Posts Tagged Gait Rehabilitation – Foot Drop
BACKGROUND: Power walking, i.e. walking with emphasized arm swing, increases energy expenditure. To characterize this moderate aerobic fitness exercise, the associated activation patterns of upper limb and trunk muscles need to be known.
AIM: To describe the amount and pattern of EMG activity of upper limb and trunk muscles during power walking and compare it to normal walking and jogging.
METHOD: Twenty volunteers were examined on a treadmill at 6 km/h during (a) normal walking, (b) power walking, (c) jogging. EMG data were collected for the trapezius (TRAP), anterior (AD) and posterior deltoid (PD), biceps (BIC), triceps (TRI), latissimus dorsi (LD) and erector spinae (ES) muscles.
RESULTS: Activity of four muscles (AD, BIC, PD, TRAP) was three- to fivefold stronger during power walking than normal walking (p<0.01). Further significant increases (p<0.01) involved the TRI, LD and ES. Two muscles (AD, TRAP) were more active during power walking than jogging (p<0.05). Normal walking and power walking involved similar EMG patterns of PD, LD, ES.
CONCLUSION: Emphasizing arm swing during power walking triples the EMG activity of upper limb muscles, compared to normal walking. Similar basic temporal muscle activation patterns in both modes of walking suggest a common underlying motor program.
AT A GLANCE
Power walking, i.e. walking with emphasized arm swing, is a moderate aerobic exercise. Compared to normal walking, the EMG activity of upper limb muscles is tripled during power walking. Similar activation patterns of some muscles in both modes of walking suggest a common underlying motor program. Two shoulder muscles are even more active during power walking than during slow running (jogging)
MediTouch Ltd. manufactures innovative physical therapy solutions for hospital, primary and home care use. The products utilize wearable motion capture devices and dedicated rehabilitation software. The MediTouch physical therapy solutions allow patients with upper and/or lower extremity movement dysfunction to practice intensive virtual functional task training of single and multi joints. In this way our systems implement impairment oriented training (IOT) with augmented motion feedback to give a tailored arm or leg exercise physical therapy program that allows the patient to achieve better functional recovery.
via Meditouch Ltd.
[ARTICLE] The Effectiveness of Functional Electrical Stimulation on Walking Speed, Functional Walking Category and Clinically Meaningful Changes for People with Multiple Sclerosis
Objective: To determine the effectiveness of functional electrical stimulation (FES) on foot drop in patients with multiple sclerosis, (MS) using data from standard clinical practice.
Design: Case series with a consecutive sample of FES users collected between 2008 and 2013.
Setting: Specialist FES centre at a District General Hospital
Participants: One hundred and eighty seven (117 females, 70 males, mean number of years since diagnosis 11.7, range of years 1-56, age range 27-80, average age 55 years) patients with MS who have foot drop. One hundred and sixty six were still using FES after 20 weeks with 153 patients completing the follow up measures.
Interventions: FES of the common peroneal nerve (178 unilateral, 9 bilateral FES users).
Outcome Measures: Clinically meaningful changes (i.e. >0.05 ms-1 and >0.1ms-1) and functional walking category derived from 10 metre walking speed.
Results: An increase in walking speed was found to be highly significant (p<.001), both initially where a minimum clinically meaningful change was observed (0.07ms-1) and after 20 weeks with a substantial clinically meaningful change (0.11ms-1). After 20 weeks treatment responders displayed a 27% average improvement in their walking speed. No significant training effect was found. Overall functional walking category was maintained or improved in 95% of treatment responders.
Conclusions: FES of the dorsiflexors is a well-accepted intervention that enables clinically meaningful changes in walking speed leading to preserved or increased functional walking category.
Since the impairment of gait is responsible for a long-term disability and handicap in many chronic stroke patient, the restoration of gait becomes a major goal in neurorehabilitation . Approximately 65% of stroke survivors with initial motor deficits of the lower extremities show some degree of motor recovery. Predicting outcome on the basis of expected neurological and associated functional recovery helps for planning the appropriate neurorehabilitation . This article is focused on the kinetic, footprint and electromyographic (EMG) gait patterns in hemiparetic walking following supratentorial stroke – the most common reason for permanent disability in stroke survivors.
Full Text PDF –> Hemiparetic Gait in Stroke Neurorehabilitation
REGIONAL TEACHING COURSE of the European Academy of Neurology preceded by 9th Meeting of the Bulgarian Society of Neurosonology and Cerebral Hemodynamics October 2–5, 2014 | Sofa, Bulgaria Programme and Lectures
[ARTICLE] Mobility and gait outcomes following intensive rehabilitation, onabotulinumtoxin a, and baclofen treatment chronic post-stroke: a case report.
PURPOSE. This case report describes the effects of intensive rehabilitation with systemic antispasticity and local neurotoxin pharmacological interventions on gait and activity outcomes for a patient with chronic impairments post-stroke.
CASE DESCRIPTION. The 56-year-old male patient was 13 months post-stroke with left hemiparesis and hypertonicity in the left upper and lower extremities. The patient received oral baclofen for widespread hypertonicity and intramuscular onabotulinumtoxin A injections in muscles of the left upper and lower extremities to target local areas of hypertonicity. The patient received weight-supported treadmill training, over-ground gait training, neuromuscular re-education, and balance training three times per week during 20 of the 25 weeks of the study period.
OUTCOMES. The patient demonstrated improvements in balance (Berg Balance Scale), mobility (Timed Up and Go test), and motor function (Stroke Rehabilitation Assessment of Movement Measure). Kinematic measures of gait also improved in ankle and knee range of motion during both stance and swing phases.
DISCUSSION. This case demonstrates that improvements in impairment and activity outcomes can occur in an individual with significant post-stroke chronic impairments after receiving intensive physical therapy in conjunction with pharmacologic interventions to control hypertonicity. The persistence and generalizability of these results need to be determined.
[BOOK] Topics in Paraplegia, Chapter 5: Functional Electrical Stimulation in Paraplegia – Full Text HTML
Functional Electrical Stimulation (FES) is a technique of eliciting controlled neural activation through the application of low levels of electrical current. FES was initially referred to as Functional Electrotherapy by Liberson  and it was not until 1967 that the term Functional Electrical Stimulation was established by Moe and Post . In 1965 Offner patented a system used to treat foot drop with the title “Electrical stimulation of muscle deprived of nervous control with a view of providing muscular contraction and producing a functionally useful moment” . Another term often used equally to FES is Functional Neuromusclular Stimulation (FNS or FNMS).
The first commercially available FES devices treated foot drop in hemiplegic patients by stimulating the peroneal nerve during gait. In this case, a switch, located in the heel end of a user’s shoe, would activate a stimulator worn by the user.
Structural discontinuity in the spinal cord after injury results in a disruption in the impulse conduction resulting in loss of various bodily functions depending upon the level of injury. The initial goal of FES technology was to provide greater mobility to the patients after SCI. However, with the advances in biomedical engineering within the last 2 decades, FES is no more limited to locomotion alone. Therefore, the definition of FES has changed considerably and is now considered to be the technique of applying safe levels of electric current to stimulate various organs of the body rendered disabled due to SCI. Electrical stimulation in the form of functional electrical stimulation (FES) can help facilitate and improve limb mobility along with other body functions lost due to injury e.g. sexual, bladder or bowel functions.
Abstract: The aim of this study is investigate the effect of arm swing exercise on balance and gait in stroke patients.
Group A (n=8): 0.5kg strap was applied during arm swing exercise in experimental group for 30 minutes a day, 3 times a week for 4 weeks. Group B (n=8): Subjects in control group performed neurodevelopmental treatment for 30 minutes a day, 3 times a week for 4 weeks. Subjects were measured for balance and gait on Berg Balance scale, 10meter walking test and Six-minute walk test.
There were significant changed of 10Meter Walking Test and 6-Minute Walk Test after experimental group performed the reinforced arm swing exercise of upper extremities and control group was provided with neurodevelopment treatment(p <0.05).
However, there was no statistically significant found difference change of Berg Balance Scale in experimental group (p >0.05). The application reinforced arm swing exercise can be said to be effective intervention for the gait training in hemiplegic stroke patient.
[PRESS RELEASE] Novel robotic walker invented by NUS researchers helps patients regain natural gait and increases productivity of physiotherapists
Survivors of stroke or other neurological conditions such as spinal cord injuries, traumatic brain injuries and Parkinson’s disease often struggle with mobility. To regain their motor functions, these patients are required to undergo physical therapy sessions. A team of researchers from the National University of Singapore’s (NUS) Faculty of Engineering has invented a novel robotic walker that helps patients carry out therapy sessions to regain their leg movements and natural gait. The system also increases productivity of physiotherapists and improves the quality of rehabilitation sessions.
Designed by a team of researchers led by Assistant Professor Yu Haoyong from the NUS Department of Biomedical Engineering, the robotic walker is capable of supporting a patient’s weight while providing the right amount of force at the pelvis of the patient to help the patient walk with a natural gait. In addition, quantitative data can be collected during the therapy sessions so that doctors and physiotherapists can monitor the progress of the patient’s rehabilitation…
BACKGROUND: Virtual reality and interactive video gaming have emerged as new treatment approaches in stroke rehabilitation. In particular, commercial gaming consoles are being rapidly adopted in clinical settings; however, there is currently little information about their effectiveness.
OBJECTIVES: To evaluate the effects of virtual reality and interactive video gaming on upper limb, lower limb and global motor function after stroke.
SEARCH STRATEGY: We searched the Cochrane Stroke Group Trials Register (March 2010), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2010, Issue 1), MEDLINE (1950 to March 2010), EMBASE (1980 to March 2010) and seven additional databases. We also searched trials registries, conference proceedings, reference lists and contacted key researchers in the area and virtual reality equipment manufacturers.
SELECTION CRITERIA: Randomised and quasi-randomised trials of virtual reality (‘an advanced form of human-computer interface that allows the user to ‘interact’ with and become ‘immersed’ in a computer-generated environment in a naturalistic fashion’) in adults after stroke. The primary outcomes of interest were: upper limb function and activity, gait and balance function and activity and global motor function.
DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials based on pre-defined inclusion criteria, extracted data and assessed risk of bias. A third review author moderated disagreements when required. The authors contacted all investigators to obtain missing information.
MAIN RESULTS: We included 19 trials which involved 565 participants. Study sample sizes were generally small and interventions and outcome measures varied, limiting the ability to which studies could be compared. Intervention approaches in the included studies were predominantly designed to improve motor function rather than cognitive function or activity performance. The majority of participants were relatively young and more than one year post stroke.
PRIMARY OUTCOMES: results were statistically significant for arm function (standardised mean difference (SMD) 0.53, 95% confidence intervals (CI) 0.25 to 0.81 based on seven studies with 205 participants). There were no statistically significant effects for grip strength or gait speed. We were unable to determine the effect on global motor function due to insufficient numbers of comparable studies.
SECONDARY OUTCOMES: results were statistically significant for activities of daily living (ADL) outcome (SMD 0.81, 95% CI 0.39 to 1.22 based on three studies with 101 participants); however, we were unable to pool results for cognitive function, participation restriction and quality of life or imaging studies. There were few adverse events reported across studies and those reported were relatively mild. Studies that reported on eligibility rates showed that only 34% (standard deviation (SD) 26, range 17 to 80) of participants screened were recruited.
AUTHORS’ CONCLUSIONS: We found limited evidence that the use of virtual reality and interactive video gaming may be beneficial in improving arm function and ADL function when compared with the same dose of conventional therapy. There was insufficient evidence to reach conclusions about the effect of virtual reality and interactive video gaming on grip strength or gait speed. It is unclear at present which characteristics of virtual reality are most important and it is unknown whether effects are sustained in the longer term. Furthermore, there are currently very few studies evaluating the use of commercial gaming consoles (such as the Nintendo Wii).
[WEB SITE] Stride frequency and length adjustments in post-stroke individuals: Influence on the margins of stability – Full HTML
OBJECTIVE: To investigate whether post-stroke participants can walk at different combinations of stride frequency and stride length and how these adaptations affect the backward and medio-lateral margins of stability.
SETTING: Computer Assisted Rehabilitation Environment (CAREN).
PARTICIPANTS: Ten post-stroke individuals.
INTERVENTION: Six trials of 2 min walking on a treadmill at different combinations of stride frequency and stride length. Treadmill speed was set at the corresponding speed, and subjects received visual feedback about the required and actual stride length.
OUTCOME MEASURES: Mean stride length and frequency and backward and medio-lateral margins of stability for each trial.
RESULTS AND CONCLUSION: Stroke patients were able to adjust step length when required, but had difficulty adjusting step frequency. When a stride frequency higher than self-selected stride frequency was imposed patients additionally needed to increase stride length in order to match the imposed treadmill speed. For trials at a high stride frequency, in particular, the increase in the backward and medio-lateral margins of stability was limited. In conclusion, training post-stroke individuals to increase stride frequency during walking might give them more opportunities to increase the margins of stability and consequently reduce fall risk.