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Hozein M, Mortada H, Hamed M, Abdelhaleem N, Elshennawy S. Effect of insole on postural control and gait of stroke patients: a systematic review and meta-analysis. Int J Rehabil Res 2024:00004356-990000000-00095. [PMID: 38881488 DOI: 10.1097/mrr.0000000000000632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
This systematic review aims to examine the evidence of adding postural insole to traditional physical therapy to improve weight distribution, gait, mobility, balance, and postural control in stroke survivors. Five databases were searched to retrieve all related randomized controlled trials examining the effect of insole on stroke patients. Two independent authors checked the potential articles against eligibility criteria according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A meta-analysis was conducted for available outcomes and the statistical heterogeneity was examined using the I2 test. Of 762 articles, only 15 with 448 patients were included after they met the inclusion criteria with most of them including participants exceeding 6 months of stroke incidence. When insole was used as compelled body weight shifting method, pooled statistical analysis revealed significant improvement in gait velocity [standardized mean difference (SMD) = 0.67; 95% confidence interval (CI): 0.31, 1.02; P = 0.0003], cadence (SMD = 0.67; 95% CI: 0.16, 1.18; P = 0.01] and stride length (SMD = 1.11; 95% CI: 0.57, 1.65; P < 0.0001), while no significant effect on step length (SMD = 0.48; 95% CI: -0.37, 1.33; P = 0.27). Pooled statistical analysis of balance outcomes revealed significant improvement in weight-bearing symmetry balance (SMD = 0.82; 95% CI: 0.25, 1.39; P = 0.005) and long-term improvement in Berg Balance Scale (SMD = 1.19; 95% CI: 0.19, 2.20; P = 0.02), while no difference was observed in balance confidence (SMD = 0.44; 95% CI: -0.15, 1.04; P = 0.14) and sensorimotor functions (SMD = 0.36; 95% CI -0.39, 1.11; P = 0.35). Insoles significantly improved spatiotemporal gait parameters, gait symmetry, and static balance compared with traditional physical therapy alone.
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Affiliation(s)
- Menna Hozein
- Department of Physical Therapy for Neurological Disorders and its Surgery, Faculty of Physical Therapy, Ahram Canadian University, Giza
| | - Hossam Mortada
- Biomechanics Unit, Department of Basic Sciences, Faculty of Physical Therapy, Galala University, Suez
| | - Maged Hamed
- Department of Physical Therapy, Sharm El Shiekh International Hospital, South Sinai
| | - Naglaa Abdelhaleem
- Department of Pediatric Physical Therapy, Faculty of Physical Therapy, Cairo University, Giza
| | - Shorouk Elshennawy
- Department of Pediatric Physical Therapy, Faculty of Physical Therapy, Cairo University, Cairo
- Department of Pediatric Physical Therapy, Faculty of Physical Therapy, Misr University for Science and Technology, Giza, Egypt
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Freitas M, Pinho F, Pinho L, Silva S, Figueira V, Vilas-Boas JP, Silva A. Biomechanical Assessment Methods Used in Chronic Stroke: A Scoping Review of Non-Linear Approaches. SENSORS (BASEL, SWITZERLAND) 2024; 24:2338. [PMID: 38610549 PMCID: PMC11014015 DOI: 10.3390/s24072338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/22/2024] [Accepted: 04/04/2024] [Indexed: 04/14/2024]
Abstract
Non-linear and dynamic systems analysis of human movement has recently become increasingly widespread with the intention of better reflecting how complexity affects the adaptability of motor systems, especially after a stroke. The main objective of this scoping review was to summarize the non-linear measures used in the analysis of kinetic, kinematic, and EMG data of human movement after stroke. PRISMA-ScR guidelines were followed, establishing the eligibility criteria, the population, the concept, and the contextual framework. The examined studies were published between 1 January 2013 and 12 April 2023, in English or Portuguese, and were indexed in the databases selected for this research: PubMed®, Web of Science®, Institute of Electrical and Electronics Engineers®, Science Direct® and Google Scholar®. In total, 14 of the 763 articles met the inclusion criteria. The non-linear measures identified included entropy (n = 11), fractal analysis (n = 1), the short-term local divergence exponent (n = 1), the maximum Floquet multiplier (n = 1), and the Lyapunov exponent (n = 1). These studies focused on different motor tasks: reaching to grasp (n = 2), reaching to point (n = 1), arm tracking (n = 2), elbow flexion (n = 5), elbow extension (n = 1), wrist and finger extension upward (lifting) (n = 1), knee extension (n = 1), and walking (n = 4). When studying the complexity of human movement in chronic post-stroke adults, entropy measures, particularly sample entropy, were preferred. Kinematic assessment was mainly performed using motion capture systems, with a focus on joint angles of the upper limbs.
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Affiliation(s)
- Marta Freitas
- Escola Superior de Saúde do Vale do Ave, Cooperativa de Ensino Superior Politécnico e Universitário, Rua José António Vidal, 81, 4760-409 Vila Nova de Famalicão, Portugal; (F.P.); (L.P.); (S.S.); (V.F.)
- HM—Health and Human Movement Unit, Polytechnic University of Health, Cooperativa de Ensino Superior Politécnico e Universitário, CRL, 4760-409 Vila Nova de Famalicão, Portugal
- Center for Rehabilitation Research (CIR), R. Dr. António Bernardino de Almeida 400, 4200-072 Porto, Portugal;
- Porto Biomechanics Laboratory (LABIOMEP), 4200-450 Porto, Portugal
| | - Francisco Pinho
- Escola Superior de Saúde do Vale do Ave, Cooperativa de Ensino Superior Politécnico e Universitário, Rua José António Vidal, 81, 4760-409 Vila Nova de Famalicão, Portugal; (F.P.); (L.P.); (S.S.); (V.F.)
- HM—Health and Human Movement Unit, Polytechnic University of Health, Cooperativa de Ensino Superior Politécnico e Universitário, CRL, 4760-409 Vila Nova de Famalicão, Portugal
| | - Liliana Pinho
- Escola Superior de Saúde do Vale do Ave, Cooperativa de Ensino Superior Politécnico e Universitário, Rua José António Vidal, 81, 4760-409 Vila Nova de Famalicão, Portugal; (F.P.); (L.P.); (S.S.); (V.F.)
- HM—Health and Human Movement Unit, Polytechnic University of Health, Cooperativa de Ensino Superior Politécnico e Universitário, CRL, 4760-409 Vila Nova de Famalicão, Portugal
- Center for Rehabilitation Research (CIR), R. Dr. António Bernardino de Almeida 400, 4200-072 Porto, Portugal;
- Porto Biomechanics Laboratory (LABIOMEP), 4200-450 Porto, Portugal
| | - Sandra Silva
- Escola Superior de Saúde do Vale do Ave, Cooperativa de Ensino Superior Politécnico e Universitário, Rua José António Vidal, 81, 4760-409 Vila Nova de Famalicão, Portugal; (F.P.); (L.P.); (S.S.); (V.F.)
- HM—Health and Human Movement Unit, Polytechnic University of Health, Cooperativa de Ensino Superior Politécnico e Universitário, CRL, 4760-409 Vila Nova de Famalicão, Portugal
- Department of Medical Sciences, University of Aveiro, 3810-193 Aveiro, Portugal
- School of Health Sciences, University of Aveiro, 3810-193 Aveiro, Portugal;
| | - Vânia Figueira
- Escola Superior de Saúde do Vale do Ave, Cooperativa de Ensino Superior Politécnico e Universitário, Rua José António Vidal, 81, 4760-409 Vila Nova de Famalicão, Portugal; (F.P.); (L.P.); (S.S.); (V.F.)
- HM—Health and Human Movement Unit, Polytechnic University of Health, Cooperativa de Ensino Superior Politécnico e Universitário, CRL, 4760-409 Vila Nova de Famalicão, Portugal
- Porto Biomechanics Laboratory (LABIOMEP), 4200-450 Porto, Portugal
| | - João Paulo Vilas-Boas
- School of Health Sciences, University of Aveiro, 3810-193 Aveiro, Portugal;
- Centre for Research, Training, Innovation and Intervention in Sport (CIFI2D), Faculty of Sport, University of Porto, 4200-450 Porto, Portugal
| | - Augusta Silva
- Center for Rehabilitation Research (CIR), R. Dr. António Bernardino de Almeida 400, 4200-072 Porto, Portugal;
- Department of Physiotherapy, School of Health, Polytechnic of Porto, 4200-072 Porto, Portugal
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Jeong T, Chung Y. The effects of visual information deprivation and feedback balance training on balance in patients with stroke. NeuroRehabilitation 2024; 54:435-448. [PMID: 38607770 DOI: 10.3233/nre-230358] [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] [Indexed: 04/14/2024]
Abstract
BACKGROUND Patients with stroke depend on visual information due to balance deficits. Therefore, it is believed that appropriate visual deprivation training could have an impact on improving balance abilities. OBJECTIVE The purpose of this study was to compare the effects of balance training performed in visual deprivation and feedback conditions on balance in stroke survivors. METHODS The 39 participants were randomly assigned to either the Visual Deprivation Group (VDG; n = 13), the Visual Feedback Group (VFG; n = 13), or the Control Group (CG; n = 13). The training sessions were conducted five times a week for three weeks. Participants completed the Berg Balance Scale (BBS), Timed Up and Go test (TUG), Four Square Step Test (FSST), and Limit of Stability (LOS) assessments. RESULTS The VDG showed significant improvements in BBS, FSST, TUG, and LOS. In VFG, significant improvements were observed in BBS and TUG. There were statistically significant differences among the groups in all variables related to balance. CONCLUSION The results of this study suggest that balance training under visual deprivation is effective in improving static and dynamic balance and gait in patients with stroke. In other words, patients with stroke need to reduce their over-reliance on visual information.
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Affiliation(s)
- Taewoong Jeong
- Department of Physical Therapy, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Yijung Chung
- Department of Physical Therapy, College of Health and Welfare, Sahmyook University, Seoul, Republic of Korea
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Akıncı M, Burak M, Yaşar E, Kılıç RT. The effects of Robot-assisted gait training and virtual reality on balance and gait in stroke survivors: A randomized controlled trial. Gait Posture 2023; 103:215-222. [PMID: 37262976 DOI: 10.1016/j.gaitpost.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 05/04/2023] [Accepted: 05/16/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Stroke survivors often experience balance and gait problems, which can affect their quality of life and independence in daily living activities. Robot-assisted gait training, such as Lokomat with virtual reality, has been found to be effective in improving gait and balance. However, the specific effects of each virtual reality application on balance and spatiotemporal parameters of gait are not yet established. This study aims to investigate the effects of different virtual reality applications on these parameters. RESEARCH QUESTION What are the specific effects of each Lokomat augmented performance feedback application on balance and spatiotemporal parameters of gait in stroke survivors? METHODS The study is a randomized controlled trial conducted with four groups: Control Group, Endurance Group, Attention and Motivation Group, and Activity Timing Group. All participants received six weeks of physiotherapy, and Lokomat groups had additional robot-assisted gait training with Lokomat for three days a week. The Endurance group used Lokomat with Faster, Attention and Motivation Group with Gabarello and Smile, and Activity Timing Group with Curve Pursuit, Treasures, and High Flyer applications. Various tests were used to assess walking and balance in the study (gait analysis, 6-minute walk test, 10-meter walk test, Berg Balance Scale, postural stability, and limits of stability). RESULTS AND SIGNIFICANCE The study involved 56 male stroke survivors (mean age: 60.02 ± 6.83 years, post-stroke time: 238.88 ± 40.88 days). All groups improved walking speed and distance significantly, but Endurance was better (p < 0.001). Balance improved significantly in all groups, but Attention and Motivation was superior in Berg Balance Scale, postural stability, and limits of stability (p < 0.001). The selection of virtual reality applications during robot-assisted gait training according to rehabilitation goals is important for successful rehabilitation, as these applications may have varying effects on balance and walking.
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Affiliation(s)
- Murat Akıncı
- Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Ankara Yıldırım Beyazıt University, Ankara, Turkey.
| | - Mustafa Burak
- Department of Physical Therapy and Rehabilitation, Faculty of Health Sciences, Fırat University, Elazığ, Turkey
| | - Evren Yaşar
- Department of Physical Therapy and Rehabilitation, Gulhane Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Rabia Tuğba Kılıç
- Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Ankara Yıldırım Beyazıt University, Ankara, Turkey
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Lee K. Balance Training with Weight Shift-Triggered Electrical Stimulation for Stroke Patients: A Randomized Controlled Trial. Brain Sci 2023; 13:brainsci13020225. [PMID: 36831768 PMCID: PMC9954639 DOI: 10.3390/brainsci13020225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/17/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023] Open
Abstract
This study aimed to determine the effects of balance training with weight shift-triggered electrical stimulation to improve balance, lower-extremity motor function, and activities of daily living in patients with stroke. The participants were randomly allocated to the balance training with electrical stimulation group (BT-ESG, n = 29) or the balance training group (BTG, n = 30). Both groups were trained 5 times per week for 6 weeks for 50 min per session. To evaluate static balance, postural sway was assessed and dynamic balance was assessed using the Berg Balance Scale (BBS), Timed Up and Go (TUG) test, and functional reach test (FRT). Lower-extremity motor function was assessed using the Fugl-Meyer assessment. Daily activities were assessed using the Modified Barthel Index. As for static balance, BT-ESG showed a significant improvement compared to BTG in postural swat in both the eyes-open (velocity moment; effect size, 0.88; 95% confidence interval, -1.16 to -1.30), or eyes-closed state (velocity moment; effect size, 0.81; 95% confidence interval, -1.22 to -0.27). Dynamic balance, which includes TUG (effect size, 0.90; 95% confidence interval, -4.67 to -1.25), BBS (effect size, 1.26; 95% confidence interval, -2.84 to 6.83), and FRT (effect size, 1.45; 95% confidence interval, 1.92 to 4.08), in addition to lower-extremity motor function (effect size, 1.38; 95% confidence interval, 2.25 to 4.97), and activities of daily living (effect size, 2.04; 95% confidence interval, 2.04 to 937), showed significant improvement in BT-ESG compared to BTG. These results suggest that balance training with weight shift-triggered electrical stimulation effectively improves balance, lower-extremity motor function, and activities of daily living in patients with stroke.
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Affiliation(s)
- Kyeongjin Lee
- Department of Physical Therapy, College of Health Science, Kyungdong University, Wonju 24764, Republic of Korea
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Kim KI, Im SC, Kim K. Effects of trunk stabilization exercises using laser pointer visual feedback in patients with chronic stroke: A randomized controlled study. Technol Health Care 2023; 31:471-483. [PMID: 36120797 DOI: 10.3233/thc-220100] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Many previous studies have cited the importance of trunk stabilization exercises in patients with stroke. However, the evidence for optimal trunk stabilization exercises for patients with stroke is still lacking. OBJECTIVE To investigate the effects of laser pointer visual feedback in trunk stabilization exercises that are important for improving trunk dysfunction in patients with stroke. METHODS In total, 30 patients with chronic stroke were randomly assigned to experimental and control groups. The experimental group underwent a traditional stroke rehabilitation program and trunk stabilization exercises using laser pointer visual feedback. The control group underwent a traditional stroke rehabilitation program and trunk stabilization exercises without visual feedback. Pre- and postintervention results after 6 weeks were evaluated using the Berg Balance Scale, static and dynamic plantar pressure, 10-m walk test, and the Korean version of the Fall Efficacy Scale. The results were analyzed using a general linear repeated measurement model. RESULTS Both groups showed significant improvements in BBS scores, static plantar pressure, dynamic plantar pressure, 10 MWT, and K-FES scores after 6 weeks of intervention (P< 0.05). Compared to the control group, significant improvements were observed in the experimental group in the Berg Balance Scale scores, dynamic paretic posterior plantar pressure, 10-m walk test, and Korean version of the Fall Efficacy Scale scores (P< 0.025). CONCLUSION Our results demonstrated the effectiveness of visual feedback during trunk stabilization exercises for resolving trunk dysfunction in patients with stroke. Trunk stabilization exercises using laser pointer visual feedback have been found to be more effective in balance, walking, and fall efficacy in patients with stroke.
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Proprioceptive Neuromuscular Facilitation Kinesio Taping Improves Range of Motion of Ankle Dorsiflexion and Balance Ability in Chronic Stroke Patients. Healthcare (Basel) 2021; 9:healthcare9111426. [PMID: 34828473 PMCID: PMC8619064 DOI: 10.3390/healthcare9111426] [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: 09/13/2021] [Revised: 10/13/2021] [Accepted: 10/19/2021] [Indexed: 11/25/2022] Open
Abstract
This study aimed to determine the effect of a proprioceptive neuromuscular facilitation (PNF) pattern Kinesio taping (KT) application on the ankle dorsiflexion range of motion (DF-ROM) and balance ability in patients with chronic stroke. This crossover study included 18 patients with stroke. The subjects were randomly assigned to three interventions: barefoot, ankle KT (A-KT), and PNF-KT. The A-KT was applied to the gastrocnemius and tibialis anterior (TA) muscles, and subtalar eversion. The PNF-KT was applied on the extensor hallucis, extensor digitorum, and TA muscles. DR-ROM was measured using the iSen™, a wearable sensor. Balance ability was assessed based on static balance, measured by the Biodex Balance System (BBS), and dynamic balance, measured by the timed up and go (TUG) test and dynamic gait index (DGI). Compared with the barefoot and A-KT interventions, PNF-KT showed significant improvements in the ankle DF-ROM and BBS scores, TUG, and DGI. PNF-KT, for functional muscle synergy, improved the ankle DF-ROM and balance ability in patients with chronic stroke. Therefore, the application of PNF-KT may be a feasible therapeutic method for improving ankle movement and balance in patients with chronic stroke. Additional research is recommended to identify the long-term effects of the PNF-KT.
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Short-Term Effect of Kinesio Taping of Lower-Leg Proprioceptive Neuromuscular Facilitation Pattern on Gait Parameter and Dynamic Balance in Chronic Stroke with Foot Drop. Healthcare (Basel) 2021; 9:healthcare9030271. [PMID: 33802448 PMCID: PMC7999191 DOI: 10.3390/healthcare9030271] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 02/24/2021] [Accepted: 02/26/2021] [Indexed: 11/16/2022] Open
Abstract
The aim of this study is to identify the effectiveness of proprioceptive neuromuscular facilitation (PNF) leg Kinesio taping on gait parameters and dynamic balance in chronic stroke patients with foot drop. A total 22 chronic stroke patients were randomly assigned to experimental (n = 11) and control groups (n = 11). All subjects underwent conventional therapy and gait training for 50 min. The experimental group additionally received KT of tibialis anterior muscle (TA) and hamstring muscles according to the PNF pattern. The control group received KT of only TA. The primary outcome measures that the gait parameter are gait velocity, cadence, step length, and stride length. Dynamic balance was measured by the timed up-and-go test (TUG) time and activity-specific balance confidence scale (ABC) as the secondary outcomes. All of the measurements were performed baseline and 24 h after intervention. Our results showed that the experimental group showed significant improvements in gait velocity, cadence, step length, stride length and TUG, and ABC score compared with the control group. We conclude that the short term effect of application of lower-leg KT according to the PNF pattern increased the gait ability and dynamic balance of chronic stroke patients with foot drop.
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Bellenfant KB, Robbins GL, Rogers RR, Kopec TJ, Ballmann CG. Effects of Dominant and Nondominant Limb Immobilization on Muscle Activation and Physical Demand during Ambulation with Axillary Crutches. J Funct Morphol Kinesiol 2021; 6:jfmk6010016. [PMID: 33572237 PMCID: PMC7931098 DOI: 10.3390/jfmk6010016] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 11/29/2022] Open
Abstract
The purpose of this study was to investigate the effects of how limb dominance and joint immobilization alter markers of physical demand and muscle activation during ambulation with axillary crutches. In a crossover, counterbalanced study design, physically active females completed ambulation trials with three conditions: (1) bipedal walking (BW), (2) axillary crutch ambulation with their dominant limb (DOM), and (3) axillary crutch ambulation with their nondominant limb (NDOM). During the axillary crutch ambulation conditions, the non-weight-bearing knee joint was immobilized at a 30-degree flexion angle with a postoperative knee stabilizer. For each trial/condition, participants ambulated at 0.6, 0.8, and 1.0 mph for five minutes at each speed. Heart rate (HR) and rate of perceived exertion (RPE) were monitored throughout. Surface electromyography (sEMG) was used to record muscle activation of the medial gastrocnemius (MG), soleus (SOL), and tibialis anterior (TA) unilaterally on the weight-bearing limb. Biceps brachii (BB) and triceps brachii (TB) sEMG were measured bilaterally. sEMG signals for each immobilization condition were normalized to corresponding values for BW.HR (p < 0.001) and RPE (p < 0.001) were significantly higher for both the DOM and NDOM conditions compared to BW but no differences existed between the DOM and NDOM conditions (p > 0.05). No differences in lower limb muscle activation were noted for any muscles between the DOM and NDOM conditions (p > 0.05). Regardless of condition, BB activation ipsilateral to the ambulating limb was significantly lower during 0.6 mph (p = 0.005) and 0.8 mph (p = 0.016) compared to the same speeds for BB on the contralateral side. Contralateral TB activation was significantly higher during 0.6 mph compared to 0.8 mph (p = 0.009) and 1.0 mph (p = 0.029) irrespective of condition. In conclusion, limb dominance appears to not alter lower limb muscle activation and walking intensity while using axillary crutches. However, upper limb muscle activation was asymmetrical during axillary crutch use and largely dependent on speed. These results suggest that functional asymmetry may exist in upper limbs but not lower limbs during assistive device supported ambulation.
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Influence of leg length discrepancy on balance and gait in post-stroke patients: a correlational study. BULLETIN OF FACULTY OF PHYSICAL THERAPY 2020. [DOI: 10.1186/s43161-020-00012-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
A frequent complaint by stroke patients presenting for physiotherapy was perceived shortness of the affected lower limb and inability to weight bear onto the affected side. So, the present study aimed to evaluate influence of limb length discrepancy (LLD) on balance and gait parameters in patients with stroke.
Subjects and methods
Twenty participants were recruited based on the inclusion and exclusion criteria and were divided into two groups group A (LLD ≤ 1 cm) and group B (LLD > 1 cm). Postural sway was measured under wide base eyes open, wide base eyes closed, narrow base eyes open, and narrow base eyes closed conditions. Weight-bearing asymmetry and functional balance were assessed using the percentage body weight asymmetry and Berg balance scale. Also, step leg ratio and 10-M walk test was used to assess gait parameters.
Results
Intergroup comparison of postural sway exhibited a significant difference between groups in the AP direction in wide-based eyes open (WBEO), wide-based eyes closed (WBEC), narrow-based eyes open (NBEO), and narrow-based eyes closed (NBEC) conditions whereas only in NBEC condition in mediolateral direction; with group B (LLD > 1 cm) displaying a greater mean postural sway in all the conditions. The correlation of LLD with postural sway showed a significant positive correlation within AP direction under all the conditions and in WBEC and NBEC conditions in mediolateral direction. Intergroup comparison of step length ratio (SLR) showed a statistical difference between groups, and a negative correlation was found between LLD and SLR. A negative correlation was also seen between percentage weight-bearing asymmetry (PWBA) and speed as well as Berg’s balance scale (BBS), and a positive correlation was observed between BBS and speed.
Conclusion
Leg length discrepancy results in a significant decrease in balance control in the sagittal and frontal planes in patients with stroke. It also adds to the asymmetries in their gait. Therefore, LLD should be considered as a factor for balance and gait asymmetries in post-stroke patients.
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Darwish MH, Ahmed S, Ismail MES, Khalifa HA. Influence of pelvic inclination on sit to stand task in stroke patients. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2019. [DOI: 10.1186/s41983-019-0132-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Stroke results in an impaired sit to stand (STS) task. Pelvic movements are essential in daily living activities. Few studies investigated the effect of spine and pelvis separately on functional activities in stroke patients.
Objective
The study aimed to assess the angles of pelvic inclination (anterior and posterior pelvic tilt angles) (APT and PPT) during sitting position and during STS movement. It aimed also to determine the influence of sagittal pelvic tilt angles on STS performance in stroke patients.
Patients and methods
Thirty male hemi-paretic stroke patients (GI) and 15 matched healthy volunteer subjects (GII) represented the sample of this study. Stroke patients were assigned into two equal groups (group Ia and Ib). Sagittal pelvic tilt angles were measured by using the palpation meter inclinometer during sitting position and during initiation and mid of STS by using two dimensional (2D) video-based motion analysis system. Time of five repetitions STS test was used to assess the ability to perform STS task.
Results
The results showed a significant increase of PPT angle during static sitting, a significant decrease in APT angle during initiation and mid of STS task and a significant increase in time taken for five repetitions STS test in both stroke groups (P < 0.05).
Conclusion
Abnormal pelvic alignment and movements affect the functional performance of stroke patients during sitting and sit to stand task.
Trial registration
NCT03053154. Registered January 22, 2017. Retrospectively registered.
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Quintino LF, Franco J, Gusmão AFM, Silva PFDS, Faria CDCDM. Trunk flexor and extensor muscle performance in chronic stroke patients: a case-control study. Braz J Phys Ther 2018; 22:231-237. [PMID: 29258736 PMCID: PMC5993948 DOI: 10.1016/j.bjpt.2017.12.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 11/17/2017] [Accepted: 12/05/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Although chronic stroke patients commonly show impairment of trunk muscle performance, this disability has only been analyzed in terms of peak torque. Therefore, other measures are needed for a more adequate description. OBJECTIVE This study aimed to compare concentric muscle performance of trunk flexor/extensor muscles between chronic stroke patients and matched-healthy subjects. METHODS 18 chronic stroke patients and 18 healthy subjects were matched according to their age, sex, body mass index and level of physical activity. After familiarization, trunk flexor/extensor concentric muscle strength was measured using an isokinetic dynamometer (Biodex Medical Systems Inc, Shirley, NY, USA) with 3 repetitions at a velocity of 60°/s and 5 repetitions at a velocity of 120°/s. Trunk muscular performance was characterized by peak torque, torque at 90°, total work, and total work normalized by trunk mass. Student's t-test was used for independent samples (α=0.05) for group comparisons. RESULTS All trunk muscle performance variables values investigated were significantly lower in chronic stroke patients when compared to matched-healthy subjects (p≤0.001). The obtained ratios of chronic stroke patients scores to that of the matched-healthy subjects at velocities of 60°/s and 120°/s were, respectively: flexor peak torque (60% & 53%)/extensor (54% & 53%); flexor torque at 90° (56.20% & 36.58%)/extensor (57.92% & 30.65%); flexor total muscular work (51.27% & 38.03%)/extensor (47.97% & 39.52%); and flexor total muscular work normalized by trunk mass (55.57% & 40%)/extensor (51.40% & 42%). CONCLUSIONS Chronic stroke patients showed decreased trunk muscle performance when compared to matched-healthy subjects in all variables investigated.
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Affiliation(s)
| | - Juliane Franco
- Universidade Federal de Minas Gerais (UFMG), Department of Physical Therapy, Belo Horizonte, MG, Brazil
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13
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Arya KN, Pandian S, Kumar V. Effect of activity-based mirror therapy on lower limb motor-recovery and gait in stroke: A randomised controlled trial. Neuropsychol Rehabil 2017; 29:1193-1210. [DOI: 10.1080/09602011.2017.1377087] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Kamal Narayan Arya
- Pandit Deendayal Upadhayaya National Institute for Persons with Physical Disabilities, New Delhi, India
| | - Shanta Pandian
- Pandit Deendayal Upadhayaya National Institute for Persons with Physical Disabilities, New Delhi, India
| | - Vikas Kumar
- Pandit Deendayal Upadhayaya National Institute for Persons with Physical Disabilities, New Delhi, India
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14
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Determinants of sit-to-stand tasks in individuals with hemiparesis post stroke: A review. Ann Phys Rehabil Med 2015; 58:167-72. [DOI: 10.1016/j.rehab.2015.04.007] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 04/21/2015] [Accepted: 04/21/2015] [Indexed: 11/23/2022]
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15
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Kumar SNS, Joseph LH, Omar B, Sulaiman R, Nor HMY, Htwe O, Hamidun N, Broadbent S. Reliability of a digital weighing scale relative to the Nintendo Wii in measuring limb load asymmetry. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2015. [DOI: 10.12968/ijtr.2015.22.2.74] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background/Aims: Limb load asymmetry (LLA) is common in clinical conditions related to the lower limbs such as degenerative joint disease, soft tissue injuries, joint replacements, amputations and stroke. However, the measurement of LLA is limited in clinical practice as the equipment used is expensive and not readily available in most health care settings. The digital weighing scale is proposed as an inexpensive alternative method of measuring LLA and the objective of this study was to investigate the reliability and accuracy of a digital weighing scale relative to the Nintendo Wii in measuring limb load asymmetry during static standing. Methods: Twenty-four participants (12 participants with knee osteoarthritis (OA) and 12 healthy participants) were recruited through convenient sampling from a public university teaching hospital. The participants were required to perform a quiet standing task during the measurement of LLA. The measurements were taken over three trials during both eyes-open (EO) and eyes-closed (EC) resting conditions. LLA was measured in kilograms and computed with a symmetry index. Intra-class correlation coefficient (ICC) (3, 1) analysis, standard error of measurement and coefficient of variation were performed to assess reliability. The Bland-Altman plot was used to test the degree of agreement between digital weighing scales and the Nintendo Wii. Results: The digital weighing scale showed an excellent reliability of 0.983 and 0.988 in EC and EO conditions, respectively. The Bland-Altman plot showed good agreement between digital weighing scales and the Nintendo Wii in measuring LLA. Conclusions: The digital weighing scale is a reliable tool to measure LLA and has excellent potential to be used in clinical settings.
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Affiliation(s)
- Senthil NS Kumar
- PhD student, School of Rehabilitation Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia
| | - Leonard H Joseph
- Senior lecturer, School of Rehabilitation Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia
| | - Baharudin Omar
- Professor, Faculty of Health Sciences, Universiti Kebangsaan Malaysia
| | - Riza Sulaiman
- Professor, Faculty of Information Science and Technology, Universiti Kebangsaan Malaysia
| | - Hamdan MY Nor
- Professor, Department of Orthopedics and Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur
| | - Ohnmar Htwe
- Associate professor, Department of Orthopedics and Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur
| | - Nursalbiyah Hamidun
- Physiotherapist, School of Rehabilitation Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia
| | - Suzanne Broadbent
- Senior lecturer in clinical exercise physiology and rehabilitation, School of Health and Human Sciences, Southern Cross University, Lismore, Australia
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16
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Park J, Yoo I. Relationships of stroke patients' gait parameters with fear of falling. J Phys Ther Sci 2014; 26:1883-4. [PMID: 25540488 PMCID: PMC4273048 DOI: 10.1589/jpts.26.1883] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 06/05/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to assess the correlation of gait parameters with
fear of falling in stroke survivors. [Subjects] In total, 12 patients with stroke
participated. [Methods] The subjects performed on a Biodex Gait Trainer 2 for 5 min to
evaluate characteristic gait parameters. The kinematic gait parameters measured were gait
speed, step cycle, step length, and time on each foot (step symmetry). All the subjects
also completed a fall anxiety survey. [Results] Correlations between gait parameters and
fear of falling scores were calculated. There was a moderate degree of correlation between
fear of falling scores and the step cycle item of gait parameters. [Conclusions] According
to our results, the step cycle gait parameter may be related to increased fall
anxiety.
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Affiliation(s)
- Jin Park
- Department of Rehabilitation Center, Dreamsol Hospital, Republic of Korea
| | - Ingyu Yoo
- Department of Occupational Therapy, College of Medical Sciences, Jeonju University, Republic of Korea
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Kumar SNS, Omar B, Joseph LH, Htwe O, Jagannathan K, Hamdan NMY, Rajalakshmi D. Evaluation of limb load asymmetry using two new mathematical models. Glob J Health Sci 2014; 7:1-7. [PMID: 25716372 PMCID: PMC4796372 DOI: 10.5539/gjhs.v7n2p1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 08/04/2014] [Indexed: 11/12/2022] Open
Abstract
Quantitative measurement of limb loading is important in orthopedic and neurological rehabilitation. In current practice, mathematical models such as Symmetry index (SI), Symmetry ratio (SR), and Symmetry angle (SA) are used to quantify limb loading asymmetry. Literatures have identified certain limitations with the above mathematical models. Hence this study presents two new mathematical models Modified symmetry index (MSI) and Limb loading error (LLE) that would address these limitations. Furthermore, the current mathematical models were compared against the new model with the goal of achieving a better model. This study uses hypothetical data to simulate an algorithmic preliminary computational measure to perform with all numerical possibilities of even and uneven limb loading that can occur in human legs. Descriptive statistics are used to interpret the limb loading patterns: symmetry, asymmetry and maximum asymmetry. The five mathematical models were similar in analyzing symmetry between limbs. However, for asymmetry and maximum asymmetry data, the SA and SR values do not give any meaningful interpretation, and SI gives an inflated value. The MSI and LLE are direct, easy to interpret and identify the loading patterns with the side of asymmetry. The new models are notable as they quantify the amount and side of asymmetry under different loading patterns.
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Kumar NS, Omar B, Joseph LH, Hamdan N, Htwe O, Hamidun N. Accuracy of a digital weight scale relative to the nintendo wii in measuring limb load asymmetry. J Phys Ther Sci 2014; 26:1205-7. [PMID: 25202181 PMCID: PMC4155220 DOI: 10.1589/jpts.26.1205] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 02/16/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The aim of the present study was to investigate the accuracy of a digital
weight scale relative to the Wii in limb loading measurement during static standing.
[Methods] This was a cross-sectional study conducted at a public university teaching
hospital. The sample consisted of 24 participants (12 with osteoarthritis and 12 healthy)
recruited through convenient sampling. Limb loading measurements were obtained using a
digital weight scale and the Nintendo Wii in static standing with three trials under an
eyes-open condition. The limb load asymmetry was computed as the symmetry index. [Results]
The accuracy of measurement with the digital weight scale relative to the Nintendo Wii was
analyzed using the receiver operating characteristic (ROC) curve and Kolmogorov-Smirnov
test (K-S test). The area under the ROC curve was found to be 0.67. Logistic regression
confirmed the validity of digital weight scale relative to the Nintendo Wii. The D
statistics value from the K-S test was found to be 0.16, which confirmed that there was no
significant difference in measurement between the equipment. [Conclusion] The digital
weight scale is an accurate tool for measuring limb load asymmetry. The low price, easy
availability, and maneuverability make it a good potential tool in clinical settings for
measuring limb load asymmetry.
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Affiliation(s)
- Ns Senthil Kumar
- Physiotherapy Program, School of Rehabilitation Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Malaysia
| | - Baharudin Omar
- Department of Biomedical Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Malaysia
| | - Leonard H Joseph
- Physiotherapy Program, School of Rehabilitation Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Malaysia
| | - Nor Hamdan
- Physiotherapy Program, School of Rehabilitation Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Malaysia
| | - Ohnmar Htwe
- Department of Orthopedic and Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Malaysia
| | - Nursalbiyah Hamidun
- Physiotherapy Program, School of Rehabilitation Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Malaysia
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Kumar SNS, Omar B, Htwe O, Joseph LH, Krishnan J, Esfehani AJ, Min LL. Reliability, agreement, and validity of digital weighing scale with MatScan in limb load measurement. ACTA ACUST UNITED AC 2014; 51:591-8. [DOI: 10.1682/jrrd.2013.07.0166] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 12/16/2013] [Indexed: 11/05/2022]
Affiliation(s)
- Senthil N. S. Kumar
- Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Baharudin Omar
- Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Ohnmar Htwe
- Department of Orthopedic and Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | | | - Jagannathan Krishnan
- Faculty of Chemical Engineering, MARA University of Technology, Shah Alam, Malaysia
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