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Park SH, Dee W, Keefer R, Roth EJ, Rymer WZ, Wu M. Enhanced phasic sensory afferents paired with controlled constraint force improve weight shift toward the paretic side in individuals post-stroke. J Stroke Cerebrovasc Dis 2023; 32:107035. [PMID: 36739709 PMCID: PMC10065899 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 02/05/2023] Open
Abstract
PURPOSE The goal of this study was to determine whether enhanced phasic sensory afferent input paired with the application of controlled constraint force during walking would improve weight shift toward the paretic side and enhance use of the paretic leg. METHODS Fourteen stroke survivors participated in two experimental conditions, sessions that consisted of 1 min treadmill walking without force and stimulation (baseline), 7 min walking with either "constraint force and sensory stimulation (constraint+stim)" or "constraint force only (constraint)" (adaptation), and then 2 min walking without force and stimulation (post-adaptation). Kinematics of the pelvis and legs, and muscle activity of the paretic leg were recorded. RESULTS Participants showed greater increases in hip abductor (p < 0.001) and adductor (p = 0.04) muscle activities, weight shift toward the paretic side (p = 0.002), and step length symmetry (p < 0.01) during the late post-adaptation period in the "constraint+stim" condition, compared with the effect of the "constraint" condition. In addition, changes in overground walking speed from baseline to 10 min post treadmill walking was significantly greater for the "constraint force and stimulation" condition than for the "constraint force only" condition (p = 0.04). CONCLUSION Enhanced targeted sensory afferent input during locomotor training may facilitate recruitment of targeted muscles of the paretic leg and facilitate use-dependent motor learning of locomotor tasks, which might retain longer and partially transfer from treadmill to overground walking, in stroke survivors.
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Affiliation(s)
- Seoung Hoon Park
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, USA; Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Weena Dee
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Renee Keefer
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Elliot J Roth
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, USA; Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - William Z Rymer
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, USA; Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Ming Wu
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, USA; Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA; Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL, USA.
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Pinheiro C, Figueiredo J, Cerqueira J, Santos CP. Robotic Biofeedback for Post-Stroke Gait Rehabilitation: A Scoping Review. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22197197. [PMID: 36236303 PMCID: PMC9573595 DOI: 10.3390/s22197197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/14/2022] [Accepted: 09/20/2022] [Indexed: 05/09/2023]
Abstract
This review aims to recommend directions for future research on robotic biofeedback towards prompt post-stroke gait rehabilitation by investigating the technical and clinical specifications of biofeedback systems (BSs), including the complementary use with assistive devices and/or physiotherapist-oriented cues. A literature search was conducted from January 2019 to September 2022 on Cochrane, Embase, PubMed, PEDro, Scopus, and Web of Science databases. Data regarding technical (sensors, biofeedback parameters, actuators, control strategies, assistive devices, physiotherapist-oriented cues) and clinical (participants' characteristics, protocols, outcome measures, BSs' effects) specifications of BSs were extracted from the relevant studies. A total of 31 studies were reviewed, which included 660 stroke survivors. Most studies reported visual biofeedback driven according to the comparison between real-time kinetic or spatiotemporal data from wearable sensors and a threshold. Most studies achieved statistically significant improvements on sensor-based and clinical outcomes between at least two evaluation time points. Future research should study the effectiveness of using multiple wearable sensors and actuators to provide personalized biofeedback to users with multiple sensorimotor deficits. There is space to explore BSs complementing different assistive devices and physiotherapist-oriented cues according to their needs. There is a lack of randomized-controlled studies to explore post-stroke stage, mental and sensory effects of BSs.
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Affiliation(s)
- Cristiana Pinheiro
- Center for MicroElectroMechanical Systems (CMEMS), University of Minho, 4800-058 Guimarães, Portugal
- LABBELS-Associate Laboratory, University of Minho, 4800-058 Guimarães, Portugal
| | - Joana Figueiredo
- Center for MicroElectroMechanical Systems (CMEMS), University of Minho, 4800-058 Guimarães, Portugal
- LABBELS-Associate Laboratory, University of Minho, 4800-058 Guimarães, Portugal
| | - João Cerqueira
- Life and Health Sciences Research Institute (ICVS), University of Minho, 4710-057 Braga, Portugal
- Clinical Academic Center (2CA-Braga), Hospital of Braga, 4710-243 Braga, Portugal
| | - Cristina P. Santos
- Center for MicroElectroMechanical Systems (CMEMS), University of Minho, 4800-058 Guimarães, Portugal
- LABBELS-Associate Laboratory, University of Minho, 4800-058 Guimarães, Portugal
- Clinical Academic Center (2CA-Braga), Hospital of Braga, 4710-243 Braga, Portugal
- Correspondence:
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Park SH, Hsu CJ, Dee W, Roth EJ, Rymer WZ, Wu M. Enhanced error facilitates motor learning in weight shift and increases use of the paretic leg during walking at chronic stage after stroke. Exp Brain Res 2021; 239:3327-3341. [PMID: 34477919 DOI: 10.1007/s00221-021-06202-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 08/18/2021] [Indexed: 12/22/2022]
Abstract
The purpose of this study was to determine whether the application of lateral pelvis pulling force toward the non-paretic side during the stance phase of the paretic leg would enhance forced use of the paretic leg and increase weight shift toward the paretic side in stroke survivors. Eleven chronic stroke survivors participated in two experimental sessions, which consisted of (1) treadmill walking with the application of "pelvis resistance" or "pelvis assistance" and (2) overground walking. During the treadmill walking, the laterally pulling force was applied during the stance phase of the paretic leg toward the non-paretic side for the "pelvis resistance" condition or toward the paretic side for the "pelvis assistance" condition during the stance phase of the paretic leg. After force release, the "pelvis resistance" condition exhibited greater enhancement in muscle activation of hip ABD, ADD, and SOL and greater improvement in lateral weight shift toward the paretic side, compared with the effect of the "pelvis assistance" condition (P < 0.03). This improved lateral weight shift was associated with the enhanced muscle activation of hip ABD and ADD (R2 = 0.67, P = 0.01). The pelvis resistance condition also improved overground walking speed and stance phase symmetry when measured 10 min after the treadmill walking (P = 0.004). In conclusion, applying pelvis resistance forces to increase error signals may facilitate motor learning of weight shift toward the paretic side and enhance use of the paretic leg in chronic stroke survivors. Results from this study may be utilized to develop an intervention approach to improve walking in stroke survivors.
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Affiliation(s)
- Seoung Hoon Park
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 E. Erie Street, 23rd floor, Chicago, IL, 60611, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Chao-Jung Hsu
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 E. Erie Street, 23rd floor, Chicago, IL, 60611, USA
| | - Weena Dee
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 E. Erie Street, 23rd floor, Chicago, IL, 60611, USA
| | - Elliot J Roth
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 E. Erie Street, 23rd floor, Chicago, IL, 60611, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - William Z Rymer
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 E. Erie Street, 23rd floor, Chicago, IL, 60611, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Ming Wu
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 E. Erie Street, 23rd floor, Chicago, IL, 60611, USA.
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA.
- Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL, USA.
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Park SH, Hsu CJ, Lin JT, Dee W, Roth EJ, Rymer WZ, Wu M. Increased motor variability facilitates motor learning in weight shift toward the paretic side during walking in individuals post-stroke. Eur J Neurosci 2021; 53:3490-3506. [PMID: 33783888 DOI: 10.1111/ejn.15212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/24/2021] [Accepted: 03/25/2021] [Indexed: 02/01/2023]
Abstract
The purpose of this study was to determine whether applying "varied" versus constant pelvis assistance force mediolaterally toward the paretic side of stroke survivors during walking would result in short-term improvement in weight shift toward the paretic side. Twelve individuals post-stroke (60.4 ± 6.2 years; gait speed: 0.53 ± 0.19 m/s) were tested under two conditions (varied vs. constant). Each condition was conducted in a single separate session, which consisted of (a) treadmill walking with no assistance force for 1 min (baseline), pelvis assistance toward the paretic side for 9 min (adaptation), and then no force for additional 1 min (post-adaptation), and (b) overground walking. In the "varied" condition, the magnitude of force was randomly changed across steps between 30% and 100% of the predetermined amount. In the abrupt condition, the magnitude of force was kept constant at 100% of the predetermined amount. Participants exhibited greater improvements in weight shift toward the paretic side (p < 0.01) and in muscle activity of plantar flexors and hip adductors of the paretic leg (p = 0.02) from baseline to late post-adaptation period for the varied condition than for the constant condition. Motor variability of the peak pelvis displacement at baseline was correlated with improvement in weight shift toward the paretic side after training for the varied (R2 = 0.64, p = 0.01) and the constant condition (R2 = 0.39, p = 0.03). These findings suggest that increased motor variability, induced by applying the varied pelvis assistance, may facilitate motor learning in weight shift and gait symmetry during walking in individuals post-stroke.
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Affiliation(s)
- Seoung Hoon Park
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Chao-Jung Hsu
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Jui-Te Lin
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Weena Dee
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Elliot J Roth
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - William Z Rymer
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Ming Wu
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA.,Department of Bioengineering, University of Illinois at Chicago, Chicago, IL, USA
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Park SH, Hsu CJ, Dee W, Roth EJ, Rymer WZ, Wu M. Gradual adaptation to pelvis perturbation during walking reinforces motor learning of weight shift toward the paretic side in individuals post-stroke. Exp Brain Res 2021; 239:1701-1713. [PMID: 33779790 DOI: 10.1007/s00221-021-06092-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 03/17/2021] [Indexed: 12/23/2022]
Abstract
The purpose of this study was to determine whether the gradual versus abrupt adaptation to lateral pelvis assistance force improves weight shift toward the paretic side and enhance forced use of the paretic leg during walking. Sixteen individuals who had sustained a hemispheric stroke participated in two experimental sessions, which consisted of (1) treadmill walking with the application of lateral pelvis assistance force (gradual vs. abrupt condition) and (2) overground walking. In the "gradual" condition, during treadmill walking, the assistance force was gradually increased from 0 to 100% of the predetermined force step by step. In the abrupt condition, the force was applied at 100% of the predetermined force throughout treadmill walking. Participants exhibited significant improvements in hip abductor and adductor, ankle dorsiflexor, and knee extensor muscle activities, weight shift toward the paretic side, and overground walking speed in the gradual condition (P < 0.05), but showed no significant changes in the abrupt condition (P > 0.20). Changes in weight shift toward the paretic side were statistically different between conditions (P < 0.001), although changes in muscle activities were not (P > 0.11). In the gradual condition, the error amplitude was proportional to the improvement in weight shift during the late post-adaptation (R2 = 0.32, P = 0.03), but not in the abrupt condition (R2 = 0.001, P = 0.93). In conclusion, the "gradual adaptation" inducing "small errors" during constraint-induced walking may improve weight shift and enhance forced use of the paretic leg in individuals post-stroke. Applying gradual pelvis assistance force during walking may be used as an intervention strategy to improve walking in individuals post-stroke.
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Affiliation(s)
- Seoung Hoon Park
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 E. Erie Street, 23rd floor, Chicago, IL, 60611, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Chao-Jung Hsu
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 E. Erie Street, 23rd floor, Chicago, IL, 60611, USA
| | - Weena Dee
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 E. Erie Street, 23rd floor, Chicago, IL, 60611, USA
| | - Elliot J Roth
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 E. Erie Street, 23rd floor, Chicago, IL, 60611, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - William Z Rymer
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 E. Erie Street, 23rd floor, Chicago, IL, 60611, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Ming Wu
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 E. Erie Street, 23rd floor, Chicago, IL, 60611, USA. .,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA. .,Department of Bioengineering, University of Illinois at Chicago, Chicago, IL, USA.
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