Constraining movement reveals motor capability in chronic stroke: an initial study

2016 ◽  
Vol 31 (8) ◽  
pp. 1126-1133 ◽  
Author(s):  
Clarisa A Martinez ◽  
Emily Mintz ◽  
Andrea E Ecsedy ◽  
Beth E Fisher
Keyword(s):  
Knee Flexion ◽  
Sagittal Plane ◽  
Step Length ◽  
Initial Study ◽  
Swing Phase ◽  
Chronic Stroke ◽  
Task Demands ◽  
Treadmill Walking ◽  
Gait Kinematics ◽  
Hip Flexion

Objective: To determine if persons with chronic stroke and decreased hip and knee flexion during swing can walk with improved swing-phase kinematics when the task demands constrained gait to the sagittal plane. Design: A one-day, within-subject design comparing gait kinematics under two conditions: Unconstrained treadmill walking and a constrained condition in which the treadmill walking space is reduced to limit limb advancement to occur in the sagittal plane. Setting: Outpatient physical therapy clinic. Subjects: Eight individuals (mean age, 64.1 ±9.3, 2 F) with mild-moderate paresis were enrolled. Main measures: Spatiotemporal gait characteristics and swing-phase hip and knee range of motion during unconstrained and constrained treadmill walking were compared using paired t-test and Cohen’s d ( d) to determine effect size. Results: There was a significant, moderate-to-large effect of the constraint on hip flexion ( p < 0.001, d = –1.1) during initial swing, and hip ( p < 0.05, d = –0.8) and knee ( p < 0.001, d = –1.1) flexion during midswing. There was a moderate effect of constraint on terminal swing knee flexion ( p = 0.238, d = –0.6). Immediate and significant changes in step width ( p < 0.05, d = 0.9) and paretic step length ( p < 0.05, d = –0.5) were noted in the constrained condition compared with unconstrained. Conclusion: Constraining the treadmill walking path altered the gait patterns among the study’s participants. The immediate change during constrained walking suggests that patients with chronic stroke may have underlying movement capability that they do not preferentially utilize.

scholarly journals Genetic Algorithms Based Approach for Designing Spring Brake Orthosis – Part I: Spring Parameters

2012 ◽  
Vol 9 (3) ◽  
pp. 303-316 ◽  
Author(s):  
M. S. Huq ◽  
M. O. Tokhi
Keyword(s):  
First Principles ◽  
Knee Flexion ◽  
Gait Cycle ◽  
Sagittal Plane ◽  
Swing Phase ◽  
Full Extension ◽  
Torsion Spring ◽  
Constant Torque ◽  
Spring Type ◽  
Hip Flexion

Spring brake orthosis (SBO) concentrates purely on the knee to generate the swing phase of the paraplegic gait with the required hip flexion occurring passively as a consequence of the ipsilateral knee flexion, generated by releasing the torsion spring mounted at the knee joint. Electrical stimulation then drives the knee back to full extension, as well as restores the spring potential energy. In this paper, genetic algorithm (GA) and its variant multi-objective GA (MOGA) is used to perform the search operation for the ‘best’ spring parameters for the SBO spring mounted on an average sized subject simulated in the sagittal plane. Conventional torsion spring is tested against constant torque type spring in terms of swing duration as, based on first principles, it is hypothesized that constant torque spring would be able to produce slower SBO swing phase as might be preferred in assisted paraplegic gait. In line with the hypothesis, it is found that it is not possible to delay the occurrence of the flexion peak of the SBO swing phase further than its occurrence in the natural gait. The use of conventional torsion spring causes the swing knee flexion peak to appear rather faster than that of the natural gait, resulting in a potentially faster swing phase and hence gait cycle. The constant torque type spring on the other hand is able to stretch duration of the swing phase to some extent, rendering it the preferable spring type in SBO.

scholarly journals A Dual-Learning Paradigm Simultaneously Improves Multiple Features of Gait Post-Stroke

2018 ◽  
Vol 32 (9) ◽  
pp. 810-820 ◽  
Author(s):  
Kendra M. Cherry-Allen ◽  
Matthew A. Statton ◽  
Pablo A. Celnik ◽  
Amy J. Bastian
Keyword(s):  
Knee Flexion ◽  
Joint Angle ◽  
Step Length ◽  
Learning Task ◽  
Gait Pattern ◽  
Learning Paradigm ◽  
Post Stroke ◽  
Learning Conditions ◽  
Hip Flexion ◽  
Gait Impairments

Background. Gait impairments after stroke arise from dysfunction of one or several features of the walking pattern. Traditional rehabilitation practice focuses on improving one component at a time, which may leave certain features unaddressed or prolong rehabilitation time. Recent work shows that neurologically intact adults can learn multiple movement components simultaneously. Objective. To determine whether a dual-learning paradigm, incorporating 2 distinct motor tasks, can simultaneously improve 2 impaired components of the gait pattern in people posttroke. Methods. Twelve individuals with stroke participated. Participants completed 2 sessions during which they received visual feedback reflecting paretic knee flexion during walking. During the learning phase of the experiment, an unseen offset was applied to this feedback, promoting increased paretic knee flexion. During the first session, this task was performed while walking on a split-belt treadmill intended to improve step length asymmetry. During the second session, it was performed during tied-belt walking. Results. The dual-learning task simultaneously increased paretic knee flexion and decreased step length asymmetry in the majority of people post-stroke. Split-belt treadmill walking did not significantly interfere with joint-angle learning: participants had similar rates and magnitudes of joint-angle learning during both single and dual-learning conditions. Participants also had significant changes in the amount of paretic hip flexion in both single and dual-learning conditions. Conclusions. People with stroke can perform a dual-learning paradigm and change 2 clinically relevant gait impairments in a single session. Long-term studies are needed to determine if this strategy can be used to efficiently and permanently alter multiple gait impairments.

scholarly journals Effects of selectively assisting impaired subtasks of walking in chronic stroke survivors

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Simone S. Fricke ◽  
Hilde J. G. Smits ◽  
Cristina Bayón ◽  
Jaap H. Buurke ◽  
Herman van der Kooij ◽  
...  
Keyword(s):  
Knee Flexion ◽  
Step Length ◽  
Gait Training ◽  
Chronic Stroke ◽  
Stroke Survivors ◽  
Baseline Trial ◽  
Gait Parameters ◽  
Flexion Extension ◽  
Spatiotemporal Parameters ◽  
Length Width

Abstract Background Recently developed controllers for robot-assisted gait training allow for the adjustment of assistance for specific subtasks (i.e. specific joints and intervals of the gait cycle that are related to common impairments after stroke). However, not much is known about possible interactions between subtasks and a better understanding of this can help to optimize (manual or automatic) assistance tuning in the future. In this study, we assessed the effect of separately assisting three commonly impaired subtasks after stroke: foot clearance (FC, knee flexion/extension during swing), stability during stance (SS, knee flexion/extension during stance) and weight shift (WS, lateral pelvis movement). For each of the assisted subtasks, we determined the influence on the performance of the respective subtask, and possible effects on other subtasks of walking and spatiotemporal gait parameters. Methods The robotic assistance for the FC, SS and WS subtasks was assessed in nine mildly impaired chronic stroke survivors while walking in the LOPES II gait trainer. Seven trials were performed for each participant in a randomized order: six trials in which either 20% or 80% of assistance was provided for each of the selected subtasks, and one baseline trial where the participant did not receive subtask-specific assistance. The influence of the assistance on performances (errors compared to reference trajectories) for the assisted subtasks and other subtasks of walking as well as spatiotemporal parameters (step length, width and height, swing and stance time) was analyzed. Results Performances for the impaired subtasks (FC, SS and WS) improved significantly when assistance was applied for the respective subtask. Although WS performance improved when assisting this subtask, participants were not shifting their weight well towards the paretic leg. On a group level, not many effects on other subtasks and spatiotemporal parameters were found. Still, performance for the leading limb angle subtask improved significantly resulting in a larger step length when applying FC assistance. Conclusion FC and SS assistance leads to clear improvements in performance for the respective subtask, while our WS assistance needs further improvement. As effects of the assistance were mainly confined to the assisted subtasks, tuning of FC, SS and WS can be done simultaneously. Our findings suggest that there may be no need for specific, time-intensive tuning protocols (e.g. tuning subtasks after each other) in mildly impaired stroke survivors.

The effect of patellofemoral bracing on walking in individuals with patellofemoral pain syndrome

2013 ◽  
Vol 37 (6) ◽  
pp. 465-470 ◽  
Author(s):  
Mokhtar Arazpour ◽  
Tahmoures T Notarki ◽  
Ahmadali Salimi ◽  
Monireh A Bani ◽  
Hoda Nabavi ◽  
...  
Keyword(s):  
Knee Flexion ◽  
Sagittal Plane ◽  
Pain Syndrome ◽  
Step Length ◽  
Patellofemoral Pain Syndrome ◽  
Patellofemoral Pain ◽  
Initial Contact ◽  
Quasi Experimental ◽  
Knee Joint Kinematics ◽  
Spatial Parameters

Background: Although knee braces are used by individuals with patellofemoral pain syndrome, the effect of patellofemoral bracing on knee flexion during walking has not been elucidated. Aim: The purpose of this study was to evaluate the effect of patellofemoral bracing on sagittal plane knee joint kinematics and temporal spatial parameters during walking in individuals with patellofemoral pain syndrome. Study design: Quasi-experimental. Methods: Ten subjects with a diagnosis of patellofemoral pain syndrome were fitted with a knee brace incorporating an infrapatellar strap. Testing was performed at baseline and after 6 weeks of use. Gait analysis and a visual analog scale were used to assess outcomes in this study. Results: A 59.6% decrease in pain was reported by using bracing. Bracing significantly improved speed of walking ( p ≤ 0.001) and step length ( p ≤ 0.001). The mean cadence was also increased following 6 weeks of patellofemoral brace use, but this was not significant ( p = 0.077). Knee flexion angles improved during initial contact, loading response, and mid-swing ( p ≤ 0.001) after 6 weeks of patellofemoral brace use. Conclusion: Knee orthoses resulted in decreased pain, improved temporal spatial parameters (speed of walking and step length), and increased knee flexion angles during ambulation in patients with patellofemoral pain syndrome. Clinical relevance The results of this study demonstrate a positive effect of patellofemoral bracing in improving specific gait parameters and provide evidence to support its use as a conservative treatment.

Relationship between hip flexion and ankle dorsiflexion during swing phase in chronic stroke patients

2015 ◽  
Vol 30 (3) ◽  
pp. 219-225 ◽  
Author(s):  
N. Roche ◽  
C. Bonnyaud ◽  
M. Geiger ◽  
B. Bussel ◽  
D. Bensmail
Keyword(s):  
Swing Phase ◽  
Chronic Stroke ◽  
Ankle Dorsiflexion ◽  
Stroke Patients ◽  
Hip Flexion

scholarly journals Sagittal Plane Hip, Knee, and Ankle Biomechanics and the Risk of Anterior Cruciate Ligament Injury: A Prospective Study

2017 ◽  
Vol 5 (12) ◽  
pp. 232596711774548 ◽  
Author(s):  
Mari Leppänen ◽  
Kati Pasanen ◽  
Tron Krosshaug ◽  
Pekka Kannus ◽  
Tommi Vasankari ◽  
...  
Keyword(s):  
Knee Flexion ◽  
Sagittal Plane ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Young Female ◽  
Roc Curve Analysis ◽  
Acl Injuries ◽  
Increased Risk ◽  
Flexion Moment ◽  
Hip Flexion

Background: Stiff landings with less knee flexion and high vertical ground-reaction forces have been shown to be associated with an increased risk of anterior cruciate ligament (ACL) injury. The literature on the association between other sagittal plane measures and the risk of ACL injuries with a prospective study design is lacking. Purpose: To investigate the relationship between selected sagittal plane hip, knee, and ankle biomechanics and the risk of ACL injury in young female team-sport athletes. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 171 female basketball and floorball athletes (age range, 12-21 years) participated in a vertical drop jump test using 3-dimensional motion analysis. All new ACL injuries, as well as match and training exposure data, were recorded for 1 to 3 years. Biomechanical variables, including hip and ankle flexion at initial contact (IC), hip and ankle ranges of motion (ROMs), and peak external knee and hip flexion moments, were selected for analysis. Cox regression models were used to calculate hazard ratios (HRs) with 95% CIs. The combined sensitivity and specificity of significant test variables were assessed using a receiver operating characteristic (ROC) curve analysis. Results: A total of 15 noncontact ACL injuries were recorded during follow-up (0.2 injuries/1000 player-hours). Of the variables investigated, landing with less hip flexion ROM (HR for each 10° increase in hip ROM, 0.61 [95% CI, 0.38-0.99]; P < .05) and a greater knee flexion moment (HR for each 10-N·m increase in knee moment, 1.21 [95% CI, 1.04-1.40]; P = .01) was significantly associated with an increased risk of ACL injury. Hip flexion at IC, ankle flexion at IC, ankle flexion ROM, and peak external hip flexion moment were not significantly associated with the risk of ACL injury. ROC curve analysis for significant variables showed an area under the curve of 0.6, indicating a poor combined sensitivity and specificity of the test. Conclusion: Landing with less hip flexion ROM and a greater peak external knee flexion moment was associated with an increased risk of ACL injury in young female team-sport players. Studies with larger populations are needed to confirm these findings and to determine the role of ankle flexion ROM as a risk factor for ACL injury. Increasing knee and hip flexion ROMs to produce soft landings might reduce knee loading and risk of ACL injury in young female athletes.

Changes in Distance Running Kinematics with Fatigue

1991 ◽  
Vol 7 (2) ◽  
pp. 138-162 ◽  
Author(s):  
Keith R. Williams ◽  
Rebecca Snow ◽  
Chris Agruss
Keyword(s):  
Factor Analysis ◽  
Knee Flexion ◽  
Step Length ◽  
Analysis Procedure ◽  
Regression Equations ◽  
Knee Flexion Angle ◽  
Distance Running ◽  
Significant Difference ◽  
Individual Variables ◽  
Hip Flexion

This study investigated changes in kinematics with fatigue during intercollegiate competition, a noncompetitive track run, and a constant speed treadmill run. To account for changes in kinematics resulting from speed differences, regression equations for each individual generated from nonfatigue data were used to predict rested kinematics for speeds matching those of the fatigue conditions. A factor analysis procedure grouped 29 kinematic variables into sets of independent factors, and both factor variables and individual variables were analyzed for changes with fatigue, which were minimal. Only one significant difference was found in the factor variables between nonfatigue and fatigue states. Comparisons of specific kinematic variables showed a significant increase in step length with fatigue, an increased maximal knee flexion angle during swing, and an increased maximal thigh angle during hip flexion. While fatigue did not result in marked changes in kinematics for the group as a whole, changes for individuals were at times large.

The influence of a powered knee–ankle–foot orthosis on walking in poliomyelitis subjects: A pilot study

2015 ◽  
Vol 40 (3) ◽  
pp. 377-383 ◽  
Author(s):  
Mokhtar Arazpour ◽  
Alireza Moradi ◽  
Mohammad Samadian ◽  
Mahmood Bahramizadeh ◽  
Mahmoud Joghtaei ◽  
...  
Keyword(s):  
Knee Joint ◽  
Knee Flexion ◽  
Stance Phase ◽  
Step Length ◽  
Gait Pattern ◽  
Swing Phase ◽  
Ankle Foot Orthosis ◽  
Active Flexion ◽  
Locked Knee ◽  
Foot Orthosis

Background:Traditionally, the anatomical knee joint is locked in extension when walking with a conventional knee–ankle–foot orthosis. A powered knee–ankle–foot orthosis was developed to provide restriction of knee flexion during stance phase and active flexion and extension of the knee during swing phase of gait.Objective:The purpose of this study was to determine differences of the powered knee–ankle–foot orthosis compared to a locked knee–ankle–foot orthosis in kinematic data and temporospatial parameters during ambulation.Study design:Quasi—experimental design.Methods:Subjects with poliomyelitis (n = 7) volunteered for this study and undertook gait analysis with both the powered and the conventional knee–ankle–foot orthoses. Three trials per orthosis were collected while each subject walked along a 6-m walkway using a calibrated six-camera three-dimensional video-based motion analysis system.Results:Walking with the powered knee–ankle–foot orthosis resulted in a significant reduction in both walking speed and step length (both 18%), but a significant increase in stance phase percentage compared to walking with the conventional knee–ankle–foot orthosis. Cadence was not significantly different between the two test conditions ( p = 0.751). There was significantly higher knee flexion during swing phase and increased hip hiking when using the powered orthosis.Conclusion:The new powered orthosis permitted improved knee joint kinematic for knee–ankle–foot orthosis users while providing knee support in stance and active knee motion in swing in the gait cycle. Therefore, the new powered orthosis provided more natural knee flexion during swing for orthosis users compared to the locked knee–ankle–foot orthosis.Clinical relevanceThis orthosis has the potential to improve knee joint kinematics and gait pattern in poliomyelitis subjects during walking activities.

scholarly journals Kinematic and EMG Responses to Pelvis and Leg Assistance Force during Treadmill Walking in Children with Cerebral Palsy

2016 ◽  
Vol 2016 ◽  
pp. 1-12 ◽  
Author(s):  
Ming Wu ◽  
Janis Kim ◽  
Pooja Arora ◽  
Deborah J. Gaebler-Spira ◽  
Yunhui Zhang
Keyword(s):  
Cerebral Palsy ◽  
Muscle Activation ◽  
Step Length ◽  
Swing Phase ◽  
Treadmill Walking ◽  
The Body ◽  
Treadmill Training ◽  
Gait Parameters ◽  
Children With Cerebral Palsy ◽  
Before And After

Treadmill training has been used for improving locomotor function in children with cerebral palsy (CP), but the functional gains are relatively small, suggesting a need to improve current paradigms. The understanding of the kinematic and EMG responses to forces applied to the body of subjects during treadmill walking is crucial for improving current paradigms. The objective of this study was to determine the kinematics and EMG responses to the pelvis and/or leg assistance force. Ten children with spastic CP were recruited to participate in this study. A controlled assistance force was applied to the pelvis and/or legs during stance and swing phase of gait through a custom designed robotic system during walking. Muscle activities and spatial-temporal gait parameters were measured at different loading conditions during walking. In addition, the spatial-temporal gait parameters during overground walking before and after treadmill training were also collected. Applying pelvis assistance improved step height and applying leg assistance improved step length during walking, but applying leg assistance also reduced muscle activation of ankle flexor during the swing phase of gait. In addition, step length and self-selected walking speed significantly improved after one session of treadmill training with combined pelvis and leg assistance.

scholarly journals Comparison of Joint Kinematics in Transition Running and Isolated Running in Elite Triathletes in Overground Conditions

Sensors ◽  
2021 ◽  
Vol 21 (14) ◽  
pp. 4869
Author(s):  
Laura Fraeulin ◽  
Christian Maurer-Grubinger ◽  
Fabian Holzgreve ◽  
David A. Groneberg ◽  
Daniela Ohlendorf
Keyword(s):  
Knee Flexion ◽  
Statistical Parametric Mapping ◽  
Step Length ◽  
Joint Kinematics ◽  
Inertial Motion ◽  
Long Distance ◽  
Kinematic Data ◽  
Warm Up ◽  
Hip Flexion ◽  
Hip Rotation

Triathletes often experience incoordination at the start of a transition run (TR); this is possibly reflected by altered joint kinematics. In this study, the first 20 steps of a run after a warm-up run (WR) and TR (following a 90 min cycling session) of 16 elite, male, long-distance triathletes (31.3 ± 5.4 years old) were compared. Measurements were executed on the competition course of the Ironman Frankfurt in Germany. Pacing and slipstream were provided by a cyclist in front of the runner. Kinematic data of the trunk and leg joints, step length, and step rate were obtained using the MVN Link inertial motion capture system by Xsens. Statistical parametric mapping was used to compare the active leg (AL) and passive leg (PL) phases of the WR and TR. In the TR, more spinal extension (~0.5–1°; p = 0.001) and rotation (~0.2–0.5°; p = 0.001–0.004), increases in hip flexion (~3°; ~65% AL−~55% PL; p = 0.001–0.004), internal hip rotation (~2.5°; AL + ~0–30% PL; p = 0.001–0.024), more knee adduction (~1°; ~80–95% AL; p = 0.001), and complex altered knee flexion patterns (~2–4°; AL + PL; p = 0.001–0.01) occurred. Complex kinematic differences between a WR and a TR were detected. This contributes to a better understanding of the incoordination in transition running.

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