scholarly journals Learning the spatial features of a locomotor task is slowed after stroke

2014 ◽  
Vol 112 (2) ◽  
pp. 480-489 ◽  
Author(s):  
Christine M. Tyrell ◽  
Erin Helm ◽  
Darcy S. Reisman
Keyword(s):  
Motor Learning ◽  
Spatial Pattern ◽  
Retention Test ◽  
Step Length ◽  
Treadmill Walking ◽  
Neurological Dysfunction ◽  
Stroke Survivors ◽  
Spatial Features ◽  
Walking Pattern ◽  
Neurologically Intact

The capacity for humans to learn a new walking pattern has been explored with a split-belt treadmill during single sessions of adaptation, but the split-belt treadmill can also be used to study longer-term motor learning. Although the literature provides some information about motor learning after stroke, existing studies have primarily involved the upper extremity and the results are mixed. The purpose of this study was to characterize learning of a novel locomotor task in stroke survivors. We hypothesized that the presence of neurological dysfunction from stroke would result in slower learning of a locomotor task and decreased retention of what was learned and that these deficits would be related to level of sensorimotor impairment. Sixteen participants with stroke and sixteen neurologically intact participants walked on a split-belt treadmill for 15 min on 5 consecutive days and during a retention test. Step length and limb phase were measured to capture learning of the spatial and temporal aspects of walking. Learning the spatial pattern of split-belt treadmill walking was slowed after stroke compared with neurologically intact subjects, whereas there were no differences between these two groups in learning the temporal pattern. During the retention test, poststroke participants demonstrated equal retention of the split-belt treadmill walking pattern compared with those who were neurologically intact. The results suggest that although stroke survivors are slower to learn a new spatial pattern of gait, if given sufficient time they are able to do so to the same extent as those who are neurologically intact.

scholarly journals Fluid Cognitive Abilities Are Important for Learning and Retention of a New, Explicitly Learned Walking Pattern in Individuals After Stroke

2021 ◽  
pp. 154596832110010
Author(s):  
Margaret A. French ◽  
Matthew L. Cohen ◽  
Ryan T. Pohlig ◽  
Darcy S. Reisman
Keyword(s):  
Cognitive Abilities ◽  
Step Length ◽  
Cognitive Measures ◽  
Retention Models ◽  
Wechsler Memory Scale ◽  
Walking Pattern ◽  
Learning Principles ◽  
The Relationship ◽  
Sequential Regression ◽  
Neurologically Intact

Background There is significant variability in poststroke locomotor learning that is poorly understood and affects individual responses to rehabilitation interventions. Cognitive abilities relate to upper extremity motor learning in neurologically intact adults, but have not been studied in poststroke locomotor learning. Objective To understand the relationship between locomotor learning and retention and cognition after stroke. Methods Participants with chronic (>6 months) stroke participated in 3 testing sessions. During the first session, participants walked on a treadmill and learned a new walking pattern through visual feedback about their step length. During the second session, participants walked on a treadmill and 24-hour retention was assessed. Physical and cognitive tests, including the Fugl-Meyer-Lower Extremity (FM-LE), Fluid Cognition Composite Score (FCCS) from the NIH Toolbox -Cognition Battery, and Spatial Addition from the Wechsler Memory Scale-IV, were completed in the third session. Two sequential regression models were completed: one with learning and one with retention as the dependent variables. Age, physical impairment (ie, FM-LE), and cognitive measures (ie, FCCS and Spatial Addition) were the independent variables. Results Forty-nine and 34 participants were included in the learning and retention models, respectively. After accounting for age and FM-LE, cognitive measures explained a significant portion of variability in learning ( R2 = 0.17, P = .008; overall model R2 = 0.31, P = .002) and retention (Δ R2 = 0.17, P = .023; overall model R2 = 0.44, P = .002). Conclusions Cognitive abilities appear to be an important factor for understanding locomotor learning and retention after stroke. This has significant implications for incorporating locomotor learning principles into the development of personalized rehabilitation interventions after stroke.

scholarly journals A Comparison of Treadmill and Overground Walking Effects on Step Cycle Asymmetry in Young and Older Individuals

2013 ◽  
Vol 29 (2) ◽  
pp. 188-193 ◽  
Author(s):  
Hanatsu Nagano ◽  
Rezaul K. Begg ◽  
William A. Sparrow ◽  
Simon Taylor
Keyword(s):  
Older Adults ◽  
Walking Speed ◽  
Step Length ◽  
Treadmill Walking ◽  
Older Individuals ◽  
Aging Effects ◽  
Overground Walking ◽  
Time Data ◽  
Step Cycle ◽  
Step Velocity

Although lower limb strength becomes asymmetrical with age, past studies of aging effects on gait biomechanics have usually analyzed only one limb. This experiment measured how aging and treadmill surface influenced both dominant and nondominant step parameters in older (mean 74.0 y) and young participants (mean 21.9 y). Step-cycle parameters were obtained from 3-dimensional position/time data during preferred-speed walking for 40 trials along a 10 m walkway and for 10 minutes of treadmill walking. Walking speed (young 1.23 m/s, older 1.24 m/s) and step velocity for the two age groups were similar in overground walking but older adults showed significantly slower walking speed (young 1.26 m/s, older 1.05 m/s) and step velocity on the treadmill due to reduced step length and prolonged step time. Older adults had shorter step length than young adults and both groups reduced step length on the treadmill. Step velocity and length of older adults’ dominant limb was asymmetrically larger. Older adults increased the proportion of double support in step time when treadmill walking. This adaptation combined with reduced step velocity and length may preserve balance. The results suggest that bilateral analyses should be employed to accurately describe asymmetric features of gait especially for older adults.

scholarly journals The Effect of External Attentional Focus and Self-Controlled Feedback on Motor Learning in Older Adults

2020 ◽  
Vol 27 (1) ◽  
pp. 9-13
Author(s):  
Sima Razaghi ◽  
Esmaeel Saemi ◽  
Rasool Abedanzadeh
Keyword(s):  
Older Adults ◽  
Motor Learning ◽  
Retention Test ◽  
Attentional Focus ◽  
Focus Of Attention ◽  
The Other ◽  
Acquisition Phase ◽  
Control Group ◽  
External Focus ◽  
Mixed Anova

AbstractIntroduction. External focus instruction and self-controlled feedback have beneficial effects on motor learning. The purpose of the present study was to investigate the benefits of combined effects of external focus instruction and self-controlled feedback on balance performance in older adults.Material and Methods. Forty older adults (mean age: 63.21 ± 3.6 years; all female) were selected and randomly divided into 4 groups: self-controlled feedback, external attention, external attention/self-controlled feedback and control group. The task of standing on the platform of the stabilometer device and trying to keep the platform horizontally as much as possible was performed in each 30-sec. trial. The participants of self-controlled group received feedback on the timing of balance after the trials. In the external focus of attention, participants noticed the signs that were located horizontally ahead of their feet. The test was conducted in two sessions. In the acquisition phase, 10 trials of 30 seconds were performed and the retention test was completed 24 hours later as 5 trials of 30 seconds.Results. The results of mixed ANOVA on time data as an indicator of balance in the acquisition phase showed that the mixed group of external focus of attention and self-controlled feedback had better performance than the other groups (p = 0.004). In the retention test, the results of mixed ANOVA showed that the participants in the combined group of external focus and self-controlled feedback had better performance than the other groups (p = 0.006). The external focus of attention and self-controlled feedback performed similarly, and both were superior to the control group (p < 0.05).Conclusions. The results of this study, supporting the OPTIMAL theory of motor learning in the elderly, showed that the combination of two factors of external focus and self-controlled feedback has a double advantage over the presence of each of the factors. Therefore, it is suggested that the combinations of external focus instructions and self-controlled feedback should be used to improve performance and motor learning in the classes of practical and clinical rehabilitation fields.

Abstract 48: Neurological Outcomes of Inpatient Cardiopulmonary Resuscitation in a University Hospital

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Lia M Thomas ◽  
Miguel Benavides ◽  
Pierre Kory ◽  
Samuel Acquah ◽  
Steven Bergmann
Keyword(s):  
Cardiac Arrest ◽  
Critical Care ◽  
Cardiopulmonary Resuscitation ◽  
Therapeutic Hypothermia ◽  
Cardiopulmonary Arrest ◽  
University Hospital ◽  
Neurological Dysfunction ◽  
Neurological Outcomes ◽  
Shockable Rhythm ◽  
Neurologically Intact

Background: Despite advances in out- of- hospital resuscitation practices, the prognosis of most patients after a cardiac arrest remains poor. The long term outcomes of patients successfully resuscitated from cardiac arrest are often complicated by neurological dysfunction. Therapeutic hypothermia has significantly improved neurological outcomes in patients successfully resuscitated from out- of- hospital cardiac arrests. The objective of this study was to look into the neurological outcomes in inpatients after successful cardiopulmonary resuscitation (CPR) in a university hospital setting. Methods: This was a retrospective observational study of 68 adult patients who experienced cardiac or respiratory arrest over an 18 month period at a metropolitan teaching hospital with dedicated, trained code teams. Arrests that occurred in the Emergency Department, Critical Care Units or Operating Rooms were excluded. Results: Of the 68 consecutive patients included in this study, 53% were resuscitated successfully. However, only 12 (18%) survived to discharge from the hospital and only 6 (10%) were discharged with intact neurological status. The initial survival was better in patients who received prompt CPR and in those with less co - morbidities. Pulseless electrical activity (PEA) or asystole were the most common rhythms (47% of the arrests). Most patients who survived and were neurologically intact had PEA (67%). We believe that most PEA arrests were more likely severe hypotension with the inability to palpate a pulse rather than true PEA. The mean time to defibrillation for all patients with an initial shockable rhythm (n=5) was 8.2 minutes. Patients who had an initial shockable rhythm and survived to discharge were shocked within 1 minute (n=2). Conclusion: Despite advances in critical care, survival from inpatient cardiopulmonary arrest to neurologically intact discharge remains poor. Therapeutic hypothermia should be expanded to those resuscitated from in - hospital cardiopulmonary arrest to determine if neurological outcomes would improve.

scholarly journals Unilateral step training can drive faster learning of novel gait patterns

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Christine N. Song ◽  
Jan Stenum ◽  
Kristan A. Leech ◽  
Chloe K. Keller ◽  
Ryan T. Roemmich
Keyword(s):  
Nervous System ◽  
Adaptive Learning ◽  
Gait Training ◽  
Treadmill Walking ◽  
Active Movement ◽  
Relative Speed ◽  
Gait Patterns ◽  
Speed Difference ◽  
Walking Pattern ◽  
Series Of Experiments

Abstract Humans are capable of learning many new walking patterns. People have learned to snowshoe up mountains, racewalk marathons, and march in precise synchrony. But what is required to learn a new walking pattern? Here, we demonstrate that people can learn new walking patterns without actually walking. Through a series of experiments, we observe that stepping with only one leg can facilitate learning of an entirely new walking pattern (i.e., split-belt treadmill walking). We find that the nervous system learns from the relative speed difference between the legs—whether or not both legs are moving—and can transfer this learning to novel gaits. We also show that locomotor learning requires active movement: observing another person adapt their gait did not result in significantly faster learning. These findings reveal that people can learn new walking patterns without bilateral gait training, as stepping with one leg can facilitate adaptive learning that transfers to novel gait patterns.

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.

Age effects on step adaptation during treadmill walking with continuous step length biofeedback

2020 ◽  
Vol 80 ◽  
pp. 174-177
Author(s):  
Mahboobeh Mehdikhani ◽  
Simon Taylor ◽  
Blynn L. Shideler ◽  
Rajna Ogrin ◽  
Rezaul Begg
Keyword(s):  
Step Length ◽  
Treadmill Walking ◽  
Age Effects

scholarly journals Mu Suppression Is Sensitive to Observational Practice but Results in Different Patterns of Activation in Comparison with Physical Practice

2018 ◽  
Vol 2018 ◽  
pp. 1-12
Author(s):  
Najah Alhajri ◽  
Nicola J. Hodges ◽  
Jill G. Zwicker ◽  
Naznin Virji-Babul
Keyword(s):  
Motor Learning ◽  
Retention Test ◽  
Motor Task ◽  
Mu Rhythm ◽  
Healthy Individuals ◽  
Physical Practice ◽  
Short Term ◽  
Mu Suppression ◽  
Index Changes ◽  
Observational Practice

Research has shown the effectiveness of observational practice for motor learning, but there continues to be debate about the mechanisms underlying effectiveness. Although cortical processes can be moderated during observation, after both physical and observational practice, how these processes change with respect to behavioural measures of learning has not been studied. Here we compared short-term physical and observational practice during the acquisition and retention of a novel motor task to evaluate how each type of practice modulates EEG mu rhythm (8–13 Hz). Thirty healthy individuals were randomly assigned to one of three groups: (1) physical practice (PP), (2) observational practice (OP), and (3) no practice (NP) control. There were four testing stages: baseline EEG, practice, postpractice observation, and delayed retention. There was significant bilateral suppression of mu rhythm during PP but only left lateralized mu suppression during OP. In the postpractice observation phase, mu suppression was bilateral and larger after PP compared to that after OP. NP control showed no evidence of suppression and was significantly different to both the OP and PP groups. When comparing the three groups in retention, the groups did not differ with respect to tracing times, but the PP group showed fewer errors, especially in comparison to the NP group. Therefore, although the neurophysiological measures index changes in the OP group, which are similar but moderated in comparison to PP, changes in these processes are not manifest in observational practice outcomes when assessed in a delayed retention test.

scholarly journals Feasibility of Using Foot–Ground Clearance Biofeedback Training in Treadmill Walking for Post-Stroke Gait Rehabilitation

2020 ◽  
Vol 10 (12) ◽  
pp. 978
Author(s):  
Hanatsu Nagano ◽  
Catherine M. Said ◽  
Lisa James ◽  
Rezaul K. Begg
Keyword(s):  
Real Time ◽  
Training Session ◽  
Step Length ◽  
Gait Training ◽  
Treadmill Walking ◽  
Biofeedback Training ◽  
Step Width ◽  
Double Support ◽  
Post Stroke ◽  
Foot Clearance

Hemiplegic stroke often impairs gait and increases falls risk during rehabilitation. Tripping is the leading cause of falls, but the risk can be reduced by increasing vertical swing foot clearance, particularly at the mid-swing phase event, minimum foot clearance (MFC). Based on previous reports, real-time biofeedback training may increase MFC. Six post-stroke individuals undertook eight biofeedback training sessions over a month, in which an infrared marker attached to the front part of the shoe was tracked in real-time, showing vertical swing foot motion on a monitor installed in front of the subject during treadmill walking. A target increased MFC range was determined, and participants were instructed to control their MFC within the safe range. Gait assessment was conducted three times: Baseline, Post-training and one month from the final biofeedback training session. In addition to MFC, step length, step width, double support time and foot contact angle were measured. After biofeedback training, increased MFC with a trend of reduced step-to-step variability was observed. Correlation analysis revealed that MFC height of the unaffected limb had interlinks with step length and ankle angle. In contrast, for the affected limb, step width variability and MFC height were positively correlated. The current pilot-study suggested that biofeedback gait training may reduce tripping falls for post-stroke individuals.

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