Walking In Stroke Patients Research Articles

Can Real-time Biofeedback of Foot Clearance Data be used to Assist with Gait Rehabilitation following Stroke?, NHMRC

A new intervention for falls-risk minimization is proposed by providing additional visual sensory information to increase foot-ground clearance in order to walk more safely. A randomised controlled trial will be employed to assess the effects of biofeedback on foot-ground clearance during gait training. The outcome will be innovative biofeedback-based gait training that could significantly enhance existing stroke rehabilitation programs. Biofeedback is the provision of information, most commonly visual or auditory, of internal biological processes that would not otherwise be sensed. The theoretical and practical significance of biofeedback is in applications such as neurological rehabilitation, where it can augment, or substitute for, the lost information provided by normally functioning sensory systems. The group is undertaking a major National Health and Medical Research Council (NHMRC) funded project in collaboration with two Melbourne hospitals (Royal Melbourne and Austin Hospital) using visually presented biofeedback of foot-ground clearance to re-train walking in stroke patients.

Lateral Symmetry of Synergies in Lower Limb Muscles of Acute Post-stroke Patients After Robotic Intervention.

Gait disturbance is commonly associated with stroke, which is a serious neurological disease. With current technology, various exoskeletons have been developed to provide therapy, leading to many studies evaluating the use of such exoskeletons as an intervention tool. Although these studies report improvements in patients who had undergone robotic intervention, they are usually reported with clinical assessment, which are unable to characterize how muscle activations change in patients after robotic intervention. We believe that muscle activations can provide an objective view on gait performance of patients. To quantify improvement of lateral symmetry before and after robotic intervention, muscle synergy analysis with Non-Negative Matrix Factorization was used to evaluate patients' EMG data. Eight stroke patients in their acute phase were evaluated before and after a course of robotic intervention with the Hybrid Assistive Limb (HAL), lasting over 3 weeks. We found a significant increase in similarity between lateral synergies of patients after robotic intervention. This is associated with significant improvements in gait measures like walking speed, step cadence, stance duration percentage of gait cycle. Clinical assessments [Functional Independence Measure-Locomotion (FIM-Locomotion), FIM-Motor (General), and Fugl-Meyer Assessment-Lower Extremity (FMA-LE)] showed significant improvements as well. Our study shows that muscle synergy analysis can be a good tool to quantify the change in neuromuscular coordination of lateral symmetry during walking in stroke patients.

Immediate synergistic effect of a trunk orthosis with joints providing resistive force and an ankle-foot orthosis on hemiplegic gait.

PurposeThe synergistic effects of a trunk orthosis and an ankle–foot orthosis (AFO) in stroke patients with a hemiplegic gait are unclear. We previously developed a trunk orthosis with joints providing resistive force (TORF) to modify malalignment of the trunk and pelvis and confirmed its positive effects in stroke patients during level walking without an AFO. The aim of the present study was to determine if this trunk orthosis and an AFO have synergistic effects during level walking in community-dwelling patients with chronic stroke.MethodsTwenty-eight community-dwelling stroke patients performed level walking at a self-selected speed with an AFO and again while wearing a TORF (TORF group) or a corset (control group). Spatiotemporal, kinematic, and kinetic data were recorded using a three-dimensional motion analysis system.ResultsWhen compared with the control group, the TORF group showed significant increases in walking speed, number of steps on the paretic leg per minute, and peak ankle plantar flexion moment during the single stance phase.ConclusionThe TORF increased the ankle joint plantar flexion moment at the end of the single stance phase during level walking in stroke patients, leading to an increase in their gait speed because of the modified trunk and pelvis alignment.

Effect of bilateral lower limb strengthening exercise on balance and walking in hemiparetic patients after stroke: a randomized controlled trial.

[Purpose] To evaluate the effect of bilateral lower limb strengthening designed to improve balance and walking in stroke patients. [Subjects and Methods] Twenty hemiparetic stroke patients were divided into two groups: a unilateral therapy group (UTG) (n=10) and a bilateral therapy group (BTG) (n=10). The UTG completed strength training only in the paretic lower limb. The BTG completed strength training in the paretic and non-paretic lower limbs. Assessment tools included the functional reach test (FRT), the Berg balance scale (BBS), the timed up and go (TUG) test, and a 10-meter walk test (10MWT). [Results] In both groups, the lower limb strengthening exercise for balance and walking significantly improved the FRT, BBS, TUG, and 10MWT scores. Compared with UTG, the BTG attained significantly improved FRT and BBS scores. [Conclusion] Bilateral therapy using this lower limb strengthening exercise effectively promotes balance in hemiparetic stroke patients.

Prefrontal cortex activation during a dual task in patients with stroke

Dual tasks destabilize task performance as they involve competing demands for cognitive and physical resources. Several studies have reported that dual-task walking activates the prefrontal cortex (PFC), and recent studies have indicated a relationship between PFC and dual-task deterioration in healthy subjects. However, PFC activity during dual-task walking in stroke patients remains unclear. We investigated the association between PFC activity and dual-task interference on physical and cognitive performance in stroke patients. This study included 14 stroke patients and 14 healthy subjects who performed a calculation task while walking at a comfortable pace on the floor. PFC activity was assessed using wearable near-infrared spectroscopy. The calculation task and trunk linear accelerations were evaluated as measures of cognitive and physical performance. The dual-task deterioration on both physical and cognitive performance of stroke patients was significantly higher than in healthy subjects. PFC activation during dual-task walking was significantly lower in stroke patients. Although right PFC activation was negatively correlated with dual-task deterioration on physical performance in stroke patients, left PFC activation was negatively correlated with the dual-task cost on cognitive performance in healthy subjects. Thus, during dual-task walking, PFC activation might prioritize physical demands in stroke patients, but might prioritize cognitive demands in healthy subjects.

Lace up for May: National Walking Month 2017

Nursing and Residential CareVol. 19, No. 5 EditorialLace up for May: National Walking Month 2017Kathryn ShawKathryn ShawSearch for more papers by this authorKathryn ShawPublished Online:12 Apr 2017https://doi.org/10.12968/nrec.2017.19.5.252AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Age UK (2016) No one should have no one at Christmas. http://bit.ly/1BdFmhJ (accessed 17 March 2017) Google ScholarCridland J (2016) Independent review of the state pension age: interim report, October 2016. http://bit.ly/2dOIhJ8 (accessed 17 March 2017) Google ScholarDepartment of Health (2011) Physical activity guidelines for adults (19–64 years). http://bit.ly/2n6dbTe (accessed 17 March 2017) Google ScholarEuropean Lung Foundation (2016) Your lungs and exercise. http://bit.ly/2hy2d6N (accessed 21 March 2017) Google ScholarJang SH (2010) The recovery of walking in stroke patients: a review. Int J Rehabil Res 33(4): 285–9. https://doi.org/https://doi.org/10.1097/MRR.0b013e32833f0500 Crossref, Google ScholarLiving Streets (2016) Walking with older people. http://bit.ly/2mAiPcA (accessed 17 March 2017) Google ScholarLiving Streets (2017) National Walking Month. http://bit.ly/24lCyAW (accessed 23 March 2017) Google ScholarMind (2007) Ecotherapy: the green agenda for mental health. http://bit.ly/1TPd9Gu (accessed 17 March 2017) Google ScholarRobertson R, Robertson ARR, Jepson R, Maxwell M (2012) Walking for depression or depressive symptoms: a systematic review and meta-analysis. Mental Health and Physical Activity 5(1): 66–75. https://doi.org/http://dx.doi.org/10.1016/j.mhpa.2012.03.002 Crossref, Google ScholarSample I (2014) Taking your brain for a walk: the secret to delaying dementia. http://bit.ly/2nzLNL4 (accessed 17 March 2017) Google Scholar FiguresReferencesRelatedDetails 2 May 2017Volume 19Issue 5ISSN (print): 1465-9301ISSN (online): 2052-2932 Metrics History Published online 12 April 2017 Published in print 2 May 2017 Information© MA Healthcare LimitedPDF download

Comparison of forward walking and backward walking in stroke hemiplegia patients focusing on the paretic side.

[Purpose] To investigate the features of backward walking in stroke patients with hemiplegia by focusing on the joint movements and moments of the paretic side, walking speed, stride length, and cadence. [Subjects and Methods] Nine stroke patients performed forward walking and backward walking along a 5-m walkway. Walking speed and stride length were self-selected. Movements were measured using a three-dimensional motion analysis system and a force plate. One walking cycle of the paretic side was analyzed. [Results] Walking speed, stride length, and cadence were significantly lower in backward walking than in forward walking. Peak hip extension was significantly lower in backward walking and peak hip flexion moment, knee extension moment, and ankle dorsiflexion and plantar flexion moments were lower in backward walking. [Conclusion] Unlike forward walking, backward walking requires conscious hip joint extension. Conscious extension of the hip joint is hard for stroke patients with hemiplegia. Therefore, the range of hip joint movement declined in backward walking, and walking speed and stride length also declined. The peak ankle plantar flexion moment was significantly lower in backward walking than in forward walking, and it was hard to generate propulsion power in backward walking. These difficulties also affected the walking speed.

Trunk exercise using the Swiss ball improves the functional balance and walking of stroke patients in the early stages of recovery

Objective To examine the effects of trunk exercises performed using a Swiss ball on functional balance and walking in the early stage of recovering from a stroke. Methods Sixty hemiplegic stroke patients were randomly assigned to a control group or an experimental group, each of 30. Both groups were treated with routine physical training. Those in the control group did conventional trunk exercises, while the patients in the experimental group were given trunk exercises performed using a Swiss ball. The trunk control test (TCT) and the Berg Balance Scale (BBS) were used to assess the patients' trunk and balance function. Gait and balance function training and assessment apparatus (model AL-080) was used to measure and compare the scope of movement of the patient's center of pressure in static sitting over 30 seconds (LOM), the limits of stability (LOS), velocities and a gait asymmetry index (GAI). Results Significant improvements in TCT, BBS, LOM and LOS were observed in both groups after the training, but all of the measures improved significantly more in the experimental group than in the control group. Conclusions Swiss ball trunk exercise can obviously improve the trunk control, functional balance and walking of stroke patients in the early stages of recovery. Key words: Stroke; Hemiplegia; Swiss ball; Trunk control; Balance; Walking

Short-Term Effect of Prosthesis Transforming Sensory Modalities on Walking in Stroke Patients with Hemiparesis.

Sensory impairments caused by neurological or physical disorders hamper kinesthesia, making rehabilitation difficult. In order to overcome this problem, we proposed and developed a novel biofeedback prosthesis called Auditory Foot for transforming sensory modalities, in which the sensor prosthesis transforms plantar sensations to auditory feedback signals. This study investigated the short-term effect of the auditory feedback prosthesis on walking in stroke patients with hemiparesis. To evaluate the effect, we compared four conditions of auditory feedback from plantar sensors at the heel and fifth metatarsal. We found significant differences in the maximum hip extension angle and ankle plantar flexor moment on the affected side during the stance phase, between conditions with and without auditory feedback signals. These results indicate that our sensory prosthesis could enhance walking performance in stroke patients with hemiparesis, resulting in effective short-term rehabilitation.

Influence of Visual Feedback Training on the Balance and Walking in Stroke Patients

Influence of Visual Feedback Training on the Balance and Walking in Stroke Patients

Comparison of Both Legs EMG Symmetry during Over-Ground Walking and Stair Walking in Stroke Patients

Comparison of Both Legs EMG Symmetry during Over-Ground Walking and Stair Walking in Stroke Patients

A pilot study of balance performance benefit of myofascial release, with a tennis ball, in chronic stroke patients

BackgroundWe hypothesised that the balance of spastic chronic stroke patients is related to myofascial problems. We performed myofascial release (MFR) with a tennis ball on the affected limb, as suggested by Myers. PurposeThis study investigated the benefits of 8 weeks of MFR using a tennis ball on the balance of spastic patients. MethodsEight stroke patients were enrolled voluntarily after providing informed consent. All subjects received 8-week interventions with MFR using a tennis ball three times per week. The patients were evaluated using the Berg Balance Scale (BBS) and Timed ‘Up & Go’ (TUG) test before and after 4 and 8 weeks of the intervention. ResultsThere were significant differences in the BBS scores (p = 0.001). The TUG time decreased significantly at 4 and 8 weeks (p = 0.034). ConclusionMyofascial release appears to improve the balance of spastic chronic stroke patients; however, further studies should evaluate the effective of MFR on walking in stroke patients and determine the mechanism of the effect of MFR.

Onset Analysis of the Turning Task While Walking in Stroke Patients(Reports Supported by JPTA Grant)

Onset Analysis of the Turning Task While Walking in Stroke Patients(Reports Supported by JPTA Grant)

Comparison of quality of life according to community walking in stroke patients.

[Purpose] The aim of this study was to examine the quality of life of stroke patients according to their degree of community walking. [Subjects] This study utilized raw data from the sixth Korea National Health and Nutrition Examination Survey conducted in 2013 by the Korea Centers for Disease Control and Prevention. The subjects were noninstitutionalized stroke patients (n = 71) diagnosed by a doctor. [Methods] Trained surveyors visited households selected for the sample and conducted face-to-face interviews in conjunction with a structured questionnaire. The content of the interview included demographic data and the EuroQoL; EQ-5D-3L. Inferential statistical analysis took into account the clustering and stratification of the sample survey data as usually done in a complex survey design. A χ2 test was performed to identify the quality of life distribution according to walking days during a typical week. Finally, logistic regression analysis was performed to identify the correlation between quality of life and walking days. [Results] Mobility, usual activities, and anxiety/depression differed significantly according to number of walking days during a normal week. No significant difference was found in the relationship between quality of life and days of walking during a normal week. [Conclusion] This study indicates that community walking every day is better than walking 1–3 days a week or no walking in terms of the effect on quality of life. However, the extent to which community walking is good for improving quality of life is unclear. Further studies need to determine the optimal duration (days) of community walking.

Effects of Cognitive-Motor Interference on Cognitive Tasks Requiring Different Types of Concentration During Preferred and Fast Walking in Stroke Patients

The purpose of this study was to examine the effect of three cognitive tasks on gait at a preferred walking speed, and at a fast speed, using dual-task methodology. A total of 29 stroke patients participated in the study. All 29 subjects performed 2 motor tasks (10-meter walk task and timed up and go task each at a preferred and a fast speed) and three cognitive tasks [Stroop, word list generation (WLG), serial subtraction (SS)] under dual-task conditions [cognitive-motor interference (CMI)] in a randomized order. Gait speeds were measured in six different conditions. A repeated-measure analysis of variance was employed to compare the results of the Stroop training, WLG, and SS tasks during preferred and fast walking. A Bonferroni adjustment use for post hoc analysis. The level of statistical significance was set at α=.05. A CMI effect occurred for performance of a 10-meter walking task at two different speed and a cognitive task (p＜.05). Stroop had a significantly greater effect than SS and WLG (p＜.05). The timed up and go task was affected when performed with fast walking speed during Stroop cognitive task (p＜.05), but was not affected if performed with preferred walking speed during a cognitive task (p＞;.05). This study showed that CMI of Stroop can be used as a rehabilitation program for stroke patients.

Immediate effects of single-leg stance exercise on dynamic balance, weight bearing and gait cycle in stroke patients

Methods: Eighteen patients with hemiplegia participated in this study. There were twelve males and six females. This study investigated the effects of the single-leg stance exercise on dynamic balance, weight bearing, and gait ability compared with four conditions. Dynamic balance and weight bearing were measured using the step test (ST) of the affected side in stroke patients. In addition, gait parameters were measured using the optogait system for analysis of the spatial and temporal parameters of walking in stroke patients. Results: This study investigated the effect of the single leg stance exercise on the paralysis side. The ST showed significant findings for all conditions (p<0.05). Therefore, knee extension and flexion exercise on the affected side single-leg stance (condition 4) significantly improved dynamic balance and weight bearing on the affected side (p<0.05). In the condition of moving the knee joint in a single-leg stance was discovered that the stance phase time significantly increased more than in the condition of supporting the maximal voluntary weight on the affected side (p<0.05). Conclusions: Single-leg stance on the paralysis side with knee flexion and extension increased symmetry in weight bearing during stance phase time. This study suggests that single-leg stance exercises augments improved gait function through sufficient weight bearing in the stance phase of the affected side.

The influence of balance support on the metabolic cost of walking in stroke patients during overground and treadmill walking

Results: The (modified) RVGA showed most improvement in the items foot positioning at initial contact and varus of the foot during swing. The results of the FAAM demonstrated an improvement in the ability to walk on uneven surface and walking up and down stairs. Walking speed did not improve on average, with high variability between subjects. No surgical or post operative complications were reported. Discussion and conclusions: A combination of surgical interventions to correct deformities of both the foot and toes seems a satisfying alternative treatment when an AFO is inadequate to correct the foot deformity or patient satisfaction with orthotic use is low. Improvement is most evident when negotiating uneven terrain and stairs. Knowledge of muscle functioning and dynamics is necessary to decide on the choice and extensiveness of the surgical interventions.

The reliability and validity of the sacral marker method when evaluating the balance of stroke patients using three dimensional motion analysis

Objective To study the reliability and validity of using sacral markers in evaluating the balance function in standing and walking of stroke patients with hemiplegia.Methods Twenty-one hemiplegic stroke patients were recruited and their baseline mean sway amplitude (MSA) and mean sway velocity (MSV) were measured using sacral markers and center of gravity analysis assuming a segmented body,the gold standard for such analysis.The data were analyzed using Bland-Altman plots to obtain the 95％ limits of agreement (LOA).Results ①Test-retest reliability:The 95％ LOA of the MSA in standing was (-4.42,5.14) on the X axis,(-6.04,4.52)on the Y axis,and (-1.75,1.31) on the Z axis.The MSV in standing was (-0.08,0.09) on the X axis,(-0.10,0.08) on the Y axis and (-0.03,0.02) on the Z axis.The 95％ LOA of the MSA in walking was (-185.74,105.53) on the X axis,(-22.57,2.76) on the Y axis and (4.43,2.76) on the Z axis.The MSV in walking was (-3.10,1.76) on the X axis,(-0.38,0.54) on the Y axis and (-0.07,0.02) on the Z axis.②Validity:The 95％ LOA of the MSA in standing was (-3.62,2.55) on the X axis,(-3.95,3.94) on the Y axis and (-7.35,19.43) on the Z axis.For the MSV in standing it was (-0.06,0.04) on the X axis,(-0.07,0.07) on the Y axis and (-0.12,0.32) on the Z axis.The 95％ LOA of the MSA in walking was (-4.40,4.74) on the X axis,(-17.35,4.14) on the Y axis and (-17.35,4.14) on theZ axis.For the MSV in walking itwas (-0.07,0.08) on the X axis,(-0.29,0.07) on the Y axis and (-0.12,0.18) on the Z axis.The 95％ LOAs of the variables representing their reliability and validity are small enough to be acceptable in clinical application.Conclusions The sacral marker method can be used in assessing the balance of stroke patients. Key words: Sacral marker method; Segmental representation; Center of gravity; Balance; Stroke; Reliability ; Validity

Effects of the Dual AFO on gait parameters in stroke patients

This study investigated how to improve the walking patterns in stroke patients by using the Dual AFO, which was devised as an alternative AFO consisting of two thin pierced plastic pieces for the lower leg and foot. Fifteen individuals with hemiplegia were recruited. Participants were seven males and eight females. Gait parameters were measured with the GAITRite system to analyze the spatial and temporal parameters of walking by stroke patients.The Dual AFO significantly improved the step time of the non-affected foot compared with barefoot walking. There was no significance difference in the affected swing time between the two conditions, and participants with the Dual AFO had a significantly shorter non-affected swing time. There was a significant difference in the affected single support time between walking with and without the Dual AFO. Additionally, the velocity was increased significantly in subjects with the Dual AFO compared with barefoot. Consequently, the Dual AFO might enhance stability during the stance phase on the affected side and mobility during the swing phase on the non-affected side to promote better walking in stroke patients.

Robot-assisted walking vs overground walking in stroke patients: An evaluation of muscle activity

There is increasing evidence that robot-assisted treadmill training might be useful for gait rehabilitation after stroke. The aim of this study was to evaluate the muscle activity of stroke patients during robot-assisted walking and overground walking, and of a group of able-bodied subjects during overground walking. Case-control observational study. Ten stroke subjects and 10 able-bodied control subjects. Electromyography measurements of 7 lower-limb muscles were made in 3 trials: robotic walking, in which stroke subjects walked in a robot-assisted gait orthosis; overground walking for the same group of stroke subjects; and overground walking for control subjects. Trials were compared with respect to electromyography amplitude of selected leg muscles. Higher muscle activity during overground walking compared with robotic walking was found in several muscles during several phases of the gait cycle. A significant trial × leg interaction revealed smaller differences in muscle activity between the paretic and non-paretic leg during robotic walking compared with overground walking. Furthermore, the muscle activity pattern was not significantly different between control walking and robotic walking, while it was different between control walking and overground walking. Despite lower muscle activity, robot-assisted treadmill training may elicit a more symmetrical pattern of leg muscle activity, which approaches that of able-bodied individuals.