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Sharma Y, Cheung L, Patterson KK, Iaboni A. Factors influencing the clinical adoption of quantitative gait analysis technology with a focus on clinical efficacy and clinician perspectives: A scoping review. Gait Posture 2024; 108:228-242. [PMID: 38134709 DOI: 10.1016/j.gaitpost.2023.12.003] [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: 08/18/2023] [Revised: 11/14/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023]
Abstract
INTRODUCTION Quantitative gait analysis (QGA) has the potential to support clinician decision-making. However, it is not yet widely accepted in practice. Evidence for clinical efficacy (i.e., efficacy and effectiveness), as well as a users' perspective on using the technology in clinical practice (e.g., ease of use and usefulness) can help impact their widespread adoption. OBJECTIVE To synthesize the literature on the clinical efficacy and clinician perspectives on the use of gait analysis technologies in the clinical care of adult populations. METHODS This scoping review followed the Joanna Briggs Institute (JBI) methodology for scoping reviews. We included peer-reviewed and gray literature (i.e., conference abstracts). A search was conducted in MEDLINE (Ovid), CENTRAL (Ovid), EMBASE (Ovid), CINAHL (EBSCO) and SPORTDiscus (EBSCO). Included full-text studies were critically appraised using the JBI critical appraisal tools. RESULTS A total of 15 full-text studies and two conference abstracts were included in this review. Results suggest that QGA technologies can influence decision-making with some evidence to suggest their role in improving patient outcomes. The main barrier to ease of use was a clinician's lack of data expertise, and main facilitator was receiving support from staff. Barriers to usefulness included challenges finding suitable reference data and data accuracy, while facilitators were enhancing patient care and supporting clinical decision-making. SIGNIFICANCE This review is the first step to understanding how QGA technologies can optimize clinical practice. Many gaps in the literature exist and reveal opportunities to improve the clinical adoption of gait analysis technologies. Further research is needed in two main areas: 1) examining the clinical efficacy of gait analysis technologies and 2) gathering clinician perspectives using a theoretical model like the Technology Acceptance Model to guide study design. Results will inform research aimed at evaluating, developing, or implementing these technologies. FUNDING This work was supported by the Walter and Maria Schroeder Institute for Brain Innovation and Recovery and AGE-WELL Graduate Student Award in Technology and Aging [2021,2022].
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Affiliation(s)
- Yashoda Sharma
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, M5G 1V7 Toronto, ON, Canada; KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, 550 University Avenue, M5G 2A2 Toronto, ON, Canada
| | - Lovisa Cheung
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, M5G 1V7 Toronto, ON, Canada; KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, 550 University Avenue, M5G 2A2 Toronto, ON, Canada; Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, M5G 1V7 Toronto, ON, Canada
| | - Kara K Patterson
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, M5G 1V7 Toronto, ON, Canada; KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, 550 University Avenue, M5G 2A2 Toronto, ON, Canada; Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, M5G 1V7 Toronto, ON, Canada
| | - Andrea Iaboni
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, M5G 1V7 Toronto, ON, Canada; KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, 550 University Avenue, M5G 2A2 Toronto, ON, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, 250 College Street, M5T 1R8 Toronto, ON, Canada.
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Barriers to Gait Training among Stroke Survivors: An Integrative Review. J Funct Morphol Kinesiol 2022; 7:jfmk7040085. [PMID: 36278746 PMCID: PMC9590000 DOI: 10.3390/jfmk7040085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 10/08/2022] [Accepted: 10/10/2022] [Indexed: 11/05/2022] Open
Abstract
Gait recovery is vital for stroke survivors' ability to perform their activities associated with daily living. Consequently, a gait impairment is a significant target for stroke survivors' physical rehabilitation. This review aims to identify barriers to gait training among stroke survivors. An integrative review was conducted following Whittemore and Knafl's methodology. The research was carried out on the electronic databases Scopus, PubMed, and B-on, applying a time span of 2006 to 2022. A total of 4189 articles were initially identified. After selecting and analyzing the articles, twelve studies were included in the sample. This review allowed for the identification of several barriers to gait training among stroke survivors, which can be grouped into three categories: individual, environmental, and rehabilitation workforce-related barriers. These findings highlight that participation in gait training is not solely dependent on the stroke survivor. Instead, the uptake of rehabilitation programs may also depend on environmental and rehabilitation workforce-related factors.
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Kinematic Analysis of Exoskeleton-Assisted Community Ambulation: An Observational Study in Outdoor Real-Life Scenarios. SENSORS 2022; 22:s22124533. [PMID: 35746315 PMCID: PMC9228687 DOI: 10.3390/s22124533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/14/2022] [Accepted: 06/14/2022] [Indexed: 02/01/2023]
Abstract
(1) Background: In neurorehabilitation, Wearable Powered Exoskeletons (WPEs) enable intensive gait training even in individuals who are unable to maintain an upright position. The importance of WPEs is not only related to their impact on walking recovery, but also to the possibility of using them as assistive technology; however, WPE-assisted community ambulation has rarely been studied in terms of walking performance in real-life scenarios. (2) Methods: This study proposes the integration of an Inertial Measurement Unit (IMU) system to analyze gait kinematics during real-life outdoor scenarios (regular, irregular terrains, and slopes) by comparing the ecological gait (no-WPE condition) and WPE-assisted gait in five able-bodied volunteers. The temporal parameters of gait and joint angles were calculated from data collected by a network of seven IMUs. (3) Results: The results showed that the WPE-assisted gait had less knee flexion in the stance phase and greater hip flexion in the swing phase. The different scenarios did not change the human–exoskeleton interaction: only the low-speed WPE-assisted gait was characterized by a longer double support phase. (4) Conclusions: The proposed IMU-based gait assessment protocol enabled quantification of the human–exoskeleton interaction in terms of gait kinematics and paved the way for the study of WPE-assisted community ambulation in stroke patients.
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Xu L, Gu H, Zhang Y. Research Hotspots of the Rehabilitation Medicine Use of sEMG in Recent 12 Years: A Bibliometric Analysis. J Pain Res 2022; 15:1365-1377. [PMID: 35592819 PMCID: PMC9112527 DOI: 10.2147/jpr.s364977] [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: 03/04/2022] [Accepted: 05/03/2022] [Indexed: 11/23/2022] Open
Abstract
Objective Surface electromyography (sEMG) has been widely applied to rehabilitation medicine. However, the bibliometric analysis of the rehabilitation medicine use of sEMG is vastly unknown. Therefore, this research aimed to investigate the current trends of the rehabilitation medicine use of sEMG in the recent 12 years by using CiteSpace (5.8). Methods Literature relating to rehabilitation medicine use of sEMG from 2010 to 2021 was retrieved from the Web of Science. CiteSpace analyzed country, institution, cited journals, authors, cited references and keywords. An analysis of counts and centrality was used to reveal publication outputs, countries, institutions, core journals, active authors, foundation references, hot topics and frontiers. Results A total of 1949 publications were retrieved from 2010 to 2021. The total number of publications continually increased over the past 12 years, and the most active countries, institutions, journals and authors in rehabilitation medicine use of sEMG were identified. The most productive country and institution in this field were America (484) and the University of Sao Paulo (36). Andersen LL (28) was the most prolific author, and Dario Farina ranked first among the cited authors. Besides, there were three main frontiers in keywords for sEMG research, including “activation”, “exercise”, and “strength”. Conclusion The findings from this bibliometric study provide the current status and trends in clinical research of rehabilitation medicine use of sEMG over the past ten years, which may help researchers identify hot topics and explore new directions for future research in this field.
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Affiliation(s)
- Liya Xu
- Faculty of Sports and Human Sciences, Beijing Sports University, Beijing, People’s Republic of China
| | - Hongyi Gu
- Faculty of Sports and Human Sciences, Beijing Sports University, Beijing, People’s Republic of China
| | - Yimin Zhang
- China Institute of sports and Health, Key Laboratory of sports and Physical Health Ministry of Education, Beijing Sports University, Beijing, People’s Republic of China
- Correspondence: Yimin Zhang, China Institute of sports and health, Key Laboratory of sports and physical health Ministry of Education, Beijing Sports University, Beijing, 100084, People’s Republic of China, Tel +86 13641108252, Email
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Longatelli V, Pedrocchi A, Guanziroli E, Molteni F, Gandolla M. Robotic Exoskeleton Gait Training in Stroke: An Electromyography-Based Evaluation. Front Neurorobot 2021; 15:733738. [PMID: 34899227 PMCID: PMC8663633 DOI: 10.3389/fnbot.2021.733738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/08/2021] [Indexed: 11/20/2022] Open
Abstract
The recovery of symmetric and efficient walking is one of the key goals of a rehabilitation program in patients with stroke. The use of overground exoskeletons alongside conventional gait training might help foster rhythmic muscle activation in the gait cycle toward a more efficient gait. About twenty-nine patients with subacute stroke have been recruited and underwent either conventional gait training or experimental training, including overground gait training using a wearable powered exoskeleton alongside conventional therapy. Before and after the rehabilitation treatment, we assessed: (i) gait functionality by means of clinical scales combined to obtain a Capacity Score, and (ii) gait neuromuscular lower limbs pattern using superficial EMG signals. Both groups improved their ability to walk in terms of functional gait, as detected by the Capacity Score. However, only the group treated with the robotic exoskeleton regained a controlled rhythmic neuromuscular pattern in the proximal lower limb muscles, as observed by the muscular activation analysis. Coherence analysis suggested that the control group (CG) improvement was mediated mainly by spinal cord control, while experimental group improvements were mediated by cortical-driven control. In subacute stroke patients, we hypothesize that exoskeleton multijoint powered fine control overground gait training, alongside conventional care, may lead to a more fine-tuned and efficient gait pattern.
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Affiliation(s)
- Valeria Longatelli
- NearLab, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Alessandra Pedrocchi
- NearLab, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | | | - Franco Molteni
- Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Italy
| | - Marta Gandolla
- Department of Mechanical Engineering, Politecnico di Milano, Milan, Italy
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Di Marco R, Rubega M, Lennon O, Formaggio E, Sutaj N, Dazzi G, Venturin C, Bonini I, Ortner R, Cerrel Bazo HA, Tonin L, Tortora S, Masiero S, Del Felice A. Experimental Protocol to Assess Neuromuscular Plasticity Induced by an Exoskeleton Training Session. Methods Protoc 2021; 4:48. [PMID: 34287357 PMCID: PMC8293335 DOI: 10.3390/mps4030048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/01/2021] [Accepted: 07/07/2021] [Indexed: 12/13/2022] Open
Abstract
Exoskeleton gait rehabilitation is an emerging area of research, with potential applications in the elderly and in people with central nervous system lesions, e.g., stroke, traumatic brain/spinal cord injury. However, adaptability of such technologies to the user is still an unmet goal. Despite important technological advances, these robotic systems still lack the fine tuning necessary to adapt to the physiological modification of the user and are not yet capable of a proper human-machine interaction. Interfaces based on physiological signals, e.g., recorded by electroencephalography (EEG) and/or electromyography (EMG), could contribute to solving this technological challenge. This protocol aims to: (1) quantify neuro-muscular plasticity induced by a single training session with a robotic exoskeleton on post-stroke people and on a group of age and sex-matched controls; (2) test the feasibility of predicting lower limb motor trajectory from physiological signals for future use as control signal for the robot. An active exoskeleton that can be set in full mode (i.e., the robot fully replaces and drives the user motion), adaptive mode (i.e., assistance to the user can be tuned according to his/her needs), and free mode (i.e., the robot completely follows the user movements) will be used. Participants will undergo a preparation session, i.e., EMG sensors and EEG cap placement and inertial sensors attachment to measure, respectively, muscular and cortical activity, and motion. They will then be asked to walk in a 15 m corridor: (i) self-paced without the exoskeleton (pre-training session); (ii) wearing the exoskeleton and walking with the three modes of use; (iii) self-paced without the exoskeleton (post-training session). From this dataset, we will: (1) quantitatively estimate short-term neuroplasticity of brain connectivity in chronic stroke survivors after a single session of gait training; (2) compare muscle activation patterns during exoskeleton-gait between stroke survivors and age and sex-matched controls; and (3) perform a feasibility analysis on the use of physiological signals to decode gait intentions.
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Affiliation(s)
- Roberto Di Marco
- Department of Neurosciences, Section of Rehabilitation, University of Padova, via Belzoni, 160, 35121 Padova, Italy; (E.F.); (G.D.); (C.V.); (S.M.); (A.D.F.)
| | - Maria Rubega
- Department of Neurosciences, Section of Rehabilitation, University of Padova, via Belzoni, 160, 35121 Padova, Italy; (E.F.); (G.D.); (C.V.); (S.M.); (A.D.F.)
| | - Olive Lennon
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, 4 Dublin, Ireland;
| | - Emanuela Formaggio
- Department of Neurosciences, Section of Rehabilitation, University of Padova, via Belzoni, 160, 35121 Padova, Italy; (E.F.); (G.D.); (C.V.); (S.M.); (A.D.F.)
| | - Ngadhnjim Sutaj
- g.tec Medical Engineering GmbH, 4521 Schiedlberg, Austria; (N.S.); (R.O.)
| | - Giacomo Dazzi
- Department of Neurosciences, Section of Rehabilitation, University of Padova, via Belzoni, 160, 35121 Padova, Italy; (E.F.); (G.D.); (C.V.); (S.M.); (A.D.F.)
| | - Chiara Venturin
- Department of Neurosciences, Section of Rehabilitation, University of Padova, via Belzoni, 160, 35121 Padova, Italy; (E.F.); (G.D.); (C.V.); (S.M.); (A.D.F.)
| | - Ilenia Bonini
- Ospedale Riabilitativo di Alta Specializzazione di Motta di Livenza, 31045 Treviso, Italy; (I.B.); (H.A.C.B.)
| | - Rupert Ortner
- g.tec Medical Engineering GmbH, 4521 Schiedlberg, Austria; (N.S.); (R.O.)
| | | | - Luca Tonin
- Department of Information Engineering, University of Padova, 35131 Padova, Italy; (L.T.); (S.T.)
| | - Stefano Tortora
- Department of Information Engineering, University of Padova, 35131 Padova, Italy; (L.T.); (S.T.)
| | - Stefano Masiero
- Department of Neurosciences, Section of Rehabilitation, University of Padova, via Belzoni, 160, 35121 Padova, Italy; (E.F.); (G.D.); (C.V.); (S.M.); (A.D.F.)
- Padova Neuroscience Center, University of Padova, 35129 Padova, Italy
| | - Alessandra Del Felice
- Department of Neurosciences, Section of Rehabilitation, University of Padova, via Belzoni, 160, 35121 Padova, Italy; (E.F.); (G.D.); (C.V.); (S.M.); (A.D.F.)
- Padova Neuroscience Center, University of Padova, 35129 Padova, Italy
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Infarinato F, Romano P, Goffredo M, Ottaviani M, Galafate D, Gison A, Petruccelli S, Pournajaf S, Franceschini M. Functional Gait Recovery after a Combination of Conventional Therapy and Overground Robot-Assisted Gait Training Is Not Associated with Significant Changes in Muscle Activation Pattern: An EMG Preliminary Study on Subjects Subacute Post Stroke. Brain Sci 2021; 11:brainsci11040448. [PMID: 33915808 PMCID: PMC8066552 DOI: 10.3390/brainsci11040448] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 01/03/2023] Open
Abstract
Background: Overground Robot-Assisted Gait Training (o-RAGT) appears to be a promising stroke rehabilitation in terms of clinical outcomes. The literature on surface ElectroMyoGraphy (sEMG) assessment in o-RAGT is limited. This paper aimed to assess muscle activation patterns with sEMG in subjects subacute post stroke after training with o-RAGT and conventional therapy. Methods: An observational preliminary study was carried out with subjects subacute post stroke who received 15 sessions of o-RAGT (5 sessions/week; 60 min) in combination with conventional therapy. The subjects were assessed with both clinical and instrumental evaluations. Gait kinematics and sEMG data were acquired before (T1) and after (T2) the period of treatment (during ecological gait), and during the first session of o-RAGT (o-RAGT1). An eight-channel wireless sEMG device acquired in sEMG signals. Significant differences in sEMG outcomes were found in the BS of TA between T1 and T2. There were no other significant correlations between the sEMG outcomes and the clinical results between T1 and T2. Conclusions: There were significant functional gains in gait after complex intensive clinical rehabilitation with o-RAGT and conventional therapy. In addition, there was a significant increase in bilateral symmetry of the Tibialis Anterior muscles. At this stage of the signals from the tibialis anterior (TA), gastrocnemius medialis (GM), rectus femoris (RF), and biceps femoris caput longus (BF) muscles of each lower extremity. sEMG data processing extracted the Bilateral Symmetry (BS), the Co-Contraction (CC), and the Root Mean Square (RMS) coefficients. Results: Eight of 22 subjects in the subacute stage post stroke agreed to participate in this sEMG study. This subsample demonstrated a significant improvement in the motricity index of the affected lower limb and functional ambulation. The heterogeneity of the subjects’ characteristics and the small number of subjects was associated with high variability research, functional gait recovery was associated with minimal change in muscle activation patterns.
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Affiliation(s)
- Francesco Infarinato
- Neurorehabilitation Research Laboratory, IRCCS San Raffaele Roma, 00163 Rome, Italy; (F.I.); (P.R.); (M.O.); (D.G.); (A.G.); (S.P.); (S.P.); (M.F.)
| | - Paola Romano
- Neurorehabilitation Research Laboratory, IRCCS San Raffaele Roma, 00163 Rome, Italy; (F.I.); (P.R.); (M.O.); (D.G.); (A.G.); (S.P.); (S.P.); (M.F.)
| | - Michela Goffredo
- Neurorehabilitation Research Laboratory, IRCCS San Raffaele Roma, 00163 Rome, Italy; (F.I.); (P.R.); (M.O.); (D.G.); (A.G.); (S.P.); (S.P.); (M.F.)
- Correspondence: ; Tel.: +39-0652252319
| | - Marco Ottaviani
- Neurorehabilitation Research Laboratory, IRCCS San Raffaele Roma, 00163 Rome, Italy; (F.I.); (P.R.); (M.O.); (D.G.); (A.G.); (S.P.); (S.P.); (M.F.)
| | - Daniele Galafate
- Neurorehabilitation Research Laboratory, IRCCS San Raffaele Roma, 00163 Rome, Italy; (F.I.); (P.R.); (M.O.); (D.G.); (A.G.); (S.P.); (S.P.); (M.F.)
| | - Annalisa Gison
- Neurorehabilitation Research Laboratory, IRCCS San Raffaele Roma, 00163 Rome, Italy; (F.I.); (P.R.); (M.O.); (D.G.); (A.G.); (S.P.); (S.P.); (M.F.)
| | - Simone Petruccelli
- Neurorehabilitation Research Laboratory, IRCCS San Raffaele Roma, 00163 Rome, Italy; (F.I.); (P.R.); (M.O.); (D.G.); (A.G.); (S.P.); (S.P.); (M.F.)
| | - Sanaz Pournajaf
- Neurorehabilitation Research Laboratory, IRCCS San Raffaele Roma, 00163 Rome, Italy; (F.I.); (P.R.); (M.O.); (D.G.); (A.G.); (S.P.); (S.P.); (M.F.)
| | - Marco Franceschini
- Neurorehabilitation Research Laboratory, IRCCS San Raffaele Roma, 00163 Rome, Italy; (F.I.); (P.R.); (M.O.); (D.G.); (A.G.); (S.P.); (S.P.); (M.F.)
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele University, 00166 Rome, Italy
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Gait Recovery with an Overground Powered Exoskeleton: A Randomized Controlled Trial on Subacute Stroke Subjects. Brain Sci 2021; 11:brainsci11010104. [PMID: 33466749 PMCID: PMC7830339 DOI: 10.3390/brainsci11010104] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/09/2021] [Accepted: 01/11/2021] [Indexed: 12/26/2022] Open
Abstract
Background: Overground Robot-Assisted Gait Training (o-RAGT) provides intensive gait rehabilitation. This study investigated the efficacy of o-RAGT in subacute stroke subjects, compared to conventional gait training. Methods: A multicenter randomized controlled trial was conducted on 75 subacute stroke subjects (38 in the Experimental Group (EG) and 37 in the Control Group (CG)). Both groups received 15 sessions of gait training (5 sessions/week for 60 min) and daily conventional rehabilitation. The subjects were assessed at the beginning (T1) and end (T2) of the training period with the primary outcome of a 6 Minutes Walking Test (6MWT), the Modified Ashworth Scale of the Affected lower Limb (MAS-AL), the Motricity Index of the Affected lower Limb (MI-AL), the Trunk Control Test (TCT), Functional Ambulation Classification (FAC), a 10 Meters Walking Test (10MWT), the modified Barthel Index (mBI), and the Walking Handicap Scale (WHS). Results: The 6MWT increased in both groups, which was confirmed by both frequentist and Bayesian analyses. Similar outcomes were registered in the MI-AL, 10MWT, mBI, and MAS-AL. The FAC and WHS showed a significant number of subjects improving in functional and community ambulation in both groups at T2. Conclusions: The clinical effects of o-RAGT were similar to conventional gait training in subacute stroke subjects. The results obtained in this study are encouraging and suggest future clinical trials on the topic.
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Cappellini G, Sylos-Labini F, Assenza C, Libernini L, Morelli D, Lacquaniti F, Ivanenko Y. Clinical Relevance of State-of-the-Art Analysis of Surface Electromyography in Cerebral Palsy. Front Neurol 2020; 11:583296. [PMID: 33362693 PMCID: PMC7759523 DOI: 10.3389/fneur.2020.583296] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 11/20/2020] [Indexed: 12/18/2022] Open
Abstract
Surface electromyography (sEMG) can be used to assess the integrity of the neuromuscular system and its impairment in neurological disorders. Here we will consider several issues related to the current clinical applications, difficulties and limited usage of sEMG for the assessment and rehabilitation of children with cerebral palsy. The uniqueness of this methodology is that it can determine hyperactivity or inactivity of selected muscles, which cannot be assessed by other methods. In addition, it can assist for intervention or muscle/tendon surgery acts, and it can evaluate integrated functioning of the nervous system based on multi-muscle sEMG recordings and assess motor pool activation. The latter aspect is especially important for understanding impairments of the mechanisms of neural controllers rather than malfunction of individual muscles. Although sEMG study is an important tool in both clinical research and neurorehabilitation, the results of a survey on the clinical relevance of sEMG in a typical department of pediatric rehabilitation highlighted its limited clinical usage. We believe that this is due to limited knowledge of the sEMG and its neuromuscular underpinnings by many physiotherapists, as a result of lack of emphasis on this important methodology in the courses taught in physical therapy schools. The lack of reference databases or benchmarking software for sEMG analysis may also contribute to the limited clinical usage. Despite the existence of educational and technical barriers to a widespread use of, sEMG does provide important tools for planning and assessment of rehabilitation treatments for children with cerebral palsy.
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Affiliation(s)
- Germana Cappellini
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Rome, Italy.,Department of Pediatric Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy
| | | | - Carla Assenza
- Department of Pediatric Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Laura Libernini
- Department of Pediatric Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Daniela Morelli
- Department of Pediatric Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Francesco Lacquaniti
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Rome, Italy.,Department of Systems Medicine, Centre of Space Bio-medicine, University of Rome Tor Vergata, Rome, Italy
| | - Yury Ivanenko
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Rome, Italy
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