement in gait independency and walking speed than conventional training in usual care. The active powered ankle assistance might facilitate users to walk more and faster with their paretic leg during stair and over-ground walking. TRIAL REGISTRATION ClinicalTrials.gov NCT03184259. Registered on 12 June 2017.
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Affiliation(s)
- Ling-Fung Yeung
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Cathy C Y Lau
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Charles W K Lai
- Physiotherapy Department, Shatin Hospital, Ma On Shan, Hong Kong
| | - Yannie O Y Soo
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, Hong Kong
| | - Man-Lok Chan
- Physiotherapy Department, Tung Wah Hospital, Sheung Wan, Hong Kong
| | - Raymond K Y Tong
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Shatin, Hong Kong.
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Liu J, Santucci V, Eicholtz S, Kesar T. Comparison of the effects of real-time propulsive force versus limb angle gait biofeedback on gait biomechanics. Gait Posture 2021; 83:107-113. [PMID: 33129170 PMCID: PMC7787119 DOI: 10.1016/j.gaitpost.2020.10.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/13/2020] [Accepted: 10/12/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Reduced forward propulsion during gait, measured as the anterior component of the ground reaction force (AGRF), may contribute to slower walking speeds in older adults and gait dysfunction in individuals with neurological impairments. Trailing limb angle (TLA) is a clinically important gait parameter that is associated with AGRF generation. Real-time gait biofeedback can induce modifications in targeted gait parameters, with potential to modulate AGRF and TLA. However, the effects of real-time TLA biofeedback on gait biomechanics have not been studied thus far. RESEARCH QUESTION What are the effects of unilateral, real-time, audiovisual trailing limb angle biofeedback on gait biomechanics in able-bodied individuals? METHODS Ten able-bodied adults participated in one session of treadmill-based gait analyses comprising 60-second walking trials under three conditions: no biofeedback, AGRF biofeedback, and TLA biofeedback. Biofeedback was provided unilaterally to the right leg. Dependent variables included AGRF, TLA, ankle moment, and ankle power. One-way repeated measures ANOVA with post-hoc tests were conducted to determine the effect of the biofeedback conditions on gait parameters. RESULTS Compared to no biofeedback, both AGRF and TLA biofeedback induced significant increases in targeted leg AGRF without concomitant changes to the non-targeted leg AGRF. Targeted leg TLA was significantly larger during TLA biofeedback compared to AGRF biofeedback. Only AGRF biofeedback induced significant increases in ankle power; and only the TLA biofeedback condition induced increases in the non-targeted leg TLA. SIGNIFICANCE Our novel findings provide support for the feasibility and promise of TLA as a gait biofeedback target. Our study demonstrates that comparable magnitudes of feedback-induced increases in AGRF in response to AGRF and TLA biofeedback may be achieved through divergent biomechanical strategies. Further investigation is needed to uncover the effects of TLA biofeedback on gait parameters in individuals with neuro-pathologies such as spinal cord injury or stroke.
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Affiliation(s)
- Justin Liu
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, 1441 Clifton Rd NE, Atlanta, GA, 30322, USA
| | - Vincent Santucci
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, 1441 Clifton Rd NE, Atlanta, GA, 30322, USA
| | - Steven Eicholtz
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, 1441 Clifton Rd NE, Atlanta, GA, 30322, USA
| | - Trisha Kesar
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, 1441 Clifton Rd NE, Atlanta, GA, 30322, USA
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Ii T, Hirano S, Tanabe S, Saitoh E, Yamada J, Mukaino M, Watanabe M, Sonoda S, Otaka Y. Robot-assisted Gait Training Using Welwalk in Hemiparetic Stroke Patients: An Effectiveness Study with Matched Control. J Stroke Cerebrovasc Dis 2020; 29:105377. [PMID: 33091753 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105377] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/27/2020] [Accepted: 09/30/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Although studies on the efficacy of the rehabilitation robot are increasing, there are few reports using the robot for gait training in the actual clinical setting. This study aimed to investigate the effectiveness of gait training using Welwalk in hemiparetic stroke patients in a real clinical setting. MATERIALS AND METHODS This prospective study included 36 hemiparetic stroke patients who underwent gait training using Welwalk. We examined the walking ability improvement efficiency using Functional Independence Measure (FIM)-walk as the primary outcome, which was compared with that of 36 patients (matched control group) who underwent conventional rehabilitation. Other outcomes were the actual gait training period using Welwalk, raw FIM-walk score, lower extremity motor functions score in Stroke Impairment Assessment Set at discharge, and duration from stroke onset until discharge. RESULTS The improvement efficiency of the FIM-walk was significantly higher in the Welwalk group than in the matched control group (control 0.48 ± 0.31, Welwalk 0.80 ± 0.38, p-value < 0.001). The mean gait training period using Welwalk was 5 weeks. No significant differences were found in other outcomes between the Welwalk group and the matched control group. CONCLUSION This study demonstrated the effectiveness of gait training using Welwalk on the improvement efficiency of the FIM-walk in hemiparetic stroke patients in an actual clinical setting.
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Munsch AE, Pietrosimone B, Franz JR. The effects of knee extensor moment biofeedback on gait biomechanics and quadriceps contractile behavior. PeerJ 2020; 8:e9509. [PMID: 32714665 PMCID: PMC7353917 DOI: 10.7717/peerj.9509] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 06/18/2020] [Indexed: 12/20/2022] Open
Abstract
Individuals with knee joint pathologies exhibit quadriceps dysfunction that, during walking, manifests as smaller peak knee extensor moment (pKEM) and reduced knee flexion excursion. These changes persist despite muscle strengthening and may alter stance phase knee joint loading considered relevant to osteoarthritis risk. Novel rehabilitation strategies that more directly augment quadriceps mechanical output during functional movements are needed to reduce this risk. As an important first step, we tested the efficacy of real-time biofeedback during walking to prescribe changes of ±20% and ±40% of normal walking pKEM values in 11 uninjured young adults. We simultaneously recorded knee joint kinematics, ground reaction forces, and, via ultrasound, vastus lateralis (VL) fascicle length change behavior. Participants successfully responded to real-time biofeedback and averaged up to 55% larger and 51% smaller than normal pKEM values with concomitant and potentially favorable changes in knee flexion excursion. While the VL muscle-tendon unit (MTU) lengthened, VL fascicles accommodated weight acceptance during walking largely through isometric, or even slight concentric, rather than eccentric action as is commonly presumed. Targeted pKEM biofeedback may be a useful rehabilitative and/or scientific tool to elicit desirable changes in knee joint biomechanics considered relevant to the development of osteoarthritis.
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Affiliation(s)
- Amanda E Munsch
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, United States of America
| | - Brian Pietrosimone
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Jason R Franz
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, United States of America
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Kline PW, Murray AM, Miller MJ, So N, Fields T, Christiansen CL. Step length symmetry adaptation to split-belt treadmill walking after acquired non-traumatic transtibial amputation. Gait Posture 2020; 80:162-7. [PMID: 32516682 DOI: 10.1016/j.gaitpost.2020.05.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 05/04/2020] [Accepted: 05/28/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Between-limb step length asymmetry is common following transtibial amputation (TTA) and contributes to negative health consequences. There are limited evidence-based interventions targeting reduced gait asymmetry for people with TTA. Split-belt treadmill walking with asymmetrical belt speeds has successfully reduced gait asymmetry in other patient populations. However, individuals with non-traumatic TTA have critical health-related impairments that may influence the ability to respond to split-belt treadmill walking. RESEARCH QUESTION Do people with acquired, non-traumatic TTA adapt and retain a more symmetrical gait pattern in response to split-belt treadmill walking? METHODS Step length asymmetry was measured during split-belt treadmill walking. Eight participants walked under two alternating belt speed conditions: symmetrical (3 sets; Baseline, TIED1, TIED2) and asymmetrical belt speeds (5 sets; SPLIT1-5). One-way repeated-measures ANOVA with post-hoc Tukey's HSD tests were used to assess adaptation and short-term retention of step length symmetry. Adaptation was assessed as the level of asymmetry during TIED walking following repeated exposure to SPLIT walking. Retention was measured as the change in level of asymmetry during each set of SPLIT walking. RESULTS Significant adaptation to split-belt walking was observed from late Baseline to early TIED1 and early TIED2. Between-limb step length asymmetry decreased from late Baseline (5.3 ± 3.4) to early TIED1 (-9.4 ± 3.6) and this change was sustained between early TIED1 and early TIED2 (-11.2 ± 3.1) (ANOVA F = 73.043, p < .001). Adaptations were retained as step length asymmetry decreased from early SPLIT1 (48.5 ± 5.3) to early SPLIT3 (31.4 ± 3.5) to early SPLIT5 (23.9 ± 5.1) (ANOVA F = 35.284, p < .001). SIGNIFICANCE Individuals with non-traumatic TTA are capable of gait adaptation to split-belt walking and short-term retention of adaptations after removal of the asymmetrical belt speeds. Adaptability of step length symmetry is possible without modification to the prosthetic limb. Split-belt walking should be tested as a potential intervention to help people with acquired, non-traumatic TTA increase between-limb step symmetry.
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Bevilacqua R, Maranesi E, Di Rosa M, Luzi R, Casoni E, Rinaldi N, Baldoni R, Lattanzio F, Di Donna V, Pelliccioni G, Riccardi GR. Rehabilitation of older people with Parkinson's disease: an innovative protocol for RCT study to evaluate the potential of robotic-based technologies. BMC Neurol 2020; 20:186. [PMID: 32404132 PMCID: PMC7222584 DOI: 10.1186/s12883-020-01759-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 05/03/2020] [Indexed: 11/12/2022] Open
Abstract
Background Parkinson’s disease is one of the most frequent causes of disability among the older adults. It is a chronic-progressive neuro-degenerative disease, characterized by several motor disorders. Balance disorders are a symptom that involves the body axis and do not respond to dopaminergic therapy used in Parkinson’s disease. Therefore, physiotherapy becomes an important intervention for the management of motor disorders. Originally, these rehabilitative approaches were based on empirical experiences, but several scientific evidences suggests that neuronal plasticity is exercise-dependent. In this context, robotic rehabilitation plays an important role because it allows to perform task-oriented exercises and to increase the number of repetitions and their intensity. This protocol study aims to evaluate the effectiveness of robotic-based intervention of the older adults with Parkinson’s disease, designed to improve the gait and to reduce the risk of falling. Methods This study is a single-blinded randomized controlled trial. The primary outcomes are: risk of falling, gait performance and fear of falling measured through Performance-Oriented Mobility Assessment (POMA), instrumental gait analysis and Short Falls Efficacy Scale – International (FES-I), respectively. One hundred ninety-five patients with PD will be recruited and randomly divided into three groups, to receive a traditional rehabilitation program or a robotic rehabilitation using Tymo system or Walker View in addition to the traditional therapy. Assessments will be performed at baseline, at the end of treatment and 6 months, 1 year and 2 years from the end of the treatment. A 10-treatment session will be conducted, divided into 2 training sessions per week, for 5 weeks. The control group will perform traditional therapy sessions lasting 50 min. The technological intervention group will carry out 30 min of traditional therapy and 20 min of treatment with a robotic system. Discussion The final goals of the present study are to propose a new approach in the PD rehabilitation, focused on the use of robotic device, and to check the results not only at the end of the treatment but also in the long term. Trial registration NCT04087031, registration date September 12, 2019.
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Affiliation(s)
| | - Elvira Maranesi
- Scientific Direction, IRCCS INRCA, Ancona, Italy.,Clinical Unit of Physical Rehabilitation, IRCCS INRCA, Ancona, Italy
| | - Mirko Di Rosa
- Unit of Geriatric Pharmacoepidemiology, IRCCS INRCA, Ancona, Italy
| | | | - Elisa Casoni
- Clinical Unit of Physical Rehabilitation, IRCCS INRCA, Ancona, Italy
| | - Nadia Rinaldi
- Clinical Unit of Physical Rehabilitation, IRCCS INRCA, Fermo, Italy
| | - Renato Baldoni
- Clinical Unit of Physical Rehabilitation, IRCCS INRCA, Ancona, Italy
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Colomera JA, Nahuelhual P. [Effectiveness of robotic assistance for gait training in children with cerebral palsy. a systematic review]. Rehabilitacion (Madr) 2020; 54:107-115. [PMID: 32370825 DOI: 10.1016/j.rh.2019.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 12/10/2019] [Accepted: 12/17/2019] [Indexed: 06/11/2023]
Abstract
INTRODUCTION In recent years, the use of gait training using robotic assistance systems has progressively increased in the paediatric population with cerebral palsy. OBJECTIVE To systematically assess the effects of robotic assistance for gait training compared with physical rehabilitation therapy in children with cerebral palsy (CP), based on the International Classification of Functioning, Health and Disability (ICF). MATERIALS AND METHODS A systematic review was carried out according to the recommendations of the Cochrane Collaboration. We included randomised or quasi-randomised clinical trials that analysed children with CP classified according to The Gross Motor Function Classification System (GMFCS) I-III. The search was carried out in PubMed, PEDro, CENTRAL, CINALH, Cochrane, Embase, Europe PMC, LILACS and Science Direct. The selection and extraction of data from the studies was carried out by two independent researchers. Disagreements were resolved by consensus. A descriptive analysis of the selected studies was performed. Assessment of risk of bias was performed with the Cochrane Collaboration tool. RESULTS Four studies met the eligibility criteria. Most of the temporal-spatial, kinetic and kinematic parameters of gait were evaluated, all corresponding to the activity component of the ICF. CONCLUSIONS Due to the methodological variability of the studies, it is not possible to determine whether robot-assisted gait training is effective for treatment in children with CP.
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Affiliation(s)
- J A Colomera
- Unidad de Kinesiología, Instituto Teletón Temuco, Temuco, Chile.
| | - P Nahuelhual
- Subdirección de investigación Teletón Santiago, Chile; Facultad de Medicina CAS UDD, Santiago, Chile
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Calabrò RS, Billeri L, Andronaco VA, Accorinti M, Milardi D, Cannavò A, Aliberti E, Militi A, Bramanti P, Naro A. Walking on the Moon: A randomized clinical trial on the role of lower body positive pressure treadmill training in post-stroke gait impairment. J Adv Res 2020; 21:15-24. [PMID: 31641534 PMCID: PMC6796731 DOI: 10.1016/j.jare.2019.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/09/2019] [Accepted: 09/18/2019] [Indexed: 12/14/2022] Open
Abstract
The effects of LBPP on locomotion in neurologic patients are poorly predictable. The mechanisms through which LPBB acts on gait are partially unknown. Gait training using AlterG improves functional gait in post-stroke patients. AlterG increases muscle activation and/or phasic muscle activation in post-stroke. This knowledge may be useful to plan patient-tailored LBPP locomotor training.
Body weight–supported treadmill training (BWSTT) can be usefully employed to facilitate gait recovery in patients with neurological injuries. Specifically, lower body positive pressure support system (LBPPSS) decreases weight-bearing and ground reaction forces with potentially positive effects on qualitative gait indices. However, which gait features are being shaped by LBPPSS in post-stroke patients is yet poorly predictable. A pilot study on the effects of LBPPSS on qualitative and quantitative gait indices was carried out in patients with hemiparesis due to stroke in the chronic phase. Fifty patients, who suffered from a first, single, ischemic, supra-tentorial stroke that occurred at least 6 months before study inclusion, were enrolled in the study. They were provided with 24 daily sessions of gait training using either the AlterG device or conventional treadmill gait training (TGT). These patients were compared with 25 age-matched healthy controls (HC), who were provided with the same amount of AlterG. Qualitative and quantitative gait features, including Functional Ambulation Categories, gait cycle features, and muscle activation patterns were analyzed before and after the training. It was found that AlterG provided the patients with higher quantitative but not qualitative gait features, as compared to TGT. In particular, AlterG specifically shaped muscle activation phases and gait cycle features in patients, whereas it increased only overall muscle activation in HC. These data suggest that treadmill gait training equipped with LBPPSS specifically targets the gait features that are abnormal in chronic post-stroke patients. It is hypothesizable that the specificity of AlterG effects may depend on a selective reshape of gait rhythmogenesis elaborated by the locomotor spinal circuits receiving a deteriorated corticospinal drive. Even though further studies are warranted to clarify the role of treadmills equipped with LBPPSS in gait training of chronic post-stroke patients, the knowledge of the exact gait pattern during weight-relief is potentially useful to plan patient-tailored locomotor training.
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Affiliation(s)
- Rocco Salvatore Calabrò
- Robotic Neurorehabilitation Unit, IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
- Corresponding author at: Rocco Salvatore Calabrò, IRCCS Centro Neurolesi Bonino Pulejo; via Palermo, SS 113, ctr. Casazza, 98124 Messina, Italy.
| | - Luana Billeri
- Robotic Neurorehabilitation Unit, IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
| | | | - Maria Accorinti
- Robotic Neurorehabilitation Unit, IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
| | - Demetrio Milardi
- Robotic Neurorehabilitation Unit, IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
- Department of Biomorphology and Biotechnologies, University of Messina, Messina, Italy
| | - Antonino Cannavò
- Robotic Neurorehabilitation Unit, IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
| | - Enrico Aliberti
- Department of Motor Sciences, University of Messina, Messina, Italy
| | - Angela Militi
- Department of Motor Sciences, University of Messina, Messina, Italy
| | - Placido Bramanti
- Robotic Neurorehabilitation Unit, IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
| | - Antonino Naro
- Robotic Neurorehabilitation Unit, IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
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Lorentzen J, Frisk R, Willerslev-Olsen M, Bouyer L, Farmer SF, Nielsen JB. Gait training facilitates push-off and improves gait symmetry in children with cerebral palsy. Hum Mov Sci 2020; 69:102565. [PMID: 31989957 DOI: 10.1016/j.humov.2019.102565] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/12/2019] [Accepted: 12/18/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Human walking involves a rapid and powerful contraction of ankle plantar flexors during push-off in late stance. OBJECTIVE Here we investigated whether impaired push-off force contributes to gait problems in children with cerebral palsy (CP) and whether it may be improved by intensive gait training. METHODS Sixteen children with CP (6-15 years) and fourteen typically developing (TD) children (4-15 years) were recruited. Foot pressure was measured by insoles and gait kinematics were recorded by 3-dimensional video analysis during treadmill and overground walking. The peak derivative of ground reaction force at push off (dPF) was calculated from the foot pressure measurements. Maximal voluntary plantar flexion (MVC) was measured while seated. Measurements were performed before and after a control period and after 4 weeks of 30 minutes daily inclined treadmill training. RESULTS dPF and MVC were significantly lower in children with CP on the most affected (MA) as compared to TD children (p < .001). dPF was lower on the MA leg as compared to the less affected (LA) leg in children with CP (p < .05). Following gait training, increases in dPF (p < .001) and MVC (p < .01) were observed for the MA leg. Following gait training children with CP showed similar timing of dPF and similar stance phase duration on both legs indicating improved symmetry of gait. These effects were also shown during overground walking. CONCLUSION Impaired ability to voluntarily activate ankle plantar flexors and produce a rapid and powerful push-off during late stance are of importance for impaired gait function in children with CP. Intensive treadmill training may facilitate the drive to ankle plantar flexors and reduce gait asymmetry during both treadmill and overground walking.
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Affiliation(s)
- Jakob Lorentzen
- Department of Neuroscience, Univ. of Copenhagen, Copenhagen, Denmark; Helene Elsass Center, Charlottenlund, Denmark
| | - Rasmus Frisk
- Department of Neuroscience, Univ. of Copenhagen, Copenhagen, Denmark; Helene Elsass Center, Charlottenlund, Denmark
| | - Maria Willerslev-Olsen
- Department of Neuroscience, Univ. of Copenhagen, Copenhagen, Denmark; Helene Elsass Center, Charlottenlund, Denmark.
| | - Laurent Bouyer
- Department of Rehabilitation, University Laval, Quebec, Canada
| | - Simon Francis Farmer
- Department of Clinical and Movement Neurosciences, Institute of Neurology of Neurology, University College London, United Kingdom; Department of Clinical Neurology, National Hospital for Neurology and Neurosurgery, United Kingdom
| | - Jens Bo Nielsen
- Department of Neuroscience, Univ. of Copenhagen, Copenhagen, Denmark
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Nakagawa S, Mutsuzaki H, Mataki Y, Endo Y, Matsuda M, Yoshikawa K, Kamada H, Yamazaki M. Newly developed hybrid assistive limb for pediatric patients with cerebral palsy: a case report. J Phys Ther Sci 2019; 31:702-707. [PMID: 31528013 PMCID: PMC6698473 DOI: 10.1589/jpts.31.702] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 05/27/2019] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The effect of fitness training on improving walking ability in cerebral palsy
is controversial. However, gait training with a wearable robot (hybrid assistive limb) has
been reported to improve gait ability in patients with cerebral palsy. For pediatric
patients, a smaller, lighter-weight hybrid assistive limb has been newly developed. We
describe the immediate effect of this newly developed smaller hybrid assistive limb on the
gait ability of a pediatric patient with cerebral palsy and examine its safety and
feasibility. [Participant and Methods] An 11-year-old male with spastic cerebral palsy
(height, 130 cm; weight, 29.0 kg) who could ambulate using an elbow crutch participated in
this study. A single session of hybrid assistive limb training comprising pre-exercise of
the hip and knee joints and walking for 20 minutes was conducted. [Results] The
intervention immediately improved his gait speed, stride length, and cadence according to
the 10-m walking test. Co-contraction of agonist/antagonist muscles during walking
improved, and the flexion angle of the right hip during the swing phase increased, which
resulted in symmetry of movement of both legs. [Conclusion] Gait training using the new,
smaller hybrid assistive limb for a pediatric patient was safe and feasible, and the newly
developed hybrid assistive limb has the potential to immediately improve walking ability
even among young children with cerebral palsy.
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Affiliation(s)
- Shogo Nakagawa
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba: 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan.,Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences, Japan
| | - Hirotaka Mutsuzaki
- Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences, Japan.,Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Yuki Mataki
- Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Yusuke Endo
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Japan
| | - Mayumi Matsuda
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Kenichi Yoshikawa
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Hiroshi Kamada
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba: 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba: 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
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Hwang BH, Kim TH. The effects of sand surface training on changes in the muscle activity of the paretic side lower limb and the improvement of dynamic stability and gait endurance in stroke patients. J Exerc Rehabil 2019; 15:439-444. [PMID: 31316938 PMCID: PMC6614773 DOI: 10.12965/jer.1938164.082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 05/27/2019] [Indexed: 11/22/2022] Open
Abstract
Subjects were divided into two groups, for sand or general surface training. The gait abilities of the patients were evaluated with the Timed Up and Go (TUG) tests and the 6-min walk test (6MWT). Muscle activity in the lower limbs was evaluated with surface electromyography obtained during general surface gait. Gait ability and muscle activity were re-evaluated after gait training for 6 weeks on a sand or general surface. The TUG test was performed 3 times, and an average of the three values was used for analysis. 6MWT was measured once under maximum effort. Electromyography was evaluated using average gait cycle values. In the TUG test, performance times decreased in both groups, while in the 6MWT, performance distance significantly increased only in the sand surface training group. Results from surface electromyography showed that activity of the rectus femoris, biceps femoris, and tibialis anterior muscles of the paretic side lower limb significantly decreased after the both interventions. When environments are similar, gait training is helpful for increasing dynamic stability; however, repeated training does not significantly improve gait endurance. Training on a continuously unstable bearing surface such as sand can improve gait endurance by utilizing diverse muscle groups and increasing joint motility. Sand surface training recruited the activity of more muscle groups than did general surface training, and sand-trained participants showed longer gait distances with lower muscle activity levels when they resumed general training than their general-surface-trained counterparts.
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Affiliation(s)
- Byoung-Ha Hwang
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University, Gyeongsan, Korea
| | - Tae-Ho Kim
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University, Gyeongsan, Korea
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Yokota C, Yamamoto Y, Kamada M, Nakai M, Nishimura K, Ando D, Sato T, Koga M, Ihara M, Toyoda K, Fujimoto Y, Odani H, Minematsu K, Nakajima T. Acute stroke rehabilitation for gait training with cyborg type robot Hybrid Assistive Limb: A pilot study. J Neurol Sci 2019; 404:11-15. [PMID: 31323516 DOI: 10.1016/j.jns.2019.07.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 07/03/2019] [Accepted: 07/09/2019] [Indexed: 11/26/2022]
Abstract
Robot-assisted gait training following acute stroke could allow patients with severe disability to receive a high dosage and intensity of gait training compared with conventional physical therapy (CP). However, given the limited data on gauging the efficacy of Hybrid Assistive Limb (HAL) on gait training in patients with acute stroke, we aimed to evaluate several outcome measures following gait training with HAL. Patients with first-ever stroke, who required a walking aid and were able to start gait training within 1 week of stroke onset were included in the current study. Patients were assigned to either the CP or HAL group. Outcome measures were collected at baseline, and at the 2nd (at 2-6 weeks), and 3rd (at 3-5 months) assessments. All patients underwent physical therapy until the 3rd assessment; patients in the HAL group underwent gait training using HAL until the 2nd assessment. Thirty-seven patients (19 from CP and 18 from HAL, median age = 69 years) completed the study. At the 2nd assessment, the total Functional Independence Measure (FIM) score was higher in the HAL group than in the CP group (90.1 vs. 79.0, p = 0.042). In conclusion, the FIM scale could be used to identify responsiveness to acute stroke rehabilitation using HAL.
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Affiliation(s)
- Chiaki Yokota
- Department of Stroke Rehabilitation, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka 564-8565, Japan; Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka 564-8565, Japan.
| | - Yukio Yamamoto
- Department of Stroke Rehabilitation, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka 564-8565, Japan.
| | - Masatoshi Kamada
- Department of Stroke Rehabilitation, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka 564-8565, Japan.
| | - Michikazu Nakai
- Department of Statistics and Data Analysis, Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka 564-8565, Japan.
| | - Kunihiro Nishimura
- Department of Statistics and Data Analysis, Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka 564-8565, Japan.
| | - Daisuke Ando
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka 564-8565, Japan
| | - Takeo Sato
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka 564-8565, Japan
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka 564-8565, Japan.
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka 564-8565, Japan.
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka 564-8565, Japan.
| | - Yasuyuki Fujimoto
- Department of Stroke Rehabilitation, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka 564-8565, Japan.
| | - Hirotaka Odani
- Department of Stroke Rehabilitation, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka 564-8565, Japan
| | - Kazuo Minematsu
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka 564-8565, Japan.
| | - Takashi Nakajima
- Niigata National Hospital, National Hospital Organization, 3-52 Akasaka, Kashiwazaki city 945-8585, Japan.
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Richie D, Bullard D. Postoperative Convalescence. Clin Podiatr Med Surg 2019; 36:153-161. [PMID: 30446042 DOI: 10.1016/j.cpm.2018.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Foot and ankle surgery can impose significant hardship on a patient when carrying out their essential activities of daily living including mobility, sourcing and preparing food, as well as maintaining personal hygiene. Pre-operative planning between the surgeon, patient and caregivers can circumvent most of the challenges imposed by the post-operative restrictions of foot and ankle surgery. Depending on the weight bearing status of the operated extremity, a wide array of durable medical equipment devices are available to provide mobility and safety for the patient. Various devices are also available to protect the patient and the operative site during bathing. Pre-operative gait training can be valuable in selecting the most appropriate mobility aid for the patient, assuring safe ambulation while keeping the operated extremity protected.
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Affiliation(s)
- Doug Richie
- Private Practice, Alamitos-Seal Beach Podiatry Group, 550 Pacific Coast Highway, Suite 209, Seal Beach, CA 90740, USA; Department of Biomechanics, California School of Podiatric Medicine at Samuel Merritt University, Oakland, CA, USA; Western University of Health Sciences, Pomona, CA, USA.
| | - Daniel Bullard
- St Vincent Charity Medical Center, 2322 East 22nd Street, Cleveland, OH 44115, USA
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Abstract
BACKGROUND Existing treadmill-based locomotion training, which has been used for gait function recovery, still has limitations, such as less attentive training. Interactive treadmills (ITMs) were developed to overcome these limitations, but it has not yet been verified that ITMs can make the user pay closer attention to walk training. METHODS An experimental comparison between ITMs and conventional treadmills was conducted by measuring the level of the user's attention using functional near-infrared spectroscopy (fNIRS). To consider the effect of task complexity on the subject's attention, we provided two (slow and fast) speed conditions for walking on both treadmills. RESULTS Both the cortical activity images and oxygenated hemoglobin (oxyHb) changes showed that the level of attention to walking induced by the ITM was significantly higher than that induced by the conventional treadmill. We found that the walking speed on the ITM also affected the level of attention. CONCLUSION ITM-based locomotion training would be a promising solution to the limitations of existing treadmill-based locomotion training currently used to improve gait function recovery. TRIAL REGISTRATION DGIST-HR-150309-03-02 . Registered 01 March 2015.
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Affiliation(s)
- Seunghue Oh
- Department of Robotics Engineering, DGIST (Daegu Gyeongbuk Institute of Science and Technology), 333 Techno Jungang-daero, Daegu, 42988 Republic of Korea
| | - Minsu Song
- Department of Robotics Engineering, DGIST (Daegu Gyeongbuk Institute of Science and Technology), 333 Techno Jungang-daero, Daegu, 42988 Republic of Korea
| | - Jonghyun Kim
- Department of Robotics Engineering, DGIST (Daegu Gyeongbuk Institute of Science and Technology), 333 Techno Jungang-daero, Daegu, 42988 Republic of Korea
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Itoh N, Imoto D, Kubo S, Takahashi K, Hishikawa N, Mikami Y, Kubo T. Gait training using a stationary, one-leg gait exercise assist robot for chronic stroke hemiplegia: a case report. J Phys Ther Sci 2018; 30:1046-1051. [PMID: 30154598 PMCID: PMC6110205 DOI: 10.1589/jpts.30.1046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 05/07/2018] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The Gait Exercise Assist Robot (GEAR) is a stationary, one-leg robot for gait training. The purpose of this case study was to evaluate the efficacy of rehabilitation using GEAR training for chronic stroke hemiplegia. [Participant and Methods] The participant was a 66-year-old male stroke survivor with left hemiparesis due to a right putaminal hemorrhage. He could walk slowly under supervision, although his gait had a constant forward trunk lean, with flexed knee, and a lack of hip extension movement on the affected side. Gait training using GEAR and physical therapy were performed for 14 days. Under both training conditions, the physical therapist made the participant conscious of extension movement of the hip joint in the affected-side stance phase. The robotic assistance was adjusted to maximize voluntary movement while observing gait. Physical function and gait ability parameters were evaluated before and after training. [Results] After training, extension motion of the hip joint increased in the affected-side stance phase, and body weight was transferred smoothly onto the affected-side limb, leading to an improvement in gait speed. [Conclusion] Gait training using GEAR and physical therapy may improve gait pattern and speed in patients with chronic stroke hemiplegia.
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Affiliation(s)
- Norihide Itoh
- Department of Advanced Rehabilitation, Kyoto Prefectural University of Medicine: 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.,Department of Rehabilitation Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Daisuke Imoto
- Department of Rehabilitation Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Shuichi Kubo
- Department of Rehabilitation, University Hospital, Kyoto Prefectural University of Medicine, Japan
| | - Kota Takahashi
- Department of Rehabilitation, University Hospital, Kyoto Prefectural University of Medicine, Japan
| | - Norikazu Hishikawa
- Department of Rehabilitation Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Yasuo Mikami
- Department of Rehabilitation Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan.,Department of Rehabilitation, University Hospital, Kyoto Prefectural University of Medicine, Japan
| | - Toshikazu Kubo
- Department of Advanced Rehabilitation, Kyoto Prefectural University of Medicine: 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.,Department of Rehabilitation Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan.,Department of Rehabilitation, University Hospital, Kyoto Prefectural University of Medicine, Japan
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Takahashi K, Mutsuzaki H, Mataki Y, Yoshikawa K, Matsuda M, Enomoto K, Sano K, Kubota A, Mizukami M, Iwasaki N, Yamazaki M. Safety and immediate effect of gait training using a Hybrid Assistive Limb in patients with cerebral palsy. J Phys Ther Sci 2018; 30:1009-1013. [PMID: 30154591 PMCID: PMC6110229 DOI: 10.1589/jpts.30.1009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 05/07/2018] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study aimed to determine the safety and immediate effect of a single
training session with the Hybrid Assistive Limb (CYBERDYNE) on walking ability in patients
with cerebral palsy. [Participants and Methods] This study included 20 patients with
cerebral palsy (15 males, 5 females, mean age 15.0 ± 6.3 years; 19 with spastic cerebral
palsy, 1 with athetoid cerebral palsy; Gross Motor Function Classification System level I:
4, II: 3, III: 9, and IV: 4). Participants completed a single 20-minute gait training
session using the Hybrid Assistive Limb. The safety and immediate effect were evaluated.
The immediate outcomes were gait speed and mean step length, and cadence before and after
training. [Results] Two participants were excluded because they were not tall enough to
use the Hybrid Assistive Limb. Eighteen participants performed the training. There were no
serious adverse events during the training. Since 14 participants were able to walk on
their own, walking evaluations were performed before and after training. Statistically
significant improvements were observed in gait speed and mean step length. [Conclusion]
Gait training using the Hybrid Assistive Limb is safe for patients with cerebral palsy and
can produce immediate effects on walking ability in ambulatory patients with cerebral
palsy.
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Affiliation(s)
- Kazushi Takahashi
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Hirotaka Mutsuzaki
- Center of Medical Science, Ibaraki Prefectural University of Health Sciences: 4669-2 Ami, Ami-machi, Inashiki-gun, Ibaraki 300-0394, Japan.,Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Yuki Mataki
- Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Kenichi Yoshikawa
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Mayumi Matsuda
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Keiko Enomoto
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Kumiko Sano
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Aoi Kubota
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Masafumi Mizukami
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Japan
| | - Nobuaki Iwasaki
- Center of Medical Science, Ibaraki Prefectural University of Health Sciences: 4669-2 Ami, Ami-machi, Inashiki-gun, Ibaraki 300-0394, Japan.,Department of Pediatrics, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
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Yeung LF, Ockenfeld C, Pang MK, Wai HW, Soo OY, Li SW, Tong KY. Randomized controlled trial of robot-assisted gait training with dorsiflexion assistance on chronic stroke patients wearing ankle-foot-orthosis. J Neuroeng Rehabil 2018; 15:51. [PMID: 29914523 PMCID: PMC6006663 DOI: 10.1186/s12984-018-0394-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 06/11/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Robot-assisted ankle-foot-orthosis (AFO) can provide immediate powered ankle assistance in post-stroke gait training. Our research team has developed a novel lightweight portable robot-assisted AFO which is capable of detecting walking intentions using sensor feedback of wearer's gait pattern. This study aims to investigate the therapeutic effects of robot-assisted gait training with ankle dorsiflexion assistance. METHODS This was a double-blinded randomized controlled trial. Nineteen chronic stroke patients with motor impairment at ankle participated in 20-session robot-assisted gait training for about five weeks, with 30-min over-ground walking and stair ambulation practices. Robot-assisted AFO either provided active powered ankle assistance during swing phase in Robotic Group (n = 9), or torque impedance at ankle joint as passive AFO in Sham Group (n = 10). Functional assessments were performed before and after the 20-session gait training with 3-month Follow-up. Primary outcome measure was gait independency assessed by Functional Ambulatory Category (FAC). Secondary outcome measures were clinical scores including Fugl-Meyer Assessment (FMA), Modified Ashworth Scale (MAS), Berg Balance Scale (BBS), Timed 10-Meter Walk Test (10MWT), Six-minute Walk Test (SMWT), supplemented by gait analysis. All outcome measures were performed in unassisted gait after patients had taken off the robot-assisted AFO. Repeated-measures analysis of covariance was conducted to test the group differences referenced to clinical scores before training. RESULTS After 20-session robot-assisted gait training with ankle dorsiflexion assistance, the active ankle assistance in Robotic Group induced changes in gait pattern with improved gait independency (all patients FAC ≥ 5 post-training and 3-month follow-up), motor recovery, walking speed, and greater confidence in affected side loading response (vertical ground reaction force + 1.49 N/kg, peak braking force + 0.24 N/kg) with heel strike instead of flat foot touch-down at initial contact (foot tilting + 1.91°). Sham Group reported reduction in affected leg range of motion (ankle dorsiflexion - 2.36° and knee flexion - 8.48°) during swing. CONCLUSIONS Robot-assisted gait training with ankle dorsiflexion assistance could improve gait independency and help stroke patients developing confidence in weight acceptance, but future development of robot-assisted AFO should consider more lightweight and custom-fit design. TRIAL REGISTRATION ClinicalTrials.gov NCT02471248 . Registered 15 June 2015 retrospectively registered.
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Affiliation(s)
- Ling-Fung Yeung
- Department of Biomedical Engineering, The Chinese University of Hong Kong, ShaTin, Hong Kong
| | - Corinna Ockenfeld
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Man-Kit Pang
- Industrial Centre, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Hon-Wah Wai
- Industrial Centre, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Oi-Yan Soo
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Ma Liu Shui, Hong Kong
| | - Sheung-Wai Li
- Division of Rehabilitation, Department of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Kai-Yu Tong
- Department of Biomedical Engineering, The Chinese University of Hong Kong, ShaTin, Hong Kong
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Liu W. A narrative review of gait training after stroke and a proposal for developing a novel gait training device that provides minimal assistance. Top Stroke Rehabil 2018; 25:375-383. [PMID: 29718796 DOI: 10.1080/10749357.2018.1466970] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Gait impairment is common in stroke survivors. Recovery of walking ability is one of the most pressing objectives in stroke rehabilitation. OBJECTIVES Of this report are to briefly review recent progress in gait training after stroke including the use of partial body weight-supported treadmill training (PBWSTT) and robot-assisted step training (RAST), and propose a minimal assistance strategy that may overcome some of limitations of current RAST. METHODS The literature review emphasizes a dilemma that recent randomized clinical trials did not support the use of RAST. The unsatisfactory results of current RAST clinical trials may be partially due to a lack of careful analysis of movement deficiencies and their relevance to gait training task specificity after stroke. Normal movement pattern is implied to be part of task specificity in the current RAST. Limitations of such task specificity are analyzed. RESULTS Based on the review, we redefine an alternative set of gait training task specificity that represents a minimal assistance strategy in terms of assisted body movements and amount of assistance. Specifically, assistances are applied only to hip flexion and ankle dorsiflexion of the affected lower limb during swing phase. Furthermore, we propose a conceptual design of a novel device that may overcome limitations of current RAST in gait training after stroke. The novel device uses a pulling cable, either manually operated by a therapist or automated by a servomotor, to provide assistive forces to help hip flexion and ankle dorsiflexion of the affected lower limb during gait training. CONCLUSION The proposed minimal assistance strategy may help to design better devices for gait or other motor training.
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Affiliation(s)
- Wen Liu
- a Department of Physical Therapy & Rehabilitation Science , University of Kansas Medical Center , Kansas City , KS , USA
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Abstract
OBJECTIVE Test the effect of a multi-joint control with implanted electrical stimulation on walking after spinal cord injury (SCI). DESIGN Single subject research design with repeated measures. SETTING Hospital-based biomechanics laboratory and user assessment of community use. PARTICIPANTS Female with C6 AIS C SCI 30 years post injury. INTERVENTIONS Lower extremity muscle activation with an implanted pulse generator and gait training. OUTCOME MEASURES Walking speed, maximum distance, oxygen consumption, upper extremity (UE) forces, kinematics and self-assessment of technology. RESULTS Short distance walking speed at one-year follow up with or without stimulation was not significantly different from baseline. However, average walking speed was significantly faster (0.22 m/s) with stimulation over longer distances than volitional walking (0.12 m/s). In addition, there was a 413% increase in walking distance from 95 m volitionally to 488 m with stimulation while oxygen consumption and maximum upper extremity forces decreased by 22 and 16%, respectively. Stimulation also produced significant (P ≤ 0.001) improvements in peak hip and knee flexion, ankle angle at foot off and at mid-swing. CONCLUSION An implanted neuroprosthesis enabled a subject with incomplete SCI to walk longer distances with improved hip and knee flexion and ankle dorsiflexion resulting in decreased oxygen consumption and UE support. Further research is required to determine the robustness, generalizability and functional implications of implanted neuroprostheses for community ambulation after incomplete SCI.
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Affiliation(s)
- Lisa M. Lombardo
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | - Rudolf Kobetic
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | - Gilles Pinault
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | - Kevin M. Foglyano
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | - Stephanie N. Bailey
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | - Stephen Selkirk
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
- Department of Neurology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Ronald J. Triolo
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
- Department of Orthopaedics and Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
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Rajasekaran V, López-Larraz E, Trincado-Alonso F, Aranda J, Montesano L, Del-Ama AJ, Pons JL. Volition-adaptive control for gait training using wearable exoskeleton: preliminary tests with incomplete spinal cord injury individuals. J Neuroeng Rehabil 2018; 15:4. [PMID: 29298691 PMCID: PMC5751847 DOI: 10.1186/s12984-017-0345-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 12/20/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Gait training for individuals with neurological disorders is challenging in providing the suitable assistance and more adaptive behaviour towards user needs. The user specific adaptation can be defined based on the user interaction with the orthosis and by monitoring the user intentions. In this paper, an adaptive control model, commanded by the user intention, is evaluated using a lower limb exoskeleton with incomplete spinal cord injury individuals (SCI). METHODS A user intention based adaptive control model has been developed and evaluated with 4 incomplete SCI individuals across 3 sessions of training per individual. The adaptive control model modifies the joint impedance properties of the exoskeleton as a function of the human-orthosis interaction torques and the joint trajectory evolution along the gait sequence, in real time. The volitional input of the user is identified by monitoring the neural signals, pertaining to the user's motor activity. These volitional inputs are used as a trigger to initiate the gait movement, allowing the user to control the initialization of the exoskeleton movement, independently. A Finite-state machine based control model is used in this set-up which helps in combining the volitional orders with the gait adaptation. RESULTS The exoskeleton demonstrated an adaptive assistance depending on the patients' performance without guiding them to follow an imposed trajectory. The exoskeleton initiated the trajectory based on the user intention command received from the brain machine interface, demonstrating it as a reliable trigger. The exoskeleton maintained the equilibrium by providing suitable assistance throughout the experiments. A progressive change in the maximum flexion of the knee joint was observed at the end of each session which shows improvement in the patient performance. Results of the adaptive impedance were evaluated by comparing with the application of a constant impedance value. Participants reported that the movement of the exoskeleton was flexible and the walking patterns were similar to their own distinct patterns. CONCLUSIONS This study demonstrates that user specific adaptive control can be applied on a wearable robot based on the human-orthosis interaction torques and modifying the joints' impedance properties. The patients perceived no external or impulsive force and felt comfortable with the assistance provided by the exoskeleton. The main goal of such a user dependent control is to assist the patients' needs and adapt to their characteristics, thus maximizing their engagement in the therapy and avoiding slacking. In addition, the initiation directly controlled by the brain allows synchronizing the user's intention with the afferent stimulus provided by the movement of the exoskeleton, which maximizes the potentiality of the system in neuro-rehabilitative therapies.
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Affiliation(s)
| | - Eduardo López-Larraz
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
| | | | - Joan Aranda
- Departamento de Automatic e Control, Universitat Politécnica de Catalunya, Barcelona-Tech, Barcelona, Spain
| | - Luis Montesano
- Departamento de Informatica e Ingenería de Sistemas and, Instituto de Investigacion en Ingeneria de Aragon (I3A), University of Zaragoza, Zaragoza, Spain
| | - Antonio J Del-Ama
- Biomechanics and Technical Aids unit, National Hospital for Spinal cord injury, Toledo, Spain
| | - Jose L Pons
- Neural Rehabilitation group, Spanish National Research Council (CSIC), Cajal Institute, Madrid, Spain
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Kim TH, Hwang BH. Effects of gait training on sand on improving the walking ability of patients with chronic stroke:a randomized controlled trial. J Phys Ther Sci 2017; 29:2172-2175. [PMID: 29643598 PMCID: PMC5890224 DOI: 10.1589/jpts.29.2172] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 09/20/2017] [Indexed: 12/04/2022] Open
Abstract
[Purpose] This study examines how difference in sandy ground between firm ground
influences the effects of gait training in patients with chronic stroke. [Subjects and
Methods] A total of 28 patients with chronic stroke were evenly divided into experimental
and control groups. Initial evaluation of the subjects was conducted by Timed Up & Go
(TUG) and 6-Minute Walking Test (6MWT). Each patient in both groups received daily,
30-minute gait training on sandy ground and firm ground, five times each week, for a total
of six weeks, after which reevaluation was conducted. [Results] In TUG, both groups showed
significant improvement after the intervention. In 6MWT, only the experimental group
achieved significantly increased distance after the intervention. However, there was no
between-group difference. Improvement in dynamic balancing ability depends on repeated
gait training rather than differences in the ground environment. However, gait endurance
showed a difference depending on the types of ground, regardless of repeated gait
training. [Conclusion] This can be attributed to the fact that gait training on sand
requires use of more diverse muscles. Hence, we can confirm the potential of sand as a new
material for training ground when attempting to improve walking ability, particularly gait
endurance, among patients with chronic stroke.
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Affiliation(s)
- Tae-Ho Kim
- Department of Physical Therapy, College of Rehabilitaion Science, Daegu University: 201 Daegudae-ro, Jillyang, Gyeongsan, Gyeongbuk, Republic of Korea
| | - Byoung-Ha Hwang
- Department of Physical Therapy, College of Rehabilitaion Science, Daegu University: 201 Daegudae-ro, Jillyang, Gyeongsan, Gyeongbuk, Republic of Korea
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Haarman JAM, Maartens E, van der Kooij H, Buurke JH, Reenalda J, Rietman JS. Manual physical balance assistance of therapists during gait training of stroke survivors: characteristics and predicting the timing. J Neuroeng Rehabil 2017; 14:125. [PMID: 29197402 PMCID: PMC5712141 DOI: 10.1186/s12984-017-0337-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 11/23/2017] [Indexed: 11/25/2022] Open
Abstract
Background During gait training, physical therapists continuously supervise stroke survivors and provide physical support to their pelvis when they judge that the patient is unable to keep his balance. This paper is the first in providing quantitative data about the corrective forces that therapists use during gait training. It is assumed that changes in the acceleration of a patient’s COM are a good predictor for therapeutic balance assistance during the training sessions Therefore, this paper provides a method that predicts the timing of therapeutic balance assistance, based on acceleration data of the sacrum. Methods Eight sub-acute stroke survivors and seven therapists were included in this study. Patients were asked to perform straight line walking as well as slalom walking in a conventional training setting. Acceleration of the sacrum was captured by an Inertial Magnetic Measurement Unit. Balance-assisting corrective forces applied by the therapist were collected from two force sensors positioned on both sides of the patient’s hips. Measures to characterize the therapeutic balance assistance were the amount of force, duration, impulse and the anatomical plane in which the assistance took place. Based on the acceleration data of the sacrum, an algorithm was developed to predict therapeutic balance assistance. To validate the developed algorithm, the predicted events of balance assistance by the algorithm were compared with the actual provided therapeutic assistance. Results The algorithm was able to predict the actual therapeutic assistance with a Positive Predictive Value of 87% and a True Positive Rate of 81%. Assistance mainly took place over the medio-lateral axis and corrective forces of about 2% of the patient’s body weight (15.9 N (11), median (IQR)) were provided by therapists in this plane. Median duration of balance assistance was 1.1 s (0.6) (median (IQR)) and median impulse was 9.4Ns (8.2) (median (IQR)). Although therapists were specifically instructed to aim for the force sensors on the iliac crest, a different contact location was reported in 22% of the corrections. Conclusions This paper presents insights into the behavior of therapists regarding their manual physical assistance during gait training. A quantitative dataset was presented, representing therapeutic balance-assisting force characteristics. Furthermore, an algorithm was developed that predicts events at which therapeutic balance assistance was provided. Prediction scores remain high when different therapists and patients were analyzed with the same algorithm settings. Both the quantitative dataset and the developed algorithm can serve as technical input in the development of (robot-controlled) balance supportive devices.
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Affiliation(s)
- Juliet A M Haarman
- Roessingh Research and Development, Roessinghsbleekweg 33b, 7522 AH, Enschede, the Netherlands. .,Department of Biomechanical Engineering, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, the Netherlands. .,Roessingh Research and Development, Roessinghsbleekweg 33b, PO Box 310, 7500 AH, Enschede, the Netherlands.
| | - Erik Maartens
- Roessingh Research and Development, Roessinghsbleekweg 33b, 7522 AH, Enschede, the Netherlands.,Department of Biomechanical Engineering, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, the Netherlands
| | - Herman van der Kooij
- Department of Biomechanical Engineering, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, the Netherlands
| | - Jaap H Buurke
- Roessingh Research and Development, Roessinghsbleekweg 33b, 7522 AH, Enschede, the Netherlands.,Department of Biomechanical Engineering, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, the Netherlands
| | - Jasper Reenalda
- Roessingh Research and Development, Roessinghsbleekweg 33b, 7522 AH, Enschede, the Netherlands.,Department of Biomechanical Engineering, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, the Netherlands
| | - Johan S Rietman
- Roessingh Research and Development, Roessinghsbleekweg 33b, 7522 AH, Enschede, the Netherlands.,Department of Biomechanical Engineering, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, the Netherlands
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Haarman JAM, Choi JT, Buurke JH, Rietman JS, Reenalda J. Performance of a visuomotor walking task in an augmented reality training setting. Hum Mov Sci 2017; 56:11-9. [PMID: 29096179 DOI: 10.1016/j.humov.2017.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 10/12/2017] [Accepted: 10/13/2017] [Indexed: 11/23/2022]
Abstract
Visual cues can be used to train walking patterns. Here, we studied the performance and learning capacities of healthy subjects executing a high-precision visuomotor walking task, in an augmented reality training set-up. A beamer was used to project visual stepping targets on the walking surface of an instrumented treadmill. Two speeds were used to manipulate task difficulty. All participants (n = 20) had to change their step length to hit visual stepping targets with a specific part of their foot, while walking on a treadmill over seven consecutive training blocks, each block composed of 100 stepping targets. Distance between stepping targets was varied between short, medium and long steps. Training blocks could either be composed of random stepping targets (no fixed sequence was present in the distance between the stepping targets) or sequenced stepping targets (repeating fixed sequence was present). Random training blocks were used to measure non-specific learning and sequenced training blocks were used to measure sequence-specific learning. Primary outcome measures were performance (% of correct hits), and learning effects (increase in performance over the training blocks: both sequence-specific and non-specific). Secondary outcome measures were the performance and stepping-error in relation to the step length (distance between stepping target). Subjects were able to score 76% and 54% at first try for lower speed (2.3 km/h) and higher speed (3.3 km/h) trials, respectively. Performance scores did not increase over the course of the trials, nor did the subjects show the ability to learn a sequenced walking task. Subjects were better able to hit targets while increasing their step length, compared to shortening it. In conclusion, augmented reality training by use of the current set-up was intuitive for the user. Suboptimal feedback presentation might have limited the learning effects of the subjects.
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Abstract
BACKGROUND In individuals with post-stroke hemiparesis, reduced push-off force generation in the paretic leg negatively impacts walking function. Gait training interventions that increase paretic push-off can improve walking function in individuals with neurologic impairment. During normal locomotion, push-off forces are modulated with variations in gait speed and slope. However, it is unknown whether able-bodied individuals can selectively modulate push-off forces from one leg in response to biofeedback. Here, in a group of young, neurologically-unimpaired individuals, we determined the effects of a real-time visual and auditory biofeedback gait training paradigm aimed at unilaterally increasing anteriorly-directed ground reaction force (AGRF) in the targeted leg. METHODS Ground reaction force data during were collected from 7 able-bodied individuals as they walked at a self-selected pace on a dual-belt treadmill instrumented with force platforms. During 11-min of gait training, study participants were provided real-time AGRF biofeedback encouraging a 20-30% increase in peak AGRF generated by their right (targeted) leg compared to their baseline (pre-training) AGRF. AGRF data were collected before, during, and after the biofeedback training period, as well as during two retention tests performed without biofeedback and after standing breaks. RESULTS Compared to AGRFs generated during the pre-training gait trials, participants demonstrated a significantly greater AGRF in the targeted leg during and immediately after training, indicating that biofeedback training was successful at inducing increased AGRF production in the targeted leg. Additionally, participants continued to demonstrate greater AGRF production in the targeted leg after two standing breaks, showing short-term recall of the gait pattern learned during the biofeedback training. No significant effects of training were observed on the AGRF in the non-targeted limb, showing the specificity of the effects of biofeedback toward the targeted limb. CONCLUSIONS These results demonstrate the short-term effects of using unilateral AGRF biofeedback to target propulsion in a specific leg, which may have utility as a training tool for individuals with gait deficits such as post-stroke hemiparesis. Future studies are needed to investigate the effects of real-time AGRF biofeedback as a gait training tool in neurologically-impaired individuals.
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Affiliation(s)
- Christopher Schenck
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Trisha M Kesar
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, 1441 Clifton Rd NE, Atlanta, GA, 30322, USA.
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Ribeiro TS, Silva EMGS, Silva IAP, Costa MFP, Cavalcanti FAC, Lindquist AR. Effects of treadmill training with load addition on non-paretic lower limb on gait parameters after stroke: A randomized controlled clinical trial. Gait Posture 2017; 54:229-235. [PMID: 28351743 DOI: 10.1016/j.gaitpost.2017.03.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 03/01/2017] [Accepted: 03/04/2017] [Indexed: 02/02/2023]
Abstract
The addition of load on the non-paretic lower limb for the purpose of restraining this limb and stimulating the use of the paretic limb has been suggested to improve hemiparetic gait. However, the results are conflicting and only short-term effects have been observed. This study aims to investigate the effects of adding load on non-paretic lower limb during treadmill gait training as a multisession intervention on kinematic gait parameters after stroke. With this aim, 38 subacute stroke patients (mean time since stroke: 4.5 months) were randomly divided into two groups: treadmill training with load (equivalent to 5% of body weight) on the non-paretic ankle (experimental group) and treadmill training without load (control group). Both groups performed treadmill training during 30min per day, for two consecutive weeks (nine sessions). Spatiotemporal and angular gait parameters were assessed by a motion system analysis at baseline, post-training (at the end of 9days of interventions) and follow-up (40days after the end of interventions). Several post-training effects were demonstrated: patients walked faster and with longer paretic and non-paretic steps compared to baseline, and maintained these gains at follow-up. In addition, patients exhibited greater hip and knee joint excursion in both limbs at post-training, while maintaining most of these benefits at follow-up. All these improvements were observed in both groups. Although the proposal gait training program has provided better gait parameters for these subacute stroke patients, our data indicate that load addition used as a restraint may not provide additional benefits to gait training.
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Affiliation(s)
- Tatiana S Ribeiro
- Department of Physical Therapy, Federal University of Rio Grande do Norte, 3000, Av. Senador Salgado Filho, Post office box: 1524, Natal, RN, 59072-970, Brazil.
| | - Emília M G S Silva
- Department of Physical Therapy, Federal University of Rio Grande do Norte, 3000, Av. Senador Salgado Filho, Post office box: 1524, Natal, RN, 59072-970, Brazil.
| | - Isaíra A P Silva
- Department of Physical Therapy, Federal University of Rio Grande do Norte, 3000, Av. Senador Salgado Filho, Post office box: 1524, Natal, RN, 59072-970, Brazil.
| | - Mayara F P Costa
- Department of Physical Therapy, Federal University of Rio Grande do Norte, 3000, Av. Senador Salgado Filho, Post office box: 1524, Natal, RN, 59072-970, Brazil.
| | - Fabrícia A C Cavalcanti
- Department of Physical Therapy, Federal University of Rio Grande do Norte, 3000, Av. Senador Salgado Filho, Post office box: 1524, Natal, RN, 59072-970, Brazil.
| | - Ana R Lindquist
- Department of Physical Therapy, Federal University of Rio Grande do Norte, 3000, Av. Senador Salgado Filho, Post office box: 1524, Natal, RN, 59072-970, Brazil.
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van Gelder L, Booth ATC, van de Port I, Buizer AI, Harlaar J, van der Krogt MM. Real-time feedback to improve gait in children with cerebral palsy. Gait Posture 2017; 52:76-82. [PMID: 27883988 DOI: 10.1016/j.gaitpost.2016.11.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 11/08/2016] [Accepted: 11/10/2016] [Indexed: 02/02/2023]
Abstract
Real-time feedback may be useful for enhancing information gained from clinical gait analysis of children with cerebral palsy (CP). It may also be effective in functional gait training, however, it is not known if children with CP can adapt gait in response to real-time feedback of kinematic parameters. Sixteen children with cerebral palsy (age 6-16; GMFCS I-III), walking with a flexed-knee gait pattern, walked on an instrumented treadmill with virtual reality in three conditions: regular walking without feedback (NF), feedback on hip angle (FH) and feedback on knee angle (FK). Clinically relevant gait parameters were calculated and the gait profile score (GPS) was used as a measure of overall gait changes between conditions. All children, except one, were able to improve hip and/or knee extension during gait in response to feedback, with nine achieving a clinically relevant improvement. Peak hip extension improved significantly by 5.1±5.9° (NF: 8.9±12.8°, FH: 3.8±10.4°, p=0.01). Peak knee extension improved significantly by 7.7±7.1° (NF: 22.2±12.0°, FK: 14.5±12.7°, p<0.01). GPS did not change between conditions due to increased deviations in other gait parameters. Responders to feedback were shown to have worse initial gait as measured by GPS (p=0.005) and functional selectivity score (p=0.049). In conclusion, ambulatory children with CP show adaptability in gait and are able to respond to real-time feedback, resulting in significant and clinically relevant improvements in peak hip and knee extension. These findings show the potential of real-time feedback as a tool for functional gait training and advanced gait analysis in CP.
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Lu HL, Lu TW, Lin HC, Hsieh HJ, Chan WP. Effects of belt speed on the body's center of mass motion relative to the center of pressure during treadmill walking. Gait Posture 2017; 51:109-115. [PMID: 27744249 DOI: 10.1016/j.gaitpost.2016.09.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 09/26/2016] [Accepted: 09/28/2016] [Indexed: 02/02/2023]
Abstract
Treadmills are often used in clinical settings to improve walking balance control in patients with gait impairments. However, knowledge of the effects of belt speed on balance control remains incomplete. The current study determined such effects in terms of inclination angles (IA) and the rate of change (RCIA) of the center of mass (COM) motion relative to the center of pressure (COP) in twelve healthy adults at five belt speeds, including the subjects' preferred walking speed (PWS), as measured using a motion capture system and an instrumented treadmill. The values of IAs and RCIAs at key gait events and their average values over single-limb support (DLS) and double-limb support (DLS) were compared between speeds using one-way repeated measures analysis of variances. While the COM-COP controls were different between SLS and DLS, they were inter-related to form an integrated whole. Among the belt speeds, the range of frontal IA during SLS was smallest at the PWS (p<0.05). With increasing speed, most variables of the sagittal IAs and RCIAs, and of the frontal RCIAs during DLS showed a linearly increasing trend (p<0.001). A linearly decreasing trend was found in the frontal IA at toe-off and in the average frontal RCIA during SLS (p<0.05). The PWS appeared to be the best compromise between frontal stability during SLS and smooth weight-transfer during DLS. The current results provide useful baseline data for selecting speeds according to training needs, and may be helpful for developing protocols for gait retraining for patients with gait impairment.
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Affiliation(s)
- Hsuan-Lun Lu
- Institute of Biomedical Engineering, National Taiwan University, Taiwan, ROC
| | - Tung-Wu Lu
- Institute of Biomedical Engineering, National Taiwan University, Taiwan, ROC; Department of Orthopaedic Surgery, School of Medicine, National Taiwan University, Taiwan, ROC.
| | - Hsiu-Chen Lin
- School of Physical Therapy, China Medical University, Taiwan, ROC
| | - Hong-Jung Hsieh
- Department of Mechanical and Automation Engineering, Kao Yuan University, Taiwan, ROC
| | - Wing P Chan
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taiwan, ROC; Department of Radiology, School of Medicine, Taipei Medical University, Taiwan, ROC
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