Posts Tagged Gait Analysis

[ARTICLE] Gait analysis with the Kinect v2: normative study with healthy individuals and comprehensive study of its sensitivity, validity, and reliability in individuals with stroke – Full Text

Abstract

Background

Gait is usually assessed by clinical tests, which may have poor accuracy and be biased, or instrumented systems, which potentially solve these limitations at the cost of being time-consuming and expensive. The different versions of the Microsoft Kinect have enabled human motion tracking without using wearable sensors at a low-cost and with acceptable reliability. This study aims: First, to determine the sensitivity of an open-access Kinect v2-based gait analysis system to motor disability and aging; Second, to determine its concurrent validity with standardized clinical tests in individuals with stroke; Third, to quantify its inter and intra-rater reliability, standard error of measurement, minimal detectable change; And, finally, to investigate its ability to identify fall risk after stroke.

Methods

The most widely used spatiotemporal and kinematic gait parameters of 82 individuals post-stroke and 355 healthy subjects were estimated with the Kinect v2-based system. In addition, participants with stroke were assessed with the Dynamic Gait Index, the 1-min Walking Test, and the 10-m Walking Test.

Results

The system successfully characterized the performance of both groups. Significant concurrent validity with correlations of variable strength was detected between all clinical tests and gait measures. Excellent inter and intra-rater reliability was evidenced for almost all measures. Minimal detectable change was variable, with poorer results for kinematic parameters. Almost all gait parameters proved to identify fall risk.

Conclusions

Results suggest that although its limited sensitivity to kinematic parameters, the Kinect v2-based gait analysis could be used as a low-cost alternative to laboratory-grade systems to complement gait assessment in clinical settings.

Background

The physiological basis of cerebrovascular accidents make gait deficits a common sequelae after stroke [1]. More than 60% of stroke survivors are unable to walk independently after the injury [2] and, even after rehabilitation, more than half of the cases still present gait-related deficits [3]. Most prevailing deficits after stroke include reduced speed [4] and increased gait inter-limb asymmetry [5]. These gait impairments can be aggravated in the elderly, due to the natural musculoskeletal and cognitive decline with age [67], where the incidence of stroke is higher [8]. Importance of these deficits relies on their great impact on independence [9], quality of life [10], and fall risk [11]. Consequently, their adequate assessment is necessary for a proper diagnosis and to plan, if required, customized interventions to each individual’s condition and evaluate the effectiveness of these interventions.

Assessment of gait is commonly performed in the clinical setting using standardized scales and tests that evaluate different aspects of human locomotion and, in some cases, compare the results of the person being tested with those obtained by a matched healthy sample [12]. Although these tools are easy to administer and, in general, not time-consuming, they can present lack of specificity and, more importantly, may have poor accuracy and be biased by subjective evaluations [13]. Over the years, different technological solutions have been proposed to overcome these limitations. Accurate estimation of spatiotemporal parameters has been enabled by instrumented walkways [14] and force plates [15], generally, from ground reaction forces during walking. Estimation of kinematic parameters, however, require the position of several joints to be tracked during the test, which has been indirectly facilitated by different technological solutions that estimate the position of some sensors that are attached to specific body parts [16,17,18]. Among them, optical motion tracking has become the most common alternative for accurate investigation of kinematic gait parameters [19]. Although instrumented systems allow for accurate spatiotemporal and kinematic analysis, their high cost and large size have restricted their use to research laboratories and large clinical centers with high economic resources [20].

In the last years, the Microsoft Kinect (Microsoft, Redmond, WA), a portable off-the-shelf infrared camera originally intended for entertainment, has enabled human motion tracking without using wearable sensors at a very low-cost. Reliability studies have shown comparable performance of the Kinect to laboratory-grade gait analysis systems, for both the first [2122] and the second version of the device [23], known as the Kinect v2, which features improved depth accuracy and number of joints tracked [24]. Characteristics of the Kinect v2 have motivated their use for assessing spatiotemporal [25,26,27] and kinematic parameters of gait [2628] with promising results in healthy individuals, even on treadmills [2829]. Its reliability in stroke population, however, remains almost unexplored. Little evidence suggests that data retrieved from the Kinect v2 can be used to differentiate healthy subjects from individuals with stroke [30] and to complement clinical assessment [31]. Despite of the existing data supporting the reliability of the Kinect v2 to assess spatiotemporal and kinematic gait parameters, the unavailability of the software, the limited investigation in individuals with stroke, and the unknown psychometric properties of Kinect-based tests in this population could compromise the clinical relevance of these results.

The objective of this study was fourfold. First, to compare a cohort of individuals with stroke with respect to a group of healthy controls to determine the sensitivity of an open-access Kinect v2-based gait analysis system to motor disability and aging. Second, to determine the concurrent validity of the system with standardized clinical tests in individuals with stroke. Third, to quantify its reliability as defined by the inter and intra-rater reliability, the standard error of measurement, and the minimal detectable change. And, finally, to investigate the ability of the system to identify risk of falls after stroke.

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Continue —>  Gait analysis with the Kinect v2: normative study with healthy individuals and comprehensive study of its sensitivity, validity, and reliability in individuals with stroke | Journal of NeuroEngineering and Rehabilitation | Full Text

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[ARTICLE] The validity of spatiotemporal gait analysis using dual laser range sensors: a cross-sectional study – Full Text

Abstract

Background

The spatiotemporal parameters were used for sophisticated gait analysis in widespread clinical use. Recently, a laser range sensor has been proposed as a new device for the spatiotemporal gait measurement. However, measurement using a single laser range sensor can only be used for short-range gait measurements because the device irradiates participants with lasers in a radial manner. For long-range gait measurement, the present study uses a modified method using dual laser range sensors installed at opposite ends of the walking path. The aim of present study was to investigate the concurrent validity of the proposed method for spatiotemporal gait measurement by comparison to a computer-based instrumented walkway system.

Methods

Ten healthy participants were enrolled in this study. Ten-meter walking tests at 100, 75, and 50% of the comfortable speed were conducted to determine the concurrent validity of the proposed method compared to instrumented walkway measurements. Frequency distributions of errors for foot-contact (FC) and foot-off (FO) estimated times between the two systems were also calculated to determine the adequacy of estimation of FC and FO from three perspectives: accuracy (smallness of mean error), precision (smallness of variability), and unambiguity (monomodality of histogram). Intra-class correlation coefficient (2,1) was used to determine the concurrent validity of spatiotemporal parameters between the two systems.

Result

The results indicate that the detection times for FC and FO estimated by the proposed method did not differ from those measured by the instrumented walkway reference system. In addition, histogram for FC and FO showed monomodality. Intra-class correlation coefficients of the spatiotemporal parameters (stance time: 0.74; double support time: 0.56; stride time: 0.89; stride length: 0.83; step length: 0.71; swing time: 0.23) were not high enough. The mean errors of all spatiotemporal parameters were small.

Conclusions

These results suggest that the proposed lacks sufficient concurrent validity for spatiotemporal gait measurement. Further improvement of this proposed system seems necessary.

Background

In gait disorder rehabilitation, gait analysis plays an important role in optimizing treatment for each patient [1234]. Conventionally, visual observation of gait analysis is easy and low cost and is commonly used in rehabilitation facilities. However, previous studies report that visual observation gait analysis has low inter-rater and test-retest reliability as well as low criterion concurrent validity in contrast to kinematic analyses using various instruments [45]. For highly accurate measurements with good inter-rater and test-retest reliability, a three-dimensional motion analysis system has been used. Although this system is able to measure whole-body joint motions, it has high costs and is time- and labor-intensive to set up [6].

Spatiotemporal gait measurement is another valuable method to identify gait deviations, make diagnoses, determine appropriate therapy, and monitor patient progress [23]. Frequently, parameters such stance time, swing time, double support time, stride time, stride length, and step length are evaluated [78910]. To calculate these spatiotemporal parameters, accurate detection of two events for switching between the stance and swing phases is essential: foot contact (FC) and foot off (FO). FC is defined as when any point of the foot first contacts and is the starting point of the stance phase. FO is when the sole is raised completely from the floor and is the onset of the swing phase. A measurement system for detection of FC and FO is a computer-based instrumented walkway system with pressure sensors and produces high inter-rater and test-retest reliability [278910]. Although this system has a relatively reasonable price as compared with a three-dimensional motion analysis system, it is still considerably expensive to become widely used. In addition, it occupies a large amount of floor space and greatly limits effective use of the exercise room. While this system is placed on the floor, the place is not able to be used for other purposes even though the exercise room has limited floor space.

Recently, spatiotemporal gait measurement using a laser range scanner has been proposed as easy to install and remove [11121314]. With a laser range scanner, both lower legs are measured using two best-fitting circles whose contours are defined by laser points. Although this method is useful for easy measurement of gait parameters in a clinical setting, the raw contour of the leg is incomplete because the sensor provides only one-sided information [11]. In addition, the number of laser points comprising the spheres decreases with long-range gait measurements because the lasers irradiate participants in a radial manner. Since the radial range decreases with increasing distance from the laser, this causes larger measurement errors.

For eliminating problems in long-range gait measurement, we proposed a method of spatiotemporal gait analysis using dual laser range sensors installed at opposite ends of the walking path. Because the measurement using laser range sensor is quick and easy method, this proposed method has a high degree of usability for clinical practice. However, it is not clear whether the proposed method has concurrent validity, which is defined as evaluation of an instrument against an already validated measure [15], for spatiotemporal gait measurement by comparison to a computer based instrumented walkway system (reference system) that was widely used for criterion-related validity. The aim of present study was to investigate the concurrent validity of the proposed method for spatiotemporal gait measurement by comparison to a reference system.

Methods

Participants

Ten healthy participants (7 males and 3 females, 20–24 years of age, 154-184 cm in height, 49-70 kg in weight) were enrolled in the present study. All participants have no history of orthopedic, neurophysiologic, and cardiovascular diseases. Informed consent was obtained from each participant before the experiments. The present study was approved by the ethics committee and was conducted according to the Declaration of Helsinki for human experiments.

Experimental procedures

This study used a cross-sectional design to assess the concurrent validity of the proposed method for spatiotemporal gait measurement by comparison to a reference system.

Participants wearing short pants were asked to get on a walking path and walk barefoot along a 12 m straight line including 3.5 m in front of the measured walking path and 3.5 m beyond the end of walking path. Each participant performed one trial at each speed: 100, 75, and 50% of the comfortable speed in a subjective manner. Before measurement, the order of the speed conditions was randomized for each participant. During the gait test, spatiotemporal measurements were carried out simultaneously using both the proposed method and the reference system. The inter-trial interval was set to 2 minutes to prevent fatigue.

Proposed method using laser range sensors

A two-dimensional radial scanning laser range sensor (UTM-30LX, Hokuyo Automatic Co., Ltd., Osaka, Japan) was used (Fig. 1a). The device has a scanning range from − 135° to 135° in steps of 0.25° (total of 1080 data points measuring the distance from the sensor to the target), and one scan is completed in 0.025 s (i.e., the sampling frequency is 40 Hz). In addition, the device exhibits very small test-retest variability and the relative error of a distance (0.1 to 10 m, σ < 0.01 m and ± 0.01 m, white Kent paper, respectively) in the repeated measurements using same laser range sensor unit (i.e. unit testing). Two devices were installed at opposite ends of a five-meter walking path at the level of the average shin height (0.25 m above the floor) [16] (Fig. 1b).

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Continue —>  The validity of spatiotemporal gait analysis using dual laser range sensors: a cross-sectional study | Archives of Physiotherapy | Full Text

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[Abstract] Effect of postural insoles on gait pattern in individuals with hemiparesis: A randomized controlled clinical trial.

Abstract

Introduction

Recovering the ability to walk is an important goal of physical therapy for patients who have survived cerebrovascular accident (stroke). Orthotics can provide a reduction in plantar flexion of the ankle, leading to greater stability in the stance phase of the gait cycle. Postural insoles can be used to reorganize the tone of muscle chains, which exerts an influence on postural control through correction reflexes. The aim of the present study was to perform kinematic and spatiotemporal analyses of gait in stroke survivors with hemiparesis during postural insole usage.

Material and Methods

Twenty stroke victims were randomly divided into two groups: 12 in the experimental group, who used insoles with corrective elements specifically designed for equinovarus foot, and eight in the control group, who used placebo insoles with no corrective elements. Both groups were also submitted to conventional physical therapy. The subjects were analyzed immediately following insole placement and after three months of insole usage. The SMART-D 140® system (BTS Engineering) with eight cameras sensitive to infrared light and the 32-channel SMART-D INTEGRATED WORKSTATION® were used for the three-dimensional gait evaluation.

Results

Significant improvements were found in kinematic range of movement in the ankle and knee as well as gains in ankle dorsiflexion and knee flexion in the experimental group in comparison to the control group after three months of using the insoles.

Conclusion

Postural insoles offer significant benefits to stroke survivors regarding the kinematics of gait, as evidenced by gains in ankle dorsiflexion and knee flexion after three months of usage in combination with conventional physical therapy.

Keywords:

via Effect of postural insoles on gait pattern in individuals with hemiparesis: A randomized controlled clinical trial – Journal of Bodywork and Movement Therapies

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[Abstract] Recent Advances on Lower Limb Exoskeleton Rehabilitation Robot

Abstract

Background: Lower limb exoskeleton rehabilitation robot is a bionic robot, which is the product of the combination of medical technology and robot technology, simulating human walking movement. It can be mainly used for rehabilitation training of patients with lower limb dysfunction.

Objective: To provide an overview of recent lower limb exoskeleton rehabilitation robot and introduce their respective characteristics and development.

Method: A recent lower limb exoskeleton rehabilitation robot is divided into passive drive, pneumatic drive, hydraulic drive and motor drive. This paper reviews various representative patents related to lower limb exoskeleton rehabilitation robot. The structural characteristics and applications of the typical lower limb exoskeleton rehabilitation robots are introduced.

Results: The differences between different types of lower limb exoskeleton rehabilitation robots are compared and analyzed, and the structural characteristics are concluded. The main problems in its development are analyzed, the development trend is foreseen, and the current and future research of the patents on lower limb exoskeleton rehabilitation robot is discussed.

Conclusion: There are a lot of patents and articles about the exoskeleton rehabilitation robots, however, if these problems can be solved, such as small size, light weight and high power output are solved at the same time, the consistency with human body will be advanced, with the combination of traditional rehabilitation medicine. It will be possible to maximize the rehabilitation of the lower limbs.

Source: Recent Advances on Lower Limb Exoskeleton Rehabilitation Robot: Ingenta Connect

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[Abstract] Advanced Gait Analysis: Insights into Human Locomotor Control (PDF Download Available)

 

Abstract
Human walking is the result of a complex interaction of multiple neuroanatomical systems and the relative importance of these systems depends on the locomotor task being performed. An understanding of these relative roles and the consequences of different CNS lesions on locomotion requires comprehensive profiling of human walking behaviours in health and disease.
We assessed humans walking on a treadmill under different locomotor conditions using 3D kinematic gait analysis. We revealed task-specific, age-dependent patterns of foot endpoint control in 121 healthy adults. In older adults, cognitive distraction while walking resulted in degraded endpoint control in the form of decreased mean toe clearance and an increase in the frequency of extremely low toe clearance values. This translated into a markedly increased modelled probability of tripping. Conversely, walking with the lower visual field restricted was associated with increased clearance, but in older adults control was intermittently degraded and tripping risk increased.
We also examined arm swing behaviour during the Stroop colour-word naming task in 83 healthy adults. Remarkably, increasing difficulty in this left-lateralised language task resulted in significantly increased arm swing asymmetry, driven by a reduction in the movement on the right.
We propose that these observations are due to unilateral inhibition of a corticospinal contribution to arm swing. Men of all ages and older women were strongly affected by this phenomenon but women under 60 appeared to be resistant. The reason for this is unclear but may represent oestrogen-dependent plasticity and redundancy in the prefrontal cortex, where activation underpinning cognitive control during the Stroop task is likely to interfere with gait control. This paradigm was then applied to patients with incomplete spinal cord injury (SCI). Patients with thoracic injuries showed a significantly larger, homogeneous shift in arm swing symmetry towards left-dominant patterns during the Stroop task than those with cervical injuries. Patients with thoracic SCI may have longstanding interruption of the long propriospinal connections between the dominant lumbar central pattern generator for locomotion and its subsidiary, cervical component which usually contributes to arm swing. As a result, their arm swing is more dependent on supraspinal control and is susceptible to interference from the Stroop task.
These results taken together support an important role of supraspinal centres in diverse aspects of human walking behaviour, from fine control of toe trajectory to the more automatic, rhythmic swinging of the arms.

Source: Advanced Gait Analysis: Insights into Human Locomotor Control (PDF Download Available)

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[ARTICLE] Bobath and traditional approaches in post-stroke gait rehabilitation in adults – Full Text PDF

Summary

Study aim: The aim of this study was to compare the outcomes of a study of post-stroke gait reeducation using the Bobath neuro-developmental treatment (NDT-Bobath) method and the traditional approach.

Material and methods: The study included 30 adult patients after ischemic stroke, aged 32–82. Patients were randomly assigned to one of the treatment groups: the study group (treated with the NDT-Bobath method combined with the traditional approach, ten sessions), and a reference group (treated with the traditional method only, ten sessions). The measurements (spatio-temporal gait parameters based on 10 m walking test: gait velocity, normalized gait velocity, cadence, normalized cadence, stride length, and normalized stride length) were administered twice: on admission (before the therapy) and after the last therapy session.

Results: Statistically significant and favorable changes in the gait velocity, cadence and stride length regarding their normalized values were observed. Moderate and high correlations among changes of assessed spatio-temporal gait parameters were observed in both groups.

Conclusions: The NDT-Bobath method may be regarded as a more effective form of gait post-stroke rehabilitation in young adults compared to traditional rehabilitation.

Introduction

Despite stroke incidence and mortality rates slowly decreasing in selected countries (especially developed Western Europe countries) [6, 7], stroke is still regarded as one of the leading causes of death and long-term disability. Ischemic stroke cases constitute approximately 70–80% of all stroke cases [6, 7]. Post-stroke gait disorder reduces mobility of patients, their independence, participation in activities of daily living and community life. Gait disorders may be reflected in spatio-temporal gait parameters. Their assessment may be a useful basic or supplementary way to assess general efficiency of gait function restoration during a neurorehabilitation program.

The Bobath neuro-developmental treatment (NDTBobath) method for adults is still one of the most popular therapeutic methods in neurorehabilitation, including gait relearning [8, 21]. Current studies concerning its use in post-stroke gait relearning have methodological concerns related to study/treatment fidelity and measurement [16]. For this moment there is insufficient evidence (especially from randomized controlled trials – RCTs) to conclude that a particular physiotherapy method (including NDT-Bobath) is more effective in promoting recovery of gait than any other approach. Moreover, combined use of NDT-Bobath and components of any other approaches may diminish the aforementioned picture. The assumption that rehabilitation using a proper mix of components derived from different approaches may be more effective than no treatment control in attaining gait function following stroke may be true [18]. Research on various mixed/eclectic approaches constitute an important step toward patient-tailored therapy and the need for further support. Current evidence concerning combined use of the NDT-Bobath method and components of another therapeutic approach is weak. Evidence of favorable combined use of the NDT-Bobath method is as follows:

− successful use of mixed rehabilitative procedures, including NDT-Bobath, in an individual training package [17],

− therapy based on the NDT-Bobath concept supported by task practice is more effective than task practice alone [9],

− injection of botulinum toxin type A combined with NDT-Bobath therapy showed improvements in lower limb spasticity, gait and balance in post-stroke patients greater than use of botulinum toxin type A alone [11].

The aim of this study was compare the outcomes of a study of post-stroke gait rehabilitation using the NDTBobath method for adults combined with the traditional approach and the sole traditional approach.

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[Abstract] Effects of treadmill training with load addition on non-paretic lower limb on gait parameters after stroke: a randomized controlled clinical trial

Highlights

  • Load use as a restraint for the movement of non-paretic lower limb is proposed.
  • Currently, only immediate effects of this practice are available.
  • Stroke patients performed gait training with and without load addition, for two weeks.
  • Kinematic gait parameters were improved after training and maintained at follow-up.
  • Load addition did not provide additional benefits to gait training.

Abstract

The addition of load on the non-paretic lower limb for the purpose of restraining this limb and stimulating the use of the paretic limb has been suggested to improve hemiparetic gait. However, the results are conflicting and only short-term effects have been observed.

This study aims to investigate the effects of adding load on non-paretic lower limb during treadmill gait training as a multisession intervention on kinematic gait parameters after stroke.

With this aim, 38 subacute stroke patients (mean time since stroke: 4.5 months) were randomly divided into two groups: treadmill training with load (equivalent to 5% of body weight) on the non-paretic ankle (experimental group) and treadmill training without load (control group). Both groups performed treadmill training during 30 minutes per day, for two consecutive weeks (nine sessions). Spatiotemporal and angular gait parameters were assessed by a motion system analysis at baseline, post-training (at the end of 9 days of interventions) and follow-up (40 days after the end of interventions).

Several post-training effects were demonstrated: patients walked faster and with longer paretic and non-paretic steps compared to baseline, and maintained these gains at follow-up. In addition, patients exhibited greater hip and knee joint excursion in both limbs at post-training, while maintaining most of these benefits at follow-up. All these improvements were observed in both groups.

Although the proposal gait training program has provided better gait parameters for these subacute stroke patients, our data indicate that load addition used as a restraint may not provide additional benefits to gait training.

Source: Effects of treadmill training with load addition on non-paretic lower limb on gait parameters after stroke: a randomized controlled clinical trial – Gait & Posture

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[ARTICLE] Validity of gait asymmetry estimation by using an accelerometer in individuals with hemiparetic stroke – Full Text PDF

Abstract.

[Purpose] The purpose of this study was to evaluate the validity of estimating step time and length asymmetries, using an accelerometer against force plate measurements in individuals with hemiparetic stroke.

[Subjects and Methods] Twenty-four individuals who previously had experienced a stroke were asked to walk without using a cane or manual assistance on a 16-m walkway. Step time and length were measured using force plates, which is the gold standard for assessing gait asymmetry. In addition to ground reaction forces, trunk acceleration was simultaneously measured using an accelerometer. To estimate step time asymmetry using accelerometer data, the time intervals between forward acceleration peaks for each leg were calculated. To estimate step length asymmetry using accelerometer data, the integration of the positive vertical accelerations following initial contact of each leg was calculated. Asymmetry was considered the affected side value divided by the unaffected side value.

[Results] Significant correlations were found between the accelerometer and the force plates for step time and length asymmetries (rho=0.83 and rho=0.64, respectively).

[Conclusion] An accelerometer might be useful for assessing step time and length asymmetries in individuals with hemiparetic stroke, although improvements are needed for estimating the accuracy of step length asymmetry.

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[Abstract] Accurate upper body rehabilitation system using kinect

Abstract:

The growing importance of Kinect as a tool for clinical assessment and rehabilitation is due to its portability, low cost and markerless system for human motion capture. However, the accuracy of Kinect in measuring three-dimensional body joint center locations often fails to meet clinical standards of accuracy when compared to marker-based motion capture systems such as Vicon. The length of the body segment connecting any two joints, measured as the distance between three-dimensional Kinect skeleton joint coordinates, has been observed to vary with time. The orientation of the line connecting adjoining Kinect skeletal coordinates has also been seen to differ from the actual orientation of the physical body segment. Hence we have proposed an optimization method that utilizes Kinect Depth and RGB information to search for the joint center location that satisfies constraints on body segment length and as well as orientation. An experimental study have been carried out on ten healthy participants performing upper body range of motion exercises. The results report 72% reduction in body segment length variance and 2° improvement in Range of Motion (ROM) angle hence enabling to more accurate measurements for upper limb exercises.

I. Introduction

Body joint movement analysis is extremely essential for health monitoring and treatment of patients with neurological disorders and stroke. Chronic hemiparesis of the upper extremity following a stroke causes major hand movement limitations. There is possibility of permanent reduction in muscle coactivation and corresponding joint torque patterns due to stroke [1]. Several studies suggest that abnormal coupling of shoulder adductors with elbow extensors and shoulder abductors with elbow flexors often leads to some stereotypical movement characteristics exhibited by severe stroke patients [2]. Therefore continuous and effective rehabilitation therapy is absolutely essential to monitor and control such abnormalities. There is a substantial need for home-based rehabilitation post-clinical therapy.

Source: Accurate upper body rehabilitation system using kinect – IEEE Xplore Document

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[ARTICLE] Hemiparetic gait and changes in functional performance due to OnabotulinumtoxinA injection to lower limb muscles

Highlights

  • Measurement of temporal spatial gait parameters helps assess function in hemiparetic patients.
  • Dynamic EMG is valuable in the selection of muscles in hemiparetic gait.
  • Gait parameters showed significant increase in walking velocity and cadence after OnabotA injection to ankle muscles.
  • Average of 320 (± 107) units of OnabotA injection to selected ankle muscles enhances functional ambulation in hemiparetic gait.

Abstract

Objective: To review gait alterations and evaluate the effects of OnabotulinumtoxinA on spatiotemporal walking parameters of patients with hemiparetic gait.

Design: Retrospective pre- and post-intervention analysis.

Setting: Gait analysis laboratory in a tertiary level rehabilitation hospital.

Participants: 42 patients with hemiparesis. 19 males and 23 females, age 18-78 years were included.

Intervention: Spatiotemporal parameters collected before and within 4 to 10 weeks after OnabotA injection to the ankle muscles. Data was recorded at self-selected velocity on a 12 meter instrumented walkway. The most common muscles injected were medial and lateral gastrocnemius, soleus and tibialis posterior. Average total OnabotulinumtoxinA dose was 320±107 units.

Main Outcome: Spatiotemporal parameters of walking assessed before (T0) and within 4 to 10 weeks post injection (T1). Paired t-test was used to compare pre- and post-intervention data. A sequential Holm-Bonferroni procedure was used to adjust for multiple comparisons and minimize the risk of type I error. Statistical significance was set at p<0.05.

Results: Statistically significant increases were seen for walking velocity (20%) (T0=0.40±0.26 m/s and T1=0.48±0.29 m/s; p=0.006), and increased cadence (T0=63.48±23.93 steps/min, and T1=70.88±23.65 steps/min; p=0.006) following OnabotulinumtoxinA injections.

Conclusion: This study demonstrates that injection of OnabotulinumtoxinA 320 units to ankle muscles selected with the aid of dynamic electromyography can significantly increase gait velocity and enhance functional ambulation in adults with hemiparesis due to upper motor neuron syndrome.

μέσω Hemiparetic gait and changes in functional performance due to OnabotulinumtoxinA injection to lower limb muscles.

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