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Igarashi T, Tani Y, Takeda R, Asakura T. Accelerometer-based gait characteristics and their discrimination of gait independence in inpatients with subacute stroke. Gait Posture 2024; 110:138-143. [PMID: 38581934 DOI: 10.1016/j.gaitpost.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 03/03/2024] [Accepted: 04/01/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Gait analysis using inertial measurement devices can identify multifaceted gait disorders after a stroke. Although the usefulness of gait assessment using inertial measurement devices has been reported, its accuracy in discriminating gait independence in patients hospitalized for subacute stroke has not yet been validated. RESEARCH QUESTION Can trunk acceleration indices discriminate between dependent and independent walking in patients with subacute stroke? METHODS Thirty-five patients with subacute stroke (mean ± standard deviation, 75.5 ± 9.8 years, 19 males), who were able to understand instructions, had a premorbid modified Rankin scale <3, and were able to walk 16 m straight ahead under supervision were included. The stride regularity, harmonic ratio, and normalized root mean square of trunk accelerations were measured in three directions (mediolateral, vertical, and anterioposterior) during comfortable walking. The Functional Ambulation Categories were used as the dependent variable to classify the patients into two groups (dependent and independent walking groups), and each trunk acceleration index was used as the independent variable to calculate the area under the curve using receiver operating characteristic curves. RESULTS Twelve patients were in the dependent group and 23 were in the independent group. The normalized root mean square in both the mediolateral and vertical directions were excellent discriminators of walking independence, with an area under the curve greater than 0.8. The cutoff values (sensitivity/specificity) were 2.20 m2/s2 (0.783/0.833) and 2.82 m2/s2 (0.739/0.833), respectively. SIGNIFICANCE The magnitude of vertical and lateral acceleration during gait in patients with subacute stroke, has excellent accuracy in discriminating between dependent and independent gaits. The results of this study will be useful for inexperienced clinicians working with stroke patients presenting with gait disturbances to accurately determine gait independence based on objective data.
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Affiliation(s)
- Tatsuya Igarashi
- Department of Physical Therapy, Faculty of Health Science Technology, Bunkyo Gakuin University, 1196 Kamekubo, Fujimino‒city, Saitama 356-8533, Japan.
| | - Yuta Tani
- Rehabilitation Division, Numata Neurosurgery and Cardiovascular Hospital, 8 Sakaemachi, Numata-city, Gunma 378-0014, Japan; Department of Rehabilitation Sciences, Graduate School of Health Sciences, Gunma University, 3-39-22 Showa, Maebashi-city, Gunma 371-8514, Japan
| | - Ren Takeda
- Day Care specialized in stroke rehabilitation "with reha", 3-19-9 Showa, Maebashi-city, Gunma 371-0034, Japan
| | - Tomoyuki Asakura
- Department of Rehabilitation Sciences, Graduate School of Health Sciences, Gunma University, 3-39-22 Showa, Maebashi-city, Gunma 371-8514, Japan
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Sakaguchi T, Sake N, Tanaka M, Fujiwara Y, Arataki S, Taoka T, Kodama Y, Takamatsu K, Yasuda Y, Nakagawa M, Utsunomiya K, Tomiyama H. Use of a Triaxial Accelerometer to Measure Changes in Gait Sway and Related Motor Function after Corrective Spinal Fusion Surgery for Adult Spinal Deformity. J Clin Med 2024; 13:1923. [PMID: 38610688 PMCID: PMC11012576 DOI: 10.3390/jcm13071923] [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: 01/26/2024] [Revised: 03/14/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Adult spinal deformity is a complex condition that causes lower back pain, causing spinal imbalance and discomfort in activities of daily life. After corrective spinal surgery, patients' gait and balance abilities might not revert to normalcy and they might be at increased risk of falling. Therefore, early evaluation of such a risk is imperative to prevent further complications such as a fall, or even worse, fractures in post-surgery ASD patients. However, there has been no report of an investigation of such early changes in gait sway before and after ASD surgery. This is a prospective to investigate changes in gait sway before and following ASD surgery, using accelerometers, and also to examine motor function related to postoperative gait sway. Methods: Twenty patients were included who underwent corrective surgery as treatment for ASD, from October 2019 to January 2023. Measurement parameters included a 10 m walking test and the timed up-and-go test (TUG), gait sway was evaluated using accelerometers (root mean square; RMS), and hip flexion and knee extension muscle strength were tested. RMS included RMS vertical: RMSV; RMS anterior posterior: RMSAP; RMS medial lateral: RMSML. The radiographic spinopelvic parameters were also evaluated preoperatively and postoperatively. p < 0.05 was noted as remarkably significant. Results: Preoperative and postoperative RMSV were 1.07 ± 0.6 and 1.31 ± 0.8, respectively (p < 0.05). RMSML significantly decreased from 0.33 ± 0.2 to 0.19 ± 0.1 postoperatively (p < 0.01). However, RMSAP did not change postoperatively (0.20 ± 0.2 vs. 0.14 ± 0.1, p > 0.05). Patients' one-month postoperative hip flexor muscle strength became significantly weaker (0.16 ± 0.04 vs. 0.10 ± 0.03 kgf/kg, p = 0.002), but TUG was maintained (11.6 ± 4.2 vs. 11.7 s, p = 0.305). RMSV was negatively correlated with quadriceps muscle strength and positively with TUG. RMSAP was negatively correlated with quadriceps muscle strength. All spinopelvic parameters became normal range after surgery. Conclusions: After corrective spinal fusion for ASD patients, the gait pattern improved significantly. Iliopsoas (hip flexor) and quadriceps femoris (knee extensor) muscles may play important roles for gait anterolateral and vertical swing, respectively.
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Affiliation(s)
- Tomoyoshi Sakaguchi
- Department of Rehabilitation, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan; (T.S.); (K.T.); (Y.Y.); (M.N.); (K.U.)
| | - Naveen Sake
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan; (N.S.); (Y.F.); (S.A.); (T.T.); (Y.K.)
| | - Masato Tanaka
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan; (N.S.); (Y.F.); (S.A.); (T.T.); (Y.K.)
| | - Yoshihiro Fujiwara
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan; (N.S.); (Y.F.); (S.A.); (T.T.); (Y.K.)
| | - Shinya Arataki
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan; (N.S.); (Y.F.); (S.A.); (T.T.); (Y.K.)
| | - Takuya Taoka
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan; (N.S.); (Y.F.); (S.A.); (T.T.); (Y.K.)
| | - Yuya Kodama
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan; (N.S.); (Y.F.); (S.A.); (T.T.); (Y.K.)
| | - Kazuhiko Takamatsu
- Department of Rehabilitation, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan; (T.S.); (K.T.); (Y.Y.); (M.N.); (K.U.)
| | - Yosuke Yasuda
- Department of Rehabilitation, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan; (T.S.); (K.T.); (Y.Y.); (M.N.); (K.U.)
| | - Masami Nakagawa
- Department of Rehabilitation, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan; (T.S.); (K.T.); (Y.Y.); (M.N.); (K.U.)
| | - Kayo Utsunomiya
- Department of Rehabilitation, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan; (T.S.); (K.T.); (Y.Y.); (M.N.); (K.U.)
| | - Hiroki Tomiyama
- Hashimoto Artificial Limb Manufacture Co., Ltd., 32-13 Urayasunishimachi, Minami Ward, Okayama 702-8025, Japan;
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Pérez-López JF, Cano-de-la-Cuerda R, Ortiz-Gutiérrez RM. Accelerometry in the Functional Assessment of Balance in People with Stroke: A Systematic Review. J Clin Med 2023; 12:7701. [PMID: 38137771 PMCID: PMC10743978 DOI: 10.3390/jcm12247701] [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: 11/16/2023] [Revised: 12/07/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023] Open
Abstract
Balance disturbances in people with lived experience of stroke affect activities of daily living and social participation, so assessing them is essential to know the level of functional independence. Accelerometers are electronic devices that allow kinematic variables of balance to be recorded and are a tool of great interest in the assessment of functional balance. To determine the validity and reliability of, as well as the most performed protocols using accelerometers in the functional assessment of balance in people with experience of stroke, a systematic search of articles published in the electronic databases PubMed, Scopus, the Web of Science, the Cochrane Library, the PEDro and the Virtual Health Library from Spain was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. We used QUADAS-2 to assess the quality of the included studies. Eight studies met the inclusion criteria, two studied reliability and validity, two studied reliability and four studied the validity of accelerometers in the assessment of balance in people with stroke. All studies indicated the kind of accelerometer, localization on the body, tests and outcome variables. The results indicate that accelerometers show excellent reliability values in the assessment of balance in people who had a prior stroke and disparate results in terms of validity. Triaxial accelerometers were most used, and the 4th and 5th lumbar and 1st and 2nd sacral vertebrae were the body areas most used for their placement.
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Affiliation(s)
- Juan Francisco Pérez-López
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Universidad Rey Juan Carlos, 28922 Madrid, Spain;
| | - Roberto Cano-de-la-Cuerda
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Universidad Rey Juan Carlos, 28922 Madrid, Spain;
| | - Rosa María Ortiz-Gutiérrez
- Radiology, Rehabilitation and Physiotherapy Department, Nursing, Physiotherapy and Podiatry Faculty, Complutense of Madrid University, Plaza Ramón y Cajal 3, 28040 Madrid, Spain;
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