Walking In Hemiplegic Patients Research Articles

Improvement of upper trunk posture during walking in hemiplegic patients after injections of botulinum toxin into the arm

BackgroundIt has been hypothesized that altered trunk movements during gait in post-stroke patients or children with cerebral palsy are compensatory to lower limb impairment. Improvement of trunk movements and posture after injections of botulinum toxin into the affected arm would be at variance with this hypothesis and hint towards a multifactorial trunk control deficit. Patients and MethodsClinical gait analysis was performed in 11 consecutively recruited hemiplegic patients immediately before and 4weeks after a botulinum toxin type A-injection into the affected arm. Kinematic data were collected using an 8 camera optical motion-capturing system and reflective skin-markers were attached according to a standard plug-in-gait model. Deviation of the trunk in lateral and forward direction and the trajectory of the C7-marker in a sacrum-fixed horizontal plane were analyzed in addition to classical gait parameters. The Wilson-signed-rank test was used for pre/post-botulinum toxin comparisons. FindingsAfter botulinum toxin injections a significant improvement of forearm flexion scores from 2.57 to 2.0 (p<0.014), and a reduced lateral deviation of the upper trunk from 3.5degrees to 2.5degrees (p<0.014) were observed. Free-walkers tended to walk faster (p<0.046, 1-sided), with reduced pre-swing duration of both legs and an increased step length of the non-affected leg. The C7-marker trajectory was shifted towards the midline. InterpretationInjections of botulinum toxin into the affected arm of hemiplegic patients improve abnormal trunk lateral flexion. This shift of the center of mass of the upper body towards the midline improves various gait parameters including gait speed.

The effect of an arm sling on energy consumption while walking in hemiplegic patients: a randomized comparison

The effect of an arm sling on energy consumption while walking in hemiplegic patients: a randomized comparison

The effect of an arm sling on energy consumption while walking in hemiplegic patients: a randomized comparison

Objective: To evaluate the effect of an arm sling on gait speed and energy efficiency of patients with hemiplegia. Design: A randomized crossover design. Setting: A rehabilitation department of a university hospital. Subjects: Thirty-seven outpatients with hemiplegia were included in this study. Interventions: All patients walked on a 20-m walkway twice on the same day, randomly with and without an arm sling, at a self selected speed. Main measures: The heart rate, gait speed, oxygen cost and oxygen rate were measured on all patients. We analysed all values with and without an arm sling and also compared them after all patients being stratified according to demographic and clinical characteristics. Results: When we compared the heart rate between walking with (90.7 ± 17.2 beats/min) and without (91.2 ± 18.6 beats/min) the arm sling, it was significantly decreased while walking with the arm sling. When we compared the gait speed between walking with (32.8 m/min) and without (30.1 m/min), it was significantly increased with the arm sling walking. The O2 rate in hemiplegic patients walking with the arm sling was significantly decreased by 7%, compared to walking without arm sling (5.8 mL/kg min and 6.2 mL/kg min, respectively). The O2 cost in hemiplegic patients walking without arm sling was significantly 1.4 times greater than walking with it (0.2 mL/kg m and 0.3 mL/kg m, respectively). Conclusion: An arm sling can be used to improve the gait efficiency.

Energy cost of machine assisted walking in hemiplegic patients: Preliminary data

Energy cost of machine assisted walking in hemiplegic patients: Preliminary data

Clinical Application of Peroneal Nerve Stimulator System Using Percutaneous Intramuscular Electrodes for Correction of Foot Drop in Hemiplegic Patients

Objective. To assess the orthotic effect of a functional electrical stimulation device (Akita Heel Sensor System; AHSS) in the treatment of hemiplegic gait with foot drop. Materials and Methods. In the AHSS, a heel sensor is attached to a small plastic heel brace, and the peroneal nerve is stimulated via percutaneous intramuscular electrodes. During the swing phase of the hemiplegic gait, the common peroneal nerve is stimulated by the AHSS. Eight patients in chronic stages of hemiplegia participated in this study. Walking speeds and step cadences on a 10-m course were compared between walking with stimulation and walking without stimulation. Results. Mean walking speed (±SD) was 0.50± 0.26m/sec without stimulation and 0.64±0.31m/sec with stimulation. The mean percentage increase in walking speed with stimulation was 30.1%. Mean step cadence was 31±7 steps/10m without stimulation and 27±7 steps/10m with stimulation. By correcting foot drop, the AHSS significantly increased walking speed and decreased cadence (p<0.05). Conclusion. The AHSS can significantly improve walking in hemiplegic patients with foot drop.

Oxygen Cost of Walking in Hemiplegic Patients.

A preliminary study was carried out to compare the walking speed (WS), walking distance, oxygen consumption and oxygen cost in hemiplegic patients. In the first test of 10-min walking, observation of WS and walking distance revealed the boundary areas between the patients who depended on a wheelchair (group D, n=18) and those who did not and could walk alone (group I, n=26). The boundary WS and boundary walking distance ranged from 20.1 to 30.0 m/min and from 201 to 300 meters, respectively. In the second test which focused on the boundary WS, oxygen consumption and oxygen cost of groups TI (7 patients of group I), BI (5 of group I), BD (3 of group D) and TD (3 of group D) were measured. As a result, oxygen consumption and oxygen cost of TI, BI, BD and TD were13.6, 10.0, 14.5 and 10.0 ml/kg/min and 0.351, 0.358, 0.628 and 0.779 ml/kg/m, respectively. TI walked at a speed of more than 30.1 m/min, BI and BD walked at the boundary WS, and TD walked at a speed of less than 20.0 m/min.The values of oxygen cost differed remarkably between the groups BI and BD. BI walked more efficiently than BD.