scholarly journals Toward goal-oriented robotic gait training: The effect of gait speed and stride length on lower extremity joint torques

2017 ◽  
Author(s):  
Robert L. McGrath ◽  
Margaret Pires-Fernandes ◽  
Brian Knarr ◽  
Jill S. Higginson ◽  
Fabrizio Sergi
Keyword(s):  
Lower Extremity ◽  
Gait Speed ◽  
Stride Length ◽  
Gait Training ◽  
Joint Torques ◽  
Robotic Gait

scholarly journals The effect of stride length on lower extremity joint kinetics at various gait speeds

2018 ◽  
Author(s):  
Robert L. McGrath ◽  
Melissa L. Ziegler ◽  
Margaret Pires-Fernandes ◽  
Brian A. Knarr ◽  
Jill S. Higginson ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Gait Speed ◽  
Stride Length ◽  
Inverse Dynamics ◽  
Sagittal Plane ◽  
Gait Training ◽  
Joint Moment ◽  
Joint Moments ◽  
Joint Kinetics ◽  
Trailing Limb Angle

AbstractRobot-assisted training is a promising tool under development for improving walking function based on repetitive goal-oriented task practice. The challenges in developing the controllers for gait training devices that promote desired changes in gait is complicated by the limited understanding of the human response to robotic input. A possible method of controller formulation can be based on the principle of bio-inspiration, where a robot is controlled to apply the change in joint moment applied by human subjects when they achieve a gait feature of interest. However, it is currently unclear how lower extremity joint moments are modulated by even basic gaitspatio-temporal parameters.In this study, we investigated how sagittal plane joint moments are affected by a factorial modulation of two important gait parameters: gait speed and stride length. We present the findings obtained from 20 healthy control subjects walking at various treadmill-imposed speeds and instructed to modulate stride length utilizing real-time visual feedback. Implementing a continuum analysis of inverse-dynamics derived joint moment profiles, we extracted the effects of gait speed and stride length on joint moment throughout the gait cycle. Moreover, we utilized a torque pulse approximation analysis to determine the timing and amplitude of torque pulses that approximate the difference in joint moment profiles between stride length conditions, at all gait speed conditions.Our results show that gait speed has a significant effect on the moment profiles in all joints considered, while stride length has more localized effects, with the main effect observed on the knee moment during stance, and smaller effects observed for the hip joint moment during swing and ankle moment during the loading response. Moreover, our study demonstrated that trailing limb angle, a parameter of interest in programs targeting propulsion at push-off, was significantly correlated with stride length. As such, our study has generated assistance strategies based on pulses of torque suitable for implementation via a wearable exoskeleton with the objective of modulating stride length, and other correlated variables such as trailing limb angle.

scholarly journals Acute and Chronic Effect of Acoustic and Visual Cues on Gait Training in Parkinson’s Disease: A Randomized, Controlled Study

2015 ◽  
Vol 2015 ◽  
pp. 1-9 ◽  
Author(s):  
Roberto De Icco ◽  
Cristina Tassorelli ◽  
Eliana Berra ◽  
Monica Bolla ◽  
Claudio Pacchetti ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Gait Speed ◽  
Visual Cues ◽  
Stride Length ◽  
Gait Training ◽  
Randomized Controlled Study ◽  
Controlled Study ◽  
Acoustic Cues ◽  
Chronic Effect ◽  
Randomized Controlled

In this randomized controlled study we analyse and compare the acute and chronic effects of visual and acoustic cues on gait performance in Parkinson’s Disease (PD). We enrolled 46 patients with idiopathic PD who were assigned to 3 different modalities of gait training: (1) use of acoustic cues, (2) use of visual cues, or (3) overground training without cues. All patients were tested with kinematic analysis of gait at baseline (T0), at the end of the 4-week rehabilitation programme (T1), and 3 months later (T2). Regarding the acute effect, acoustic cues increased stride length and stride duration, while visual cues reduced the number of strides and normalized the stride/stance distribution but also reduced gait speed. As regards the chronic effect of cues, we recorded an improvement in some gait parameters in all 3 groups of patients: all 3 types of training improved gait speed; visual cues also normalized the stance/swing ratio, acoustic cues reduced the number of strides and increased stride length, and overground training improved stride length. The changes were not retained at T2 in any of the experimental groups. Our findings support and characterize the usefulness of cueing strategies in the rehabilitation of gait in PD.

scholarly journals Non-Discriminant Relationships between Leg Muscle Strength, Mass and Gait Performance in Healthy Young and Old Adults

Gerontology ◽  
2017 ◽  
Vol 64 (1) ◽  
pp. 11-18 ◽  
Author(s):  
Thomas Muehlbauer ◽  
Urs Granacher ◽  
Ron Borde ◽  
Tibor Hortobágyi
Keyword(s):  
Muscle Strength ◽  
Lower Extremity ◽  
Gait Speed ◽  
Stride Length ◽  
Tissue Mass ◽  
Gait Performance ◽  
Old Adults ◽  
Lower Extremity Strength ◽  
Strength Exercises ◽  
Leg Muscle

Background: Gait speed declines with increasing age, but it is unclear if gait speed preferentially correlates with leg muscle strength or mass. Objective: We determined the relationship between gait speed and (1) leg muscle strength measured at 3 lower extremity joints and (2) leg lean tissue mass (LTM) in healthy young (age: 25 years, n = 20) and old (age: 70 years, n = 20) adults. Methods: Subjects were tested for maximal isokinetic hip, knee, and ankle extension torque, leg LTM by bioimpedance, and gait performance (i.e., gait speed, stride length) at preferred and maximal gait speeds. Results: We found no evidence for a preferential relationship between gait performance and leg muscle strength compared with gait performance and leg LTM in healthy young and old adults. In old adults, hip extensor strength only predicted habitual gait speed (R2 = 0.29, p = 0.015), whereas ankle plantarflexion strength only predicted maximal gait speed and stride length (both R2 = 0.40, p = 0.003). Conclusions: Gait speed did not preferentially correlate with leg muscle strength or leg LTM, favoring neither outcome for predicting mobility. Thus, we recommend that both leg muscle strength and leg LTM should be tested and trained complementarily. Further, hip and ankle extension torque predicted gait performance, and thus we recommend to test and train healthy old adults by functional integrated multiarticular rather than monoarticular lower extremity strength exercises.

scholarly journals Task-specific training for improving propulsion symmetry and gait speed in people in the chronic phase after stroke: a proof-of-concept study

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
J. F. Alingh ◽  
B. E. Groen ◽  
J. F. Kamphuis ◽  
A. C. H. Geurts ◽  
V. Weerdesteyn
Keyword(s):  
Gait Speed ◽  
Daily Life ◽  
Gait Training ◽  
Chronic Stroke ◽  
Stroke Survivors ◽  
Proof Of Concept ◽  
Concept Study ◽  
Walking Activity ◽  
Robotic Gait ◽  
Functional Gait

Abstract Background After stroke, some individuals have latent, propulsive capacity of the paretic leg, that can be elicited during task-specific gait training. The aim of this proof-of-concept study was to investigate the effect of five-week robotic gait training for improving propulsion symmetry by increasing paretic propulsion in chronic stroke survivors. Methods Twenty-nine individuals with chronic stroke and impaired paretic propulsion (≥ 8% difference in paretic vs. non-paretic propulsive impulse) were enrolled. Participants received ten 60-min sessions of individual robotic gait training targeting paretic propulsion (five weeks, twice a week), complemented with home exercises (15 min/day) focusing on increasing strength and practicing learned strategies in daily life. Propulsion measures, gait kinematics and kinetics, self-selected gait speed, performance of functional gait tasks, and daily-life mobility and physical activity were assessed five weeks (T0) and one week (T1) before the start of intervention, and one week (T2) and five weeks (T3) after the intervention period. Results Between T0 and T1, no significant differences in outcomes were observed, except for a marginal increase in gait speed (+ 2.9%). Following the intervention, propulsion symmetry (+ 7.9%) and paretic propulsive impulse had significantly improved (+ 8.1%), whereas non-paretic propulsive impulse remained unchanged. Larger gains in propulsion symmetry were associated with more asymmetrical propulsion at T0. In addition, following the intervention significantly greater paretic trailing limb angles (+ 6.6%) and ankle plantarflexion moments (+ 7.1%) were observed. Furthermore, gait speed (+ 7.2%), 6-Minute Walk Test (+ 6.4%), Functional Gait Assessment (+ 6.5%), and daily-life walking intensity (+ 6.9%) had increased following the intervention. At five-week follow-up (T3), gains in all outcomes were retained, and gait speed had further increased (+ 3.6%). Conclusions The post-intervention gain in paretic propulsion did not only translate into improved propulsion symmetry and gait speed, but also pertained to performance of functional gait tasks and daily-life walking activity levels. These findings suggest that well-selected chronic stroke survivors may benefit from task-specific targeted training to utilize the residual propulsive capacity of the paretic leg. Future research is recommended to establish simple baseline measures for identification of individuals who may benefit from such training and confirm benefits of the used training concepts in a randomized controlled trial. Trial registration: Registry number ClinicalTrials.gov (www.clinicaltrials.gov): NCT04650802, retrospectively registered 3 December 2020.

scholarly journals Repeated Gait Perturbation Training in Parkinson's Disease and Healthy Older Adults: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 15 ◽  
Author(s):  
Femke Hulzinga ◽  
Veerle de Rond ◽  
Britt Vandendoorent ◽  
Moran Gilat ◽  
Pieter Ginis ◽  
...  
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Gait Speed ◽  
Stride Length ◽  
Meta Analysis ◽  
Gait Training ◽  
Healthy Older Adults ◽  
Perturbation Training

Background: Gait impairments are common in healthy older adults (HOA) and people with Parkinson's disease (PwPD), especially when adaptations to the environment are required. Traditional rehabilitation programs do not typically address these adaptive gait demands in contrast to repeated gait perturbation training (RGPT). RGPT is a novel reactive form of gait training with potential for both short and long-term consolidation in HOA and PwPD. The aim of this systematic review with meta-analysis is to determine whether RGPT is more effective than non-RGPT gait training in improving gait and balance in HOA and PwPD in the short and longer term.Methods: This review was conducted according to the PRISMA-guidelines and pre-registered in the PROSPERO database (CRD42020183273). Included studies tested the effects of any form of repeated perturbations during gait in HOA and PwPD on gait speed, step or stride length. Studies using balance scales or sway measures as outcomes were included in a secondary analysis. Effects of randomized controlled trials (RCT) on RGPT were pooled using a meta-analysis of final measures.Results: Of the 4421 studies, eight studies were deemed eligible for review, of which six could be included in the meta-analysis, totaling 209 participants (159 PwPD and 50 HOA). The studies were all of moderate quality. The meta-analysis revealed no significant effects of RGPT over non-RGPT training on gait performance (SMD = 0.16; 95% CI = −0.18, 0.49; Z = 0.92; P = 0.36). Yet, in some individual studies, favorable effects on gait speed, step length and stride length were observed immediately after the intervention as well as after a retention period. Gait variability and asymmetry, signifying more direct outcomes of gait adaptation, also indicated favorable RGPT effects in some individual studies.Conclusion: Despite some promising results, the pooled effects of RGPT on gait and balance were not significantly greater as compared to non-RGPT gait training in PwPD and HOA. However, these findings could have been driven by low statistical power. Therefore, the present review points to the imperative to conduct sufficiently powered RCT's to verify the true effects of RGPT on gait and balance in HOA and PwPD.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php? Identifier: CRD42020183273.

scholarly journals Longitudinal Changes in Temporospatial Gait Characteristics during the First Year Post-Stroke

2021 ◽  
Vol 11 (12) ◽  
pp. 1648
Author(s):  
John W. Chow ◽  
Dobrivoje S. Stokic
Keyword(s):  
Lower Extremity ◽  
Gait Speed ◽  
Stride Length ◽  
Double Support ◽  
Post Stroke ◽  
Gait Characteristics ◽  
Gait Parameters ◽  
Support Time ◽  
Post Onset ◽  
Step Parameters

Given the paucity of longitudinal data in gait recovery after stroke, we compared temporospatial gait characteristics of stroke patients during subacute (<2 months post-onset, T0) and at approximately 6 and 12 months post-onset (T1 and T2, respectively) and explored the relationship between gait characteristics at T0 and the changes in gait speed from T0 to T1. Forty-six participants were assessed at T0 and a subsample of 24 participants at T2. Outcome measures included Fugl-Meyer lower-extremity motor score, 14 temporospatial gait parameters and symmetry indices of 5 step parameters. Except for step width, all temporospatial parameters improved from T0 to T1 (p ≤ 0.0001). Additionally, significant improvements in symmetry were found for the initial double-support time and single-support time (p ≤ 0.0001). Although group results at T2 were not different from those at T1, the individual analysis revealed that 42% (10/24) of the subsample showed a significant increase in gait speed. The increase in gait speed from T0 to T1 was negatively correlated with gait speed and stride length, and positively correlated with the symmetry indices of stance and single-support times at T0 (p ≤ 0.002). Temporospatial gait parameters and stance time symmetry improve over the first 6 months after stroke with an apparent plateau thereafter. Approximately 40% of the subsample continue to increase gait speed from 6 to 12 months post-stroke. A greater increase in gait speed during the first 6 months post-stroke is associated with initially slower walking, shorter stride length, and more pronounced asymmetry in stance and single-support times. The improvement in lower-extremity motor function and bilateral improvements in step parameters collectively suggest that gait changes over the first 12 months after stroke are likely due to neurological recovery, although some compensation by the non-paretic side cannot be excluded.

scholarly journals The effect of pelvic movements of a gait training system for stroke patients: a single blind, randomized, parallel study

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Choonghyun Son ◽  
Anna Lee ◽  
Junkyung Lee ◽  
DaeEun Kim ◽  
Seung-Jong Kim ◽  
...  
Keyword(s):  
Stride Length ◽  
Stance Phase ◽  
Walking Speed ◽  
Gait Training ◽  
Training System ◽  
Transverse Plane ◽  
Gait Rehabilitation ◽  
Stroke Patients ◽  
Pelvic Movement ◽  
Robotic Gait

Abstract Background Aging societies lead to higher demand for gait rehabilitation as age-related neurological disorders such as stroke and spinal cord injury increase. Since conventional methods for gait rehabilitation are physically and economically burdensome, robotic gait training systems have been studied and commercialized, many of which provided movements confined in the sagittal plane. For better outcomes of gait rehabilitation with more natural gait patterns, however, it is desirable to provide pelvic movements in the transverse plane. In this study, a robotic gait training system capable of pelvic motions in the transverse plane was used to evaluate the effect of the pelvic motions on stroke patients. Method Healbot T, which is a robotic gait training system and capable of providing pelvic movements in the transverse plane as well as flexion/extension of the hip and knee joints and adduction/abduction of the hip joints, is introduced and used to evaluate the effect of the pelvic movement on gait training of stroke patients. Gait trainings in Healbot T with and without pelvic movements are carried out with stroke patients having hemiparesis. Experiment Twenty-four stroke patients with hemiparesis were randomly assigned into two groups and 23 of them successfully completed the experiment except one subject who had dropped out due to personal reasons. Pelvis-on group was provided with pelvic motions whereas no pelvic movement was allowed for pelvis-off group during 10 sessions of gait trainings in Healbot T. Electromyography (EMG) signals and interaction forces as well as the joint angles of the robot were measured. Gait parameters such as stride length, cadence, and walking speed were measured while walking on the ground without assistance of Healbot T after gait training on 1st, 5th, and 10th day. Result Stride length significantly increased in both groups. Furthermore, cadence and walking speed of the pelvis-on group were increased by 10.6% and 11.8%. Although interaction forces of both groups except the thighs showed no differences, EMG signals from gluteus medius of the pelvis-on group increased by 88.6% during stance phase. In addition, EMG signals of biceps femoris, gastrocnemius medial, and gastrocnemius lateral of the pelvis-on group increased whereas EMG signals of the pelvis-off group except gastrocnemius lateral showed no difference after gait trainings. Conclusion Gait training using a robotic gait training system with pelvic movements was conducted to investigate the effects of lateral and rotational pelvic movements in gait training of stroke patients. The pelvic movements affected to increase voluntary muscle activation during the stance phase as well as cadence and walking speed. Clinical trial registration KCT0003762, 2018-1254, Registered 28 October 2018, https://cris.nih.go.kr/cris/search/search_result_st01_kren.jsp?seq=14310&ltype=&rtype=

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