Repeatability of plantar pressure assessment during barefoot walking in people with stroke

Pedobarographic evaluations in physical medicine and rehabilitation practice

The feet are complex structures that transmit loads transferred by other parts of the body to the ground and are involved in many static and dynamic activities, such as standing and walking. The contact area and pressure changes between the feet and the ground surface can be measured using pedobarographic devices. With pedobarographic examinations, it is possible to obtain a wide range of information needed to support clinical evaluation and diagnostic tests in physical medicine and rehabilitation practice. Foot structure and function, postural stability, lower extremity biomechanics, and gait analysis are among the areas that can be further investigated using pedobarography.

Correlation analysis of balance function with plantar pressure distribution and gait parameters in patients with cerebral infarction in the basal ganglia region

Objective

To analyze the correlation between balance function and gait parameters of patients with basal ganglia infarction. And to observe the influence of balance function on plantar pressure and hemiplegia gait based on the Berg Balance Scale (BBS) score.

Methods

One hundred and forty patients with cerebral infarction hemiplegia in the basal ganglia region (a study group, n = 140) and healthy people (a control group, n = 140) were enrolled. The study group was evaluated with the BBS, the 10 m walking test (10MWT), and the timed up-and-go test (TUGT). The gait parameters and the peak plantar pressure were measured in both groups while walking, and the differences between the groups were compared. In addition, the characteristics of the plantar pressure curve of the hemiplegic and non-hemiplegic sides during walking and the correlation between the 10MWT, the TUGT, the plantar pressure peak, the gait parameters,and the BBS score were analyzed in the study group.

Results

The peak plantar pressure of the forefoot and heel, stride length, lateral symmetry, stand phase, swing phase, and dual stand phase of both sides in the study group were significantly lower than those in the control group (P < 0.05). The BBS score negatively correlated with the 10MWT, the TUGT, the peak plantar pressure of the hemiplegic forefoot, midfoot, and the non-hemiplegic midfoot, the anterior to posterior position (ant/post position), hemiplegic stand phase, and the dual stand phase (P < 0.05). The BBS score positively correlated with the hemiplegic swing phase and stride length (P < 0.05).

Conclusion

A correlation was found between the forefoot plantar pressure and the stand phase of the hemiplegic limbs, the ant/post position, and the balance function after basal ganglion cerebral infarction. This association can be used in walking and balance assessment for stroke rehabilitation. Correcting forefoot pressure or the front and ant/post position can improve balance function.

Effect of Customized Insoles on Gait in Post-Stroke Hemiparetic Individuals: A Randomized Controlled Trial

Background: Insoles have been widely applied to many diseases, but stroke involves complex problems and there is a paucity of research on the application of insoles in stroke patients. Aim: To evaluate the effect of customized insoles on gait in patients with hemiplegia. Design: A randomized controlled trial. Setting: Rehabilitation department of a hospital. Population: A total of 50 stroke patients were randomized into an experimental group (n = 25) or a control group (n = 25). Methods: Both groups received conventional gait training, which was conducted five times a week, every 40 min for four weeks and patients in the experimental group were required to wear customized insoles for at least 1 h per day for four weeks. The primary outcome measure was the Tinetti Gait Scale (TGS) and the secondary outcome measures were the plantar pressure test, 6-min walking test (6MWT), lower extremity Fugl-Meyer assessment (FMA-LE), Berg Balance Scale (BBS), and the modified Barthel index (MBI). Results: Compared to the control group, there were significant increases in the experimental group after four weeks (p = 0.014) and at the four week follow-up (p = 0.001) in the change in TGS, weight-bearing on the involved side (p = 0.012) or forefoot (p = 0.028) when standing, weight-bearing on the involved side (p = 0.01 6) or forefoot (p = 0.043) when walking, early stance phase (p = 0.023) and mid stance phase (p = 0.013) on the involved side, FMA-LE (p = 0.029), BBS (p = 0.005), and MBI (p = 0.009), but there were no differences in the late stance phase (p = 0.472) on the involved side when walking or in the 6MWT (p = 0.069). Conclusions: Customized insoles had great efficacy in enhancing gait performance in stroke patients.

Activity recognition using multiplex limited penetrable visibility graph

To solve the dynamic problem of different activities in human activity recognition research, an activity recognition method based on a multiplex limited penetrable visibility graph is proposed. The 21 pressure values for each sampling are mapped to nodes in the first-layer network; then the average path length of nodes in the asynchronous periodic network is obtained, and the second-layer network used to explore different activities is built. Finally, the characteristic parameters and dynamic characteristics of different activities are explored and analyzed. The experimental results demonstrate that through the joint distribution of the average clustering coefficient and the maximum degree parameter of the node, the discrimination problems of different postures can be better realized, and it has good adaptability. It provides a new approach to gait recognition research that can be used in medical clinical diagnosis, rehabilitation training, and public health.

Assessment Methods of Post-stroke Gait: A Scoping Review of Technology-Driven Approaches to Gait Characterization and Analysis

Background: Gait dysfunction or impairment is considered one of the most common and devastating physiological consequences of stroke, and achieving optimal gait is a key goal for stroke victims with gait disability along with their clinical teams. Many researchers have explored post stroke gait, including assessment tools and techniques, key gait parameters and significance on functional recovery, as well as data mining, modeling and analyses methods.

Research Question: This study aimed to review and summarize research efforts applicable to quantification and analyses of post-stroke gait with focus on recent technology-driven gait characterization and analysis approaches, including the integration of smart low cost wearables and Artificial Intelligence (AI), as well as feasibility and potential value in clinical settings.

Methods: A comprehensive literature search was conducted within Google Scholar, PubMed, and ScienceDirect using a set of keywords, including lower extremity, walking, post-stroke, and kinematics. Original articles that met the selection criteria were included.

Results and Significance: This scoping review aimed to shed light on tools and technologies employed in post stroke gait assessment toward bridging the existing gap between the research and clinical communities. Conventional qualitative gait analysis, typically used in clinics is mainly based on observational gait and is hence subjective and largely impacted by the observer's experience. Quantitative gait analysis, however, provides measured parameters, with good accuracy and repeatability for the diagnosis and comparative assessment throughout rehabilitation. Rapidly emerging smart wearable technology and AI, including Machine Learning, Support Vector Machine, and Neural Network approaches, are increasingly commanding greater attention in gait research. Although their use in clinical settings are not yet well leveraged, these tools promise a paradigm shift in stroke gait quantification, as they provide means for acquiring, storing and analyzing multifactorial complex gait data, while capturing its non-linear dynamic variability and offering the invaluable benefits of predictive analytics.

Plantar Pressure Variability and Asymmetry in Elderly Performing 60-Minute Treadmill Brisk-Walking: Paving the Way towards Fatigue-Induced Instability Assessment Using Wearable In-Shoe Pressure Sensors

Evaluation of potential fatigue for the elderly could minimize their risk of injury and thus encourage them to do more physical exercises. Fatigue-related gait instability was often assessed by the changes of joint kinematics, whilst planar pressure variability and asymmetry parameters may complement and provide better estimation. We hypothesized that fatigue condition (induced by the treadmill brisk-walking task) would lead to instability and could be reflected by the variability and asymmetry of plantar pressure. Fifteen elderly adults participated in the 60-min brisk walking trial on a treadmill without a pause, which could ensure that the fatigue-inducing effect is continuous and participants will not recover halfway. The plantar pressure data were extracted at baseline, the 30th minute, and the 60th minute. The median of contact time, peak pressure, and pressure-time integrals in each plantar region was calculated, in addition to their asymmetry and variability. After 60 min of brisk walking, there were significant increases in peak pressure at the medial and lateral arch regions, and central metatarsal regions, in addition to their impulses (p < 0.05). In addition, the variability of plantar pressure at the medial arch was significantly increased (p < 0.05), but their asymmetry was decreased. On the other hand, the contact time was significantly increased at all plantar regions (p < 0.05). The weakened muscle control and shock absorption upon fatigue could be the reason for the increased peak pressure, impulse, and variability, while the improved symmetry and prolonged plantar contact time could be a compensatory mechanism to restore stability. The outcome of this study can facilitate the development of gait instability or fatigue assessment using wearable in-shoe pressure sensors.

Pedobarography in Physiotherapy: A Narrative Review on Current Knowledge

Pedobarography is a modern technology enabling the assessment of the locomotor system based on the plantar pressure distribution. The technic is useful in the rehabilitation of various types of dysfunction of body movement. This chapter aims to describe the application of pedobarography in clinical therapy. The qualitative analysis is based on a review of articles in English, French, German, Polish, Portuguese, Spanish, Turkish, and Chinese in Medline/PubMed, Cochrane Library, Embase, and PEDro databases. The search covered the articles on clinical trials, randomized controlled trials, meta-analyses, and reviews published over 1984-2020. The literature shows that pedobarography is a safe non-invasive method that is useful for the examination of foot biomechanics with a reference to the entire musculoskeletal system. A pedobarographic examination enables insight into a motion disorder, its plausible relation to a systemic pathology, and monitoring the course of treatment and rehabilitation.