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Fang L, Zhang W, Wu J, Yu H, Zhang H, Chen S, Zheng B, Cao M, Zhang Y, Dai L, Chen J. Effects of combining rTMs and augmented reality gait adaptive training on walking function of patients with stroke based on three-dimensional gait analysis and sEMG: a randomized controlled trial. Physiother Theory Pract 2024:1-11. [PMID: 39007911 DOI: 10.1080/09593985.2024.2378905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 07/06/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Augmented reality gait adaptive training (ARGAT) and repetitive transcranial magnetic stimulation (rTMS) have both demonstrated efficacy in improving lower limb motor function in survivors of stroke. PURPOSE To investigate the effects of combining rTMS and ARGAT on motor function in survivors of stroke. METHODS The experimental group received a combination of rTMS and ARGAT, while the control group received ARGAT alone. The interventions comprised a total of 20 sessions, conducted over four weeks with five consecutive daily sessions. Outcome measures included three-dimensional gait analysis (3DGA), surface electromyography (sEMG), Fugl-Meyer assessment for the lower extremity (FMA-LE), and the Berg Balance Scale (BBS). RESULTS Following the intervention, both groups showed significant improvements in walking speed, symmetry index, affected step length, affected stride length, FMA-LE, and BBS scores (p < .05). Furthermore, the experimental group demonstrated greater improvements in walking speed (F = 4.58, p = .040), cadence (F = 5.67, p = .023), affected step length (F = 5.79, p = .022), affected stride length (F = 4.84, p = .035), FMA-LE (Z = 2.43, p = .019), and BBS (F = 4.76, p = .036) compared to the control group. The experimental group demonstrated a significant improvement in the co-contraction index (CCI) of the knee joint (F = 14.88, p < .001), a change not observed in the control group (F = 2.16, p = .151). However, neither group showed significant alterations in CCI of the ankle joint (F = 1.58, p = .218), step width (F = 0.24, p = .630), unaffected step length (F = 0.22, p = .641), or unaffected stride length (F = 2.99, p = .093). CONCLUSION The combination of low-frequency rTMS and ARGAT demonstrated superior effects on motor function recovery compared to ARGAT alone in survivors of stroke.
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Affiliation(s)
- Linjie Fang
- The Affiliated Rehabilitation Hospital of Zhejiang Chinese Medical University (Zhejiang Rehabilitation Medical Center), Hangzhou, China
- Department of Center for Rehabilitation Assessment and Therapy, Zhejiang Rehabilitation Medical Center, Hangzhou, Zhejiang, China
- The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Wanying Zhang
- Department of Center for Rehabilitation Assessment and Therapy, Zhejiang Rehabilitation Medical Center, Hangzhou, Zhejiang, China
- The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jianing Wu
- Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Hong Yu
- The Affiliated Rehabilitation Hospital of Zhejiang Chinese Medical University (Zhejiang Rehabilitation Medical Center), Hangzhou, China
- Department of Center for Rehabilitation Assessment and Therapy, Zhejiang Rehabilitation Medical Center, Hangzhou, Zhejiang, China
| | - Huihuang Zhang
- The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Shishi Chen
- The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Beisi Zheng
- The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Manting Cao
- The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yujia Zhang
- The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Lei Dai
- Rehabilitation Center, Hefei Fourth People's Hospital, Hefei, Anhui, China
| | - Jianer Chen
- The Affiliated Rehabilitation Hospital of Zhejiang Chinese Medical University (Zhejiang Rehabilitation Medical Center), Hangzhou, China
- The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
- The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- Department of Geriatric Rehabilitation, Zhejiang Rehabilitation Medical Center, Hangzhou, Zhejiang, China
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Igusa T, Uchida H, Tsuchiya K, Sema S, Kaneko S, Yoshita T, Nagai S, Kobayashi T, Akiba T, Tanaka Y, Kikuchi S, Hirao K. Effects of rhythmic auditory stimulation on gait speed in older adult inpatients in a convalescent rehabilitation ward: a pilot randomized controlled trial. Eur Geriatr Med 2024:10.1007/s41999-024-01010-0. [PMID: 38890234 DOI: 10.1007/s41999-024-01010-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 06/12/2024] [Indexed: 06/20/2024]
Abstract
PURPOSE To assess the impact of gait training with rhythmic auditory stimulation (RAS) on enhancing gait speed in older people admitted to a convalescent rehabilitation ward (CRW), compared to conventional gait training methods. METHODS The study was designed as a single-center, open-label, pilot, randomized, parallel-group study. Thirty older people admitted to CRW were divided into two groups: the experimental group, which received gait training with RAS (n = 15, females = 53.3%, mean age = 83.9, SD = 6.5), and the control group, which underwent usual gait training (n = 15, females = 60.0%, mean age = 81.3, SD = 8.4). Regardless of their assigned group, all participants underwent 30 min training sessions, five times a week, for 3 weeks. The primary outcome was the 10 m walk test (10mWT), and the secondary outcomes included the Medical Outcome Study 8-Item Short-Form Health Survey and the Japanese version of the modified Gait Efficacy Scale. All measurements were taken at baseline and again at week 3. RESULTS Results indicated that older people in CRWs in the experimental group showed significant improvements in their 10mWT (effect size - 1.02) compared to the control group. None of the secondary outcomes were significant. CONCLUSIONS This study suggests the preliminary effectiveness and feasibility of a gait practice intervention using RAS in a CRW. TRIAL REGISTRATION The University Hospital Medical Information Network (UMIN) Registered 1 October 2022 (UMIN000049089).
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Affiliation(s)
- Takumi Igusa
- Graduate School of Health Sciences, Gunma University, 3-39-22 Showa, Maebashi, Gunma, 371-8514, Japan
- Department of Rehabilitation, Medical Corporation Taiseikai, Uchida Hospital, Numata, Japan
| | - Hiroyuki Uchida
- Graduate School of Health Sciences, Gunma University, 3-39-22 Showa, Maebashi, Gunma, 371-8514, Japan
- Department of Rehabilitation, Kurashiki Heisei Hospital, Kurashiki, Japan
| | - Kenji Tsuchiya
- Department of Rehabilitation, Faculty of Health Sciences, Nagano University of Health and Medicine, Nagano, Japan
| | - Shota Sema
- Department of Rehabilitation, Medical Corporation Taiseikai, Uchida Hospital, Numata, Japan
| | - Shunsuke Kaneko
- Department of Rehabilitation, Medical Corporation Taiseikai, Uchida Hospital, Numata, Japan
| | - Taiki Yoshita
- Department of Rehabilitation, Medical Corporation Taiseikai, Uchida Hospital, Numata, Japan
| | - Sakyo Nagai
- Department of Rehabilitation, Medical Corporation Taiseikai, Uchida Hospital, Numata, Japan
| | - Takuya Kobayashi
- Graduate School of Health Sciences, Gunma University, 3-39-22 Showa, Maebashi, Gunma, 371-8514, Japan
- Department of Rehabilitation, Japan Community Healthcare Organization, Gunma Chuo Hospital, Maebashi, Japan
| | - Takanari Akiba
- Department of Rehabilitation, Japan Community Healthcare Organization, Gunma Chuo Hospital, Maebashi, Japan
| | - Yukiko Tanaka
- Department of Rehabilitation, Medical Corporation Taiseikai, Uchida Hospital, Numata, Japan
| | - Senichiro Kikuchi
- Graduate School of Health Sciences, Gunma University, 3-39-22 Showa, Maebashi, Gunma, 371-8514, Japan
| | - Kazuki Hirao
- Graduate School of Health Sciences, Gunma University, 3-39-22 Showa, Maebashi, Gunma, 371-8514, Japan.
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Ouendi N, Hubaut R, Pelayo S, Anceaux F, Wallard L. The rehabilitation robot: factors influencing its use, advantages and limitations in clinical rehabilitation. Disabil Rehabil Assist Technol 2024; 19:546-557. [PMID: 35921160 DOI: 10.1080/17483107.2022.2107095] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 07/14/2022] [Accepted: 07/24/2022] [Indexed: 10/16/2022]
Abstract
PURPOSE Despite the proven effectiveness of rehabilitation robots (RR) in the literature, they are still little used in clinical rehabilitation. The aim of this study was to analyse the factors influencing the use of RR and the perception of therapists who used RR. METHOD In order to characterize the factors influencing the use of RR by therapists, a semi-structured interview was conducted with 18 therapists. These interviews are based on an interview guide inspired by the Unified Theory of Acceptance and Use of Technology model. The interviews were recorded and then transcribed, summarized and finally synthesized cross-sectionally. In addition and in parallel, the System Usability Scale (SUS) was also proposed to clinicians in order to collect quantitative data. RESULTS The interviews highlight the facilitators perceived by the therapists, such as the intensity of the movement, the complementarity with conventional rehabilitation. The results also showed the possible barriers perceived, these can be sometimes inconclusive (e.g., bugs). The SUS results show no effect, either on the gender of the users, their therapists, or the duration of use of the tool. CONCLUSION Better communication on the functionality of the robot and the construction of achievable goals would lead to more results that are conclusive but also better patient care. To date, and despite the evidence for the effectiveness of RRs, therapists believe that there are still many barriers to their use. They agree, however, that if changes are made, RRs will become an integral part of therapy.IMPLICATIONS FOR REHABILITATIONThe study idenfied and highlighted the factors influencing the use of the rehabilitation robot in the clinics through metric and ergonomic evaluations.The study allowed to quantify the level of acceptance of the Lokomat among therapists.This study allowed to identify negative factors that could be resolved through the implementation of a structured and generalized protocol for patients and thus improve their care.
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Affiliation(s)
- Nawel Ouendi
- Laboratoire d'Automatique de Mécanique et d'Informatique Industrielles et Humaines, Univ. Polytechnique Hauts-de-France, CNRS, UMR 8201 - LAMIH, Valenciennes, France
| | - Remy Hubaut
- Laboratoire d'Automatique de Mécanique et d'Informatique Industrielles et Humaines, Univ. Polytechnique Hauts-de-France, CNRS, UMR 8201 - LAMIH, Valenciennes, France
| | - Sylvia Pelayo
- Évaluation des technologies de santé et des pratiques médicales, & Inserm -CIC-IT 1403, Univ. Lille, CHU Lille, ULR 2694 - METRICS, Lille, France
| | - Françoise Anceaux
- Laboratoire d'Automatique de Mécanique et d'Informatique Industrielles et Humaines, Univ. Polytechnique Hauts-de-France, CNRS, UMR 8201 - LAMIH, Valenciennes, France
| | - Laura Wallard
- Laboratoire d'Automatique de Mécanique et d'Informatique Industrielles et Humaines, Univ. Polytechnique Hauts-de-France, CNRS, UMR 8201 - LAMIH, Valenciennes, France
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Varas-Diaz G, Bhatt T, Oken B, Roth E, Hayes J, Cordo P. Concurrent ankle-assisted movement, biofeedback, and proprioceptive stimulation reduces lower limb motor impairment and improves gait in persons with stroke. Physiother Theory Pract 2024; 40:477-486. [PMID: 36102364 DOI: 10.1080/09593985.2022.2122763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 07/20/2022] [Accepted: 09/05/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Persons with stroke live with residual sensorimotor impairments in their lower limbs (LL), which affects their gait. PURPOSE We investigated whether these residual impairments and resulting gait deficits can be reduced through concurrently applied assisted movement, biofeedback, and proprioceptive stimulation. METHODS A robotic device provided impairment-oriented training to the affected LL of 24 persons with stroke (PwS) with moderate-to-severe LL impairment. Participants were given 22-30 training sessions over 2-3 months. During training, the interventional device cyclically dorsiflexed and plantarflexed the ankle at 5 deg/s through ±15 deg for 30 min while the participant assisted with the imposed movement. Concurrently, participants received visual biofeedback of assistive joint torque or agonist EMG while mechanical vibration was applied to the currently lengthening (i.e. antagonist) tendon. RESULTS Sensorimotor impairment significantly decreased over the training period, which was sustained over 3 months, based on the Fugl-Meyer Assessment (FMA-LL) (p < .001), modified Ashworth scale in dorsiflexors (p < .05), and an ankle strength test (dorsiflexors and plantarflexors) (p < .05). Balance and gait also improved, based on the Tinetti Performance Oriented Mobility Assessment (POMA) (p < .05). CONCLUSION Impairment-oriented training using a robotic device capable of applying assisted movement, biofeedback, and proprioceptive stimulation significantly reduces LL impairment and improves gait in moderately-to-severely impaired PwS.
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Affiliation(s)
- Gonzalo Varas-Diaz
- School of Kinesiology, Faculty of Medicine, Universidad Finis Terrae, Santiago, Chile
- Department of Physical Therapy, University of Illinois at Chicago, College of Applied Health Sciences, Chicago, IL, USA
| | - Tanvi Bhatt
- Department of Physical Therapy, University of Illinois at Chicago, College of Applied Health Sciences, Chicago, IL, USA
| | - Barry Oken
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA
| | - Elliot Roth
- Department of Physical Medicine and Rehabilitation, Northwestern University, Evanston, IL, USA
| | - John Hayes
- College of Optometry, Pacific University, Forest Grove, OR, USA
| | - Paul Cordo
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA
- AMES Technology Inc, Portland, OR, USA
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5
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Olsen S, Alder G, Rashid U, Gomes E, Aislabie M, Chee F, Smith C, Kean B, Towersey N, Signal N. Challenge Level Contributes to the Efficacy of Treadmill Interventions after Stroke: A Systematic Review and Meta-Analysis. Brain Sci 2023; 13:1729. [PMID: 38137177 PMCID: PMC10741427 DOI: 10.3390/brainsci13121729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/09/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023] Open
Abstract
Intervention parameters such as the challenge, amount, and dosage (challenge × amount) have the potential to alter the efficacy of rehabilitation interventions after stroke. This systematic review investigated the effect of intervention parameters of challenge, amount, and dosage on improvements in walking outcomes following treadmill training (TT) and comparison interventions in people with stroke. Randomized controlled trials were included if they: (i) investigated interventions of TT or bodyweight-supported TT (BWSTT); (ii) made comparisons with other physiotherapy interventions, other types of TT, or no intervention; (iii) studied people with stroke; (iv) reported sufficient data on challenge and amount parameters; and (v) measured walking speed or endurance. Completeness of reporting was evaluated using the TIDieR-Rehab checklist and risk of bias was assessed using the revised Cochrane risk-of-bias tool. The review included 26 studies; 15 studies compared TT or BWSTT with other physiotherapy interventions and 11 studies compared different types of TT. Meta-analyses provided evidence with low to moderate certainty that greater differences in challenge and dosage between treadmill and comparison physiotherapy interventions produced greater effects on walking endurance (p < 0.01). However, challenge and dosage did not influence walking speed outcomes. The analysis of intervention amount was limited by the lack of studies that manipulated the amount of intervention. Overall, the findings indicate that, after stroke, some of the efficacy of TT on walking endurance can be explained by the challenge level during training. This supports the implementation of TT at higher challenge levels in stroke rehabilitation practice.
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Affiliation(s)
- Sharon Olsen
- Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland 0627, New Zealand; (G.A.); (U.R.); (E.G.); (N.T.); (N.S.)
| | - Gemma Alder
- Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland 0627, New Zealand; (G.A.); (U.R.); (E.G.); (N.T.); (N.S.)
| | - Usman Rashid
- Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland 0627, New Zealand; (G.A.); (U.R.); (E.G.); (N.T.); (N.S.)
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland 1060, New Zealand
| | - Emeline Gomes
- Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland 0627, New Zealand; (G.A.); (U.R.); (E.G.); (N.T.); (N.S.)
| | - Madeleine Aislabie
- Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland 0627, New Zealand; (G.A.); (U.R.); (E.G.); (N.T.); (N.S.)
| | - Fran Chee
- Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland 0627, New Zealand; (G.A.); (U.R.); (E.G.); (N.T.); (N.S.)
| | - Caitlin Smith
- Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland 0627, New Zealand; (G.A.); (U.R.); (E.G.); (N.T.); (N.S.)
| | - Brody Kean
- Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland 0627, New Zealand; (G.A.); (U.R.); (E.G.); (N.T.); (N.S.)
| | - Nicola Towersey
- Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland 0627, New Zealand; (G.A.); (U.R.); (E.G.); (N.T.); (N.S.)
| | - Nada Signal
- Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland 0627, New Zealand; (G.A.); (U.R.); (E.G.); (N.T.); (N.S.)
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6
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Burley CV, Casey AN, Jones MD, Wright KE, Parmenter BJ. Nonpharmacological approaches for pain and symptoms of depression in people with osteoarthritis: systematic review and meta-analyses. Sci Rep 2023; 13:15449. [PMID: 37723233 PMCID: PMC10507102 DOI: 10.1038/s41598-023-41709-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 08/30/2023] [Indexed: 09/20/2023] Open
Abstract
People with osteoarthritis often experience pain and depression. These meta-analyses examined and compared nonpharmacological randomized controlled trials (RCTs) for pain and symptoms of depression in people living with osteoarthritis. RCTs published up until April 2022 were sourced by searching electronic databases EMBASE, PUBMED & MEDLINE, Web of Science, CINAHL and PEDro. Random-effects meta-analyses were performed to calculate pooled effect sizes (ES) and 95% confidence intervals (CI) for pain and depression. Subgroup analyses examined intervention subtypes. For pain, 29 interventions (n = 4382; 65 ± 6.9 years; 70% female), revealed a significant effect on reducing pain (ES = 0.43, 95% CI [0.25, 0.61], p < 0.001). Effect sizes were significant (p < 0.001) for movement meditation (ES = 0.52; 95% CI [0.35, 0.69]), multimodal approaches (ES = 0.37; 95% CI [0.22, 0.51]), and psychological therapy (ES = 0.21; 95% CI [0.11, 0.31]), and significant (p = 0.046) for resistance exercise (ES = 0.43, 95% CI [- 0.07, 0.94]. Aerobic exercise alone did not improve pain. For depression, 28 interventions (n = 3377; 63 ± 7.0 years; 69% female), revealed a significant effect on reducing depressive symptoms (ES = 0.29, 95% CI [0.08, 0.49], p < 0.001). Effect sizes were significant for movement meditation (ES = 0.30; 95% CI [0.06, 0.55], p = 0.008) and multimodal interventions (ES = 0.12; 95% CI [0.07, 0.18], p < 0.001). Resistance/aerobic exercise or therapy alone did not improve depressive symptoms. Mind-body approaches were more effective than aerobic/resistance exercise or therapy alone for reducing pain and depression in people with osteoarthritis.Systematic review registration: PROSPERO CRD42022338051.
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Affiliation(s)
- Claire V Burley
- UNSW Medicine & Health Lifestyle Clinic, School of Health Sciences, University of New South Wales, Sydney, Australia.
- Centre for Healthy Brain Ageing, School of Clinical Medicine, University of New South Wales, Sydney, Australia.
| | - Anne-Nicole Casey
- Centre for Healthy Brain Ageing, School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Matthew D Jones
- Department of Exercise Physiology, School of Health Sciences, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Kemi E Wright
- Department of Exercise Physiology, School of Health Sciences, University of New South Wales, Sydney, Australia
| | - Belinda J Parmenter
- UNSW Medicine & Health Lifestyle Clinic, School of Health Sciences, University of New South Wales, Sydney, Australia
- Department of Exercise Physiology, School of Health Sciences, University of New South Wales, Sydney, Australia
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7
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Dantas MTAP, Fernani DCGL, Silva TDD, Assis ISAD, Carvalho ACD, Silva SB, Abreu LCD, Barbieri FA, Monteiro CBDM. Gait Training with Functional Electrical Stimulation Improves Mobility in People Post-Stroke. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095728. [PMID: 37174247 PMCID: PMC10178257 DOI: 10.3390/ijerph20095728] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/08/2023] [Accepted: 04/17/2023] [Indexed: 05/15/2023]
Abstract
(1) Background: Stroke is one of the leading causes of disability. To identify the best treatment strategies for people with stroke (PwS), the aim of the current study was to compare the effects of training on a treadmill with functional electrical stimulation (TT-FES) with training on a treadmill (TT), and to analyze the effects of sequence of training on mobility and the parameters of walking ability. (2) Methods: Prospective, longitudinal, randomized and crossover study, in which 28 PwS were distributed into groups, namely the A-B Group (TT-FES followed by TT) and B-A Group (TT followed by TT-FES), using the foot drop stimulator, and were measured with functional tests. (3) Results: We found improved mobility, balance, non-paretic limb coordination, and endurance only in the group that started with TT-FES. However, sensorimotor function improved regardless of the order of training, and paretic limb coordination only improved in the B-A Group, but after TT-FES. These data indicate that the order of the protocols changed the results. (4) Conclusions: Although biomechanical evaluation methods were not used, which can be considered a limitation, our results showed that TT-FES was superior to isolated training on a treadmill with regard to balance, endurance capacity, and coordination of the non-paretic limb.
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Affiliation(s)
- Maria Tereza Artero Prado Dantas
- Laboratory Design and Scientific Writing, Department of Basic Sciences, ABC Faculty of Medicine, Santo André 09060-650, Brazil
- School of Arts, Sciences and Humanities, University of São Paulo (EACH/USP), São Paulo 03828-000, Brazil
- Course of Physiotherapy, University of West Paulista (UNOESTE), Presidente Prudente 19050-920, Brazil
| | - Deborah Cristina Gonçalves Luiz Fernani
- Laboratory Design and Scientific Writing, Department of Basic Sciences, ABC Faculty of Medicine, Santo André 09060-650, Brazil
- Course of Physiotherapy, University of West Paulista (UNOESTE), Presidente Prudente 19050-920, Brazil
| | - Talita Dias da Silva
- Postgraduate Program in Medicine (Cardiology) at Paulista School of Medicine, Federal University of São Paulo (EPM/UNIFESP), São Paulo 04024-002, Brazil
- Faculty of Medicine, University City of Sao Paulo (UNICID), São Paulo 03071-000, Brazil
| | - Iramaia Salomão Alexandre de Assis
- Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), São Paulo State University (UNESP), Bauru 17033-360, Brazil
| | | | - Sidney Benedito Silva
- Laboratory Design and Scientific Writing, Department of Basic Sciences, ABC Faculty of Medicine, Santo André 09060-650, Brazil
| | - Luiz Carlos de Abreu
- Laboratory Design and Scientific Writing, Department of Basic Sciences, ABC Faculty of Medicine, Santo André 09060-650, Brazil
- Department of Integrated Health Education, Federal University of Espírito Santo (UFES), Vitória 29040-090, Brazil
| | - Fabio Augusto Barbieri
- Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), São Paulo State University (UNESP), Bauru 17033-360, Brazil
| | - Carlos Bandeira de Mello Monteiro
- Laboratory Design and Scientific Writing, Department of Basic Sciences, ABC Faculty of Medicine, Santo André 09060-650, Brazil
- School of Arts, Sciences and Humanities, University of São Paulo (EACH/USP), São Paulo 03828-000, Brazil
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8
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Hao J, Buster TW, Cesar GM, Burnfield JM. Virtual reality augments effectiveness of treadmill walking training in patients with walking and balance impairments: A systematic review and meta-analysis of randomized controlled trials. Clin Rehabil 2023; 37:603-619. [PMID: 36366806 DOI: 10.1177/02692155221138309] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To systematically summarize and examine current evidence regarding the combination of virtual reality and treadmill training in patients with walking and balance impairments. DATA SOURCES English language randomized controlled trials, participants with walking and balance impairments, intervention group used virtual reality and treadmill, control group only used treadmill with the same training frequency and number of sessions. Six bioscience and engineering databases were searched. METHODS Two independent reviewers conducted study selection, data extraction, and quality assessment. Methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) scale. RESULTS Sixteen randomized controlled trials including 829 participants were identified. Compared to treadmill-only training, virtual reality augmented treadmill training induced significantly faster walking (p < 0.001; standardized mean difference (SMD) = 0.55, 95%CI: 0.30 to 0.81), longer step length (p < 0.001; SMD = 0.74, 95%CI: 0.42 to 1.06), narrower step width (p = 0.03; SMD = -0.52, 95%CI: -0.97 to -0.06), longer single leg stance period (p = 0.003; SMD = 0.77, 95%CI: 0.27 to 1.27), better functional mobility (p = 0.003; SMD = -0.44, 95%CI: - 0.74 to -0.15), improved balance function (p = 0.04; SMD = 0.24, 95%CI: 0.01 to 0.47), and enhanced balance confidence (p = 0.03; SMD = 0.73, 95%CI: 0.08 to 1.37). Walking endurance did not differ significantly between groups (p = 0.21; SMD = 0.13, 95%CI: -0.07 to 0.34). CONCLUSIONS Virtual reality augmented treadmill walking training enhances outcomes compared to treadmill-only training in patients with walking and balance impairments. The results of this review support the clinical significance of combining virtual reality with treadmill training with level 1A empirical evidence.
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Affiliation(s)
- Jie Hao
- Institute for Rehabilitation Science and Engineering, 20936Madonna Rehabilitation Hospitals, Lincoln, NE, USA
- Division of Physical Therapy Education, 12284University of Nebraska Medical Center, Omaha, NE, USA
| | - Thad W Buster
- Institute for Rehabilitation Science and Engineering, 20936Madonna Rehabilitation Hospitals, Lincoln, NE, USA
| | - Guilherme M Cesar
- Institute for Rehabilitation Science and Engineering, 20936Madonna Rehabilitation Hospitals, Lincoln, NE, USA
| | - Judith M Burnfield
- Institute for Rehabilitation Science and Engineering, 20936Madonna Rehabilitation Hospitals, Lincoln, NE, USA
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9
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Igusa T, Kobayashi T, Uchida H, Tsuchiya K, Akiba T, Sema S, Kaneko S, Yoshita T, Nagai S, Tanaka Y, Kikuchi S, Hirao K. Effect of gait training using rhythmic auditory stimulation on gait speed in older adults admitted to convalescent rehabilitation wards: A study protocol for a pilot randomized controlled clinical trial. Contemp Clin Trials Commun 2023; 33:101125. [PMID: 37091510 PMCID: PMC10119504 DOI: 10.1016/j.conctc.2023.101125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/23/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
Background Decreased walking speed in older patients admitted to convalescent rehabilitation wards (CRWs) is one of the factors that inhibit home discharge. Therefore, interventions to improve gait speed in older patients admitted to CRWs are important, and rhythmic auditory stimulation (RAS) may be an effective intervention strategy. However, the effect of RAS on gait speed in older patients admitted to CRWs is not well known. Therefore, this study protocol aims to determine the feasibility of the RAS-based gait practice for older patients admitted to the CRW. Methods The study is designed as a single-center, open-label, pilot, randomized, parallel-group study. Participants will be 30 patients aged ≥65 years admitted to the CRW and randomly assigned to the experimental group (RAS-based gait practice; n = 15) or the control group (normal gait practice; n = 15). In both groups, interventions will be conducted for 30 min per session, 5 times per week for 3 weeks. The primary outcome is the change in the 10-m walk test 3 weeks after the baseline assessment. Secondary outcome is the change in the score of the Medical Outcome Study 8-Item Short-Form Health Survey and the Japanese version of the modified Gait Efficacy Scale from baseline assessment to 3 weeks later. Discussion This exploratory RCT was developed using strict scientific standards and is based on defined protocols. Thus, this study will be used to assess the viability of a larger investigation into RAS-based gait practice. If our theory is accurate, this study could serve as a foundation for establishing RAS-based gait practice in CRWs as a common rehabilitation strategy. Trial registration This study was registered in the University Hospital Medical Information Network (UMIN) clinical trials registry in Japan (UMIN000049089).
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Affiliation(s)
- Takumi Igusa
- Graduate School of Health Sciences, Gunma University, Maebashi, Japan
- Department of Rehabilitation, Medical Corporation Taiseikai, Uchida Hospital, Numata, Japan
| | - Takuya Kobayashi
- Graduate School of Health Sciences, Gunma University, Maebashi, Japan
- Department of Rehabilitation, Japan Community Healthcare Organization, Gunma Chuo Hospital, Maebashi, Japan
| | - Hiroyuki Uchida
- Department of Rehabilitation, Kurashiki Heisei Hospital, Kurashiki, Japan
| | - Kenji Tsuchiya
- Department of Rehabilitation, Faculty of Health Sciences, Nagano University of Health and Medicine, Nagano, Japan
| | - Takanari Akiba
- Department of Rehabilitation, Japan Community Healthcare Organization, Gunma Chuo Hospital, Maebashi, Japan
| | - Shota Sema
- Department of Rehabilitation, Medical Corporation Taiseikai, Uchida Hospital, Numata, Japan
| | - Shunsuke Kaneko
- Department of Rehabilitation, Medical Corporation Taiseikai, Uchida Hospital, Numata, Japan
| | - Taiki Yoshita
- Department of Rehabilitation, Medical Corporation Taiseikai, Uchida Hospital, Numata, Japan
| | - Sakyo Nagai
- Department of Rehabilitation, Medical Corporation Taiseikai, Uchida Hospital, Numata, Japan
| | - Yukiko Tanaka
- Department of Rehabilitation, Medical Corporation Taiseikai, Uchida Hospital, Numata, Japan
| | - Senichiro Kikuchi
- Graduate School of Health Sciences, Gunma University, Maebashi, Japan
| | - Kazuki Hirao
- Graduate School of Health Sciences, Gunma University, Maebashi, Japan
- Corresponding author. Graduate School of Health Sciences, Gunma University, 3-39-22 Showa, Maebashi, Gunma, 371-8514, Japan.
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Chan H, Lam PY, Cheung CY, Chow KT, Lau CH, Lee KY, Po SY, Askin N, Rabbani R, Zarychanski R, Abou-Setta AM. Inclined treadmill training (ITT) for people with chronic stroke - a systematic review and meta-analysis. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2022. [DOI: 10.1080/21679169.2022.2161628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Hong Chan
- College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Pui Yan Lam
- Physiotherapy Department, Kowloon Hospital, Hospital Authority, Hong Kong, China
| | - Chung Yan Cheung
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Kai Tak Chow
- Physiotherapy Department, Kowloon Hospital, Hospital Authority, Hong Kong, China
| | - Chun Ho Lau
- Physiotherapy Department, Kowloon Hospital, Hospital Authority, Hong Kong, China
| | - Ka Ying Lee
- Physiotherapy Department, Kowloon Hospital, Hospital Authority, Hong Kong, China
| | - Sing Yu Po
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Nicole Askin
- Neil John Maclean Health Sciences Library, University of Manitoba, Winnipeg, Canada
| | - Rasheda Rabbani
- George & Fay Yee Center for Healthcare Innovation, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Ryan Zarychanski
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Ahmed M. Abou-Setta
- George & Fay Yee Center for Healthcare Innovation, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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11
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Wang D, Li L, Pan H, Huang L, Sun X, He C, Wei Q. Comparison of the Effects of Constraint-Induced Movement Therapy and Unconstraint Exercise on Oxidative Stress and Limb Function-A Study on Human Patients and Rats with Cerebral Infarction. Brain Sci 2022; 13:brainsci13010004. [PMID: 36671986 PMCID: PMC9856592 DOI: 10.3390/brainsci13010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/25/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
Most conventional post-stroke rehabilitation treatments do not involve imposed constraints of the unaffected limb. In contrast, Constraint-Induced Movement Therapy (CIMT) is comprised of massed task practice with the affected limb and constraint of the unaffected limb. CIMT is a promising rehabilitation technique used for motor recovery of affected limbs after stroke, but its effectiveness and mechanism are not fully understood. We compared the effects of the two exercise modes on limb function post-stroke in animal models and human subjects, and investigated whether oxidative stress response was involved in regulating the effects. We first conducted a randomized controlled trial (RCT), in which 84 subjects with cerebral infarction were assigned to dose-matched constraint-induced movement therapy (CIMT), or unconstraint exercise (UE), or conventional rehabilitation treatment. Motor functions of the limb are primary outcomes of the RCT measured using Brief Fugl-Meyer upper extremity score (FMA-UE), Ashworth score, and Barthel scale. Psychological influence of CIMT and UE was also examined using Self-Rating Depression Scale (SDS). Next, we investigated the effects of CIMT and UE in rats undergoing middle cerebral artery occlusion and reperfusion (MCAO/R). Motor function, infarct volume, and pathohistological changes were investigated by mNSS, MRI, and histological studies. The role of Keap1-Nrf2-ARE was investigated using qRT-PCR, Western blot, immunochemistry, immunofluorescence, and ELISA experiments. In RCT, patients taking CIMT had a higher score in FMA-UE, Barthel index, and SDS, and a lower score in modified Ashworth, compared to those taking UE. In rats receiving CIMT, motor function was increased, and infarct volume was decreased compared to those receiving UE. The expression of Keap1 protein and mRNA in the peri-infarct tissue was decreased, and Nrf2 and ARE protein and mRNA were increased in rats receiving CIMT compared with UE. Nrf2 agonist t-BHQ increased the benefits of CIMT. In conclusion, CIMT is more effective than UE in improving upper limb motor function, reducing muscle spasm in patients with cerebral infarction compared to UE, but patients receiving CIMT may feel depressed. Moreover, both CIMT and UE are beneficial to limb function recovery and limit the infarct expansion in MCAO/R rats, but CIMT was more effective than UE. Oxidative stress reaction has an essential role in regulating the CIMT induced benefits.
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Affiliation(s)
- Dong Wang
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 611135, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Sichuan University, Chengdu 611135, China
- Department of Rehabilitation Medicine, Affiliated Hospital of Chengdu University, Chengdu 610081, China
| | - Lijuan Li
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 611135, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Sichuan University, Chengdu 611135, China
| | - Hongxia Pan
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 611135, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Sichuan University, Chengdu 611135, China
| | - Liyi Huang
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 611135, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Sichuan University, Chengdu 611135, China
| | - Xin Sun
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 611135, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Sichuan University, Chengdu 611135, China
| | - Chengqi He
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 611135, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Sichuan University, Chengdu 611135, China
| | - Quan Wei
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 611135, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Sichuan University, Chengdu 611135, China
- Correspondence: ; Tel.: +86-2885422847
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Karpatkin H, Rachwani J, Rhodes R, Rodriguez L, Rodriguez R, Rubeo A, Cohen E. The effect of intermittent vs. continuous walking on distance to fatigue in persons with multiple sclerosis. Disabil Rehabil 2022; 44:8429-8435. [PMID: 35297715 DOI: 10.1080/09638288.2021.2018055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE Previous studies provided evidence that persons with Multiple Sclerosis (pwMS) who walk intermittently experience less fatigue and walk longer distances than when walking continuously. However, total distance pwMS can walk in either condition is unknown. We examined time and distance to fatigability in pwMS comparing intermittent walking (IW) to continuous walking (CW). MATERIALS AND METHODS 18 pwMS, with Expanded Disability Status Scale median of 4.75 [range = 2-6.5, IQR = 2.5] participated in this randomized crossover study. The IW condition consisted of alternating 30 s treadmill walking and 30 s seated rests. The CW condition consisted of treadmill walking without breaks. Treadmill speed (TS) was determined by an overground 2-min walk test. Walking fatigability was determined by participants walking on the treadmill, until gait fatigue was noted by patient or examiners. Total time and distance to gait fatigue, and subjective fatigue as measured by the Visual analog scale of fatigue were recorded. RESULTS Participants had significantly longer duration and distance to fatigue in the IW condition than the CW condition (ps ≤ 0.037). No difference in VASF scores between the two conditions were noted. CONCLUSION In this sample, IW allowed pwMS to perform a greater volume of walking and can be an option to improve walking endurance in this population.IMPLICATIONS FOR REHABILITATIONMultiple sclerosis (MS) is a disease that progressively impacts walking, resulting in a decrease in the maximum distance that a person with MS can walk.Intermittent walking has been shown to improve 6-min walk test performance in persons with MS (pwMS) compared to continuous walking, but its effects on longer and shorter walks is not known.The use of distance to fatigue should be considered a viable option for measuring walking fatigability in pwMS as it does not exclude persons based on their ability to complete a 6-min walk, nor would it be too easy for persons with pwMS with mild disability.By using distance to fatigue as an outcome measure, this study provides evidence that intermittent walking results in less fatigability regardless of walking ability.PwMS, regardless of their walking ability, can walk longer distances intermittently than continuously, suggesting that clinical treatment of walking fatigability in pwMS should utilize intermittent rather than continuous walking training.
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Affiliation(s)
- Herbert Karpatkin
- Department of Physical Therapy, Hunter College, City University of New York, New York, NY, USA
| | - Jaya Rachwani
- Department of Physical Therapy, Hunter College, City University of New York, New York, NY, USA
| | - Rachel Rhodes
- Department of Physical Therapy, Hunter College, City University of New York, New York, NY, USA
| | - Lourdes Rodriguez
- Department of Physical Therapy, Hunter College, City University of New York, New York, NY, USA
| | - Rosie Rodriguez
- Department of Physical Therapy, Hunter College, City University of New York, New York, NY, USA
| | - Anna Rubeo
- Department of Physical Therapy, Hunter College, City University of New York, New York, NY, USA
| | - Evan Cohen
- Department of Rehabilitation and Movement Sciences, Rutgers, The State University of New Jersey, Blackwood, NJ, USA
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Cherni Y, Tremblay A, Simon M, Bretheau F, Blanchette AK, Mercier C. Corticospinal Responses Following Gait-Specific Training in Stroke Survivors: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15585. [PMID: 36497663 PMCID: PMC9737604 DOI: 10.3390/ijerph192315585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/22/2022] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
Corticospinal excitability is subject to alterations after stroke. While the reversal of these alterations has been proposed as an underlying mechanism for improved walking capacity after gait-specific training, this has not yet been clearly demonstrated. Therefore, the objective of this review is to evaluate the effect of gait-specific training on corticospinal excitability in stroke survivors. We conducted an electronic database search in four databases (i.e., Medline, Embase, CINAHL and Web of Science) in June 2022. Two authors screened in an independent way all the studies and selected those that investigated the effect of gait-specific training on variables such as motor-evoked potential amplitude, motor threshold, map size, latency, and corticospinal silent period in stroke survivors. Nineteen studies investigating the effect of gait-specific training on corticospinal excitability were included. Some studies showed an increased MEP amplitude (7/16 studies), a decreased latency (5/7studies), a decreased motor threshold (4/8 studies), an increased map size (2/3 studies) and a decreased cortical silent period (1/2 study) after gait-specific training. No change has been reported in terms of short interval intracortical inhibition after training. Five studies did not report any significant effect after gait-specific training on corticospinal excitability. The results of this systematic review suggest that gait-specific training modalities can drive neuroplastic adaptation among stroke survivors. However, given the methodological disparity of the included studies, additional clinical trials of better methodological quality are needed to establish conclusions. The results of this review can therefore be used to develop future studies to better understand the effects of gait-specific training on the central nervous system.
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Affiliation(s)
- Yosra Cherni
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Québec City, QC G1M 2S8, Canada
- Département de Réadaptation, Faculté de Médecine, Université Laval, Québec City, QC G1V 0A6, Canada
- TOPMED, Centre Collégial de Transfert de Technologie en Orthèses, Prothèses et Équipements Médicaux, Québec City, QC G1S 1C1, Canada
| | - Alexia Tremblay
- Département de Réadaptation, Faculté de Médecine, Université Laval, Québec City, QC G1V 0A6, Canada
| | - Margaux Simon
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Québec City, QC G1M 2S8, Canada
- Département de Réadaptation, Faculté de Médecine, Université Laval, Québec City, QC G1V 0A6, Canada
| | - Floriane Bretheau
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Québec City, QC G1M 2S8, Canada
| | - Andréanne K. Blanchette
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Québec City, QC G1M 2S8, Canada
- Département de Réadaptation, Faculté de Médecine, Université Laval, Québec City, QC G1V 0A6, Canada
| | - Catherine Mercier
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Québec City, QC G1M 2S8, Canada
- Département de Réadaptation, Faculté de Médecine, Université Laval, Québec City, QC G1V 0A6, Canada
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A Comprehensive Appraisal of Meta-Analyses of Exercise-Based Stroke Rehabilitation with Trial Sequential Analysis. Healthcare (Basel) 2022; 10:healthcare10101984. [PMID: 36292431 PMCID: PMC9602124 DOI: 10.3390/healthcare10101984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/25/2022] [Accepted: 09/29/2022] [Indexed: 11/04/2022] Open
Abstract
Meta-analysis is a common technique used to synthesise the results of multiple studies through the combination of effect size estimates and testing statistics. Numerous meta-analyses have investigated the efficacy of exercise programmes for stroke rehabilitation. However, meta-analyses may also report false-positive results because of insufficient information or random errors. Trial sequential analysis (TSA) is an advanced technique for calculating the required information size (RIS) and more restrictive statistical significance levels for the precise assessment of any specific treatment. This study used TSA to examine whether published meta-analyses in the field of stroke rehabilitation reached the RIS and whether their overall effect sizes were sufficient. A comprehensive search of six electronic databases for articles published before May 2022 was conducted. The intervention methods were divided into four primary groups, namely aerobic or resistance exercise, machine-assisted exercise, task-oriented exercise, and theory-based exercise. The primary outcome measure was gait speed and the secondary outcome measure was balance function. The data were obtained either from the meta-analyses or as raw data from the original cited texts. All data analysis was performed in TSA software. In total, 38 articles with 46 analysable results were included in the TSA. Only 17 results (37.0%) reached the RIS. In conclusion, meta-analysis interpretation is challenging. Clinicians must consider the RIS of meta-analyses before applying the results in real-world situations. TSA can provide accurate evaluations of treatment effects, which is crucial to the development of evidence-based medicine.
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Balinski M, Madhavan S. "Magic" Number of Treadmill Sessions Needed to Achieve Meaningful Change in Gait Speed After Stroke: A Systematic Review. Am J Phys Med Rehabil 2022; 101:826-835. [PMID: 34799509 PMCID: PMC9108112 DOI: 10.1097/phm.0000000000001920] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The purpose of this systematic review was to determine the number of treadmill training sessions needed to make a meaningful change in gait speed for chronic stroke survivors. Relevant databases were searched up through February 2020. Articles were included if they fit the following criteria: stroke onset more than 5 mos, intention to treat with traditional treadmill training, and gait speed included as an outcome. Change in gait speed after intervention was used to classify treadmill groups as responders (at least 0.1 m/sec change) or nonresponders (less than 0.1 m/sec change). Seventeen articles met our criteria, resulting in a total of 19 intervention groups. Ten groups were classified as responders and completed a mean of 30.5 sessions within 6 wks, whereas nonresponders completed 20.4 sessions within 10 wks, indicating that at least 30 treadmill sessions (preferably in a period of 10 wks and at least 40 mins per session) is necessary to reach a meaningful change in gait speed. Although these trends were noted between the responder and nonresponder groups, no firm conclusions can be drawn regarding the "magic" number of sessions chronic stroke survivors should perform given the low correlation between number of sessions and change in gait speed.
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Affiliation(s)
- Mariah Balinski
- Brain Plasticity Lab, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
- Graduate Program in Rehabilitation Science, College of Applied Health Sciences, University of Illinois, Chicago, IL, USA
| | - Sangeetha Madhavan
- Brain Plasticity Lab, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
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A Decoding Prediction Model of Flexion and Extension of Left and Right Feet from Electroencephalogram. Behav Sci (Basel) 2022; 12:bs12080285. [PMID: 36004856 PMCID: PMC9404826 DOI: 10.3390/bs12080285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 08/11/2022] [Accepted: 08/11/2022] [Indexed: 11/26/2022] Open
Abstract
Detection of limb motor functions utilizing brain signals is a significant technique in the brain signal gain model (BSM) that can be effectively employed in various biomedical applications. Our research presents a novel technique for prediction of feet motor functions by applying a deep learning model with cascading transfer learning technique to use the electroencephalogram (EEG) in the training stage. Our research deduces the electroencephalogram data (EEG) of stroke incidence to propose functioning high-tech interfaces for predicting left and right foot motor functions. This paper presents a transfer learning with several source input domains to serve a target domain with small input size. Transfer learning can reduce the learning curve effectively. The correctness of the presented model is evaluated by the abilities of motor functions in the detection of left and right feet. Extensive experiments were performed and proved that a higher accuracy was reached by the introduced BSM-EEG neural network with transfer learning. The prediction of the model accomplished 97.5% with less CPU time. These accurate results confirm that the BSM-EEG neural model has the ability to predict motor functions for brain-injured stroke therapy.
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17
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A Deep Learning Model for Stroke Patients’ Motor Function Prediction. Appl Bionics Biomech 2022; 2022:8645165. [PMID: 36032046 PMCID: PMC9410966 DOI: 10.1155/2022/8645165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 06/29/2022] [Accepted: 07/16/2022] [Indexed: 11/17/2022] Open
Abstract
Deep learning models are effectively employed to transfer learning to adopt learning from other areas. This research utilizes several neural structures to interpret the electroencephalogram images (EEG) of brain-injured cases to plan operative imagery-computerized interface models for controlling left and right hand movements. This research proposed a model parameter tuning with less training time using transfer learning techniques. The precision of the proposed model is assessed by the aptitudes of motor imagery detection. The experiments depict that the best performance is attained with the incorporation of the proposed EEG-DenseNet and the transfer model. The prediction accuracy of the model reached 96.5% with reduced time computational cost. These high performance proves that the EEG-DenseNet model has high prospective for motor imagery brain-injured therapy systems. It also productively exhibited the effectiveness of transfer learning techniques for enhancing the accuracy of electroencephalogram brain-injured therapy models.
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García-Salazar LF, Pacheco MM, Alcantara CC, Russo TL, Pereira ND. Lower Extremity Constraint-Induced Movement Therapy Increase Variability in the Intra-Limb Coordination during Walking in Chronic Post-Stroke. ECOLOGICAL PSYCHOLOGY 2022. [DOI: 10.1080/10407413.2022.2086461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Luisa Fernanda García-Salazar
- Department of Physiotherapy, Federal University of São Carlos (UFSCar)
- Rehabilitation Science Research Group, School of Medicine and Health Sciences, Universidad del Rosario
| | | | | | - Thiago Luiz Russo
- Department of Physiotherapy, Federal University of São Carlos (UFSCar)
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Bishnoi A, Lee R, Hu Y, Mahoney JR, Hernandez ME. Effect of Treadmill Training Interventions on Spatiotemporal Gait Parameters in Older Adults with Neurological Disorders: Systematic Review and Meta-Analysis of Randomized Controlled Trials. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052824. [PMID: 35270516 PMCID: PMC8909968 DOI: 10.3390/ijerph19052824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 12/07/2022]
Abstract
Objective: Treadmill interventions have been shown to promote ‘normal’ walking patterns, as they facilitate the proper movement and timing of the lower limbs. However, prior reviews have not examined which intervention provides the most effective treatment of specific gait impairments in neurological populations. The objective of this systematic review was to review and quantify the changes in gait after treadmill interventions in adults with neurological disorders. Data Sources: A keyword search was performed in four databases: PubMed, CINAHL, Scopus, and Web of Science (January 2000−December 2021). We performed the search algorithm including all possible combinations of keywords. Full-text articles were examined further using forward/backward search methods. Study Selection: Studies were thoroughly screened using the following inclusion criteria: study design: Randomized Controlled Trial (RCT); adults ≥55 years old with a neurological disorder; treadmill intervention; spatiotemporal gait characteristics; and language: English. Data Extraction: A standardized data extraction form was used to collect the following methodological outcome variables from each of the included studies: author, year, population, age, sample size, and spatiotemporal gait parameters including stride length, stride time, step length, step width, step time, stance time, swing time, single support time, double support time, or cadence. Data Synthesis: We found a total of 32 studies to be included in our systematic review through keyword search, out of which 19 studies included adults with stroke and 13 studies included adults with PD. We included 22 out of 32 studies in our meta-analysis that examined gait in adults with neurological disorders, which only yielded studies including Parkinson’s disease (PD) and stroke patients. A meta-analysis was performed among trials presenting with similar characteristics, including study population and outcome measure. If heterogeneity was >50% (denoted by I2), random plot analysis was used, otherwise, a fixed plot analysis was performed. All analyses used effect sizes and standard errors and a p < 0.05 threshold was considered statistically significant (denoted by *). Overall, the effect of treadmill intervention on cadence (z = 6.24 *, I2 = 11.5%) and step length (z = 2.25 *, I2 = 74.3%) in adults with stroke was significant. We also found a significant effect of treadmill intervention on paretic step length (z = 2.34 *, I2 = 0%) and stride length (z = 6.09 *, I2 = 45.5%). For the active control group, including adults with PD, we found that overground physical therapy training had the largest effect on step width (z = −3.75 *, I2 = 0%). Additionally, for PD adults in treadmill intervention studies, we found the largest significant effect was on step length (z = 2.73 *, I2 = 74.2%) and stride length (z = −2.54 *, I2 = 96.8%). Conclusion: Treadmill intervention with sensory stimulation and body weight support treadmill training were shown to have the largest effect on step length in adults with PD and stroke.
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Affiliation(s)
- Alka Bishnoi
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA; (A.B.); (Y.H.)
| | - Rachel Lee
- Department of Solid Organ Transplant, University of Chicago Medical Center, Chicago, IL 60637, USA;
| | - Yang Hu
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA; (A.B.); (Y.H.)
| | - Jeannette R. Mahoney
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY 10461, USA;
| | - Manuel E. Hernandez
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA; (A.B.); (Y.H.)
- Correspondence:
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Brauer SG, Kuys SS, Paratz JD, Ada L. High-intensity treadmill training and self-management for stroke patients undergoing rehabilitation: a feasibility study. Pilot Feasibility Stud 2021; 7:215. [PMID: 34876235 PMCID: PMC8650326 DOI: 10.1186/s40814-021-00941-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 10/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physical activity undertaken by stroke survivors is generally low. This trial investigated the feasibility of delivering a high-intensity treadmill and self-management program to people with stroke undergoing inpatient rehabilitation and determine whether physical activity, walking ability and cardiorespiratory fitness could be increased. METHOD A phase I, single-group, pre-post intervention study was conducted with stroke survivors undergoing inpatient rehabilitation who could walk. Participants undertook a high-intensity treadmill and self-management program for up to 30 min, three times a week for 8 weeks under the supervision of their usual physiotherapist. Feasibility was determined by examining compliance, satisfaction and adverse events. Clinical outcomes were amount of physical activity, walking ability, and cardiorespiratory fitness collected pre-training (week 0), post-training (week 8), and at follow-up (week 26). RESULTS Forty stroke survivors participated, completing 10 (SD 6) sessions, 94% at the specified training intensity, with high satisfaction and no adverse events related to the intervention. At week 8, participants completed 2749 steps/day (95% CI 933 to 4564) more physical activity than at week 0. Walking distance increased by 110 m (95% CI 23 to 196), walking speed by 0.24 m/s (95% CI 0.05 to 0.42), and VO2 peak by 0.29 ml/kg/min (95% CI 0.03 to 0.56). At week 26, increases in physical activity, walking distance and speed, and cardiorespiratory fitness were maintained. CONCLUSIONS A high-intensity treadmill training program embedded within a self-management approach during inpatient rehabilitation appears feasible and potentially may offer sustained improvements in physical activity, walking ability, fitness, and quality of life. A randomised trial is warranted. TRIAL REGISTRATION This feasibility study was registered with the Australian New Zealand Clinical Trials Registry ( ACTRN12613000764730 ).
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Affiliation(s)
- Sandra G Brauer
- Discipline of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia.
| | - Suzanne S Kuys
- School of Physiotherapy, Australian Catholic University, Banyo, Queensland, Australia
| | - Jennifer D Paratz
- Burns, Trauma and Critical Care Research Centre, University of Queensland, Brisbane, Queensland, Australia.,School of Allied Health Sciences, Griffith University, Southport, Queensland, Australia
| | - Louise Ada
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
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Scalp Acupuncture and Treadmill Training Inhibits Neuronal Apoptosis through Activating cIAP1 in Cerebral Ischemia Rats. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:1418616. [PMID: 34804173 PMCID: PMC8604578 DOI: 10.1155/2021/1418616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 10/02/2021] [Accepted: 10/26/2021] [Indexed: 12/20/2022]
Abstract
Stroke is the leading cause of long-term disability in developed countries. Multitudinous evidence suggests that treadmill training treatment is beneficial for balance and stroke rehabilitation; however, the need for stroke therapy remains unmet. In the present study, a cerebral ischemia rat model was established by permanent middle cerebral artery occlusion (pMCAO) to explore the therapeutic effect and mechanism of scalp acupuncture combined with treadmill training on ischemic stroke. Terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling and neuronal nuclear protein (NeuN) double staining and cellular inhibitor of apoptosis protein-1 (cIAP1) and NeuN immunofluorescence double staining were used to detect the short-term and long-term neuroprotective effects of scalp acupuncture combined with treadmill training on pMCAO rats. In addition, the antiapoptotic effect of the combined treatment was evaluated in pMCAO rats transfected with cIAP1 shRNA. Western blotting was used to detect the relative protein expression in the caspase-8/-9/-3 activation pathway downstream of cIAP1 to further clarify its regulatory mechanism. Our results showed that scalp acupuncture combined with treadmill training successfully achieved short-term and long-term functional improvement within 14 days after stroke, significantly inhibited neuronal apoptosis, and upregulated the expression of cIAP1 protein in the ischemic penumbra area of the ischemic brain. However, no significant functional improvement and antiapoptotic effect were found in pMCAO rats transfected with cIAP1 shRNA. Western blotting results showed that the combined therapy markedly inhibited the activation of the caspase-8/-9/-3 pathway. These findings indicate that scalp acupuncture combined with treadmill training therapy may serve as a more effective alternative modality in the treatment of ischemic stroke, playing an antiapoptotic role by upregulating the expression of cIAP1 and inhibiting the activation of the caspase-8/-9/-3 pathway.
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Temporal Changes in Electromyographic Activity and Gait Ability during Extended Walking in Individuals Post-Stroke: A Pilot Study. Healthcare (Basel) 2021; 9:healthcare9040444. [PMID: 33920156 PMCID: PMC8070003 DOI: 10.3390/healthcare9040444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/29/2021] [Accepted: 04/08/2021] [Indexed: 11/24/2022] Open
Abstract
Abnormal gait, particularly in patients with stroke, causes neuromuscular fatigue. We aimed to clarify temporal changes in gait performance and lower limb muscle activity during extended walking in people with stroke hemiplegia. Twelve adults with stroke and eleven healthy controls performed an extended trial involving 20-min continuous walk at a comfortable speed. The primary outcome was electromyography amplitude during the trial and secondary outcomes were walking performance and the instantaneous mean frequency of electromyography during the trial. Data at 1, 6, 12, and 18 min after initiating walking were compared. Performance during extended walking in people with stroke was maintained over time. The electromyography amplitude decreased in the tibialis anterior during the pre-swing phase and increased in the rectus femoris during the single-support phase over time; these changes were similar on the paretic and nonparetic sides. Instantaneous mean frequency decreased over time on the nonparetic side in the tibialis anterior and on the paretic side in the rectus femoris. Healthy subjects did not show any changes over time. The changes in muscle activity in patients with stroke differed between the paretic and nonparetic sides, muscle type, and gait phase; walking performance was maintained despite being affected by neuromuscular fatigue.
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Canete S, Jacobs DA. Novel velocity estimation for symmetric and asymmetric self-paced treadmill training. J Neuroeng Rehabil 2021; 18:27. [PMID: 33546729 PMCID: PMC7866478 DOI: 10.1186/s12984-021-00825-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 01/14/2021] [Indexed: 11/23/2022] Open
Abstract
Background Self-paced treadmills (SPT) can provide an engaging setting for gait rehabilitation by responding directly to the user’s intent to modulate the external environment and internal effort. They also can improve gait analyses by allowing scientists and clinicians to directly measure the effect of an intervention on walking velocity. Unfortunately, many common SPT algorithms are not suitable for individuals with gait impairment because they are designed for symmetric gait patterns. When the user’s gait is asymmetric due to paresis or if it contains large accelerations, the performance is diminished. Creating and validating an SPT that is suitable for asymmetric gait will improve our ability to study rehabilitation interventions in populations with gait impairment. The objective of this study was to test and validate a novel self-paced treadmill on both symmetric and asymmetric gait patterns and evaluate differences in gait kinematics, kinetics, and muscle activity between fixed-speed and self-paced treadmill walking. Methods We collected motion capture, ground reaction force data, and muscle activity from 6 muscles in the dominant leg during walking from 8 unimpaired subjects. In the baseline condition, the subjects walked at 3 fixed-speeds normalized to their leg length as Froude numbers. We developed a novel kinematic method for increasing the accuracy of the user’s estimated walking velocity and compared our method against other published algorithms at each speed. Afterward, subjects walked on the SPT while matching their walking speed to a given target velocity using visual feedback of the treadmill speed. We evaluated the SPT by measuring steady-state error and the number of steps to reach the desired speed. We split the gait cycle into 7 phases and compared the kinematic, kinetic, and muscle activity between the fixed speed and self-paced mode in each phase. Then, we validated the performance of the SPT for asymmetric gait by having subjects walk on the SPT while wearing a locked-knee brace set to 0° on the non-dominant leg. Results Our SPT enabled controlled walking for both symmetric and asymmetric gait patterns. Starting from rest, subjects were able to control the SPT to reach the targeted speeds using visual feedback in 13–21 steps. With the locked knee brace, subjects controlled the treadmill with substantial step length and step velocity asymmetry. One subject was able to execute a step-to gait and halt the treadmill on heel-strikes with the braced leg. Our kinematic correction for step-length outperformed the competing algorithms by significantly reducing the velocity estimation error at the tested velocities. The joint kinematics, joint torques, and muscle activity were generally similar between fixed-speed and self-paced walking. Statistically significant differences were found in 5 of 63 tests for joint kinematics, 2 of 63 tests for joint torques, and 9 of 126 tests for muscle activity. The differences that were statistically significant were not found across all speeds and were generally small enough to be of limited clinical relevance. Conclusions We present a validated method for implementing a self-paced treadmill for asymmetric and symmetric gaits. As a result of the increased accuracy of our estimation algorithm, our SPT produced controlled walking without including a position feedback controller, thereby reducing the influence of the controller on measurements of the user’s true walking speed. Our method relies only on a kinematic correction to step length and step time which can support transfer to systems outside of the laboratory for symmetric and asymmetric gaits in clinical populations.
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Affiliation(s)
- Santiago Canete
- Department of Mechanical Engineering, Temple University, 1947 N. 12th Street, Philadelphia, PA, 19122, USA.
| | - Daniel A Jacobs
- Department of Mechanical Engineering, Temple University, 1947 N. 12th Street, Philadelphia, PA, 19122, USA
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De Luca R, Maresca G, Balletta T, Cannavò A, Leonardi S, Latella D, Maggio MG, Portaro S, Naro A, Calabrò RS. Does overground robotic gait training improve non-motor outcomes in patients with chronic stroke? Findings from a pilot study. J Clin Neurosci 2020; 81:240-245. [PMID: 33222923 DOI: 10.1016/j.jocn.2020.09.070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/25/2020] [Accepted: 09/28/2020] [Indexed: 01/18/2023]
Abstract
Stroke is the leading cause of disability among the elderly in the industrialized world. No more than 40% of stroke survivors walk independently, and only after receiving appropriate rehabilitation treatment; many stroke patients have also non-motor symptoms. The aim of this pilot study is to evaluate the effects of Ekso-training on non-motor outcomes, including gastrointestinal function and psychological well-being, in post stroke patients. We enrolled 30 post-stroke subjects, which were randomized into two groups in order of recruitment: 15 patients were trained with the overground exoskeleton Ekso-GT (experimental group, EG), whereas 15 patients were submitted to a standard gait training (control group, CG). Both the groups underwent the same amount of physiotherapy. At the end of the training, only in the EG we observed a significant improvement in constipation, mood, and coping strategies, with regard to social support, as well as in the perception of quality of life (as per SF-12). According to these preliminary data, overground robotic gait training can be considered a valuable tool in improving non-motor symptoms, including constipation and behavioral disorders in patients with chronic stroke.
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Affiliation(s)
- Rosaria De Luca
- IRCCS Centro Neurolesi Bonino Pulejo - Piemonte, Messina, Italy.
| | - Giuseppa Maresca
- IRCCS Centro Neurolesi Bonino Pulejo - Piemonte, Messina, Italy.
| | - Tina Balletta
- IRCCS Centro Neurolesi Bonino Pulejo - Piemonte, Messina, Italy.
| | - Antonino Cannavò
- IRCCS Centro Neurolesi Bonino Pulejo - Piemonte, Messina, Italy.
| | - Simona Leonardi
- IRCCS Centro Neurolesi Bonino Pulejo - Piemonte, Messina, Italy.
| | - Desiree Latella
- IRCCS Centro Neurolesi Bonino Pulejo - Piemonte, Messina, Italy.
| | | | - Simona Portaro
- IRCCS Centro Neurolesi Bonino Pulejo - Piemonte, Messina, Italy.
| | - Antonino Naro
- IRCCS Centro Neurolesi Bonino Pulejo - Piemonte, Messina, Italy.
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Nascimento LR, de Menezes KKP, Scianni AA, Faria-Fortini I, Teixeira-Salmela LF. Deficits in motor coordination of the paretic lower limb limit the ability to immediately increase walking speed in individuals with chronic stroke. Braz J Phys Ther 2020; 24:496-502. [PMID: 31561961 PMCID: PMC7779964 DOI: 10.1016/j.bjpt.2019.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 08/01/2019] [Accepted: 09/04/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To explore the relationships between clinical measures and the ability to increase walking speed in ambulatory people with chronic stroke and to identify which measures would best predict walking speed reserve. METHODS An exploratory, cross-sectional study was conducted with 114 individuals with chronic stroke. The outcome of interest was walking speed reserve, defined as the difference between individuals' comfortable and maximal walking speeds. Predictors were characteristics of the participants (age, sex, time since stroke, relative lower-limb dominance) and motor impairments (tonus, strength, and motor coordination). RESULTS The characteristics of the participants did not significantly correlate with walking speed reserve. All measures of motor impairments, i.e., tonus, strength, and motor coordination, were significantly correlated with walking speed reserve (p < 0.01), but only motor coordination was kept in the regression model. Motor coordination alone explained 35% (F = 61.5; p < 0.001) of the variance in walking speed reserve. CONCLUSIONS The level of motor coordination of the paretic lower limb is associated with the walking speed reserve of individuals with stroke. Interventions aimed at improving motor coordination may have the potential to improve everyday situations that require immediate increases in walking speed.
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Affiliation(s)
- Lucas Rodrigues Nascimento
- Center of Health Sciences, Discipline of Physiotherapy, Universidade Federal do Espírito Santo (UFES), Vitória, ES, Brazil; NeuroGroup, Discipline of Physiotherapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
| | | | - Aline Alvim Scianni
- NeuroGroup, Discipline of Physiotherapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Iza Faria-Fortini
- NeuroGroup, Discipline of Physiotherapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil; Department of Occupational Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
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Nascimento LR, da Silva LA, Araújo Barcellos JVM, Teixeira-Salmela LF. Ankle-foot orthoses and continuous functional electrical stimulation improve walking speed after stroke: a systematic review and meta-analyses of randomized controlled trials. Physiotherapy 2020; 109:43-53. [PMID: 33120054 DOI: 10.1016/j.physio.2020.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Indexed: 10/23/2022]
Abstract
BACKGROUND Foot-drop is a common impairment after stroke, which reduces walking ability. OBJECTIVE To examine the efficacy of interventions aimed at reducing foot-drop, i.e., ankle-foot orthoses and functional electrical stimulation, on walking speed and balance after stroke. DATA SOURCES MEDLINE, EMBASE, Cochrane, PsycINFO, and PEDro databases. ELIGIBILITY CRITERIA The review included only parallel, randomized trials. Participants were ambulatory adults after stroke. The experimental interventions were the use of an ankle-foot orthosis or functional electrical stimulation. DATA SYNTHESIS Outcome data related to walking speed and balance were extracted from the eligible trials and combined in random-effects meta-analyses. The quality of trials was assessed by the PEDro scores and the quality of evidence was determined according the Grading of Recommendations Assessment, Development, and Evaluation system. RESULTS Eleven trials involving 1135 participants were included. The mean PEDro score of the trials was 5.8 (ranging from 4 to 7). Ankle-foot orthoses (MD 0.24m/s; 95% CI 0.06 to 0.41) and functional electrical stimulation (MD 0.09m/s; 95% CI 0.03 to 0.14) significantly increased walking speed, compared with no intervention/placebo. Results regarding balance were inconclusive. Ankle-foot orthoses were not superior to functional electrical stimulation for improving walking speed (MD 0.00m/s; 95% CI -0.06 to 0.05) or balance (MD 0.27 points on the Berg Balance Scale; 95% CI -0.85 to 1.39) after stroke. CONCLUSIONS This systematic review provided moderate-quality evidence that both ankle-foot orthoses and functional electrical stimulation improve walking speed after stroke, but the effects on balance remain unclear. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42019130988.
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Affiliation(s)
- Lucas Rodrigues Nascimento
- Center of Health Sciences, Discipline of Physical Therapy, Universidade Federal do Espírito Santo (UFES), Vitória, ES, Brazil; NeuroGroup, Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
| | - Layla Alvarenga da Silva
- Center of Health Sciences, Discipline of Physical Therapy, Universidade Federal do Espírito Santo (UFES), Vitória, ES, Brazil.
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Madhavan S, Cleland BT, Sivaramakrishnan A, Freels S, Lim H, Testai FD, Corcos DM. Cortical priming strategies for gait training after stroke: a controlled, stratified trial. J Neuroeng Rehabil 2020; 17:111. [PMID: 32799922 PMCID: PMC7429759 DOI: 10.1186/s12984-020-00744-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/05/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Stroke survivors experience chronic gait impairments, so rehabilitation has focused on restoring ambulatory capacity. High-intensity speed-based treadmill training (HISTT) is one form of walking rehabilitation that can improve walking, but its effectiveness has not been thoroughly investigated. Additionally, cortical priming with transcranial direct current stimulation (tDCS) and movement may enhance HISTT-induced improvements in walking, but there have been no systematic investigations. The objective of this study was to determine if motor priming can augment the effects of HISTT on walking in chronic stroke survivors. METHODS Eighty-one chronic stroke survivors participated in a controlled trial with stratification into four groups: 1) control-15 min of rest (n = 20), 2) tDCS-15 min of stimulation-based priming with transcranial direct current stimulation (n = 21), 3) ankle motor tracking (AMT)-15 min of movement-based priming with targeted movements of the ankle and sham tDCS (n = 20), and 4) tDCS+AMT-15 min of concurrent tDCS and AMT (n = 20). Participants performed 12 sessions of HISTT (40 min/day, 3 days/week, 4 weeks). Primary outcome measure was walking speed. Secondary outcome measures included corticomotor excitability (CME). Outcomes were measured at pre, post, and 3-month follow-up assessments. RESULTS HISTT improved walking speed for all groups, which was partially maintained 3 months after training. No significant difference in walking speed was seen between groups. The tDCS+AMT group demonstrated greater changes in CME than other groups. Individuals who demonstrated up-regulation of CME after tDCS increased walking speed more than down-regulators. CONCLUSIONS Our results support the effectiveness of HISTT to improve walking; however, motor priming did not lead to additional improvements. Upregulation of CME in the tDCS+AMT group supports a potential role for priming in enhancing neural plasticity. Greater changes in walking were seen in tDCS up-regulators, suggesting that responsiveness to tDCS might play an important role in determining the capacity to respond to priming and HISTT. TRIAL REGISTRATION ClinicalTrials.gov , NCT03492229. Registered 10 April 2018 - retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03492229 .
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Affiliation(s)
- Sangeetha Madhavan
- Department of Physical Therapy, Brain Plasticity Lab, University of Illinois at Chicago, 1919 W. Taylor St, Chicago, IL, 60612, USA.
| | - Brice T Cleland
- Department of Physical Therapy, Brain Plasticity Lab, University of Illinois at Chicago, 1919 W. Taylor St, Chicago, IL, 60612, USA
| | - Anjali Sivaramakrishnan
- Department of Physical Therapy, Brain Plasticity Lab, University of Illinois at Chicago, 1919 W. Taylor St, Chicago, IL, 60612, USA
| | - Sally Freels
- University of Illinois at Chicago, Epidemiology and Biostatistics, Chicago, IL, USA
| | - Hyosok Lim
- Department of Physical Therapy, Brain Plasticity Lab, University of Illinois at Chicago, 1919 W. Taylor St, Chicago, IL, 60612, USA
| | - Fernando D Testai
- University of Illinois at Chicago, Department of Neurology and Rehabilitation, Chicago, IL, USA
| | - Daniel M Corcos
- Northwestern University, Physical Therapy & Human Movement Sciences, Chicago, IL, USA
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Chua K, Lim WS, Lim PH, Lim CJ, Hoo CM, Chua KC, Chee J, Ong WS, Liu W, Wong CJ. An Exploratory Clinical Study on an Automated, Speed-Sensing Treadmill Prototype With Partial Body Weight Support for Hemiparetic Gait Rehabilitation in Subacute and Chronic Stroke Patients. Front Neurol 2020; 11:747. [PMID: 32793109 PMCID: PMC7394021 DOI: 10.3389/fneur.2020.00747] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/17/2020] [Indexed: 11/29/2022] Open
Abstract
Impairments in walking speed, capacity, and endurance are commonly seen after stroke. Treadmill training improves endurance and gait speed. However, the lack of variable training speed and automated speed progression increases the risk of backward displacement and falling. An automated, speed-sensing treadmill prototype with partial body weight support, the Variable Automated Speed and Sensing Treadmill II (VASST II), was tested in an outpatient rehabilitation setting. Eleven subacute or chronic hemiplegics who could ambulate at > 0.2 m/s for >50 m participated in the study. All subjects underwent physiotherapist-supervised training on VASST II for 60 min daily, 3 times per week, for 5 weeks (total 15 h). Outcome measures at Week 3 (mid-VASST II training), Week 6 (post-VASST II training), Week 12 (first follow-up), and Week 24 (second follow-up) included the 6 minute walk test (6 MWT), 10 meter walk test (10 MWT), Berg Balance Scale (BBS) score, and Functional Ambulation category (FAC) score. User acceptability of VASST II for both study subjects and physiotherapists were also assessed. All subjects [median (IQR) age: 53.0 (22) years; median (IQR) duration post-stroke: 524 (811) days] completed VASST II training. At baseline, mean ± SD 6 MWT was 114 ± 50.9 m; mean ± SD 10 MWT was 0.37 ± 0.18 m/s; mean ± SD BBS score was 40 ± 10; and, mean ± SD FAC score was 4 ± 1. At Week 6, there were significant improvements in the 6 MWT [158.91 ± 88.69 m; P = 0.003], 10 MWT [0.49 ± 0.30 m/s; P = 0.016], and BBS score [42 ± 10; P = 0.003]. Improvements in 6 MWT and BBS scores were sustained at Week 24, but not in the 10 MWT. No VASST II-training related falls were reported. All subjects rated their VASST II training positively and indicated that it improved their current walking ability. VASST II training was effective, feasible, and safe in patients with subacute or chronic post-stroke hemiparetic gait, with sustained gains in distance walked (6 MWT) and functional balance (BBS score) up to 19 weeks post-intervention.
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Affiliation(s)
- Karen Chua
- Department of Rehabilitation Medicine, Centre of Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore
| | - Wei Sheong Lim
- Department of Rehabilitation Medicine, Centre of Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore
| | - Pang Hung Lim
- Department of Rehabilitation Medicine, Centre of Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore
| | - Chien Joo Lim
- Clinical Research & Innovation Office, Tan Tock Seng Hospital, Singapore, Singapore
| | - Chuan Mien Hoo
- School of Engineering, Ngee Ann Polytechnic, Singapore, Singapore
| | - Kuang Chua Chua
- School of Engineering, Ngee Ann Polytechnic, Singapore, Singapore
| | - Johnny Chee
- School of Engineering, Ngee Ann Polytechnic, Singapore, Singapore
| | - Wai Sing Ong
- School of Engineering, Ngee Ann Polytechnic, Singapore, Singapore
| | - Weidong Liu
- School of Engineering, Ngee Ann Polytechnic, Singapore, Singapore
| | - Chin Jung Wong
- Department of Rehabilitation Medicine, Centre of Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore
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Exploratory analysis of randomized clinical trials in physiotherapy aimed at improving walking speed after stroke. Int J Rehabil Res 2020; 43:361-368. [DOI: 10.1097/mrr.0000000000000426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Nascimento LR, Flores LC, de Menezes KK, Teixeira-Salmela LF. Water-based exercises for improving walking speed, balance, and strength after stroke: a systematic review with meta-analyses of randomized trials. Physiotherapy 2020; 107:100-110. [DOI: 10.1016/j.physio.2019.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Indexed: 11/25/2022]
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Li HQ, Spitzer NC. Exercise enhances motor skill learning by neurotransmitter switching in the adult midbrain. Nat Commun 2020; 11:2195. [PMID: 32366867 PMCID: PMC7198516 DOI: 10.1038/s41467-020-16053-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 04/07/2020] [Indexed: 02/07/2023] Open
Abstract
Physical exercise promotes motor skill learning in normal individuals and those with neurological disorders but its mechanism of action is unclear. We find that one week of voluntary wheel running enhances the acquisition of motor skills in normal adult mice. One week of running also induces switching from ACh to GABA expression in neurons in the caudal pedunculopontine nucleus (cPPN). Consistent with regulation of motor skills, we show that the switching neurons make projections to the substantia nigra (SN), ventral tegmental area (VTA) and ventrolateral-ventromedial nuclei of the thalamus (VL-VM). Use of viral vectors to override transmitter switching blocks the beneficial effect of running on motor skill learning. We suggest that neurotransmitter switching provides the basis by which sustained running benefits motor skill learning, presenting a target for clinical treatment of movement disorders.
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Affiliation(s)
- Hui-Quan Li
- Neurobiology Section, Division of Biological Sciences and Center for Neural Circuits and Behavior, La Jolla, CA, 92093-0357, USA.
- Kavli Institute for Brain and Mind, University of California San Diego, La Jolla, CA, 92093-0357, USA.
| | - Nicholas C Spitzer
- Neurobiology Section, Division of Biological Sciences and Center for Neural Circuits and Behavior, La Jolla, CA, 92093-0357, USA.
- Kavli Institute for Brain and Mind, University of California San Diego, La Jolla, CA, 92093-0357, USA.
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Han YG, Yun CK. Effectiveness of treadmill training on gait function in children with cerebral palsy: meta-analysis. J Exerc Rehabil 2020; 16:10-19. [PMID: 32161730 PMCID: PMC7056486 DOI: 10.12965/jer.1938748.374] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 01/30/2020] [Indexed: 11/22/2022] Open
Abstract
The purpose of this review was to analysis the effects of treadmill training on gait function in children with cerebral palsy. Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database (PEDro), PubMed and Web of Science were searched. Investigating the effects of treadmill training on gait endurance, gait speed, limb support time, cadence, and step length in children with cerebral palsy. Similar outcomes were pooled by calculating the standardized mean difference. Of the eight studies, 179 participants were included. The average PEDro score was 6.25/10. The results of the sensitivity test for bias evaluation using the duval and tweedie's trim and fill method showed low publication bias. The test regarding the effect of treadmill training on overall gait function yielded a moderate effect size of 0.53, which was a statistically significant effect as its confidence interval did not include. The overall effect size of gait endurance was 0.85. The overall effect size of gait speed and limb support time were 0.52 and 0.73. The overall effect size of cadence and step length were 0.14 and 0.21, indicating a nonsignificant improvement. These findings suggested that treadmill training on cerebral palsy was effective for gait endurance, gait speed and limb support time than cadence and step length.
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Affiliation(s)
- Yong-Gu Han
- Department of Physical Therapy, College of Rehabilitation Sciences, Daegu University, Gyeongsan, Korea
| | - Chang-Kyo Yun
- Department of Physical Therapy, College of Rehabilitation Sciences, Daegu University, Gyeongsan, Korea
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The effects of electromyography-triggered neuromuscular electrical stimulation plus tilt sensor functional electrical stimulation training on gait performance in patients with subacute stroke: a randomized controlled pilot trial. Int J Rehabil Res 2019; 42:358-364. [DOI: 10.1097/mrr.0000000000000371] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Gelaw AY, Janakiraman B, Teshome A, Ravichandran H. Effectiveness of treadmill assisted gait training in stroke survivors: A systematic review and meta-analysis. GLOBAL EPIDEMIOLOGY 2019. [DOI: 10.1016/j.gloepi.2019.100012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Lodha N, Patel P, Casamento-Moran A, Gauger K, Christou EA. Endpoint accuracy of goal-directed ankle movements correlates to over-ground walking in stroke. Clin Neurophysiol 2019; 130:1008-1016. [PMID: 31005051 DOI: 10.1016/j.clinph.2019.03.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 02/22/2019] [Accepted: 03/22/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Goal-directed movements are essential for voluntary motor control. The inability to execute precise goal-directed movements after stroke can impair the ability to perform voluntary functions, learn new skills, and hinder rehabilitation. However, little is known about how the accuracy of single-joint, goal-directed ankle movements relates to multi-joint, lower limb function in stroke. Here, we determined the impact of stroke on the accuracy of goal-directed ankle movements and its relation to over-ground walking. METHODS Stroke (N = 28) and control (N = 28) participants performed (1) goal-directed ankle dorsiflexion movements to accurately match 9 degrees in 180 ms and (2) over-ground walking. During goal-directed ankle movements, we measured the endpoint error, position error, time error and the activation of the agonist and antagonist muscles. During over-ground walking, we measured the walking speed, paretic stride length, and cadence. RESULTS The stroke group demonstrated increased endpoint error than the controls. Increased endpoint error was associated with increased co-activation between agonist-antagonist muscles. Endpoint error was a significant predictor of walking speed and paretic stride length in stroke. CONCLUSIONS Impaired accuracy of goal-directed, ankle movements is correlated to over-ground walking in stroke. SIGNIFICANCE Quantifying accuracy of goal-directed ankle movements may provide insights into walking function post-stroke.
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Affiliation(s)
- Neha Lodha
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, USA.
| | - Prakruti Patel
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, USA
| | | | - Katlyn Gauger
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
| | - Evangelos A Christou
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
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Abstract
Patients who require neurological rehabilitation often do not comply with conventional programs because they find the therapy uninteresting. As a result, specialized interactive video games have been designed to be more enjoyable than conventional therapy (CT) tasks. This study aimed to assess the trunk control and gait ability of patients with chronic stroke after participation in driving-based interactive video games (DBIVG). Participants included 24 chronic stroke patients allocated to an experimental group (n = 13, CT + DBIVG) or a control group (n = 11, CT + treadmill walking training). Both groups received CT five days/week; the experimental and control groups participated in DBIVG and treadmill walking training, respectively, three days/week for four weeks. The primary outcome of trunk control was measured by the trunk impairment scale (TISall) and TIS subscales, including static sitting balance (TISssb), dynamic sitting balance (TISdsb), and trunk co-ordination (TISco). Gait ability was measured by the dynamic gait index (DGI), timed walking test (TWT), and time up and go test (TUGT). Both groups demonstrated significant improvements in TISall, TISdsb, and TUGT results. The experimental group showed significantly greater improvement in TISssb, TISco, and DGI than the control group. Our findings indicate that DBIVG can improve trunk control and gait ability in patients with chronic stroke.
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Affiliation(s)
- Daegyun Lee
- Department of Physical Therapy, Graduate School, Gachon University, Incheon, Republic of Korea
| | - Youngsook Bae
- Department of Physical Therapy, Graduate School, Gachon University, Incheon, Republic of Korea.,Department of Physical Therapy, College of Health Science, Gachon University, Incheon, Republic of Korea
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Effects of (music-based) rhythmic auditory cueing training on gait and posture post-stroke: A systematic review & dose-response meta-analysis. Sci Rep 2019; 9:2183. [PMID: 30778101 PMCID: PMC6379377 DOI: 10.1038/s41598-019-38723-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 01/09/2019] [Indexed: 01/22/2023] Open
Abstract
Gait dysfunctions are common post-stroke. Rhythmic auditory cueing has been widely used in gait rehabilitation for movement disorders. However, a consensus regarding its influence on gait and postural recovery post-stroke is still warranted. A systematic review and meta-analysis was performed to analyze the effects of auditory cueing on gait and postural stability post-stroke. Nine academic databases were searched according to PRISMA guidelines. The eligibility criteria for the studies were a) studies were randomized controlled trials or controlled clinical trials published in English, German, Hindi, Punjabi or Korean languages b) studies evaluated the effects of auditory cueing on spatiotemporal gait and/or postural stability parameters post-stroke c) studies scored ≥4 points on the PEDro scale. Out of 1,471 records, 38 studies involving 968 patients were included in this present review. The review and meta-analyses revealed beneficial effects of training with auditory cueing on gait and postural stability. A training dosage of 20–45 minutes session, for 3–5 times a week enhanced gait performance, dynamic postural stability i.e. velocity (Hedge’s g: 0.73), stride length (0.58), cadence (0.75) and timed-up and go test (−0.76). This review strongly recommends the incorporation of rhythmic auditory cueing based training in gait and postural rehabilitation, post-stroke.
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Effects of high intensity speed-based treadmill training on ambulatory function in people with chronic stroke: A preliminary study with long-term follow-up. Sci Rep 2019; 9:1985. [PMID: 30760772 PMCID: PMC6374472 DOI: 10.1038/s41598-018-37982-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 12/17/2018] [Indexed: 12/12/2022] Open
Abstract
High intensity treadmill training has shown to be beneficial for stroke survivors, yet the feasibility and long-term effects remain unclear. In this study, we aimed to determine whether a 4-week high intensity speed-based treadmill training (HISTT) is feasible for chronic stroke survivors, and we examined its effects on ambulatory function, and long-term retention. Sixteen individuals post-stroke participated in 40 minutes of HISTT for four weeks at a frequency of three sessions per week. Gait speed was measured using the 10-meter walk test, endurance was measured using the 6-minute walk test, and quality of life was assessed using the Stroke Impact Scale (SIS) at baseline, post-training, and at 3-month follow-up. All participants successfully completed the training without any serious adverse events. Participants significantly increased fastest walking speed by 19%, self-selected walking speed by 18%, and walking endurance by 12% after the training. These improvements were maintained for 3 months after the intervention. Our results indicate that this modified speed-based high intensity walking program has the potential to be a feasible and effective method of gait training for stroke survivors. However, the small sample size and lack of a control group warrant caution in interpretation of results. Further studies are recommended to better understand effectiveness of this protocol in combination with other physical therapy interventions for functional recovery after stroke.
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Vaz PG, Salazar APDS, Stein C, Marchese RR, Lukrafka JL, Plentz RDM, Pagnussat AS. Noninvasive brain stimulation combined with other therapies improves gait speed after stroke: a systematic review and meta-analysis. Top Stroke Rehabil 2019; 26:201-213. [PMID: 30735104 DOI: 10.1080/10749357.2019.1565696] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are noninvasive brain stimulation (NIBS) techniques able to modulate cortical excitability. OBJECTIVE To determine the effects of NIBS combined with other therapies on gait speed after stroke. METHODS Electronic databases searched were PUBMED, EMBASE, COCHRANE, SCOPUS, SCIELO and PEDro. Eligibility criteria were randomized controlled trials that reported the effects of tDCS and rTMS combined with other therapies for improving gait speed, walking cadence, functional ambulation category (FAC) and motricity index (MI-LE) after stroke. Risk of bias was assessed by Cochrane risk of bias assessment tool. Mean differences (MD) and 95% confidence intervals were calculated. Quality of evidence was assessed by Grades of Researches, Assessment, Development and Evaluation approach. RESULTS Ten studies (226 subjects) were included in the meta-analysis. NIBS combined with other therapies was effective for improving gait speed (MD 0.09 m/s [95% CI, 0.05 to 0.13; I2 0%, p < 0.0001]). Gait speed improved in both acute/subacute (MD 0.08 m/s [95% CI, 0.02 to 0.14]) and chronic phases (MD 0.08 m/s [95% CI, 0.03 to 0.13]). Furthermore, inhibitory (MD 0.09 m/s [95% CI, 0.04 to 0.14]) and excitatory (MD 0.07 m/s [95% CI, 0.02 to 0.12]) protocols were effective to improve gait speed. NIBS was also effective to improve walking cadence but was unable to modify other outcomes (FAC and MI-LE). CONCLUSIONS This systematic review with meta-analysis synthesizes moderate-quality evidence that NIBS combined with other therapies are effective to improve gait speed after stroke. Systematic Review registration number: PROSPERO registration number CDR42015024237.
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Affiliation(s)
- Patricia Graef Vaz
- a Health Sciences Graduate Program , Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) , Porto Alegre , Brazil.,b Department of Physiotherapy , Centro Universitário Ritter dos Reis (UniRitter) - Laureate International Universities , Porto Alegre , Brazil.,c Movement Analysis and Neurological Rehabilitation Laboratory , Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) , Porto Alegre , Brazil
| | - Ana Paula da Silva Salazar
- c Movement Analysis and Neurological Rehabilitation Laboratory , Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) , Porto Alegre , Brazil.,d Rehabilitation Sciences Graduate Program , Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) , Porto Alegre , Brazil
| | - Cinara Stein
- a Health Sciences Graduate Program , Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) , Porto Alegre , Brazil
| | - Ritchele Redivo Marchese
- c Movement Analysis and Neurological Rehabilitation Laboratory , Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) , Porto Alegre , Brazil
| | - Janice Luisa Lukrafka
- c Movement Analysis and Neurological Rehabilitation Laboratory , Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) , Porto Alegre , Brazil.,d Rehabilitation Sciences Graduate Program , Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) , Porto Alegre , Brazil
| | - Rodrigo Della Méa Plentz
- a Health Sciences Graduate Program , Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) , Porto Alegre , Brazil.,d Rehabilitation Sciences Graduate Program , Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) , Porto Alegre , Brazil
| | - Aline Souza Pagnussat
- a Health Sciences Graduate Program , Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) , Porto Alegre , Brazil.,c Movement Analysis and Neurological Rehabilitation Laboratory , Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) , Porto Alegre , Brazil.,d Rehabilitation Sciences Graduate Program , Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) , Porto Alegre , Brazil
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Küçükdeveci AA, Stibrant Sunnerhagen K, Golyk V, Delarque A, Ivanova G, Zampolini M, Kiekens C, Varela Donoso E, Christodoulou N. Evidence-based position paper on Physical and Rehabilitation Medicine professional practice for persons with stroke. The European PRM position (UEMS PRM Section). Eur J Phys Rehabil Med 2019; 54:957-970. [DOI: 10.23736/s1973-9087.18.05501-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Nascimento LR, Ada L, Rocha GM, Teixeira-Salmela LF. Perceptions of individuals with stroke regarding the use of a cane for walking: A qualitative study. J Bodyw Mov Ther 2019; 23:166-170. [DOI: 10.1016/j.jbmt.2018.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Dee M, Lennon O, O'Sullivan C. A systematic review of physical rehabilitation interventions for stroke in low and lower-middle income countries. Disabil Rehabil 2018; 42:473-501. [PMID: 30508495 DOI: 10.1080/09638288.2018.1501617] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Purpose: Approximately 70% of strokes occur in low and middle income countries, yet the effectiveness of physical rehabilitation in these contexts remains undetermined. This systematic review identifies and summarises the current evidence supporting physical rehabilitation interventions post-stroke in low and lower-middle income countries.Methods: Five databases were comprehensively searched (April 2017) for randomised controlled trials, clinical controlled trials, and cohort studies testing rehabilitation interventions post-stroke in these countries. The Effective Public Health Practice Project Tool assessed quality of included studies.Results: Sixty-two studies (2115 participants) were included. Interventions addressed upper limb (n = 26), lower limb (n = 22), and other (n = 14) outcomes. Seven studies were rated as strong in quality, 16 moderate and 39 rated as weak. Overall, in addition to usual care, physical rehabilitation interventions improved outcomes for stroke survivors. Best evidence synthesis provides level I (b) evidence supporting constraint induced movement therapy and mirror therapy to improve upper limb functional outcomes. Level I (b) evidence supports multimodal interventions that include lower limb motor imagery to improve gait parameters. Level II (b) evidence supports sit-to-stand training to improve balance outcomes.Conclusions: Exercise-based and brain training interventions improved functional outcomes post-stroke in low and lower-middle income countries. Further high-quality studies including participation outcomes are required.Implications for RehabilitationLow-cost physical rehabilitation interventions requiring minimal resources can improve functional outcomes after stroke in low and lower-middle income countries.Exercise-based interventions can improve upper limb, lower limb, gait, and balance outcomes after stroke.Brain training paradigms such as mirror therapy and motor imagery, when included in therapy packages, can improve upper limb and gait outcomes.The proven efficacy for rehabilitation interventions in improving stroke outcomes in low and lower-middle income countries supports the need to strengthen the rehabilitation workforce in this context.
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Affiliation(s)
- Muireann Dee
- UCD School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland
| | - Olive Lennon
- UCD School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland
| | - Cliona O'Sullivan
- UCD School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland
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Practice Variability Combined with Task-Oriented Electromyographic Biofeedback Enhances Strength and Balance in People with Chronic Stroke. Behav Neurol 2018; 2018:7080218. [PMID: 30598705 PMCID: PMC6287124 DOI: 10.1155/2018/7080218] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 08/10/2018] [Accepted: 10/14/2018] [Indexed: 11/17/2022] Open
Abstract
Objectives To investigate the effects of practice variability combined with task-oriented electromyographic biofeedback (EMGBFB) on strength and balance in people with chronic stroke. Methods Thirty-three participants were randomly assigned into the constant force EMGBFB tibialis anterior (TA) exercise (constant) group, the variable force EMGBFB tibialis anterior exercise (variable) group, or the upper extremity exercise without EMGBFB (control) group. Subjects in each group received 6 weekly sessions of exercise training (18 sessions, 40 minutes each). Motor outcomes were TA strength, balance (anteroposterior sway amplitude defined by limits of stability test in dynamic posturography), walking speed, Timed Up and Go test (TUGT), and six-minute walk test (6MWT). Data were measured at baseline, 1 day, 2 weeks, and 6 weeks posttraining. Results TA strength increased significantly in both the constant and variable groups after training. Balance significantly improved only in the variable group. All participants showed improvements in walking speed, TUGT, and 6MWT. Conclusions Task-oriented EMGBFB-assisted TA exercise training improved muscle strength in people with chronic stroke. Practicing to reach varying force levels during EMGBFB-assisted tibialis anterior exercises facilitated improvements in the ability to sway in the anteroposterior direction while standing. Our findings highlight the importance of task-oriented and motor learning principles while using the EMGBFB as an adjunct therapy in stroke rehabilitation. This trial was registered with trial registration number NCT01962662.
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Washabaugh EP, Krishnan C. A wearable resistive robot facilitates locomotor adaptations during gait. Restor Neurol Neurosci 2018. [PMID: 29526856 DOI: 10.3233/rnn-170782] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Robotic-resisted treadmill walking is a form of task-specific training that has been used to improve gait function in individuals with neurological injury, such as stroke, spinal cord injury, or cerebral palsy. Traditionally, these devices use active elements (e.g., motors or actuators) to provide resistance during walking, making them bulky, expensive, and less suitable for overground or in-home rehabilitation. We recently developed a low-cost, wearable robotic brace that generates resistive torques across the knee joint using a simple magnetic brake. However, the possible effects of training with this device on gait function in a clinical population are currently unknown. OBJECTIVE The purpose of this study was to test the acute effects of resisted walking with this device on kinematics, muscle activation patterns, and gait velocity in chronic stroke survivors. METHODS Six stroke survivors wore the resistive brace and walked on a treadmill for 20 minutes (4×5 minutes) at their self-selected walking speed while simultaneously performing a foot trajectory-tracking task to minimize stiff-knee gait. Electromyography, sagittal plane gait kinematics, and overground gait velocity were collected to evaluate the acute effects of the device on gait function. RESULTS Robotic-resisted treadmill training resulted in a significant increase in quadriceps and hamstring EMG activity during walking. Significant aftereffects (i.e., improved joint excursions) were also observed on the hip and knee kinematics, which persisted for several steps after training. More importantly, training resulted in significant improvements in overground gait velocity. These results were consistent in all the subjects tested. CONCLUSION This study provides preliminary evidence indicating that robotic-resisted treadmill walking using our knee brace can result in meaningful biomechanical aftereffects that translate to overground walking.
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Affiliation(s)
- Edward P Washabaugh
- Department of Physical Medicine and Rehabilitation, NeuRRo Lab, Michigan Medicine, Ann Arbor, MI, USA.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Chandramouli Krishnan
- Department of Physical Medicine and Rehabilitation, NeuRRo Lab, Michigan Medicine, Ann Arbor, MI, USA.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
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Effects of a 6-Week Aquatic Treadmill Exercise Program on Cardiorespiratory Fitness and Walking Endurance in Subacute Stroke Patients. J Cardiopulm Rehabil Prev 2018; 38:314-319. [DOI: 10.1097/hcr.0000000000000243] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Thompson K, Mattern-Baxter K. Intensive, functional training leads to optimal outcomes in a young woman post brain stem hemorrhage due to cerebral cavernous malformation. Physiother Theory Pract 2018; 36:741-752. [PMID: 29979899 DOI: 10.1080/09593985.2018.1493166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE Cerebral cavernous malformations (CCMs) can cause intracranial hemorrhages and account for 5-15% of all cerebral vascular malformations. The purpose of this retrospective case report is to describe the unusual motor recovery of a young woman following a large hemorrhage of a previously unknown brainstem CCM, otherwise not reported in the literature. Case Description: The patient was a 29-year-old female who presented with severe hemiparesis on the left 6 weeks after a first-ever hemorrhage. She had demonstrated minimal improvement in her motor recovery to date, was dependent on a walker for ambulation, and had no distal left upper extremity function. An intensive evidence-based plan of care over 6 weeks included progressive task-specific strengthening, treadmill training, and dynamic balance training. Outcomes: The patient achieved complete motor recovery, indicated by improvement from 23/66 to 64/66 in the Fugl-Meyer Upper Extremity Subscale score and from 12/30 to 30/30 in the Functional Gait Assessment. She returned to independent ambulation with functional gait speeds and kinematics. Discussion: This case report demonstrates an unusual clinical course of unexpected full recovery in a young woman after a large brainstem CCM after an intensive 6-week course of physical therapy. Other patients with a similar presentation after CCM may benefit from an intensive plan of care. Clinicians should be aware of the possibility of unusual recovery in this population as not to limit expectations for recovery.
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Affiliation(s)
- Kasey Thompson
- Dignity Health, Mercy San Juan Medical Center ,Carmichael, CA
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Karageorge A, Vargas J, Ada L, Kelly PJ, McCluskey A. Previous experience and walking capacity predict community outings after stroke: An observational study. Physiother Theory Pract 2018; 36:170-175. [PMID: 29902102 DOI: 10.1080/09593985.2018.1484829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Background: Following hospital discharge, stroke survivors may experience a decline in mobility, outings, and community participation. The aim of this study was to examine the relationship between demographic and clinical measures, and the level of participation by community-dwelling stroke survivors. Methods: A prospective, multicenter, observational study was conducted. Participants were 83 community-dwelling stroke survivors with participation goals who were undergoing post-inpatient rehabilitation in Australia. Predictors collected at baseline, early after hospital discharge were demographic (age, gender, living situation, home access) and clinical measures (walking capacity, driving status, baseline outings). The outcome of interest was community participation 6 months later, measured over 7 days as number of outings (collected in a self-report diary). An outing was any excursion beyond the perimeter of the participants' dwelling into a public street. Results: Number of outings 6 months after admission to the study (mean 8.5/week, SD 5.3) was predicted by number of outings at baseline, walking capacity, and age. Driving status did not predict number of outings. Conclusion: The strongest predictors of community participation were the number of outings early post-inpatient rehabilitation, walking capacity, and age. The only significant modifiable predictor was walking capacity.
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Affiliation(s)
- Aspasia Karageorge
- Discipline of Occupational Therapy, The University of Sydney, Sydney, Australia
| | - Janine Vargas
- Discipline of Physiotherapy, The University of Sydney, Sydney, Australia
| | - Louise Ada
- Discipline of Physiotherapy, The University of Sydney, Sydney, Australia
| | - Patrick J Kelly
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Annie McCluskey
- Discipline of Occupational Therapy, The University of Sydney, Sydney, Australia
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Drużbicki M, Przysada G, Guzik A, Brzozowska-Magoń A, Kołodziej K, Wolan-Nieroda A, Majewska J, Kwolek A. The Efficacy of Gait Training Using a Body Weight Support Treadmill and Visual Biofeedback in Patients with Subacute Stroke: A Randomized Controlled Trial. BIOMED RESEARCH INTERNATIONAL 2018; 2018:3812602. [PMID: 29850509 PMCID: PMC5907400 DOI: 10.1155/2018/3812602] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 11/10/2017] [Accepted: 03/07/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study was designed to determine whether or not gait training based on the use of treadmill with visual biofeedback and body weight support (BWS) would produce better effects in patients with subacute stroke compared to BWS treadmill training with no visual biofeedback. MATERIALS AND METHODS 30 patients with subacute stroke were randomly assigned to do body weight supported treadmill training with visual biofeedback (BB group) or BWS treadmill training without visual biofeedback. Their gait was assessed with a 3D system (spatiotemporal gait parameters and symmetry index) and by means of 2-minute walk test (2 MWT), 10-metre walk test (10 MWT), and Timed Up & Go test. Subjects in both groups participated in 15 treadmill training sessions (30 minutes each). RESULTS The participants from both groups achieved a statistically significant improvement in spatiotemporal gait parameters, walking speed, endurance, and mobility. The average change in the BB group after the end of the programme did not differ significantly compared to the change in the control group. The change in the symmetry index value of stance phase in the BB group was 0.03 (0.02) and in the control group was 0.02 (0.02). The difference was not statistically significant (p = 0.902). The statistically significantly higher improvement in the BB group was found in the range of walking speed (p = 0.003) and endurance (p = 0.012), but the difference between groups was of low clinical significance. CONCLUSIONS The findings do not confirm that BWS treadmill training with the function of visual biofeedback leads to significantly greater improvement in gait compared to BWS treadmill training with no visual biofeedback at an early stage after stroke. This study was registered at ClinicalTrials.gov, ID: ACTRN12616001283460.
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Affiliation(s)
- Mariusz Drużbicki
- Institute of Physiotherapy, University of Rzeszów, Warszawska 26a, Rzeszów, Poland
- Clinical Rehabilitation Ward of Province Hospital No. 2 in Rzeszów, Lwowska 60, Rzeszów, Poland
- Centre for Innovative Research in Medical and Natural Sciences, University of Rzeszów, Warzywna 1a, 35-310 Rzeszów, Poland
| | - Grzegorz Przysada
- Institute of Physiotherapy, University of Rzeszów, Warszawska 26a, Rzeszów, Poland
- Clinical Rehabilitation Ward of Province Hospital No. 2 in Rzeszów, Lwowska 60, Rzeszów, Poland
- Centre for Innovative Research in Medical and Natural Sciences, University of Rzeszów, Warzywna 1a, 35-310 Rzeszów, Poland
| | - Agnieszka Guzik
- Institute of Physiotherapy, University of Rzeszów, Warszawska 26a, Rzeszów, Poland
- Centre for Innovative Research in Medical and Natural Sciences, University of Rzeszów, Warzywna 1a, 35-310 Rzeszów, Poland
| | - Agnieszka Brzozowska-Magoń
- Institute of Physiotherapy, University of Rzeszów, Warszawska 26a, Rzeszów, Poland
- Centre for Innovative Research in Medical and Natural Sciences, University of Rzeszów, Warzywna 1a, 35-310 Rzeszów, Poland
| | - Krzysztof Kołodziej
- Institute of Physiotherapy, University of Rzeszów, Warszawska 26a, Rzeszów, Poland
- Clinical Rehabilitation Ward of Province Hospital No. 2 in Rzeszów, Lwowska 60, Rzeszów, Poland
| | | | - Joanna Majewska
- Institute of Physiotherapy, University of Rzeszów, Warszawska 26a, Rzeszów, Poland
| | - Andrzej Kwolek
- Institute of Physiotherapy, University of Rzeszów, Warszawska 26a, Rzeszów, Poland
- Clinical Rehabilitation Ward of Province Hospital No. 2 in Rzeszów, Lwowska 60, Rzeszów, Poland
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Lin SH, Dionne TP. Interventions to Improve Movement and Functional Outcomes in Adult Stroke Rehabilitation: Review and Evidence Summary. J Particip Med 2018; 10:e3. [PMID: 33052128 PMCID: PMC7434068 DOI: 10.2196/jopm.8929] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 07/02/2017] [Indexed: 12/30/2022] Open
Abstract
Background Patients who have had a stroke may not be familiar with the terminology nor have the resources to efficiently search for evidence-based rehabilitation therapies to restore movement and functional outcomes. Recognizing that a thorough systematic review on this topic is beyond the scope of this article, we conducted a rapid review evidence summary to determine the level of evidence for common rehabilitation interventions to improve movement/motor and functional outcomes in adults who have had a stroke. Objective The objective of this study was to find evidence for common rehabilitation interventions to improve movement/motor and functional outcomes in adults who have had a stroke. Methods Medline Complete, PubMed, CINAHL Complete, Cochrane Database, Rehabilitation and Sports Medicine Source, Dissertation Abstracts International, and National Guideline Clearinghouse, from 1996 to April of 2016, were searched. From 348 articles, 173 met the following inclusion criteria: (1) published systematic reviews or meta-analyses, (2) outcomes target functional movement or motor skills of the upper and lower limbs, (3) non-pharmacological interventions that are commonly delivered to post-stroke population (acute and chronic), (4) human studies, and (5) English. Evidence tables were created to analyze the findings of systematic reviews and meta-analyses by category of interventions and outcomes. Results This rapid review found that the following interventions possess credible evidence to improve functional movement of persons with stroke: cardiorespiratory training, therapeutic exercise (ie, strengthening), task-oriented training (task-specific training), constraint-induced movement therapy (CIMT), mental practice, and mirror therapy. Neuromuscular electrical stimulation (NMES) (ie, functional electrical stimulation) shows promise as an intervention for stroke survivors. Conclusions Most commonly delivered therapeutic interventions to improve motor recovery after a stroke possess moderate quality evidence and are effective. Future research recommendations, such as optimal timing and dosage, would help rehabilitation professionals tailor interventions to achieve the best outcomes for stroke survivors.
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Affiliation(s)
- Susan Hamady Lin
- Institute of Health Professions, Department of Occupational Therapy, Massachusetts General Hospital Institute of Health Professions, Boston, MA, United States
| | - Timothy P Dionne
- Department of Rehabilitation Sciences, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, NY, United States
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