Immediate augmented real-time forefoot weight bearing using visual feedback improves gait symmetry in chronic stroke

2020 ◽  
Vol 28 (6) ◽  
pp. 733-741
Author(s):  
Jihye Jung ◽  
Wonjae Choi ◽  
Seungwon Lee
Keyword(s):  
Visual Feedback ◽  
Weight Bearing ◽  
Step Length ◽  
Gait Pattern ◽  
Gait Symmetry ◽  
Affected Side ◽  
Gait Parameters ◽  
Weight Shift ◽  
Spatiotemporal Parameters ◽  
Single Limb Support

BACKGROUND: Symmetry of gait is an important component of rehabilitation in stroke patients. Insufficient weight-bearing causes gait asymmetry. OBJECTIVE: This study aimed to identify the immediate effects of sufficient weight-bearing on the forefoot during the stance phase using visual feedback. METHODS: Twenty-seven individuals with stroke enrolled in this study. All patients were evaluated for gait parameters with and without visual feedback. Visual feedback was provided through a smart application and a beam projector screen that showed a weight shift as a change in color. Spatiotemporal gait parameters were evaluated, resulting in values for a calculated symmetry index, in addition to heel % and toe % temporal values. RESULTS: Velocity and cadence were significantly decreased when visual feedback was provided (p< 0.05). Spatiotemporal parameters, except for bilateral step length, swing time of affected side, and single-limb support of less affected side, showed significant improvement (p< 0.05). The gait pattern of subjects was more symmetrical with visual feedback compared to non-visual feedback (p< 0.05). The toe-on time significantly improved on the affected side with visual feedback (p< 0.05). CONCLUSION: This study suggests that visual feedback aids in the improvement of gait symmetry, forefoot weight-bearing on the affected side, and spatiotemporal parameters.

The Effect of Prosthesis Alignment on the Symmetry of Gait in Subjects with Unilateral Transtibial Amputation

2006 ◽  
Vol 30 (2) ◽  
pp. 114-128 ◽  
Author(s):  
Daniel H. K. Chow ◽  
Andrew D. Holmes ◽  
Christina K. L. Lee ◽  
S. W. Sin
Keyword(s):  
Knee Flexion ◽  
Dynamic Testing ◽  
Reaction Force ◽  
Step Length ◽  
Gait Pattern ◽  
Vertical Ground Reaction Force ◽  
Gait Symmetry ◽  
Prosthetic Alignment ◽  
Gait Parameters ◽  
Study Results

A high degree of gait symmetry is characteristic of healthy gait. The aim of this study is to examine the symmetry of various gait parameters in subjects with unilateral trans-tibial amputation over a range of acceptable anteroposterior translational and tilt alignments, and further to examine if a consistent alignment of highest symmetry can be found. Acceptable alignments were determined by bench, static and dynamic testing on level and non-level surfaces. A total of 15 kinetic and kinematic parameters were then measured in the seven subjects participating in this study. Results indicate that some parameters show consistently higher symmetries, particularly the vertical ground reaction force parameters and the stance duration, step length and time to full knee flexion during the swing phase. Symmetries in other parameters such as knee flexion at loading response, acceleration impulse, and peak anteroposterior propulsive force seem to have little relevance in determining whether the gait pattern for that prosthetic alignment is acceptable or not. While analysis of the symmetry of more relevant gait parameters may assist the prosthetist in consistently and objectively identifying a most symmetrical alignment within the acceptable range, further clinical study is required before any conclusions can be drawn regarding evaluation of symmetry as a tool in defining any optimum alignment.

Feasibility and Preliminary Efficacy of Gait Training Assisted by Multichannel Functional Electrical Stimulation in Early Stroke Rehabilitation: A Pilot Randomized Controlled Trial

2021 ◽  
Vol 35 (2) ◽  
pp. 131-144
Author(s):  
Maijke van Bloemendaal ◽  
Sicco A. Bus ◽  
Frans Nollet ◽  
Alexander C. H. Geurts ◽  
Anita Beelen
Keyword(s):  
Electrical Stimulation ◽  
Functional Electrical Stimulation ◽  
Step Length ◽  
Gait Training ◽  
Control Group ◽  
Significant Group ◽  
Gait Symmetry ◽  
Gait Parameters ◽  
Walking Capacity ◽  
Experimental Group

Background. Many stroke survivors suffer from leg muscle paresis, resulting in asymmetrical gait patterns, negatively affecting balance control and energy cost. Interventions targeting asymmetry early after stroke may enhance recovery of walking. Objective. To determine the feasibility and preliminary efficacy of up to 10 weeks of gait training assisted by multichannel functional electrical stimulation (MFES gait training) applied to the peroneal nerve and knee flexor or extensor muscle on the recovery of gait symmetry and walking capacity in patients starting in the subacute phase after stroke. Methods. Forty inpatient participants (≤31 days after stroke) were randomized to MFES gait training (experimental group) or conventional gait training (control group). Gait training was delivered in 30-minute sessions each workday. Feasibility was determined by adherence (≥75% sessions) and satisfaction with gait training (score ≥7 out of 10). Primary outcome for efficacy was step length symmetry. Secondary outcomes included other spatiotemporal gait parameters and walking capacity (Functional Gait Assessment and 10-Meter Walk Test). Linear mixed models estimated treatment effect postintervention and at 3-month follow-up. Results. Thirty-seven participants completed the study protocol (19 experimental group participants). Feasibility was confirmed by good adherence (90% of the participants) and participant satisfaction (median score 8). Both groups improved on all outcomes over time. No significant group differences in recovery were found for any outcome. Conclusions. MFES gait training is feasible early after stroke, but MFES efficacy for improving step length symmetry, other spatiotemporal gait parameters, or walking capacity could not be demonstrated. Trial Registration. Netherlands Trial Register (NTR4762).

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 Persons post-stroke improve step length symmetry by walking asymmetrically

2020 ◽  
Author(s):  
Purnima Padmanabhan ◽  
Keerthana Sreekanth ◽  
Shivam Gulhar ◽  
Kendra M. Cherry-Allen ◽  
Kristan A. Leech ◽  
...  
Keyword(s):  
Center Of Mass ◽  
Metabolic Cost ◽  
Step Length ◽  
Gait Pattern ◽  
Future Research ◽  
Cost Of Transport ◽  
Post Stroke ◽  
Paretic Limb ◽  
Gait Parameters ◽  
The Many

Abstract Background Restoration of step length symmetry is a common rehabilitation goal after stroke. Persons post-stroke often retain the ability to walk with symmetric step lengths ("symmetric steps") at an elevated metabolic cost relative to healthy adults. Two key questions with direct implications for rehabilitation have emerged: 1) how do persons post-stroke generate symmetric steps, and 2) why do symmetric steps remain so effortful? Here, we aimed to understand how persons post-stroke generate symmetric steps and explored how the resulting gait pattern may relate to the metabolic cost of transport. Methods We recorded kinematic, kinetic, and metabolic data as nine persons post-stroke walked on an instrumented treadmill under two conditions: preferred walking and symmetric stepping (using visual feedback). Results Gait kinematics and kinetics remained markedly asymmetric even when persons post-stroke improved step length symmetry. Impaired paretic propulsion and abnormal movement of the center of mass were evident during both preferred walking and symmetric stepping. These deficits contributed to diminished positive work performed by the paretic limb on the center of mass in both conditions. Within each condition, decreased positive paretic work correlated with increased metabolic cost of transport and decreased walking speed across participants. Conclusions It is critical to consider the mechanics used to restore symmetric steps when designing interventions to improve walking after stroke. Future research should consider the many dimensions of asymmetry in post-stroke gait, and additional within-participant manipulations of gait parameters are needed to improve our understanding of the elevated metabolic cost of walking after stroke.

scholarly journals THE DIFFERENCES OF GAIT PARAMETERS AMONG TYPE OF FOOT ARCH (NORMAL FOOT, FLATFOOT, AND CAVUS FOOT) IN CHILDREN AGED 10-12 YEARS AT ELEMENTARY SCHOOL IN WEST DENPASAR

2020 ◽  
Vol 8 (2) ◽  
pp. 57
Author(s):  
Komang Githa Pradnyamitha Dewi ◽  
Anak Ayu Nyoman Trisna Narta Dewi ◽  
Ni Komang Ayu Juni Antari ◽  
Agung Wiwiek Indrayani
Keyword(s):  
Elementary School ◽  
Stride Length ◽  
Step Length ◽  
Gait Pattern ◽  
Homogeneity Test ◽  
Flat Foot ◽  
Cross Sectional ◽  
Gait Parameters ◽  
Cavus Foot ◽  
Foot Arch

Growth and development in children are important. One of these is the development of walking or gait. Some parents often feel worried when their child’s gait pattern looks abnormal, which can be caused by the presence of abnormalities in the type of foot arch. The type of foot arch consists of normal foot, flat foot, and the cavus foot. The foot arch can affect the gait pattern; the gait pattern can be measured with gait parameters. Basic gait parameters which were often used; the cadence, stride length, step length, and speed. The purpose of this research is to analyze the existence of differences in gait parameters in each type of foot arch at elementary school children between aged 10-12 years in West Denpasar. This analytical study was used a cross-sectional study design that was held on March 2019. The number of samples in the study were 113 people (58 men, 55 women) between aged 10-12 years. The type of foot arch measured the independent variable by doing the footprint, and the classification used Clarke's Angle. Measurements of the dependent variables using the different way. Cadence is measured by asking the persons to walk for a minute and then counted the number of their steps in a minute. Measurement of stride length and step length by doing the footprint on the long cover paper. Speed is calculated using the formula of results cadence and stride length. After obtaining the data, the normality test used Kolmogorov Smirnov Test and homogeneity test by Levene's had been done. The analysis used the Kruskal Wallis Test to find out significant mean difference among the group (p = 0.000). Based on this study, it was concluded that there are different gait parameters among normal foot, flat foot and cavus foot in children aged 10-12 years at elementary school in West Denpasar.

scholarly journals Effects of Robot-Assisted Therapy on Gait Parameters in Pediatric Patients With Spastic Cerebral Palsy

2021 ◽  
Vol 12 ◽  
Author(s):  
Faustyna Manikowska ◽  
Sabina Brazevic ◽  
Anna Krzyżańska ◽  
Marek Jóźwiak
Keyword(s):  
Cerebral Palsy ◽  
Gait Training ◽  
Spastic Cerebral Palsy ◽  
Gait Symmetry ◽  
Double Support ◽  
Patient Profile ◽  
Gait Parameters ◽  
Gait Deviation Index ◽  
Spatiotemporal Parameters

Background: Gait dysfunction is a crucial factor that restricts independence and quality of life in children with cerebral palsy (CP). Gait training based on robotic-assisted therapy (RAT) is widely used, but information about effectiveness and ideal patient profile is not sufficient. Aim of this study was to assess the effect of RAT on gait parameters in spastic children with CP, and to determine whether changes in gait parameters are different among patients on different ambulatory levels.Method: A total of 26 children with bilateral spastic CP were divided into two groups based on their functional ability: non-assisted ambulator (NAS) or assisted ambulator (AS); and underwent a RAT program (30 training sessions of RAT during 10 weeks). Gait analysis was performed: before the therapy (t1), right after (t2), and 6 weeks later (t3).Results: No significant changes in spatiotemporal parameters or gait deviation index at t2 or t3. Double support symmetry significantly improved (t1 vs. t3, p = 0.03) for the whole group (NAS + AS). Walking speed symmetry significantly improved (t2 vs. t3, p = 0.02) for group AS.Conclusion: RAT based on our protocol did not change spatiotemporal parameters and kinematics of walking except limited improvement in some aspects of gait symmetry. We did not find differences in changes in selected objective gait parameters among children with CP in different ambulatory levels.

scholarly journals Analysis of the spatio-temporal gait parameters of transtibial amputees

2018 ◽  
Vol 1 (2) ◽  
pp. 247-253
Author(s):  
Yuliana Ruiz-Piragauta ◽  
Brigette Paola Torres-Bello ◽  
Esperanza Camargo-Casallas
Keyword(s):  
Lower Limb ◽  
Stride Length ◽  
Inertial Sensors ◽  
Step Length ◽  
Gait Pattern ◽  
Gait Parameters ◽  
Length Step ◽  
Spatio Temporal ◽  
Antipersonnel Mines ◽  
Transtibial Amputees

In this study we analyzed the spatio-temporal parameters (step length, step time, stride length, stride time, speed and rate) of three unilateral transtibial amputees in order to find the best gait pattern and this verify the adaptation of the prosthesis, using inertial sensors of the TECHNAID ® brand in order to make the diagnosis in an objective way; the data were processed using the MARCHA ET software of the DIGITI research group of the Universidad Distrital Francisco José de Caldas. In this study, were analyzed three subjects from the Hospital Militar Central (HMC) the cause of amputation is due to trauma caused by antipersonnel mines. It was found that subjects with unilateral transtibial amputation lean on more time and carry more weight on their healthy lower limb, which leads to an increase in mechanical demand on the knee joint of the amputated leg.

scholarly journals Characterization of speed adaptation while walking on an omnidirectional treadmill

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Smit Soni ◽  
Anouk Lamontagne
Keyword(s):  
Lower Limb ◽  
Muscle Activation ◽  
Low Cost ◽  
Weight Bearing ◽  
Step Length ◽  
Overground Walking ◽  
Walking Pattern ◽  
Spatiotemporal Parameters ◽  
Walking Speeds ◽  
The Impact

Abstract Background Conventional treadmills are widely used for gait retraining in rehabilitation setting. Their usefulness for training more complex locomotor tasks, however, remains limited given that they do not allow changing the speed nor the direction of walking which are essential walking adaptations for efficient and safe community ambulation. These drawbacks can be addressed by using a self-pace omnidirectional treadmill, as those recently developed by the gaming industry, which allows speed changes and locomotor movements in any direction. The extent to which these treadmills yield a walking pattern that is similar to overground walking, however, is yet to be determined. Methods The objective of this study was to compare spatiotemporal parameters, body kinematics and lower limb muscle activation of healthy young individuals walking at different speeds (slow, comfortable, fast) on a low-cost non-motorized omnidirectional treadmill with and without virtual reality (VR) vs. overground. Results Results obtained from 12 young healthy individuals (18–29 years) showed that participants achieved slower speed on the treadmill compared to overground. On the treadmill, faster walking speeds were achieved by a mere increase in cadence, as opposed to a combined increase in cadence and step length when walking overground. At matched speed, enhanced stance phase knee flexion, reduced late stance ankle plantarflexion, as well as enhanced activation amplitudes of hip extensors in late stance and hip extensors in early swing were observed. The addition of VR to treadmill walking had little or no effect of walking outcomes. Collectively, results show that the omnidirectional treadmill yields a different walking pattern and lead to different adaptations to speed compared to overground walking. We suggest that these alterations are mainly driven by the reduced shear forces between the weight bearing foot and supporting surface and a perceived threat to balance on the omnidirectional treadmill. Conclusion Since such treadmills are likely to be used for prolonged periods of time by gamers or patients undergoing physical rehabilitation, further research should aim at determining the impact of repeated exposure on gait biomechanics and lower limb musculoskeletal integrity.

Hemiparetic Gait Parameters in Overground Versus Treadmill Walking

2001 ◽  
Vol 15 (2) ◽  
pp. 105-112 ◽  
Author(s):  
Michelle L. Harris-Love ◽  
Larry W. Forrester ◽  
Richard F. Macko ◽  
Kenneth H. C. Silver ◽  
Gerald V. Smith
Keyword(s):  
Gait Pattern ◽  
Supporting Evidence ◽  
Gait Symmetry ◽  
Paretic Limb ◽  
Hemiparetic Gait ◽  
Gait Parameters ◽  
Stance Time ◽  
Hemiparetic Stroke ◽  
Chronic Hemiparetic Stroke ◽  
Sparse Methods

Objective: Hemiparetic gait is characterized by high stride-cycle variability, di minished stance time, single-limb stance time, and stance/swing ratio in the paretic limb. Recent studies suggest treadmill (TM) training may improve the motor control underlying these variables, but supporting evidence is sparse. Methods: This study compared gait patterns of untrained chronic hemiparetic stroke patients (n = 18; mean, 39.5 months poststroke) during overground (OG) and TM walking at matched velocities. Variables included relative stance time, relative single-limb stance time, stance/swing ratio, peak force, and impulse. Within-subject variability of these meas ures (CV) was used to assess gait pattern stability. Results: OG and TM cycle dura tions were similar, but CVs differed (TM < OG, p < 0.05). In the paretic limb, dif ferences were seen in relative stance time, relative single-limb stance time, and stance/swing ratio, respectively (TM > OG, p < 0.05). These variables decreased in the nonparetic limb during TM walking (p < 0.05 for all). Improved interlimb sym metry and coordination were evidenced by decreased between-limb differences and improved relative temporal phasing, respectively, in the TM condition (p < 0.05). Conclusions: Collectively, these results demonstrate that the TM induces an imme diate alteration toward a more consistent and symmetric gait pattern. Further inves tigation is needed to determine whether TM training leads to motor relearning and neuroplasticity in chronic hemiparetic subjects. Key Words: Stroke—Rehabilitation— Hemiparetic gait-Treadmill-Gait symmetry.

scholarly journals The Impact of Different Periods of Walking Experience on Kinematic Gait Parameters in Toddlers

2021 ◽  
Vol 19 (1) ◽  
pp. 58
Author(s):  
Marta Gimunová ◽  
Martin Sebera ◽  
Michal Bozděch ◽  
Kateřina Kolářová ◽  
Tomáš Vodička ◽  
...  
Keyword(s):  
Step Length ◽  
Gait Pattern ◽  
Step Width ◽  
Gait Parameters ◽  
Significant Difference ◽  
Group 3 ◽  
Group 2 ◽  
Morphological Differences ◽  
Hip Flexion ◽  
The Impact

This study aimed to analyse the kinematic differences in gait between three groups of toddlers who differed in their weeks of independent walking (IW) experience, but not in anthropometrical characteristics, to determine the relationship between walking experience without the side effect of morphological differences on gait parameters. Twenty-six toddlers participated in this study. Depending on the week of their IW, toddlers were divided into three groups: Group 1 (1–5 weeks of IW), Group 2 (6–10 weeks of IW), and Group 3 (11–15 weeks of IW). Each toddler walked barefooted over a 2-m long pathway, and 3D kinematic data were obtained. A decrease in the upper limb position, hip flexion, and step width, i.e., changes towards the adult gait pattern, were observed in Group 3. Less experienced walkers exhibited a wider step width despite no statistically significant difference in body mass and height between groups. Results of this study show no statistically significant difference in step length between groups, suggesting that step length is more related to height than to the walking experience. The increased step length in more experienced walkers reported in previous studies may therefore be a result of different heights and not walking experience.

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