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Shi C, Xiao Y, Zang D, Ren H. Effectiveness of Treadmill Training Intervention for the Management of Patients With Stroke: A Systematic Review and Meta-Analysis. Int J Nurs Pract 2025; 31:e70020. [PMID: 40344634 PMCID: PMC12063472 DOI: 10.1111/ijn.70020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Revised: 03/27/2025] [Accepted: 04/25/2025] [Indexed: 05/11/2025]
Abstract
BACKGROUND Treadmill training, including body weight-supported treadmill training (BWSTT), is widely used in stroke rehabilitation. However, its efficacy in improving walking outcomes may vary depending on patients' baseline functional status. OBJECTIVE This study aims to systematically evaluate effectiveness of treadmill training on walking speed and endurance in stroke survivors and to assess influence of baseline dependency and use of BWSTT. METHODS We performed systematic review and meta-analysis as per PRISMA 2020 guidelines. Comprehensive search was conducted using Scopus, MEDLINE, EMBASE, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Cochrane Library, Google Scholar and ScienceDirect for studies published from January 1964 to April 2024. Eligible studies were randomized controlled trials assessing treadmill training in stroke patients with outcomes as walking speed and/or endurance. Data extraction and risk of bias assessment were independently performed by two reviewers using Cochrane Risk of Bias-2 tool. Standardized mean differences (SMDs) and 95% confidence intervals (CIs) were calculated using random effects model. Subgroup analyses were conducted based on baseline dependency and BWSTT use. RESULTS Fifty-nine studies were included. Meta-analysis demonstrated significant improvements in walking speed (SMD = 0.255; 95%CI: 0.141-0.369) and walking endurance (SMD = 0.277; 95%CI: 0.134-0.421) among stroke survivors receiving treadmill training. Subgroup analysis revealed that independent participants experienced greater benefits in walking speed (SMD = 0.345) and endurance (SMD = 0.374) compared to dependent participants. Studies employing BWSTT reported enhanced outcomes relative to those without BWSTT. Moderate to high heterogeneity was observed, and publication bias was detected. CONCLUSION Treadmill training, particularly when combined with BWSTT, effectively enhances walking speed and endurance in stroke survivors.
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Affiliation(s)
- Chenyi Shi
- Department of RehabilitationBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Yuxi Xiao
- Department of TraumaBeijing Water Conservancy HospitalBeijingChina
| | - Dawei Zang
- Department of RehabilitationBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Hongjun Ren
- Department of TraumaBeijing Water Conservancy HospitalBeijingChina
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Bonanno M, De Pasquale P, Lombardo Facciale A, Dauccio B, De Luca R, Quartarone A, Calabrò RS. May Patients with Chronic Stroke Benefit from Robotic Gait Training with an End-Effector? A Case-Control Study. J Funct Morphol Kinesiol 2025; 10:161. [PMID: 40407445 PMCID: PMC12101270 DOI: 10.3390/jfmk10020161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2025] [Revised: 05/02/2025] [Accepted: 05/05/2025] [Indexed: 05/26/2025] Open
Abstract
Background: Gait and balance alterations in post-stroke patients are one of the most disabling symptoms that can persist in chronic stages of the disease. In this context, rehabilitation has the fundamental role of promoting functional recovery, mitigating gait and balance deficits, and preventing falling risk. Robotic end-effector devices, like the G-EO system (e.g., G-EO system, Reha Technology, Olten, Switzerland), can be a useful device to promote gait recovery in patients with chronic stroke. Materials and Methods: Twelve chronic stroke patients were enrolled and evaluated at baseline (T0) and at post-treatment (T1). These patients received forty sessions of robotic gait training (RGT) with the G-EO system (experimental group, EG), for eight weeks consecutively, in addition to standard rehabilitation therapy. The data of these subjects were compared with those coming from a sample of twelve individuals (control group, CG) matched for clinical and demographic features who underwent the same amount of conventional gait training (CGT), in addition to standard rehabilitation therapy. Results: All patients completed the trial, and none reported any side effects either during or following the training. The EG showed significant improvements in balance (p = 0.012) and gait (p = 0.004) functions measured with the Tinetti Scale (TS) after RGT. Both groups (EG and CG) showed significant improvement in functional independence (FIM, p < 0.001). The Fugl-Meyer Assessment-Lower Extremity (FMA-LE) showed significant improvements in motor function (p = 0.001, p = 0.031) and passive range of motion (p = 0.031) in EG. In EG, gait and balance improvements were influenced by session, age, gender, time since injury (TSI), cadence, and velocity (p < 0.05), while CG showed fewer significant effects, mainly for age, TSI, and session. EG showed significantly greater improvements than CG in balance (p = 0.003) and gait (p = 0.05) based on the TS. Conclusions: RGT with end-effectors, like the G-EO system, can be a valuable complementary treatment in neurorehabilitation, even for chronic stroke patients. Our findings suggest that RGT may improve gait, balance, and lower limb motor functions, enhancing motor control and coordination.
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Affiliation(s)
- Mirjam Bonanno
- IRCCS Centro Neurolesi Bonino-Pulejo, 98124 Messina, Italy; (M.B.); (A.L.F.); (B.D.); (R.D.L.); (A.Q.); (R.S.C.)
| | - Paolo De Pasquale
- IRCCS Centro Neurolesi Bonino-Pulejo, 98124 Messina, Italy; (M.B.); (A.L.F.); (B.D.); (R.D.L.); (A.Q.); (R.S.C.)
| | - Antonino Lombardo Facciale
- IRCCS Centro Neurolesi Bonino-Pulejo, 98124 Messina, Italy; (M.B.); (A.L.F.); (B.D.); (R.D.L.); (A.Q.); (R.S.C.)
| | - Biagio Dauccio
- IRCCS Centro Neurolesi Bonino-Pulejo, 98124 Messina, Italy; (M.B.); (A.L.F.); (B.D.); (R.D.L.); (A.Q.); (R.S.C.)
| | - Rosaria De Luca
- IRCCS Centro Neurolesi Bonino-Pulejo, 98124 Messina, Italy; (M.B.); (A.L.F.); (B.D.); (R.D.L.); (A.Q.); (R.S.C.)
| | - Angelo Quartarone
- IRCCS Centro Neurolesi Bonino-Pulejo, 98124 Messina, Italy; (M.B.); (A.L.F.); (B.D.); (R.D.L.); (A.Q.); (R.S.C.)
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98125 Messina, Italy
| | - Rocco Salvatore Calabrò
- IRCCS Centro Neurolesi Bonino-Pulejo, 98124 Messina, Italy; (M.B.); (A.L.F.); (B.D.); (R.D.L.); (A.Q.); (R.S.C.)
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Morales Mayoral R, Logan SW, Fitter NT. Human-centered design and early evaluation of an interface for mobile-manipulator-mediated pediatric occupational therapy. Front Robot AI 2025; 12:1520216. [PMID: 40170879 PMCID: PMC11958963 DOI: 10.3389/frobt.2025.1520216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2024] [Accepted: 02/17/2025] [Indexed: 04/03/2025] Open
Abstract
Assistive mobile robots can play an important role in supporting individuals with disabilities. While the field of robot control interfaces for individuals with disabilities is growing, there is little work done on such systems for children end users specifically. Accordingly, we pursued the design of an adapted robot control interface for use in child pediatric occupational therapy (OT). Our target end user, a nine-year-old child with cerebral palsy, leveraged the interface to perform instrumental activities of daily living (e.g., play) with a modern mobile manipulator. We used an iterative design process to adjust and improve the interface via input from the participant's caregivers and occupational therapist, as well as objective participant performance data. Furthermore, we tested the participant's ability to utilize our interface by creating two testing cases: a control case (in which our participant performed standard ALD/IADL tasks) and an experimental case (in which our participant performed ADL/IADL practice activities more tailored toward the child). Key insights during the process included the need for sensitivity to taking up space on the child user's existing power wheelchair, the advantages of integrating technologies familiar to the child (e.g., gaming controls, iPads) in our system design, and the potential value of integrating playful mischief (including playful interactions between the child, their caregivers, and their clinicians) as a part of the playbook for pediatric OT. This work can serve to inform and augment new OT strategies for the marginalized population of young children with disabilities.
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Affiliation(s)
- Rafael Morales Mayoral
- Collaborative Robotics and Intelligent Systems Institute (CoRIS), Oregon State University, Corvallis, OR, United States
| | - Samuel W. Logan
- Disability and Mobility Do-it-Yourself Co-Op, Oregon State University, Corvallis, OR, United States
| | - Naomi T. Fitter
- Collaborative Robotics and Intelligent Systems Institute (CoRIS), Oregon State University, Corvallis, OR, United States
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Schneider VM, de Abreu RF, Tanaka H, Ferrari R. Post-exercise hypotension after different volumes of combined calisthenic and walking exercises in older adults with hypertension: a randomized controlled trial. J Hum Hypertens 2025; 39:22-28. [PMID: 39443753 DOI: 10.1038/s41371-024-00972-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 10/15/2024] [Accepted: 10/17/2024] [Indexed: 10/25/2024]
Abstract
This study aimed to analyze the acute effects of combined calisthenic and walking exercises using different volumes on blood pressure (BP) in aging adults with primary hypertension. A total of 48 participants with primary hypertension aged 50-80 years were randomly assigned into two groups that performed two experimental sessions each: a non-exercising CONTROL session and a LOW (group 1) or HIGH (group 2) volume exercise session. The order of these sessions was randomized. The exercise protocols lasted 30 min (LOW) or 60 min (HIGH) and consisted of calisthenic exercises combined with continuous walking or jogging. Exercise intensity was controlled using a rating of perceived exertion (RPE) scale. BP was measured at baseline and after each session for 60 min. Results showed that systolic BP was lower after the HIGH session at post 30' (p = 0.03), post 40' (p = 0.03), post 50' (p = 0.04), and post 60' (p < 0.02), and after the LOW session at post 30' (p = 0.02), post 40' (p < 0.01), post 50' (p < 0.01), and post 60' (p < 0.01) when compared to the corresponding CONTROL at the same time point. There were no significant differences in systolic and diastolic BP between the HIGH and LOW sessions. In conclusion, a pragmatic combined training session using different volumes acutely reduces BP in older adults with primary hypertension.
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Affiliation(s)
- Vinícius Mallmann Schneider
- Postgraduate Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Sports and Exercise Training Study Group, Clinical Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Rodrigo Flores de Abreu
- Postgraduate Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Sports and Exercise Training Study Group, Clinical Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Hirofumi Tanaka
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX, USA
| | - Rodrigo Ferrari
- Postgraduate Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
- Sports and Exercise Training Study Group, Clinical Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.
- Postgraduate Program in Human Movement Sciences, School of Physical Education, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
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Usman JS, Wong TWL, Ng SSM. Effects of treadmill training combined with transcranial direct current stimulation on mobility, motor performance, balance function, and other brain-related outcomes in stroke survivors: a systematic review and meta-analysis. Neurol Sci 2025; 46:99-111. [PMID: 39294410 PMCID: PMC11698808 DOI: 10.1007/s10072-024-07768-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Accepted: 09/10/2024] [Indexed: 09/20/2024]
Abstract
INTRODUCTION Treadmill training (TT) is a gait training technique that has commonly been used in neurorehabilitation, and has positive effects on gait, mobility, and related outcomes in stroke survivors. Transcranial direct current stimulation (tDCS) is a non-invasive approach for modulating brain cortex excitability. AIM To evaluate the available scientific evidence on the effects of TT combined with tDCS on mobility, motor performance, balance function, and brain-related outcomes in stroke survivors. METHODS Five databases namely the Cochrane library, PEDro, Web of Science, PubMed, and EMBASE, were searched for relevant studies from inception to March, 2024. Only randomized controlled trials were included, and their methodological quality and risk of bias (ROB) were evaluated using the PEDro scale and Cochrane ROB assessment tool respectively. Qualitative and quantitative syntheses (using fixed effects meta-analysis) were employed to analyze the data. RESULTS The results revealed that TT combined with active tDCS had significant beneficial effects on some mobility parameters, some gait spatiotemporal parameters, some gait kinematic parameters, gait endurance, gait ability, and corticomotor excitability in stroke survivors, but no significant difference on gait speed (P > 0.05), functional mobility (P > 0.05), motor performance (P > 0.05), or some balance functions (P > 0.05), compared with the control conditions. CONCLUSIONS TT combined with active tDCS significantly improves some gait/mobility outcomes and corticomotor excitability in stroke survivors.
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Affiliation(s)
- Jibrin Sammani Usman
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
| | - Thomson Wai-Lung Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
| | - Shamay Sheung Mei Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China.
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Jiang Z, Zhang X, Fu Q, Tao Y. Effects of body weight support training on balance and walking function in stroke patients: a systematic review and meta-analysis. Front Neurol 2024; 15:1413577. [PMID: 39258157 PMCID: PMC11384990 DOI: 10.3389/fneur.2024.1413577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 08/15/2024] [Indexed: 09/12/2024] Open
Abstract
Objective To comprehensively and quantitatively evaluate the impact of body weight support training (BWST) on balance and gait function in stroke patients based on an evidence-based basis and to identify the most effective intervention strategies. Methods PubMed, Web of Science, The Cochrane Library, CNKI, Wanfang, and Chinese SinoMed Database were searched until November 25, 2023. Quality assessment and meta-analysis were performed using RevMan 5.2 and Stata 14.0 software. Results A total of 31 randomized controlled trials involving 1,918 patients were included in the study. The meta-analysis demonstrated that body weight support training (BWST) significantly improved Berg Balance Scale (BBS) scores (MD = 3.60; 95% CI: 1.23 to 5.98; p = 0.003), gait speed (SMD = 0.77; 95% CI: 0.38 to 1.15; p < 0.0001), and step length (SMD = 0.46; 95% CI: 0.19 to 0.72; p = 0.0008) in stroke patients compared to conventional rehabilitation. For enhancing balance function, the most effective interventions were identified as a disease duration of 3-6 months (MD = 5.16; 95% CI: 0.76 to 9.57; p = 0.02), intervention time of 4-8 weeks (MD = 5.70; 95% CI: 2.90 to 8.50; p < 0.0001), a maximum body weight support level above 30% (MD = 3.80; 95% CI: 1.48 to 6.13; p = 0.001), and a maximum training walking speed of 0.2 m/s or more (MD = 4.66; 95% CI: 0.37 to 9.70; p = 0.03). For improving walking function, the optimal interventions were also a disease duration of 3-6 months (gait speed: SMD = 0.59; 95% CI: 0.15 to 1.03; p = 0.008; step length: SMD = 0.27; 95% CI: 0.06 to 0.56; p = 0.04), intervention time of 4-8 weeks (gait speed: SMD = 1.01; 95% CI: 0.44 to 1.59; p = 0.0006; step length: SMD = 0.83; 95% CI: 0.54 to 1.12; p < 0.00001), a maximum body weight support level above 30% (gait speed: SMD = 0.79; 95% CI: 0.36 to 1.22; p = 0.0003; step length: SMD = 0.79; 95% CI: 0.47 to 1.11; p < 0.00001), and a maximum training walking speed of 0.2 m/s or more (gait speed: SMD = 1.26; 95% CI: 0.62 to 1.90; p = 0.0001; step length: SMD = 0.85; 95% CI: 0.38 to 1.31; p = 0.0003). Conclusion Compared with conventional rehabilitation training, BWST demonstrates superior efficacy in enhancing balance and walking function in stroke patients, with a consistent optimal intervention strategy. The most effective program includes a disease duration of 3-6 months, an intervention period of 4-8 weeks, a maximum body weight support of 30% or more, and a maximum training walking speed of 0.2 m/s or greater. Systematic review registration http://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022358963.
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Affiliation(s)
- Zhaoxiang Jiang
- College of Physical Education and Health, Guangxi Normal University, Guilin, China
- School of Sports Economics and Management, Guangxi University of Finance and Economics, Nanning, China
| | - Xinxin Zhang
- College of Physical Education and Health, Guangxi Normal University, Guilin, China
| | - Qian Fu
- College of Physical Education and Health, Guangxi Normal University, Guilin, China
| | - Yimin Tao
- Guilin University of Aerospace Technology, Guilin, China
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Zhang LJ, Wen X, Peng Y, Hu W, Liao H, Liu ZC, Liu HY. Effectiveness of the A3 robot on lower extremity motor function in stroke patients: A prospective, randomized controlled trial. World J Clin Cases 2024; 12:5523-5533. [PMID: 39188596 PMCID: PMC11269979 DOI: 10.12998/wjcc.v12.i24.5523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 05/29/2024] [Accepted: 06/12/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND The results of existing lower extremity robotics studies are conflicting, and few relevant clinical trials have examined short-term efficacy. In addition, most of the outcome indicators in existing studies are scales, which are not objective enough. We used the combination of objective instrument measurement and scale to explore the short-term efficacy of the lower limb A3 robot, to provide a clinical reference. AIM To investigate the improvement of lower limb walking ability and balance in stroke treated by A3 lower limb robot. METHODS Sixty stroke patients were recruited prospectively in a hospital and randomized into the A3 group and the control group. They received 30 min of A3 robotics training and 30 min of floor walking training in addition to 30 min of regular rehabilitation training. The training was performed five times a week, once a day, for 2 wk. The t-test or non-parametric test was used to compare the three-dimensional gait parameters and balance between the two groups before and after treatment. RESULTS The scores of basic activities of daily living, Stroke-Specific Quality of Life Scale, FM balance meter, Fugl-Meyer Assessment scores, Rivermead Mobility Index, Stride speed, Stride length, and Time Up and Go test in the two groups were significantly better than before treatment (19.29 ± 12.15 vs 3.52 ± 4.34; 22.57 ± 17.99 vs 4.07 ± 2.51; 1.21 ± 0.83 vs 0.18 ± 0.40; 3.50 ± 3.80 vs 0.96 ± 2.08; 2.07 ± 1.21 vs 0.41 ± 0.57; 0.89 ± 0.63 vs 0.11 ± 0.32; 12.38 ± 9.00 vs 2.80 ± 3.43; 18.84 ± 11.24 vs 3.80 ± 10.83; 45.12 ± 69.41 vs 8.41 ± 10.20; 29.45 ± 16.62 vs 8.68 ± 10.74; P < 0.05). All outcome indicators were significantly better in the A3 group than in the control group, except the area of the balance parameter. CONCLUSION For the short-term treatment of patients with subacute stroke, the addition of A3 robotic walking training to conventional physiotherapy appears to be more effective than the addition of ground-based walking training.
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Affiliation(s)
- Lin-Jian Zhang
- Department of Rehabilitation Medicine, Yuebei People's Hospital, Shaoguan 512000, Guangdong Province, China
| | - Xin Wen
- Department of Rehabilitation Medicine, Yuebei People's Hospital, Shaoguan 512000, Guangdong Province, China
| | - Yang Peng
- Department of Rehabilitation Medicine, Yuebei People's Hospital, Shaoguan 512000, Guangdong Province, China
| | - Wei Hu
- Department of Rehabilitation Medicine, Yuebei People's Hospital, Shaoguan 512000, Guangdong Province, China
| | - Hui Liao
- Department of Rehabilitation Medicine, Yuebei People's Hospital, Shaoguan 512000, Guangdong Province, China
| | - Zi-Cai Liu
- Department of Rehabilitation Medicine, Shaoguan First People's Hospital, Shaoguan 512000, Guangdong Province, China
| | - Hui-Yu Liu
- Department of Rehabilitation Medicine, Yuebei Second People's Hospital, Shaoguan 512026, Guangdong Province, China
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Tarihci Cakmak E, Yaliman A, Torna G, Sen EI. The effectiveness of bodyweight-supported treadmill training in stroke patients: randomized controlled trial. Neurol Sci 2024; 45:3277-3285. [PMID: 38363446 DOI: 10.1007/s10072-024-07385-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 02/01/2024] [Indexed: 02/17/2024]
Abstract
OBJECTIVE This study aimed to assess the impact of conventional rehabilitation (CR) and the combination of bodyweight-supported treadmill training (BWSTT) with CR on walking speed, endurance, balance, mobility, and the quality of life in stroke survivors. METHOD In this prospective, randomized, controlled, and single-blind study, 30 stroke patients were included (ClinicalTrials.gov registration number: NCT04597658 date: October 22, 2020). These patients were divided into two groups: (1) CR only (control group, n = 14) and (2) CR with BWSTT (experimental group, n = 16). Both groups received CR for 3 consecutive weeks, 5 days a week, for 30 min each day. The experimental group received an additional 30 min of BWSTT per session. Patients were evaluated using the 10-m walk test (10MWT), the six-minute walk test (6MWT), the Tinetti Balance and Gait Assessment Score, the Timed Up and Go (TUG) test, the Rivermead Mobility Index (RMI), and the Stroke-Specific Quality of Life Scale (SS-QOL) before and after the intervention. RESULTS Both groups showed significant improvements across all scales after the intervention. The BWSTT group exhibited particularly noteworthy enhancements in comfortable 10MWT and TUG scores (p = 0.043 and p = 0.025, respectively) compared to the CR group post-intervention. CONCLUSION In conclusion, a holistic approach combining conventional physiotherapy with overground gait training can enhance various aspects of mobility. This approach offers a cost-effective and equipment-free alternative to BWSTT and necessitates specialized treadmill and bodyweight support systems, incurring higher costs. However, using BWSTT as a co-therapy therapy can be costly but provides additional benefits for enhancing functional mobility.
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Affiliation(s)
- Elif Tarihci Cakmak
- Department of Physical Medicine and Rehabilitation, University of Health Sciences Türkiye, Bagcilar Training and Research Hospital, Istanbul, Türkiye.
| | - Ayse Yaliman
- Department of Physical Medicine and Rehabilitation, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Gaye Torna
- Department of Physical Medicine and Rehabilitation, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Ekin Ilke Sen
- Department of Physical Medicine and Rehabilitation, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
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Cho KH, Lee DG, Song WK, Lee G. Usefulness of one-arm motorized gait device for chronic hemiplegic stroke survivors. Technol Health Care 2024; 32:335-342. [PMID: 37661897 DOI: 10.3233/thc-230197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
BACKGROUND After stroke, gait training is a key component of rehabilitation, and most individuals use a variety of walking aids depending on their physical condition and environment. OBJECTIVE This study aimed to investigate the potential effect of a one-arm motorized gait device for gait assist of chronic hemiplegic stroke survivors through comparison with traditional gait devices (parallel bar and hemi-walker). METHODS This study was conducted on 14 chronic hemiplegic stroke survivors. The participants were asked to walk under three conditions using different gait devices, and their gait parameters during walking were collected and analyzed. The first condition involved walking on parallel bars; second condition, walking using hemi-walkers; and third condition, walking using one-arm motorized gait devices. With the use of a gait analysis system, the spatio-temporal gait parameters in each condition were collected, such as gait velocity, cadence, step length, stride length, single support time, and double support time. RESULTS In the results by repeated-measures ANOVA or the Friedman test, a significant difference was found in the gait parameters among all three conditions (p< 0.05). The post-hoc test showed a significant change in the spatio-temporal gait parameters (especially, velocity, cadence and affected side single and double support time) when one-arm motorized gait device were used compared with parallel bars and hemi-walkers (p< 0.05). CONCLUSION The results of this study suggest that one-arm motorized gait devices developed for hemiplegic stroke survivors may be more effective potentially than parallel bars and hemi-walkers in gait assistance of chronic hemiplegic stroke survivors.
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Affiliation(s)
- Ki-Hun Cho
- Department of Physical Therapy, Korea National University of Transportation, Jeungpyeong, Korea
| | - Dong-Geon Lee
- Department of Physical Therapy, Graduate School of Kyungnam University, Changwon, Korea
| | - Won-Kyung Song
- Department of Rehabilitative and Assistive Technology, National Rehabilitation Research Institute, National Rehabilitation Center, Seoul, Korea
| | - Gyuchang Lee
- Outreach Physical, Occupational, and Speech Therapy, New York, NY, USA
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Song S, Fernandes NJ, Nordin AD. Characterizing Bodyweight-Supported Treadmill Walking on Land and Underwater Using Foot-Worn Inertial Measurement Units and Machine Learning for Gait Event Detection. SENSORS (BASEL, SWITZERLAND) 2023; 23:7945. [PMID: 37766002 PMCID: PMC10536282 DOI: 10.3390/s23187945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/06/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023]
Abstract
Gait rehabilitation commonly relies on bodyweight unloading mechanisms, such as overhead mechanical support and underwater buoyancy. Lightweight and wireless inertial measurement unit (IMU) sensors provide a cost-effective tool for quantifying body segment motions without the need for video recordings or ground reaction force measures. Identifying the instant when the foot contacts and leaves the ground from IMU data can be challenging, often requiring scrupulous parameter selection and researcher supervision. We aimed to assess the use of machine learning methods for gait event detection based on features from foot segment rotational velocity using foot-worn IMU sensors during bodyweight-supported treadmill walking on land and underwater. Twelve healthy subjects completed on-land treadmill walking with overhead mechanical bodyweight support, and three subjects completed underwater treadmill walking. We placed IMU sensors on the foot and recorded motion capture and ground reaction force data on land and recorded IMU sensor data from wireless foot pressure insoles underwater. To detect gait events based on IMU data features, we used random forest machine learning classification. We achieved high gait event detection accuracy (95-96%) during on-land bodyweight-supported treadmill walking across a range of gait speeds and bodyweight support levels. Due to biomechanical changes during underwater treadmill walking compared to on land, accurate underwater gait event detection required specific underwater training data. Using single-axis IMU data and machine learning classification, we were able to effectively identify gait events during bodyweight-supported treadmill walking on land and underwater. Robust and automated gait event detection methods can enable advances in gait rehabilitation.
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Affiliation(s)
- Seongmi Song
- Division of Kinesiology, Texas A&M University, College Station, TX 77843, USA;
| | - Nathaniel J. Fernandes
- Department of Computer Science & Engineering, Texas A&M University, College Station, TX 77843, USA;
| | - Andrew D. Nordin
- Division of Kinesiology, Texas A&M University, College Station, TX 77843, USA;
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843, USA
- Texas A&M Institute for Neuroscience, Texas A&M University, College Station, TX 77843, USA
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11
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Dantas MTAP, Fernani DCGL, Silva TDD, Assis ISAD, Carvalho ACD, Silva SB, Abreu LCD, Barbieri FA, Monteiro CBDM. Gait Training with Functional Electrical Stimulation Improves Mobility in People Post-Stroke. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095728. [PMID: 37174247 PMCID: PMC10178257 DOI: 10.3390/ijerph20095728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/08/2023] [Accepted: 04/17/2023] [Indexed: 05/15/2023]
Abstract
(1) Background: Stroke is one of the leading causes of disability. To identify the best treatment strategies for people with stroke (PwS), the aim of the current study was to compare the effects of training on a treadmill with functional electrical stimulation (TT-FES) with training on a treadmill (TT), and to analyze the effects of sequence of training on mobility and the parameters of walking ability. (2) Methods: Prospective, longitudinal, randomized and crossover study, in which 28 PwS were distributed into groups, namely the A-B Group (TT-FES followed by TT) and B-A Group (TT followed by TT-FES), using the foot drop stimulator, and were measured with functional tests. (3) Results: We found improved mobility, balance, non-paretic limb coordination, and endurance only in the group that started with TT-FES. However, sensorimotor function improved regardless of the order of training, and paretic limb coordination only improved in the B-A Group, but after TT-FES. These data indicate that the order of the protocols changed the results. (4) Conclusions: Although biomechanical evaluation methods were not used, which can be considered a limitation, our results showed that TT-FES was superior to isolated training on a treadmill with regard to balance, endurance capacity, and coordination of the non-paretic limb.
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Affiliation(s)
- Maria Tereza Artero Prado Dantas
- Laboratory Design and Scientific Writing, Department of Basic Sciences, ABC Faculty of Medicine, Santo André 09060-650, Brazil
- School of Arts, Sciences and Humanities, University of São Paulo (EACH/USP), São Paulo 03828-000, Brazil
- Course of Physiotherapy, University of West Paulista (UNOESTE), Presidente Prudente 19050-920, Brazil
| | - Deborah Cristina Gonçalves Luiz Fernani
- Laboratory Design and Scientific Writing, Department of Basic Sciences, ABC Faculty of Medicine, Santo André 09060-650, Brazil
- Course of Physiotherapy, University of West Paulista (UNOESTE), Presidente Prudente 19050-920, Brazil
| | - Talita Dias da Silva
- Postgraduate Program in Medicine (Cardiology) at Paulista School of Medicine, Federal University of São Paulo (EPM/UNIFESP), São Paulo 04024-002, Brazil
- Faculty of Medicine, University City of Sao Paulo (UNICID), São Paulo 03071-000, Brazil
| | - Iramaia Salomão Alexandre de Assis
- Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), São Paulo State University (UNESP), Bauru 17033-360, Brazil
| | | | - Sidney Benedito Silva
- Laboratory Design and Scientific Writing, Department of Basic Sciences, ABC Faculty of Medicine, Santo André 09060-650, Brazil
| | - Luiz Carlos de Abreu
- Laboratory Design and Scientific Writing, Department of Basic Sciences, ABC Faculty of Medicine, Santo André 09060-650, Brazil
- Department of Integrated Health Education, Federal University of Espírito Santo (UFES), Vitória 29040-090, Brazil
| | - Fabio Augusto Barbieri
- Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), São Paulo State University (UNESP), Bauru 17033-360, Brazil
| | - Carlos Bandeira de Mello Monteiro
- Laboratory Design and Scientific Writing, Department of Basic Sciences, ABC Faculty of Medicine, Santo André 09060-650, Brazil
- School of Arts, Sciences and Humanities, University of São Paulo (EACH/USP), São Paulo 03828-000, Brazil
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12
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Lyu T, Yan K, Lyu J, Zhao X, Wang R, Zhang C, Liu M, Xiong C, Liu C, Wei Y. Comparative efficacy of gait training for balance outcomes in patients with stroke: A systematic review and network meta-analysis. Front Neurol 2023; 14:1093779. [PMID: 37077566 PMCID: PMC10106590 DOI: 10.3389/fneur.2023.1093779] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/01/2023] [Indexed: 04/05/2023] Open
Abstract
BackgroundGrowing evidence suggests that gait training can improve stroke patients’ balance outcomes. However, it remains unclear which type of gait training is more effective in improving certain types of balance outcomes in patients with stroke. Thus, this network meta-analysis (NMA) included six types of gait training (treadmill, body-weight-supported treadmill, virtual reality gait training, robotic-assisted gait training, overground walking training, and conventional gait training) and four types of balance outcomes (static steady-state balance, dynamic steady-state balance, proactive balance, and balance test batteries), aiming to compare the efficacy of different gait training on specific types of balance outcomes in stroke patients and determine the most effective gait training.MethodWe searched PubMed, Embase, Medline, Web of Science, and Cochrane Library databases from inception until 25 April 2022. Randomized controlled trials (RCTs) of gait training for the treatment of balance outcomes after stroke were included. RoB2 was used to assess the risk of bias in the included studies. Frequentist random-effects network meta-analysis (NMA) was used to evaluate the effect of gait training on four categories of balance outcomes.ResultA total of 61 RCTs from 2,551 citations, encompassing 2,328 stroke patients, were included in this study. Pooled results showed that body-weight-support treadmill (SMD = 0.30, 95% CI [0.01, 0.58]) and treadmill (SMD = 0.25, 95% CI [0.00, 0.49]) could improve the dynamic steady-state balance. Virtual reality gait training (SMD = 0.41, 95% CI [0.10, 0.71]) and body-weight-supported treadmill (SMD = 0.41, 95% CI [0.02, 0.80]) demonstrated better effects in improving balance test batteries. However, none of included gait training showed a significant effect on static steady-state balance and proactive balance.ConclusionGait training is an effective treatment for improving stroke patients’ dynamic steady-state balance and balance test batteries. However, gait training had no significant effect on static steady-state balance and proactive balance. To achieve maximum efficacy, clinicians should consider this evidence when recommending rehabilitation training to stroke patients. Considering body-weight-supported treadmill is not common for chronic stroke patients in clinical practice, the treadmill is recommended for those who want to improve dynamic steady-state balance, and virtual reality gait training is recommended for those who want to improve balance test batteries.LimitationMissing evidence in relation to some types of gait training is supposed to be taken into consideration. Moreover, we fail to assess reactive balance in this NMA since few included trials reported this outcome.Systematic Review RegistrationPROSPERO, identifier CRD42022349965.
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Affiliation(s)
- Tianyi Lyu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Kang Yan
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Jiaxuan Lyu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Xirui Zhao
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Ruoshui Wang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Chaoyang Zhang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Meng Liu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Chao Xiong
- L3 & Maintenance Solutions, SUSE Software (Beijing) Co., Ltd., Beijing, China
| | - Chengjiang Liu
- Department of General Medicine, Affiliated Anqing First People’s Hospital of Anhui Medical University, HeFei, Anhui, China
| | - Yulong Wei
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
- *Correspondence: Yulong Wei,
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Patathong T, Klaewkasikum K, Woratanarat P, Rattanasiri S, Anothaisintawee T, Woratanarat T, Thakkinstian A. The efficacy of gait rehabilitations for the treatment of incomplete spinal cord injury: a systematic review and network meta-analysis. J Orthop Surg Res 2023; 18:60. [PMID: 36683024 PMCID: PMC9869518 DOI: 10.1186/s13018-022-03459-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 12/16/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Recent pieces of evidence about the efficacy of gait rehabilitation for incomplete spinal cord injury remain unclear. We aimed to estimate the treatment effect and find the best gait rehabilitation to regain velocity, distance, and Walking Index Spinal Cord Injury (WISCI) among incomplete spinal cord injury patients. METHOD PubMed and Scopus databases were searched from inception to October 2022. Randomized controlled trials (RCTs) were included in comparison with any of the following: conventional physical therapy, treadmill, functional electrical stimulation and robotic-assisted gait training, and reported at least one outcome. Two reviewers independently selected the studies and extracted the data. Meta-analysis was performed using random-effects or fixed-effect model according to the heterogeneity. Network meta-analysis (NMA) was indirectly compared with all interventions and reported as pooled unstandardized mean difference (USMD) and 95% confidence interval (CI). Surface under the cumulative ranking curve (SUCRA) was calculated to identify the best intervention. RESULTS We included 17 RCTs (709 participants) with the mean age of 43.9 years. Acute-phase robotic-assisted gait training significantly improved the velocity (USMD 0.1 m/s, 95% CI 0.05, 0.14), distance (USMD 64.75 m, 95% CI 27.24, 102.27), and WISCI (USMD 3.28, 95% CI 0.12, 6.45) compared to conventional physical therapy. In NMA, functional electrical stimulation had the highest probability of being the best intervention for velocity (66.6%, SUCRA 82.1) and distance (39.7%, SUCRA 67.4), followed by treadmill, functional electrical stimulation plus treadmill, robotic-assisted gait training, and conventional physical therapy, respectively. CONCLUSION Functional electrical stimulation seems to be the best treatment to improve walking velocity and distance for incomplete spinal cord injury patients. However, a large-scale RCT is required to study the adverse events of these interventions. TRIAL REGISTRATION PROSPERO number CRD42019145797.
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Affiliation(s)
- Tanyaporn Patathong
- grid.10223.320000 0004 1937 0490Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Payathai, Ratchathewi, Bangkok, 10400 Thailand
| | - Krongkaew Klaewkasikum
- grid.10223.320000 0004 1937 0490Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Payathai, Ratchathewi, Bangkok, 10400 Thailand
| | - Patarawan Woratanarat
- grid.10223.320000 0004 1937 0490Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Payathai, Ratchathewi, Bangkok, 10400 Thailand
| | - Sasivimol Rattanasiri
- grid.10223.320000 0004 1937 0490Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400 Thailand
| | - Thunyarat Anothaisintawee
- grid.10223.320000 0004 1937 0490Department of Family Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400 Thailand
| | - Thira Woratanarat
- grid.7922.e0000 0001 0244 7875Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330 Thailand
| | - Ammarin Thakkinstian
- grid.10223.320000 0004 1937 0490Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400 Thailand
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14
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Kaźmierczak K, Wareńczak-Pawlicka A, Miedzyblocki M, Lisiński P. Effect of Treadmill Training with Visual Biofeedback on Selected Gait Parameters in Subacute Hemiparetic Stroke Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16925. [PMID: 36554805 PMCID: PMC9779267 DOI: 10.3390/ijerph192416925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/11/2022] [Accepted: 12/13/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Functional limitations after a stroke are unique to each person and often include impaired independent mobility. A reduction in existing gait deficits after a stroke is often one of the main goals of rehabilitation. Gait re-education after stroke is a complex process, which consists of the effects of many therapeutic interventions. OBJECTIVE The study aimed to analyze the effects of using a treadmill with visual feedback in gait re-education in the sub-acute stroke period and assess the impact of biofeedback treadmill training on selected gait parameters, improving static balance and reducing the need for orthopedic aids. METHODS The study included 92 patients (F: 45, M: 47) aged 63 ± 12 years, with post-ischemic sub-acute (within six months onset) stroke hemiparesis, treated at a neurological rehabilitation ward. All patients participated in a specific rehabilitation program, and in addition, patients in the study group (n = 62) have a further 10 min of treadmill training with visual feedback. Patients in the control group (n = 30) participated in additional conventional gait training under the direct supervision of a physiotherapist. The evaluation of static balance was assessed with the Romberg Test. A Biodex Gait Trainer 3 treadmill with biofeedback function was used to evaluate selected gait parameters (walking speed, step length, % limb loading, and traveled distance). The use of an orthopedic aid (walker or a crutch) was noted. RESULTS After four weeks of rehabilitation, step length, walking speed, traveled distance, and static balance were significantly improved for the study and control group (p < 0.05). Treadmill gait training yielded significantly better results than a conventional rehabilitation program. Only the study group observed a corrected walking base (p < 0.001). All participants showed a reduction in the use of walking aids (p = 0.006). There was no asymmetry in the % of limb loading for either group prior to or following rehabilitation. CONCLUSIONS The treadmill with visual biofeedback as conventional gait training has resulted in a significant improvement in parameters such as step length, walking speed, static balance, and a reduction in the use of locomotion aids. However, the achieved improvement in gait parameters is still not in line with the physiological norm.
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15
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Lee JJ, Park C, You J(SH. Effectiveness of a wearable ankle-tubing gait training on ankle kinematics and motor control in hemiparetic stroke. NeuroRehabilitation 2022; 51:123-132. [DOI: 10.3233/nre-210277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: While excessive ankle plantarflexion is a common neuromuscular impairment resulting from insufficient coordination of selective ankle neuromotor control and kinematics during gait. We recently developed a wearable, inexpensive and sustainable wearable ankle-tubing gait training (WAGT) aimed at improving selective ankle motor control and kinematic coordination. OBJECTIVE: We investigated the effects of WAGT on tibialis anterior (TA) and gastrocnemius (GCM) muscle electromyography (EMG) activity, TA: GCM muscle imbalance ratio, and ankle joint kinematics during gait in hemiparetic stroke patients. METHODS: A convenience sample of 33 participants (15 non-stroke healthy adults and 18 hemiparetic stroke patients) underwent standardized electromyography and kinematic biomechanical tests under conventional gait training (CGT) and WAGT conditions. Analysis of variance (ANOVA) was used to determine the significance of differences in the TA: GCM muscle activation, muscle imbalance ratio, and ankle joint kinematics before and after the intervention and between the two groups at P < 0.05. RESULTS: WAGT was more effective than CGT in improving TA muscle activation (P < 0.01), TA: GCM muscle imbalance ratio (P < 0.01), and kinematic movement (P < 0.01) in adults with or without hemiparetic stroke. CONCLUSIONS: This study demonstrated that WAGT is relatively ease to design, wear and affordable to most clinicians and patients, hence it is suitable for many health care applications to correct gait-related movement abnormalities presented in the hemiparetic stroke patients.
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Affiliation(s)
- Jeong Jae Lee
- Rehabilitation Team, Myongji Hospital, Goyang, Republic of Korea
- Sports Movement Artificial-Intelligence Robotics Technology (SMART) Institute, Department of Physical Therapy, Yonsei University, Wonju, Republic of Korea
- Department of Physical Therapy, Yonsei University, Wonju, Republic of Korea
| | - Chanhee Park
- Sports Movement Artificial-Intelligence Robotics Technology (SMART) Institute, Department of Physical Therapy, Yonsei University, Wonju, Republic of Korea
- Department of Physical Therapy, Yonsei University, Wonju, Republic of Korea
| | - Joshua (Sung) H. You
- Sports Movement Artificial-Intelligence Robotics Technology (SMART) Institute, Department of Physical Therapy, Yonsei University, Wonju, Republic of Korea
- Department of Physical Therapy, Yonsei University, Wonju, Republic of Korea
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16
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Cui W, Huang L, Tian Y, Luo H, Chen S, Yang Y, Li Y, Fu J, Yu Q, Xu L. Effect and mechanism of mirror therapy on lower limb rehabilitation after ischemic stroke: A fMRI study. NeuroRehabilitation 2022; 51:65-77. [PMID: 35311718 DOI: 10.3233/nre-210307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Mirror therapy has been gradually adopted for lower limb rehabilitation, but its efficacy and neural mechanism are not well understood. OBJECTIVE This study aims to investigate the effect and neural mechanism of mirror therapy on lower limb rehabilitation after ischemic stroke by using resting state functional magnetic resonance imaging (rs-fMRI). METHODS A single-blind and randomized controlled pilot study was conducted. 32 patients with ischemic stroke were included in this study and randomly divided into two groups - the control group (CT, n = 16) and the mirror therapy group (MT, n = 16). Both the CT and MT groups received medication and routine rehabilitation training. In addition, mirror therapy was added to the MT group 5 times a week for 30 minutes each time over a period of 3 weeks. Patients' motor functions, functional connectivity (FC), regional homogeneity (ReHo), and fractional amplitude of low-frequency fluctuations (fALFF) were analyzed both before and immediately after the treatment. RESULTS Patients' motor functions showed significant improvement in both groups compared to those before treatment (p < 0.01). Moreover, the MT group showed significantly better improvement than the CT group after the treatment (p < 0.05). FC, ReHo and fALFF indicated enhanced neuronal activities in motor function-related brain regions in the MT group compared to the CT group. CONCLUSION Mirror therapy promotes the recovery of lower limb motor functions in patients with ischemic stroke. Through the comparative rs-fMRI analysis, it is found that the mirror therapy promotes the functional reorganization of the injured brain.
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Affiliation(s)
- Wei Cui
- Department of Rehabilitation Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Sichuan, China
| | - Lin Huang
- Department of Rehabilitation Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Sichuan, China
| | - Yang Tian
- Department of Rehabilitation Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Sichuan, China
| | - Hong Luo
- Department of Rehabilitation Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Sichuan, China
| | - Shuang Chen
- Department of Rehabilitation Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Sichuan, China
| | - Yan Yang
- Department of Rehabilitation Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Sichuan, China
| | - Yamei Li
- Department of Rehabilitation Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Sichuan, China
| | - Jing Fu
- Department of Rehabilitation Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Sichuan, China
| | - Qian Yu
- Department of Rehabilitation Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Sichuan, China
| | - Li Xu
- Department of Rehabilitation Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Sichuan, China
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Hong JC, Ohashi H, Iwata H. High-Dorsiflexion Assistive System for Passive Swing Phase Dorsiflexion Training and Preventing Compensatory Movements. JOURNAL OF ROBOTICS AND MECHATRONICS 2022. [DOI: 10.20965/jrm.2022.p0121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Over the last few years, numerous robotic ankle-foot orthoses have been developed to help stroke patients optimize gait rehabilitation. In this paper, we present a study on the effects of assistance on dorsiflexion-restricted gait. Our high-dorsiflexion assistive system aims to provide full assistance to realize passive training of dorsiflexion during the swing phase and prevent compensatory movements. This system, which includes a McKibben-type artificial muscle and an air source, is lightweight and provides a high-dorsiflexion torque. The device could help boost overground gait rehabilitation in stroke patients. With this system, we conducted an experiment on five healthy participants whose dorsiflexion movements were restricted, and the extent of their compensatory movements differed. The results of the processed surface electromyography data differed significantly when dorsiflexion movement was assisted by our system. The spatial parameters also showed significantly improved compensatory movement inclination with sufficient assistance. These results indicate the potential of our system to assist in passive training of ankle dorsiflexion movements and to prevent incorrect gait in patients with low dorsiflexion abilities.
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18
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Marzolini S, Wu C, Hussein R, Xiong LY, Kangatharan S, Peni A, Cooper CR, Lau KS, Nzodjou Makhdoom G, Pakosh M, Zaban SA, Nguyen MM, Banihashemi MA, Swardfager W. Associations Between Time After Stroke and Exercise Training Outcomes: A Meta-Regression Analysis. J Am Heart Assoc 2021; 10:e022588. [PMID: 34913357 PMCID: PMC9075264 DOI: 10.1161/jaha.121.022588] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Knowledge gaps exist regarding the effect of time elapsed after stroke on the effectiveness of exercise training interventions, offering incomplete guidance to clinicians. Methods and Results To determine the associations between time after stroke and 6-minute walk distance, 10-meter walk time, cardiorespiratory fitness and balance (Berg Balance Scale score [BBS]) in exercise training interventions, relevant studies in post-stroke populations were identified by systematic review. Time after stroke as continuous or dichotomized (≤3 months versus >3 months, and ≤6 months versus >6 months) variables and weighted mean differences in postintervention outcomes were examined in meta-regression analyses adjusted for study baseline mean values (pre-post comparisons) or baseline mean values and baseline control-intervention differences (controlled comparisons). Secondary models were adjusted additionally for mean age, sex, and aerobic exercise intensity, dose, and modality. We included 148 studies. Earlier exercise training initiation was associated with larger pre-post differences in mobility; studies initiated ≤3 months versus >3 months after stroke were associated with larger differences (weighted mean differences [95% confidence interval]) in 6-minute walk distance (36.3 meters; 95% CI, 14.2-58.5), comfortable 10-meter walk time (0.13 m/s; 95% CI, 0.06-0.19) and fast 10-meter walk time (0.16 m/s; 95% CI, 0.03-0.3), in fully adjusted models. Initiation ≤3 months versus >3 months was not associated with cardiorespiratory fitness but was associated with a higher but not clinically important Berg Balance Scale score difference (2.9 points; 95% CI, 0.41-5.5). In exercise training versus control studies, initiation ≤3 months was associated with a greater difference in only postintervention 6-minute walk distance (baseline-adjusted 27.3 meters; 95% CI, 6.1-48.5; fully adjusted, 24.9 meters; 95% CI, 0.82-49.1; a similar association was seen for ≤6 months versus >6 months after stroke (fully adjusted, 26.6 meters; 95% CI, 2.6-50.6). Conclusions There may be a clinically meaningful benefit to mobility outcomes when exercise is initiated within 3 months and up to 6 months after stroke.
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Affiliation(s)
- Susan Marzolini
- KITE Research Institute, Toronto Rehabilitation Institute ‐ University Health NetworkTorontoONCanada
- Healthy Living for Pandemic Event Protection (HL–PIVOT) NetworkTorontoONCanada
- Rehabilitation Sciences InstituteUniversity of TorontoONCanada
- Faculty of Kinesiology and Physical EducationUniversity of TorontoONCanada
| | - Che‐Yuan Wu
- Department of Pharmacology and ToxicologyUniversity of TorontoONCanada
- Hurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoONCanada
| | | | - Lisa Y. Xiong
- Department of Pharmacology and ToxicologyUniversity of TorontoONCanada
- Hurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoONCanada
| | - Suban Kangatharan
- KITE Research Institute, Toronto Rehabilitation Institute ‐ University Health NetworkTorontoONCanada
| | - Ardit Peni
- KITE Research Institute, Toronto Rehabilitation Institute ‐ University Health NetworkTorontoONCanada
| | | | - Kylie S.K. Lau
- Department of Human BiologyUniversity of TorontoONCanada
| | | | - Maureen Pakosh
- Library & Information ServicesUniversity Health NetworkToronto Rehabilitation InstituteTorontoONCanada
| | - Stephanie A. Zaban
- Faculty of Kinesiology and Physical EducationUniversity of TorontoONCanada
| | - Michelle M. Nguyen
- Department of Pharmacology and ToxicologyUniversity of TorontoONCanada
- Hurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoONCanada
| | - Mohammad Amin Banihashemi
- Hurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoONCanada
- Institute of Medical ScienceUniversity of TorontoTorontoONCanada
| | - Walter Swardfager
- KITE Research Institute, Toronto Rehabilitation Institute ‐ University Health NetworkTorontoONCanada
- Department of Pharmacology and ToxicologyUniversity of TorontoONCanada
- Hurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoONCanada
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19
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Kuo CY, Liu CW, Lai CH, Kang JH, Tseng SH, Su ECY. Prediction of robotic neurorehabilitation functional ambulatory outcome in patients with neurological disorders. J Neuroeng Rehabil 2021; 18:174. [PMID: 34922571 PMCID: PMC8684617 DOI: 10.1186/s12984-021-00965-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/02/2021] [Indexed: 01/01/2023] Open
Abstract
Introduction Conflicting results persist regarding the effectiveness of robotic-assisted gait training (RAGT) for functional gait recovery in post-stroke survivors. We used several machine learning algorithms to construct prediction models for the functional outcomes of robotic neurorehabilitation in adult patients. Methods and materials Data of 139 patients who underwent Lokomat training at Taipei Medical University Hospital were retrospectively collected. After screening for data completeness, records of 91 adult patients with acute or chronic neurological disorders were included in this study. Patient characteristics and quantitative data from Lokomat were incorporated as features to construct prediction models to explore early responses and factors associated with patient recovery. Results Experimental results using the random forest algorithm achieved the best area under the receiver operating characteristic curve of 0.9813 with data extracted from all sessions. Body weight (BW) support played a key role in influencing the progress of functional ambulation categories. The analysis identified negative correlations of BW support, guidance force, and days required to complete 12 Lokomat sessions with the occurrence of progress, while a positive correlation was observed with regard to speed. Conclusions We developed a predictive model for ambulatory outcomes based on patient characteristics and quantitative data on impairment reduction with early-stage robotic neurorehabilitation. RAGT is a customized approach for patients with different conditions to regain walking ability. To obtain a more-precise and clearer predictive model, collecting more RAGT training parameters and analyzing them for each individual disorder is a possible approach to help clinicians achieve a better understanding of the most efficient RAGT parameters for different patients. Trial registration: Retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12984-021-00965-6.
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Affiliation(s)
- Chao-Yang Kuo
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, 172-1, Sec. 2, Keelung Rd., 10675, Taipei City, Taiwan
| | - Chia-Wei Liu
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, 252 Wuxing St, Xinyi District, 11031, Taipei City, Taiwan
| | - Chien-Hung Lai
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, 252 Wuxing St, Xinyi District, 11031, Taipei City, Taiwan.,Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, 250 Wu-Hsing Street, 11031, Taipei City, Taiwan
| | - Jiunn-Horng Kang
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, 252 Wuxing St, Xinyi District, 11031, Taipei City, Taiwan.,Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, 250 Wu-Hsing Street, 11031, Taipei City, Taiwan
| | - Sung-Hui Tseng
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, 252 Wuxing St, Xinyi District, 11031, Taipei City, Taiwan. .,Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, 250 Wu-Hsing Street, 11031, Taipei City, Taiwan.
| | - Emily Chia-Yu Su
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, 172-1, Sec. 2, Keelung Rd., 10675, Taipei City, Taiwan. .,Clinical Big Data Research Center, Taipei Medical University Hospital, 252 Wuxing St, Xinyi District, 11031, Taipei City, Taiwan. .,Research Center for Artificial Intelligence in Medicine, Taipei Medical University, 250 Wu-Hsing Street, 11031, Taipei, Taiwan.
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The Efficacy of Interlimb-Coordinated Intervention on Gait and Motor Function Recovery in Patients with Acute Stroke: A Multi-Center Randomized Controlled Trial Study Protocol. Brain Sci 2021; 11:brainsci11111495. [PMID: 34827494 PMCID: PMC8615375 DOI: 10.3390/brainsci11111495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/05/2021] [Accepted: 11/08/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The efficacy of interlimb-coordinated training on gait and upper limb functional improvement remains unclear. The latest published randomized controlled trials have supported the potential benefits of interlimb-coordinated training to enhance gait function. Upper limb functional recovery may also benefit from interlimb-coordinated training since most everyday activities require the coordinated use of both hands to complete a task. This study investigates the efficacy of interlimb-coordinated training on gait and upper limb functional recovery over a short-medium term period. METHODS A total of 226 acute stroke patients will be recruited from four centres over four years. Patients will be randomly allocated to either conventional therapy or conventional therapy plus interlimb-coordinated training. Outcomes will be recorded at baseline, after 2 weeks of intervention, and at 3- and 6-months post-intervention. Gait speed is the primary outcome measure. Secondary outcome measures include Fugl-Meyer Assessment of Motor Recovery, Berg Balance Scale, Timed Up and Go test, Action Research Arm Test, electroencephalography, and magnetic resonance imaging. CONCLUSION The results of this trial will provide an in-depth understanding of the efficacy of early interlimb-coordinated intervention on gait and upper functional rehabilitation and how it may relate to the neural plasticity process.
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Li X, He B, Deng Z, Chen Y, Wang D, Fan Y, Su H, Yu H. A Center of Mass Estimation and Control Strategy for Body-Weight-Support Treadmill Training. IEEE Trans Neural Syst Rehabil Eng 2021; 29:2388-2398. [PMID: 34748495 DOI: 10.1109/tnsre.2021.3126104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Walking disorders are common in post-stroke. Body weight support (BWS) systems have been proposed and proven to enhance gait training systems for recovering in individuals with hemiplegia. However, the fixed weight support and walking speed increase the risk of falling and decrease the active participation of the subjects. This paper proposes a strategy to enhance the efficiency of BWS treadmill training. It consists in regulating the height of the BWS system to track the height of the subject's center of mass (CoM), whereby the CoM is estimated through a long-short term memory (LSTM) network and a locomotion recognition system. The LSTM network takes the walking speed, body-height to leg-length ratio, hip and knee joint angles of the hemiplegic subjects' non-paretic side from the locomotion recognition system as input signals and outputs the CoM height to a BWS treadmill training robot. Besides, the hip and knee joints' ranges of motion are increased by 34.54% and 25.64% under the CoM height regulation compared to the constant weight support, respectively. With the CoM height regulation strategy, the stance phase duration of the paretic side is significantly increased by 14.6% of the gait cycle, and the symmetry of the gait is also promoted. The CoM height kinematics by adjustment strategy is in good agreement with the mean values of the 14 non-disabled subjects, which demonstrated that the adjustment strategy improves the stability of CoM height during the training.
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22
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Li IH, Lin YS, Lee LW, Lin WT. Design, Manufacturing, and Control of a Pneumatic-Driven Passive Robotic Gait Training System for Muscle-Weakness in a Lower Limb. SENSORS 2021; 21:s21206709. [PMID: 34695920 PMCID: PMC8540960 DOI: 10.3390/s21206709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/02/2021] [Accepted: 10/04/2021] [Indexed: 02/04/2023]
Abstract
We designed and manufactured a pneumatic-driven robotic passive gait training system (PRPGTS), providing the functions of body-weight support, postural support, and gait orthosis for patients who suffer from weakened lower limbs. The PRPGTS was designed as a soft-joint gait training rehabilitation system. The soft joints provide passive safety for patients. The PRPGTS features three subsystems: a pneumatic body weight support system, a pneumatic postural support system, and a pneumatic gait orthosis system. The dynamic behavior of these three subsystems are all involved in the PRPGTS, causing an extremely complicated dynamic behavior; therefore, this paper applies five individual interval type-2 fuzzy sliding controllers (IT2FSC) to compensate for the system uncertainties and disturbances in the PRGTS. The IT2FSCs can provide accurate and correct positional trajectories under passive safety protection. The feasibility of weight reduction and gait training with the PRPGTS using the IT2FSCs is demonstrated with a healthy person, and the experimental results show that the PRPGTS is stable and provides a high-trajectory tracking performance.
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Affiliation(s)
- I-Hsum Li
- Department of Mechanical and Electro-Mechanical Engineering, Tamkang University, New Taipei City 25137, Taiwan; (I.-H.L.); (W.-T.L.)
| | - Yi-Shan Lin
- Department of Mechanical Engineering, National Chung Hsing University, Taichung City 40227, Taiwan;
| | - Lian-Wang Lee
- Department of Mechanical Engineering, National Chung Hsing University, Taichung City 40227, Taiwan;
- Correspondence: ; Tel.: +886-4-22840433 (ext. 420); Fax: +886-4-22877170
| | - Wei-Ting Lin
- Department of Mechanical and Electro-Mechanical Engineering, Tamkang University, New Taipei City 25137, Taiwan; (I.-H.L.); (W.-T.L.)
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Prideaux N, Barr C, Drummond C, van den Berg M. Towards a Clinical Decision-Making Algorithm Guiding Locomotor Therapy Modality in Subacute Stroke: An Exploratory Study. J Stroke Cerebrovasc Dis 2021; 30:106112. [PMID: 34601241 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/25/2021] [Accepted: 09/06/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To propose a clinical decision-making algorithm guiding modality choice and transition from the Lokomat® robotic to body-weight supported treadmill training in subacute stroke, due to current evidence being limited, making clinical decisions difficult. MATERIALS AND METHODS For 10 adult patients with subacute stroke completing Lokomat® therapy, physiotherapist clinical judgement regarding body-weight supported treadmill training readiness and the following objective measurements were collected; Functional Ambulation Category; sit to stand/standing ability; Lokomat® settings; maximal active hip and knee flexion in standing; and gait biomechanics during body-weight supported treadmill training. Based on observed patterns a proposed clinical decision-making algorithm was developed. RESULTS Clinical judgement deemed four of 10 participants ready to transition to body-weight supported treadmill training. Unlike participants judged not ready, these participants had: a) a Functional Ambulation Category of 1; b) independence with sit to stand and standing with even weight bearing; c) Lokomat®: Body-Weight Support <30%, Guidance Force <30-35%, speed >2.0kph; d) >45° standing active hip and knee flexion; e) no significant issues with physiological stepping in treadmill training or only requiring assistance from one therapist to achieve this. CONCLUSION Participants judged ready for transition from the Lokomat® to body-weight supported treadmill training presented with increased independent functional ability, more challenging Lokomat® settings, greater active volitional lower-limb control, and less issues with physiological stepping in treadmill training, than those participants judged not ready. Results were translated into a proposed clinical decision-making algorithm guiding transition from the Lokomat® to body-weight supported treadmill training, to be further tested in clinical trials.
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Affiliation(s)
- Nicole Prideaux
- Bachelor of Applied Science Physiotherapy (honours), Master Clinical Rehabilitation, Physiotherapist, Rehabilitation, Aged Care, and Palliative Division, Southern Adelaide Local Health Network: c/o Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia, 5042, Australia.
| | - Christopher Barr
- Bachelor Physiology, Sports Science and Nutrition (honours), Masters Research Bioengineering, PhD Bioengineering, College of Nursing and Health Sciences, Flinders University: GPO Box 2100, Adelaide 5001, South Australia, Australia.
| | - Claire Drummond
- Bachelor of Applied Science (Exercise and Sports Science), Human Movement (honours), PhD Health Sciences, College of Nursing and Health Sciences, Flinders University; GPO Box 2100, Adelaide 5001, South Australia, Australia.
| | - Maayken van den Berg
- Bachelor of Physiotherapy, Master of Movement Sciences, PhD Rehabilitation Sciences, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide 5001, South Australia, Australia.
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24
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Vanoglio F, Olivares A, Bonometti GP, Damiani S, Gaiani M, Comini L, Luisa A. A decision making algorithm for rehabilitation after stroke: A guide to choose an appropriate and safe treadmill training. NeuroRehabilitation 2021; 49:75-85. [PMID: 34057102 DOI: 10.3233/nre-210065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Walking independently after a stroke can be difficult or impossible, and walking reeducation is vital. But the approach used is often arbitrary, relying on the devices available and subjective evaluations by the doctor/physiotherapist. Objective decision making tools could be useful. OBJECTIVES To develop a decision making algorithm able to select for post-stroke patients, based on their motor skills, an appropriate mode of treadmill training (TT), including type of physiotherapist support/supervision required and safety conditions necessary. METHODS We retrospectively analyzed data from 97 post-stroke inpatients admitted to a NeuroRehabilitation unit. Patients attended TT with body weight support (BWSTT group) or without support (FreeTT group), depending on clinical judgment. Patients' sociodemographic and clinical characteristics, including the Cumulative Illness Rating Scale (CIRS) plus measures of walking ability (Functional Ambulation Classification [FAC], total Functional Independence Measure [FIM] and Tinetti Performance-Oriented Mobility Assessment [Tinetti]) and fall risk profile (Morse and Stratify) were retrieved from institutional database. RESULTS No significant differences emerged between the two groups regarding sociodemographic and clinical characteristics. Regarding walking ability, FAC, total FIM and its Motor component and the Tinetti scale differed significantly between groups (for all, p < 0.001). FAC and Tinetti scores were used to elaborate a decision making algorithm classifying patients into 4 risk/safety (RS) classes. As expected, a strong association (Pearson chi-squared, p < 0.0001) was found between RS classes and the initial BWSTT/FreeTT classification. CONCLUSION This decision making algorithm provides an objective tool to direct post-stroke patients, on admission to the rehabilitation facility, to the most appropriate form of TT.
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Affiliation(s)
- Fabio Vanoglio
- Istituti Clinici Scientifici Maugeri IRCCS, Neurological Rehabilitation Unit of the Institute of Lumezzane, Brescia, Italy
| | - Adriana Olivares
- Istituti Clinici Scientifici Maugeri IRCCS, Scientific Direction of the Institute of Lumezzane, Brescia, Italy
| | - Gian Pietro Bonometti
- Istituti Clinici Scientifici Maugeri IRCCS, Neurological Rehabilitation Unit of the Institute of Lumezzane, Brescia, Italy
| | - Silvia Damiani
- Istituti Clinici Scientifici Maugeri IRCCS, Neurological Rehabilitation Unit of the Institute of Lumezzane, Brescia, Italy
| | - Marta Gaiani
- Istituti Clinici Scientifici Maugeri IRCCS, Neurological Rehabilitation Unit of the Institute of Lumezzane, Brescia, Italy
| | - Laura Comini
- Istituti Clinici Scientifici Maugeri IRCCS, Scientific Direction of the Institute of Lumezzane, Brescia, Italy
| | - Alberto Luisa
- Istituti Clinici Scientifici Maugeri IRCCS, Neurological Rehabilitation Unit of the Institute of Lumezzane, Brescia, Italy
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25
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Koshisaki H, Nagai S. Effect of the use of a body weight-supported walker on gait parameters in hemiplegic stroke patients. J Phys Ther Sci 2021; 33:434-438. [PMID: 34083884 PMCID: PMC8165362 DOI: 10.1589/jpts.33.434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 02/23/2021] [Indexed: 11/29/2022] Open
Abstract
[Purpose] This study investigated gait parameter changes in hemiplegic stroke patients
who walked with a body weight-supported (BWS) walker and evaluated the usefulness of using
the BWS walker in a walking exercise. [Participants and Methods] Nineteen hemiplegic
stroke patients hospitalized in a convalescent rehabilitation ward were enrolled in the
study. Trunk acceleration was used to evaluate walking with and without a BWS walker. Gait
speed, cadence, stride length, step time symmetry, stride time variability, and stride
time regularity were calculated from the accelerometer waveform. [Results] Hemiplegic
stroke patients had a faster gait speed, walked more symmetrically, and had less variation
in their gait cycle when using the BWS walker than when not using it. [Conclusion] Using a
BWS walker may help hemiplegic stroke patients learn to walk more efficiently in terms of
their gait speed.
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Affiliation(s)
- Hiroo Koshisaki
- Department of Rehabilitation, Nanto Municipal Hospital: 938 Inami, Nanto, Toyama 932-0211, Japan.,Master's Program, Kinjo University Graduate School of Rehabilitation, Japan
| | - Shota Nagai
- Kinjo University Graduate School of Rehabilitation, Japan
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26
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Effects of Body Weight Support-Tai Chi Footwork Training on Balance Control and Walking Function in Stroke Survivors with Hemiplegia: A Pilot Randomized Controlled Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2020:9218078. [PMID: 33414842 PMCID: PMC7769631 DOI: 10.1155/2020/9218078] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/11/2020] [Accepted: 12/10/2020] [Indexed: 11/18/2022]
Abstract
Background Tai Chi (TC) is known to enhance balance control and walking function in stroke survivors. However, motor disorders in stroke patients may limit the implementation of TC exercise and increase the risk of falling. The body weight support (BWS) device can provide protection during the early rehabilitation of stroke survivors using an overhead suspension system. Theoretically, combining TC with BWS may be an effective intervention for stroke survivors. This study aimed to examine the effects of body weight support-Tai Chi training on balance control and walking function in stroke survivors with hemiplegia. Methods Seventy-one stroke survivors with hemiplegia aged 30-75 years were randomly allocated to the control group (N = 35) or the BWS-TC group (N = 36). During BWS-TC training, the subjects performed 7 Tai Chi footwork forms, and gradual easy-to-difficult progression (from 40% to 0% body weight) was followed. The subjects participated in 40 min rehabilitation sessions three times per week for 12 weeks. The primary outcome was dynamic balance in the limits-of-stability test. The secondary outcomes, which reflect improvements walking function, included spatiotemporal parameters, the joint range of motion in the affected limb during the swing phase, the Berg Balance Scale score, and the Fugl-Meyer Assessment score. Evaluations were performed at baseline and 12 weeks and compared between groups. Results After training, significant between-group differences were observed in the scores for overall, forward, left, right, forward-left, and forward-right directional control in the limits-of-stability test (P < 0.05). Furthermore, the scores for gait cycle time, step length, step velocity, and range of motion of the joints were better in the BWS-TC group than in the control group (P < 0.05). Conclusions The 12-week BWS-TC training may enhance dynamic balance and walking function in stroke survivors with hemiplegia.
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28
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MacLean MK, Ferris DP. Design and Validation of a Low-Cost Bodyweight Support System for Overground Walking. J Med Device 2020; 14:045001. [PMID: 33442440 PMCID: PMC7580661 DOI: 10.1115/1.4047996] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 07/10/2020] [Indexed: 11/08/2022] Open
Abstract
Walking with bodyweight support is a vital tool for both gait rehabilitation and biomechanics research. There are few commercially available bodyweight support systems for overground walking that are able to provide a near constant lifting force of more than 50% bodyweight. The devices that do exist are expensive and are not often used outside of rehabilitation clinics. Our aim was to design, build, and validate a bodyweight support device for overground walking that: (1) cost less than $5000, (2) could support up to 75% of the users' bodyweight (BW), and (3) had small (±5% BW) fluctuations in force. We used pairs of constant force springs to provide the constant lifting force. To validate the force fluctuation, we recruited eight participants to walk at 0.4, 0.8, 1.2, and 1.6 m/s with 0%, 22%, 46%, and 69% of their bodyweight supported. We used a load cell to measure force through the system and motion capture data to create a vector of the supplied lifting force. The final prototype cost less than $4000 and was able to support 80% of the users' bodyweight. Fluctuations in vertical force increased with speed and bodyweight support, reaching a maximum of 10% at 1.6 m/s and 69% BW support.
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Affiliation(s)
- Mhairi K MacLean
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Building 1275 Center Drive, Gainesville, FL 32611
| | - Daniel P Ferris
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Building 1275 Center Drive, Gainesville, FL 32611
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Effect of Post-Stroke Rehabilitation on Body Mass Composition in Relation to Socio-Demographic and Clinical Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17145134. [PMID: 32708623 PMCID: PMC7400096 DOI: 10.3390/ijerph17145134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/09/2020] [Accepted: 07/14/2020] [Indexed: 12/15/2022]
Abstract
Background and objectives: Stroke is one of the leading causes of morbidity, mortality and long-term adult disability. The aim of this study was to assess the changes in body mass composition in patients after stroke in connection with selected socio-demographic and clinical factors (sex, age, type of stroke and time from the first symptoms) following the rehabilitation process. Materials and Methods: The study group consisted of 100 post-stroke subjects who participated in a comprehensive rehabilitation program for a duration of five weeks. The measurements of body composition by a Tanita MC 780 MA analyser were performed on the day of admission to hospital, on the day of discharge (after 5 weeks) and 12 weeks after discharge from hospital. Results: It was shown that before rehabilitation (Exam I) in the study group there were significant differences in body composition relative to sex, age and time from stroke. The rates of fat mass % and visceral fat level decreased after rehabilitation (Exam II) in both males and females. Exam II, at the end hospital rehabilitation, showed lower levels of fat mass %, visceral fat level, as well as fat-free mass % and higher values of total body water % and muscle mass %. In Exam III, i.e., 12 weeks after discharge, all of the parameters retained their values. Conclusions: The study shows an association between stroke risk factors (primarily age, sex and time from the onset of the first symptoms of stroke) and body mass composition resulting from rehabilitation. The type of stroke and the effects of rehabilitation on body mass components showed no differences. Comprehensive rehabilitation had a positive effect on the body mass components.
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Mustafaoglu R, Erhan B, Yeldan I, Gunduz B, Tarakci E. Does robot-assisted gait training improve mobility, activities of daily living and quality of life in stroke? A single-blinded, randomized controlled trial. Acta Neurol Belg 2020; 120:335-344. [PMID: 31989505 DOI: 10.1007/s13760-020-01276-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 01/07/2020] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to investigate the effects of robot-assisted gait training (RAGT) on mobility, activities of daily living (ADLs), and quality of life (QoL) in stroke rehabilitation. Fifty-one stroke patients randomly assigned to Group 1, Group 2, and Group 3 received conventional training (CT) plus RAGT, CT, and RAGT, respectively. The training duration was for 6 weeks. The primary outcome measures were the Barthel Index (BI), Stroke Specific Quality of Life Scale (SS-QOL), 6-Minute Walk Test (6-MWT), and Stair Climbing Test (SCT). The secondary outcomes were Fugl Meyer Assessment-Lower Extremity (FMA-LE), Comfortable 10-m Walk Test (CWT), Fast 10-m Walk Test (FWT), and Rate of Perceived Exertion (RPE). The mean change in all the primary [BI (p = 0.001), 6-MWT (p = 0.001), SS-QOL (p < 0.0001), and SCT (p = 0.004)] and except the FWT (p = 0.354) all the other secondary outcomes [FMA-LE (p = 0.049), CWT (p = 0.025) and RPE (p = 0.023)] improved significantly between the three groups. In the subgroup analysis, BI, 6-MWT, SS-QOL, and SCT improved significantly in Group 1 compared to Group 2 and Group 3 (p < 0.016). However, FMA-LE, CWT, and the RPE significantly improved in Group 1 compared to Group 2 and, also, only CWT improved significantly in Group 1 compared to Group 3 (p = 0.011). In a subgroup analysis of the primary and secondary outcome measures, there were no significant differences in Group 2 compared to Group 3 (p > 0.05). While combined training leads to more improvement in mobility, ADLs, and QoL, CT showed a similar improvement compared to the RAGT in stroke patients.
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Affiliation(s)
- Rustem Mustafaoglu
- Department of Physiotherapy and Rehabilitation, Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Belgin Erhan
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Ipek Yeldan
- Department of Physiotherapy and Rehabilitation, Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University-Cerrahpasa, Istanbul, Turkey.
| | - Berrin Gunduz
- Istanbul Physical Medicine and Rehabilitation Training Hospital, Istanbul, Turkey
| | - Ela Tarakci
- Department of Physiotherapy and Rehabilitation, Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University-Cerrahpasa, Istanbul, Turkey
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31
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Saunders DH, Sanderson M, Hayes S, Johnson L, Kramer S, Carter DD, Jarvis H, Brazzelli M, Mead GE, Cochrane Stroke Group. Physical fitness training for stroke patients. Cochrane Database Syst Rev 2020; 3:CD003316. [PMID: 32196635 PMCID: PMC7083515 DOI: 10.1002/14651858.cd003316.pub7] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Levels of physical activity and physical fitness are low after stroke. Interventions to increase physical fitness could reduce mortality and reduce disability through increased function. OBJECTIVES The primary objectives of this updated review were to determine whether fitness training after stroke reduces death, death or dependence, and disability. The secondary objectives were to determine the effects of training on adverse events, risk factors, physical fitness, mobility, physical function, health status and quality of life, mood, and cognitive function. SEARCH METHODS In July 2018 we searched the Cochrane Stroke Trials Register, CENTRAL, MEDLINE, Embase, CINAHL, SPORTDiscus, PsycINFO, and four additional databases. We also searched ongoing trials registers and conference proceedings, screened reference lists, and contacted experts in the field. SELECTION CRITERIA Randomised trials comparing either cardiorespiratory training or resistance training, or both (mixed training), with usual care, no intervention, or a non-exercise intervention in stroke survivors. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, assessed quality and risk of bias, and extracted data. We analysed data using random-effects meta-analyses and assessed the quality of the evidence using the GRADE approach. Diverse outcome measures limited the intended analyses. MAIN RESULTS We included 75 studies, involving 3017 mostly ambulatory participants, which comprised cardiorespiratory (32 studies, 1631 participants), resistance (20 studies, 779 participants), and mixed training interventions (23 studies, 1207 participants). Death was not influenced by any intervention; risk differences were all 0.00 (low-certainty evidence). There were few deaths overall (19/3017 at end of intervention and 19/1469 at end of follow-up). None of the studies assessed death or dependence as a composite outcome. Disability scores were improved at end of intervention by cardiorespiratory training (standardised mean difference (SMD) 0.52, 95% CI 0.19 to 0.84; 8 studies, 462 participants; P = 0.002; moderate-certainty evidence) and mixed training (SMD 0.23, 95% CI 0.03 to 0.42; 9 studies, 604 participants; P = 0.02; low-certainty evidence). There were too few data to assess the effects of resistance training on disability. Secondary outcomes showed multiple benefits for physical fitness (VO2 peak and strength), mobility (walking speed) and physical function (balance). These physical effects tended to be intervention-specific with the evidence mostly low or moderate certainty. Risk factor data were limited or showed no effects apart from cardiorespiratory fitness (VO2 peak), which increased after cardiorespiratory training (mean difference (MD) 3.40 mL/kg/min, 95% CI 2.98 to 3.83; 9 studies, 438 participants; moderate-certainty evidence). There was no evidence of any serious adverse events. Lack of data prevents conclusions about effects of training on mood, quality of life, and cognition. Lack of data also meant benefits at follow-up (i.e. after training had stopped) were unclear but some mobility benefits did persist. Risk of bias varied across studies but imbalanced amounts of exposure in control and intervention groups was a common issue affecting many comparisons. AUTHORS' CONCLUSIONS Few deaths overall suggest exercise is a safe intervention but means we cannot determine whether exercise reduces mortality or the chance of death or dependency. Cardiorespiratory training and, to a lesser extent mixed training, reduce disability during or after usual stroke care; this could be mediated by improved mobility and balance. There is sufficient evidence to incorporate cardiorespiratory and mixed training, involving walking, within post-stroke rehabilitation programmes to improve fitness, balance and the speed and capacity of walking. The magnitude of VO2 peak increase after cardiorespiratory training has been suggested to reduce risk of stroke hospitalisation by ˜7%. Cognitive function is under-investigated despite being a key outcome of interest for patients. Further well-designed randomised trials are needed to determine the optimal exercise prescription, the range of benefits and any long-term benefits.
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Affiliation(s)
- David H Saunders
- University of EdinburghPhysical Activity for Health Research Centre (PAHRC)St Leonards LandHolyrood RoadEdinburghMidlothianUKEH8 8AQ
| | - Mark Sanderson
- University of the West of ScotlandInstitute of Clinical Exercise and Health ScienceRoom A071A, Almada BuildingHamiltonUKML3 0JB
| | - Sara Hayes
- University of LimerickSchool of Allied Health, Ageing Research Centre, Health Research InstituteLimerickIreland
| | - Liam Johnson
- University of MelbourneThe Florey Institute of Neuroscience and Mental HealthHeidelbergAustralia3084
| | - Sharon Kramer
- University of MelbourneThe Florey Institute of Neuroscience and Mental HealthHeidelbergAustralia3084
| | - Daniel D Carter
- University of LimerickSchool of Allied Health, Faculty of Education and Health SciencesLimerickIreland
| | - Hannah Jarvis
- Manchester Metropolitan UniversityResearch Centre for Musculoskeletal Science and Sports Medicine, Faculty of Science and EngineeringJohn Dalton BuildingChester StreetManchesterUKM1 5GD
| | - Miriam Brazzelli
- University of AberdeenHealth Services Research UnitHealth Sciences BuildingForesterhillAberdeenUKAB25 2ZD
| | - Gillian E Mead
- University of EdinburghCentre for Clinical Brain SciencesRoom S1642, Royal InfirmaryLittle France CrescentEdinburghUKEH16 4SA
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Iyer SS, Joseph JV, Vashista V. Evolving Toward Subject-Specific Gait Rehabilitation Through Single-Joint Resistive Force Interventions. Front Neurorobot 2020; 14:15. [PMID: 32226372 PMCID: PMC7080984 DOI: 10.3389/fnbot.2020.00015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 02/17/2020] [Indexed: 11/25/2022] Open
Abstract
Walking is one of the most relevant tasks that a person performs in their daily routine. Despite its mechanical complexities, any change in the external conditions that applies some external perturbation, or in the human musculoskeletal system that limits an individual's movement, entails a motor response that can either be compensatory or adaptive in nature. Incidentally, with aging or due to the occurrence of a neuro-musculoskeletal disorder, a combination of such changes including reduced sensory perception, muscle weakness, spasticity, etc. has been reported, and this can significantly degrade the human walking performance. Various studies in gait rehabilitation literature have identified a need for the development of better rehabilitation paradigms and have implied that an efficient human robot interaction is critical. Understanding how humans respond to a particular gait alteration can be beneficial in designing an effective rehabilitation paradigm. In this context, the current work investigates human locomotor adaptation to resistive alteration to the hip and ankle strategies of walking. A cable-driven robotic system, which does not add mobility constraints, was used to implement resistive force interventions within the hip and ankle joints separately through two experiments with eight healthy adult participants in each. In both cases, the intervention was applied during the push-off phase of walking, i.e., from pre-swing to terminal swing. The results showed that subjects in both groups adopted a compensatory response to the applied intervention and demonstrated intralimb and interlimb adaptation. Overall, the participants demonstrated a deviant gait implying lower limb musculoskeletal adjustments as if to compensate for a hip or ankle abnormality.
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Affiliation(s)
- S Srikesh Iyer
- Human Centered Robotics Lab, Indian Institute of Technology Gandhinagar, Gandhinagar, India
| | - Joel V Joseph
- Human Centered Robotics Lab, Indian Institute of Technology Gandhinagar, Gandhinagar, India
| | - Vineet Vashista
- Human Centered Robotics Lab, Indian Institute of Technology Gandhinagar, Gandhinagar, India
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Bergeron L, Busuttil V, Botto JM. Multipotentiality of skin-derived precursors: application to the regeneration of skin and other tissues. Int J Cosmet Sci 2020; 42:5-15. [PMID: 31612512 DOI: 10.1111/ics.12587] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/12/2019] [Indexed: 12/13/2022]
Abstract
Skin-derived precursors (SKPs) have been described as multipotent dermal precursors. Here, we provide a review of the breadth and depth of scientific literature and studies regarding SKPs, accounting for a large number of scientific publications. Interestingly, these progenitors can be isolated from embryonic and adult skin, as well as from a population of dermal cells cultured in vitro in monolayer. Gathering information from different authors, this review explores different aspects of the SKP theme, such as the potential distinct origins of SKPs in rodents and in humans, and also their ability to differentiate in vitro and in vivo into multiple lineages of different progeny. This remarkable capacity makes SKPs an interesting endogenous source of precursors to explore in the framework of experimental and therapeutic applications in different domains. SKPs are not only involved in the skin's dermal maintenance and support as well as wound healing, but also in hair follicle morphogenesis. This review points out the interests of future researches on SKPs for innovative perspectives that may be helpful in many different types of scientific and medical domains.
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Affiliation(s)
- L Bergeron
- Ashland Specialties France, Global Skin Research Center, 655, route du Pin Montard, 06904, Sophia Antipolis, France
| | - V Busuttil
- Ashland Specialties France, Global Skin Research Center, 655, route du Pin Montard, 06904, Sophia Antipolis, France
| | - J-M Botto
- Ashland Specialties France, Global Skin Research Center, 655, route du Pin Montard, 06904, Sophia Antipolis, France
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Effectiveness of rehabilitation interventions to improve paretic propulsion in individuals with stroke - A systematic review. Clin Biomech (Bristol, Avon) 2020; 71:176-188. [PMID: 31770660 DOI: 10.1016/j.clinbiomech.2019.10.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 09/19/2019] [Accepted: 10/18/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Stroke survivors often show reduced walking velocity and gait asymmetry. These gait abnormalities are associated with reduced propulsion of the paretic leg. This review aimed to provide an overview of the potential effectiveness of post-stroke rehabilitation interventions to improve paretic propulsion, ankle kinetics and walking velocity. METHODS A systematic search was performed in Pubmed, Web of Science, Embase, and Pedro. Studies were eligible if they reported changes in propulsion measures (impulse, peak value and symmetry ratios) or ankle kinetics (moment and power) following intervention in stroke survivors (group size ≥10). Study selection, data extraction and quality assessment were performed independently by two authors. FINDINGS A total of 28 studies were included, of which 25 studies applied exercise interventions, two studies focused on surgical interventions, and one on non-invasive brain stimulation. The number of high-quality trials was limited (N = 6; score Downs and Black scale ≥19). Propulsion measures were the primary outcome in eight studies. In general, mixed results were reported with 14 interventions yielding improvements in propulsion and ankle kinetics. In contrast, gains in walking velocity were observed in the vast majority of studies (N = 20 out of 23). INTERPRETATION Interventions that yielded gains in propulsion appeared to have in common that they challenged and/or enabled the utilization of latent propulsive capacity of the paretic leg during walking. Walking speed generally increased, regardless of the observed change in propulsion, suggesting the use of compensatory mechanisms. Findings should, however, be interpreted with some caution, as the evidence base for this emerging focus of rehabilitation is limited.
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Anggelis E, Powell ES, Westgate PM, Glueck AC, Sawaki L. Impact of motor therapy with dynamic body-weight support on Functional Independence Measures in traumatic brain injury: An exploratory study. NeuroRehabilitation 2019; 45:519-524. [PMID: 31868690 PMCID: PMC7029315 DOI: 10.3233/nre-192898] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND: Contemporary goals of rehabilitation after traumatic brain injury (TBI) aim to improve cognitive and motor function by applying concepts of neuroplasticity. This can be challenging to carry out in TBI patients with motor, balance, and cognitive impairments. OBJECTIVE: To determine whether use of dynamic body-weight support (DBWS) would allow safe administration of intensive motor therapy during inpatient rehabilitation and whether its use would yield greater improvement in functional recovery than standard-of-care (SOC) therapy in adults with TBI. METHODS: Data in this retrospective cohort study was collected from patients with TBI who receive inpatient rehabilitation incorporating DBWS (n = 6) and who received inpatient rehabilitation without DBWS (SOC, n = 6). The primary outcome measure was the change in Functional Independence Measures (FIM) scores from admission to discharge. RESULTS: There was significant improvement in total FIM scores at discharge compared to admission for both the DBWS (p = 0.001) and SOC (p = 0.005) groups. Overall, the DBWS group had greater improvement in total FIM score and FIM subscales compared to the SOC group. CONCLUSIONS: Our results suggest DBWS has the potential to allow a greater intensity of therapy during inpatient rehabilitation and yield better outcomes compared to SOC in patients with TBI.
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Affiliation(s)
- Emily Anggelis
- University of Kentucky, College of Medicine, Lexington, KY, USA
| | - Elizabeth Salmon Powell
- Department of Physical Medicine and Rehabilitation, University of Kentucky, Lexington, KY, USA
| | - Philip M Westgate
- Department of Biostatistics, University of Kentucky, College of Public Health, Lexington, KY, USA
| | - Amanda C Glueck
- Department of Neurology, University of Kentucky, Lexington, KY, USA
| | - Lumy Sawaki
- Department of Physical Medicine and Rehabilitation, University of Kentucky, Lexington, KY, USA
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Narasaki-Jara M, Wagatsuma M, Holt JL, Acuña SM, Vrongistinos K, Jung T. Aquatic treadmill walking at three depths of water in people with traumatic brain injury. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2019; 25:e1817. [PMID: 31758753 DOI: 10.1002/pri.1817] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 08/05/2019] [Accepted: 10/03/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The purpose of this study was to analyse kinematic and spatiotemporal gait characteristics of aquatic treadmill walking among three different depths of water in individuals with traumatic brain injury. METHODS A total of 13 individuals with traumatic brain injury participated in the study and completed walking trials at three different depths as follows: waist, chest, and neck level, which was adjusted by a movable floor pool. A self-selected comfortable walking speed at the waist level was used as a matched speed for all walking trials. Participants completed three aquatic treadmill walking trials under each of the three water depths. Each participant's gait was captured by a customized underwater motion analysis system and processed by a two-dimensional motion analysis software. RESULTS The repeated measures analysis of variance showed significant differences in spatiotemporal and joint kinematic variables across three conditions: stance swing ratio (p = .023), peak hip flexion (p = .001), hip range of motion (p = .047), and peak ankle dorsiflexion (p = .000). Various water properties in conjunction with motor impairments might have contributed to alterations in gait kinematics. CONCLUSION Our findings suggest that walking in neck-depth water may not be ideal for gait training as it appears to limit hip flexion and ankle dorsiflexion. It is recommended that waist to chest-depth water be used to provide an accommodating environment for aquatic gait rehabilitation.
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Affiliation(s)
- Mai Narasaki-Jara
- Center of Achievement, California State University, Northridge, CA, USA
| | - Mayumi Wagatsuma
- Center of Achievement, California State University, Northridge, CA, USA
| | - Jacob Lee Holt
- Center of Achievement, California State University, Northridge, CA, USA
| | | | | | - Taeyou Jung
- Center of Achievement, California State University, Northridge, CA, USA
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Hsu CY, Cheng YH, Lai CH, Lin YN. Clinical non-superiority of technology-assisted gait training with body weight support in patients with subacute stroke: A meta-analysis. Ann Phys Rehabil Med 2019; 63:535-542. [PMID: 31676456 DOI: 10.1016/j.rehab.2019.09.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Technology-assisted gait training (TAGT) with body weight support (BWS) has been designed to provide high numbers of repetitions during stepping practice, but its benefits have been inconclusive. OBJECTIVE We evaluated the superiority of TAGT over conventional overground training (COT) to judge the clinical benefits. METHODS We searched PubMed, Embase and Web of Science databases from their earliest record to July 1, 2019 and included randomized controlled trials of TAGT with BWS, such as robot-assisted gait training and body weight-supported treadmill training, for treating walking disability in patients within 6months after stroke. We conducted a meta-analysis of the outcomes motor impairment, mobility capacity, walking speed, endurance and fitness, balance, and activities of daily living as well as subgroup analyses of initial ambulatory ability and stroke duration. RESULTS Among 14robotics and 10body weight-supported treadmill studies included for review, 23studies involving 1452participants contributed to the meta-analysis. We found no significant standardized mean differences between TAGT and COT (P>0.05) across all outcome categories in the robotics subgroup, the body weight-supported treadmill subgroup, or both subgroups combined, for both the short and long term. Further subgroup analyses also revealed non-significant standardized mean differences (P>0.05) across all outcomes in the subgroups initially ambulatory, non-ambulatory, or stroke duration less than 3 months. CONCLUSIONS TAGT with BWS was not superior to COT in improving post-stroke recovery in patients with subacute stroke. Strategies other than simply increasing the repetitions by external assistance may be considered to augment the treatment effects of TAGT.
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Affiliation(s)
- Chih-Yang Hsu
- Department of Physical Medicine and Rehabilitation, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yu-Hsuan Cheng
- Department of Physical Medicine and Rehabilitation, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chien-Hung Lai
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yen-Nung Lin
- Department of Physical Medicine and Rehabilitation, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan; Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan.
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Bao X, Luo JN, Shao YC, Tang ZQ, Liu HY, Liu H, Tan JW. Effect of functional electrical stimulation plus body weight-supported treadmill training for gait rehabilitation in patients with poststroke: a retrospective case-matched study. Eur J Phys Rehabil Med 2019; 56:34-40. [PMID: 31615194 DOI: 10.23736/s1973-9087.19.05879-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Functional electrical stimulation (FES) plus body weight-supported treadmill training (BWSTT) provide effective gait training for poststroke patients with abnormal gait. These features promote a successful active motor relearning of ambulation in stroke survivors. AIM This is a retrospective study to assess the effect of FES plus BWSTT for gait rehabilitation in patients poststroke. DESIGN A retrospective case-matched study. SETTING Participants were recruited from a rehabilitation department in an acute university-affiliated hospital POPULATION: Ninety patients poststroke from Yue Bei People's Hospital underwent BWSTT (A: control group) were compared to an equal number of cross-matched patients who received FES plus BWSTT (B: FES plus BWSTT group). METHODS While B group received FES for 45 minutes plus BSWTT for 30 minutes in the program, group A received time-matched BWSTT alone. The walking speed, step length, step cadence, Fugl-Meyer Lower-Limb Scale (LL-FMA), composite spasticity scale (CSS), 10-Meter Walk Test (10MWT), Tinetti Balance Test (TBT) and nerve physiology testing were collected before and after intervention. RESULTS One hundred and eighty patients with poststroke abnormal gait were chosen. There were significant differences in walking speed, step length, step cadence, LL-FMA, CSS, TBT, and 10MWT between baseline and postintervention (P<0.05). There were significant differences in walking speed, step length, step cadence, LL-FMA, CSS, TBT, and 10MWT between two groups at the end of the eighth week (P<0.05), but not at baseline (P>0.05). In comparison with group A, the peak of somatosensory evoked potential (SEP) and motor evoked potential (MEP) amplitude increased, the latency was shortened, and the conduction velocity of sensory nerve (SCV) and motor nerve (MCV) was significantly increased in the group B (P<0.05). No adverse events occurred during the study. CONCLUSIONS This study suggests that FES plus BWSTT could be more effective than BWSTT alone in the improvement of gait, balance, spasticity, and function of the lower limb in patients poststroke. CLINICAL REHABILITATION IMPACT Introduce effective rehabilitation strategies for poststroke patients with abnormal gait.
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Affiliation(s)
- Xiao Bao
- Department of Rehabilitation Medicine, Yue Bei People's Hospital, ShaoGuan, China
| | - Jin-Ning Luo
- Department of Rehabilitation Medicine, Yue Bei People's Hospital, ShaoGuan, China
| | - Yu-Chun Shao
- Department of Rehabilitation Medicine, Yue Bei People's Hospital, ShaoGuan, China
| | - Zhou-Quan Tang
- Department of Rehabilitation Medicine, Yue Bei People's Hospital, ShaoGuan, China
| | - Hui-Yu Liu
- Department of Rehabilitation Medicine, Yue Bei People's Hospital, ShaoGuan, China
| | - Howe Liu
- Department of Physical Therapy, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Jie-Wen Tan
- Department of Rehabilitation Medicine, Xinhua College of Sun Yat-sen University, GuangZhou, China -
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Denissen S, Staring W, Kunkel D, Pickering RM, Lennon S, Geurts ACH, Weerdesteyn V, Verheyden GSAF, Cochrane Stroke Group. Interventions for preventing falls in people after stroke. Cochrane Database Syst Rev 2019; 10:CD008728. [PMID: 31573069 PMCID: PMC6770464 DOI: 10.1002/14651858.cd008728.pub3] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Falls are one of the most common complications after stroke, with a reported incidence ranging between 7% in the first week and 73% in the first year post stroke. This is an updated version of the original Cochrane Review published in 2013. OBJECTIVES To evaluate the effectiveness of interventions aimed at preventing falls in people after stroke. Our primary objective was to determine the effect of interventions on the rate of falls (number of falls per person-year) and the number of fallers. Our secondary objectives were to determine the effects of interventions aimed at preventing falls on 1) the number of fall-related fractures; 2) the number of fall-related hospital admissions; 3) near-fall events; 4) economic evaluation; 5) quality of life; and 6) adverse effects of the interventions. SEARCH METHODS We searched the trials registers of the Cochrane Stroke Group (September 2018) and the Cochrane Bone, Joint and Muscle Trauma Group (October 2018); the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 9) in the Cochrane Library; MEDLINE (1950 to September 2018); Embase (1980 to September 2018); CINAHL (1982 to September 2018); PsycINFO (1806 to August 2018); AMED (1985 to December 2017); and PEDro (September 2018). We also searched trials registers and checked reference lists. SELECTION CRITERIA Randomised controlled trials of interventions where the primary or secondary aim was to prevent falls in people after stroke. DATA COLLECTION AND ANALYSIS Two review authors (SD and WS) independently selected studies for inclusion, assessed trial quality and risk of bias, and extracted data. We resolved disagreements through discussion, and contacted study authors for additional information where required. We used a rate ratio and 95% confidence interval (CI) to compare the rate of falls (e.g. falls per person-year) between intervention and control groups. For risk of falling we used a risk ratio and 95% CI based on the number of people falling (fallers) in each group. We pooled results where appropriate and applied GRADE to assess the quality of the evidence. MAIN RESULTS We included 14 studies (of which six have been published since the first version of this review in 2013), with a total of 1358 participants. We found studies that investigated exercises, predischarge home visits for hospitalised patients, the provision of single lens distance vision glasses instead of multifocal glasses, a servo-assistive rollator and non-invasive brain stimulation for preventing falls.Exercise compared to control for preventing falls in people after strokeThe pooled result of eight studies showed that exercise may reduce the rate of falls but we are uncertain about this result (rate ratio 0.72, 95% CI 0.54 to 0.94, 765 participants, low-quality evidence). Sensitivity analysis for single exercise interventions, omitting studies using multiple/multifactorial interventions, also found that exercise may reduce the rate of falls (rate ratio 0.66, 95% CI 0.50 to 0.87, 626 participants). Sensitivity analysis for the effect in the chronic phase post stroke resulted in little or no difference in rate of falls (rate ratio 0.58, 95% CI 0.31 to 1.12, 205 participants). A sensitivity analysis including only studies with low risk of bias found little or no difference in rate of falls (rate ratio 0.88, 95% CI 0.65 to 1.20, 462 participants). Methodological limitations mean that we have very low confidence in the results of these sensitivity analyses.For the outcome of number of fallers, we are very uncertain of the effect of exercises compared to the control condition, based on the pooled result of 10 studies (risk ratio 1.03, 95% CI 0.90 to 1.19, 969 participants, very low quality evidence). The same sensitivity analyses as described above gives us very low certainty that there are little or no differences in number of fallers (single interventions: risk ratio 1.09, 95% CI 0.93 to 1.28, 796 participants; chronic phase post stroke: risk ratio 0.94, 95% CI 0.73 to 1.22, 375 participants; low risk of bias studies: risk ratio 0.96, 95% CI 0.77 to 1.21, 462 participants).Other interventions for preventing falls in people after strokeWe are very uncertain whether interventions other than exercise reduce the rate of falls or number of fallers. We identified very low certainty evidence when investigating the effect of predischarge home visits (rate ratio 0.85, 95% CI 0.43 to 1.69; risk ratio 1.48, 95% CI 0.71 to 3.09; 85 participants), provision of single lens distance glasses to regular wearers of multifocal glasses (rate ratio 1.08, 95% CI 0.52 to 2.25; risk ratio 0.74, 95% CI 0.47 to 1.18; 46 participants) and a servo-assistive rollator (rate ratio 0.44, 95% CI 0.16 to 1.21; risk ratio 0.44, 95% CI 0.16 to 1.22; 42 participants).Finally, transcranial direct current stimulation (tDCS) was used in one study to examine the effect on falls post stroke. We have low certainty that active tDCS may reduce the number of fallers compared to sham tDCS (risk ratio 0.30, 95% CI 0.14 to 0.63; 60 participants). AUTHORS' CONCLUSIONS At present there exists very little evidence about interventions other than exercises to reduce falling post stroke. Low to very low quality evidence exists that this population benefits from exercises to prevent falls, but not to reduce number of fallers.Fall research does not in general or consistently follow methodological gold standards, especially with regard to fall definition and time post stroke. More well-reported, adequately-powered research should further establish the value of exercises in reducing falling, in particular per phase, post stroke.
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Affiliation(s)
- Stijn Denissen
- KU LeuvenDepartment of Rehabilitation SciencesLeuvenBelgium
- Vrije Universiteit BrusselCIME Cognition and Modeling group, Center For Neurosciences (C4N)BrusselsBelgium1050
| | - Wouter Staring
- Radboud University Medical CentreDepartment of Rehabilitation, Donders Institute for Brain, Cognition and BehaviourNijmegenNetherlands
| | - Dorit Kunkel
- University of SouthamptonFaculty of Health SciencesSouthampton General HospitalMP 886, Tremona RoadSouthamptonUKSO16 6YD
| | - Ruth M Pickering
- University of SouthamptonDepartment of Public Health Sciences and Medical StatisticsSouthampton General Hospital, MP 805Tremona RoadSouthamptonUKSO16 6YD
| | - Sheila Lennon
- Flinders UniversityPhysiotherapy, College of Nursing & Health SciencesAdelaideAustralia
| | - Alexander CH Geurts
- Radboud University Medical CentreDepartment of Rehabilitation, Donders Institute for Brain, Cognition and BehaviourNijmegenNetherlands
- Sint Maartenskliniek ResearchNijmegenNetherlands
| | - Vivian Weerdesteyn
- Radboud University Medical CentreDepartment of Rehabilitation, Donders Institute for Brain, Cognition and BehaviourNijmegenNetherlands
- Sint Maartenskliniek ResearchNijmegenNetherlands
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Huang S, Yu X, Lu Y, Qiao J, Wang H, Jiang LM, Wu X, Niu W. Body weight support-Tai Chi footwork for balance of stroke survivors with fear of falling: A pilot randomized controlled trial. Complement Ther Clin Pract 2019; 37:140-147. [PMID: 31570211 DOI: 10.1016/j.ctcp.2019.101061] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 09/22/2019] [Accepted: 09/22/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND PURPOSE Balance impairment is the predominant risk factor for falls in stroke survivors. This study examined the effects of body weight support-Tai Chi (BWS-TC) footwork on balance control among stroke survivors with fear of falling (FOF). MATERIALS AND METHODS Twenty-eight stroke survivors with FOF were randomly allocated to either control or BWS-TC groups. Those in BWS-TC underwent Tai Chi training for 12 weeks. Outcomes were assessed in all participants by evaluation of the limits of stability test, modified clinical test of sensory integration of balance, fall risk index, and Fugl-Meyer assessment of lower limbs at baseline and 12 weeks. RESULTS The BWS-TC group displayed significant enhancement in dynamic control and vestibular and somatosensory integration. CONCLUSION BWS-TC may enhance dynamic control and sensory integration of balance and reduce the risk of fall in stroke survivors with FOF.
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Affiliation(s)
- ShangJun Huang
- Department of Rehabilitation Sciences, School of Medicine, Tongji University, Shanghai, 200092, China; Department of Rehabilitation, Shanghai Seventh People's Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200137, China
| | - XiaoMing Yu
- Department of Rehabilitation, Shanghai Seventh People's Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200137, China
| | - Yan Lu
- Department of Rehabilitation, Shanghai Seventh People's Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200137, China
| | - Jun Qiao
- Department of Treatment, The Second Rehabilitation Hospital of Shanghai, Shanghai, 200441, China
| | - HongLin Wang
- Department of Rehabilitation, Shanghai Seventh People's Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200137, China
| | - Li-Ming Jiang
- Department of Rehabilitation, Shanghai Seventh People's Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200137, China
| | - XuBo Wu
- School of Rehabilitation Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China.
| | - WenXin Niu
- YangZhi Rehabilitation Hospital, Tongji University School of Medicine, Shanghai, 201619, China.
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Body weight supported treadmill vs. overground gait training for acute stroke gait rehabilitation. Int J Rehabil Res 2019; 42:270-274. [DOI: 10.1097/mrr.0000000000000357] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Leszczak J, Czenczek-Lewandowska E, Przysada G, Baran J, Weres A, Wyszyńska J, Mazur A, Kwolek A. Association Between Body Mass Index and Results of Rehabilitation in Patients After Stroke: A 3-Month Observational Follow-Up Study. Med Sci Monit 2019; 25:4869-4876. [PMID: 31257360 PMCID: PMC6618340 DOI: 10.12659/msm.915586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background We assessed the relationship between body mass index and results of rehabilitation in stroke patients. Material/Methods The study was carried out at the Clinical Rehabilitation Ward with Early Neurological Rehabilitation Unit at the Clinical Hospital. The examinations were performed 3 times. Based on inclusion and exclusion criteria, 128 subjects were qualified for the first examination, the second examination involved 114 subjects, and 100 stroke patients participated in the third examination. Body mass was examined with an accuracy of 0.1 kg, using a Tanita MC–780 MA body composition analyser. Body mass index (BMI) was calculated for all of the subjects. Effects of rehabilitation were assessed with the Barthel index and Ashworth scale. Results Higher functional status in daily life, measured with the Barthel scale, was found in patients with normal body mass, compared to the overweight and obese subjects (examination I, II, and II). Exam I showed that before rehabilitation the overweight patients obtained significantly higher results in assessment of upper limbs, based on the Ashworth scale (mean=0.35±0.54) compared to the obese patients (mean=0.03±0.32) and those with normal body weight (mean=0.24±0.75). Conclusions Following hospital-based rehabilitation, patients with normal body mass achieved greater functional efficiency. The findings also show a trend towards normalization of BMI. The positive effect of rehabilitation was sustained for 3 months (Exam III), which may contribute to decreased risk of cardiovascular diseases and complications such as stroke.
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Affiliation(s)
| | | | - Grzegorz Przysada
- Medical Faculty, University of Rzeszów, Rzeszów, Poland.,Clinical Regional Hospital No. 2 in Rzeszów, Rzeszów, Poland
| | - Joanna Baran
- Medical Faculty, University of Rzeszów, Rzeszów, Poland
| | - Aneta Weres
- Medical Faculty, University of Rzeszów, Rzeszów, Poland
| | | | - Artur Mazur
- Medical Faculty, University of Rzeszów, Rzeszów, Poland.,Clinical Regional Hospital No. 2 in Rzeszów, Rzeszów, Poland
| | - Andrzej Kwolek
- University of Rzeszów, University of Rzeszów, Medical Faculty, Rzeszów, Poland
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Broderick P, Horgan F, Blake C, Ehrensberger M, Simpson D, Monaghan K. Mirror therapy and treadmill training for patients with chronic stroke: a pilot randomized controlled trial. Top Stroke Rehabil 2018; 26:163-172. [PMID: 30580672 DOI: 10.1080/10749357.2018.1556504] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Previous lower-limb mirror therapy research has focused on non-weight bearing interventions. OBJECTIVES The primary aim of this study was to investigate the effect and feasibility of a combination of mirror therapy and treadmill training on post-stroke lower-limb recovery compared to a placebo intervention. METHODS All patients (N = 30) walked on a treadmill for 30 min per day, 3 days per week, for 4 weeks. The mirror therapy and treadmill training group (n = 15) walked on the treadmill while viewing a reflection of their non-paretic limb in a mirror positioned in their mid-sagittal plane. The placebo group (n = 15) received no mirror visual feedback due to an altered mirror position. PRIMARY OUTCOME MEASURES Ten Metre Walk Test (10MWT) and Six Minute Walk Test (6MWT). SECONDARY OUTCOME MEASURES Modified Ashworth Scale (MAS) and Fugl-Meyer Assessment-Lower Extremity (FMA-LE). Feasibility was appraised by examining participant compliance and any adverse events. RESULTS No significant between group differences were demonstrated for the 10MWT, 6MWT or FMA-LE at post-training or 3-month follow-up assessment. A significant between group difference on the MAS was demonstrated in the reduction of ankle dorsiflexion muscle tone (p = 0.006) and ankle plantarflexion muscle tone (p = 0.01) in the mirror therapy group compared to the placebo group at post-training assessment but not at 3-month follow-up. CONCLUSION Our study reveals that in our group of patients with chronic stroke, mirror therapy combined with treadmill training facilitated significant reductions in ankle muscle tone (p < 0.05) compared to a placebo intervention.
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Affiliation(s)
- P Broderick
- a School of Science , Institute of Technology Sligo , Sligo , Ireland
| | - F Horgan
- b School of Physiotherapy , Royal College of Surgeons in Ireland , Dublin , Ireland
| | - C Blake
- c School of Public Health , University College Dublin , Dublin , Ireland
| | - M Ehrensberger
- a School of Science , Institute of Technology Sligo , Sligo , Ireland
| | - D Simpson
- a School of Science , Institute of Technology Sligo , Sligo , Ireland
| | - K Monaghan
- a School of Science , Institute of Technology Sligo , Sligo , Ireland
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Lin IH, Tsai HT, Wang CY, Hsu CY, Liou TH, Lin YN. Effectiveness and Superiority of Rehabilitative Treatments in Enhancing Motor Recovery Within 6 Months Poststroke: A Systemic Review. Arch Phys Med Rehabil 2018; 100:366-378. [PMID: 30686327 DOI: 10.1016/j.apmr.2018.09.123] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 08/19/2018] [Accepted: 09/21/2018] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To investigate the effects of various rehabilitative interventions aimed at enhancing poststroke motor recovery by assessing their effectiveness when compared with no treatment or placebo and their superiority when compared with conventional training program (CTP). DATA SOURCE A literature search was based on 19 Cochrane reviews and 26 other reviews. We also updated the searches in PubMed up to September 30, 2017. STUDY SELECTION Randomized controlled trials associated with 18 experimented training programs (ETP) were included if they evaluated the effects of the programs on either upper extremity (UE) or lower extremity (LE) motor recovery among adults within 6 months poststroke; included ≥10 participants in each arm; and had an intervention duration of ≥10 consecutive weekdays. DATA EXTRACTION Four reviewers evaluated the eligibility and quality of literature. Methodological quality was assessed using the PEDro scale. DATA SYNTHESIS Among the 178 included studies, 129 including 7450 participants were analyzed in this meta-analysis. Six ETPs were significantly effective in enhancing UE motor recovery, with the standard mean differences (SMDs) and 95% confidence intervals outlined as follow: constraint-induced movement therapy (0.82, 0.45-1.19), electrostimulation (ES)-motor (0.42, 0.22-0.63), mirror therapy (0.71, 0.22-1.20), mixed approach (0.21, 0.01-0.41), robot-assisted training (0.51, 0.22-0.80), and task-oriented training (0.57, 0.16-0.99). Six ETPs were significantly effective in enhancing LE motor recovery: body-weight-supported treadmill training (0.27, 0.01-0.52), caregiver-mediated training (0.64, 0.20-1.08), ES-motor (0.55, 0.27-0.83), mixed approach (0.35, 0.15-0.54), mirror therapy (0.56, 0.13-1.00), and virtual reality (0.60, 0.15-1.05). However, compared with CTPs, almost none of the ETPs exhibited significant SMDs for superiority. CONCLUSIONS Certain experimented interventions were effective in enhancing poststroke motor recovery, but little evidence supported the superiority of experimented interventions over conventional rehabilitation.
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Affiliation(s)
- I-Hsien Lin
- Department of Physical Medicine and Rehabilitation, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Han-Ting Tsai
- Department of Physical Medicine and Rehabilitation, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chien-Yung Wang
- Department of Physical Medicine and Rehabilitation, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chih-Yang Hsu
- Department of Physical Medicine and Rehabilitation, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Yen-Nung Lin
- Department of Physical Medicine and Rehabilitation, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan; Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan.
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The effects of body weight-supported treadmill training on static and dynamic balance in stroke patients: A pilot, single-blind, randomized trial. Turk J Phys Med Rehabil 2018; 64:344-352. [PMID: 31453532 DOI: 10.5606/tftrd.2018.2672] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 06/27/2018] [Indexed: 11/21/2022] Open
Abstract
Objectives This study aims to compare effectiveness of isolated body weight-supported treadmill training (BWSTT) with conventional and combined training on balance, mobility, and fear of falling in stroke patients. Patients and methods Between November 2014 and November 2015, a total of 45 post-stroke patients (32 males, 13 females; mean age 53.1±13.2 years; range, 19 to 73 years) were randomly assigned to combined training group (CombTG), conventional training group (CTG), and BWSTT group (BWSTTG). The CombTG received 45 min conventional therapy for five days a week along with 45 min of BWSTT twice a week. The CTG received only conventional therapy for five days a week. The BWSTTG received only BWSTT twice a week. Training duration was six weeks for all groups. Primary outcome measures were the Berg Balance Scale (BBS), affected and non-affected side Single Leg Stance Test (e-SLST/n-SLST), and Timed Up and Go Test (TUG) results. Secondary outcomes were the Falls Efficacy Scale-International (FES-I), Rivermead Mobility Index (RMI), Comfortable 10-m Walk Test (CWT), and Stair Climbing Test (SCT) results. Results The mean change of outcome measures demonstrated that the improvements between groups were significantly different among the three groups, except for the CWT (p=0.135). In subgroup analysis, except for the RMI and CWT, all primary and secondary outcome measures improved significantly in favor of the CombTG, compared to the CTG and BWSTTG (p<0.016). However, no statistically significant difference was found in the mean change of the CTG and BWSTTG (p>0.05). Conclusion This study demonstrates that combined training has considerable effects on balance, mobility, and fear of falling parameters, while lower frequency of isolated BWSTT is as much effective as higher frequency of conventional training in ambulatory post-stroke patients.
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De Luca A, Vernetti H, Capra C, Pisu I, Cassiano C, Barone L, Gaito F, Danese F, Antonio Checchia G, Lentino C, Giannoni P, Casadio M. Recovery and compensation after robotic assisted gait training in chronic stroke survivors. Disabil Rehabil Assist Technol 2018; 14:826-838. [PMID: 29741134 DOI: 10.1080/17483107.2018.1466926] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background: Gait re-education is a primary rehabilitation goal after stroke. In the last decades, robots with different mechanical structures have been extensively used in the clinical practice for gait training of stroke survivors. However, the effectiveness of robotic training is still controversial, especially for chronic subjects. In this study, we investigated the short-term effects of gait training assisted by an endpoint robot in a population of chronic stroke survivors.Methods: Subjects were evaluated before and after training with clinical scales and instrumented gait analysis. Our primary outcome indicator was the walking speed. Next, we investigated the changes in kinetic and kinematic gait patterns as well as the intersegmental coordination at the level of the lower limbs.Results: Most subjects improved their speed in over-ground walking, by modifying the temporal more than the spatial gait parameters. These changes led to an improvement in the ankle power for both sides and to a slight reduction of the inclination of the pelvis during the swing phase, mainly due to a decreased knee flexion and an increased hip extension on the unimpaired leg.Conclusions: These results indicate that the proposed training induced mainly a functional change rather than an improvement of the quality of gait.Implication for RehabilitationGait re-education is a primary goal in stroke rehabilitation.Nowadays several robotic devices for gait rehabilitation are used in the clinical practice, but their effectiveness is controversial, especially for chronic survivors.After a 20-session training with an endpoint robot the chronic stroke survivors showed an improvement in overground gait speed.The increased gait speed was mainly due to functional changes of the temporal parameters and of the kinetic variables at the level of both ankle joints, as well as to a reduction of compensatory strategies observable in the unimpaired side.
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Affiliation(s)
- Alice De Luca
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Genoa, Italy.,Recovery and Functional Reeducation Unit, Rehabilitation Department, Santa Corona Hospital, Pietra Ligure, Savona, Italy
| | - Honoré Vernetti
- Recovery and Functional Reeducation Unit, Rehabilitation Department, Santa Corona Hospital, Pietra Ligure, Savona, Italy
| | - Cristina Capra
- Recovery and Functional Reeducation Unit, Rehabilitation Department, Santa Corona Hospital, Pietra Ligure, Savona, Italy
| | - Ivano Pisu
- Recovery and Functional Reeducation Unit, Rehabilitation Department, Santa Corona Hospital, Pietra Ligure, Savona, Italy
| | - Cinzia Cassiano
- Recovery and Functional Reeducation Unit, Rehabilitation Department, Santa Corona Hospital, Pietra Ligure, Savona, Italy
| | - Laura Barone
- Recovery and Functional Reeducation Unit, Rehabilitation Department, Santa Corona Hospital, Pietra Ligure, Savona, Italy
| | - Federica Gaito
- Recovery and Functional Reeducation Unit, Rehabilitation Department, Santa Corona Hospital, Pietra Ligure, Savona, Italy
| | - Federica Danese
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Genoa, Italy
| | - Giovanni Antonio Checchia
- Recovery and Functional Reeducation Unit, Rehabilitation Department, Santa Corona Hospital, Pietra Ligure, Savona, Italy
| | - Carmelo Lentino
- Recovery and Functional Reeducation Unit, Rehabilitation Department, Santa Corona Hospital, Pietra Ligure, Savona, Italy
| | - Psiche Giannoni
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Genoa, Italy
| | - Maura Casadio
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Genoa, Italy
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Guzik A, Drużbicki M, Wolan-Nieroda A. Assessment of two gait training models: conventional physical therapy and treadmill exercise, in terms of their effectiveness after stroke. Hippokratia 2018; 22:51-59. [PMID: 31217676 PMCID: PMC6548526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Rehabilitation provided to patients after stroke mainly aims at improvement in gait function. The most common gait training strategies include treadmill exercise and traditional overground gait training. The study was designed to assess the effectiveness of two models of gait re-education in post-stroke patients, namely conventional physical therapy and treadmill training. METHODS A systematic literature review was performed, taking into account the online databases of Medline (PubMed), Science Direct, Web of Science, Google Scholar, and clinical trials registries. The following inclusion criteria were applied: studies published from 2008 to 2018, written in English, involving treatment and control groups, investigating conventional physical therapy and treadmill training administered for gait re-education after stroke. RESULTS Out of 160 articles identified, 23 met the inclusion criteria and were reviewed and analyzed. One hundred fifteen projects involving clinical trials were identified; out of these nine reports from the last five years are included in the review. The number of participants in all the studies totaled at 1,772. The participants in all the studies represented both sexes, and their age ranged from 18 to the late 80s, with an average of 60+ years of age. In most cases, the patients examined were at a chronic stage post-stroke, i.e., more than six months following stroke onset. The most frequently applied types of treadmill training included: high-intensity aerobic treadmill training and treadmill training with or without body weight support. Most interventions involved participation in 30- or 60-minute sessions, from three to five times weekly, for the duration of six to 16 weeks. CONCLUSIONS Treadmill training seems to be a valuable and effective method of gait re-education, which can be used at various periods following a stroke, and mainly leads to improvement in walking speed and walking capacity. However, no standard has been defined so far with regard to treadmill-supported recovery of gait function in patients after stroke. We still do not know the optimum duration and frequency of exercise. Further study should investigate long-term effects and the way treadmill training impacts on patients' daily activities. HIPPOKRATIA 2018, 22(2): 51-59.
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Affiliation(s)
- A Guzik
- Institute of Physiotherapy, Medical Faculty, University of Rzeszów, Rzeszów, Poland
| | - M Drużbicki
- Institute of Physiotherapy, Medical Faculty, University of Rzeszów, Rzeszów, Poland
| | - A Wolan-Nieroda
- Institute of Physiotherapy, Medical Faculty, University of Rzeszów, Rzeszów, Poland
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Broderick P, Horgan F, Blake C, Hickey P, O'Reilly J, Ehrensberger M, Simpson D, Roberts D, Monaghan K. Mirror therapy and treadmill training for a patient with chronic stroke: A case report. Physiother Theory Pract 2018; 35:478-488. [PMID: 29589777 DOI: 10.1080/09593985.2018.1453903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
INTRODUCTION A large proportion of patients with chronic stroke have permanent lower limb functional disability leading to reduced levels of independent mobility. Individually, both mirror therapy and treadmill training have been shown to improve aspects of lower limb functioning in patients with stroke. This case report examined whether a new combination of both interventions would lead to improvements in lower limb functional disability for a patient with chronic stroke. CASE DESCRIPTION The participant was a 50-year-old female who had a left middle cerebral artery infarction (47 months' post stroke). Due to hemiparesis, she had lower limb motor impairment and gait deficits. INTERVENTION The participant engaged in a combination of mirror therapy and treadmill training for 30 minutes per day, 3 days per week, for 4 weeks. OUTCOMES Modified Ashworth Scale, Fugl-Meyer Assessment-Lower Extremity and the 10 m Walk Test demonstrated clinically meaningful change. The 6 Minute Walk Test did not demonstrate meaningful change. DISCUSSION The positive outcomes from this new combination therapy for this participant are encouraging given the relatively small dose of training and indicate the potential benefit of mirror therapy as an adjunct to treadmill training for enhancing lower limb muscle tone, motor function and walking velocity in patients with chronic stroke.
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Affiliation(s)
- Patrick Broderick
- a Department of Science , Institute of Technology Sligo , Sligo , Ireland
| | - Frances Horgan
- b Department of Physiotherapy , Royal College of Surgeons in Ireland , Dublin , Ireland
| | - Catherine Blake
- c Department of Health Science , University College Dublin , Dublin , Ireland
| | - Paula Hickey
- d Department of Geriatrics , Sligo University Hospital , Sligo , Ireland
| | - Joanne O'Reilly
- e Department of Physiotherapy , Sligo University Hospital , Sligo , Ireland
| | | | - Daniel Simpson
- a Department of Science , Institute of Technology Sligo , Sligo , Ireland
| | - David Roberts
- f Department of Design , Institute of Technology Sligo , Sligo , Ireland
| | - Kenneth Monaghan
- g Department of Health Science , Institute of Technology Sligo , Sligo , Ireland
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Wang HQ, Dong GR, Bao CL, Jiao ZH. Immediate effect of scalp acupuncture on the gait of patients with subacute intracerebral haemorrhage analysed by three-dimensional motion: secondary analysis of a randomised controlled trial. Acupunct Med 2018; 36:71-79. [PMID: 29439994 DOI: 10.1136/acupmed-2016-011272] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2017] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To investigate the immediate effect of scalp acupuncture on walking pattern, using three-dimensional gait analysis (3D-GA), among patients in the subacute stage of intracerebral haemorrhage (ICH). METHODS A subset of 30 patients with subacute ICH participating in a recently published randomised controlled trial who were able to walk independently were assessed by 3D-GA before and immediately after scalp acupuncture treatment (treatment group) or no intervention (control group) and the results presented here as a secondary analysis. The acupuncture manipulation was repeated three times with an interval of 5 min. Spatiotemporal and kinematic parameters during walking were collected and analysed using a 3D motion analysis system. RESULTS After treatment, there were significant differences between the treatment and control groups in the spatiotemporal parameters of step length, velocity and cadence (p<0.05) and double-limb support. No significant difference was found in step width. When kinematic parameters were evaluated, the treatment group showed a significantly decreased peak pelvic anterior tilt angle and an increased hip extension angle after scalp acupuncture treatment, whereas the control group demonstrated no temporal changes. There were no significant changes in any other kinematic parameters in either group. CONCLUSIONS As the first exploratory study to investigate the effect of the scalp acupuncture on gait performance in patients with subacute ICH, this secondary analysis of a recent randomised trial suggested an immediate effect of treatment on spatiotemporal parameters. Improvement in gait pattern may be associated with a decreased anterior tilt of the pelvis and augmented hip joint motion during walking. TRIAL REGISTRATION NUMBER ChiCTR-TRC-08000225; Post-results.
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Affiliation(s)
- Hai-Qiao Wang
- Department of Traditional Chinese Medicine, South Campus, Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Gui-Rong Dong
- Department of Acupuncture, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chun-Ling Bao
- Department of Acupuncture, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhi-Hua Jiao
- Department of Acupuncture, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Khan RA, Naseer N, Qureshi NK, Noori FM, Nazeer H, Khan MU. fNIRS-based Neurorobotic Interface for gait rehabilitation. J Neuroeng Rehabil 2018; 15:7. [PMID: 29402310 PMCID: PMC5800280 DOI: 10.1186/s12984-018-0346-2] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 01/17/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In this paper, a novel functional near-infrared spectroscopy (fNIRS)-based brain-computer interface (BCI) framework for control of prosthetic legs and rehabilitation of patients suffering from locomotive disorders is presented. METHODS fNIRS signals are used to initiate and stop the gait cycle, while a nonlinear proportional derivative computed torque controller (PD-CTC) with gravity compensation is used to control the torques of hip and knee joints for minimization of position error. In the present study, the brain signals of walking intention and rest tasks were acquired from the left hemisphere's primary motor cortex for nine subjects. Thereafter, for removal of motion artifacts and physiological noises, the performances of six different filters (i.e. Kalman, Wiener, Gaussian, hemodynamic response filter (hrf), Band-pass, finite impulse response) were evaluated. Then, six different features were extracted from oxygenated hemoglobin signals, and their different combinations were used for classification. Also, the classification performances of five different classifiers (i.e. k-Nearest Neighbour, quadratic discriminant analysis, linear discriminant analysis (LDA), Naïve Bayes, support vector machine (SVM)) were tested. RESULTS The classification accuracies obtained from SVM using the hrf were significantly higher (p < 0.01) than those of the other classifier/ filter combinations. Those accuracies were 77.5, 72.5, 68.3, 74.2, 73.3, 80.8, 65, 76.7, and 86.7% for the nine subjects, respectively. CONCLUSION The control commands generated using the classifiers initiated and stopped the gait cycle of the prosthetic leg, the knee and hip torques of which were controlled using the PD-CTC to minimize the position error. The proposed scheme can be effectively used for neurofeedback training and rehabilitation of lower-limb amputees and paralyzed patients.
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Affiliation(s)
- Rayyan Azam Khan
- Department of Mechatronics Engineering, Air University, Islamabad, Pakistan
| | - Noman Naseer
- Department of Mechatronics Engineering, Air University, Islamabad, Pakistan
| | - Nauman Khalid Qureshi
- Department of Biomedical Engineering, Faculty of Electronic Information and Electrical Engineering, Dalian University of Technology, Dalian, China
| | - Farzan Majeed Noori
- Department of Electrical and Computer Engineering, Institute of Systems and Robotics, University of Coimbra, Coimbra, Portugal
| | - Hammad Nazeer
- Department of Mechatronics Engineering, Air University, Islamabad, Pakistan
| | - Muhammad Umer Khan
- Department of Mechatronics Engineering, Air University, Islamabad, Pakistan
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