scholarly journals Necessity and Content of Swing Phase Gait Coordination Training Post Stroke; A Case Report

2021 ◽  
Vol 11 (11) ◽  
pp. 1498
Author(s):  
Jessica P. McCabe ◽  
Kristen Roenigk ◽  
Janis J. Daly

Background/Problem: Standard neurorehabilitation and gait training has not proved effective in restoring normal gait coordination for many stroke survivors. Rather, persistent gait dyscoordination occurs, with associated poor function, and progressively deteriorating quality of life. One difficulty is the array of symptoms exhibited by stroke survivors with gait deficits. Some researchers have addressed lower limb weakness following stroke with exercises designed to strengthen muscles, with the expectation of improving gait. However, gait dyscoordination in many stroke survivors appears to result from more than straightforward muscle weakness. Purpose: Thus, the purpose of this case study is to report results of long-duration gait coordination training in an individual with initial good strength, but poor gait swing phase hip/knee and ankle coordination. Methods: Mr. X was enrolled at >6 months after a left hemisphere ischemic stroke. Gait deficits included a ‘stiff-legged gait’ characterized by the absence of hip and knee flexion during right mid-swing, despite the fact that he showed good initial strength in right lower limb quadriceps, hamstrings, and ankle dorsiflexors. Treatment was provided 4 times/week for 1.5 h, for 12 weeks. The combined treatment included the following: motor learning exercises designed for coordination training of the lower limb; functional electrical stimulation (FES) assisted practice; weight-supported coordination practice; and over-ground and treadmill walking. The FES was used as an adjunct to enhance muscle response during motor learning and prior to volitional recovery of motor control. Weight-supported treadmill training was administered to titrate weight and pressure applied at the joints and to the plantar foot surface during stance phase and pre-swing phase of the involved limb. Later in the protocol, treadmill training was administered to improve speed of movement during the gait cycle. Response to treatment was assessed through an array of impairment, functional mobility, and life role participation measures. Results: At post-treatment, Mr. X exhibited some recovery of hip, knee, and ankle coordination during swing phase according to kinematic measures, and the stiff-legged gait was resolved. Muscle strength measures remained essentially constant throughout the study. The modified Ashworth scale showed improved knee extensor tone from baseline of 1 to normal (0) at post-treatment. Gait coordination overall improved by 12 points according to the Gait Assessment and Intervention Tool, Six Minute Walk Test improved by 532′, and the Stroke Impact Scale improved by 12 points, including changes in daily activities; mobility; and meaningful activities. Discussion: Through the combined use of motor learning exercises, FES, weight-support, and treadmill training, coordination of the right lower limb improved sufficiently to exhibit a more normal swing phase, reducing the probability of falls, and subsequent downwardly spiraling dysfunction. The recovery of lower limb coordination during swing phase illustrates what is possible when strength is sufficient and when coordination training is targeted in a carefully titrated, highly incrementalized manner. Conclusions/Contribution to the Field: This case study contributes to the literature in several ways: (1) illustrates combined interventions for gait training and response to treatment; (2) provides supporting case evidence of relationships among knee flexion coordination, swing phase coordination, functional mobility, and quality of life; (3) illustrates that strength is necessary, but not sufficient to restore coordinated gait swing phase after stroke in some stroke survivors; and (4) provides details regarding coordination training and progression of gait training treatment for stroke survivors.

2011 ◽  
Vol 36 (1) ◽  
pp. 113-120 ◽  
Author(s):  
Christopher Kevin Wong ◽  
Lauri Bishop ◽  
Joel Stein

Background and Aim: Until recently, robotic devices for stroke rehabilitation had multi-joint designs that were often tethered to a treadmill for gait training. A new single-joint wearable robotic knee orthosis (RKO) has been designed that provides patient-initiated powered-assistance in untethered functional mobility. This case-series documents application of the wearable RKO in untethered functional training with stroke survivors.Technique: Three ambulatory adult stroke survivors used a wearable RKO during 18 one-hour sessions within a six-week physical therapy programme. Subjects were assessed with a variety of balance, gait and functional tests including the Berg Balance Scale (BBS); six-minute walk test (6MWT); and Emory Functional Ambulation Profile (EFAP) at pre-treatment, post-treatment, one-month and three-month follow-up.Discussion: All subjects improved balance, gait and functional performances with mean individual improvements of 12.6% for BBS, 12.0% for 6MWT and 16.7% for EFAP post-treatment. No adverse events occurred. These three stroke survivors may have benefited from the task-specific functional training programme augmented by RKO use.Clinical relevancePhysical therapists may find a wearable robotic knee orthosis useful for providing patient-initiated assisted movement for ambulatory chronic stroke survivors during functional task-specific balance and mobility training.


2014 ◽  
Vol 21 (1) ◽  
pp. 67-73 ◽  
Author(s):  
Camila Rocha Simão ◽  
Élida Rayanne Viana Pinheiro Galvão ◽  
Débora Oliveira da Silveira Fonseca ◽  
Dayse Aleixo Bezerra ◽  
Amanda Capistrano de Andrade ◽  
...  

Our purpose in this study was to analyze the immediate effects of locomotor gait training with different loads on a treadmill on the kinematic parameters of gait in children with Spastic Hemiparetic Cerebral Palsy (SHCP), as well as investigating which load prompted the most adequate motor responses to promote the propulsion of the Paretic Lower Limb (PLL). This case report included 3 children of both sexes, aged 8-12 years. The children walked on the treadmill with loads on their ankles that corresponded to 40, 50 and 60% of the weight of the Lower Limb (LL), on 3 different non-consecutive days. The kinematic parameters were assessed during the pre-training phase (PTPH) and immediately after training (PHI). The spatiotemporal variables did not change immediately after gait training with the aforementioned loads. On the other hand, we observed wider joint angles in the hip and knee during the swing phase immediately after training, especially with a load of 60% of the weight of the lower limb. These findings indicate that the 60% load is the most appropriate to prompt immediate changes in the joint kinematics of the PLL. These alterations can be important in improving propulsion during the swing phase of gait in children with SHCP.


2018 ◽  
Vol 27 (5) ◽  
pp. 501-512
Author(s):  
Jung-Eun Yun ◽  
Yong-Gwan Song ◽  
Chang-Ha Lim ◽  
Sang-Hyup Choi ◽  
Jin-Hoon Park

Burns ◽  
2021 ◽  
Author(s):  
Özden Özkal ◽  
Kemal Kısmet ◽  
Ali Konan ◽  
Mutlu Hayran ◽  
Semra Topuz

Author(s):  
Antonio Rodríguez-Fernández ◽  
Joan Lobo-Prat ◽  
Josep M. Font-Llagunes

AbstractGait disorders can reduce the quality of life for people with neuromuscular impairments. Therefore, walking recovery is one of the main priorities for counteracting sedentary lifestyle, reducing secondary health conditions and restoring legged mobility. At present, wearable powered lower-limb exoskeletons are emerging as a revolutionary technology for robotic gait rehabilitation. This systematic review provides a comprehensive overview on wearable lower-limb exoskeletons for people with neuromuscular impairments, addressing the following three questions: (1) what is the current technological status of wearable lower-limb exoskeletons for gait rehabilitation?, (2) what is the methodology used in the clinical validations of wearable lower-limb exoskeletons?, and (3) what are the benefits and current evidence on clinical efficacy of wearable lower-limb exoskeletons? We analyzed 87 clinical studies focusing on both device technology (e.g., actuators, sensors, structure) and clinical aspects (e.g., training protocol, outcome measures, patient impairments), and make available the database with all the compiled information. The results of the literature survey reveal that wearable exoskeletons have potential for a number of applications including early rehabilitation, promoting physical exercise, and carrying out daily living activities both at home and the community. Likewise, wearable exoskeletons may improve mobility and independence in non-ambulatory people, and may reduce secondary health conditions related to sedentariness, with all the advantages that this entails. However, the use of this technology is still limited by heavy and bulky devices, which require supervision and the use of walking aids. In addition, evidence supporting their benefits is still limited to short-intervention trials with few participants and diversity among their clinical protocols. Wearable lower-limb exoskeletons for gait rehabilitation are still in their early stages of development and randomized control trials are needed to demonstrate their clinical efficacy.


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