Functional recovery of gait and joint kinematics after right hemispheric stroke

Modified Constraint-Induced Movement Therapy for Improving Balance and Gait in a Case of Ganglio-Capsular Infarct: A Single-Case Study

The ganglio-capsular region consists of the basal ganglia nuclei (caudate nucleus and lentiform nucleus), thalamus, and internal capsule. A disorder of the ganglio-capsular region typically presents with movement disturbance and cognitive impairment. This report presents the case of a 52-year-old male who was diagnosed with acute non-hemorrhagic infarct in the right parietal-occipital-temporal region predominantly involving the cortex and in the right ganglio-capsular region. The patient exhibited typical symptoms, which include impaired reflexes, decreased strength, reduced range of motion, and tone abnormalities. Targeted early physiotherapy intervention (TERI) was initiated from the bedside in the intensive care unit (ICU). Modified constraint-induced movement therapy (mCIMT) along with conventional therapy was selected as the rehabilitation approach for the case as it deals with "forced use" of the affected extremities, which addresses "learned non-use." The case was managed for a duration of six weeks, in which clinical outcomes, including the Berg Balance Scale (BBS), 10-meter walk test (10MWT), functional reach test (FRT), dynamic gait index (DGI), trunk impairment scale (TIS), and fall efficacy test (FET), reported crucial changes in balance, strength, coordination, and tone, which improved the quality of life of the patient.

Gait pattern after electromechanically-assisted gait training with the Hybrid Assistive Limb and conventional gait training in sub-acute stroke rehabilitation-A subsample from a randomized controlled trial

Introduction

Electromechanically-assisted gait training has been introduced in stroke rehabilitation as a means to enable gait training with a large number of reproducible and symmetrical task repetitions, i.e. steps. However, few studies have evaluated its impact on gait pattern functions. This study includes persons with no independent ambulation function at the start of a 4-week neurorehabilitation period in the sub-acute phase after stroke. The primary aim of the study was to evaluate whether the addition of electromechanically-assisted gait training to conventional training resulted in better gait pattern function than conventional training alone. The secondary aim was to identify correlations between overall gait quality and standardized clinical assessments.

Participants and methods

Seventeen patients with no independent ambulation function who participated in a Prospective Randomized Open Blinded End-point study in the sub-acute phase after stroke were randomized into two groups; one group (n = 7) to undergo conventional training only (CONV group) and the other group (n = 10) to undergo conventional training with additional electromechanically-assisted gait training (HAL group). All patients were assessed with 3D gait analysis and clinical assessments after the 4-week intervention period. Overall gait quality as per the Gait Profile Score (GPS), as well as kinematic, and kinetic and other spatiotemporal metrics were collected and compared between intervention groups. Correlations between biomechanical and clinical outcomes were evaluated.

Results

Both the CONV and HAL groups exhibited similar gait patterns with no significant differences between groups in any kinematic, kinetic parameters or other spatiotemporal metrics. The GPS for the paretic limb had a median (IQR) of 12.9° (7.8°) and 13.4° (4.3°) for the CONV and HAL groups, respectively (p = 0.887). Overall gait quality was correlated with independence in walking, walking speed, movement function and balance. We found no added benefit in gait pattern function from the electromechanically-assisted gait training compared to the conventional training alone.

Discussion

This finding raises new questions about how to best design effective and optimal post-stroke rehabilitation programs in patients with moderate to severe gait impairments to achieve both independent walking and optimal gait pattern function, and about which patients should be in focus in further studies on the efficacy of electromechanically-assisted gait training.

Clinical trial registration

The study was retrospectively registered at ClinicalTrials.gov, identifier (NCT02410915) on April 2015.

Effect of gait training using Welwalk on gait pattern in individuals with hemiparetic stroke: a cross-sectional study

Introduction

We aimed to explore the effect of gait training using Welwalk on gait patterns by comparing differences in gait patterns between robotic-assisted gait training using Welwalk and gait training using an orthosis in individuals with hemiparetic stroke.

Methods

This study included 23 individuals with hemiparetic stroke who underwent gait training with Welwalk combined with overground gait training using an orthosis. Three-dimensional motion analysis on a treadmill was performed under two conditions for each participant: during gait training with Welwalk and with the ankle-foot orthosis. The spatiotemporal parameters and gait patterns were compared between the two conditions.

Results

The affected step length was significantly longer, the step width was significantly wider, and the affected single support phase ratio was significantly higher in the Welwalk condition than in the orthosis condition. The index values of abnormal gait patterns were significantly lower while using Welwalk than in the orthosis condition. The following four indices were lower in the Welwalk condition: contralateral vaulting, insufficient knee flexion, excessive hip external rotation during the paretic swing phase, and paretic forefoot contact.

Discussion

Gait training using Welwalk increased the affected step length, step width, and single support phase while suppressing abnormal gait patterns as compared to gait training using the ankle-foot orthosis. This study suggests that gait training using Welwalk may promote a more efficient gait pattern reacquisition that suppresses abnormal gait patterns.

Trial registration

Prospectively registered in the Japan Registry of Clinical Trials (https://jrct.niph.go.jp; jRCTs042180152).

Treatment of knee hyperextension in post-stroke gait. A systematic review

BACKGROUND

Post-stroke, patients exhibit considerable variations in gait patterns. One of the variations that can be present in post-stroke gait is knee hyperextension in the stance phase.

RESEARCH QUESTION

What is the current evidence for the effectiveness of the treatment of knee hyperextension in post-stroke gait?

METHODS

MEDLINE, EMBASE, PEDro, CINAHL, and the Cochrane library were searched for relevant controlled trials. Two researchers independently extracted the data and assessed the methological quality. A best evidence synthesis was conducted to summarize the results.

RESULTS

Eight controlled trials (5 RCTs, 3 CCTs) were included. Three types of interventions were identified: proprioceptive training, orthotic treatment, and functional electrostimulation (FES). In the included studies, the time since the stroke occurrence varied from the (sub)acute phase to the chronic phase. Only short-term effects were investigated. The adjustment from a form of proprioceptive training to physiotherapy training programs seems to be effective (moderate evidence) for treating knee hyperextension in gait, as applied in the subacute phase post-stroke. Neither evidence for effects on gait speed nor gait symmetry were found as a result of proprioceptive training. Orthoses that cover the knee have some effects (limited evidence) on knee hyperextension and gait speed. No evidence was found for FES.

SIGNIFICANCE

This is the first systematic literature review on the effectiveness of interventions on knee hyperextension in post-stroke gait. We found promising results (moderate evidence) for some "proprioceptive approaches" as an add-on therapy to physiotherapy training programs for treating knee hyperextension during the subacute phase post-stroke, in the short-term. Therefore, initially, clinicians should implement a training program with a proprioceptive approach in order to restore knee control in these patients. Because only studies reporting short-term results were found, more high-quality RCTs and CCTs are needed that also study mid- and long-term effects.

Analysis of Gait Characteristics Using Hip-Knee Cyclograms in Patients with Hemiplegic Stroke

Gait disturbance is a common sequela of stroke. Conventional gait analysis has limitations in simultaneously assessing multiple joints. Therefore, we investigated the gait characteristics in stroke patients using hip-knee cyclograms, which have the advantage of simultaneously visualizing the gait kinematics of multiple joints. Stroke patients (n = 47) were categorized into two groups according to stroke severity, and healthy controls (n = 32) were recruited. An inertial measurement unit sensor-based gait analysis system, which requires placing seven sensors on the dorsum of both feet, the shafts of both tibias, the middle of both femurs, and the lower abdomen, was used for the gait analysis. Then, the hip-knee cyclogram parameters (range of motion, perimeter, and area) were obtained from the collected data. The coefficient of variance of the cyclogram parameters was obtained to evaluate gait variability. The cyclogram parameters differed between the stroke patients and healthy controls, and differences according to stroke severity were also observed. The gait variability parameters mainly differed in patients with more severe stroke, and specific visualized gait patterns of stroke patients were obtained through cyclograms. In conclusion, the hip-knee cyclograms, which show inter-joint coordination and visualized gait cycle in stroke patients, are clinically significant.

Walking with robot-generated haptic forces in a virtual environment: a new approach to analyze lower limb coordination

Background

Walking with a haptic tensile force applied to the hand in a virtual environment (VE) can induce adaptation effects in both chronic stroke and non-stroke individuals. These effects are reflected in spatiotemporal outcomes such as gait speed. However, the concurrent kinematic changes occurring in bilateral lower limb coordination have yet to be explored.

Methods

Chronic stroke participants were stratified based on overground gait speed into lower functioning (LF < 0.8 m/s, N = 7) and higher functioning (HF ≥ 0.8 m/s, N = 7) subgroups. These subgroups and an age-matched control group (N = 14, CG) walked on a self-paced treadmill in a VE with either robot-generated haptic leash forces delivered to the hand and then released or with an instrumented cane. Walking in both leash (10 and 15 N) and cane conditions were compared to pre-force baseline values to evaluate changes in lower limb coordination outcomes.

Results

All groups showed some kinematic changes in thigh, leg and foot segments when gait speed increased during force and post-force leash as well as cane walking. These changes were also reflected in intersegmental coordination and 3D phase diagrams, which illustrated increased intersegmental trajectory areas (p < 0.05) and angular velocity. These increases could also be observed when the paretic leg transitions from stance to swing phases while walking with the haptic leash. The Sobolev norm values accounted for both angular position and angular velocity, providing a single value for potentially quantifying bilateral (i.e. non-paretic vs paretic) coordination during walking. These values tended to increase (p < 0.05) proportionally for both limbs during force and post-force epochs as gait speed tended to increase.

Conclusions

Individuals with chronic stroke who increased their gait speed when walking with tensile haptic forces and immediately after force removal, also displayed moderate concurrent changes in lower limb intersegmental coordination patterns in terms of angular displacement and velocity. Similar results were also seen with cane walking. Although symmetry was less affected, these findings appear favourable to the functional recovery of gait. Both the use of 3D phase diagrams and assigning Sobolev norm values are potentially effective for detecting and quantifying these coordination changes.

Pelvis-Toe Distance: 3-Dimensional Gait Characteristics of Functional Limb Shortening in Hemiparetic Stroke

We aimed to investigate whether a newly defined distance in the lower limb can capture the characteristics of hemiplegic gait compared to healthy controls. Three-dimensional gait analyses were performed on 42 patients with chronic stroke and 10 age-matched controls. Pelvis-toe distance (PTD) was calculated as the absolute distance between an anterior superior iliac spine marker and a toe marker during gait normalized by PTD in the bipedal stance. The shortening peak during the swing phase was then quantified as PTDmin. The sagittal clearance angle, the frontal compensatory angle, gait speed, and the observational gait scale were also collected. PTDmin in the stroke group showed less shortening on the affected side and excessive shortening on the non-affected side compared to controls. PTDmin on the affected side correlated negatively with the sagittal clearance peak angle and positively with the frontal compensatory peak angle in the stroke group. PTDmin in stroke patients showed moderate to high correlations with gait speed and observational gait scale. PTDmin adequately reflected gait quality without being affected by apparent improvements due to frontal compensatory patterns. Our results showed that various impairments and compensations were included in the inability to shorten PTD, which can provide new perspectives on gait rehabilitation in stroke patients.

Effects of different acupuncture methods combined with routine rehabilitation on gait of stroke patients

BACKGROUND

Stroke refers to a group of cerebrovascular diseases associated with organic brain injury. It is characterized by the sudden and rapid onset of focal or diffuse dysfunction. In recent years, in addition to routine treatment, Chinese medicine acupuncture has been administered to patients with hemiplegia, and it can be considered a new treatment for rehabilitation.

AIM

To investigate the effects of eye acupuncture needle retention and body acupuncture combined with routine rehabilitation on gait performance and plantar pressure in patients recovering from stroke.

METHODS

Thirty-two stroke patients who met the inclusion criteria were randomly divided into an experimental group and a control group, with 16 patients in each group. Both groups underwent routine rehabilitation. The experimental group was treated by eye acupuncture needle retention, and the control group was treated by body acupuncture. Before and after 4 wk of treatment, both groups underwent kinematic and plantar pressure synchronous tests to assess gait performance.

RESULTS

The step length, gait speed, step frequency, joint angles of the lower limbs, and ground reaction force impulse in the anterior region of the affected foot in both groups significantly increased from before to after treatment (P < 0.05); the center of mass displacement, peak pressure values, and impulse in the anterior region of the healthy foot and posterior regions of both the affected and healthy feet significantly decreased from before to after treatment (P < 0.05). The patients in the experimental group showed greater improvement in the following parameters than the control group: Step length, gait speed, step frequency, lower extremity joint angles, center of gravity displacement, and peak pressure values and impulse in the anterior and posterior regions of both the affected and healthy feet (P < 0.05).

CONCLUSION

Eye acupuncture needle retention and body acupuncture combined with routine rehabilitation can effectively improve the gait performance of patients recovering from stroke. Between these two treatments, eye acupuncture needle retention combined with routine treatment is better than body acupuncture, and it can be considered a practical and effective clinical treatment.

Factors Leading to Improved Gait Function in Patients with Subacute or Chronic Central Nervous System Impairments Who Receive Functional Training with the Robot Suit Hybrid Assistive Limb

The factors that lead to the improvement of gait function in patients with diseases of the central nervous system (CNS) who use a hybrid assistive limb (HAL) are not yet fully understood. The purpose of the present study was to analyze these factors to determine the prognosis of the patients' gait function. Patients whose CNS disease was within 180 days since onset were designated as the subacute-phase patients, and patients whose disease onset had occurred more than 180 days previously were designated as chronic-phase patients. Fifteen subacute-phase patients and 15 chronic-phase patients were given HAL training. The study analyzed how post-training walking independence in these patients was affected by the following factors: age, disease, lesion area, lower limb function, balance, period until the start of training, number of training sessions, additional rehabilitation, higher-order cognitive dysfunction, HAL model, and the use of a non-weight-bearing walking-aid. In subacute-phase patients, walking independence was related to lower limb function (r_s = 0.35). In chronic-phase patients, there was a statistically significant correlation between post-training walking independence and balance (r_s = 0.78). In addition, in patients with a severe motor dysfunction that was accompanied by inattention and global cognitive dysfunction, little improvement occurred, even with double-leg model training, because they had difficulty wearing the device. The results demonstrated that the factors that improved walking independence post HAL training differed between patients with subacute- and chronic-stage CNS diseases. The findings may serve as valuable information for future HAL training of patients with CNS diseases.

Quantitative assessment of retropulsion of the hip, excessive hip external rotation, and excessive lateral shift of the trunk over the unaffected side in hemiplegia using three-dimensional treadmill gait analysis

BACKGROUND

Gait assessment is important to determine the most effective strategy to regain gait function during stroke rehabilitation. To understand the mechanisms that cause abnormal gait patterns, it is useful to objectively identify and quantify the abnormal gait patterns. Objective assessment also helps evaluate the efficacy of treatments and can be used to provide suggestions for treatment.

OBJECTIVE

To evaluate the validity of quantitative indices for retropulsion of the hip, excessive hip external rotation, and excessive lateral shift of the trunk over the unaffected side in hemiplegic patients.

METHODS

Forty-six healthy control subjects and 112 hemiplegic patients participated. From the 112 patients, 50 patients were selected into each abnormal gait pattern with some overlap. Participants were instructed to walk on a treadmill and were recorded using a three-dimensional motion analysis system. An index to quantify each of the three abnormal gait patterns was calculated from the three-dimensional coordinate data. The index values of patients were compared with those of healthy subjects and with the results of observational gait assessment by three physical therapists with expertise in gait analysis.

RESULTS

Strong correlation was observed between the index value and the median observational rating for all three abnormal gait patterns (-0.56 to -0.74). Most of the patients with an abnormal gait pattern had a higher index value than the healthy subjects.

CONCLUSIONS

The proposed indices are useful for clinical gait analysis. Our results encourage a more detailed analysis of hemiplegic gait using a motion analysis system.

Effects of modified constraint-induced movement therapy on the lower extremities in patients with stroke: a pilot study

PURPOSE

This study aimed to qualify the improvements of modified constraint-induced movement therapy (m-CIMT) on the lower limb of stroke patients via assessing the centre of mass (COM) displacement and the basic gait parameters.

METHODS

A total of 22 hemiplegic patients after stroke with first-time clinical cerebral infarction or haemorrhagic cerebrovascular accident were included in this study from May to December, 2014. The patients were randomly divided into m-CIMT group and the conventional therapy group (control group), and received corresponding training for five days/week for four weeks. The COM displacement and gait parameters were assessed by three-dimensional segmental kinematics method in pre-intervention and post- intervention therapy.

RESULTS

After four weeks of m-CIMT, the COM displacement on sagittal plane of paretic leg during stance phase was increased (pre: 91.04 ± 4.39 cm, post: 92.38 ± 4.58 cm, p < 0.05) and swing range of frontal plane was remarkably decreased (pre: 10.15 ± 3.05 cm, post: 7.83 ± 1.90 cm, p < 0.001). Meantime, the normalised swing range of COM in m-CIMT was superior to that in control group. Moreover, the gait parameters, including velocity (0.27 m/s), step width (0.10 m), step length (0.22 m) and swing time percentage (29.80%), were significantly improved by post-interventions of m-CIMT (p < 0.05).

CONCLUSION

The m-CIMT intervention improves the COM displacement in sagittal and frontal plane, as well as gait parameters. These suggest that m-CIMT intervention may be feasible and effective for the rehabilitation of hemiplegic gait. Implications for Rehabilitation Segmental kinematics method was used to estimate the displacement of the COM. m-CIMT interventions improved the COM displacement of patients after stroke. m-CIMT interventions improved the hemiplegic gait parameters.

Muscle synergies and spinal maps are sensitive to the asymmetry induced by a unilateral stroke

Background

Previous studies have shown that a cerebrovascular accident disrupts the coordinated control of leg muscles during locomotion inducing asymmetric gait patterns. However, the ability of muscle synergies and spinal maps to reflect the redistribution of the workload between legs after the trauma has not been investigated so far.

Methods

To investigate this issue, twelve post-stroke and ten healthy participants were asked to walk on a treadmill at controlled speeds (0.5, 0.7, 0.9, 1.1 km/h), while the EMG activity of twelve leg muscles was recorded on both legs. The synergies underlying muscle activation and the estimated motoneuronal activity in the lumbosacral enlargement (L2-S2) were computed and compared between groups.

Results

Results showed that muscle synergies in the unaffected limb were significantly more comparable to those of the healthy control group than the ones in the affected side. Spinal maps were dissimilar between the affected and unaffected sides highlighting a significant shift of the foci of the activity toward the upper levels of the spinal cord in the unaffected leg.

Conclusions

Muscle synergies and spinal maps reflect the asymmetry as a motor deficit after stroke. However, further investigations are required to support or reject the hypothesis that the altered muscular organization highlighted by muscle synergies and spinal maps may be due to the concomitant contribution of the altered information coming from the upper part of the CNS, as resulting from the stroke, and to the abnormal sensory feedback due to the neuromuscular adaptation of the patients.

Relation between abnormal synergy and gait in patients after stroke

Background

The abnormal synergy seen in patients after stroke is considered to limit the ability of these patients. However, in the lower extremity, antigravity torque generation rather than precise movement is needed for functions such as sit-to-stand movement and gait. Therefore, the ability to generate torque may be important either as a primary movement or as an abnormal synergy. We attempted to quantify the torque generation in the lower limb, selectively and as an abnormal synergy, and its relation with gait.

Methods

Selectively generated plantar flexion torque in the ankle and plantar flexion torque secondarily generated accompanying maximal hip extension (i.e., torque generated with abnormal synergy) were measured in subjects after stroke and control subjects. In subjects after stroke, secondary torque generation while controlling hip extension torque as 25%, 50%, and 75% of the maximal hip extension was also measured. The relation of torque generation with the gait speed and timed-up-and go test (TUG) was also analyzed.

Results

In subjects after stroke, there was no difference between the amount of plantar flexion torque generated secondarily and the selectively generated torque, whereas the selective torque was significantly greater in control subjects. Pearson product–moment correlation coefficient analysis revealed that TUG speed is related to secondarily generated torque accompanying maximal hip extension but not with selectively generated torque.

Conclusion

Secondarily generated torque was found to be a factor that affects TUG speed, and the ability to generate torque even through abnormal synergy may help for gait ability in subjects after stroke.

Electronic supplementary material

The online version of this article (doi:10.1186/1743-0003-11-141) contains supplementary material, which is available to authorized users.

Comparison of Gait Aspects According to FES Stimulation Position Applied to Stroke Patients

[Purpose] This study sought to identify the gait aspects according to the FES stimulation position in stroke patients during gait training. [Subjects and Methods] To perform gait analysis, ten stroke patients were grouped based on 4 types of gait conditions: gait without FES stimulation (non-FES), gait with FES stimulation on the tibialis anterior (Ta), gait with FES stimulation on the tibialis anterior and quadriceps (TaQ), and gait with FES stimulation on the tibialis anterior and gluteus medius (TaGm). [Results] Based on repeated measures analysis of variance of measurements of gait aspects comprised of gait speed, gait cycle, and step length according to the FES stimulation position, the FES stimulation significantly affected gait aspects. [Conclusion] In conclusion, stimulating the tibialis anterior and quadriceps and stimulating the tibialis anterior and gluteus medius are much more effective than stimulating only the tibialis anterior during gait training in stroke patients using FES.

Spatio-temporal parameters and intralimb coordination patterns describing hemiparetic locomotion at controlled speed

Background

Comparison between healthy and hemiparetic gait is usually carried out while subjects walk overground at preferred speed. This generates bias due to the lack of uniformity across selected speeds because they reflect the great variability of the functional level of post-stroke patients. This study aimed at examining coordinative adaptations during walking in response to unilateral brain damage, while homologous participants walked at two fixed speeds.

Methods

Five patients with left and five with right chronic hemiparesis, characterized by similar level of motor functioning, were enrolled. Ten non-disabled volunteers were recruited as matched control group. Spatio-temporal parameters, and intralimb thigh-leg and leg-foot coordination patterns were used to compare groups while walking on a treadmill at 0.4 and 0.6 m/s. The likelihood of Continuous Relative Phase patterns between healthy and hemiparetic subjects was evaluated by means of the root mean square of the difference and the cross correlation coefficient. The effects of the group (i.e., healthy vs. hemiparetics), side (i.e., affected vs.unaffected), and speed (e.g., slow vs. fast) were analyzed on all metrics using the Analysis of Variance.

Results

Spatio-temporal parameters of all hemiparetic subjects did not significantly differ from those of healthy subjects nor showed any asymmetry between affected and unaffected limbs. Conversely, both thigh-leg and foot-leg coordination patterns appeared to account for pathology related modifications.

Conclusion

Comparisons between hemiparetic and healthy gait should be carried out when all participants are asked to seek the same suitable dynamic equilibrium led by the same external (i.e., the speed) and internal (i.e., severity of the pathology) conditions. In this respect, biomechanical adaptations reflecting the pathology can be better highlighted by coordinative patterns of coupled segments within each limb than by the spatio-temporal parameters. Accordingly, a deep analysis of the intralimb coordination may be helpful for clinicians while designing therapeutic treatments.

Associations between gait patterns, brain lesion factors and functional recovery in stroke patients

Brain CT scans and neurological condition were evaluated in 74 stroke patients. Firstly, we found that using a classification-tree technique based on CT scan parameters (an innovative method, analyzing four parameters simultaneously) coincided with our previously proposed kinematic artificial neural network (ANN) classification technique for 71.3% of patients. Lesion size and location were found to be the most significant CT scan predictors of gait classification. Secondly, we sought to gauge post-rehabilitation functional recovery in patients within the same three groups of gait pattern. We found significant differences in scores between the three gait pattern groups, before and after rehabilitation (Kruskal-Wallis test, p<0.001), while significant improvement was observed in each group (Wilcoxon text; p<0.01). We conclude that patient classification into pathological gait groups on the basis of gait or CT scan parameters may serve as an early predictor of future functional outcome.

The reliability of postural balance measures in single and dual tasking in elderly fallers and non-fallers

Background

The purpose of this study was to determine the reliability of a forceplate postural balance protocol in a group of elderly fallers and non-fallers. The measurements were tested in single and dual-task conditions, with and without vision.

Methods

37 elderly (mean age 73 ± 6 years) community-dwellers were included in this study. All were tested in a single (two-legged stance) and in a dual-task (two-legged stance while counting backwards aloud in steps of 7's) condition, with and without vision. A forceplate was used for registering postural variables: the maximal and the root-mean-square amplitude in medio-lateral (Max-ML, RMS-ML) and antero-posterior (Max-AP, RMS-AP) direction, mean velocity (MV), and the area of the 95% confidence ellipse (AoE). Reliability of the test protocol was expressed with intraclass correlation coefficients (ICC), with 95% limits of agreement (LoA), and with the smallest detectable difference (SDD).

Results

The ICCs for inter-rater reliability and test-retest reliability of the balance variables were r = 0.70–0.89. For the variables Max-AP and RMS-AP the ICCs were r = 0.52–0.74. The SDD values were for variable Max-ML and Max-AP between 0.37 cm and 0.83 cm, for MV between 0.48 cm/s and 1.2 cm/s and for AoE between 1.48 cm² and 3.75 cm². The LoA analysis by Bland-Altman plots showed no systematic differences between test-retest measurements.

Conclusion

The study showed good reliability results for group assessment and no systematic errors of the measurement protocol in measuring postural balance in the elderly in a single-task and dual-task condition.

Gait coordination after stroke: benefits of acoustically paced treadmill walking

BACKGROUND AND PURPOSE

Gait coordination often is compromised after stroke. The purpose of this study was to evaluate the efficacy of acoustically paced treadmill walking as a method for improving gait coordination in people after stroke.

PARTICIPANTS

Ten people after stroke volunteered for the study and comprised the experimental group. Nine elderly people who were healthy served as a control group.

METHODS

Gait cycle parameters, interlimb coordination, and auditory-motor coordination were examined while participants walked on a treadmill with and without acoustic pacing.

RESULTS

Stride frequency was adjusted to different acoustic pacing frequencies in all participants. In people after stroke, gait symmetry improved with acoustic pacing. They predominantly coordinated movements of the nonparetic limb to ipsilateral tones.

DISCUSSION AND CONCLUSION

The results suggest that acoustically paced treadmill walking provides an effective means for immediately modifying stride frequency and improving gait coordination in people after stroke and, therefore, may be usefully applied in physical therapist practice. Future research directions for developing guidelines for using acoustically paced treadmill walking in physical therapist practice are discussed.

Gluteal taping improves hip extension during stance phase of walking following stroke

The aim of this study was to determine whether gluteal taping on the affected side improved hip extension during stance phase of walking for persons following stroke. Fifteen subjects who had suffered a stroke months to years previously resulting in mild to moderate gait impairments participated in the study. Their gait was measured under control, sham, and gluteal taping conditions, in random order. For each condition, subjects walked at a self-selected and a fast speed. Hip angle relative to that obtained during quiet standing, step length, stride length and walking velocity were measured. Hip extension increased significantly with gluteal taping (p < 0.05) for both walking speeds at late stance phase of walk compared to sham taping and control. The mean absolute difference between gluteal and control conditions for self-selected velocity was 14.2 degrees (95% CI 8.6 to 19.8) whereas the difference between sham and control conditions was 2.0 degrees (95% CI -2.0 to 6.0). Also, for both speeds, step length on the unaffected side increased significantly with gluteal taping compared with either the control or placebo conditions. The absolute difference between gluteal taping and control conditions at self-selected velocity was 3.3 cm (95% CI 2.2 to 4.3) and between sham and control conditions was 0.6 cm (95% CI -0.8 to 1.9). Affected step length and walking velocity, however, remained unchanged. Lastly, there was no significant difference between the control and sham taping condition for any of the measured variables. Gluteal taping may be a useful adjunct to current rehabilitation gait training strategies.