Sound Leg Research Articles

Biomechanical Analysis of Recreational Cycling with Unilateral Transtibial Prostheses

Leg prostheses specially adapted for cycling in patients with transtibial amputation can be advantageous for recreational practice; however, their required features are not fully understood. Therefore, we aimed to evaluate the efficiency of unilateral cycling with a transtibial prosthesis and the characteristics of different attachment positions (middle and tip of the foot) between the prosthetic foot and the pedal. The cycling practice was performed on an ergometer at 40 W and 60 W resistance levels while participants (n = 8) wore custom-made orthoses to simulate prosthesis conditions. Using surface electromyogram, motion tracking, and power meter pedals, biomechanical data were evaluated and compared with data obtained through regular cycling. The results showed that power delivery became more asymmetrical at lower workloads for both orthosis conditions, while hip flexion and muscle activity of the knee extensor muscles in the sound leg increased. While both pedal attachment positions showed altered hip and knee joint angles for the leg wearing the orthosis, the middle of the foot attachment presented more symmetric power delivery. In conclusion, the middle of the foot attachment position presented better symmetry between the intact and amputated limbs during cycling performed for rehabilitation or recreation.

Prediction of Contralateral Lower-Limb Joint Angles Using Vibroarthrography and Surface Electromyography Signals in Time-Series Network

Multisource biosignals are being increasingly used in human–machine interaction applications. In particular, a critical problem in exoskeleton-assisted rehabilitation for patients with hemiplegia is the generation of rhythmic and symmetrical locomotion. To support lower limb rehabilitation, we propose a model for predicting contralateral joint angles using multisource biosignals. First, a vibroarthrography (VAG) sensor is attached to the affected leg, and surface electromyography sensors are attached to the sound leg. The corresponding signals are used to estimate the hip, knee, and ankle joint angles of the affected leg. Second, an algorithm based on a temporal convolution network (TCN) is introduced to predict the contralateral lower-limb joint angles during human locomotion. The TCN is compared with a long short-term memory (LSTM) network and a convolutional neural network. Experiments were conducted by 10 healthy participants. The results of the proposed model were compared with measurements from encoders in three joints mounted on an exoskeleton to verify the applicability of the proposed model. In addition, by using the outputs of a motion capture system as the ground truth, the experimental results validated the model prediction performance. The prediction root mean square error (RMSE) of the TCN was 52%–70% lower than that of the LSTM network and CNN at different paces. The prediction RMSE using VAG was 20%–24% lower than that without using VAG. Note to Practitioners—We propose a model for predicting the contralateral lower-limb joint angles of an exoskeleton. The model uses measurements from multiple biosignal sensors to support exoskeleton-assisted hemiplegia rehabilitation. A sensing system based on acoustic signals and bioelectric signals is developed to improve the joint angle prediction in the affected leg of patients with hemiplegia. A temporal convolution network is implemented to estimate joint angles, and training considering the root mean square error and Pearson correlation coefficient as evaluation indicators is performed. Unlike similar methods that include no sensory feedback from the affected leg, the proposed method incorporates VAG signals from the affected leg and sEMG signals from the sound leg to handle different degrees of hemiplegia and support the generation of rhythmic and symmetrical locomotion for gait rehabilitation using an exoskeleton.

Real-Time Locomotion Mode Recognition and Assistive Torque Control for Unilateral Knee Exoskeleton on Different Terrains

Stroke may lead to considerable physical impairment and functional disability, which affects walking ability. As a potential way to assist gaits, lower limb exoskeletons have been developed. To supply appropriate assistive torque, real-time accurate recognition of current gait mode is important. In this article, a hierarchical control system was proposed to recognize locomotion modes in real time for a unilateral knee exoskeleton on different terrains with specific assistive control strategies. Support vector machine classifier was used to recognize the locomotion mode based on two inertia measurement units. The corresponding assistive control strategy was designed according to the recognition result. Real-time recognition experiments under assistive torque control were conducted on five able-bodied subjects and one stroke patient, respectively. For the able-bodied subjects: first, no significance was found on the total recognition accuracies whichever the leading leg was for the five subjects (p = 0.057), which indicated the proposed method in this article was suitable whichever the leading leg was as far as the overall classification accuracy was concerned. Second, transitions occurred in swing phase when the leading leg was the paretic leg and transitions occurred in stance phase when the leading leg was the sound leg. No significance was found on mean delay time for the five subjects (p = 0.785) whichever the leading leg was, which indicated that the proposed method in this article was suitable for these two leading legs as far as the mean delay time were concerned. Third, the method of generating the assistance based on the previous gait cycle time was demonstrated to be reasonable and the tracking performance of the torque could meet the requirement. For the stroke patient, similar experimental results were obtained.

Successful prosthetic rehabilitation and gait analysis of individual with bilateral transtibial amputation: A case study with comparison to able-bodied gait

Background: Intensive rehabilitation of individuals with bilateral lower limb loss poses a great challenge to both rehabilitation team and amputees themselves due to unavailability of a sound leg to provide stability in standing and gait. Although gait characteristics of individuals with unilateral transtibial amputations are well documented in the literature, very less is known about those with bilateral limb loss. Aim: To examine the gait characteristics of an individual with bilateral transtibial amputation (BTA) and its comparison with an able-bodied (AB). This study also provides a real-life presentation of successful prosthetic rehabilitation. Case content and methodology: Temporal–spatial, kinematic and kinetic gait parameters were analysed for a 45-year-old male individual with traumatic BTA using prosthesis in a motion analysis laboratory setting with force platform (BTS P-6000) and cameras with reflective markers (BTS SMART-DX6000). Findings and conclusion: Variances in many temporal–spatial, kinematic and kinetic parameters were observed. The findings of temporal–spatial parameters revealed that the individual with BTA walked with slower speed, lower cadence, shorter step lengths and wider step width compared to that of AB. Ankle dorsiflexion, stance knee flexion and swing hip hiking were reduced in an individual with BTA compared to AB. In kinetics, he demonstrated low peak ankle muscle power, increased muscle power amplitudes and phase duration at the hip and knee joints compared to AB individual. The combination of an intensive prosthetic rehabilitation led to completely independent and remarkable degree of functional ambulation.

The prevalence of osteoarthritis: Higher risk after transfemoral amputation?-A database analysis with 1,569 amputees and matched controls.

BackgroundSeveral studies have shown that patients with a unilateral amputation have an increased risk of developing osteoarthritis (OA) in the knee of their sound leg. OBJECTIVE: The first objective was to investigate whether amputees are more frequently affected by gon-, cox- or polyarthritis as well as back pain or spinal disorders. We hypothesized that mobile and active transfemoral amputees more often experience OA and spinal disorders than non-amputees. The second objective was to compare the mean age of the patients with OA.PatientsPatients with a unilateral transfemoral amputation (n = 1,569) and five abled-body control groups (each n = 1,569) matched in terms of age and gender resulting in total of 9,414 participants.MethodsGroups were analyzed regarding the prevalence of six selected diagnoses regarding musculoskeletal disorders.ResultsA significantly decreased prevalence of OA and specific disorders of the spine in transfemoral amputees compared to a control group was found. The amputees with OA are significantly younger than patients with OA in the control group.ConclusionThe results from the presented study contradict previously published literature. Apparently circumstances of life play an important role, like physical work and strenuous activities which are likely to be underrepresented in the amputee group. The results of the study need to be used cautiously due to the major limitation of the study which is the lack of detail in individual patients caused by the methodology.

Hankelet-based action classification for motor intention recognition

Powered lower-limb prostheses require a natural, and an easy-to-use, interface for communicating amputee’s motor intention in order to select the appropriate motor program in any given context, or simply to commute from active (powered) to passive mode of functioning. To be widely accepted, such an interface should not put additional cognitive load at the end-user, it should be reliable and minimally invasive.In this paper we present a one such interface based on a robust method for detecting and recognizing motor actions from a low-cost wearable sensor network mounted on a sound leg providing inertial (accelerometer, gyrometer and magnetometer) data in real-time. We assume that the sensor measurement trajectories – in a given temporal window – can be represented as the output of a linear time invariant system. We describe such set of trajectories via a Hankel matrix, which embeds the observability matrix of the LTI system generating the set of trajectories. The use of Hankel matrices (known as Hankelets) avoids the burden of performing system identification while providing a computationally convenient descriptor for the dynamics of a time-series.For the recognition of actions, we use two off-the-shelf classifiers, nearest neighbor (NN) and support vector machines (SVM), in cross-subject validation. We present results using either the joint angles or the raw sensor data showing a net improvement of the Hankelet-based approach against a baseline method. In addition, we compare results on action recognition using joint angles provided by trakSTAR, a high-accuracy motion tracking unit, demonstrating – somewhat surprisingly – that best results (in terms of average recognition accuracy over different actions) are provided by raw inertial data, paving the way towards a wider usage of our method in the field of active prosthetics, in particular, and motor intention recognition, in general.

Comparison of dynamic balancing responses following outward lateral perturbations during walking of healthy and post-stroke subjects

Abstract: Efficient dynamic balancing and movement coordination during walking are essential for stability. The objective of this preliminary study was to assess dynamic balancing responses in a selected post-stroke subject and to compare them with those assessed in neurologically intact individual. Balance Assessment Robot, a haptic robot that interfaces to a pelvis of a subject walking on an instrumented treadmill, was used to deliver perturbing pushes to the pelvis. We have assessed centre-of-pressure (CoP) and horizontal components of ground reaction forces (GRF) following outward pushes. The results have shown that depending on the amplitude of a perturbing push neurologically intact individual responded predominantly by “ankle” and “hip” strategies at lower amplitude of perturbation and “ankle” and “stepping” strategies at higher amplitude of perturbation. Post-stroke subject responded mainly by “ankle” and “hip” strategies when perturbed on the sound leg while the response when perturbed on the impaired leg was similar to the one observed in healthy subject. These preliminary results indicate that post-stroke subjects might be reluctant or not able to perform “cross step” with their impaired leg which is needed when counteracting outward perturbation.

Assessment of transfemoral amputees using a passive microprocessor-controlled knee versus an active powered microprocessor-controlled knee for level walking.

BackgroundIn transfemoral (TF) amputees, the forward propulsion of the prosthetic leg in swing has to be mainly carried out by hip muscles. With hip strength being the strongest predictor to ambulation ability, an active powered knee joint could have a positive influence, lowering hip loading and contributing to ambulation mobility. To assess this, gait of four TF amputees was measured for level walking, first while using a passive microprocessor-controlled prosthetic knee (P-MPK), subsequently while using an active powered microprocessor-controlled prosthetic knee (A-MPK). Furthermore, to assess long-term effects of the use of an A-MPK, a 4-weeks follow-up case study was performed.MethodsThe kinetics and kinematics of the gait of four TF amputees were assessed while walking with subsequently the P-MPK and the A-MPK. For one amputee, a follow-up study was performed: he used the A-MPK for 4 weeks, his gait was measured weekly.ResultsThe range of motion of the knee was higher on both the prosthetic and the sound leg in the A-MPK compared to the P-MPK. Maximum hip torque (HT) during early stance increased for the prosthetic leg and decreased for the sound leg with the A-MPK compared to the P-MPK. During late stance, the maximum HT decreased for the prosthetic leg. The difference between prosthetic and sound leg for HT disappeared when using the A-MPK. Also, an increase in stance phase duration was observed. The follow-up study showed an increase in confidence with the A-MPK over time.ConclusionsResults suggested that, partially due to an induced knee flexion during stance, HT can be diminished when walking with the A-MPK compared to the P-MPK. The single case follow-up study showed positive trends indicating that an adaptation time is beneficial for the A-MPK.

Evaluation Of Smartphone-Based Assessment System In Chronic Ankle Instability

Ankle sprains are the most common sports-related injury. About 80% subjects suffer recurrent sprains. Repeated injuries may cause chronic ankle instability, which will affect sports efficacy and postural control ability. In recent years, smartphones had become very popular and powerful devices, and been showed to have good validity on measuring range of motion and assessing gait patterns. The purpose of this study is to evaluate the feasibility of smartphone-based system in postural control ability assessment on chronic ankle instability. METHODS: Fifteen subjects (6 male, 9 female; age=23.4±5.28 y/o) who have at least one leg scoring lower than 27 points in Cumberland Ankle Instability Tool were recruited. ASUS Zenfone 2 smartphone was used to conduct the postural control assessment, by recording its built-in accelerometer data with an App developed using MIT App inventor. Subjects performed single leg stance for 20 seconds in eyes-open and eyes-closed conditions with each leg. The smartphone was fixed on the middle of shin with an exercise armband. The average of recorded acceleration data was used to represent the postural control performance, and the higher value indicated more instability. Data was analyzed with paired t-test with SPSS 17.0, and statistical significance was set as alpha < 0.05. RESULTS: Significant difference was found between sound leg and injured leg under both eyes-open and eyes-closed conditions (eyes-open: sound leg 0.051±0.018 vs injured leg 0.072±0.034, p=0.027; eyes-closed: sound leg 0.100±0.031 vs injured leg 0.123±0.038, p=0.001, unit: g). Significant difference was also found between eyes-open and eyes-closed conditions under both single leg standing with sound leg and injured leg (sound leg: eyes-open 0.051±0.018 vs eyes-closed 0.100±0.031, p<0.001; injured leg: eyes-open 0.072±0.034 vs eyes-closed 0.123±0.038, p=0.001, unit: g). The results demonstrate that the smartphone can be used to discriminate the different performance between sound leg and injured leg, and also between eyes-open and eyes-closed conditions. CONCLUSION: The study shows that smartphone may have the potential to be a convenient, easy-used and valid tool for assessment of postural control ability on chronic ankle instability.

Unilateral rupture of the serratus ventralis muscle in a filly

A 3-year-old Arabian filly with a history of abnormal instability of the scapula of the left foreleg following an accident during training. Unilateral partial rupture of serratus ventralis was diagnosed after ultrasonographic examination of the affected leg in comparison with the other sound leg.

Genetic association between leg conformation in young pigs and sow reproduction

Lameness is an issue of concern in pig production due both to animal welfare and to economical aspects. Lame sows are believed to suffer from pain and stress which is reported to have a negative influence on reproduction. Leg conformation and locomotion traits in young animals are associated with the risk of lameness at higher age. The purpose of this study was to estimate the genetic parameters of leg conformation traits recorded at performance testing (around 5 months of age) and their genetic correlations with reproduction traits. Information on leg conformation traits from 123,307 pigs scored and on reproduction traits from 22,204 litters in the first and second parity from Swedish Yorkshire nucleus herds were available for genetic analysis. Eight conformation and locomotion traits, coming from the old or the new scoring system in Sweden, included old movement, old overall leg score, new movement, new toes quality, new front leg quality, new rear leg quality, standing-under-position syndrome and new overall score. Four reproduction traits were analyzed by parity: the number of total born piglets, the number of liveborn piglets, the number of stillborn piglets and weaning to service interval. Estimates of heritabilities and genetic correlations between traits were obtained using a multi-trait linear animal mixed model. The heritability estimates were low to moderate, ranging from 0.02 to 0.20 for conformation traits and from 0.06 to 0.10 for reproduction traits. Significant genetic correlations were found between new toes quality and new overall score and the number of liveborn piglets in the 1st parity (−0.35 and −0.31, respectively), indicating that sows with even toes and better overall leg score tend to have higher number of liveborn piglets. Old movement score showed significant correlations with number of total born and number of liveborn piglets in both parities (0.20 to 0.36) and with weaning to service interval in the 2nd parity (−0.35±0.11). Similarly, standing-under-position syndrome was highly associated with number of total born and number of liveborn piglets in both parities (−0.54 to −0.35), indicating that sows with better movement and not suffering from standing-under-position syndrome are likely to have larger litter size and shorter interval to return heat after weaning. Heritabilities and significantly favorable genetic correlation estimates suggest the possibility of simultaneous improvement of both leg quality and reproduction performance by selecting on sound leg conformation and locomotion of young pigs.

Delayed lower leg compartment syndrome in the uninjured limb following hemilithotomy positioning: Report of three cases, review of the literature, and recommendations for prevention

Compartment syndrome in the uninjured leg as a complication of prolonged positioning in a hemilithotomy position is a serious complication. Prolonged operative time, external compression, and elevation of the sound leg are contributing factors. This is a devastating, but rare complication in the uninjured leg

Ankle–knee prosthesis with active ankle and energy transfer: Development of the CYBERLEGs Alpha-Prosthesis

This paper presents the development of the CYBERLEGs Alpha-Prototype prosthesis, a new transfemoral prosthesis incorporating a new variable stiffness ankle actuator based on the MACCEPA architecture, a passive knee with two locking mechanisms, and an energy transfer mechanism that harvests negative work from the knee and delivers it to the ankle to assist pushoff. The CYBERLEGs Alpha-Prosthesis is part of the CYBERLEGs FP7-ICT project, which combines a prosthesis system to replace a lost limb in parallel with an exoskeleton to assist the sound leg, and sensory array to control both systems. The prosthesis attempts to produce a natural level ground walking gait that approximates the joint torques and kinematics of a non-amputee while maintaining compliant joints, which has the potential to decrease impulsive losses, and ultimately reduce the end user energy consumption. This first prototype consists of a passive knee and an active ankle which are energetically coupled to reduce the total power consumption of the device. Here we present simulations of the actuation system of the ankle and the passive behavior of the knee module with and without the energy transfer effects, the mechanical design of the prosthesis, and empirical results from testing of the physical device with amputee subjects.

Rehabilitation of People with Lower-Limb Amputations

Rehabilitation of persons with lower-limb amputation is a complex endeavor that requires the consideration of a multitude of factors. This article provides an overview of the current practice of prosthesis prescription, mobility training, and the utilization of wheeled mobility options in the clinical care for this population. Recent technological advancements have helped fit persons with lower-limb amputation with more functional, better fitting, and less activity-limiting artificial limbs and wheelchairs. This is exemplified in modern computer-controlled prosthetic components and biomechanically optimized socket-fitting methods, as well as light weight and versatile wheelchairs to supplement or replace prosthetic devices. In the research setting, technology has enabled new approaches to the kinematic and kinetic assessment of prosthetic interventions, and the development of more accurate fitting and evaluation methods. Despite the noted progress in the field, there is still a considerable gap between the functionality of a sound leg and even the most advanced prosthesis. It can be predicted that continued research efforts will be undertaken to further close this gap.

Physical activity, functional capacity, and step variability during walking in people with lower-limb amputation

Physical activity is important for general health. For an individual with amputation to sustain physical activity, certain functional capacity might be needed. Gait variability is related to the incidence of falls. This study explored the relationship between physical activity and a few common performance measures (six-minute walk test, step length variability, step width variability, and comfortable walking speed) in individuals with unilateral lower-limb amputation. Twenty individuals completed the study (age: 50±11yrs). Twelve of them had transtibial amputation, seven had transfemoral amputation, and one had through-knee amputation. Gait data was collected by the GaitRite instrumented walkway while participants performed a 3-min comfortable walking trial followed by a six-minute walk test. Physical activity was indicated by the mean of 7-day step counts via a pedometer. Gait variability was calculated by the coefficient of variation. Pearson correlation analysis was conducted between physical activity level and the 4 performance measures. Significance level was set at 0.05. Physical activity correlates strongly to comfortable walking speed (r=0.76), six-minute walk distance (r=0.67), and correlates fairly to step width variability (r=0.44). On the contrary, physical activity is inversely related to step length variability of the prosthetic leg (r=−0.46) and of the sound leg (r=−0.47). Having better functional capacity and lateral stability might enable an individual with lower-limb amputation to engage in a higher physical activity level, or vise versa. However, our conclusions are only preliminary as limited by the small sample size.

Amputation effects on the underlying complexity within transtibial amputee ankle motion

The presence of chaos in walking is considered to provide a stable, yet adaptable means for locomotion. This study examined whether lower limb amputation and subsequent prosthetic rehabilitation resulted in a loss of complexity in amputee gait. Twenty-eight individuals with transtibial amputation participated in a 6 week, randomized cross-over design study in which they underwent a 3 week adaptation period to two separate prostheses. One prosthesis was deemed "more appropriate" and the other "less appropriate" based on matching/mismatching activity levels of the person and the prosthesis. Subjects performed a treadmill walking trial at self-selected walking speed at multiple points of the adaptation period, while kinematics of the ankle were recorded. Bilateral sagittal plane ankle motion was analyzed for underlying complexity through the pseudoperiodic surrogation analysis technique. Results revealed the presence of underlying deterministic structure in both prostheses and both the prosthetic and sound leg ankle (discriminant measure largest Lyapunov exponent). Results also revealed that the prosthetic ankle may be more likely to suffer loss of complexity than the sound ankle, and a "more appropriate" prosthesis may be better suited to help restore a healthy complexity of movement within the prosthetic ankle motion compared to a "less appropriate" prosthesis (discriminant measure sample entropy). Results from sample entropy results are less likely to be affected by the intracycle periodic dynamics as compared to the largest Lyapunov exponent. Adaptation does not seem to influence complexity in the system for experienced prosthesis users.

Рівень фізичної підготовленості й розвитку психомоторних якостей студентів військово-юридичного факультету

Purpose:to identify the level of the individual application of psychomotor skills and physical fitness of students of the Law University. Material: the study involved 48 boys and 19 girls 1 Course Military Law Faculty. Results: notes professionally applied physical training future military lawyer should focus on the assimilation of certain knowledge and skills, among them – professionally important psychomotor quality, providing a high degree of readiness to perform their duties. Conclusions: the level of physical fitness, which was determined by the results of the test exercises for strength, endurance, coordination, insufficient set of girls and middle men. For all tests, the level of development harkterizuyuschim psychomotor qualities (reaction time to light and sound hand, the sound leg, with a choice reaction time and individual minutes), except for the reaction time to the light footed, indicators are within normal limits.

Keep moving forward

The incidence of foot amputations increased in the Netherlands to 3.3/100,000 people up to 1994. Despite these numbers, only a few basic prosthetic and orthotic devices are available, and all lack functionality to restore ankle and foot mobility. The aim of this explorative study was to design and test a unique prosthesis for Syme or Pirogoff amputees with the necessary low installation height but restoring ankle and foot mobility. A case study was performed. The new prosthesis was designed and numerically analyzed on aspects concerning strength and deformation. A prototype was tested in a case study to assess the biomechanical behavior of the new foot. As a reference, six Syme/Pirogoff amputees were measured. Additionally, all volunteers filled out a questionnaire to evaluate their prosthetic feet. The self-selected and maximum walking speed of the case subject at 0° and 5° slopes was higher using the new foot (0.36 m/s and 0.53 m/s, respectively) comparing to the Low Rider (Otto Bock HealthCare) (0.31 m/s and 0.31 m/s, respectively). Using the new foot, a more symmetrical walking pattern was achieved. The case study shows that this new prosthetic foot could be an improvement compared to existing prosthetic feet. Foot amputees with low available installation height still experience daily the inconvenience of missing ankle and foot mobility. Their low velocity and cosmetically poor walking pattern influence on their sound leg and overall walking functionality. A more functional prosthesis would have a great impact on their daily activities.

Transtibial Amputee Joint Motion has Increased Attractor Divergence During Walking Compared to Non-Amputee Gait

The amputation and subsequent prosthetic rehabilitation of a lower leg affects gait. Dynamical systems theory would predict the use of a prosthetic device should alter the functional attractor dynamics to which the system self-organizes. Therefore, the purpose of this study was to compare the largest Lyapunov exponent (a nonlinear tool for assessing attractor dynamics) for amputee gait compared to healthy non-amputee individuals. Fourteen unilateral, transtibial amputees and fourteen healthy, non-amputee individuals ambulated on a treadmill at preferred, self-selected walking speed. Our results showed that the sound hip (p = 0.013), sound knee (p = 0.05), and prosthetic ankle (p = 0.023) have significantly greater largest Lyapunov exponents than healthy non-amputees. Furthermore, the prosthetic ankle has a significantly greater (p = 0.0.17) largest Lyapunov exponent than the sound leg ankle. These findings indicate attractor states for amputee gait with increased divergence. The increased attractor divergence seems to coincide with decreased ability for motor control between the natural rhythms of the individual and those of the prosthetic device. Future work should consider the impact of different prostheses and rehabilitation on the attractor dynamics.

Pilot Study of Split Belt Treadmill Based Gait Rehabilitation System for Symmetric Stroke Gait

A split belt treadmill for gait rehabilitation was developed to improve the symmetry of the stance phase time of patients with stroke. The system, which increases the stance phase time of the affected leg and then realizes a well-balanced gait, is divided into two components. First, the stance phases of the sound and affected legs were measured and presented visually in real time to the patient and physical therapist as biofeedback. Second, using stance phase biofeedback, the physical therapist sets two different velocities of treadmill belts for sound and affected legs. In an experiment, 11 patients with chronic stroke participated in a short-term intervention trial (20 gait cycles) of the developed treadmill system. Three of the five subjects who had lost balance between the stance phase of the sound leg and that of the affected one improved their gait balance in the intervention trial. In addition, one subject kept the well-balanced gait after the intervention.