Posts Tagged AMBULATION
[Abstract] Effect of activity-based mirror therapy on lower limb motor-recovery and gait in stroke: A randomised controlled trial
Objective: To determine the effect of activity-based mirror therapy (MT) on motor recovery and gait in chronic poststroke hemiparetic subjects.
Design: A randomised, controlled, assessor-blinded trial.
Setting: Rehabilitation institute.
Participants: Thirty-six chronic poststroke (15.89 ± 9.01 months) hemiparetic subjects (age: 46.44 ± 7.89 years, 30 men and functional ambulation classification of median level 3).
Interventions: Activity-based MT comprised movements such as ball-rolling, rocker-board, and pedalling. The activities were provided on the less-affected side in front of the mirror while hiding the affected limb. The movement of the less-affected lower limb was projected as over the affected limb. Conventional motor therapy based on neurophysiological approaches was also provided to the experimental group. The control group received only conventional management.
Main outcome measures: Brunnstrom recovery stages (BRS), Fugl-Meyer assessment lower extremity (FMA-LE), Rivermead visual gait assessment (RVGA), and 10-metre walk test (10-MWT).
Results: Postintervention, the experimental group exhibited significant and favourable changes for FMA-LE (mean difference = 3.29, 95% CI = 1.23–5.35, p = .003) and RVGA (mean difference = 5.41, 95% CI = 1.12–9.71, p = .015) in comparison to the control group. No considerable changes were observed on 10-MWT.
Conclusions: Activity-based MT facilitates motor recovery of the lower limb as well as reduces gait deviations among chronic poststroke hemiparetic subjects.
[ARTICLE] Effect of ankle foot orthosis on gait parameters and functional ambulation in patients with stroke – Full Text PDF
Objectives: This study aims to investigate the effect of ankle foot orthosis (AFO) on temporospatial parameters, ankle kinematics, and functional ambulation level in patients with stroke.
Patients and methods: Records of 286 adult patients with stroke assessed in the gait and motion analysis laboratory between April 2005 and January 2013 were reviewed. The data of 28 patients (16 males, 12 females; mean age 43.2±15.9 years; range 20 to 72 years) who were analyzed with and without AFO during the same session were selected for the study. Temporospatial parameters (walking speed, cadence, opposite foot contact, double support time, single support time, step time, and step length) and ankle kinematics (ankle dorsiflexion at initial contact and midswing) were measured using the Vicon 512 motion analysis system. The video and medical records of patients were examined to determine their ambulation level according to Functional Ambulation Category.
Results: Walking speed, cadence, and ankle dorsiflexion at initial contact and midswing were significantly increased while walking with AFO compared to walking barefoot (p<0.05). There were significant reduction in step time and significant increase in step length and opposite foot contact with AFO on the affected side (p<0.05). Single support time reduced significantly with AFO on the unaffected side (p<0.05). Functional Ambulation Category score improved significantly with use of AFO (p<0.05).
Conclusion: The use of AFO has positive effects on gait parameters and functional ambulation in patients with stroke.
Dr. Karen Nolan’s Ted Talk at TEDxHerndon from May 2016 has been finally uploaded to YouTube. In her talk, Dr. Nolan focuses on the rehabilitation needs of post-stroke patients suffering from hemiplegia. Hemiplegia is a form of paralysis on one side of the body due to brain damage from stroke.
Dr. Karen Nolan is a Senior Research Scientist in Human Performance and Engineering Research at the Kessler Foundation. You might remember her from her very persuasive and thorough presentation on the Ekso GT as a rehabilitation tool back in February 2016: Stroke Recovery Clinical Trials With Ekso GT
In her TEDxHerndon talk, Dr. Nolan spends more than half of her time focusing on the needs and challenges faced by stroke patients with hemiplegia and hemiparesis (weakness on one side). She then slowly transitions into the potential of robotics for stroke rehabilitation.
At the 11 minute mark, Dr. Nolan brings up the intensity of her talk to an 11. She presents a video segment demonstrating real world rehabilitation. She then compares the classical rehabilitation with that of a robotics device, the Ekso GT. But this is just the beginning, as Dr. Nolan is an authority on biomechanics.
Dr. Nolan dissects the usefulness of the Ekso GT rehabilitation exoskeleton beyond what can be observed by the naked eye. In her talk, she presents the muscle activations of a major muscle group with and without the exoskeleton. Furthermore, she exhibits a full 3D kinematics model of the human body with and without the use of an exoskeleton:
In the image above, you can see a person performing walking with the help of the Ekso GT. The person is moving towards the screen. The left hand is supported by a cane. Both feet are pointing in the correct direction and the step will not be executed until proper weight shift is detected by the exoskeleton.
In the image to the right, the patient is undergoing classical rehabilitation. One person is holding a cart which supports the left arm. A second person is manually moving the right leg. Note that the leg is pointing outwards. More importantly, and what would be missed by just looking at a video, there isn’t a proper weight distribution. The person is leaning on the cart with their left arm, and the right foot is being dragged along. This dramatically decreases the quality of the rehabilitation session.
Dr. Nolan concludes her presentation with a suggestion on how robotics for stroke rehabilitation can be improved. She suggests that engineers, medical professionals, patients, and researchers work more closely together. The goal of this collaboration would be to more closely define who would and wouldn’t benefit from using rehabilitation robotics. How long should the sessions be and what procedures should be followed? Amazingly, these are exactly the same challenges listed by Dr. Dylan Edwards in his June presentation at Ekso Bionics:
In her Ted Talk, Dr. Nolan lists the now familiar primary and secondary advantages of using rehabilitation exoskeletons (more specifically the Ekso GT). She elevates the discussion by presenting videos, muscle activation graphs and 3D models of classical vs. robotic rehabilitation. This is the strongest objective argument for exoskeleton rehabilitation presented to the public so far.
Robotics for Stroke Rehabilitation | Karen J. Nolan | TEDxHerndon, August 2016, Recorded May 2016, TEDxHerndon, NS2 National Security Services, YouTube https://www.youtube.com/watch?v=MK9AkQ2Zu_w
[ARTICLE] Does stroke location predict walk speed response to gait rehabilitation? – Full Text PDF/HTML
Recovery of independent ambulation after stroke is a major goal. However, which rehabilitation regimen best benefits each individual is unknown and decisions are currently made on a subjective basis. Predictors of response to specific therapies would guide the type of therapy most appropriate for each patient. Although lesion topography is a strong predictor of upper limb response, walking involves more distributed functions. Earlier studies that assessed the cortico-spinal tract (CST) were negative, suggesting other structures may be important.
Experimental Design: The relationship between lesion topography and response of walking speed to standard rehabilitation was assessed in 50 adult-onset patients using both volumetric measurement of CST lesion load and voxel-based lesion–symptom mapping (VLSM) to assess non-CST structures. Two functional mobility scales, the functional ambulation category (FAC) and the modified rivermead mobility index (MRMI) were also administered. Performance measures were obtained both at entry into the study (3–42 days post-stroke) and at the end of a 6-week course of therapy. Baseline score, age, time since stroke onset and white matter hyperintensities score were included as nuisance covariates in regression models.
Principal Observations: CST damage independently predicted response to therapy for FAC and MRMI, but not for walk speed. However, using VLSM the latter was predicted by damage to the putamen, insula, external capsule and neighbouring white matter.
Walk speed response to rehabilitation was affected by damage involving the putamen and neighbouring structures but not the CST, while the latter had modest but significant impact on everyday functions of general mobility and gait.
[ARTICLE] Combining Afferent Stimulation and Mirror Therapy for Rehabilitating Motor Function, Motor Control, Ambulation, and Daily Functions After Stroke – Full Text HTML
Background. Mirror therapy (MT) and mesh glove (MG) afferent stimulation may be effective in reducing motor impairment after stroke. A hybrid intervention of MT combined with MG (MT + MG) may broaden aspects of treatment benefits.
Objective. To demonstrate the comparative effects of MG + MT, MT, and a control treatment (CT) on the outcomes of motor impairments, manual dexterity, ambulation function, motor control, and daily function.
Methods. Forty-three chronic stroke patients with mild to moderate upper extremity impairment were randomly assigned to receive MT + MG, MT, or CT for 1.5 hours/day, 5 days/week for 4 weeks. Outcome measures were the Fugl-Meyer Assessment (FMA) and muscle tone measured by Myoton-3 for motor impairment and the Box and Block Test (BBT) and 10-Meter Walk Test (10 MWT) for motor function. Secondary outcomes included kinematic parameters for motor control and the Motor Activity Log and ABILHAND Questionnaire for daily function. Results. FMA total scores were significantly higher and synergistic shoulder abduction during reach was less in the MT + MG and MT groups compared with the CT group. Performance on the BBT and the 10 MWT (velocity and stride length in self-paced task and velocity in as-quickly-as-possible task) were improved after MT + MG compared with MT.
Conclusions. MT + MG improved manual dexterity and ambulation. MT + MG and MT reduced motor impairment and synergistic shoulder abduction more than CT. Future studies may integrate functional task practice into treatments to enhance functional outcomes in patients with various levels of motor severity. The long-term effects of MG + MT remain to be evaluated.
[ARTICLE] Lower limb movement preparation in chronic stroke: A pilot study toward an fNIRS-BCI for gait rehabilitation.
Background. Thus far, most of the brain–computer interfaces (BCIs) developed for motor rehabilitation used electroencephalographic signals to drive prostheses that support upper limb movement. Only few BCIs used hemodynamic signals or were designed to control lower extremity prostheses. Recent technological developments indicate that functional near-infrared spectroscopy (fNIRS)-BCI can be exploited in rehabilitation of lower limb movement due to its great usability and reduced sensitivity to head motion artifacts.
Objective. The aim of this proof of concept study was to assess whether hemodynamic signals underlying lower limb motor preparation in stroke patients can be reliably measured and classified.
Methods. fNIRS data were acquired during preparation of left and right hip movement in 7 chronic stroke patients.
Results. Single-trial analysis indicated that specific hemodynamic changes associated with left and right hip movement preparation can be measured with fNIRS. Linear discriminant analysis classification of totHB signal changes in the premotor cortex and/or posterior parietal cortex indicated above chance accuracy in discriminating paretic from nonparetic movement preparation trials in most of the tested patients.
Conclusion. The results provide first evidence that fNIRS can detect brain activity associated with single-trial lower limb motor preparation in stroke patients. These findings encourage further investigation of fNIRS suitability for BCI applications in rehabilitation of patients with lower limb motor impairment after stroke.