Evaluation of the Effectiveness of Stepping in Place with Rhythmic Auditory Stimulation on Improving Gait in a Community Dwelling Stroke Population

2018 ◽  
Author(s):  
Emma Swaffield
Keyword(s):  
Step Length ◽  
Auditory Stimulation ◽  
Community Dwelling ◽  
Stroke Survivors ◽  
Walking Ability ◽  
Limited Mobility ◽  
Stroke Population ◽  
Rhythmic Auditory Stimulation ◽  
Before And After ◽  
Stepping In Place

Stroke survivors often exhibit asymmetric walking patterns associated with one-sided weakness, or hemiparesis, resulting in a reduced walking ability and lower levels of independence. Rhythmic Auditory Stimulation (RAS) is an emerging strategy that uses music with a strong beat to help cue walking. RAS has successfully improved walking ability and symmetry in stroke survivors, yet the use of RAS while stepping in place has been only minimally explored. Due to limited mobility in this population, stepping in place may be a more feasible method of practicing walking patterns. The purpose of this study is two-fold: 1) to determine the immediate effects of stepping in place with RAS on kinematic walking parameters, and 2)to evaluate whether any changes in gait parameters translate to walking following a RAS session. The study is currently underway, with an objective of testing 8 to 10 participants who have experienced a stroke resulting in hemiparesis and reduced walking ability. The testing protocol is divided into two parts; part one involves an initial walking assessment to determine stepping cadence. In part two, participants complete a gait analysis and functional assessment before and after the stepping in place with RAS session. Two-dimensional analysis using a motion capture system and force plates allows for multiple spatiotemporal and kinematic outcome measures to be collected such as walking speed, step length, and joint angles. Ultimately, findings from this study will help to determine if and how stepping in place with RAS can improve gait in stroke survivors.

scholarly journals Gait Training Methods and ChangesiIn Gait Parameters in Parkinson`s Disease (Literature Review)

2020 ◽  
Vol 2 (7) ◽  
Author(s):  
Aušra Stuopelytė ◽  
Rasa Šakalienė
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Step Length ◽  
Gait Training ◽  
Auditory Stimulation ◽  
Training Methods ◽  
Dual Tasking ◽  
Gait Parameters ◽  
Rhythmic Auditory Stimulation ◽  
Walking Velocity

Parkinson’s disease is a chronic progressive neurological disorder that can impact function to a variable degree. Changes in gait parameters are the most common signs of Parkinson’s disease. Patients with Parkinson’s disease walk with a reduced step length, step time, walking velocity and walking cadence, increased stride cycle time, coefficient of variation of the step amplitude and step time and increased risk to fall. So, various gait training methods are applied. The effect of rhythmic auditory stimulation on gait in Parkinson’s disease patients is analysed. We can use various kinds of music, metronome, scansion and clapping as a rhythmic auditory stimulation.One of gait training methods in Parkinson’s disease patients is treadmill training. There are attempts to combine treadmill training with transcranial magnetic stimulation and virtual reality. We can use Nordic walking method and because walking technique requires straight posture, trunk rotation, bigger step and heel stride. More often robot–assisted gait training is used in patients with Parkinson’s disease gait training. The effect of dual–tasking and walking with music methods for gait and balance training in patients with Parkinson’s disease is also analysed. This method requires participants to perform primary and secondary tasks at the same time. The secondary task can be cognitive or motor. Dual–tasking is widely analysed because opinions about applying this method are very controversial. Walking with music method is more often analysed in scientific literature. This method could not be compared to rhythmic auditory stimulation method because the latter requires precise walking to rhythm and walking with music method is oriented to emotional component (music is chosen according patients’ music taste). As these methods are applied, we can see an increase in chosen walking and maximal walking velocities, step length and time, distance covered, and decrease in the coefficient of variation of the step time and turning time.Keywords: Gait impairments, walking velocity, rhythmic auditory stimulation.

scholarly journals Immediate Effect on Ground Reaction Forces Induced by Step Training Based on Discrete Skill during Gait in Poststroke Individuals: A Pilot Study

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Masanori Wakida ◽  
Koji Ohata ◽  
Yu Hashiguchi ◽  
Kimihiko Mori ◽  
Kimitaka Hase ◽  
...  
Keyword(s):  
Pilot Study ◽  
Walking Speed ◽  
Community Dwelling ◽  
Ground Reaction Forces ◽  
Clear Understanding ◽  
Walking Ability ◽  
Training Methods ◽  
Before And After ◽  
Reaction Forces ◽  
Response Phase

Background/Aim. Improving walking ability, especially the step-to-step transition control, is important in individuals after stroke. Although walking is a continuous skill, the discrete skills of gait, defined as movements with a clear beginning and end, may effectively modify walking performance. This pilot study shows the immediate effects of a discrete skill-based step training on ground reaction forces (GRFs) during gait in individuals with chronic hemiplegia following stroke. Methods. Twenty-two community-dwelling patients with chronic hemiplegia participated in this study. Eight participants performed only discrete-skill step training during the loading response phase, focusing on paretic hip extension movement (LR group). Another eight performed only discrete-skill step training during the preswing phase, focusing on paretic swing movement (PSw group). The remaining six were trained using both training methods, with at least 6 months in each group to washout the influence of previous training. Therefore, the final number of participants in each group was 14. The braking and propulsive forces of GRFs were measured during gait before and after 30 repetitions of the discrete-skill step training. Results. Although both groups showed a significant increase in stride length, walking speed was increased only in the LR group. The PSw group showed an increase in braking forces of both sides without any change in propulsion. In the LR group, paretic braking impulse did not change, while nonparetic propulsion increased. Conclusion. The discrete-skill step training during loading response phase induced an increase in nonparetic propulsion, resulting in increased walking speed. This study provides a clear understanding of immediate effects of the discrete-skill step training in patients with chronic stroke and helps improve interventions in long-term rehabilitation.

From Soundwaves to BrainWaves: The effects of choral singing on recovery from stroke and aphasia

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X696821 ◽  
Author(s):  
John Marley ◽  
Bernadette Matthias ◽  
Linda Worrall ◽  
Maya Guest ◽  
Christopher Allan
Keyword(s):  
Quality Of Life ◽  
New England ◽  
Outcome Measurement ◽  
Well Being ◽  
Community Dwelling ◽  
Stroke Survivors ◽  
Choral Singing ◽  
Before And After ◽  
Qualitative Work

BackgroundStroke is a leading cause of death and disability. Recovery is frequently compromised by reduced well-being, mood, socialisation and quality of life. Music and singing are recognised as enhancing well-being and benefit people with chronic illness. Evidence suggested that choir singing may improve the fluency of people with aphasia. Choirs existed for people with brain impairment; no studies had robust design and outcome measurement.AimTo conduct a pilot study in Newcastle, Australia in a collaboration between Hunter New England Health and the University of Newcastle. To explore the effects of choral singing on quality of life, well-being, mood, social participation and communication skills of community-dwelling stroke survivors including people with aphasia.MethodA mixed methods waitlist control design was used. 39 people at least 6 months post-stroke were assessed before and after a 12-week choir rehearsal period. Carers were invited to participate. Subjects were interviewed at the end of the period.ResultsMeasures of communication improved significantly and a trend to improvement in overall quality of life was seen. Depression and disability were significant in their impact on overall quality of life scores. Qualitative work reported increased quality of life, confidence, independence, mood and socialization and improvements in speech and communication were also reported.ConclusionOur pilot showed that a 12-week choir program for stroke survivors and carers is feasible and benefits quality of life, well-being, mood, community participation and communication in people with aphasia.

Feasibility of a rhythmic auditory stimulation gait training in community-dwelling adults after TBI: A case report

2021 ◽  
pp. 1-10
Author(s):  
Conor Sheridan ◽  
Corene Thaut ◽  
Dina Brooks ◽  
Kara K. Patterson
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Gait Speed ◽  
Controlled Trial ◽  
Gait Training ◽  
Auditory Stimulation ◽  
Gait Variability ◽  
Community Dwelling ◽  
Rhythmic Auditory Stimulation ◽  
Walking Endurance

BACKGROUND: Traumatic brain injury has multiple impacts on gait including decreased speed and increased gait variability. Rhythmic auditory stimulation (RAS) gait training uses the rhythm and timing structure of music to train and ultimately improve slow and variable walking patterns. OBJECTIVE: To describe the feasibility of RAS gait training in community-dwelling adults with traumatic brain injury (TBI). A secondary objective is to report changes in spatiotemporal gait parameters and clinical measures of balance and walking endurance. METHODS: Two individuals with a TBI participated in nine sessions of gait training with RAS over a 3-week period. At baseline, post-training and 3-week follow-up, spatiotemporal parameters of walking were analyzed at preferred pace, maximum pace and dual-task walking conditions. Secondary outcomes included the Community Balance and Mobility Scale and the 6-Minute Walk Test. Feasibility was assessed using reports of physical fatigue, adverse event reporting, and perceived satisfaction. RESULTS: Both participants completed all 9 planned intervention sessions. The sessions were well tolerated with no adverse events. Participant 1 and 2 exhibited different responses to the intervention in line with the therapeutic goals set with the therapist. Participant 1 exhibited improved speed and decreased gait variability. Participant 2 exhibited reduced gait speed but less fatigue during the 6MWT. CONCLUSIONS: RAS was found to be a safe and feasible gait intervention with the potential to improve some aspects of gait impairments related to gait speed, gait variability, dynamic balance and walking endurance. Further investigation including a pilot randomized controlled trial is warranted.

scholarly journals Physical Activity after Stroke: A Systematic Review and Meta-Analysis

ISRN Stroke ◽  
2013 ◽  
Vol 2013 ◽  
pp. 1-13 ◽  
Author(s):  
Matthew J. Field ◽  
Nick Gebruers ◽  
Thavapriya Shanmuga Sundaram ◽  
Sarah Nicholson ◽  
Gillian Mead
Keyword(s):  
Physical Activity ◽  
Systematic Review ◽  
Meta Analysis ◽  
Random Effect ◽  
Community Dwelling ◽  
Whole Body ◽  
Stroke Survivors ◽  
Significant Heterogeneity ◽  
Walking Ability ◽  
High Functioning

Background and Purpose. Physical activity is beneficial after stroke, but it is unclear how active stroke survivors are. This systematic review and meta-analysis sought to determine levels of activity and factors predicting activity. Summary of Review: Methods. MEDLINE (1946 to present) and EMBASE (1980 to present) were systematically searched until July 2012. All studies quantifying whole-body-free living physical activity by objective and self-reported methods in a community dwelling population with stroke were included. A random effect meta-analysis was performed. Results. Twenty-six studies were included (n=1105), of which eleven (n=315) contained sufficient data for meta-analysis. There were heterogeneous designs, measurements, and procedures. The studies generally recruited small samples of high-functioning participants. Level of physical activity was generally low in quantity, duration and intensity. Poorer walking ability, specific sensorimotor functions, and low mood were correlates of low physical activity. Meta-analysis generated an estimate of 4355.2 steps/day (95% CI: 3210.4 to 5499.9) with no significant heterogeneity (I2 = 0). Conclusions. In high-functioning stroke survivors, physical activity including walking was generally low. Strategies are needed to promote and maintain physical activity in stroke survivors. Research is needed to establish reasons for low physical activity after stroke.

scholarly journals Effects of a Music-Based Rhythmic Auditory Stimulation on Gait and Balance in Subacute Stroke

2021 ◽  
Vol 18 (4) ◽  
pp. 2032
Author(s):  
Samira Gonzalez-Hoelling ◽  
Carme Bertran-Noguer ◽  
Gloria Reig-Garcia ◽  
Rosa Suñer-Soler
Keyword(s):  
Functional Independence ◽  
Auditory Stimulation ◽  
Group Differences ◽  
Control Group ◽  
Stroke Severity ◽  
Walking Ability ◽  
Subacute Stroke ◽  
Rhythmic Auditory Stimulation ◽  
Secondary Outcomes ◽  
Conventional Physiotherapy

Gait and balance impairments are common after stroke. This study aimed to evaluate the effect of a music-based rhythmic auditory stimulation (RAS) in combination with conventional physiotherapy on gait parameters and walking ability in subacute stroke. This single-blind, historical controlled trial, included 55 patients who had suffered a stroke within the three weeks prior to enrolment. Patients from 2018 (n = 27) were assigned as the historical control group whereas 2019 patients (n = 28) received music-based RAS three times a week. Both groups received 11 h of conventional physiotherapy per week during hospitalization. Primary outcomes were gait and balance parameters (Tinetti test and Timed Up&Go test) and walking ability (Functional Ambulation Category scale). Secondary outcomes were trunk control, assistive devices, functional independence (Functional Independence Measure, Barthel index), and stroke severity and disability (modified Rankin scale, National Institutes of Health Stroke Scale). Results: No between-group differences were identified for gait and balance parameters nor for secondary outcomes. Significant between-group differences were observed in the Functional Ambulation Category: the intervention group (Δmean ± SD; 3.43 ± 1.17) showed greater improvement (p = 0.002) than the control group (Δmean ± SD; 2.48 ± 1.09). Compared with conventional physiotherapy alone, our results suggest that the walking ability of subacute stroke patients might be improved with music-based RAS combined with conventional physiotherapy, but this treatment is not more effective than conventional physiotherapy in obtaining gait and balance gains.

scholarly journals Feasibility of ActivABLES to promote home-based exercise and physical activity of community-dwelling stroke survivors with support from caregivers: A mixed methods study (Preprint)

2019 ◽  
Author(s):  
Steinunn A. Olafsdottir ◽  
Helga Jónsdóttir ◽  
Ingibjörg Bjartmarz ◽  
Charlotte Magnusson ◽  
Héctor Caltenco ◽  
...  
Keyword(s):  
Physical Activity ◽  
Mixed Methods ◽  
Qualitative Data ◽  
Community Dwelling ◽  
Mixed Methods Study ◽  
Stroke Survivors ◽  
Technical Problems ◽  
Home Based ◽  
Before And After ◽  
Need For Support

BACKGROUND Technical applications can promote home-based exercise and physical activity of community-dwelling stroke survivors to improve function and decrease physical inactivity and sedentary behavior. Informal caregivers are often able and willing to assist with home-based exercise and physical activity but may lack knowledge and practical resources. ActivABLES is an international collaboration which was established to promote home-based exercise and physical activity among community-dwelling stroke survivors, with support from their caregivers. OBJECTIVE The aim of this study is to investigate the feasibility of ActivABLES in terms of acceptability, demand, implementation and practicality. METHODS We conducted a mixed methods study with 10 community-dwelling stroke survivors, including five women and five men, with the median age of 72 years, who used ActivABLES for four weeks with support from their caregivers (seven women and three men, median age 68 years). Data collection included quantitative functional standardized measures of the stroke survivors before and after the 4-week use. Additionally, qualitative data was collected through individual semi-structured interviews with the stroke survivors and their caregivers after the 4-week use. Quantitative and qualitative data were also collected during the 4-week use. Descriptive statistics were used to analyze quantitative data and Wilcoxon signed rank test was used to analyze changes between the measures before and after the 4-week use. Qualitative data were analyzed with direct content analysis to identify subcategories to define the data further in context with the predetermined categories. RESULTS Acceptability was identified in four subcategories: appreciation, functional improvements, self-initiated activities and expressed potential use for future stroke survivors. Functional improvements of the stroke survivors were confirmed by quantitative and qualitative data and some mentioned changes in physical activity and self-initiated activities. All participants described ActivABLES to be feasible and to have potential for future stroke survivors. Demand was identified in three subcategories: reported use, interest in further use and need for follow-up. Most of the stroke survivors did follow the recommendation of using ActivABLES, confirmed by quantitative and qualitative data and showed interest in further use. Implementation was identified in three subcatagories: importance of feedback, variety of exercises and progression of exercises. Visual feedback was thought to be important and encouraging for continuing. About half of the stroke survivors felt that there was a lack of variation in exercises and about half used the progression of exercises. Practicality was identified in two subcatagories: need for support and technical problems. All participants agreed there was little need for support while using ActivABLES and the stroke survivors only needed minor assistance. All particants experienced some technical problems. CONCLUSIONS The results from this study indicate that ActivABLES is feasible and can be a good asset for stroke survivors with slight or moderate disability to use in their homes.

scholarly journals Effects of Multi-Directional Step-Up Training with Rhythmic Auditory Stimulation on Gait and Balance Ability in Stroke Patients

2021 ◽  
Vol 17 ◽  
pp. 758-763
Author(s):  
Jieun Choi ◽  
Joong-Hwi Kim
Keyword(s):  
Berg Balance Scale ◽  
Auditory Stimulation ◽  
Control Group ◽  
Stroke Patients ◽  
Rhythmic Auditory Stimulation ◽  
Before And After ◽  
Balance Ability ◽  
Functional Gait ◽  
Experimental Group ◽  
10 Meter Walk Test

The purpose of this study was to investigate the effects of multi-directional step-up training with rhythmic auditory stimulation on gait and balance ability in stroke patients and also to help develop fall prevention and exercise programs for returning to daily life after stroke. The intervention method was randomly assigned to sixteen stroke patients, eight patients each in the experimental group and the control group. The experimental group carried out multi-directional step-up training with rhythmic auditory stimulation, and the control group performed only multi-directional step-up training. The training proceeded twelve times for 30 minutes for four weeks, and functional gait assessment, 10-meter walk test, and dynamic (by the Berg balance scale) and static (by Balancia software, Mintosys, Korea) balance ability assessments were conducted to examine the effect of the training on improving balance and gait ability. The study compared and analyzed the differences in the amount of change within the groups before and after training, and the differences in the amount of change between the two groups. Both groups showed more improved results after training than before in all assessments that measured gait and balance ability (p < 0.05). However, the experimental group showed a greater difference in the amount of change in every gait and balance ability assessment compared to the control group. (p < 0.05). Therefore, multi-directional step-up training can be an efficient intervention to improve the gait and balance ability of stroke patients and when accompanied by rhythmic auditory stimulation, the effectiveness could be maximized.

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