scholarly journals Error-augmentation gait training to improve gait symmetry in patients with non-traumatic lower limb amputation: A proof-of-concept study

2019 ◽  
Vol 43 (4) ◽  
pp. 426-433
Author(s):  
Paul W Kline ◽  
Amanda M Murray ◽  
Matthew J Miller ◽  
Thomas Fields ◽  
Cory L Christiansen
Keyword(s):  
Step Length ◽  
Gait Training ◽  
Limb Amputation ◽  
Single Session ◽  
Overground Walking ◽  
Transtibial Amputation ◽  
Time Asymmetry ◽  
Gait Symmetry ◽  
Stance Time ◽  
Training Protocol

Background:Asymmetrical stepping patterns are chronic gait impairment for individuals with non-traumatic lower limb amputation. Persistent gait asymmetries contribute to poor gait efficiency, decreased physical function, and development of secondary orthopedic conditions.Objectives:Evaluate the feasibility and preliminary responsiveness of a treadmill-based, error-augmentation gait training protocol to improve gait symmetry in patients with non-traumatic transtibial amputation.Study design:Single group, pre- and post-test.Methods:The error-augmentation gait training protocol involved walking on a split-belt treadmill with asymmetrical belt speeds for five 3-min sets. Spatiotemporal gait characteristics during overground walking at self-selected and fast walking speeds were assessed prior to, immediately after, and 20 min following the error-augmentation gait training protocol. Outcomes included practicality, implementation feasibility, safety, participant acceptability, and change in gait asymmetry.Results:All four participants completed the error-augmentation gait training protocol as prescribed, without adverse events, and found the intervention to be acceptable. Step length and stance time asymmetry during overground walking changed immediately following the error-augmentation gait training protocol with inconsistent changes retained after a 20 min washout period.Conclusions:A single session of error-augmentation gait training is a feasible and safe intervention to modify gait asymmetry in patients with non-traumatic transtibial amputation. Additional study with larger sample sizes and repeated error-augmentation gait training dosing are warranted.Clinical relevanceGait training using error-augmentation on a split-belt treadmill may modify step length and stance time asymmetry for patients with non-traumatic transtibial amputation, but additional research is needed regarding short- and long-term efficacy. Additional training sessions may be needed to sustain initial changes achieved from a single session.

Feasibility and Preliminary Efficacy of Gait Training Assisted by Multichannel Functional Electrical Stimulation in Early Stroke Rehabilitation: A Pilot Randomized Controlled Trial

2021 ◽  
Vol 35 (2) ◽  
pp. 131-144
Author(s):  
Maijke van Bloemendaal ◽  
Sicco A. Bus ◽  
Frans Nollet ◽  
Alexander C. H. Geurts ◽  
Anita Beelen
Keyword(s):  
Electrical Stimulation ◽  
Functional Electrical Stimulation ◽  
Step Length ◽  
Gait Training ◽  
Control Group ◽  
Significant Group ◽  
Gait Symmetry ◽  
Gait Parameters ◽  
Walking Capacity ◽  
Experimental Group

Background. Many stroke survivors suffer from leg muscle paresis, resulting in asymmetrical gait patterns, negatively affecting balance control and energy cost. Interventions targeting asymmetry early after stroke may enhance recovery of walking. Objective. To determine the feasibility and preliminary efficacy of up to 10 weeks of gait training assisted by multichannel functional electrical stimulation (MFES gait training) applied to the peroneal nerve and knee flexor or extensor muscle on the recovery of gait symmetry and walking capacity in patients starting in the subacute phase after stroke. Methods. Forty inpatient participants (≤31 days after stroke) were randomized to MFES gait training (experimental group) or conventional gait training (control group). Gait training was delivered in 30-minute sessions each workday. Feasibility was determined by adherence (≥75% sessions) and satisfaction with gait training (score ≥7 out of 10). Primary outcome for efficacy was step length symmetry. Secondary outcomes included other spatiotemporal gait parameters and walking capacity (Functional Gait Assessment and 10-Meter Walk Test). Linear mixed models estimated treatment effect postintervention and at 3-month follow-up. Results. Thirty-seven participants completed the study protocol (19 experimental group participants). Feasibility was confirmed by good adherence (90% of the participants) and participant satisfaction (median score 8). Both groups improved on all outcomes over time. No significant group differences in recovery were found for any outcome. Conclusions. MFES gait training is feasible early after stroke, but MFES efficacy for improving step length symmetry, other spatiotemporal gait parameters, or walking capacity could not be demonstrated. Trial Registration. Netherlands Trial Register (NTR4762).

scholarly journals Use of Visual and Proprioceptive Feedback to Improve Gait Speed and Spatiotemporal Symmetry Following Chronic Stroke: A Case Series

2012 ◽  
Vol 92 (5) ◽  
pp. 748-756 ◽  
Author(s):  
Michael D. Lewek ◽  
Jeff Feasel ◽  
Erin Wentz ◽  
Frederick P. Brooks ◽  
Mary C. Whitton
Keyword(s):  
Gait Speed ◽  
Case Series ◽  
Step Length ◽  
Gait Training ◽  
Chronic Stroke ◽  
Proprioceptive Feedback ◽  
Immersive Virtual Environment ◽  
Time Symmetry ◽  
Stance Time

Background and Purpose Persistent deficits in gait speed and spatiotemporal symmetry are prevalent following stroke and can limit the achievement of community mobility goals. Rehabilitation can improve gait speed, but has shown limited ability to improve spatiotemporal symmetry. The incorporation of combined visual and proprioceptive feedback regarding spatiotemporal symmetry has the potential to be effective at improving gait. Case Description A 60-year-old man (18 months poststroke) and a 53-year-old woman (21 months poststroke) each participated in gait training to improve gait speed and spatiotemporal symmetry. Each patient performed 18 sessions (6 weeks) of combined treadmill-based gait training followed by overground practice. To assist with relearning spatiotemporal symmetry, treadmill-based training for both patients was augmented with continuous, real-time visual and proprioceptive feedback from an immersive virtual environment and a dual belt treadmill, respectively. Outcomes Both patients improved gait speed (patient 1: 0.35 m/s improvement; patient 2: 0.26 m/s improvement) and spatiotemporal symmetry. Patient 1, who trained with step-length symmetry feedback, improved his step-length symmetry ratio, but not his stance-time symmetry ratio. Patient 2, who trained with stance-time symmetry feedback, improved her stance-time symmetry ratio. She had no step-length asymmetry before training. Discussion Both patients made improvements in gait speed and spatiotemporal symmetry that exceeded those reported in the literature. Further work is needed to ascertain the role of combined visual and proprioceptive feedback for improving gait speed and spatiotemporal symmetry after chronic stroke.

scholarly journals Rapid and Long-term Adaptations in Gait Symmetry Following Unilateral Step Training in People With Hemiparesis

2009 ◽  
Vol 89 (5) ◽  
pp. 474-483 ◽  
Author(s):  
Jennifer H Kahn ◽  
T George Hornby
Keyword(s):  
Step Length ◽  
Control Group ◽  
Overground Walking ◽  
Gait Symmetry ◽  
Gait Parameters ◽  
Impaired Limb ◽  
Repeated Training ◽  
Minute Session

Background and Objective Evidence for specific physical interventions that improve walking symmetry in individuals with hemiparesis poststroke is limited. The aim of this study was to investigate the rapid and prolonged effects of unilateral step training (UST) on step length asymmetry (SLA) in people with hemiparesis. Subjects and Design Eighteen individuals with chronic hemiparesis and substantial SLA during overground walking participated in a single-group, pretest-posttest study. The study consisted of 2 phases, with 10 subjects participating in each phase; 2 subjects participated in both phases. Interventions and Measurements To investigate rapid effects of UST, the participants completed a 20-minute session of UST on a treadmill with their unimpaired limb, with the impaired limb held stationary off the treadmill. Data for spatiotemporal gait parameters during overground walking at self-selected and fastest speeds were collected prior to and following UST, with follow-up measurements at 1 day and 1 week. To investigate the prolonged effects, the participants completed ten 20-minute sessions of UST. Data for spatiotemporal gait parameters were collected prior to training as well as after every third session, with follow-up measurements at 1 and 2 weeks. Results Immediately following UST, SLA tested during fast-paced overground walking improved by up to 13% (49% reduced to a 36% SLA), with changes retained for up to 24 hours. Following 10 sessions of UST, SLA improved significantly, with changes retained for up to 2 weeks. Limitations Despite repeated baseline measurements, the absence of a control group was a limitation. Furthermore, stepping characteristics during UST were not quantified. Conclusion Unilateral step training may improve spatiotemporal patterns in people with substantial gait asymmetry poststroke. Repeated training may be necessary for maintenance of adaptations.

scholarly journals Effects of extended powered knee prosthesis stance time via visual feedback on gait symmetry of individuals with unilateral amputation: a preliminary study

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Andrea Brandt ◽  
William Riddick ◽  
Jonathan Stallrich ◽  
Michael Lewek ◽  
He Helen Huang
Keyword(s):  
Visual Feedback ◽  
Repeated Measures ◽  
Knee Prosthesis ◽  
Motor Pattern ◽  
Side Peak ◽  
Time Asymmetry ◽  
Gait Symmetry ◽  
Time Symmetry ◽  
Stance Time ◽  
Powered Prosthesis

Abstract Background Establishing gait symmetry is a major aim of amputee rehabilitation and may be more attainable with powered prostheses. Though, based on previous work, we postulate that users transfer a previously-learned motor pattern across devices, limiting the functionality of more advanced prostheses. The objective of this study was to preliminarily investigate the effect of increased stance time via visual feedback on amputees’ gait symmetry using powered and passive knee prostheses. Methods Five individuals with transfemoral amputation or knee disarticulation walked at their self-selected speed on a treadmill. Visual feedback was used to promote an increase in the amputated-limb stance time. Individuals were fit with a commercially-available powered prosthesis by a certified prosthetist and practiced walking during a prior visit. The same protocol was completed with a passive knee and powered knee prosthesis on separate days. We used repeated-measures, two-way ANOVA (alpha = 0.05) to test for significant effects of the feedback and device factors. Our main outcome measures were stance time asymmetry, peak anterior-posterior ground reaction forces, and peak anterior propulsion asymmetry. Results Increasing the amputated-limb stance time via visual feedback significantly improved the stance time symmetry (p = 0.012) and peak propulsion symmetry (p = 0.036) of individuals walking with both prostheses. With the powered knee prosthesis, the highest feedback target elicited 36% improvement in stance time symmetry, 22% increase in prosthesis-side peak propulsion, and 47% improvement in peak propulsion symmetry compared to a no feedback condition. The changes with feedback were not different with the passive prosthesis, and the main effects of device/ prosthesis type were not statistically different. However, subject by device interactions were significant, indicating individuals did not respond consistently with each device (e.g. prosthesis-side propulsion remained comparable to or was greater with the powered versus passive prosthesis for different subjects). Overall, prosthesis-side peak propulsion averaged across conditions was 31% greater with the powered prosthesis and peak propulsion asymmetry improved by 48% with the powered prosthesis. Conclusions Increasing prosthesis-side stance time via visual feedback favorably improved individuals’ temporal and propulsive symmetry. The powered prosthesis commonly enabled greater propulsion, but individuals adapted to each device with varying behavior, requiring further investigation.

scholarly journals Gait Training in Virtual Reality: Short-Term Effects of Different Virtual Manipulation Techniques in Parkinson’s Disease

Cells ◽  
2019 ◽  
Vol 8 (5) ◽  
pp. 419 ◽  
Author(s):  
Omar Janeh ◽  
Odette Fründt ◽  
Beate Schönwald ◽  
Alessandro Gulberti ◽  
Carsten Buhmann ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Virtual Reality ◽  
Pilot Study ◽  
Freezing Of Gait ◽  
Strong Relationship ◽  
Step Length ◽  
Gait Training ◽  
Time Variability ◽  
Gait Symmetry

It is well documented that there is a strong relationship between gait asymmetry and the freezing of gait (FOG) in Parkinson’s Disease. The purpose of this pilot study was to find a “virtual reality (VR)- based” gait manipulation strategy to improve gait symmetry by equalizing step length. Fifteen male PD patients (mean age of 67.6 years) with FOG were assessed on a GAITRite® walkway. Natural gait was compared with walking conditions during “VR-based” gait modulation tasks that aimed at equalizing gait symmetry using visual or proprioceptive signals. Compared to natural gait, VR manipulation tasks significantly increased step width and swing time variability for both body sides. Within the VR conditions, only the task with “proprioceptive-visual dissociation” by artificial backward shifting of the foot improved spatial asymmetry significantly with comparable step lengths of both sides. Specific, hypothesis-driven VR tasks represent an efficient tool to manipulate gait features as gait symmetry in PD potentially preventing FOG. This pilot study offers promising “VR-based” approaches for rehabilitative training strategies to achieve gait symmetry and prevent FOG.

scholarly journals Effects of extended stance time on a powered knee prosthesis and gait symmetry on the lateral control of balance during walking in individuals with unilateral amputation

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Andrea Brandt ◽  
He ( Helen) Huang
Keyword(s):  
Visual Feedback ◽  
Lower Limb ◽  
Knee Prosthesis ◽  
Center Of Mass ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Gait Symmetry ◽  
Margin Of Stability ◽  
Hip Abductor ◽  
Stance Time

Abstract Background Individuals with lower limb amputation commonly exhibit large gait asymmetries that are associated with secondary health issues. It has been shown that they are capable of attaining improved temporal and propulsive symmetry when walking with a powered knee prosthesis and visual feedback, but they perceive this pattern of gait to be more difficult. Rather than improving the efficiency of gait, improved gait symmetry may be increasing individuals’ effort associated with maintaining lateral balance. Methods In this study, we used a simple visual feedback paradigm to increase the prosthesis-side stance time of six individuals with unilateral TFA or KD as they walked on a powered knee prosthesis at their self-selected speed. As they walked more symmetrically, we evaluated changes in medial-lateral center-of-mass excursion, lateral margin of stability, stride width, and hip abductor activity. Results As the subjects increased their prosthesis-side stance time, their center-of-mass excursion and hip abductor activity significantly increased, while their lateral margin of stability significantly decreased on the prosthesis-side only. Stride width remained relatively unchanged with testing condition. Conclusions Extended stance time on a powered knee prosthesis (yielding more symmetric gait) challenged the lateral balance of individuals with lower limb amputation. Lateral stability may be a reason they prefer an asymmetric gait, even with more advanced technology. Hip muscular changes post-amputation may contribute to the decline in stability on the prosthesis side. Interventions and advancements in prosthesis control aimed at improving their control of lateral balance may ameliorate the difficulty in walking with improved gait symmetry.

scholarly journals The role of movement errors in modifying spatiotemporal gait asymmetry post stroke: a randomized controlled trial

2017 ◽  
Vol 32 (2) ◽  
pp. 161-172 ◽  
Author(s):  
Michael D Lewek ◽  
Carty H Braun ◽  
Clint Wutzke ◽  
Carol Giuliani
Keyword(s):  
Randomized Controlled Trial ◽  
Motor Learning ◽  
Learning Strategies ◽  
Gait Speed ◽  
Controlled Trial ◽  
Step Length ◽  
Verbal Feedback ◽  
Gait Symmetry ◽  
Randomized Controlled ◽  
Stance Time

Objective: Current rehabilitation to improve gait symmetry following stroke is based on one of two competing motor learning strategies: minimizing or augmenting symmetry errors. We sought to determine which of those motor learning strategies best improves overground spatiotemporal gait symmetry. Design: Randomized controlled trial. Setting: Rehabilitation research lab. Subjects: In all, 47 participants (59 ± 12 years old) with chronic hemiparesis post stroke and spatiotemporal gait asymmetry were randomized to error augmentation, error minimization, or conventional treadmill training (control) groups. Interventions: To augment or minimize asymmetry on a step-by-step basis, we developed a responsive, “closed-loop” control system, using a split-belt instrumented treadmill that continuously adjusted the difference in belt speeds to be proportional to the patient’s current asymmetry. Main measures: Overground spatiotemporal asymmetries and gait speeds were collected prior to and following 18 training sessions. Results: Step length asymmetry reduced after training, but stance time did not. There was no group × time interaction. Gait speed improved after training, but was not affected by type of asymmetry, or group. Of those who trained to modify step length asymmetry, there was a moderately strong linear relationship between the change in step length asymmetry and the change in gait speed. Conclusion: Augmenting errors was not superior to minimizing errors or providing only verbal feedback during conventional treadmill walking. Therefore, the use of verbal feedback to target spatiotemporal asymmetry, which was common to all participants, appears to be sufficient to reduce step length asymmetry. Alterations in stance time asymmetry were not elicited in any group.

scholarly journals EFFECT OF PHASE-SHIFTED AUDITORY CUE ON GAIT SYMMETRY AND TRUNK DISPLACEMENT DURING TREADMILL WALKING

2020 ◽  
Vol 20 (10) ◽  
pp. 2040033
Author(s):  
BYUNG-WOO KO ◽  
WON-KYUNG SONG
Keyword(s):  
Step Length ◽  
Gait Training ◽  
Gait Pattern ◽  
Treadmill Walking ◽  
Phase Advance ◽  
Gait Symmetry ◽  
Phase Time ◽  
Time Symmetry ◽  
Auditory Cue ◽  
Auditory Cueing

This study investigated changes in gait symmetry with trunk displacement during phase-shifted auditory paced treadmill walking for effective training with auditory cueing provided in conventional gait training. Eighteen able-bodied participants walked at a comfortable speed on a treadmill and the measured cadence was set at 100% (baseline). The phase-shifted auditory cue was set to both phase advance and delay of 20% at 5% intervals based on the baseline with respect to matching foot contact to the auditory cue. Trunk displacement increased with the phase-shifted auditory cue, and the largest value was found in the 120% condition compared to baseline ([Formula: see text]). Step length, step time, and swing phase time symmetry ratio gradually increased with increasing phase delay and gradually decreased with increasing phase advance on the linear model. However, single support time and stance phase time symmetry ratio showed contrasting characteristics compared to above parameters. The results indicate that the phase-shifted auditory cue significantly changes gait symmetry and trunk displacement. Particularly, the 20% phase advance and delay cues yielded about a 5% change in the step length symmetry ratio. These results could be used to induce a symmetric gait pattern when an asymmetric gait appears in hemiplegia.

The Relationship Between Spatiotemporal Gait Asymmetry and Balance in Individuals With Chronic Stroke

2014 ◽  
Vol 30 (1) ◽  
pp. 31-36 ◽  
Author(s):  
Michael D. Lewek ◽  
Claire E. Bradley ◽  
Clinton J. Wutzke ◽  
Steven M. Zinder
Keyword(s):  
Weight Distribution ◽  
Balance Control ◽  
Step Length ◽  
Chronic Stroke ◽  
Step Width ◽  
Time Asymmetry ◽  
Swing Time ◽  
Gait Asymmetry ◽  
Stance Time ◽  
The Relationship

Falls are common after stroke and often attributed to poor balance. Falls often occur during walking, suggesting that walking patterns may induce a loss of balance. Gait after stroke is frequently spatiotemporally asymmetric, which may decrease balance. The purpose of this study is to determine the relationship between spatiotemporal gait asymmetry and balance control. Thirty-nine individuals with chronic stroke walked at comfortable and fast speeds to calculate asymmetry ratios for step length, stance time, and swing time. Balance measures included the Berg Balance Scale, step width during gait, and the weight distribution between legs during standing. Correlational analyses determined the relationships between balance and gait asymmetry. At comfortable and fast gait speeds, step width was correlated with stance time and swing time asymmetries (r= 0.39−0.54). Berg scores were correlated with step length and swing time asymmetries (r= –0.36 to –0.63). During fast walking, the weight distribution between limbs was correlated with stance time asymmetry (r= –0.41). Spatiotemporal gait asymmetry was more closely related to balance measures involving dynamic tasks than static tasks, suggesting that gait asymmetry may be related to the high number of falls poststroke. Further study to determine if rehabilitation that improves gait asymmetry has a similar influence on balance is warranted.

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