Spatiotemporal, Kinematic and Kinetic Assessment of the Effects of a Foot Drop Stimulator for Home-Based Rehabilitation of Patients with Chronic Stroke -- A Three-Dimensional Motion Analysis

2021 ◽  
Author(s):  
Yurong Mao ◽  
Jiangli Zhao ◽  
Minjie Bian ◽  
Wai Leung Ambrose Lo ◽  
Yan Leng ◽  
...  
Keyword(s):  
Peroneal Nerve ◽  
Three Dimensional ◽  
Gait Training ◽  
Chronic Stroke ◽  
Transverse Plane ◽  
Foot Drop ◽  
Initial Contact ◽  
Foot Progression Angle ◽  
Home Based ◽  
Gait Parameters

Abstract Background: Gait disability affects the daily lives of patients with stroke in both home and community settings. An abnormal foot–ankle position can cause instability on the supporting surface and negatively affect gait. Our research team explored the ability of a portable peroneal nerve-targeting electrical stimulator to improve gait ability by adjusting the foot–ankle position during walking in patients with chronic stroke undergoing home-based rehabilitation. Methods: This was a double-blinded, parallel-group randomized controlled trial. Thirty-one patients with chronic stroke and ankle–foot motor impairment were randomized to receive 3 weeks of gait training, which involved using the transcutaneous peroneal nerve stimulator while walking (tPNS group; n = 16, mean age: 52.25 years), or conventional home and/or community gait training therapy (CT group; n = 15, mean age: 54.8 years). Functional assessments were performed before and after the 3-week intervention. The outcome measures included spatiotemporal gait parameters, three-dimensional kinematic and kinetic data on the ankle-foot joint, and a clinical motor and balance function assessment based on the Fugl–Meyer Assessment of Lower Extremity (FMA-LE) and Berg Balance scales (BBS). Additionally, 16 age-matched healthy adults served as a baseline control of three-dimensional gait data for both trial groups.Results: The FMA-LE and BBS scores improved in both the tPNS groups (p = .004 and .001, respectively) and CT groups (p = .034 and .028, respectively) from before to after training. Participants in the tPNS group exhibited significant differences in spatiotemporal gait parameters, including opposite foot off, double support, stride length, and walking speed, after training (p = .010, .042, .017 and .001, respectively). Additionally, the tPNS group exhibited significant differences in kinematic parameters, such as the ankle angle at the transverse plane (p = .021) and foot progression angle at the frontal plane (p = .009) upon initial contact, and the peak ankle joint angle at the transverse plane (p = .023) and foot progression angle at the frontal and transverse planes (p = .032 and .046, respectively) during gait cycles after 3 weeks of training.Conclusions: Use of a portable tPNS device during walking tasks appeared to improve spatiotemporal gait parameters and ankle and foot angles more effectively than conventional home rehabilitation in patients with chronic stroke. Although guidelines for home-based rehabilitation training services and an increasing variety of market devices are available, no evidence for improvement of motor function and balance was superior to conventional rehabilitation.Trial registration: Chictr, ChiCTR2000040137. Registered 22 November 2020, https://www.chictr.org.cn/showproj.aspx?proj=64424

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.

Reliability and Accuracy in Three-Dimensional Gait Analysis: A Comparison of Two Lower Body Protocols

2013 ◽  
Vol 29 (1) ◽  
pp. 105-111 ◽  
Author(s):  
Felix Stief ◽  
Harald Böhm ◽  
Katja Michel ◽  
Ansgar Schwirtz ◽  
Leonhard Döderlein
Keyword(s):  
Knee Joint ◽  
Gait Analysis ◽  
Three Dimensional ◽  
Frontal Plane ◽  
Transverse Plane ◽  
Lower Body ◽  
Landmark Identification ◽  
Gait Parameters ◽  
Custom Made ◽  
Flexion Extension

The standard Plug-in-Gait (PiG) protocol used in three-dimensional gait analysis is prone to errors arising from inconsistent anatomical landmark identification and knee axis malalignment. The purpose of this study was to estimate the reliability and accuracy of a custom made lower body protocol (MA) compared with the PiG protocol. Twenty-fve subjects volunteered to evaluate the intertrial reliability. In addition, intersession reliability was examined in 10 participants. An indirect indicator of accuracy according to the knee varus/valgus and flexion/extension range of motion (ROM) was used. Regarding frontal plane knee angles and moments as well as transverse plane motions in the knee and hip joint, the intersession errors were lower for the MA compared with the standard approach. In reference to the knee joint angle cross-talk, the MA produced 4.7° more knee flexion/extension ROM and resulted in 6.5° less knee varus/valgus ROM in the frontal plane. Therefore, the MA tested in this study produced a more accurate and reliable knee joint axis compared with the PiG protocol. These results are especially important for measuring frontal and transverse plane gait parameters.

scholarly journals Effect of combined home-based, overground robotic-assisted gait training and usual physiotherapy on clinical functional outcomes in people with chronic stroke: A randomized controlled trial

2020 ◽  
pp. 026921552098413
Author(s):  
Amy Wright ◽  
Keeron Stone ◽  
Louis Martinelli ◽  
Simon Fryer ◽  
Grace Smith ◽  
...  
Keyword(s):  
Physical Activity ◽  
Functional Outcomes ◽  
Controlled Trial ◽  
Gait Training ◽  
Berg Balance Scale ◽  
Chronic Stroke ◽  
Control Group ◽  
Robotic Assisted ◽  
Home Based ◽  
Dynamic Gait Index

Objectives: To assess the effect of a home-based over-ground robotic-assisted gait training program using the AlterG Bionic Leg orthosis on clinical functional outcomes in people with chronic stroke. Design: Randomized controlled trial. Setting: Home. Participants: Thirty-four ambulatory chronic stroke patients who recieve usual physiotherapy. Intervention: Usual physiotherapy plus either (1)10-week over-ground robotic-assisted gait training program ( n = 16), using the device for ⩾30 minutes per day, or (2) control group ( n = 18), 30 minutes of physical activity per day. Measurements: The primary outcome was the Six-Minute Walk Test. Secondary outcomes included: Timed-Up-and-Go, Functional Ambulation Categories, Dynamic Gait Index and Berg Balance Scale. Physical activity and sedentary time were assessed using accelerometry. All measurements were completed at baseline, 10 and 22 weeks after baseline. Results: Significant increases in walking distance were observed for the Six-Minute Walk Test between baseline and 10 weeks for over-ground robotic-assisted gait training (135 ± 81 m vs 158 ± 93 m, respectively; P ⩽ 0.001) but not for control (122 ± 92 m vs 119 ± 84 m, respectively). Findings were similar for Functional Ambulation Categories, Dynamic Gait Index and Berg Balance Scale (all P ⩽ 0.01). For over-ground robotic-assisted gait training, there were increases in time spent stepping, number of steps taken, number of sit-to-stand transitions, and reductions in time spent sitting/supine between baseline and 10 weeks (all P < 0.05). The differences observed in all of the aforementioned outcome measures were maintained at 22 weeks, 12 weeks after completing the intervention (all P > 0.05). Conclusion: Over-ground robotic-assisted gait training combined with physiotherapy in chronic stroke patients led to significant improvements in clinical functional outcomes and physical activity compared to the control group. Improvements were maintained at 22 weeks.

The biomechanical effects of the inclusion of a torque absorber on trans-femoral amputee gait, a pilot study

2002 ◽  
Vol 26 (1) ◽  
pp. 35-43 ◽  
Author(s):  
M. L. van der Linden ◽  
N. Twiste ◽  
S. V. S. Rithalia
Keyword(s):  
Pilot Study ◽  
Three Dimensional ◽  
Axial Rotation ◽  
Transverse Plane ◽  
Kinematic Parameters ◽  
Shear Forces ◽  
Prosthetic Limb ◽  
Skin Breakdown ◽  
Gait Parameters ◽  
Sound Side

This paper reports on a pilot study investigating the effects on the gait of two trans-femoral amputees of to the inclusion of a torque absorber (TA) and its location relative to the knee unit. Both subjects carried out gait tests with a prosthesis with no TA with, a TA proximal to the knee unit and with a TA distal to the knee unit. Three-dimensional gait analysis was carried out to establish the kinematic and kinetic gait parameters of both the prosthetic and sound side. It was found that the TA did not significantly affect the sagittal kinetic and kinematic parameters of the sound or the prosthetic side. However, for one subject the axial rotation of the socket relative to the foot was significantly greater with the TA. It was concluded that by using the methodology of this pilot study, it is possible to investigate the rotations in the transverse plane within the prosthetic limb and pelvis. Further, including a TA may reduce the relative motion between the stump and the socket and therefore may decrease skin breakdown due to diminished shear forces.

scholarly journals Development of an Active Ankle Foot Orthosis to Prevent Foot Drop and Toe Drag in Hemiplegic Patients: A Preliminary Study

2011 ◽  
Vol 8 (3-4) ◽  
pp. 377-384 ◽  
Author(s):  
Jungyoon Kim ◽  
Sungjae Hwang ◽  
Ryanghee Sohn ◽  
Younghee Lee ◽  
Youngho Kim
Keyword(s):  
Ankle Joint ◽  
Three Dimensional ◽  
Swing Phase ◽  
Foot Drop ◽  
Initial Contact ◽  
Ankle Foot Orthosis ◽  
Series Elastic Actuator ◽  
Spatial Parameters ◽  
Preliminary Study ◽  
Foot Orthosis

We developed an active ankle-foot orthosis (AAFO) that controls dorsiflexion/plantarflexion of the ankle joint to prevent foot drop and toe drag during hemiplegic walking. To prevent foot slap after initial contact, the ankle joint must remain active to minimize forefoot collision against the ground. During late stance, the ankle joint must also remain active to provide toe clearance and to aid with push-off. We implemented a series elastic actuator in our AAFO to induce ankle dorsiflexion/plantarflexion. The activator was controlled by signals from force sensing register (FSR) sensors that detected gait events. Three dimensional gait analyses were performed for three hemiplegic patients under three different gait conditions: gait without AFO (NAFO), gait with a conventional hinged AFO that did not control the ankle joint (HAFO), and gait with the newly-developed AFO (AAFO). Our results demonstrate that our newly-developed AAFO not only prevents foot drop by inducing plantarflexion during loading response, but also prevents toe drag by facilitating plantarflexion during pre-swing and dorsiflexion during swing phase, leading to improvement in most temporal-spatial parameters. However, only three hemiplegic patients were included in this gait analysis. Studies including more subjects will be required to evaluate the functionality of our newly developed AAFO.

Rhythmic auditory stimulation for reduction of falls in Parkinson’s disease: a randomized controlled study

2018 ◽  
Vol 33 (1) ◽  
pp. 34-43 ◽  
Author(s):  
Michael H Thaut ◽  
Ruth R Rice ◽  
Thenille Braun Janzen ◽  
Corene P Hurt-Thaut ◽  
Gerald C McIntosh
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Fear Of Falling ◽  
Gait Training ◽  
Auditory Stimulation ◽  
Controlled Study ◽  
Control Group ◽  
Home Based ◽  
Gait Parameters ◽  
Rhythmic Auditory Stimulation

Objective: To test whether rhythmic auditory stimulation (RAS) training reduces the number of falls in Parkinson’s disease patients with a history of frequent falls. Design: Randomized withdrawal study design. Subjects: A total of 60 participants (aged 62–82 years) diagnosed with idiopathic Parkinson’s disease (Hoehn and Yahr stages III or IV) with at least two falls in the past 12 months. Intervention: Participants were randomly allocated to two groups and completed 30 minutes of daily home-based gait training with metronome click–embedded music. The experimental group completed 24 weeks of RAS training, whereas the control group discontinued RAS training between weeks 8 and 16. Main measures: Changes in clinical and kinematic parameters were assessed at baseline, weeks 8, 16, and 24. Results: Both groups improved significantly at week 8. At week 16—after the control group had discontinued training—significant differences between groups emerged including a rise in the fall index for the control group ( M = 10, SD = 6). Resumption of training reduced the number of falls so that group differences were no longer significant at week 24 ( Mexperimental = 3, SD = 2.6; Mcontrol = 5, SD = 4.4; P > 0.05). Bilateral ankle dorsiflexion was significantly correlated with changes in gait, fear of falling, and the fall index, indicating ankle flexion as a potential kinematic mechanism RAS addresses to reduce falls. Conclusion: RAS training significantly reduced the number of falls in Parkinson’s disease and modified key gait parameters, such as velocity and stride length.

scholarly journals Effects of soft tissue surgery on transverse kinematics in patients with cerebral palsy

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Byeong-Seop Park ◽  
Chin Youb Chung ◽  
Moon Seok Park ◽  
Kyoung Min Lee ◽  
Seong Hee Cho ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Soft Tissue ◽  
Transverse Plane ◽  
Ankle Dorsiflexion ◽  
Initial Contact ◽  
Tibial Rotation ◽  
Affecting Factors ◽  
Foot Progression Angle ◽  
External Angle ◽  
Soft Tissue Surgery

Abstract Background Gait disturbances, including flexed knee gait, stiff knee gait, and tip-toeing gait, are common in patients with cerebral palsy (CP). There has been no reports regarding kinematic changes in the transverse plane after soft tissue surgeries, such as distal hamstring lengthening (DHL), rectus femoris transfer (RFT), and tendo-Achilles lengthening (TAL). This study aimed to evaluate changes in the transverse plane after soft tissue surgery in patients with CP by assessing the effects of the DHL, RFT, and TAL. Methods The study enrolled 156 consecutive patients (mean age, 8.4 years; range, 4.4 to 20.9), representing 213 operated limbs, who underwent soft tissue surgery including DHL with semitendinosus transfer, RFT, and TAL. All patients were assessed by preoperative and 1-year postoperative three-dimensional gait analysis. Changes in transverse plane kinematics after soft tissue surgery and affecting factors were analyzed. Results Sagittal kinematics including knee flexion at initial contact, ankle dorsiflexion at initial contact, and mean ankle dorsiflexion in the stance phase were significantly improved after single event multilevel surgery (all p < 0.001). Transverse kinematics, including mean tibial rotation and foot progression angle, were significantly improved to a more external angle after soft tissue surgeries (− 2.9°, p = 0.004 and − 9.5°, p < 0.001). The mean hip rotation was significantly improved to a more external angle by RFT (− 4.7°, p = 0.010) and the foot progression angle was significantly improved to a more external angle by TAL (− 3.9°, p = 0.028). Conclusions This study found that the transverse kinematics were improved to a more external angle after soft tissue surgery in patients with CP. Therefore, clinicians should consider that soft tissue surgery can affect the transverse plane kinematics in patients with CP. To confirm our findings, further research regarding the natural history of femoral and tibial torsion in children with CP is needed.

Clinical effectiveness of peroneal nerve functional electrical stimulation in chronic stroke patients with hemiplegia (PLEASURE): A multicentre, prospective, randomised controlled trial

2020 ◽  
pp. 026921552096670
Author(s):  
Kenji Hachisuka ◽  
Mitsuhiro Ochi ◽  
Takashi Kikuchi ◽  
Satoru Saeki
Keyword(s):  
Peroneal Nerve ◽  
Controlled Trial ◽  
Gait Training ◽  
Foot Drop ◽  
Control Group ◽  
Walk Test ◽  
Stroke Patients ◽  
Control Groups ◽  
Secondary Endpoints ◽  
And Control

Objective: To compare the effectiveness of gait training using a peroneal nerve stimulation device with the effectiveness of gait training without the device in improving gait ability and ankle-specific body functions. Design: Multicentre, prospective, randomised, open-label trial. Setting: Twenty-three hospitals. Subjects: In total, 119 stroke patients with foot drop were randomly assigned to the experimental (with the device) or control (without the device) group. Intervention: Subjects underwent 480-minute self-directed training over four weeks, followed by 260-minute physical therapist-assisted gait training with or without the device. Main measures: The primary endpoint was a change in the six-minute walk test (6MWT) without the device from baseline to after the four-week intervention. The secondary endpoints were changes in the 10-metre walk test (10MWT) without the device, Fugl-Meyer Assessment, range of motion, muscle strength, Modified Ashworth Scale, Stroke Impact Scale Japanese edition (J-SIS) and adverse events. Results: Fifty-six experimental and 59 control group participants, with an average age of 59 years (SD 12) completed the trial. The 6MWT distance changes (m) for the experimental and control groups were 14.7 (SD 37.6) and 22.2 (SD 49.3), respectively. The 10MWT speed changes (m/sec) for the experimental and control groups were 0.06 (SD 0.12) and 0.07 (SD 0.17), respectively. No significant differences were observed in these changes between both groups, and no differences were found in the other secondary endpoints, except for the J-SIS patient’s subjective assessment ( P = 0.048). Conclusion: The improvement in gait ability and body functions were equivalent with or without the use of the device.

scholarly journals Changes in Balance, Gait and Electroencephalography Oscillations after Robot-Assisted Gait Training: An Exploratory Study in People with Chronic Stroke

2020 ◽  
Vol 10 (11) ◽  
pp. 821
Author(s):  
Hoon-Ming Heng ◽  
Ming-Kuei Lu ◽  
Li-Wei Chou ◽  
Nai-Hsin Meng ◽  
Hui-Chun Huang ◽  
...  
Keyword(s):  
Analysis Data ◽  
Gait Training ◽  
Berg Balance Scale ◽  
Chronic Stroke ◽  
Cycle Duration ◽  
Robot Assisted ◽  
Gait Parameters ◽  
Before And After ◽  
High Beta

Robot-assisted gait training (RAGT) systems offer the advantages of standard rehabilitation and provide precise and quantifiable control of therapy. We examined the clinical outcome of RAGT and analyzed the correlations between gait analysis data and event-related desynchronization (ERD) and event-related synchronization (ERS) in patients with chronic stroke. We applied the Berg balance scale (BBS) and analyzed gait parameters and the ERD and ERS of self-paced voluntary leg movements performed by patients with chronic stroke before and after undergoing RAGT. A significant change was observed in BBS (p = 0.011). We also showed preliminary outcomes of changes in gait cycle duration (p = 0.015) and in ipsilesional ERS in the low-beta (p = 0.033) and high-beta (p = 0.034) frequency bands before and after RAGT. In addition, correlations were observed between BBS and ipsilesional ERS in the alpha and low-beta bands (r = −0.52, p = 0.039; r = −0.52, p = 0.040). The study demonstrated that RAGT can improve balance and provided an idea of the possible role of brain oscillation and clinical outcomes in affecting stroke rehabilitation.

Sign in / Sign up

Export Citation Format

Share Document