scholarly journals Use of Visual and Proprioceptive Feedback to Improve Gait Speed and Spatiotemporal Symmetry Following Chronic Stroke: A Case Series

2012 ◽  
Vol 92 (5) ◽  
pp. 748-756 ◽  
Author(s):  
Michael D. Lewek ◽  
Jeff Feasel ◽  
Erin Wentz ◽  
Frederick P. Brooks ◽  
Mary C. Whitton
Keyword(s):  
Gait Speed ◽  
Case Series ◽  
Step Length ◽  
Gait Training ◽  
Chronic Stroke ◽  
Proprioceptive Feedback ◽  
Immersive Virtual Environment ◽  
Time Symmetry ◽  
Stance Time

Background and Purpose Persistent deficits in gait speed and spatiotemporal symmetry are prevalent following stroke and can limit the achievement of community mobility goals. Rehabilitation can improve gait speed, but has shown limited ability to improve spatiotemporal symmetry. The incorporation of combined visual and proprioceptive feedback regarding spatiotemporal symmetry has the potential to be effective at improving gait. Case Description A 60-year-old man (18 months poststroke) and a 53-year-old woman (21 months poststroke) each participated in gait training to improve gait speed and spatiotemporal symmetry. Each patient performed 18 sessions (6 weeks) of combined treadmill-based gait training followed by overground practice. To assist with relearning spatiotemporal symmetry, treadmill-based training for both patients was augmented with continuous, real-time visual and proprioceptive feedback from an immersive virtual environment and a dual belt treadmill, respectively. Outcomes Both patients improved gait speed (patient 1: 0.35 m/s improvement; patient 2: 0.26 m/s improvement) and spatiotemporal symmetry. Patient 1, who trained with step-length symmetry feedback, improved his step-length symmetry ratio, but not his stance-time symmetry ratio. Patient 2, who trained with stance-time symmetry feedback, improved her stance-time symmetry ratio. She had no step-length asymmetry before training. Discussion Both patients made improvements in gait speed and spatiotemporal symmetry that exceeded those reported in the literature. Further work is needed to ascertain the role of combined visual and proprioceptive feedback for improving gait speed and spatiotemporal symmetry after chronic stroke.

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.

scholarly journals EFFECTS OF A 6-WEEK TASK SPECIFIC POWER TRAINING WITH AND WITHOUT COGNITIVE TRAINING AMONG OLDER ADULTS WITH SLOW GAIT

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S875-S875
Author(s):  
Elisa F Ogawa ◽  
Rebekah Harris ◽  
Joseph DeGutis ◽  
Rachel Ward ◽  
Jennifer Brach ◽  
...  
Keyword(s):  
Cognitive Training ◽  
Gait Speed ◽  
Step Length ◽  
Specific Power ◽  
Power Training ◽  
Short Term ◽  
Time Step ◽  
Mobility Performance ◽  
Gait Characteristics ◽  
Stance Time

Abstract Task-specific power training (InVEST) targets leg power and mobility skills that are beneficial for treating slow gait speed for older adults. This study investigated the efficacy of a short-term InVEST training on leg power, mobility performance, and gait characteristics and further examine whether the addition of cognitive training would augment the impact on the outcomes. Mobility limited community-dwelling older Veterans age ≥65 years were recruited. Participants were randomly assigned to either InVEST training (n=10) or InVEST+cognitive training (n=11). Training occurred 3 times per week for 6 weeks. Sessions were either 70 minutes (InVest+cognitive training) or 40 minutes (InVEST) in duration. Leg power, mobility performance (Short Physical Performance Battery), and gait characteristics (gait speed, stance time, step width, swing time, step length and their variabilities under single-task, simple and complex dual-task walking conditions) were evaluated. Twenty-one men with mean age 76±7 years completed the study and 86% were of white race. Among all participants, clinically relevant and statistically significant improvements in leg power, mobility performance, and gait characteristics (gait speed, step length, stance time under all three gait conditions) were observed. There were no statistically significant or clinically relevant group differences among any of the outcomes based on cognitive training status. Short-term InVEST training led to clinically meaningful improvements in leg power, mobility performance, and gait characteristics. These findings add to the body of evidence supporting the benefits of InVEST training on mobility and do not support the contention that mixed modes of training (cognitive and physical) may augment mobility outcomes.

scholarly journals Error-augmentation gait training to improve gait symmetry in patients with non-traumatic lower limb amputation: A proof-of-concept study

2019 ◽  
Vol 43 (4) ◽  
pp. 426-433
Author(s):  
Paul W Kline ◽  
Amanda M Murray ◽  
Matthew J Miller ◽  
Thomas Fields ◽  
Cory L Christiansen
Keyword(s):  
Step Length ◽  
Gait Training ◽  
Limb Amputation ◽  
Single Session ◽  
Overground Walking ◽  
Transtibial Amputation ◽  
Time Asymmetry ◽  
Gait Symmetry ◽  
Stance Time ◽  
Training Protocol

Background:Asymmetrical stepping patterns are chronic gait impairment for individuals with non-traumatic lower limb amputation. Persistent gait asymmetries contribute to poor gait efficiency, decreased physical function, and development of secondary orthopedic conditions.Objectives:Evaluate the feasibility and preliminary responsiveness of a treadmill-based, error-augmentation gait training protocol to improve gait symmetry in patients with non-traumatic transtibial amputation.Study design:Single group, pre- and post-test.Methods:The error-augmentation gait training protocol involved walking on a split-belt treadmill with asymmetrical belt speeds for five 3-min sets. Spatiotemporal gait characteristics during overground walking at self-selected and fast walking speeds were assessed prior to, immediately after, and 20 min following the error-augmentation gait training protocol. Outcomes included practicality, implementation feasibility, safety, participant acceptability, and change in gait asymmetry.Results:All four participants completed the error-augmentation gait training protocol as prescribed, without adverse events, and found the intervention to be acceptable. Step length and stance time asymmetry during overground walking changed immediately following the error-augmentation gait training protocol with inconsistent changes retained after a 20 min washout period.Conclusions:A single session of error-augmentation gait training is a feasible and safe intervention to modify gait asymmetry in patients with non-traumatic transtibial amputation. Additional study with larger sample sizes and repeated error-augmentation gait training dosing are warranted.Clinical relevanceGait training using error-augmentation on a split-belt treadmill may modify step length and stance time asymmetry for patients with non-traumatic transtibial amputation, but additional research is needed regarding short- and long-term efficacy. Additional training sessions may be needed to sustain initial changes achieved from a single session.

scholarly journals Robotic-Assisted Gait Training Effect on Function and Gait Speed in Subacute and Chronic Stroke Population: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2019 ◽  
Vol 81 (3-4) ◽  
pp. 103-111 ◽  
Author(s):  
Jaya Shanker Tedla ◽  
Snehil Dixit ◽  
Kumar Gular ◽  
Mohammed Abohashrh
Keyword(s):  
Systematic Review ◽  
Effect Size ◽  
Gait Speed ◽  
Meta Analysis ◽  
Gait Training ◽  
Chronic Stroke ◽  
Total Effect ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Subacute Stroke

Background: The review is intended to provide the effectiveness of robotic-assisted gait training (RAGT) for functional gait recovery in poststroke survivors through a systematic review and to provide evidence for gait speed improvements through the meta-analysis of randomized controlled trials (RCTs). Summary: In this systematic review, PubMed, Web of Science, Wiley Online Library, Science Direct, Science Robotics, Scopus, UpToDate, MEDLINE, Google Scholar, ­CINHAL, EMBASE, and EBSCO were reviewed to identify relevant RCTs. Articles included in the study were thoroughly examined by 2 independent reviewers. The included RCTs were having a PEDro score between 6 and 8 points. The initial database review yielded 1,371 studies and, following further screening; 9 studies finally were selected for systematic review and meta-analysis. Out of the 9 studies, 4 were on chronic stroke and 5 were on subacute stroke. The meta-analysis of gait speed showed an effect size value ranging between –0.91 and 0.64, with the total effect size of all the studies being –0.12. During subgroup analysis, the subacute stroke total effect size was identified as –0.48, and the chronic stroke total effect size was noted as 0.04. Meta-analysis revealed no significant differences between RAGT and conventional gait training (CGT). Key Messages: Our systematic review revealed that the RAGT application demonstrated a better or similar effect to that of CGT in a poststroke population. A meta-analysis of gait speed involving all the studies identified here indicated no significant differences between RAGT and CGT. However, the subanalysis of chronic stroke survivors showed a slight positive effect of RAGT on gait speed.

The role of augmented feedback in pediatric robotic-assisted gait training: A case series

2010 ◽  
Vol 22 (4) ◽  
pp. 215-227 ◽  
Author(s):  
Benjamin L. Patritti ◽  
Monica Sicari ◽  
Lynn C. Deming ◽  
Fernanda Romaguera ◽  
Marlena M. Pelliccio ◽  
...  
Keyword(s):  
Case Series ◽  
Gait Training ◽  
Augmented Feedback ◽  
Robotic Assisted

scholarly journals Effects of Long-Term Gait Training Using Visual Cues in an Individual With Parkinson Disease

2006 ◽  
Vol 86 (2) ◽  
pp. 186-194 ◽  
Author(s):  
Ben Sidaway ◽  
Jennifer Anderson ◽  
Garth Danielson ◽  
Lucas Martin ◽  
Garth Smith
Keyword(s):  
Motor Control ◽  
Parkinson Disease ◽  
Lower Limb ◽  
Gait Speed ◽  
Visual Cues ◽  
Step Length ◽  
Gait Training ◽  
Visual Cueing ◽  
Gait Phase

Background and Purpose. In an attempt to improve the gait of people with Parkinson disease (PD), researchers have examined the effect of visual cues placed on the floor. These studies typically have used a single session of training with such cues and have not examined the long-term carryover of such training. In the present study, therefore, gait was analyzed during uncued, cued, and retention phases, each lasting 1 month. Subject. A 78-year-old woman who had been diagnosed with PD 12 years previously (Hoehn and Yahr classification of disability, stage III) volunteered for the study. Methods. During the initial uncued gait phase, the subject was required to walk a distance of 10 m as many times as she could in 30 minutes, 3 times per week for 4 weeks. During the 4-week cued gait phase, visual cues were placed on the floor along the 10-m walkway. The cues were initially 110% of the uncued step length and were later increased to 120%. Following this cued gait phase, the subject’s gait was recorded periodically for 1 month without cues available. Step length, gait speed, and 2-dimensional lower-limb kinematics were compared within and across the 3 experimental phases. Celeration lines were calculated for the initial uncued phase and then extrapolated across the cued training and uncued retention phases. Binomial tests were used to analyze the significance of changes from the initial phase of the experiment. Results. Step length (0.53–0.56 m) and gait speed (0.77–0.82 m·s−1) were essentially unchanged during uncued gait training after the first day; however, during the cued gait phase, gait speed improved, from 0.87 m·s−1 to 1.13 m·s−1, as step length was increased with visual cues. Improvements in step length (0.68 m) and gait speed (1.08 m·s−1) were still evident 1 month following the removal of the cues. Analyses of angle-angle diagrams and phase-plane portraits revealed that training with visual cues increased hip and knee range of motion and engendered more stable motor control of the lower limb. Discussion and Conclusion. In contrast to previous studies in which the benefits of visual cueing were relatively short-lived, in this study, 1 month of gait training with visual cues was successful in establishing a lasting improvement in gait speed and step length while increasing the stability of the underlying motor control system. [Sidaway B, Anderson J, Danielson G, et al. Effects of long-term gait training using visual cues in an individual with Parkinson disease.

scholarly journals Task-specific training for improving propulsion symmetry and gait speed in people in the chronic phase after stroke: a proof-of-concept study

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
J. F. Alingh ◽  
B. E. Groen ◽  
J. F. Kamphuis ◽  
A. C. H. Geurts ◽  
V. Weerdesteyn
Keyword(s):  
Gait Speed ◽  
Daily Life ◽  
Gait Training ◽  
Chronic Stroke ◽  
Stroke Survivors ◽  
Proof Of Concept ◽  
Concept Study ◽  
Walking Activity ◽  
Robotic Gait ◽  
Functional Gait

Abstract Background After stroke, some individuals have latent, propulsive capacity of the paretic leg, that can be elicited during task-specific gait training. The aim of this proof-of-concept study was to investigate the effect of five-week robotic gait training for improving propulsion symmetry by increasing paretic propulsion in chronic stroke survivors. Methods Twenty-nine individuals with chronic stroke and impaired paretic propulsion (≥ 8% difference in paretic vs. non-paretic propulsive impulse) were enrolled. Participants received ten 60-min sessions of individual robotic gait training targeting paretic propulsion (five weeks, twice a week), complemented with home exercises (15 min/day) focusing on increasing strength and practicing learned strategies in daily life. Propulsion measures, gait kinematics and kinetics, self-selected gait speed, performance of functional gait tasks, and daily-life mobility and physical activity were assessed five weeks (T0) and one week (T1) before the start of intervention, and one week (T2) and five weeks (T3) after the intervention period. Results Between T0 and T1, no significant differences in outcomes were observed, except for a marginal increase in gait speed (+ 2.9%). Following the intervention, propulsion symmetry (+ 7.9%) and paretic propulsive impulse had significantly improved (+ 8.1%), whereas non-paretic propulsive impulse remained unchanged. Larger gains in propulsion symmetry were associated with more asymmetrical propulsion at T0. In addition, following the intervention significantly greater paretic trailing limb angles (+ 6.6%) and ankle plantarflexion moments (+ 7.1%) were observed. Furthermore, gait speed (+ 7.2%), 6-Minute Walk Test (+ 6.4%), Functional Gait Assessment (+ 6.5%), and daily-life walking intensity (+ 6.9%) had increased following the intervention. At five-week follow-up (T3), gains in all outcomes were retained, and gait speed had further increased (+ 3.6%). Conclusions The post-intervention gain in paretic propulsion did not only translate into improved propulsion symmetry and gait speed, but also pertained to performance of functional gait tasks and daily-life walking activity levels. These findings suggest that well-selected chronic stroke survivors may benefit from task-specific targeted training to utilize the residual propulsive capacity of the paretic leg. Future research is recommended to establish simple baseline measures for identification of individuals who may benefit from such training and confirm benefits of the used training concepts in a randomized controlled trial. Trial registration: Registry number ClinicalTrials.gov (www.clinicaltrials.gov): NCT04650802, retrospectively registered 3 December 2020.

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.

scholarly journals Innovative Long-Dose Neurorehabilitation for Balance and Mobility in Chronic Stroke: A Preliminary Case Series

2020 ◽  
Vol 10 (8) ◽  
pp. 555
Author(s):  
Catherine Boissoneault ◽  
Tyler Grimes ◽  
Dorian K. Rose ◽  
Michael F. Waters ◽  
Anna Khanna ◽  
...  
Keyword(s):  
Gait Speed ◽  
Case Series ◽  
Functional Independence ◽  
Limb Movement ◽  
Chronic Stroke ◽  
Small Sample ◽  
Functional Mobility ◽  
Stroke Survivors ◽  
Convenience Sample ◽  
Long Duration

(1) Objective: The objective was two-fold: (a) test a protocol of combined interventions; (b) administer this combined protocol within the framework of a six-month, intensive, long-duration program. The array of interventions was designed to target the treatment-resistant impairments underlying persistent mobility dysfunction: weakness, balance deficit, limb movement dyscoordination, and gait dyscoordination. (2) Methods: A convenience sample of eight chronic stroke survivors (>4 months post stroke) was enrolled. Treatment was 5 days/week, 1–2.5 h/day for 6 months, as follows: strengthening exercise, balance training, limb/gait coordination training, and aerobic exercise. Outcome measures: Berg Balance Scale (BBS), Fugl-Meyer Lower Limb Coordination (FM), gait speed, 6 Minute Walk Test (6MWT), Timed up and Go (TUG), Functional Independence Measure (FIM), Craig Handicap Assessment Rating Tool (CHART), and personal milestones. Pre-/post-treatment comparisons were conducted using the Permutation Test, suitable for ordinal measures and small sample size. (3) Results: For the group, there was a statistically (p ≤ 0.04) significant improvement in balance, limb movement coordination (FM), gait speed, functional mobility (TUG), and functional activities (FIM). There were measurable differences (minimum detectible change: MDC) in BBS, FM, gait speed, 6MWT, and TUG. There were clinically significant milestones achieved for selected subjects according to clinical benchmarks for the BBS, 6MWT, gait speed, and TUG, as well as achievement of personal milestones of life role participation. Effect sizes (Cohen’s D) ranged from 0.5 to 1.0 (with the exception of the (6MWT)). After six months of treatment, the above array of gains were beyond that reported by other published studies of chronic stroke survivor interventions. Personal milestones included: walking to mailbox, gardening/yardwork, walking a distance to neighbors, return to driving, membership at a fitness center, vacation trip to the beach, swimming at local pool, returning to work, housework, cooking meals. (4) Conclusions: Stroke survivors with mobility dysfunction were able to participate in the long-duration, intensive program, with the intervention array targeted to address impairments underlying mobility dysfunction. There were either clinically or statistically significant improvements in an array of measures of impairment, functional mobility, and personal milestone achievements.

scholarly journals Effects of Obesity on Adaptation Transfer from Treadmill to Over-Ground Walking

2021 ◽  
Vol 11 (5) ◽  
pp. 2108
Author(s):  
Daekyoo Kim ◽  
Phillip C. Desrochers ◽  
Cara L. Lewis ◽  
Simone V. Gill
Keyword(s):  
Step Length ◽  
Gait Training ◽  
Normal Weight ◽  
Treadmill Walking ◽  
Time Symmetry ◽  
Temporal Adaptation ◽  
Before And After ◽  
Walking Adaptation ◽  
Support Time ◽  
Over Ground Walking

Discerning whether individuals with obesity transfer walking adaptation from treadmill to over-ground walking is critical to advancing our understanding of walking adaptation and its usefulness in rehabilitating obese populations. We examined whether the aftereffects following split-belt treadmill adaptation transferred to over-ground walking in adults with normal-weight body mass index (BMI) and obese BMI. Nineteen young adults with obesity and 19 age-matched adults with normal weight walked on flat ground at their preferred speed before and after walking on a treadmill with tied belts (preferred speed) and with the split-belt at their preferred speed and at a speed 50% slower than their preferred speed. The adaptation and aftereffects in step length and double-limb support time symmetry were calculated. We found that the amount of temporal adaptation was similar for adults with obesity and with normal weight (p > 0.05). However, adults with obesity showed greater asymmetry for double-limb support time following split-belt treadmill walking compared to adults with normal weight (p < 0.05). Furthermore, the transfer of asymmetry for double-limb support time from the treadmill to over-ground walking was less in adults with obesity than in adults with normal weight (p < 0.05). The transfer of adapted gait following split-belt treadmill walking provides insight into how atypical walking patterns in individuals with obesity could be remediated using long-term gait training.

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