Abstract
The main purpose of the present study was to assess the effects of foot drop stimulators (FDS) in individuals with stroke by means of spatio-temporal and step-to-step symmetry, harmonic ratio (HR), parameters obtained from trunk accelerations acquired using a wearable inertial sensor. Thirty-two patients (age: 56.84 ± 9.10 years; 68.8% male) underwent an instrumental gait analysis, performed using a wearable inertial sensor before and a day after the 10-session treatment (PRE and POST sessions). The treatment consisted of 10 sessions of 20 min of walking on a treadmill while using the FDS device. The spatio-temporal parameters and the HR in the anteroposterior (AP), vertical (V), and mediolateral (ML) directions were computed from trunk acceleration data. The results showed that time had a significant effect on the spatio-temporal parameters; in particular, a significant increase in gait speed was detected. Regarding the HRs, the HR in the ML direction was found to have significantly increased (+20%), while those in the AP and V directions decreased (approximately 13%). Even if further studies are necessary, from these results, the HR seems to provide additional information on gait patterns with respect to the traditional spatio-temporal parameters, advancing the assessment of the effects of FDS devices in stroke patients.
Highlights
Stroke and cerebrovascular disease are leading causes of morbidity, mortality, and disability and represent the most common reason for long-term care in developed countries, and in low- and middle-income countries where stroke is the fourth-leading cause of disability among people older than age 65 [1]
The different degrees of impairment that characterize the affected and not-affected side suggest that the study of gait symmetry represents a crucial feature in characterizing and quantifying locomotion in hemiparetic individuals, considering that an asymmetric gait pattern is generally characterized by poor efficiency and requires high energy expenditure
The purpose of the present study was to assess the effects of foot drop stimulators (FDS) use in individuals with stroke by means of spatio-temporal and step-to-step symmetry parameters obtained from trunk accelerations acquired using a wearable inertial sensor
Summary
Stroke and cerebrovascular disease are leading causes of morbidity, mortality, and disability and represent the most common reason for long-term care in developed countries, and in low- and middle-income countries where stroke is the fourth-leading cause of disability among people older than age 65 [1]. The most evident alterations in gait, besides a marked asymmetry, include walking speed reduction, longer durations of double-stance and paretic swing phases, reduced paretic single-stance phase duration, cadence, and stride length [3,8], asymmetric postural behavior during walking and standing [9], altered kinematics, and reduced ankle push-off ability in terminal stance [10,11] In this context, gait impairments cause difficulties with performing the activities of daily living and mobility, reducing independence and quality of life [12]. FDSs are based on the functional electrical stimulation (FES) of the peroneal nerve to elicit ankle dorsiflexion during the swing phase of the step cycle [38,39,40] Such devices have been proven to be effective in enhancing gait speed in short- and long-term studies [41,42,43], but there is no evidence about the reduction of step-to-step symmetry. Our hypothesis is that changes in the spatio-temporal parameters of gait previously reported [41,43] could be accompanied by modifications of step-to-step symmetry in stroke patients
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