Analysis of Gait Characteristics Using Hip-Knee Cyclograms in Patients with Hemiplegic Stroke

Gait disturbance is a common sequela of stroke. Conventional gait analysis has limitations in simultaneously assessing multiple joints. Therefore, we investigated the gait characteristics in stroke patients using hip-knee cyclograms, which have the advantage of simultaneously visualizing the gait kinematics of multiple joints. Stroke patients (n = 47) were categorized into two groups according to stroke severity, and healthy controls (n = 32) were recruited. An inertial measurement unit sensor-based gait analysis system, which requires placing seven sensors on the dorsum of both feet, the shafts of both tibias, the middle of both femurs, and the lower abdomen, was used for the gait analysis. Then, the hip-knee cyclogram parameters (range of motion, perimeter, and area) were obtained from the collected data. The coefficient of variance of the cyclogram parameters was obtained to evaluate gait variability. The cyclogram parameters differed between the stroke patients and healthy controls, and differences according to stroke severity were also observed. The gait variability parameters mainly differed in patients with more severe stroke, and specific visualized gait patterns of stroke patients were obtained through cyclograms. In conclusion, the hip-knee cyclograms, which show inter-joint coordination and visualized gait cycle in stroke patients, are clinically significant.

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Impaired cerebral autoregulation and neurovascular coupling in middle cerebral artery stroke: Influence of severity?

Journal of Cerebral Blood Flow & Metabolism ◽

10.1177/0271678x18794835 ◽

2018 ◽

Vol 39 (11) ◽

pp. 2277-2285 ◽

Cited By ~ 13

Author(s):

Angela SM Salinet ◽

Nathália CC Silva ◽

Juliana Caldas ◽

Daniel S de Azevedo ◽

Marcelo de-Lima-Oliveira ◽

...

Keyword(s):

Middle Cerebral Artery ◽

Functional Outcome ◽

Cerebral Artery ◽

Cerebral Autoregulation ◽

Cerebral Blood Flow Velocity ◽

Neurovascular Coupling ◽

Stroke Severity ◽

Healthy Controls ◽

Stroke Patients ◽

Severe Stroke

We aimed to assess cerebral autoregulation (CA) and neurovascular coupling (NVC) in stroke patients of differing severity comparing responses to healthy controls and explore the association between CA and NVC with functional outcome. Patients admitted with middle cerebral artery (MCA) stroke and healthy controls were recruited. Stroke severity was defined by the National Institutes of Health Stroke Scale (NIHSS) scores: ≤4 mild, 5–15 moderate and ≥16 severe. Transcranial Doppler ultrasound and Finometer recorded MCA cerebral blood flow velocity (CBFv) and blood pressure, respectively, over 5 min baseline and 1 min passive movement of the elbow to calculate the autoregulation index (ARI) and CBFv amplitude responses to movement. All participants were followed up for three months. A total of 87 participants enrolled in the study, including 15 mild, 27 moderate and 13 severe stroke patients, and 32 control subjects. ARI was lower in the affected hemisphere (AH) of moderate and severe stroke groups. Decreased NVC was seen bilaterally in all stroke groups. CA and NVC correlated with stroke severity and functional outcome. CBFv regulation is significantly impaired in acute stroke, and further compromised with increasing stroke severity. Preserved CA and NVC in the acute period were associated with improved three-month functional outcome.

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Prevention of Venous Thromboembolism after Acute Ischemic Stroke with Enoxaparin Versus Unfractionated Heparin and the Impact of Stroke Severity.

Blood ◽

10.1182/blood.v108.11.713.713 ◽

2006 ◽

Vol 108 (11) ◽

pp. 713-713 ◽

Cited By ~ 2

Author(s):

David G. Sherman ◽

Gregory W. Albers ◽

Christopher Bladin ◽

Min Chen ◽

Cesare Fieschi ◽

...

Keyword(s):

Ischemic Stroke ◽

Venous Thromboembolism ◽

Acute Ischemic Stroke ◽

Stroke Severity ◽

Primary Efficacy ◽

Primary Efficacy Endpoint ◽

Stroke Patients ◽

Nihss Score ◽

Vte Prophylaxis ◽

Clinically Significant

Abstract Background: Venous thromboembolism (VTE) prophylaxis with low-molecular-weight heparin (LMWH) or unfractionated heparin (UFH) is recommended in acute ischemic stroke patients, but most studies comparing LMWH and UFH are limited in methodology or sample size. The PREVAIL study was designed to assess the superiority of enoxaparin over UFH for VTE prophylaxis in acute ischemic stroke patients and to evaluate efficacy and safety according to stroke severity. Methods: Patients with acute ischemic stroke, confirmed by CT scan, and unable to walk unassisted due to motor impairment of the leg were enrolled in this prospective, open-label, parallel group, multicenter study. Patients from 15 countries were randomized within 48 h of stroke symptoms to receive enoxaparin 40 mg SC qd or UFH 5000 IU SC q12h for 10±4 days. Patients were stratified by NIH Stroke Scale score (NIHSS; severe ≥14, less severe <14). The primary efficacy endpoint was the composite of symptomatic or asymptomatic deep-vein thrombosis (DVT), symptomatic pulmonary embolism (PE), or fatal PE during treatment. DVT was confirmed primarily by venography, or ultrasonography when venography was not practical. PE was confirmed by VQ or CT scan, or angiography. Primary safety endpoints included clinically significant intracranial and major extracranial bleeding. Results: 1762 acute ischemic stroke patients were randomized. Characteristics were similar between groups; mean age was 66.0±12.9 yrs, mean NIHSS score was 11.3. In the efficacy population, enoxaparin (n=666) and UFH (n=669) were given for a mean of 10.5±3.2 days. Enoxaparin resulted in a 43% relative reduction in the risk of the primary efficacy endpoint compared with UFH (10.2% vs 18.1%; RR 0.57; 95% CI 0.44–0.76; p=0.0001, adjusted for NIHSS score). Incidences of VTE events are shown in Table 1. Reductions in the primary endpoint remained significant in patients with a NIHSS score ≥14 (16.3% vs 29.7%, p=0.0036) and <14 (8.3% vs 14.0%, p=0.0043). The composite of clinically significant intracranial and major extracranial bleeding was low and not significantly different between groups (Table 1). Conclusion: Enoxaparin 40 mg qd is superior to UFH q12h for reducing the risk of VTE in acute ischemic stroke patients, with no significant difference in clinically relevant bleeding. The reduction in VTE risk was consistent in patients with a NIHSS score ≥14 or <14. Table 1: Incidence of VTE and bleeding Endpoint Enoxaparin n/N (%, 95% CI) UFH n/N (%, 95% CI) *P<0.001 Symptomatic VTE 2/666 (0.3, 0.0–0.7) 6/669 (0.9, 0.2–1.6) Proximal DVT 30/666 (4.5, 2.9–6.1) 64/669 (9.6, 7.3–11.8)* Distal DVT 44/666 (6.6, 4.7–8.5) 85/669 (12.7, 10.2–15.2)* PE 1/666 (0.2, 0.0–0.4) 6/669 (0.9, 0.2–1.6) Composite of major extracranial and clinically significant intracranial bleeding 11/877 (1.3, 0.5–1.9) 6/872 (0.7, 0.1–1.2)

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Biomechanical Analysis on the Foot under Normal and Abnormal Gait for Orthotics Design

Key Engineering Materials ◽

10.4028/www.scientific.net/kem.353-358.2179 ◽

2007 ◽

Vol 353-358 ◽

pp. 2179-2182 ◽

Cited By ~ 1

Author(s):

Jae Ok Lee ◽

Young Shin Lee ◽

Se Hoon Lee ◽

Young Jin Choi ◽

Soung Ha Park

Keyword(s):

Gait Analysis ◽

Human Body ◽

Center Of Pressure ◽

Reaction Force ◽

The Body ◽

Biomechanical Analysis ◽

Gait Characteristics ◽

Abnormal Gait ◽

Experimental Apparatus ◽

Analysis System

The foot plays an important role in supporting the body and keeping body balance. An abnormal walking habit breaks the balance of the human body as well as the function of the foot. The foot orthotics which is designed to consider biomechanics effectively distributes the load of the human body on the sole of the foot. In this paper, gait analysis is performed for subjects wearing the orthotics. In this study, three male subjects were selected. The experimental apparatus consists of a plantar pressure analysis system and digital EMG system. The gait characteristics are simulated by ADAMS/LifeMOD. The COP (Center of Pressure), EMG and ground reaction force were investigated. As a result of gait analysis, the path of COP was improved and muscle activities were decreased with orthotics on the abnormal walking subjects.

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Determining the Most Appropriate Assistive Walking Device Using the Inertial Measurement Unit-Based Gait Analysis System in Disabled Patients

Annals of Rehabilitation Medicine ◽

10.5535/arm.2020.44.1.48 ◽

2020 ◽

Vol 44 (1) ◽

pp. 48-57

Author(s):

Junhee Lee ◽

Chang Hoon Bae ◽

Aeri Jang ◽

Seoyon Yang ◽

Hasuk Bae

Keyword(s):

Gait Analysis ◽

Inertial Measurement Unit ◽

Gait Pattern ◽

Assistive Devices ◽

Assistive Device ◽

Measurement Unit ◽

Inertial Measurement ◽

Disabled Patients ◽

Analysis System ◽

Gait Disturbances

Objective To evaluate the gait pattern of patients with gait disturbances without consideration of defilades due to assistive devices. This study focuses on gait analysis using the inertial measurement unit (IMU) system, which can also be used to determine the most appropriate assistive device for patients with gait disturbances.Methods Records of 18 disabled patients who visited the Department of Rehabilitation from May 2018 to June 2018 were selected. Patients’ gait patterns were analyzed using the IMU system with different assistive devices to determine the most appropriate device depending on the patient’s condition. Evaluation was performed using two or more devices, and the appropriate device was selected by comparing the 14 parameters of gait evaluation. The device showing measurements nearer or the nearest to the normative value was selected for rehabilitation.Results The result of the gait evaluation in all 18 patients was analyzed using the IMU system. According to the records, the patients were evaluated using various assistive devices without consideration of defilades. Moreover, this gait analysis was effective in determining the most appropriate device for each patient. Increased gait cycle time and swing phase and decreased stance phase were observed in devices requiring significant assistance.Conclusion The IMU-based gait analysis system is beneficial in evaluating gait in clinical fields. Specifically, it is useful in evaluating patients with gait disturbances who require assistive devices. Furthermore, it allows the establishment of an evidence-based decision for the most appropriate assistive walking devices for patients with gait disturbances.

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Quantitative gait analysis of idiopathic normal pressure hydrocephalus using deep learning algorithms on monocular videos

Scientific Reports ◽

10.1038/s41598-021-90524-9 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Sungmoon Jeong ◽

Hosang Yu ◽

Jaechan Park ◽

Kyunghun Kang

Keyword(s):

Deep Learning ◽

Gait Analysis ◽

Normal Pressure Hydrocephalus ◽

Learning Algorithms ◽

Normal Pressure ◽

Gait Variability ◽

Stride Time ◽

Analysis Method ◽

Gait Parameters ◽

Analysis System

AbstractA vision-based gait analysis method using monocular videos was proposed to estimate temporo-spatial gait parameters by leveraging deep learning algorithms. This study aimed to validate vision-based gait analysis using GAITRite as the reference system and analyze relationships between Frontal Assessment Battery (FAB) scores and gait variability measured by vision-based gait analysis in idiopathic normal pressure hydrocephalus (INPH) patients. Gait data from 46 patients were simultaneously collected from the vision-based system utilizing deep learning algorithms and the GAITRite system. There was a strong correlation in 11 gait parameters between our vision-based gait analysis method and the GAITRite gait analysis system. Our results also demonstrated excellent agreement between the two measurement systems for all parameters except stride time variability after the cerebrospinal fluid tap test. Our data showed that stride time and stride length variability measured by the vision-based gait analysis system were correlated with FAB scores. Vision-based gait analysis utilizing deep learning algorithms can provide comparable data to GAITRite when assessing gait dysfunction in INPH. Frontal lobe functions may be associated with gait variability measurements using vision-based gait analysis for INPH patients.

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Leukocyte TNFR1 and TNFR2 Expression Contributes to the Peripheral Immune Response in Cases with Ischemic Stroke

Cells ◽

10.3390/cells10040861 ◽

2021 ◽

Vol 10 (4) ◽

pp. 861

Author(s):

Rikke B. Hansen ◽

Cathrine C. H. Laursen ◽

Niala Nawaz ◽

Jonna S. Madsen ◽

Helle H. Nielsen ◽

...

Keyword(s):

Ischemic Stroke ◽

Plasma Levels ◽

Infarct Volume ◽

Plasma Concentrations ◽

Tumor Necrosis Factor Receptor ◽

Immunological Response ◽

Stroke Severity ◽

Healthy Controls ◽

Stroke Patients ◽

Cellular Expression

Tumor necrosis factor receptor 1 and 2 (TNFR1 and TNFR2) have been found in brain parenchyma of stroke patients, and plasma levels are increased in the acute phase of stroke. We evaluated associations between TNFR1 and TNFR2 plasma levels and stroke severity, infarct size, and functional outcome. Furthermore, we examined cellular expression of TNFR1 and TNFR2 on leukocyte subpopulations to explore the origin of the increased receptor levels. Blood samples were taken from 33 acute ischemic stroke patients and 10 healthy controls. TNFR1 and TNFR2 plasma concentrations were measured and correlated against the Scandinavian Stroke Scale at admission, infarct volume, and the modified Rankin Scale score three months after stroke onset. Classical, intermediate, and non-classical monocytes as well as neutrophils were purified, and cellular expression of TNFR1 and TNFR2 was examined using flow cytometry. TNFR1 and TNFR2 plasma levels were both increased after ischemic stroke, but we found no correlation with patient outcome measurements. Compared to healthy controls, ischemic stroke patients had decreased non-classical monocyte and neutrophil populations expressing TNFR1 and increased neutrophils expressing TNFR2, and decreased non-classical populations co-expressing both TNFR1 and TNFR2. This study supports the hypothesis of an acute immunological response orchestrated by the peripheral immune system following an ischemic stroke. However, the origin of the increased TNFR1 and TNFR2 plasma levels could not be clearly linked to peripheral monocytes or neutrophils. Future studies are needed and will help clarify the potential role as treatment target.

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Clinometric Gait Analysis Using Smart Insoles in Patients With Hemiplegia After Stroke: Pilot Study (Preprint)

10.2196/preprints.22208 ◽

2020 ◽

Author(s):

Minseok Seo ◽

Myung-Jun Shin ◽

Tae Sung Park ◽

Jong-Hwan Park

Keyword(s):

Gait Analysis ◽

Objective Assessment ◽

Assessment Tools ◽

Stroke Severity ◽

Walking Ability ◽

Healthy Controls ◽

Gait Parameters ◽

Sound Side ◽

Smart Insole ◽

Stance Duration

BACKGROUND For effective rehabilitation after stroke, it is essential to conduct an objective assessment of the patient’s functional status. Several stroke severity scales have been used for this purpose, but such scales have various limitations. OBJECTIVE Gait analysis using smart insole technology can be applied continuously, objectively, and quantitatively, thereby overcoming the shortcomings of other assessment tools. METHODS To confirm the reliability of gait analysis using smart insole technology, normal healthy controls wore insoles in their shoes during the Timed Up and Go (TUG) test. The gait parameters were compared with the manually collected data. To determine the gait characteristics of patients with hemiplegia due to stroke, they were asked to wear insoles and take the TUG test; gait parameters were calculated and compared with those of control subjects. To investigate whether the gait analysis accurately reflected the patients’ clinical condition, we analyzed the relationships of 22 gait parameters on 4 stroke severity scales. RESULTS The smart insole gait parameter data were similar to those calculated manually. Among the 18 gait parameters tested, 14 were significantly effective at distinguishing patients from healthy controls. The smart insole data revealed that the stance duration on both sides was longer in patients than controls, which has proven difficult to show using other methods. Furthermore, the sound side in patients showed a markedly longer stance duration. Regarding swing duration, that of the sound side was shorter in patients than controls, whereas that of the hemiplegic side was longer. We identified 10 significantly correlated gait parameters on the stroke severity scales. Notably, the difference in stance duration between the sound and hemiplegic sides was significantly correlated with the Fugl-Meyer Assessment (FMA) lower extremity score. CONCLUSIONS This study confirmed the feasibility and applicability of the smart insole as a device to assess the gait of patients with hemiplegia due to stroke. In addition, we demonstrated that the FMA score was significantly correlated with the smart insole data. Providing an environment where stroke patients can easily measure walking ability helps to maintain chronic functions as well as acute rehabilitation. CLINICALTRIAL UMIN Clinical Trials Registry UMIN000041646, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000047538

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