1
|
Choi JY, Oh DW, Son SM, Kim CJ. Physiotherapy strategies for functional improvement in a child with complicated hereditary spastic paraplegia: 1-year follow-up of a case report using a changing criterion design. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2023:e2006. [PMID: 37058697 DOI: 10.1002/pri.2006] [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: 10/19/2022] [Revised: 02/07/2023] [Accepted: 03/21/2023] [Indexed: 04/16/2023]
Abstract
BACKGROUND and Purpose: Hereditary spastic paraplegias (HSP) are a group of clinically diverse genetic disorders that share the neurologic symptom of difficulty in walking due to progressive serious muscle weakness and spasticity in the legs. This study describes a physiotherapy program for improving the functional ability of a child diagnosed with complicated HSP and reports the treatment results. METHODS A 10-year-old boy with complicated HSP received a physiotherapy intervention that included strengthening of the leg muscles and treadmill training for 1 h per session, three to four times a week for 6 weeks. Outcome measures included sit-to-stand, 10-m walk, 1-min walk tests, and gross motor function measures (dimensions D and E). RESULTS After the intervention, the sit-to-stand, 1-min walk, and 10-m walk test scores improved by 6.75 times, 2.57 m, and 0.05 m/s, respectively. Furthermore, the gross motor function measure dimensions D and E scores improved by 8% (46%-54%) and 5% (22%-27%), respectively. The gains in each parameter were maintained at the 3- and 6-month and 1-year follow-ups. CONCLUSION These results suggest that structured physiotherapy programs can benefit the functional rehabilitation of children with complicated HSP.
Collapse
Affiliation(s)
- Ji-Young Choi
- Department of Physical Therapy, Dodam Development Center, Cheongju, Chungcheongbuk-do, Republic of Korea
| | - Duck-Won Oh
- Department of Physical Therapy, College of Health and Medical Science, Cheongju University, Cheongju, Chungcheongbuk-do, Republic of Korea
| | - Sung-Min Son
- Department of Physical Therapy, College of Health and Medical Science, Cheongju University, Cheongju, Chungcheongbuk-do, Republic of Korea
| | - Chang-Ju Kim
- Department of Physical Therapy, College of Health and Medical Science, Cheongju University, Cheongju, Chungcheongbuk-do, Republic of Korea
| |
Collapse
|
2
|
An J, Son YW, Lee BH. Effect of Combined Kinematic Chain Exercise on Physical Function, Balance Ability, and Gait in Patients with Total Knee Arthroplasty: A Single-Blind Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3524. [PMID: 36834218 PMCID: PMC9961064 DOI: 10.3390/ijerph20043524] [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: 12/04/2022] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
Total knee arthroplasty (TKA) is an effective treatment for end-stage osteoarthritis. However, evidence of combined kinematic chain exercise (CCE) in early-phase rehabilitation after TKA remains lacking. This study investigated the effects of CCE training on physical function, balance ability, and gait in 40 patients who underwent TKA. Participants were randomly assigned to the CCE (n = 20) and open kinematic chain exercise (OKCE) groups (n = 20). The CCE and OKCE groups were trained five times a week (for 4 weeks) for 30 min per session. Physical function, range of motion (ROM), balance, and gait were assessed before and after the intervention. The time × group interaction effects and time effect as measured with the Western Ontario and McMaster Universities Osteoarthritis Index, ROM, Knee Outcome Survey-Activities of Daily Living, balancing ability (e.g., confidence ellipse area, path length, and average speed), and gait parameters (e.g., timed up-and-go test, gait speed, cadence, step length, and stride length) were statistically significant (p < 0.05). In the group comparison of pre- and postintervention measurements for all variables, the CCE group showed substantial improvements compared to the OKCE group (p < 0.05). Both groups showed significant within-group improvement from baseline to postintervention. Our results suggest that CCE training positively affects physical function, balance ability, and gait as an early intervention for patients undergoing TKA.
Collapse
Affiliation(s)
- Jungae An
- Graduate School of Physical Therapy, Sahmyook University, Seoul 01795, Republic of Korea
| | - Young-Wan Son
- Graduate School of Physical Therapy, Sahmyook University, Seoul 01795, Republic of Korea
| | - Byoung-Hee Lee
- Department of Physical Therapy, Sahmyook University, Seoul 01795, Republic of Korea
| |
Collapse
|
3
|
Harrington JW, Anguiano-Hernandez JG, Kingston DC. Muscle activation and rating of perceived exertion of typically developing children during DRY and aquatic treadmill walking. J Electromyogr Kinesiol 2023; 68:102737. [PMID: 36549263 PMCID: PMC9868073 DOI: 10.1016/j.jelekin.2022.102737] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/21/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022] Open
Abstract
Aquatic treadmill gait training is a poorly understood rehabilitation method that alters bodyweight support, increases lower limb resistance, and assists with postural stability. This training could be an attractive tool for clinical populations with balance control issues or limited weight-bearing prescriptions for the lower limb. As a first step, the purpose of this study was to quantify differences in mean muscle activity of the tibialis anterior, rectus femoris, medial gastrocnemius, and semitendinosus, and perceived exertion (RPE) in typically developing children (7:8 M:F, age = 11.3 ± 4.1 years, 1.46 ± 0.18 m, and 44.2 ± 16.8 kg) during dry and aquatic treadmill walking at 75 %, 100 %, and 125 % self-selected speed. We hypothesized that the greatest mean muscle activity, normalized to percent maximum voluntary contraction and averaged across all strides, would be observed during 125 % dry treadmill walking and that aquatic treadmill walking would produce lower RPE. Overall, aquatic treadmill walking reduced mean medial gastrocnemius activity by 50.2 % (padj < 0.001), increased mean rectus femoris activity at least 32.8 % (padj < 0.006), and produced 78.0 % (padj = 0.007) greater RPE compared to dry treadmill walking. This study provides normative pediatric data for future aquatic treadmill walking studies in clinical populations to help inform gait rehabilitation protocols.
Collapse
Affiliation(s)
- Joseph W Harrington
- Department of Biomechanics, University of Nebraska Omaha, 6001 Dodge St, Omaha, Nebraska 68182, USA.
| | - Jose G Anguiano-Hernandez
- Department of Biomechanics, University of Nebraska Omaha, 6001 Dodge St, Omaha, Nebraska 68182, USA.
| | - David C Kingston
- Department of Biomechanics, University of Nebraska Omaha, 6001 Dodge St, Omaha, Nebraska 68182, USA.
| |
Collapse
|
4
|
Srivastava S, Seamon BA, Patten C, Kautz SA. Variation of body weight supported treadmill training parameters during a single session can modulate muscle activity patterns in post-stroke gait. Exp Brain Res 2023; 241:615-627. [PMID: 36639543 PMCID: PMC9895011 DOI: 10.1007/s00221-023-06551-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 01/05/2023] [Indexed: 01/15/2023]
Abstract
Evidence supporting the benefits of locomotor training (LT) to improve walking ability following stroke are inconclusive and could likely be improved with a better understanding of the effects of individual parameters i.e., body weight support (BWS), speed, and therapist assistance and their interactions with walking ability and specific impairments. We evaluated changes in muscle activity of thirty-seven individuals with chronic stroke (> 6 months), in response to a single session of LT at their self-selected or fastest-comfortable speed (FS) with three levels of BWS (0%, 15%, and 30%), and at FS with 30% BWS and seven different combinations of therapist assistance at the paretic foot, non-paretic foot, and trunk. Altered Muscle Activation Pattern (AMAP), a previously developed tool in our lab was used to evaluate the effects of LT parameter variation on eight lower-extremity muscle patterns in individuals with stroke. Repeated-measures mixed-model ANOVA was used to determine the effects of speed, BWS, and their interaction on AMAP scores. The Wilcoxon-signed rank test was used to determine the effects of therapist-assisted conditions on AMAP scores. Increased BWS mostly improved lower-extremity muscle activity patterns, but increased speed resulted in worse plantar flexor activity. Abnormal early plantar flexor activity during stance decreased with assistance at trunk and both feet, exaggerated plantar flexor activity during late swing decreased with assistance to the non-paretic foot or trunk, and diminished gluteus medius activity during stance increased with assistance to paretic foot and/or trunk. Therefore, different sets of training parameters have different immediate effects on activation patterns of each muscle and gait subphases.
Collapse
Affiliation(s)
- Shraddha Srivastava
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, 77 President Street, Charleston, SC 29425 USA
- Ralph H. Johnson VA Health Care System Medical Center, Charleston, SC 29401 USA
| | - Bryant A. Seamon
- Ralph H. Johnson VA Health Care System Medical Center, Charleston, SC 29401 USA
- Division of Physical Therapy, Department of Rehabilitation Sciences, Medical University of South Carolina, Charleston, SC 29425 USA
| | - Carolynn Patten
- Biomechanics, Rehabilitation, and Integrative Neuroscience (BRaIN) Lab, Department of Physical Medicine and Rehabilitation, University of California Davis School of Medicine, Sacramento, CA 95817 USA
- VA Northern California Health Care System, Martinez, CA 94553 USA
| | - Steven A. Kautz
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, 77 President Street, Charleston, SC 29425 USA
- Ralph H. Johnson VA Health Care System Medical Center, Charleston, SC 29401 USA
| |
Collapse
|
5
|
Phothirook P, Amatachaya S, Peungsuwan P. Muscle Activity and Co-Activation of Gait Cycle during Walking in Water and on Land in People with Spastic Cerebral Palsy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1854. [PMID: 36767224 PMCID: PMC9914649 DOI: 10.3390/ijerph20031854] [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: 12/20/2022] [Revised: 01/15/2023] [Accepted: 01/17/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The purpose of this study was to investigate the differences in the muscle activity and co-activation index (CoA) of the rectus femoris (RF), biceps femoris (BF), gastrocnemius medialis (GM,) and tibialis anterior (TA) during walking on land and in water in healthy adolescents compared with those with spastic diplegia cerebral palsy (CP) adolescents. METHODS Four healthy individuals (median; age: 14 years, height: 1.57 cm, BMI: 16.58 kg/m2) and nine CP individuals (median; age: 15 years, height: 1.42 cm, BMI: 17.82 kg/m2) participated in this study and performed three walking trials under both conditions. An electromyography (EMG) collection was recorded with a wireless system Cometa miniwave infinity waterproof device, and the signals were collected using customized software named EMG and Motion Tools, Inc. software version 7 (Cometa slr, Milan, Italy) and was synchronized with an underwater VDO camera. RESULTS A significant decrease in the muscle activity of all muscles and CoA of RF/BF muscles, but an increase in TA/GM was observed within the CP group while walking in water during the stance phase. Between groups, there was a lower CoA of RF/BF and a greater CoA of TA/GM during the stance phase while walking in water and on land in the CP group. A non-significant difference was observed within the healthy group. CONCLUSION Walking in water can decrease muscle activity in lower limbs and co-activation of thigh muscles in people with spastic CP, whereas CoA muscles around ankle joints increased to stabilize foot weight acceptance.
Collapse
Affiliation(s)
- Pariyaporn Phothirook
- Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Khon Kaen University, Khon Kaen 40002, Thailand
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Sugalya Amatachaya
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Punnee Peungsuwan
- Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Khon Kaen University, Khon Kaen 40002, Thailand
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand
| |
Collapse
|
6
|
Effects of Transcranial Direct Current Stimulation of Bilateral Supplementary Motor Area on the Lower Limb Motor Function in a Stroke Patient with Severe Motor Paralysis: A Case Study. Brain Sci 2022; 12:brainsci12040452. [PMID: 35447983 PMCID: PMC9029581 DOI: 10.3390/brainsci12040452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 03/23/2022] [Accepted: 03/26/2022] [Indexed: 02/04/2023] Open
Abstract
In patients with severe motor paralysis, increasing the excitability of the supplementary motor area (SMA) in the non-injured hemisphere contributes to the recovery of lower limb motor function. However, the contribution of transcranial direct current stimulation (tDCS) over the SMA of the non-injured hemisphere in the recovery of lower limb motor function is unclear. This study aimed to examine the effects of tDCS on bilateral hemispheric SMA combined with assisted gait training. A post-stroke patient with severe motor paralysis participated in a retrospective AB design. Assisted gait training was performed only in period A and tDCS to the SMA of the bilateral hemisphere combined with assisted gait training (bi-tDCS) was performed in period B. Additionally, three conditions were performed for 20 min each in the intervals between the two periods: (1) assisted gait training only, (2) assisted gait training combined with tDCS to the SMA of the injured hemisphere, and (3) bi-tDCS. Measurements were muscle activity and beta-band intermuscular coherence (reflecting corticospinal tract excitability) of the vastus medialis muscle. The bi-tDCS immediately and longitudinally increased muscle activity and intermuscular coherence. We consider that bi-tDCS may be effective in recovering lower limb motor function in a patient with severe motor paralysis.
Collapse
|
7
|
Mayag LJA, Múnera M, Cifuentes CA. Human-in-the-Loop Control for AGoRA Unilateral Lower-Limb Exoskeleton. J INTELL ROBOT SYST 2021. [DOI: 10.1007/s10846-021-01487-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
8
|
Devasahayam AJ, Kelly LP, Williams JB, Moore CS, Ploughman M. Fitness Shifts the Balance of BDNF and IL-6 from Inflammation to Repair among People with Progressive Multiple Sclerosis. Biomolecules 2021; 11:504. [PMID: 33810574 PMCID: PMC8066063 DOI: 10.3390/biom11040504] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/20/2021] [Accepted: 03/24/2021] [Indexed: 12/21/2022] Open
Abstract
Physical sedentarism is linked to elevated levels of circulating cytokines, whereas exercise upregulates growth-promoting proteins such as brain-derived neurotrophic factor (BDNF). The shift towards a 'repair' phenotype could protect against neurodegeneration, especially in diseases such as multiple sclerosis (MS). We investigated whether having higher fitness or participating in an acute bout of maximal exercise would shift the balance of BDNF and interleukin-6 (IL-6) in serum samples of people with progressive MS (n = 14), compared to matched controls (n = 8). Participants performed a maximal graded exercise test on a recumbent stepper, and blood samples were collected at rest and after the test. We assessed walking speed, fatigue, and maximal oxygen consumption (V·O2max). People with MS achieved about 50% lower V·O2max (p = 0.003) than controls. At rest, there were no differences in BDNF between MS and controls; however, IL-6 was significantly higher in MS. Higher V·O2max was associated with a shift in BDNF/IL-6 ratio from inflammation to repair (R = 0.7, p = 0.001) when considering both groups together. In the MS group, greater ability to upregulate BDNF was associated with faster walking speed and lower vitality. We present evidence that higher fitness indicates a shift in the balance of blood biomarkers towards a repair phenotype in progressive MS.
Collapse
Affiliation(s)
- Augustine Joshua Devasahayam
- L.A. Miller Centre, Recovery and Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL A1K 5A1, Canada; (A.J.D.); (L.P.K.)
| | - Liam Patrick Kelly
- L.A. Miller Centre, Recovery and Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL A1K 5A1, Canada; (A.J.D.); (L.P.K.)
| | - John Bradley Williams
- Division of BioMedical Sciences, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL A1B 3V6, Canada; (J.B.W.); (C.S.M.)
| | - Craig Stephen Moore
- Division of BioMedical Sciences, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL A1B 3V6, Canada; (J.B.W.); (C.S.M.)
| | - Michelle Ploughman
- L.A. Miller Centre, Recovery and Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL A1K 5A1, Canada; (A.J.D.); (L.P.K.)
- Division of BioMedical Sciences, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL A1B 3V6, Canada; (J.B.W.); (C.S.M.)
| |
Collapse
|
9
|
Does the Environment Cause Changes in Hemiparetic Lower Limb Muscle Activity and Gait Velocity During Walking in Stroke Survivors? J Stroke Cerebrovasc Dis 2020; 29:105174. [PMID: 32912567 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/10/2020] [Accepted: 07/16/2020] [Indexed: 11/22/2022] Open
Abstract
Stroke survivors often face difficulty in community ambulation though they attain steady-state walking in clinical setups. Compliance and unpredictability of the environment may alter the muscle activity and challenge the individual's gait. Successful reintegration into the community requires gait assessment and training in a real-life challenging environment. Little is known about the assessment and training of gait in the community environment under challenging mobility dimensions. Hence, we aimed to study the changes that real-life environmental dimensions have on the activity of selected muscles in hemiparetic lower limb and gait velocity in stroke survivors. METHODS An observational cross-sectional study was conducted on 16 ambulatory stroke survivors to assess the hemiparetic lower limb muscle activity during walking in real-life environmental dimensions. Participants were made to walk in the community on a walkway consisting of even surface, ramp, stairs, uneven terrain and obstacles. They were also made to manoeuvre through traffic and pick a load while walking for a distance in the walkway. Muscle activity of Rectus Femoris, Biceps Femoris, Gastrocnemius Medialis and Tibialis Anterior of the paretic lower limb were continuously recorded while walking using wireless surface electromyography. Gait velocity for the entire walkway and level of perceived difficulty while walking in different dimensions were also measured. Paired t-test was used to compare the percentage Maximum Voluntary Contraction (%MVC) of lower limb muscles between even surface and real-life environment dimensions while walking. One sample t-test was used to compare the gait velocity in real-life dimensions versus gait velocity in even surface measured in an earlier study. RESULTS There was a significant reduction (p < 0.01) in the activity of all four hemiparetic lower limb muscles while walking under the influence of real-life environmental dimensions compared to even surface. Gait velocity (0.33 ± 0.17 m/s) was significantly lower than that is essential to be a community ambulator. The level of perceived difficulty across all dimensions was reported qualitatively with the highest difficulty reported during stair and obstacle clearance. CONCLUSION Real-life environmental dimensions lead to the reduction of paretic lower limb muscle activities and gait velocity during walking in community-dwelling stroke survivors. Stroke survivors perceived more difficulty while walking in real-life environment dimensions particularly while negotiating stairs and obstacles. SIGNIFICANCE Knowledge about the influence of real-life environmental dimensions will help the clinicians to target rehabilitation methods to improve walking adaptability.
Collapse
|
10
|
Daryabor A, Yamamoto S, Orendurff M, Kobayashi T. Effect of types of ankle-foot orthoses on energy expenditure metrics during walking in individuals with stroke: a systematic review. Disabil Rehabil 2020; 44:166-176. [DOI: 10.1080/09638288.2020.1762767] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Aliyeh Daryabor
- Physiotherapy Research Center, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- International University of Health and Welfare, Tokyo, Japan
| | - Sumiko Yamamoto
- International University of Health and Welfare, Tokyo, Japan
| | | | - Toshiki Kobayashi
- Department of Biomedical Engineering, Faculty of Engineering, Hong Kong Polytechnic University, Hong Kong, China
| |
Collapse
|
11
|
Bunketorp-Käll L, Pekna M, Pekny M, Blomstrand C, Nilsson M. Effects of horse-riding therapy and rhythm and music-based therapy on functional mobility in late phase after stroke. NeuroRehabilitation 2019; 45:483-492. [PMID: 31868694 PMCID: PMC7029334 DOI: 10.3233/nre-192905] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Persons with stroke commonly have residual neurological deficits that seriously hamper mobility. OBJECTIVE To investigate whether horse-riding therapy (H-RT) and rhythm and music-based therapy (R-MT) affect functional mobility in late phase after stroke. METHODS This study is part of a randomized controlled trial in which H-RT and R-MT was provided twice weekly for 12 weeks. Assessment included the timed 10-meter walk test (10 mWT), the six-minute walk test (6 MWT) and Modified Motor Assessment Scale (M-MAS). RESULTS 123 participants were assigned to H-RT (n = 41), R-MT (n = 41), or control (n = 41). Post-intervention, the H-RT group completed the 10 mWT faster at both self-selected (-2.22 seconds [95% CI, -3.55 to -0.88]; p = 0.001) and fast speed (-1.19 seconds [95% CI, -2.18 to -0.18]; p = 0.003), with fewer steps (-2.17 [95% CI, -3.30 to -1.04]; p = 0.002 and -1.40 [95% CI, -2.36 to -0.44]; p = 0.020, respectively), as compared to controls. The H-RT group also showed improvements in functional task performance as measured by M-MAS UAS (1.13 [95% CI, 0.74 to 1.52]; p = 0.001). The gains were partly maintained at 6 months among H-RT participants. The R-MT did not produce any immediate gains. However, 6 months post-intervention, the R-MT group performed better with respect to time; -0.75 seconds [95% CI, -1.36 to -0.14]; p = 0.035) and number of steps -0.76 [95% CI, -1.46 to -0.05]; p = 0.015) in the 10 mWT at self-selected speed. CONCLUSIONS The present study supports the efficacy of H-RT in producing immediate gains in gait and functional task performance in the late phase after stroke, whereas the effectiveness of R-MT is less clear.
Collapse
Affiliation(s)
- Lina Bunketorp-Käll
- Center for Brain Repair, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Center for Advanced Reconstruction of Extremities C.A.R.E. Institute of Clinical Sciences, Sahlgrenska University Hospital/Mölndal, Sweden
| | - Marcela Pekna
- Center for Brain Repair, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Florey Institute of Neuroscience and Mental Health, Parkville, Melbourne, Australia
| | - Milos Pekny
- Center for Brain Repair, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Florey Institute of Neuroscience and Mental Health, Parkville, Melbourne, Australia
- University of Newcastle, New South Wales, Australia
| | - Christian Blomstrand
- Center for Brain Repair, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Neuroscience, Stroke Center West, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Michael Nilsson
- Center for Brain Repair, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Florey Institute of Neuroscience and Mental Health, Parkville, Melbourne, Australia
- Centre for Rehab Innovations (CRI), University of Newcastle and Hunter Medical Research Institute (HMRI) Newcastle, Australia
- LKC School of Medicine, Nanyang Technological University, Singapore
| |
Collapse
|
12
|
Maddalozzo GF, Aikenhead K, Sheth V, Perisic MN. A Novel Treatment Combination for Failed Back Surgery Syndrome, With a 41-Month Follow-Up: A Retrospective Case Report. J Chiropr Med 2019; 17:256-263. [PMID: 30846918 DOI: 10.1016/j.jcm.2018.03.007] [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] [Received: 04/26/2017] [Revised: 01/02/2018] [Accepted: 03/21/2018] [Indexed: 01/20/2023] Open
Abstract
Objective The purpose of this retrospective case report was to describe chiropractic management of a patient with failed back surgery syndrome. Clinical Features A 45-year-old woman presented 2 years after L4-L5 and L5-S1 fusion surgery with low back and sciatic pain. Her physical exam included a positive straight leg raise and diminished lower-extremity reflexes and muscle strength. The patient's magnetic resonance imaging showed right disc bulging and annular tearing at L2-L3 and L3-L4 disc bulging with foraminal impingement. Intervention and Outcome A total of 52 treatments were provided over 28 weeks consisting of multidirectional functional decompression (FD) unweighted gait training, core exercises while in FD, strengthening exercises on a vibration platform, and supine spinal FD with vibration and chiropractic spinal manipulative therapy. Over the course of treatment, the patient noted gradual improvement in function (Oswestry Disability Index) and pain (Numeric Rating Scale), with a reduction in pain medications. Follow-up of 41 months posttreatment revealed an Oswestry Disability Index score of 0 and Numeric Rating Scale score of 0, and the patient no longer was using any pain medication. Conclusion After a course of care, the patient in this study reported resolution of symptoms, decrease in pain medications, and improvement of function.
Collapse
Affiliation(s)
- Gianni F Maddalozzo
- School of Biological and Population Health Sciences, Oregon State University, Corvallis, Oregon.,Illinois Back Institute, Wheaton, Illinois
| | - Kristine Aikenhead
- Clinical Sciences, National University of Health Sciences, Lombard, Illinois
| | - Vani Sheth
- Illinois Back Institute, Wheaton, Illinois
| | | |
Collapse
|
13
|
Lefeber N, De Buyzer S, Dassen N, De Keersmaecker E, Kerckhofs E, Swinnen E. Energy consumption and cost during walking with different modalities of assistance after stroke: a systematic review and meta-analysis. Disabil Rehabil 2019; 42:1650-1666. [DOI: 10.1080/09638288.2018.1531943] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Nina Lefeber
- Rehabilitation Research—Neurological Rehabilitation research group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotic Research Center, Vrije Universiteit Brussel, Brussels, Belgium
| | - Sam De Buyzer
- Rehabilitation Research—Neurological Rehabilitation research group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Nikkie Dassen
- Rehabilitation Research—Neurological Rehabilitation research group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Emma De Keersmaecker
- Rehabilitation Research—Neurological Rehabilitation research group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotic Research Center, Vrije Universiteit Brussel, Brussels, Belgium
| | - Eric Kerckhofs
- Rehabilitation Research—Neurological Rehabilitation research group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotic Research Center, Vrije Universiteit Brussel, Brussels, Belgium
| | - Eva Swinnen
- Rehabilitation Research—Neurological Rehabilitation research group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotic Research Center, Vrije Universiteit Brussel, Brussels, Belgium
| |
Collapse
|
14
|
Afzal MR, Pyo S, Oh MK, Park YS, Yoon J. Evaluating the effects of delivering integrated kinesthetic and tactile cues to individuals with unilateral hemiparetic stroke during overground walking. J Neuroeng Rehabil 2018; 15:33. [PMID: 29661237 PMCID: PMC5902868 DOI: 10.1186/s12984-018-0372-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 03/27/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Integration of kinesthetic and tactile cues for application to post-stroke gait rehabilitation is a novel concept which needs to be explored. The combined provision of haptic cues may result in collective improvement of gait parameters such as symmetry, balance and muscle activation patterns. Our proposed integrated cue system can offer a cost-effective and voluntary gait training experience for rehabilitation of subjects with unilateral hemiparetic stroke. METHODS Ten post-stroke ambulatory subjects participated in a 10 m walking trial while utilizing the haptic cues (either alone or integrated application), at their preferred and increased gait speeds. In the system a haptic cane device (HCD) provided kinesthetic perception and a vibrotactile feedback device (VFD) provided tactile cue on the paretic leg for gait modification. Balance, gait symmetry and muscle activity were analyzed to identify the benefits of utilizing the proposed system. RESULTS When using kinesthetic cues, either alone or integrated with a tactile cue, an increase in the percentage of non-paretic peak activity in the paretic muscles was observed at the preferred gait speed (vastus medialis obliquus: p < 0.001, partial eta squared (η2) = 0.954; semitendinosus p < 0.001, partial η2 = 0.793) and increased gait speeds (vastus medialis obliquus: p < 0.001, partial η2 = 0.881; semitendinosus p = 0.028, partial η2 = 0.399). While using HCD and VFD (individual and integrated applications), subjects could walk at their preferred and increased gait speeds without disrupting trunk balance in the mediolateral direction. The temporal stance symmetry ratio was improved when using tactile cues, either alone or integrated with a kinesthetic cue, at their preferred gait speed (p < 0.001, partial η2 = 0.702). CONCLUSIONS When combining haptic cues, the subjects walked at their preferred gait speed with increased temporal stance symmetry and paretic muscle activity affecting their balance. Similar improvements were observed at higher gait speeds. The efficacy of the proposed system is influenced by gait speed. Improvements were observed at a 20% increased gait speed, whereas, a plateau effect was observed at a 40% increased gait speed. These results imply that integration of haptic cues may benefit post-stroke gait rehabilitation by inducing simultaneous improvements in gait symmetry and muscle activity.
Collapse
Affiliation(s)
- Muhammad Raheel Afzal
- School of Integrated Technology, Gwangju Institute of Science and Technology, 123 Cheomdangwagi-ro, Buk-gu, Gwangju, 61005 Republic of Korea
| | - Sanghun Pyo
- School of Integrated Technology, Gwangju Institute of Science and Technology, 123 Cheomdangwagi-ro, Buk-gu, Gwangju, 61005 Republic of Korea
| | - Min-Kyun Oh
- Department of Rehabilitation Medicine, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, 52727 Republic of Korea
| | - Young Sook Park
- Department of Physical Medicine and Rehabilitation, Sungkyunkwan University School of Medicine, Samsung Changwon Hospital, Changwon, 51353 Republic of Korea
| | - Jungwon Yoon
- School of Integrated Technology, Gwangju Institute of Science and Technology, 123 Cheomdangwagi-ro, Buk-gu, Gwangju, 61005 Republic of Korea
| |
Collapse
|
15
|
Pourmoghaddam A, Dettmer M, O'Connor DP, Paloski WH, Layne CS. Measuring multiple neuromuscular activation using EMG - a generalizability analysis. BIOMED ENG-BIOMED TE 2016; 61:595-605. [PMID: 26684346 DOI: 10.1515/bmt-2015-0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 11/09/2015] [Indexed: 11/15/2022]
Abstract
Analysis of electromyography (EMG) data has been shown to be valuable in biomedical and clinical research. However, most analysis tools do not consider the non-linearity of EMG data or the synergistic effects of multiple neuromuscular activities. The SYNERGOS algorithm was developed to assess a single index based on non-linear analysis of multiple neuromuscular activation (MNA) of different muscles. This index has shown promising results in Parkinsonian gait, but it was yet to be explored whether the SYNERGOS index is generalizable. In this study, we evaluated generalizability of the SYNERGOS index over the course of several trials and over separate days with different walking speeds. Ten healthy adults aged from 18 to 40 years walked on a treadmill on two different days, while EMG data was collected from the upper and lower right leg. SYNERGOS indices were obtained and a generalizability analysis was conducted. The algorithm detected changes in MNA in response to altering gait speed and depicted a high generalizability coefficient ( ρ^2 ${\hat \rho ^2}$ ) of 0.823 with a standard error of 5.117 with nominal inter-trial or inter-day effects. We concluded SYNERGOS may be a valuable tool in EMG analysis due to its generalizability and its sensitivity to task modifications and associated neuromotor changes.
Collapse
|
16
|
Oh YS, Woo YK. The Effects of Backward Walking Training With Inclined Treadmill on the Gait in Chronic Stroke Patients. ACTA ACUST UNITED AC 2016. [DOI: 10.12674/ptk.2016.23.3.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Yong-seop Oh
- Dept. of Physical Therapy, Prime Rehabilitation & Pain Clinic
| | - Young-keun Woo
- Dept. of Physical Therapy, College of Medical Sciences, Jeunju University
| |
Collapse
|
17
|
Werner C, Lindquist AR, Bardeleben A, Hesse S. The Influence of Treadmill Inclination on the Gait of Ambulatory Hemiparetic Subjects. Neurorehabil Neural Repair 2016; 21:76-80. [PMID: 17172557 DOI: 10.1177/1545968306289958] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction. This study evaluated the influence of the degree of treadmill belt inclination for training of ambulatory patients with hemiparetic stroke. Methods. Twelve patients were instructed to walk at 5 different levels of inclination (0%-8%) while harness-secured on the treadmill. The gait velocity was kept constant during all conditions. Dependent variables were heart rate, gait cycle-dependent parameters, and electromyographic activation patterns of the weight-bearing muscles. Results. Heart rate increased across all inclination levels, stride length increased and cadence decreased, whereas swing symmetry improved due to shortening of the relative swing phase of the affected side at the 6% and 8% inclination levels. No change in the activation pattern of the leg muscles was found. Conclusion. An inclination up to at least 8% can be accommodated for treadmill training by ambulatory stroke patients. For a given belt speed, heart rate increased without exceeding critical levels and patients walked with a more symmetric pattern. This protocol appeared to be safe in this selected group of subjects.
Collapse
Affiliation(s)
- C Werner
- Klinik Berlin, Department Neurological Rehabilitation, Charité - University Medicine Berlin, Germany
| | | | | | | |
Collapse
|
18
|
Eich HJ, Mach H, Werner C, Hesse S. Aerobic treadmill plus Bobath walking training improves walking in subacute stroke: a randomized controlled trial. Clin Rehabil 2016; 18:640-51. [PMID: 15473116 DOI: 10.1191/0269215504cr779oa] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To evaluate the immediate and long-term effects of aerobic treadmill plus Bobath walking training in subacute stroke survivors compared with Bobath walking training alone. Design: Randomized controlled trial. Setting: Rehabilitation unit. Subjects: Fifty patients, first-time supratentorial stroke, stroke interval less than six weeks, Barthel Index (0 / 100) from 50 to 80, able to walk a minimum distance of 12 m with either intermittent help or stand-by while walking, cardiovascular stable, minimum 50 W in the bicycle ergometry, randomly allocated to two groups, A and B. Interventions: Group A 30 min of treadmill training, harness secured and minimally supported according to patients' needs, and 30 min of physiotherapy, every workday for six weeks, speed and inclination of the treadmill were adjusted to achieve a heart rate of HR: (Hrmax / HRrest)*0.6 / HRrest; in group B 60 min of daily physiotherapy for six weeks. Main outcome measures: Primary outcome variables were the absolute improvement of walking velocity (m/s) and capacity (m), secondary were gross motor function including walking ability (score out of 13) and walking quality (score out of 41), blindly assessed before and after the intervention, and at follow-up three months later. Results: Patients tolerated the aerobic training well with no side-effects, significantly greater improvement of walking velocity and capacity both at study end (p / 0.001 versus p / 0.002) and at follow-up (p < 0.001 versus p<0.001) in the experimental group. Between weeks 0 and 6, the experimental group improved walking speed and capacity by a mean of.31 m/s and 91 m, the control group by a mean of 0.16 m/s and 56 m. Between weeks 0 and 18, the experimental group improved walking speed and capacity by a mean of 0.36 m/s and 111 m, the control group by a mean of 0.15 m/s and 57 m. Gross motor function and walking quality did not differ at any time. Conclusions: Aerobic treadmill plus Bobath walking training in moderately affected stroke patients was better than Bobath walking training alone with respect to the improvement of walking velocity and capacity. The treatment approach is recommended in patients meeting the inclusion criteria. A multicentre trial should follow to strengthen the evidence.
Collapse
Affiliation(s)
- H-J Eich
- Neurologische Fachklinik Schwaan-Waldeck, Klinik Berlin, Department of Neurological Rehabilitation, Free University Berlin, Germany
| | | | | | | |
Collapse
|
19
|
Partial body weight support treadmill training speed influences paretic and non-paretic leg muscle activation, stride characteristics, and ratings of perceived exertion during acute stroke rehabilitation. Hum Mov Sci 2016; 47:16-28. [PMID: 26845732 DOI: 10.1016/j.humov.2016.01.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 01/12/2016] [Accepted: 01/20/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Intensive task-specific training is promoted as one approach for facilitating neural plastic brain changes and associated motor behavior gains following neurologic injury. Partial body weight support treadmill training (PBWSTT), is one task-specific approach frequently used to improve walking during the acute period of stroke recovery (<1month post infarct). However, only limited data have been published regarding the relationship between training parameters and physiologic demands during this early recovery phase. OBJECTIVE To examine the impact of four walking speeds on stride characteristics, lower extremity muscle demands (both paretic and non-paretic), Borg ratings of perceived exertion (RPE), and blood pressure. DESIGN A prospective, repeated measures design was used. METHODS Ten inpatients post unilateral stroke participated. Following three familiarization sessions, participants engaged in PBWSTT at four predetermined speeds (0.5, 1.0, 1.5 and 2.0mph) while bilateral electromyographic and stride characteristic data were recorded. RPE was evaluated immediately following each trial. RESULTS Stride length, cadence, and paretic single limb support increased with faster walking speeds (p⩽0.001), while non-paretic single limb support remained nearly constant. Faster walking resulted in greater peak and mean muscle activation in the paretic medial hamstrings, vastus lateralis and medial gastrocnemius, and non-paretic medial gastrocnemius (p⩽0.001). RPE also was greatest at the fastest compared to two slowest speeds (p<0.05). CONCLUSIONS During the acute phase of stroke recovery, PBWSTT at the fastest speed (2.0mph) promoted practice of a more optimal gait pattern with greater intensity of effort as evidenced by the longer stride length, increased between-limb symmetry, greater muscle activation, and higher RPE compared to training at the slowest speeds.
Collapse
|
20
|
Seo KC, Kim HA. The effects of ramp gait exercise with PNF on stroke patients' dynamic balance. J Phys Ther Sci 2015; 27:1747-9. [PMID: 26180312 PMCID: PMC4499975 DOI: 10.1589/jpts.27.1747] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 02/14/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study examined the effects of ramp gait training using lower extremity patterns of proprioceptive neuromuscular facilitation (PNF) on chronic stroke patients' dynamic balance ability. [Subjects and Methods] In total, 30 stroke patients participated in this study, and they were assigned randomly and equally to an experimental group and a control group. The experimental group received exercise treatment for 30 min and ramp gait training with PNF for 30 min. The control group received exercise treatment for 30 min and ground gait training for 30 min. The interventions were conducted in 30 min sessions, three times per week for four week. The subjects were assessed with the Berg balance scale test, timed up and go test, and functional reach test before and after the experiment and the results were compared. [Results] After the intervention, the BBS and FRT values had significantly increased and the TUG value had significantly decreased in the experimental group; however, the BBS, FRT, and TUG values showed no significant differences in the control group. In addition, differences between the two groups before the intervention and after the intervention were not significant. [Conclusion] In conclusion, ramp gait training with PNF improved stroke patients' dynamic balance ability, and a good outcome of ramp gait training with PNF is also expected for other neurological system disease patients.
Collapse
Affiliation(s)
- Kyo Chul Seo
- Department of Physical Therapy, Korea Nazarene University, Republic of Korea
| | - Hyeon Ae Kim
- Department of Physical Therapy, Pohang University, Republic of Korea
| |
Collapse
|
21
|
Park BS, Kim MY, Lee LK, Yang SM, Lee WD, Noh JW, Shin YS, Kim JH, Lee JU, Kwak TY, Lee TH, Kim JY, Kim J. Effects of conventional overground gait training and a gait trainer with partial body weight support on spatiotemporal gait parameters of patients after stroke. J Phys Ther Sci 2015; 27:1603-7. [PMID: 26157272 PMCID: PMC4483450 DOI: 10.1589/jpts.27.1603] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 01/31/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to confirm the effects of both conventional
overground gait training (CGT) and a gait trainer with partial body weight support (GTBWS)
on spatiotemporal gait parameters of patients with hemiparesis following chronic stroke.
[Subjects and Methods] Thirty stroke patients were alternately assigned to one of two
treatment groups, and both groups underwent CGT and GTBWS. [Results] The functional
ambulation classification on the affected side improved significantly in the CGT and GTBWS
groups. Walking speed also improved significantly in both groups. [Conclusion] These
results suggest that the GTBWS in company with CGT may be, in part, an effective method of
gait training for restoring gait ability in patients after a stroke.
Collapse
Affiliation(s)
- Byoung-Sun Park
- Laboratory of Health Science and Nanophysiotherapy, Department of Physical Therapy, Graduate School, Yongin University, Republic of Korea
| | - Mee-Young Kim
- Laboratory of Health Science and Nanophysiotherapy, Department of Physical Therapy, Graduate School, Yongin University, Republic of Korea
| | - Lim-Kyu Lee
- Laboratory of Health Science and Nanophysiotherapy, Department of Physical Therapy, Graduate School, Yongin University, Republic of Korea ; Commercializations Promotion Agency for R&D Outcomes, Republic of Korea
| | - Seung-Min Yang
- Laboratory of Health Science and Nanophysiotherapy, Department of Physical Therapy, Graduate School, Yongin University, Republic of Korea
| | - Won-Deok Lee
- Laboratory of Health Science and Nanophysiotherapy, Department of Physical Therapy, Graduate School, Yongin University, Republic of Korea
| | - Ji-Woong Noh
- Laboratory of Health Science and Nanophysiotherapy, Department of Physical Therapy, Graduate School, Yongin University, Republic of Korea
| | - Yong-Sub Shin
- Laboratory of Health Science and Nanophysiotherapy, Department of Physical Therapy, Graduate School, Yongin University, Republic of Korea
| | - Ju-Hyun Kim
- Department of Physical Therapy, College of Health Welfare, Wonkwang Health Science University, Republic of Korea
| | - Jeong-Uk Lee
- Department of Physical Therapy, College of Health Science, Honam University, Republic of Korea
| | - Taek-Yong Kwak
- Department of Taekwondo Instructor Education, College of Martial Arts, Yongin University, Republic of Korea
| | - Tae-Hyun Lee
- Department of Combative Martial Arts Training, College of Martial Arts, Yongin University, Republic of Korea
| | - Ju-Young Kim
- Department of Combative Martial Arts Training, College of Martial Arts, Yongin University, Republic of Korea
| | - Junghwan Kim
- Department of Physical Therapy, College of Public Health & Welfare, Yongin University, Republic of Korea
| |
Collapse
|
22
|
Na KP, Kim YL, Lee SM. Effects of gait training with horizontal impeding force on gait and balance of stroke patients. J Phys Ther Sci 2015; 27:733-6. [PMID: 25931719 PMCID: PMC4395703 DOI: 10.1589/jpts.27.733] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 10/21/2014] [Indexed: 12/04/2022] Open
Abstract
[Purpose] The purpose of this study was to investigate the effects of treadmill training
with a horizontal impeding force applied to the center of upper body mass on the gait and
balance of post-stroke patients. [Subjects and Methods] Twenty-four subjects with
hemiplegia less than 3 months after stroke onset were randomly assigned to 2 groups: an
applied horizontal impeding force on treadmill training (experimental) group (n = 12), and
a control group (n = 12). Both groups walked on a treadmill at a comfortable or moderate
speed for 20 minutes per day, 3 sessions per week for 8 weeks after a pre-test. The
experimental group also had a horizontal impeding force applied to the center of their
upper body mass. [Results] All groups demonstrated significant improvement after 8 weeks
compared to baseline measurements. In intra-group comparisons, the subjects’ gait ability
(CGS, MGS, cadence, and step length) and balance ability (TUG, BBS, and FRT) significantly
improved. In inter-group comparisons, the experimental group’s improvement was
significantly better in CGS MGS, cadence, step length, TUG, and BBS, but not in FRT.
[Conclusion] Treadmill training was identified as an effective training method that
improved gait and balance ability. A horizontal impeding force applied during treadmill
training was more effective than treadmill walking training alone at improving the gait
and dynamic balance of patients with stroke.
Collapse
Affiliation(s)
- Kyung-Pil Na
- Department of Physical Therapy, Sahmyook University, Republic of Korea
| | - You Lim Kim
- Department of Physical Therapy, Sahmyook University, Republic of Korea
| | - Suk Min Lee
- Department of Physical Therapy, Sahmyook University, Republic of Korea
| |
Collapse
|
23
|
Kim TW, Kim YW. Treadmill sideways gait training with visual blocking for patients with brain lesions. J Phys Ther Sci 2014; 26:1415-8. [PMID: 25276026 PMCID: PMC4175247 DOI: 10.1589/jpts.26.1415] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 03/09/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The aim of this study was to verify the effect of sideways treadmill training
with and without visual blocking on the balance and gait function of patients with brain
lesions. [Subjects] Twenty-four stroke and traumatic brain injury subjects participated in
this study. They were divided into two groups: an experimental group (12 subjects) and a
control group (12 subjects). [Methods] Each group executed a treadmill training session
for 20 minutes, three times a week, for 6 weeks. The sideways gait training on the
treadmill was performed with visual blocking by the experimental group and with normal
vision by the control group. A Biodex Gait Trainer 2 was used to assess the gait function.
It was used to measure walking speed, walking distance, step length, and stance time on
each foot. The Five-Times-Sit-To-Stand test (FTSST) and Timed Up and Go test (TUG) were
used as balance measures. [Results] The sideways gait training with visual blocking group
showed significantly improved walking speed, walking distance, step length, and stance
time on each foot after training; FTSST and TUG times also significantly improved after
training in the experimental group. Compared to the control group, the experimental group
showed significant increases in stance time on each foot. [Conclusion] Sideways gait
training on a treadmill with visual blocking performed by patients with brain lesions
significantly improved their balance and gait function.
Collapse
Affiliation(s)
- Tea-Woo Kim
- Department of Rehabilitation Science, The Graduate School, Jeonju University, Republic of Korea
| | - Yong-Wook Kim
- Department of Physical Therapy, College of Medical Sciences, Jeonju University, Republic of Korea
| |
Collapse
|
24
|
Change of muscle architecture following body weight support treadmill training for persons after subacute stroke: evidence from ultrasonography. BIOMED RESEARCH INTERNATIONAL 2014; 2014:270676. [PMID: 24783198 PMCID: PMC3982255 DOI: 10.1155/2014/270676] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 01/30/2014] [Accepted: 02/14/2014] [Indexed: 11/18/2022]
Abstract
Although the body weight support treadmill training (BWSTT) in rehabilitation therapy has been appreciated for a long time, the biomechanical effects of this training on muscular system remain unclear. Ultrasonography has been suggested to be a feasible method to measure muscle morphological changes after neurological diseases such as stroke, which may help to enhance the understanding of the mechanism underlying the impaired motor function. This study investigated the muscle architectural changes of tibialis anterior and medial gastrocnemius in patients after subacute stroke by ultrasound. As expected, we found the effect of BWSTT on the muscular system. Specifically, the results showed larger pennation angle and muscle thickness of tibialis anterior and longer fascicle length of medial gastrocnemius after the training. The findings of this study suggest that the early rehabilitation training of BWSTT in subacute stage of stroke provides positive changes of the muscle architecture, leading to the potential improvement of the force generation of the muscle. This may not only help us understand changes of subacute stroke in muscular system but also have clinical implications in the evaluation of rehabilitation training after neurological insults.
Collapse
|
25
|
Methodologies to assess muscle co-contraction during gait in people with neurological impairment – A systematic literature review. J Electromyogr Kinesiol 2014; 24:179-91. [DOI: 10.1016/j.jelekin.2013.11.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 10/01/2013] [Accepted: 11/05/2013] [Indexed: 02/05/2023] Open
|
26
|
Ovando AC, Michaelsen SM, Pereira ND, Dias JA, Carvalho TD. Frequência cardíaca e percepção subjetiva de esforço durante o andar para trás em velocidade confortável e máxima em adultos com hemiparesia. REV BRAS MED ESPORTE 2013. [DOI: 10.1590/s1517-86922013000600011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO E OBJETIVO: Estudos sobre o andar para trás (AT) em indivíduos saudáveis demonstraram que esse exercício demanda maior consumo de oxigênio e esforço cardiopulmonar comparado ao andar para frente (AF). Em indivíduos após acidente vascular encefálico (AVE), o AT demonstrou ser uma forma de terapia benéfica para melhorar parâmetros de marcha. Este estudo teve como objetivo comparar as variáveis frequência cardíaca (FC) e percepção subjetiva de esforço (PSE) entre o AF e AT em esteira rolante em duas velocidades distintas em indivíduos com hemiparesia, algo que poderá contribuir para a definição da melhor estratégia para colocar os indivíduos na zona-alvo de um exercício visando ao aprimoramento das condições cardiorrespiratórias. MÉTODOS: Participaram 13 indivíduos adultos de ambos os sexos (53,7 ± 13,5 anos) com sequela de AVE crônica (38,5 ± 31,2 meses de acometimento). Os indivíduos realizaram a tarefa de AT na esteira em velocidade confortável e máxima, repetindo os procedimentos em velocidades idênticas durante o AF. Foi utilizada uma ANOVA fatorial para testar o efeito do sentido (AF e AT) e da velocidade (confortável e máxima) sobre a FC e PSE. RESULTADOS: A FC foi maior durante o AT nas duas velocidades, sendo essa incrementada com o aumento da velocidade (p < 0,01 para todas comparações). Da mesma forma, a PSE foi maior durante o AT nas duas velocidades, sendo incrementada com o aumento da velocidade (p < 0,01 para todas as comparações). CONCLUSÃO: Andar para trás é uma atividade física mais intensa que andar para frente em uma mesma velocidade para indivíduos com hemiparesia. Os achados sugerem que esta atividade poderia ser uma alternativa na realização de programas com ênfase no condicionamento cardiopulmonar e como complemento de outros procedimentos na reeducação do andar após AVE.
Collapse
|
27
|
Comparative analysis of speed's impact on muscle demands during partial body weight support motor-assisted elliptical training. Gait Posture 2013; 39:314-20. [PMID: 23973354 DOI: 10.1016/j.gaitpost.2013.07.120] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Revised: 07/10/2013] [Accepted: 07/26/2013] [Indexed: 02/02/2023]
Abstract
Individuals with walking limitations often experience challenges engaging in functionally relevant exercise. An adapted elliptical trainer (motor to assist pedal movement, integrated body weight harness, ramps/stairs, and grab rails) has been developed to help individuals with physical disabilities and chronic conditions regain/retain walking capacity and fitness. However, limited published studies are available to guide therapeutic interventions. This repeated measures study examined the influence of motor-assisted elliptical training speed on lower extremity muscle demands at four body weight support (BWS) levels commonly used therapeutically for walking. Electromyography (EMG) and pedal trajectory data were recorded as ten individuals without known disability used the motor-assisted elliptical trainer at three speeds [20,40, 60 revolutions per minute (RPM)] during each BWS level (0%, 20%, 40%, 60%). Overall, the EMG activity (peak, mean, duration) in key stabilizer muscles (i.e., gluteus medius, gluteus maximus, vastus lateralis, medial gastrocnemius and soleus) recorded at 60 RPM exceeded those at 40 RPM, which were higher than values at 20 RPM in all but three situations (gluteus medius mean at 0% BWS, vastus lateralis mean at 20% BWS, soleus duration at 40% BWS); however, these differences did not always achieve statistical significance. Slower motor-assisted speeds can be used to accommodate weakness of gluteus medius, gluteus maximus, vastus lateralis, medial gastrocnemius and soleus. As strength improves, training at faster motor-assisted speeds may provide a means to progressively challenge key lower extremity stabilizers.
Collapse
|
28
|
Abstract
This review discusses challenges faced by clinicians and researchers when measuring ambulation in individuals with central neurologic disorders within 3 distinct environments: clinical, laboratory, and community. Even the most robust measure of ambulation is affected by the environment in which it is implemented and by the clinical or research question and the specificity of the hypothesis being investigated. The ability to accurately measure ambulation (one of the most important metrics used to show transition into a community environment) is essential to measure treatment effectiveness and rehabilitation outcomes in populations with central neurologic disorders.
Collapse
|
29
|
Esquenazi A, Lee S, Packel AT, Braitman L. A randomized comparative study of manually assisted versus robotic-assisted body weight supported treadmill training in persons with a traumatic brain injury. PM R 2012. [PMID: 23200117 DOI: 10.1016/j.pmrj.2012.10.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES (1) To compare the effects of robotic-assisted treadmill training (RATT) and manually assisted treadmill training (MATT) in participants with traumatic brain injury (TBI) and (2) to determine the potential impact on the symmetry of temporal walking parameters, 6-minute walk test, and the mobility domain of the Stroke Impact Scale, version 3.0 (SIS). DESIGN Randomized prospective study. SUBJECTS A total of 16 participants with TBI and a baseline over ground walking self-selected velocity (SSV) of ≥0.2 m/s to 0.6 m/s randomly assigned to either the RATT or MATT group. INTERVENTION Gait training for 45 minutes, 3 times a week with either RATT or MATT for a total of 18 training sessions. OUTCOME MEASURES Primary: Overground walking SSV, maximal velocity. Secondary: Spatiotemporal symmetry, 6-minute walk test, and SIS. RESULTS Between-group differences were not statistically significant for any measure. However, from pretraining to post-training, the average SSV increased by 49.8% for the RATT group (P = .01) and by 31% for MATT group (P = .06). The average maximal velocity increased by 14.9% for the RATT group (P = .06) and by 30.8% for the MATT group (P = .01). Less staffing and effort was needed for RATT in this study. Step-length asymmetry ratio improved during SSV by 33.1% for the RATT group (P = .01) and by 9.1% for the MATT group (P = .73). The distance walked increased by 11.7% for the robotic group (P = .21) and by 19.3% for manual group (P = .03). A statistically significant improvement in the mobility domain of the SIS was found for both groups (P ≤ .03). CONCLUSIONS The results of this study demonstrate greater improvement in symmetry of gait (step length) for RATT and no significant differences between RATT and MATT with regard to improvement in gait velocity, endurance, and SIS. Our study provides evidence that participants with a chronic TBI can experience improvements in gait parameters with gait training with either MATT or RATT.
Collapse
Affiliation(s)
- Alberto Esquenazi
- Gait and Motion Analysis Laboratory, Department of Physical Medicine and Rehabilitation, MossRehab, 60 Township Line Rd, Elkins Park, PA 19027, USA.
| | | | | | | |
Collapse
|
30
|
Hutin E, Pradon D, Barbier F, Bussel B, Gracies JM, Roche N. Walking velocity and lower limb coordination in hemiparesis. Gait Posture 2012; 36:205-11. [PMID: 22551503 DOI: 10.1016/j.gaitpost.2012.02.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Revised: 02/15/2012] [Accepted: 02/19/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND/OBJECTIVE Gait training at fast speed has been suggested as an efficient rehabilitation method in hemiparesis. We investigated whether maximal speed walking might positively impact inter-segmental coordination in hemiparetic subjects. METHODS We measured thigh-shank and shank-foot coordination in the sagittal plane during gait at preferred (P) and maximal (M) speed using the continuous relative phase (CRP), in 20 healthy and 27 hemiparetic subjects. We calculated the root-mean square (CRP(RMS)) and its variability (CRP(SD)) over each phase of the gait cycle. A small CRP(RMS) indicates in-phasing, i.e. high level of synchronization between two segments along the gait cycle. A small CRP(SD) indicates high stability of the inter-segmental coordination across gait cycles. RESULTS Increase from preferred to maximal speed was 57% in healthy and 49% in hemiparetic subjects (difference NS). In healthy subjects, the main change was shank-foot in-phasing at stance (CRP(Shank-Foot/RMS), P, 98±10; M, 67±12, p<0.001). In hemiparetic subjects, we also found shank-foot in-phasing at late stance bilaterally (non-paretic CRP(Shank-Foot/RMS), P, 37±9; M, 29±8, p<0.001; paretic CRP(Shank-Foot/RMS), P, 38±13; M, 32±12, p<0.001), and thigh-shank in-phasing at mid-stance in the non-paretic limb (CRP(Thigh-Shank/RMS), P, 57±9; M, 49±9, p<0.001). CRP(Thigh-Shank) variability diminished in the paretic limb (CRP(Thigh-Shank/SD), P, 18.3±6.3; M, 16.1±5.2, p<0.001). CONCLUSION During gait velocity increase in hemiparesis, there is improvement of thigh-shank coordination stability in the paretic limb and of shank-foot synchronization at late stance bilaterally, which optimizes the propulsive phase similarly to healthy subjects. These findings may add incentive for rehabilitation clinicians to explore maximal velocity gait training in hemiparesis.
Collapse
Affiliation(s)
- Emilie Hutin
- Laboratoire d'Analyse du Mouvement, CIC-IT 805, AP-HP, CHU Raymond Poincaré, Garches, France.
| | | | | | | | | | | |
Collapse
|
31
|
Seo K, Lee J, Lee S. Impact of PNF-based Walking Exercise on a Ramp on Gait Performance of Stroke Patients. J Phys Ther Sci 2012. [DOI: 10.1589/jpts.24.1243] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- KyoChul Seo
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University
| | - JeonHyeng Lee
- Department of Physical Therapy, Daegu Health University
| | - SangYong Lee
- Department of Physical Therapy, Youngdong University
| |
Collapse
|
32
|
Abstract
BACKGROUND Fast treadmill training improves walking speed to a greater extent than training at a self-selected speed after stroke. It is unclear whether fast treadmill walking facilitates a more normal gait pattern after stroke, as has been suggested for treadmill training at self-selected speeds. Given the massed stepping practice that occurs during treadmill training, it is important for therapists to understand how the treadmill speed selected influences the gait pattern that is practiced on the treadmill. OBJECTIVE The purpose of this study was to characterize the effect of systematic increases in treadmill speed on common gait deviations observed after stroke. DESIGN A repeated-measures design was used. METHODS Twenty patients with stroke walked on a treadmill at their self-selected walking speed, their fastest speed, and 2 speeds in between. Using a motion capture system, spatiotemporal gait parameters and kinematic gait compensations were measured. RESULTS Significant improvements in paretic- and nonparetic-limb step length and in single- and double-limb support were found. Asymmetry of these measures improved only for step length. Significant improvements in paretic hip extension, trailing limb position, and knee flexion during swing also were found as speed increased. No increases in circumduction or hip hiking were found with increasing speed. Limitations Caution should be used when generalizing these results to survivors of a stroke with a self-selected walking speed of less than 0.4 m/s. This study did not address changes with speed during overground walking. CONCLUSIONS Faster treadmill walking facilitates a more normal walking pattern after stroke, without concomitant increases in common gait compensations, such as circumduction. The improvements in gait deviations were observed with small increases in walking speed.
Collapse
|
33
|
Schönberger M, Humle F, Zeeman P, Teasdale TW. Patient compliance in brain injury rehabilitation in relation to awareness and cognitive and physical improvement. Neuropsychol Rehabil 2011; 16:561-78. [PMID: 16952893 DOI: 10.1080/09602010500263084] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
UNLABELLED The purpose of the present study was to investigate the relationship between patients' compliance and awareness and outcome of brain injury rehabilitation. Subjects were 98 patients who underwent a holistic neuropsychological outpatient rehabilitation programme. Patients had suffered a traumatic brain injury (n = 26), a cerebrovascular accident (n = 58), or another neurological insult (n = 14). MEASURES Two staff members, a neuropsychologist and a physiotherapist, retrospectively and separately rated patients' awareness and their compliance. Outcome was measured with the d2 test of concentration, measures of oxygen uptake, strength endurance, running speed, and patients' and relatives' ratings of patients' cognitive, physical, and overall problems on the European Brain Injury Questionnaire (EBIQ). The discrepancy between patients' and relatives' ratings on the EBIQ was incorporated as a second measure of patients' awareness. RESULTS The neuropsychologist's compliance ratings were significantly related to measures of insight, improvement of d2 performance accuracy and stability, improvement of oxygen uptake, and reduction of cognitive and overall problems as reported by the patients, while the physiotherapist's compliance ratings were related to measures of insight, improvement of d2 performance speed, improvement of oxygen uptake and strength endurance, and all three EBIQ patient scales. DISCUSSION The results suggest a differential relationship between situation-specific compliance and outcome.
Collapse
Affiliation(s)
- Michael Schönberger
- Center for Rehabilitation of Brain Injury, University of Copenhagen, Copenhagen, Denmark.
| | | | | | | |
Collapse
|
34
|
Lam HSP, Lau FWK, Chan GKL, Sykes K. The validity and reliability of a 6-Metre Timed Walk for the functional assessment of patients with stroke. Physiother Theory Pract 2010; 26:251-5. [DOI: 10.3109/09593980903015235] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
35
|
Gait parameters associated with responsiveness to treadmill training with body-weight support after stroke: an exploratory study. Phys Ther 2010; 90:209-23. [PMID: 20022996 DOI: 10.2522/ptj.20090141] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Task-specific training programs after stroke improve walking function, but it is not clear which biomechanical parameters of gait are most associated with improved walking speed. OBJECTIVE The purpose of this study was to identify gait parameters associated with improved walking speed after a locomotor training program that included body-weight-supported treadmill training (BWSTT). DESIGN A prospective, between-subjects design was used. METHODS Fifteen people, ranging from approximately 9 months to 5 years after stroke, completed 1 of 3 different 6-week training regimens. These regimens consisted of 12 sessions of BWSTT alternated with 12 sessions of: lower-extremity resistive cycling; lower-extremity progressive, resistive strengthening; or a sham condition of arm ergometry. Gait analysis was conducted before and after the 6-week intervention program. Kinematics, kinetics, and electromyographic (EMG) activity were recorded from the hemiparetic lower extremity while participants walked at a self-selected pace. Changes in gait parameters were compared in participants who showed an increase in self-selected walking speed of greater than 0.08 m/s (high-response group) and in those with less improvement (low-response group). RESULTS Compared with participants in the low-response group, those in the high-response group displayed greater increases in terminal stance hip extension angle and hip flexion power (product of net joint moment and angular velocity) after the intervention. The intensity of soleus muscle EMG activity during walking also was significantly higher in participants in the high-response group after the intervention. LIMITATIONS Only sagittal-plane parameters were assessed, and the sample size was small. CONCLUSIONS Task-specific locomotor training alternated with strength training resulted in kinematic, kinetic, and muscle activation adaptations that were strongly associated with improved walking speed. Changes in both hip and ankle biomechanics during late stance were associated with greater increases in gait speed.
Collapse
|
36
|
Coza A, von Tscharner V, Nigg B. Activity mapping of lower leg muscles using a circumferential electrode array. FOOTWEAR SCIENCE 2009. [DOI: 10.1080/19424280903535421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
37
|
Abstract
BACKGROUND AND OBJECTIVE Walking speed influences energy cost in healthy adults, but its influence when walking is impaired due to stroke is not clear. This study investigated the effect of manipulating walking speed on the energy economy of walking poststroke. METHODS Sixteen persons with chronic stroke underwent a clinical examination, including several lower extremity impairment measures. consumption (VO(2)) was measured as they walked at their self-selected speed (Free), 20% slower (Slow), their fastest possible speed (Fastest), and 2 speeds between Free and Fastest speeds. VO(2) was normalized to body mass and speed, resulting in energy cost per meter walked (CW). RESULTS A main effect for speed was observed (P = .00001), with faster than self-selected speeds showing greater relative economy as a whole. However, for 5 subjects with the fastest walking speeds (>1.2 m/s), there was a trend toward decreasing relative economy at speeds higher than self-selected speed (P = .18). There was a negative correlation between improvement in CW at the most economical speed and (a) Free speed (r = -.857; P < .0001) and (b) lower extremity Fugl-Meyer scores (r = -.653; P = .006). CONCLUSIONS For those poststroke whose fastest walking speed after stroke is below 1.2 m/s, walking economy improves when speed is increased above the self-selected walking speed. The results suggest that for persons poststroke with very slow self-selected walking speeds, improvements in walking speed could be accompanied by improvements in walking economy if faster walking speeds can be attained through intervention.
Collapse
Affiliation(s)
- Darcy S Reisman
- Department of Physical Therapy, University of Delaware, Newark, Delaware 19716, USA.
| | | | | |
Collapse
|
38
|
Smith PS, Thompson M. Treadmill training post stroke: are there any secondary benefits? A pilot study. Clin Rehabil 2008; 22:997-1002. [DOI: 10.1177/0269215508088988] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To explore the secondary benefits of treadmill training for people in the chronic stage of recovery from stroke. Design: Modified random assignment, matched-pair control group design with repeated measures. Setting: Outpatient stroke centre. Participants: Twenty individuals post first stroke who acknowledged walking slower than pre stroke. Participants matched by side of hemiparesis and motor impairment. Interventions: Twelve 20-minute sessions of walking on a treadmill or weekly phone call. Main outcome measures: Depression (Beck Depression Index), mobility and social participation (Stroke Impact Scale 3.0 subscales) were assessed initially, at the end of 12 treatments (four weeks) and six weeks later. Results: No significant difference was found between groups for any dependent measure. The ANOVA to investigate main effects in each group found no significant findings in the control group; however in the treatment group significant improvements over time for depression (P=0.005, P<0.001), mobility (P=0.008) and social participation (P= 0.004) were demonstrated. Conclusions: A task-specific intervention designed to improve gait speed may potentially provide secondary benefits by positively impacting depression, mobility and social participation for people post stroke.
Collapse
Affiliation(s)
- Patricia S Smith
- Department of Physical Therapy, The University of Texas Southwestern Medical Center,
| | - Mary Thompson
- School of Physical Therapy, Texas Woman's University, Dallas, Texas, USA
| |
Collapse
|
39
|
Kuys SS, Brauer SG, Ada L, Russell TG. Immediate effect of treadmill walking practice versus overground walking practice on overground walking pattern in ambulatory stroke patients: an experimental study. Clin Rehabil 2008; 22:931-9. [DOI: 10.1177/0269215508094245] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To determine whether 10 minutes of treadmill walking had a different effect on overground walking pattern compared with 10 minutes of overground walking in newly ambulatory stroke patients. Are any changes influenced by walking ability? Design: A within-participant, repeated measures experimental study was conducted. Each participant carried out 10 minutes of overground walking practice followed by 10 minutes of treadmill walking practice at matched heart rate on separate days. Setting: An inpatient rehabilitation facility. Subjects: Twenty-one participants receiving inpatient rehabilitation following stroke. Measures: Overground walking pattern was measured as linear and angular kinematics using GAITRite and a two-dimensional webcam application respectively. Results: Following treadmill walking practice, there was 6 degrees (95% confidence interval (CI) 2 to 10) more knee extension at heel strike during overground walking than following overground walking practice. Poorer walkers increased non-paretic limb step length following treadmill walking practice more than those with better walking ability (mean difference 2.2 cm, 95% CI 0 to 5). Conclusions: Ten minutes of treadmill walking practice resulted in a similar overground walking pattern compared with overground walking practice in newly ambulatory stroke patients undergoing rehabilitation, regardless of walking ability.
Collapse
Affiliation(s)
- Suzanne S Kuys
- School of Physiotherapy and Exercise Science, Griffith University, , Physiotherapy Department, Princess Alexandra Hospital, Brisbane, Division of Physiotherapy, University of Queensland
| | | | - Louise Ada
- Discipline of Physiotherapy, The University of Sydney
| | | |
Collapse
|
40
|
Resistance-based, reciprocal upper and lower limb locomotor training in chronic stroke: a randomized, controlled crossover study. Clin Rehabil 2008; 22:610-7. [DOI: 10.1177/0269215508088987] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To determine efficacy of a bilateral reciprocal training regimen on affected leg impairment and dynamic balance. Design: Randomized, controlled, single-blinded crossover study. Setting: Outpatient rehabilitation hospital. Participants: Seven patients who experienced stroke >1 year prior to study entry exhibiting affected leg weakness. Intervention: Subjects were randomly assigned to receive both of the following in a randomized, sequential order: (a) a resistance-based, reciprocal, affected leg locomotor training protocol using the NuStep apparatus ( n = 4) and (b) a home exercise programme (HEP) consisting of self-supervised practice with fractionated joint movements of the lower limb. Each phase of the intervention was performed for 30 minutes each session, three days a week, and conducted over an eight-week period. Main outcome measures: Outcomes were evaluated by a blinded rater using the lower extremity scale of the Fugl-Meyer and the Berg Balance Scale. Results: After HEP participation, subjects showed nominal or no changes on any of the outcome measures. After NuStep participation, patients in both treatment groups showed impairment reductions as shown by the Fugl-Meyer (+4.3; +2.2), and increased balance as shown by the Berg Balance Scale (+4.0; +4.0). These trends were exhibited regardless of group assignment. Conclusion: Impairment reductions and balance gains may be achieved using a resistance-based, reciprocal upper and lower limb locomotor training protocol.
Collapse
|
41
|
Increasing intensity during treadmill walking does not adversely affect walking pattern or quality in newly-ambulating stroke patients: an experimental study. ACTA ACUST UNITED AC 2008; 54:49-54. [DOI: 10.1016/s0004-9514(08)70066-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
42
|
Reisman DS, Wityk R, Silver K, Bastian AJ. Locomotor adaptation on a split-belt treadmill can improve walking symmetry post-stroke. Brain 2007; 130:1861-72. [PMID: 17405765 PMCID: PMC2977955 DOI: 10.1093/brain/awm035] [Citation(s) in RCA: 354] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Human locomotion must be flexible in order to meet varied environmental demands. Alterations to the gait pattern occur on different time scales, ranging from fast, reactive adjustments to slower, more persistent adaptations. A recent study in humans demonstrated that the cerebellum plays a key role in slower walking adaptations in interlimb coordination during split-belt treadmill walking, but not fast reactive changes. It is not known whether cerebral structures are also important in these processes, though some studies of cats have suggested that they are not. We used a split-belt treadmill walking task to test whether cerebral damage from stroke impairs either type of flexibility. Thirteen individuals who had sustained a single stroke more than 6 months prior to the study (four females) and 13 age- and gender-matched healthy control subjects were recruited to participate in the study. Results showed that stroke involving cerebral structures did not impair either reactive or adaptive abilities and did not disrupt storage of new interlimb relationships (i.e. after-effects). This suggests that cerebellar interactions with brainstem, rather than cerebral structures, comprise the critical circuit for this type of interlimb control. Furthermore, the after-effects from a 15-min adaptation session could temporarily induce symmetry in subjects who demonstrated baseline asymmetry of spatiotemporal gait parameters. In order to re-establish symmetric walking, the choice of which leg is on the fast belt during split-belt walking must be based on the subject's initial asymmetry. These findings demonstrate that cerebral stroke survivors are indeed able to adapt interlimb coordination. This raises the possibility that asymmetric walking patterns post-stroke could be remediated utilizing the split-belt treadmill as a long-term rehabilitation strategy.
Collapse
Affiliation(s)
- Darcy S Reisman
- Department of Physical Therapy, University of Delaware, 322 McKinly Laboratory, Newark, DE 19716, USA.
| | | | | | | |
Collapse
|
43
|
Lamontagne A, Stephenson JL, Fung J. Physiological evaluation of gait disturbances post stroke. Clin Neurophysiol 2007; 118:717-29. [PMID: 17307395 DOI: 10.1016/j.clinph.2006.12.013] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2006] [Revised: 12/08/2006] [Accepted: 12/26/2006] [Indexed: 11/16/2022]
Abstract
A large proportion of stroke survivors have to deal with problems in mobility. Proper evaluations must be undertaken to understand the sensorimotor impairments underlying locomotor disorders post stroke, so that evidence-based interventions can be developed. The current electrophysiological, biomechanical, and imagery evaluations that provide insight into locomotor dysfunction post stroke, as well as their advantages and limitations, are reviewed in this paper. In particular, electrophysiological evaluations focus on the contrast of electromyographic patterns and integrity of spinal reflex pathways during perturbed and unperturbed locomotion between persons with stroke and healthy individuals. At a behavioral level, biomechanical evaluations that include temporal distance factors, kinematic and kinetic analyses, as well as the mechanical energy and metabolic cost, are useful when combined with electrophysiological measures for the interpretation of gait disturbances that are related to the control of the central nervous system or secondary to biomechanical constraints. Finally, current methods in imaging and transcranial magnetic stimulation can provide further insight into cortical control of locomotion and the integrity of the corticospinal pathways.
Collapse
Affiliation(s)
- Anouk Lamontagne
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada.
| | | | | |
Collapse
|
44
|
Sullivan K, Klassen T, Mulroy S. Combined Task-Specific Training and Strengthening Effects On Locomotor Recovery Post-Stroke. J Neurol Phys Ther 2006; 30:130-41. [PMID: 17029656 DOI: 10.1097/01.npt.0000281950.86311.82] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Task-specific and strength training have demonstrated efficacy as therapeutic interventions poststroke. The intent of this case study is to describe outcomes associated with a therapy program that combines task-specific and strength training in an individual post-stroke and to discuss some possible mechanisms and modulating factors that may affect post-stroke neurologic recovery and responsiveness to intervention. CASE DESCRIPTION The participant was a 38-year-old female with right middle cerebral artery stroke, evaluated 15 months postonset. She ambulated independently with an ankle-foot orthosis and straight cane. Her free and fast overground velocity was 0.50 m/s and 0.62 m/s, respectively. Body-weight supported treadmill training and a limb-loaded cycling exercise were alternated over 24 treatments sessions (4 times/wk for 6 wks). Measurements were taken pre-, post-treatment, and at a 6-mo follow-up. Instrumented gait and motion analysis with fine-wire EMG recording of LE muscle activity occurred pre- and post-treatment. OUTCOMES Post-treatment, walking speed increased 18% for free--(0.59 m/ s) and 14.4% for fast-velocity (0.71 m/s); 6-min walking distance increased 4% (184.4 m). At 6-mos, continued improvements in all walking outcomes were evident. Gait and motion analysis revealed that functional locomotor recovery was associated with increases in magnitude of paretic leg gluteus maximus and gluteus medius activation during gait. Motion analysis confirmed an increase of hip and knee extension motions throughout stance and swing. DISCUSSION For the person in this case clinically meaningful changes in walking function were associated with a combined therapeutic program that included both task-specific and LE strength training. Possible mechanisms associated with response to therapy were related to improved motor unit activation associated with increased strength in key muscles used in gait.
Collapse
Affiliation(s)
- Katherine Sullivan
- Department of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, USA.
| | | | | |
Collapse
|
45
|
Bayat R, Barbeau H, Lamontagne A. Speed and temporal-distance adaptations during treadmill and overground walking following stroke. Neurorehabil Neural Repair 2005; 19:115-24. [PMID: 15883355 DOI: 10.1177/1545968305275286] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare the maximum gait speed of stroke subjects attained during treadmill and overground in stroke subjects and to identify the temporal-distance determinants of the maximal gait speed. METHODS Ten individuals with hemiparetic gait deficits and whose walking speeds ranged between 0.24 m/s and 0.82 m/s participated. Five healthy age-matched controls were also tested to provide comparative data for the gait speed transfer between the 2 modes of locomotion. Following a brief habituation process to walking on the treadmill, subjects were tested while walking at comfortable and maximal speeds on the treadmill and overground, in a random order. Main Outcome Measure. Self-selected comfortable and maximum gait speed and temporal-distance factors were acquired using a 6-camera Vicontrade mark motion analysis system and compared between treadmill and overground walking at a similar speed. RESULTS Overground walking resulted in higher maximal speeds (P < 0.001), greater stride lengths (P < 0.001), and a lower cadence (P < 0.02), as compared to tread-mill. The comfortable gait speed and the maximum stride length proved to be strong determinants for the maximal speed on both modes of locomotion (P < 0.01), but the maximum cadence was correlated to maximum speed only for overground locomotion (P < 0.05). CONCLUSIONS Stroke subjects walked slower on the treadmill as compared to overground. They also used a different strategy to increase gait speed, relying mostly on increasing the stride length during treadmill ambulation.
Collapse
Affiliation(s)
- Roain Bayat
- School of Physical and Occupational Therapy, McGill University, Montréal, Québec, Canada
| | | | | |
Collapse
|
46
|
Yelnik A. Évolution des concepts en rééducation du patient hémiplégique. ACTA ACUST UNITED AC 2005; 48:270-7. [PMID: 15914263 DOI: 10.1016/j.annrmp.2005.02.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2004] [Accepted: 02/24/2005] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The author attempts to show the evolution of the ideas guiding the rehabilitation treatment of motricity disorders after a vascular or traumatic brain lesion. METHOD Expert opinion based on an uncomprehensive review of the literature, from the databases Reedoc and Medline and from the Institut Lionnois library in Nancy and the Charcot library in Paris. RESULTS AND DISCUSSION Many theories and techniques have been proposed. The modern history of this rehabilitation treatment has been marked by a period that stressed control of the abnormal motricity characterizing central motor disorders, sometimes too exclusively. The development of evidence-based medicine in the 1980s undermined certain dogmas. At the same time, the advent of cerebral imaging technology confirmed clinical observations and hypotheses concerning cerebral plasticity. Today, the rehabilitation treatment of these motor disorders uses notions of learning; the diversity and complementarity of the exercises, which must be task-oriented; relative earliness and intensity of therapy; close interactions between sensitivity and motricity; and different concepts as mental imagery, the perception of verticality, or muscle strengthening. CONCLUSION To its well-known preventive and palliative roles, rehabilitation treatment has now added a curative role. All the concepts applied today are not new, but the spirit of their application is new. Because we are sure that neurological recovery can be improved, no idea can be rejected at the outset; its effect must be demonstrated. Among the numerous ideas presently proposed, future studies will define the best ones, for the most suitable patient, at the best time.
Collapse
Affiliation(s)
- A Yelnik
- Service de médecine physique et de réadaptation, groupe hospitalier G.H.-Lariboisière-F.-Widal, AP-HP, 200, rue du Faubourg-Saint-Denis, 75010 Paris, France.
| |
Collapse
|
47
|
Abstract
Background and Purpose—
The instantaneous adaptations to speed and load changes during overground locomotion have major implications for mobility after stroke. We examined the extent to which stroke subjects could increase their overground walking speed with respect to speed and unloading changes.
Methods—
Twelve subjects with a unilateral stroke were evaluated while walking overground full weight bearing (FWB) or with body weight support (BWS) at preferred or fast speed. On the basis of their preferred walking speed, subjects were classified as high (≥45 cm/s) or low functioning (<45 cm/s). Gait speed, temporal distance factors (TDFs), as well as movements and muscle activation of the lower limbs were measured and compared across the conditions.
Results—
FWB-Fast condition induced marked (165%) increment in gait speed in all subjects. BWS at preferred speed induced faster speeds in low- but not the high-functioning subjects, whereas combined BWS and fast walking yielded further speed increments in the high-functioning subjects. Fast walking was associated with bilateral increases in joint excursion and muscle activation, as well as improved symmetry in some TDFs. BWS favored a hip flexion strategy in early swing while decreasing limb circumduction.
Conclusions—
This study shows that stroke subjects can increase substantially their walking speed without deleterious effects. Fast walking induces marked speed-related improvements in body and limb kinematics and muscle activation patterns. BWS during overground walking also increases gait speed, but to a lesser extent and only in low-functioning subjects. The combination of BWS with fast speed produces the greatest increments in walking speed in all subjects.
Collapse
Affiliation(s)
- Anouk Lamontagne
- Jewish Rehabilitation Hospital, Centre for Interdisciplinary Research in Rehabilitation, Montreal, Canada.
| | | |
Collapse
|
48
|
Abstract
Rehabilitation after hemiplegic stroke has typically relied on the training of patients in compensatory strategies. The translation of neuroscientific research into care has led to new approaches and renewed promise for better outcomes. Improved motor control can progress with task-specific training incorporating increased use of proximal and distal movements during intensive practice of real-world activities. Functional gains are incorrectly said to plateau by 3-6 months. Many patients retain latent sensorimotor function that can be realised any time after stroke with a pulse of goal-directed therapy. The amount of practice probably best determines gains for a given level of residual movement ability. Clinicians should encourage patients to build greater strength, speed, endurance, and precision of multijoint movements on tasks that increase independence and enrich daily activity. Imaging tools may help clinicians determine the capacity of residual networks to respond to a therapeutic approach and help establish optimal dose-response curves for training. Promising adjunct approaches include practice with robotic devices or in a virtual environment, electrical stimulation to increase cortical excitability during training, and drugs to optimise molecular mechanisms for learning. Biological strategies for neural repair may augment rehabilitation in the next decade.
Collapse
Affiliation(s)
- Bruce H Dobkin
- Neurologic Rehabilitation and Research Program, Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, USA.
| |
Collapse
|
49
|
|
50
|
Hesse S, Werner C, von Frankenberg S, Bardeleben A. Treadmill training with partial body weight support after stroke. Phys Med Rehabil Clin N Am 2003; 14:S111-23. [PMID: 12625641 DOI: 10.1016/s1047-9651(02)00061-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Treadmill therapy with partial BWS is a promising new approach to improve gait ability after stroke. This task-specific approach enables nonambulatory patients the repetitive practice of complex gait cycles instead of single-limb gait-preparatory maneuvers. Patients walk more symmetrically with less spasticity and better cardiovascular efficiency on the treadmill than with floor walking. Several controlled, clinical studies have shown the potential of treadmill training as a therapeutic intervention for nonambulatory patients with chronic stroke-related hemiplegia. Furthermore, controlled trials in acute stroke survivors have shown that treadmill training is as effective as other physiotherapy approaches that stress the repetitive practice of gait. Controlled multicenter trials comparing locomotor training with conventional therapy will be forthcoming. An electromechanical gait trainer that relieves the strenuous effort of the therapists and provides control of the trunk in a phase-dependent manner is a new technical alternative for gait training in severely impaired stroke patients.
Collapse
Affiliation(s)
- Stefan Hesse
- Department of Neurological Rehabilitation, Klinik Berlin, Free University, Kladower Damm 223, 14089 Berlin, Germany.
| | | | | | | |
Collapse
|