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Smayda KE, Lavanture J, Bourque M, Jayawardena N, Kane S, Roberts H, Heikens B. One-year budget impact of InTandem™: a novel neurorehabilitation system for individuals with chronic stroke walking impairment. J Comp Eff Res 2024:e240010. [PMID: 39224948 DOI: 10.57264/cer-2024-0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
Abstract
Aim: Chronic stroke walking impairment is associated with high healthcare resource utilization (HCRU) costs. InTandem™ is a neurorehabilitation system that autonomously delivers a rhythmic auditory stimulation (RAS)-based intervention for the at-home rehabilitation of walking impairment in adults in the chronic phase of stroke recovery. This study was conducted to estimate the budget impact of InTandem in comparison with currently available intervention strategies for improvement of gait/ambulation in individuals with chronic stroke walking impairment. Methods & materials: A budget impact analysis (BIA) for InTandem was conducted based on a 1-million-member US third-party payer perspective over a 1-year time horizon. Key inputs for the budget impact model were: costs for each intervention strategy (InTandem, physical therapy, self-directed walking and no treatment), HCRU costs for persons with chronic stroke and anticipated HCRU cost offsets due to improvements in gait/ambulatory status as measured by self-selected comfortable walking speed (based on functional ability). In addition to the reference case analysis, a sensitivity analysis was conducted. Results: Based on the reference case, introduction of InTandem was projected to result in overall cost savings of $439,954 in one year. Reduction of HCRU costs (-$2,411,778) resulting from improved walking speeds with InTandem offset an increase in intervention costs (+$1,971,824). Demonstrations of cost savings associated with InTandem were robust and were consistently evident in nearly all scenarios evaluated in the sensitivity analysis (e.g., with increased/decreased patient shares, increased HCRU cost or increased InTandem rental duration). Conclusion: The InTandem system is demonstrated to improve walking and ambulation in adults in the chronic phase of stroke recovery after a five-week intervention period. The BIA predicts that introduction of InTandem will be associated with overall cost savings to the payer.
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Affiliation(s)
| | | | - Megan Bourque
- Value & Evidence, Eversana, Burlington, ON L7N 3H8, Canada
| | | | - Sarah Kane
- Value & Evidence, Eversana, Burlington, ON L7N 3H8, Canada
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Wade F, Huang CH, Foucher KC. Individual joint contributions to forward propulsion during treadmill walking in women with hip osteoarthritis. J Orthop Res 2024. [PMID: 39217413 DOI: 10.1002/jor.25964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 07/12/2024] [Accepted: 08/12/2024] [Indexed: 09/04/2024]
Abstract
As we age, reliance on the ankle musculature for push-off during walking reduces and increased reliance on the hip musculature is observed. It is unclear how joint pathology like osteoarthritis may affect this distal-to-proximal redistribution of propulsion. Here, we revisited a proof-of-concept study to study the effect of split-belt treadmill training, designed to reduce step length asymmetry, on forward propulsion during walking. Eleven women with hip osteoarthritis and five age-matched control participants walked on an instrumented split-belt treadmill at their preferred speed (hip osteoarthritis: 0.73 ± 0.11 m/s; controls: 0.59 ± 0.26 m/s). Women with hip osteoarthritis had less ankle power and propulsive force than controls, and greater hip contributions to forward propulsion on their involved limb. Following split-belt treadmill training, propulsive force increased on the involved limb. Five of 11 participants experienced a change in redistribution ratio that was greater than the minimal clinically meaningful difference. These "responders" had greater variability in pre-training redistribution ratio compared to non-responders. Women with hip osteoarthritis had poorer propulsive gait mechanics than controls yet split-belt treadmill training improved propulsive force. Redistribution ratio also changed in participants with high baseline variability. Our results suggest that split-belt treadmill training may be beneficial to people with hip osteoarthritis who have high variability in walking parameters. Further, the age-related shift to increased hip contributions to propulsion across populations of older adults may be due to increased variability during walking.
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Affiliation(s)
- Francesca Wade
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, Illinois, USA
- School of Exercise and Nutritional Science, San Diego State University, San Diego, California, USA
| | - Chun-Hao Huang
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, Illinois, USA
- Department of Kinesiology and Health, Georgia State University, Atlanta, Georgia, USA
| | - Kharma C Foucher
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, Illinois, USA
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Hirano S, Saitoh E, Imoto D, Ii T, Tsunoda T, Otaka Y. Effects of robot-assisted gait training using the Welwalk on gait independence for individuals with hemiparetic stroke: an assessor-blinded, multicenter randomized controlled trial. J Neuroeng Rehabil 2024; 21:76. [PMID: 38745235 PMCID: PMC11092154 DOI: 10.1186/s12984-024-01370-5] [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: 10/10/2023] [Accepted: 05/02/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Gait disorder remains a major challenge for individuals with stroke, affecting their quality of life and increasing the risk of secondary complications. Robot-assisted gait training (RAGT) has emerged as a promising approach for improving gait independence in individuals with stroke. This study aimed to evaluate the effect of RAGT in individuals with subacute hemiparetic stroke using a one-leg assisted gait robot called Welwalk WW-1000. METHODS An assessor-blinded, multicenter randomized controlled trial was conducted in the convalescent rehabilitation wards of eight hospitals in Japan. Participants with first-ever hemiparetic stroke who could not walk at pre-intervention assessment were randomized to either the Welwalk group, which underwent RAGT with conventional physical therapy, or the control group, which underwent conventional physical therapy alone. Both groups received 80 min of physical therapy per day, 7 days per week, while the Welwalk group received 40 min of RAGT per day, 6 days per week, as part of their physical therapy. The primary outcome was gait independence, as assessed using the Functional Independence Measure Walk Score. RESULTS A total of 91 participants were enrolled, 85 of whom completed the intervention. As a result, 91 participants, as a full analysis set, and 85, as a per-protocol set, were analyzed. The primary outcome, the cumulative incidence of gait-independent events, was not significantly different between the groups. Subgroup analysis revealed that the interaction between the intervention group and stroke type did not yield significant differences in either the full analysis or per-protocol set. However, although not statistically significant, a discernible trend toward improvement with Welwalk was observed in cases of cerebral infarction for the full analysis and per-protocol sets (HR 4.167 [95%CI 0.914-18.995], p = 0.065, HR 4.443 [95%CI 0.973-20.279], p = 0.054, respectively). CONCLUSIONS The combination of RAGT using Welwalk and conventional physical therapy was not significantly more effective than conventional physical therapy alone in promoting gait independence in individuals with subacute hemiparetic stroke, although a trend toward earlier gait independence was observed in individuals with cerebral infarction. TRIAL REGISTRATION This study was registered with the Japan Registry of Clinical Trials ( https://jrct.niph.go.jp ; jRCT 042180078) on March 3, 2019.
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Affiliation(s)
- Satoshi Hirano
- Department of Rehabilitation Medicine, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.
| | - Eiichi Saitoh
- Department of Rehabilitation Medicine, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Daisuke Imoto
- Department of Rehabilitation, Fujita Health University Hospital, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Takuma Ii
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Tetsuya Tsunoda
- Department of Rehabilitation Medicine, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Yohei Otaka
- Department of Rehabilitation Medicine, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
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Leow XRG, Ng SLA, Lau Y. Overground Robotic Exoskeleton Training for Patients With Stroke on Walking-Related Outcomes: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Arch Phys Med Rehabil 2023; 104:1698-1710. [PMID: 36972746 DOI: 10.1016/j.apmr.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 03/07/2023] [Accepted: 03/09/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE This review aims to evaluate the effectiveness of solely overground robotic exoskeleton (RE) training or overground RE training with conventional rehabilitation in improving walking ability, speed, and endurance among patients with stroke. DATA SOURCES Nine databases, 5 trial registries, gray literature, specified journals, and reference lists from inception until December 27, 2021. STUDY SELECTION Randomized controlled trials adopting overground robotic exoskeleton training for patients with any phases of stroke on walking-related outcomes were included. DATA EXTRACTION Two independent reviewers extracted items and performed risk of bias using the Cochrane Risk of Bias tool 1 and certainty of evidence using the Grades of Recommendation Assessment, Development, and Evaluation. DATA SYNTHESIS Twenty trials involving 758 participants across 11 countries were included in this review. The overall effect of overground robotic exoskeletons on walking ability at postintervention (d=0.21; 95% confidence interval [CI], 0.01, 0.42; Z=2.02; P=.04) and follow-up (d=0.37; 95% CI, 0.03, 0.71; Z=2.12; P=.03) and walking speed at postintervention (d=0.23; 95% CI, 0.01, 0.46; Z=2.01; P=.04) showed significant improvement compared with conventional rehabilitation. Subgroup analyses suggested that RE training should combine with conventional rehabilitation. A preferable gait training regime is <4 times per week over ≥6 weeks for ≤30 minutes per session among patients with chronic stroke and ambulatory status of independent walkers before training. Meta-regression did not identify any effect of the covariates on the treatment effect. The majority of randomized controlled trials had small sample sizes, and the certainty of the evidence was very low. CONCLUSION Overground RE training may have a beneficial effect on walking ability and walking speed to complement conventional rehabilitation. Further large-scale and long-term, high-quality trials are recommended to enhance the quality of overground RE training and confirm its sustainability.
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Affiliation(s)
- Xin Rong Gladys Leow
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Si Li Annalyn Ng
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ying Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
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Alhirsan SM, Capó-Lugo CE, Hurt CP, Uswatte G, Qu H, Brown DA. The Immediate Effects of Different Types of Augmented Feedback on Fast Walking Speed Performance and Intrinsic Motivation After Stroke. Arch Rehabil Res Clin Transl 2023; 5:100265. [PMID: 37312981 PMCID: PMC10258376 DOI: 10.1016/j.arrct.2023.100265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Abstract
Objective To examine the immediate effects of different types of augmented feedback on walking speed and intrinsic motivation post-stroke. Design A within-subjects repeated-measures design. Setting A university rehabilitation center. Participants Eighteen individuals with chronic stroke hemiparesis with a mean age of 55.67±13.63 years and median stroke onset of 36 (24, 81) months (N=18). Interventions Not applicable. Primary outcome Fast walking speed measured on a robotic treadmill for 13 meters without feedback and 13 meters with augmented feedback on each of the 3 experimental conditions: (1) without virtual reality (VR), (2) with a simple VR interface, and (3) with VR-exergame. Intrinsic motivation was measured using the Intrinsic Motivation Inventory (IMI). Results Although the differences were not statistically significant, fast-walking speed was higher in the augmented feedback without VR (0.86±0.44 m/s); simple VR interface (0.87±0.41 m/s); VR-exergame (0.87±0.44 m/s) conditions than in the fast-walking speed without feedback (0.81±0.40 m/s) condition. The type of feedback had a significant effect on intrinsic motivation (P=.04). The post hoc analysis revealed borderline significance on IMI-interest and enjoyment between the VR-exergame condition and the without-VR condition (P=.091). Conclusion Augmenting feedback affected the intrinsic motivation and enjoyment of adults with stroke asked to walk fast on a robotic treadmill. Additional studies with larger samples are warranted to examine the relations among these aspects of motivation and ambulation training outcomes.
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Affiliation(s)
- Saleh M. Alhirsan
- Department of Physical Therapy, School of Applied Medical Sciences, Jouf University, Aljouf, Saudi Arabia
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL
| | - Carmen E. Capó-Lugo
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL
| | - Christopher P. Hurt
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL
| | - Gitendra Uswatte
- Department of Psychology, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL
| | - Haiyan Qu
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL
| | - David A. Brown
- Division of Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch, Galveston, TX
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The contribution of walking speed versus recent stroke to temporospatial gait variability. Gait Posture 2023; 100:216-221. [PMID: 36621194 DOI: 10.1016/j.gaitpost.2022.12.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/25/2022] [Accepted: 12/26/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Inconsistent results have been reported for temporospatial gait variability after stroke. Given the large differences in gait speed across stroke subjects and relative to healthy controls, it is not clear which changes in temporospatial gait variability can be ascribed to the walking speed during gait evaluation versus the consequences of stroke. RESEARCH QUESTIONS Does temporospatial gait variability differ between (1) stroke subjects grouped in clinically-relevant functional ambulation classes, (2) the paretic and non-paretic legs within each class, and (3) stroke and healthy subjects after controlling for gait speed? METHODS Stroke subjects were evaluated at their comfortable speed < 2 months post-onset and classified into the household (<40 cm/s, n = 38), limited-community (40-80 cm/s, n = 35), and full-community (>80 cm/s, n = 14) walkers. Coefficients of variation (CVs) for paretic and non-paretic stance, initial double-support, and single-support times, step length, step cadence, and step width were compared across the stroke ambulation classes and between the two legs. For the parameters with significantly different CVs between stroke subjects and 33 age-matched controls walking at very-slow and free speeds, a 1-way ANCOVA was used with the gait speed as a covariate. RESULTS For most step parameters, CVs were greater in slower stroke ambulation classes except for the smaller step width CV. The differences between the paretic and non-paretic legs emerged in slower walkers only. After controlling for the gait speed, CVs of stroke subjects no longer significantly differed from controls walking at very-slow speed. With controls walking at free speed, however, CVs for the paretic and non-paretic single-support times and the non-paretic step time remained significantly different. SIGNIFICANCE Gait is more variable at slower speeds both in stroke subjects and healthy controls. After accounting for the free gait speed, the increased variability of only a few temporal parameters may be attributed to a recent stroke.
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Sánchez Silverio V, Abuín Porras V, Rodríguez Costa I, Cleland JA, Villafañe JH. Effects of action observation training on the walking ability of patients post stroke: a systematic review. Disabil Rehabil 2022; 44:7339-7348. [PMID: 34644226 DOI: 10.1080/09638288.2021.1989502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To determine the effect of action observation (AO) training on the walking ability of patients post stroke. METHODS MEDLINE, CINAHL, EMBASE and PEDro were searched systematically for human studies written in English up to August 31st 2021. Two authors screened titles and abstracts against predefined inclusion criteria; a third author resolved discrepancies. Data were analyzed through qualitative synthesis. Articles evaluating the effects of AO training on the walking ability of patients post stroke were included. Methodological quality was assessed using the PEDro scale. RESULTS From first search that included 1,578 studies, 7 were included in this review. According to the PEDro scale, most of the studies exhibited a methodological quality between Good and Fair (N = 6). Most of the studies applied a protocol based on a 30-minute training session applied 3 to 5 times per week over a 4-week period (N = 5). Using clinical measures and gait parameters, all studies confirmed the beneficial effects of AO training on walking ability. However, the effects of AO training on walking ability were not confirmed at the long-term follow-up. CONCLUSIONS AO training has a positive effect on the walking ability of patients post stroke. Additional studies are needed to confirm these results across the entire spectrum of patient's post stoke including long-term clinical effects.Implications for RehabilitationAction observation training can have potentially positive effects on the walking ability of stroke patients.Clinical measurements (10-meter walk test) and gait parameters (stride length and gait speed) could be used to assess the effect of action observation training on walking ability.The patient's concentration is an important factor to consider when applying observational training.
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Affiliation(s)
- Víctor Sánchez Silverio
- School of Applied Health Sciences, Pontificia Universidad Católica Madre y Maestra, Santiago De Los Caballeros, Dominican Republic
| | - Vanesa Abuín Porras
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Spain Madrid.,Fundación DACER. Área de investigación, Madrid, Spain
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Polese JC, da Silva SLA, Lacerda CSA, Roza EA, Torriani-Pasin C. Community ambulation after chronic stroke: A cross-sectional study. J Bodyw Mov Ther 2022. [DOI: 10.1016/j.jbmt.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Ribeiro de Souza F, Sales M, Rabelo Laporte L, Melo A, Manoel da Silva Ribeiro N. Body structure/function impairments and activity limitations of post-stroke that predict social participation: a systematic review. Top Stroke Rehabil 2022:1-14. [PMID: 35787246 DOI: 10.1080/10749357.2022.2095086] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Stroke is the leading cause of death and disability in Brazil, and its prognostic indicators of social reintegration are not well established yet. OBJECTIVE To identify body structure/function impairments and activity limitations in post-stroke that predict social participation restrictions in the community. METHODS cohort studies were selected, involving adult post-stroke participants, which investigated body structure and function impairments or activity limitations of post-stroke individuals as predictors of social participation in the community. Studies that included individuals with subarachnoid hemorrhage, other neurological disorders and participants in long-term care facilities were excluded. The Newcastle-Ottawa quality assessment scale was applied to assess the methodological quality. The results were synthesized according to the found exposures, considering the used statistical models. RESULTS Eleven articles were included, with a total of 2,412 individuals, 58.4% men, 83.7% ischemic stroke. Seven exposures were assessed across studies, in which 10 studies assessed body structure and function exposures (stroke severity, cognitive, executive, emotional and motor function), and 8 studies assessed activity exposures (daily living activity and walking ability). CONCLUSION There is some evidence that stroke severity, mental and motor deficits, limitations in activities of daily living and the ability to walk after a stroke can predict social participation in the community. PROSPERO registration CRD42020177591.
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Affiliation(s)
| | - Matheus Sales
- Epidemiologia, Universidade Federal da BahiaDivisão de Neurologia e , Salvador, Brazil
| | - Larrie Rabelo Laporte
- Grupo Brasileiro de Metaciência, Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil
| | - Ailton Melo
- Epidemiologia, Universidade Federal da BahiaDivisão de Neurologia e , Salvador, Brazil.,Saúde Mental, Faculdade de Medicina da Bahia, Universidade Federal da BahiaDepartamento de Neurociências e , Salvador, Brasil
| | - Nildo Manoel da Silva Ribeiro
- Epidemiologia, Universidade Federal da BahiaDivisão de Neurologia e , Salvador, Brazil.,Departamento de fisioterapia, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Brasil
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Huber SK, Knols RH, Held JPO, Christen T, de Bruin ED. Agreement, Reliability, and Concurrent Validity of an Outdoor, Wearable-Based Walk Ratio Assessment in Healthy Adults and Chronic Stroke Survivors. Front Physiol 2022; 13:857963. [PMID: 35795644 PMCID: PMC9252290 DOI: 10.3389/fphys.2022.857963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/16/2022] [Indexed: 11/22/2022] Open
Abstract
Purpose: The walk ratio (WR)—the step-length/cadence relation—is a promising measure for gait control. GPS-running watches deliver clinically relevant outcomes including the WR. The aim of this study was to determine test-retest agreement, reliability and concurrent validity of an outdoor WR assessment using a GPS-running watch. Methods: Healthy adults and moderate—high functioning stroke survivors (≥6 months), performed the 1 km-outdoor walk twice using a GPS-running watch (Garmin Forerunner 35, GFR35) and a Step Activity Monitor (SAM 3). Global cognition was assessed using the Montreal Cognitive Assessment. Test-retest agreement and reliability were assessed using Bland-Altman plots, standard error of measurement (SEM), intraclass correlation coefficients (ICCs) and smallest detectable changes (SDCs). Concurrent validity was determined by the mean difference (MD), standard error (SE), mean absolute percentage errors (MAPEs) and Spearman’s Rho between GFR35 and SAM3. WR values of the two groups were compared by a Welch’s test. A hierarchical multiple regression was performed with the WR as dependent variable and possible predictors as independent variables. Results: Fifty-one healthy adults [median: 60.0 (47.0, 67.0) years) and 20 stroke survivors [mean: 63.1 (12.4) years, median: 76 (30, 146) months post-stroke] were included. Test-retest agreement and reliability were excellent (SEM% ≤ 2.2, ICCs > 0.9, SDC% ≤ 6.1) and concurrent validity was high (MAPE < 5, ρ > 0.7) for those walking ≥ 1 m/s. Walking < 1 m/s impaired accurate step counting and reduced agreement, reliability, and validity. The WR differed between healthy adults and stroke survivors (t = −2.126, p = 0.045). The hierarchical regression model including stroke and global cognition (Montreal Cognitive Assessment, 0—30) explained 25% of the WR variance (ΔR2 = 0.246, p < 0.001). Stroke had no effect (β = −0.05, p = 0.682), but global cognition was a predictor for an altered WR (β = 0.44, p = 0.001). Discussion: The outdoor WR assessment using the GFR35 showed excellent test-retest agreement, reliability and concurrent validity in healthy adults and chronic stroke survivors walking at least 1 m/s. As the WR seems relevant in chronic stroke, future studies should further investigate this parameter.
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Affiliation(s)
- Simone K. Huber
- Physiotherapy and Occupational Therapy Research Centre, Directorate of Research and Education, University Hospital Zurich, Zurich, Switzerland
- Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Ruud H. Knols
- Physiotherapy and Occupational Therapy Research Centre, Directorate of Research and Education, University Hospital Zurich, Zurich, Switzerland
- Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Department of Physiotherapy and Occupational Therapy, University Hospital Zurich, Zurich, Switzerland
| | - Jeremia P. O. Held
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital and University Zurich, Zurich, Switzerland
- Rehabilitation Center Triemli Zurich, Valens Clinics, Zurich, Switzerland
| | - Tom Christen
- Physiotherapy and Occupational Therapy Research Centre, Directorate of Research and Education, University Hospital Zurich, Zurich, Switzerland
- Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Eling D. de Bruin
- Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
- Department of Health, OST—Eastern Swiss University of Applied Sciences, St. Gallen, Switzerland
- *Correspondence: Eling D. de Bruin,
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Effects of different types of augmented feedback on intrinsic motivation and walking speed performance in post-stroke: A study protocol. Contemp Clin Trials Commun 2021; 24:100863. [PMID: 34841123 PMCID: PMC8606339 DOI: 10.1016/j.conctc.2021.100863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 09/22/2021] [Accepted: 11/09/2021] [Indexed: 11/01/2022] Open
Abstract
Introduction During recovery from stroke, augmented performance feedback can be applied with simple displays of metrics, as well as enhanced with virtual reality (VR) and exergames. VR, as augmented feedback, can provided to enhance walking speed after six months of stroke onset. There are several mechanisms to induce improved motor performance and motivation. Our objective is to design a study to demonstrate the different effects of augmented feedback, simple VR and exergaming applications on motivation and walking speed performance in post stroke. Methods Eighteen individuals with chronic stroke will be recruited and asked to walk as fast and safely as they can while on a robotic, user speed-driven treadmill (KineAssist-MX®) in three conditions: (1) with simple visual augmented feedback, but without a VR interface, (2) with a basic VR interface and (3) with a VR exergame. The main outcome measures are 30 s of fast walking speed and intrinsic motivation measured using the Intrinsic Motivation Inventory-Interest and Enjoyment Subscale. A within-subjects repeated measure ANOVA test and post hoc analysis will be used to determine the differences in changes of maximum walking speeds among the three performance conditions. Discussion The additive impact of augmented feedback with or without VR and VR-exergames on motivation and walking speed during stroke rehabilitation is unknown, a gap we aim to address. Our findings will contribute key details regarding the effects of different types of augmented feedback on walking speed and intrinsic motivation and to the refinement of theoretical frameworks that guide the design and implementation of augmented feedback during recovery after stroke.
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Evangelista DG, Malaguti C, Meirelles FDA, de Jesus LADS, José A, Cabral LF, Silva VC, Cabral LA, Oliveira CC. Social Participation and Associated Factors in Individuals with Chronic Obstructive Pulmonary Disease on Long-Term Oxygen Therapy. COPD 2021; 18:630-636. [PMID: 34847806 DOI: 10.1080/15412555.2021.2005012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Long-term oxygen therapy (LTOT) reduces hypoxaemia and mitigate systemic alterations in chronic obstructive pulmonary disease (COPD), however, it is related to inactivity and social isolation. Social participation and its related factors remain underexplored in individuals on LTOT. This study investigated social participation in individuals with COPD on LTOT and its association with dyspnoea, exercise capacity, muscle strength, symptoms of anxiety and depression, and quality of life. The Assessment of Life Habits (LIFE-H) assessed social participation. The modified Medical Research Council dyspnoea scale, the 6-Minute Step test (6MST) and handgrip dynamometry were used for assessments. In addition, participants responded to the Hospital Anxiety and Depression Scale (HADS) and the Chronic Respiratory Questionnaire (CRQ). Correlation coefficients and multivariate linear regression analyses were applied. Fifty-seven participants with moderate to very severe COPD on LTOT were included (71 ± 8 years, FEV1: 40 ± 17%predicted). Social participation was associated with dyspnoea (rs=-0.46, p < 0.01), exercise capacity (r = 0.32, p = 0.03) and muscle strength (r = 0.25, p = 0.05). Better participation was also associated with fewer depression symptoms (rs=-0.40, p < 0.01) and a better quality of life (r = 0.32, p = 0.01). Dyspnoea was an independent predictor of social participation (p < 0.01) on regression models. Restricted social participation is associated with increased dyspnoea, reduced muscle strength and exercise capacity. Better participation is associated with fewer depression symptoms and better quality of life in individuals with COPD on LTOT.
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Affiliation(s)
- Deborah Gollner Evangelista
- Post-Graduate Research Program on Rehabilitation Sciences and Physical Function Performance, Faculty of Physiotherapy, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Carla Malaguti
- Post-Graduate Research Program on Rehabilitation Sciences and Physical Function Performance, Faculty of Physiotherapy, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Felipe de Azevedo Meirelles
- Post-Graduate Research Program on Rehabilitation Sciences and Physical Function Performance, Faculty of Physiotherapy, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Luciana Angélica da Silva de Jesus
- Post-Graduate Research Program on Rehabilitation Sciences and Physical Function Performance, Faculty of Physiotherapy, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Anderson José
- Post-Graduate Research Program on Rehabilitation Sciences and Physical Function Performance, Faculty of Physiotherapy, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Leandro Ferracini Cabral
- Post-Graduate Research Program on Rehabilitation Sciences and Physical Function Performance, Faculty of Physiotherapy, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Vanessa Cardoso Silva
- Department of Physiotherapy, Federal University of Juiz de Fora, Governador Valadares, Minas Gerais, Brazil
| | - Laura Alves Cabral
- Department of Physiotherapy, Federal University of Juiz de Fora, Governador Valadares, Minas Gerais, Brazil
| | - Cristino Carneiro Oliveira
- Post-Graduate Research Program on Rehabilitation Sciences and Physical Function Performance, Faculty of Physiotherapy, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil.,Department of Physiotherapy, Federal University of Juiz de Fora, Governador Valadares, Minas Gerais, Brazil
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Necessity and Content of Swing Phase Gait Coordination Training Post Stroke; A Case Report. Brain Sci 2021; 11:brainsci11111498. [PMID: 34827497 PMCID: PMC8615654 DOI: 10.3390/brainsci11111498] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/28/2021] [Accepted: 11/05/2021] [Indexed: 11/17/2022] Open
Abstract
Background/Problem: Standard neurorehabilitation and gait training has not proved effective in restoring normal gait coordination for many stroke survivors. Rather, persistent gait dyscoordination occurs, with associated poor function, and progressively deteriorating quality of life. One difficulty is the array of symptoms exhibited by stroke survivors with gait deficits. Some researchers have addressed lower limb weakness following stroke with exercises designed to strengthen muscles, with the expectation of improving gait. However, gait dyscoordination in many stroke survivors appears to result from more than straightforward muscle weakness. PURPOSE Thus, the purpose of this case study is to report results of long-duration gait coordination training in an individual with initial good strength, but poor gait swing phase hip/knee and ankle coordination. METHODS Mr. X was enrolled at >6 months after a left hemisphere ischemic stroke. Gait deficits included a 'stiff-legged gait' characterized by the absence of hip and knee flexion during right mid-swing, despite the fact that he showed good initial strength in right lower limb quadriceps, hamstrings, and ankle dorsiflexors. Treatment was provided 4 times/week for 1.5 h, for 12 weeks. The combined treatment included the following: motor learning exercises designed for coordination training of the lower limb; functional electrical stimulation (FES) assisted practice; weight-supported coordination practice; and over-ground and treadmill walking. The FES was used as an adjunct to enhance muscle response during motor learning and prior to volitional recovery of motor control. Weight-supported treadmill training was administered to titrate weight and pressure applied at the joints and to the plantar foot surface during stance phase and pre-swing phase of the involved limb. Later in the protocol, treadmill training was administered to improve speed of movement during the gait cycle. Response to treatment was assessed through an array of impairment, functional mobility, and life role participation measures. RESULTS At post-treatment, Mr. X exhibited some recovery of hip, knee, and ankle coordination during swing phase according to kinematic measures, and the stiff-legged gait was resolved. Muscle strength measures remained essentially constant throughout the study. The modified Ashworth scale showed improved knee extensor tone from baseline of 1 to normal (0) at post-treatment. Gait coordination overall improved by 12 points according to the Gait Assessment and Intervention Tool, Six Minute Walk Test improved by 532', and the Stroke Impact Scale improved by 12 points, including changes in daily activities; mobility; and meaningful activities. DISCUSSION Through the combined use of motor learning exercises, FES, weight-support, and treadmill training, coordination of the right lower limb improved sufficiently to exhibit a more normal swing phase, reducing the probability of falls, and subsequent downwardly spiraling dysfunction. The recovery of lower limb coordination during swing phase illustrates what is possible when strength is sufficient and when coordination training is targeted in a carefully titrated, highly incrementalized manner. Conclusions/Contribution to the Field: This case study contributes to the literature in several ways: (1) illustrates combined interventions for gait training and response to treatment; (2) provides supporting case evidence of relationships among knee flexion coordination, swing phase coordination, functional mobility, and quality of life; (3) illustrates that strength is necessary, but not sufficient to restore coordinated gait swing phase after stroke in some stroke survivors; and (4) provides details regarding coordination training and progression of gait training treatment for stroke survivors.
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14
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Kossi O, Agbetou M, Noukpo SI, Triccas LT, Dossou-Yovo DE, Amanzonwe ER, Adoukonou T. Factors associated with balance impairments amongst stroke survivors in northern Benin: A cross-sectional study. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2021; 77:1559. [PMID: 34693069 PMCID: PMC8517725 DOI: 10.4102/sajp.v77i1.1559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/28/2021] [Indexed: 11/04/2022] Open
Abstract
Background Balance impairment is the predominant risk factor for falls in stroke survivors. A fear of falling after stroke can contribute to sedentary lifestyles, increased disability and risk of recurrence, leading to poor quality of life. Objective To determine the frequency and factors associated with balance impairments amongst stroke survivors at the University Hospital of Parakou. Method This cross-sectional study included adult stroke survivors. Stroke survivors after discharge were enrolled at the University Hospital of Parakou between 01 January 2020 and 30 September 2020. Balance impairments were measured by using the Berg Balance Scale (BBS), the Timed Up and Go (TUG) and the Get Up and Go (GUG) tests. Results A total of 54 stroke survivors were included, with a mean age of 58.37 ± 12.42 years and a male predominance of 68.52%. The mean BBS score was 36.87 ± 14.34 with a minimum and a maximum of 10 and 56, respectively. Thirteen (24.07%) had balance impairments (BBS score ≤ 20), 34 (62.96%) had a TUG score ≥ 14 s (abnormal), 9 (16.67%) presented a moderate risk of falling and 6 (11.11%) presented high risk of fall with the GUG test. Post-stroke duration (odds ratio [OR] = 0.04; 95% CI: 0.04–0.30; p < 0.01), severity of disability (OR = 8.33; 95% CI: 1.03–67.14; p = 0.03) and the number of physiotherapy sessions (OR = 0.18; 95% CI: 0.03–0.93; p = 0.02) were significantly associated with balance impairments. Conclusion Our results showed that almost one quarter of stroke survivors after discharge at the University Hospital of Parakou had balance impairments. Post-stroke duration, severity of disability and the number of physiotherapy sessions were significantly associated with balance impairments. Clinical implications [AQ1] Balance should be regularly assessed in people post-stroke. Further studies should document the content of rehabilitation and any rehabilitative efforts to improve balance in people post-stroke in Benin.
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Affiliation(s)
- Oyéné Kossi
- National School of Public Health and Epidemiological Surveillance (ENATSE), University of Parakou, Parakou, Benin.,Unit of Neuro Rehabilitation, Department of Neurology, University Hospital of Parakou, Parakou, Benin.,REVAL, Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Mendinatou Agbetou
- Department of Neurology, Faculty of Medicine, University of Parakou, Parakou, Benin
| | - Sènadé I Noukpo
- Unit of Neuro Rehabilitation, Department of Neurology, University Hospital of Parakou, Parakou, Benin
| | - Lisa T Triccas
- REVAL, Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Daniel-Eude Dossou-Yovo
- National School of Public Health and Epidemiological Surveillance (ENATSE), University of Parakou, Parakou, Benin
| | - Elogni R Amanzonwe
- REVAL, Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Thierry Adoukonou
- National School of Public Health and Epidemiological Surveillance (ENATSE), University of Parakou, Parakou, Benin.,Department of Neurology, Faculty of Medicine, University of Parakou, Parakou, Benin
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15
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Barboza TV, Weizemann C, Carvalho ARD. Causal relationship between spatiotemporal parameters of walking and the locomotor rehabilitation index in healthy people. Gait Posture 2021; 90:320-325. [PMID: 34564005 DOI: 10.1016/j.gaitpost.2021.09.191] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 09/07/2021] [Accepted: 09/19/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Walking speed is a functional vital sign affecting mechanical parameters individually. Further, there is a tendency for pathological gait to occur at slower speeds, which does not always allow for an adequate comparison with normal gait. Therefore, recognizing the influence of spatiotemporal adjustments on healthy gait can broaden our understanding of the applicability of gait quality markers. RESEARCH QUESTION This study aimed to identify the causal relationship between the stride length-frequency walking ratio index (R_SL/SF) at the self-selected walking speed (SSWS) and optimal walking speed (OWS) and the locomotor rehabilitation index (LRI) in healthy adults. MATERIALS AND METHODS Healthy adults (n = 68) of both sexes aged 20-59 years were included in this study. The SSWS was determined using a 30-m walkway. The OWS and LRI were predicted by equations proposed in the literature. The volunteers walked on the treadmill at speeds corresponding to the OWS and SSWS in two bouts of 60 s each, with a break in between. The spatiotemporal parameters were recorded using a high-speed digital video camera, digitalized, and mathematically processed. Multiple linear regression was applied using the forced regression method. RESULTS Significant correlations were found between the LRI and R_SL/SF at the SSWS (R = 0.397; p < 0.001) and OWS (R = 0.266; p = 0.014). The regression model showed that 16 % of the variability in the LRI was attributable to the R_SL/SF variability at the SSWS. The average and 95 % confidence interval LRI were 94.7 % (91.6 %-97.8 %). CONCLUSION The LRI average is around 95 % for healthy and young adults and the R_SL/SF explained just 16 % of the variance in LRI.
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Affiliation(s)
- Taise Vieira Barboza
- Integrative Biodynamics Evaluation Laboratory, Western Paraná State University (Universidade Estadual do Oeste do Paraná - UNIOESTE), Cascavel, PR, Brazil
| | - Carolina Weizemann
- Integrative Biodynamics Evaluation Laboratory, Western Paraná State University (Universidade Estadual do Oeste do Paraná - UNIOESTE), Cascavel, PR, Brazil
| | - Alberito Rodrigo de Carvalho
- Integrative Biodynamics Evaluation Laboratory, Western Paraná State University (Universidade Estadual do Oeste do Paraná - UNIOESTE), Cascavel, PR, Brazil.
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Kim DH, Kang CS, Kyeong S. Robot-assisted gait training promotes brain reorganization after stroke: A randomized controlled pilot study. NeuroRehabilitation 2020; 46:483-489. [DOI: 10.3233/nre-203054] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Dae Hyun Kim
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, South Korea
| | - Chang Soon Kang
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, South Korea
| | - Sohyun Kyeong
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, South Korea
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