Posts Tagged gait training

[NEWS] Walk This Way to Post-Stroke Recovery

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by Kate Drolet, PT, DPT, NCS, CLT-LANA, and Kristine Buchler, PT, DPT

In the heart of Chicago’s bustling Streeterville neighborhood lies Shirley Ryan AbilityLab, formerly the Rehabilitation Institute of Chicago. In March 2017, the organization opened a $550 million, 1.2-million-square-foot facility as a “translational” research hospital in which clinicians, scientists, innovators, and technologists work together in the same space, surrounding patients, discovering new approaches, and applying (or “translating”) research in real time.

Within the 27-floor rehabilitation hospital, this translational model plays out in the five ability labs—applied research and therapeutic spaces—each focused on specific functional outcomes. Together, therapists and researchers offer evidence-based interventions for a minimum of 3 hours each day. The goal: better, faster outcomes for patients.

For instance, the Legs + Walking Lab is a dynamic, two-story space designed for inpatients to focus specifically on gait training, stairs, balance and strengthening related to lower-body impairments due to brain injury, stroke, spinal cord injury, or diseases of the nerves, muscles, or bones.

While this list is not all-encompassing, one of the most prevalent diagnoses treated in the Legs + Walking Lab is stroke—and one of the most common therapies offered for post-stroke patients is gait training.

At the heart of Shirley Ryan AbilityLab’s efforts to lead patients toward an optimum outcome are more than 200 active clinical trials and research studies aimed at improving recovery post-stroke. Interdisciplinary teams consisting of physical therapists, occupational therapists, speech-language pathologists, doctors, nurses, researchers, psychologists, and social workers work together with patients to identify specific goals and then outline a treatment program aimed at maximizing functional independence.

Patients also are referred to therapists based within the various ability labs who specialize in areas such as gait training, vestibular therapy, task-specific upper extremity training, aphasia, dysphagia, cognition, and pain. These therapists work closely with the primary therapists to identify the proper dosage, intensity and duration of sessions needed to facilitate neural reorganization for their specific interventions.

 

 

Gait Training Out of the Gate

In the Shirley Ryan AbilityLab Legs + Walking Lab, gait therapists focus on promoting locomotor recovery for patients post-stroke. The primary physical therapists refer patients to gait therapy if walking goals are indicated, usually soon after completion of the initial evaluation.

Why is it so important to commence gait therapy soon after evaluation? Research indicates that earlier and more intensive rehabilitation post-stroke yields a quicker return to independent ambulation and improved functional mobility.1As a result, getting patients up and moving as quickly as possible is the expectation once vitals are stable. If gait training is indicated but is not yet safe due to unstable vitals or orthostatic hypotension, patients still often will be referred to gait therapists to assist with tolerance to upright training using the tilt table or stander before progressing to ambulation.

The literature has shown that repetition, intensity, and task-specificity are important principles of neuroplasticity to consider for gait recovery post-stroke.2 Gait therapists work with the primary physical therapists to promote large amounts of high-intensity, task-specific gait training with each patient to facilitate plasticity of both neuromuscular and cardiopulmonary systems. Walking practice is prioritized during most physical therapy sessions to achieve sufficient dosage and repetition.

Although conventional practice often involves spending time on multiple different interventions, research has indicated that high-intensity gait training also can translate to improvements in non-walking tasks such as balance and transfers, despite not focusing on those tasks.2-4

Using the Latest Specialized Equipment

At Shirley Ryan AbilityLab, therapists are fortunate to have a great deal of specialized equipment readily available to assist with implementing gait interventions with stroke survivors.

Therapists often are helping patients get up for the first time after their strokes. This may require a great deal of assistance. Because the safety of both patients and therapists is always a priority, the Legs + Walking Lab is outfitted with body-weight supported treadmills and overhead gait tracks for mobilizing lower-level patients.

Even for patients who may not require body weight support, harness systems are still used for safety and fall prevention when performing treadmill training or when challenging patients during higher-level balance activities overground. There is also a suspension system over the staircase in the Legs + Walking Lab, which provides a safe method for patients to relearn stair climbing.

In terms of modality of walking practice, the evidence is unclear as to whether treadmill or overground training is more effective in facilitating locomotor recovery. Therefore, therapists must consider how best to achieve the principles of neuroplasticity when choosing the modality for gait training. For lower-level patients who require more assistance, this generally means an increased, early focus on body weight-supported treadmill training early on to maximize repetition and intensity. Then, as patients progress, therapists can integrate overground gait training more frequently to promote increased task specificity. For patients who require less assistance, treatment sessions are generally more evenly divided between treadmill and overground gait training.

Although the Legs + Walking Lab has a robotic treadmill device, it is not commonly used during stroke rehabilitation. Evidence indicates that robotic-assisted gait training is less effective than therapist-assisted gait training in improving walking ability post-stroke.5,6 However, there are certain circumstances in which robotic-assisted gait training may be indicated to reduce the physical burden placed on therapists when gait training with stroke survivors who do not have much motor return and require a significant amount of assistance to advance both legs.

In addition, therapists have access to various exoskeletons for patients in the Legs + Walking Lab that are used in conjunction with treadmill and overground gait training due to limited research using exoskeletons in the post-stroke population.

The Shirley Ryan AbilityLab’s Legs + Walking Lab is designed for patients and research participants with diagnoses affecting lower-body function due to brain or spinal cord injury and diseases of the nerves, muscles, and bones. Researchers and clinicians focus on  advancing trunk, pelvic, and leg function, movement, and balance in this dynamic, applied research and therapeutic space.

The Shirley Ryan AbilityLab’s Legs + Walking Lab is designed for patients and research participants with diagnoses affecting lower-body function due to brain or spinal cord injury and diseases of the nerves, muscles, and bones. Researchers and clinicians focus on advancing trunk, pelvic, and leg function, movement, and balance in this dynamic, applied research and therapeutic space.

When to Challenge, When to Modify

When progressing gait interventions for patients post-stroke, the initial focus is on decreasing the amount of body weight support or level of assistance as able. Once patients begin to require less assistance and are able to perform stepping without assistance, therapists can begin to progress the challenge of the task. Evidence suggests that variability and error play an important role in motor learning and can contribute to improvements in locomotor function in stroke survivors.3,5-8 Therefore, these principles are crucial to integrate into gait interventions. This is done by allowing kinematic variability and providing variation to the task and environment, incorporating activities such as multi-directional stepping, obstacle negotiation, uneven surfaces, or changes in gait speed. Therapists can then adjust the level of challenge depending on patient response. If a patient does not make any errors, it generally means that the task is not challenging enough and should be progressed. Conversely, if a patient demonstrates several consecutive errors and is unable to correct without assistance, that generally indicates that the task is too challenging and should be modified.

Throughout the progression of gait training, the physical therapists monitor intensity and exercise tolerance based on heart rate and blood pressure response to activity, rating of perceived exertion (RPE), and verbal and nonverbal signs and symptoms if a patient has cognitive and/or communication deficits. It is also important to evaluate progress in order to guide clinical decision-making and determine whether the interventions are effective. This is done using various outcome measures, such as the Functional Independence Measure, 6 Minute Walk Test, 10 Meter Walk Test, Berg Balance Scale and Functional Gait Assessment, in addition to clinical judgment and observation. At times, primary physical therapists or lab therapists who specialize in gait training may need to decrease the frequency of gait training sessions if a patient is not responding well, if progress is limited, or if the goals of a patient’s stay shift to family education in preparation for discharge.

The Next Chapter: Therapy After Discharge

After patients discharge from the hospital, they will likely continue at a Shirley Ryan AbilityLab DayRehab or Shirley Ryan AbilityLab outpatient location. There, they will receive additional therapy, similar to the inpatient setting, while commuting to and from their homes. Therapists at DayRehab and outpatient locations continue to promote high-intensity gait training with an emphasis on home exercise programs, community reintegration, and return to work, when appropriate.

Some patients travel long distances for the intensive inpatient therapy program, so outpatient therapy at a local clinic or hospital may be the only option close to home after discharge. For these patients, inpatient therapists at the Shirley Ryan AbilityLab train families and personal caregivers to implement the principles of neuroplasticity and advocate for high-intensity gait training after discharge.

Regardless of a patient’s particular journey, the message for post-stroke recovery is clear: the more walking, the better. RM

Kate Drolet, PT, DPT, NCS, CLT-LANA, earned a bachelor’s degree in exercise physiology and a doctorate in physical therapy from Marquette University in Milwaukee. She is a Board Certified Clinical Specialist in Neurological Physical Therapy and a Certified Lymphedema Therapist through the Lymphology Association of North America. She practices at the Shirley Ryan AbilityLab (formerly Rehabilitation Institute of Chicago) and specializes in gait training for patients with neurologic conditions in the inpatient setting.

Kristine Buchler, PT, DPT, earned a bachelor’s degree in kinesiology at the University of Illinois at Urbana-Champaign and a doctor of physical therapy degree at Northwestern University. She currently practices as a physical therapist at the Shirley Ryan AbilityLab and specializes in gait training for patients with neurologic conditions in the inpatient setting. For more information, contact RehabEditor@medqor.com.

This article appears in the January/February 2019 print issue of Rehab Management with the title, “Walk This Way.”

References

1. Cumming TB, Thrift AG, Collier JM, et al. Very early mobilization after stroke fast-tracks return to walking. Stroke. 2011;42(1):153-158. https://doi.org/10.1161/strokeaha.110.594598

2. Hornby TG, Straube DS, Kinnaird CR, et al. Importance of specificity, amount, and intensity of locomotor training to improve ambulatory function in patients poststroke. Top Stroke Rehabil. 2011;18(4):293-307. https://doi.org/10.1310/tsr1804-293

3. Hornby TG, Holleran CL, Hennessy PW, et al. Variable intensive early walking poststroke (VIEWS). Neurorehabil Neural Repair. 2015;30(5):440-450. https://doi.org/10.1177/1545968315604396

4. Straube DD, Holleran CL, Kinnaird CR, Leddy AL, Hennessy PW, Hornby TG. Effects of dynamic stepping training on nonlocomotor tasks in individuals poststroke. Phys Ther. 2014;94(7):921-933. https://doi.org/10.2522/ptj.20130544

5. Hornby TG, Campbell DD, Kahn JH, Demott T, Moore JL, Roth HR. Enhanced gait-related improvements after therapist- versus robotic-assisted locomotor training in subjects with chronic stroke. Stroke. 2008;39(6):1786-1792. https://doi.org/10.1161/strokeaha.107.504779

6. Hidler J, Nichols D, Pelliccio M, et al. Multicenter randomized clinical trial evaluating the effectiveness of the Lokomat in subacute stroke. Neurorehabil Neural Repair. 2009;23(1):5-13. https://doi.org/10.1177/1545968308326632

7. Holleran CL, Straube DD, Kinnaird CR, Leddy AL, Hornby TG. Feasibility and potential efficacy of high-intensity stepping training in variable contexts in subacute and chronic stroke. Neurorehabil Neural Repair. 2014;28(7):643-651. https://doi.org/10.1177/1545968314521001

8. Reisman DS, McLean H, Keller J, Danks KA, Bastian AJ. Repeated split-belt treadmill training improves poststroke step length asymmetry. Neurorehabil Neural Repair. 2013;27(5):460-468. https://doi.org/10.1177/1545968312474118

 

via Walk This Way to Post-Stroke Recovery – Rehab Managment

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[ARTICLE] Randomized controlled trial of robot-assisted gait training with dorsiflexion assistance on chronic stroke patients wearing ankle-foot-orthosis – Full Text

Abstract

Background

Robot-assisted ankle-foot-orthosis (AFO) can provide immediate powered ankle assistance in post-stroke gait training. Our research team has developed a novel lightweight portable robot-assisted AFO which is capable of detecting walking intentions using sensor feedback of wearer’s gait pattern. This study aims to investigate the therapeutic effects of robot-assisted gait training with ankle dorsiflexion assistance.

Methods

This was a double-blinded randomized controlled trial. Nineteen chronic stroke patients with motor impairment at ankle participated in 20-session robot-assisted gait training for about five weeks, with 30-min over-ground walking and stair ambulation practices. Robot-assisted AFO either provided active powered ankle assistance during swing phase in Robotic Group (n = 9), or torque impedance at ankle joint as passive AFO in Sham Group (n = 10). Functional assessments were performed before and after the 20-session gait training with 3-month Follow-up. Primary outcome measure was gait independency assessed by Functional Ambulatory Category (FAC). Secondary outcome measures were clinical scores including Fugl-Meyer Assessment (FMA), Modified Ashworth Scale (MAS), Berg Balance Scale (BBS), Timed 10-Meter Walk Test (10MWT), Six-minute Walk Test (SMWT), supplemented by gait analysis. All outcome measures were performed in unassisted gait after patients had taken off the robot-assisted AFO. Repeated-measures analysis of covariance was conducted to test the group differences referenced to clinical scores before training.

Results

After 20-session robot-assisted gait training with ankle dorsiflexion assistance, the active ankle assistance in Robotic Group induced changes in gait pattern with improved gait independency (all patients FAC ≥ 5 post-training and 3-month follow-up), motor recovery, walking speed, and greater confidence in affected side loading response (vertical ground reaction force + 1.49 N/kg, peak braking force + 0.24 N/kg) with heel strike instead of flat foot touch-down at initial contact (foot tilting + 1.91°). Sham Group reported reduction in affected leg range of motion (ankle dorsiflexion − 2.36° and knee flexion − 8.48°) during swing.

Conclusions

Robot-assisted gait training with ankle dorsiflexion assistance could improve gait independency and help stroke patients developing confidence in weight acceptance, but future development of robot-assisted AFO should consider more lightweight and custom-fit design.

Background

Stroke is caused by intracranial haemorrhage or thrombosis, which cuts off arterial supply to brain tissue and usually damages the motor pathway of the central nervous system affecting one side of the body. About half of the stroke survivors cannot walk at stroke onset, but they have 60% chance to regain independent walking after rehabilitation [1]. Reduced descending neural drive to the paretic ankle joint causes muscle weakness and spasticity, often accompanied with drop foot which is characterized by the foot pointing downward and dragging on the ground during walking [23]. To maintain sufficient foot clearance in swing phase, people with dropped foot have to compensate either by hip hiking with exaggerated flexion in hip and knee joints, or circumduction gait with the body leaning on the unaffected side and the leg swinging outward through an arc away from the midline [456]. These inefficient asymmetric gait patterns hinder the walking ability and contribute to slower walking speed [78], increasing risk of falling [910], and greater energy expenditure [11]. Poor mobility results in sedentary lifestyle and limited physical exercise [12], which further deteriorates lower-limb functionality.

Foot drop can be managed using ankle-foot-orthosis (AFO), which is rigid or articulated ankle brace that controls ankle range of motion (ROM). Meta-analysis shows walking in conventional AFO has immediate or short-term beneficial effects on gait pattern and mobility of stroke patients, including an overall increase in ankle dorsiflexion throughout gait cycle, improvements in Functional Ambulatory Category (FAC), walking speed, and stairs-climbing speed [131415]. Recent development in robot-assisted AFO demonstrates power assistance at ankle joint can facilitate walking of patients presenting with foot drop, by actively assisting ankle dorsiflexion for foot clearance in swing phase and minimizing occurrence of foot slap at initial contact [161718]. Previous studies only evaluated the immediate effects of stroke patients walking in passive AFO [1415] or robot-assisted AFO [1920], but they were not sure whether any assistive effects could be carried over to unassisted gait after the patients had taken off the devices, i.e. the therapeutic effects.

Neuroscience studies suggest the brain is capable of altering its functions and structures for adapting to internal and external environment; an ability known as neuroplasticity [22122]. Researches show intensive repetitive skill training can enhance neuroplasticity and promote motor relearning of stroke patients [2324], which is achievable utilizing robot-assistance in clinical setting. The Anklebot that was developed in MIT can provide power assistance to stroke patients performing repetitive voluntary ankle sagittal movements in seated position, and a single-arm pilot study reports stroke patients (n = 8) had improved volitional ankle control and spatial-temporal gait parameters after 6-week 18-session training using the Anklebot [25]; 30-min seated skill training at ankle joint can induce plastic changes in cortical excitability in area controlling dorsiflexor [26]. Thus robot-assisted AFO with dorsiflexion assistance can potentially stimulate motor recovery of stroke patients with foot drop problem. Neuroscience studies further show the functional outcome of neuroplasticity is task-specific and dependent on the training nature [2212227]. It implies that in order to improve independent walking ability, stroke patients are expected to practise real over-ground walking instead of seated training. Incorporation of stair ambulation into gait training could facilitate generalization towards activity of daily-living, which requires stroke patients to perform skilled ankle dorsiflexion and plantarflexion when they are negotiating steps. Another characteristics of neuroplasticity is the importance of salient experiences for motor relearning from error correction [22122]. During gait training, powered ankle assistance from a robot-assisted AFO could serve as a source of salient proprioceptive feedback synchronized to gait pattern [28]. The robot can strengthen the experience-driven neuroplasticity by producing this proprioceptive feedback at each successfully triggered ankle power assistance [28]. In summary, researches on experience-driven neuroplasticity suggest stroke patients presenting with foot drop problem can potentially restore some level of independent walking ability through robot-assisted gait training with ankle dorsiflexion assistance on over-ground walking and stair ambulation.

To our knowledge, up to now no randomized controlled trial (RCT) has been carried out to validate the rehabilitation approach of robot-assisted AFO [2930]. The current study aims to evaluate whether gait training with robot-assisted AFO with dorsiflexion assistance can bring greater improvement in independent walking ability than training with passive AFO. In each session, stroke patients were trained in 20-min over-ground walking and 10-min stair ambulation. Assessments on the participating stroke patients focused on functional changes in unassisted gait after they had discontinued to wear the devices, i.e. the therapeutic effects. A meta-analysis study recommends FAC to be the primary outcome measure for clinical trials involving electromechanical gait training [30]. FAC is a reliable measurement of independent walking ability on level ground walking and stair ambulation, which is a good prediction of independent community walking post-stroke [31]. The demonstration of safety and effectiveness of the robot-assisted gait training can have positive impact on post-stroke rehabilitation and can potentially establish a new treatment method for stroke patients presenting with foot drop.[…]

 

Continue —>  Randomized controlled trial of robot-assisted gait training with dorsiflexion assistance on chronic stroke patients wearing ankle-foot-orthosis | Journal of NeuroEngineering and Rehabilitation | Full Text

Figure 1

Fig. 1a Robot-assisted AFO, and b Stroke patients walking on stairs wearing the robot-assisted AFO

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[Abstract] Improving real-world walking habits after stroke requires behavioural change techniques, not just exercise and gait training [synopsis]

Synopsis

Summary of: Stretton CM, Mudge S, Kayes NM, McPherson KM. Interventions to improve real-world walking after stroke: a systematic review and meta-analysis. Clin Rehabil. 2017;31:310-318.

Objective: To examine whether interventions that target walking in the real world are more effective than usual care or no intervention for improving actual walking behaviour in real-world settings in people with stroke.

Data sources: EBSCO Megafile, AMED, Scopus, Cochrane Database of Systemic Reviews, PEDro, OTseeker, and PsycBITE were searched from inception to November 2015. The database search was supplemented by hand searching.

Study selection: Randomised or quasi-randomised, controlled trials examining progressive task-oriented exercise interventions with or without behavioural change techniques. Studies had to have a usual care comparison group or a no-intervention/attention control group and measure the effects of the interventions on real-world walking (activity monitoring and/or self-report questionnaires).

Data extraction: Two reviewers extracted data. Methodological quality was assessed using the Cochrane Risk of Bias tool.

Data synthesis: Of the 4478 studies initially identified by the search, nine studies (10 treatment arms) with a total of 693 participants in the experimental group and 565 in the control group met the selection criteria and were included in the meta-analysis. Overall, the included studies were evaluated to have a low risk of bias. Based on the quantitative pooling of the available data from these trials, at post-intervention assessment there was a statistically significant difference in real-world walking in favour of the intervention group, by a standardised mean difference (SMD) of 0.29 (95% CI 0.17 to 0.41). Quantitative pooling of five studies with 3 to 6 month follow-up data found a SMD of 0.32 (95% CI 0.16 to 0.48) in favour of the intervention group. Pre-planned subgroup analysis found that interventions that incorporated at least one behaviour change technique were effective (SMD 0.27, 95% CI 0.12 to 0.43) whereas those without any behaviour change strategies were not effective (SMD –0.19, 95% CI –0.11 to 0.49).

Conclusion: Task-oriented exercise interventions alone appeared to be insufficient for improving real-world walking habits in people with stroke. Exercise and gait-oriented interventions that employed behaviour change techniques were more likely to be effective in changing real-world walking behaviour, but the estimated treatment effect was small.

Provenance: Invited. Not peer reviewed.

Source: Improving real-world walking habits after stroke requires behavioural change techniques, not just exercise and gait training [synopsis] – Journal of Physiotherapy

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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] The Efficacy of State of the Art Overground Gait Rehabilitation Robotics: A Bird’s Eye View – Full Text

Abstract

To date, rehabilitation robotics has come a long way effectively aiding the rehabilitation process of the patients suffering from paraplegia or hemiplegia due to spinal cord injury (SCI) or stroke respectively, through partial or even full functional recovery of the affected limb. The increased therapeutic outcome primarily results from a combination of increased patient independence and as well as reduced physical burden on the therapist. Especially for the case of gait rehabilitation following SCI or stroke, the rehab robots have the potential to significantly increase the independence of the patient during the rehabilitation process without the patient’s safety being compromised. An intensive gait-oriented rehabilitation therapy is often effective irrespective of the type of rehabilitation paradigm. However, eventually overground gait training, in comparison with body-weight supported treadmill training (BWSTT), has the potential of higher therapeutic outcome due its associated biomechanics being very close to that of the natural gait. Recognizing the apparent superiority of the overground gait training paradigms, a through literature survey on all the major overground robotic gait rehabilitation approaches was carried out and is presented in this paper. The survey includes an in-depth comparative study amongst these robotic approaches in terms of gait rehabilitation efficacy.

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Source: The Efficacy of State of the Art Overground Gait Rehabilitation Robotics: A Bird’s Eye View

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[ARTICLE] Sustained effects of once-a-week gait training with hybrid assistive limb for rehabilitation in chronic stroke: case study

Abstract.

[Purpose] The purpose of this study was to investigate the accumulated and sustained effects of oncea-week gait training with a powered exoskeleton suit, Hybrid Assistive Limb, in a subject with chronic stroke.

[Subject and Methods] The subject was a woman in her early sixties who had stroke onset approximately 5 years ago. A single-case ABA design was used. A 2-month baseline period was followed by an 8-week period of weekly gait training and a subsequent 2-month follow-up period. Throughout the study period, she underwent conventional physiotherapy. Outcome measures were the 10-meter walking test, timed up and go test, functional reach test, twostep test, and Berg Balance Scale.

[Results] Significant improvements were seen in all outcome measures during the gait training period. Improvements in all outcome measures except walking speed were maintained at follow-up.

[Conclusion] Continued gait training with Hybrid Assistive Limb once a week can improve gait and balance performance in patients with chronic stroke, and these improvements are maintained at least for two months.

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[ARTICLE] Rehabilitation interventions to improve locomotor outcome in chronic stroke survivors: A prospective, repeated-measure study – Full Text HTML

Abstract

Objective: To ascertain whether rehabilitation interventions improve locomotion beyond 6 months post stroke.

Site: The Neurological Rehabilitation Department of a university tertiary research hospital.

Study Design: Prospective, repeated-measure study.

Patients: Patients with first episode of supra-tentorial stroke of more than 6 months duration.

Intervention: Twenty sessions of task-specific interventions consisting of lower limb resistive exercises and treadmill gait training to locomotor abilities (90 min/day, 5 days/week for 4 weeks). Evaluations were performed at the beginning and end of training and at a follow-up of 3 months.

Outcome Measures: Stroke severity (Scandinavian Stroke Scale – SSS), balance (Berg Balance scale – BBS), ambulation (Functional Ambulation Category), walking ability (speed 10-m walk test – WS) and functional ability (Barthel Index – BI).

Results: Forty patients (32 men and eight women; age range: 22-65 years; mean post-stroke duration of 18.90 ± 12.76 months) were included in the study. Thirty-two (80.0%) patients completed their training and 28 (70.0%) patients reported at a follow up of 3-months. At the beginning, the end of training and at follow-up, the mean SSS scores were 41.71, 44.09, and 43.96; the BBS scores were 36.28, 46.75 and 46.82; the WS scores were 0.41, 0.53 and 0.51; and the BI scores were 77.34, 89.06 and 92.32, respectively. All outcome measures showed statistically significant improvement (P < 0.001) at the end of training and at follow-up.

Conclusion: Rehabilitation interventions significantly improve locomotor outcome even in the chronic phase following a stroke.

Full Text HTML —>  Rehabilitation interventions to improve locomotor outcome in chronic stroke survivors: A prospective, repeated-measure study Srivastava A, Taly AB, Gupta A, Murali T Neurol India.

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[ARTICLE] Effect of gait training with constrained-induced movement therapy (CIMT) on the balance of stroke patients – Full Text PDF

Abstract

[Purpose] The purpose of the present study was to examine the effect of intensive gait training using a constrained induced movement therapy (CIMT) technique applied to the non-paretic upper extremity on the balance ability of stroke patients.

[Subjects and Methods] Twenty stroke patients were randomly assigned to an experimental group or a control group. The experimental group received gait training with CIMT for 30 minutes per session, three sessions per week for four weeks, and the control group received gait training alone.

[Results] The experimental group showed improvements in dynamic balance and the degree of improvement in this group was greater than that observed in the control group. Furthermore, the experimental group showed improvements in movement distances to the paretic side. On the other hand, the control group showed no significant improvements in balance indices after the intervention.

[Conclusion] Gait training of stroke patients using CIMT techniques should be regarded as a treatment that can improve the balance of stroke patients.

via Effect of gait training with constrained-induced movement therapy (CIMT) on the balance of stroke patients.

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[ARTICLE] Mechanical stimulation of the foot sole in a supine position for ground reaction force simulation – Full Text HTML

Abstract (provisional)

Background: To promote early rehabilitation of walking, gait training can start even when patients are on bed rest. Supine stepping in the early phase after injury is proposed to maximise the beneficial effects of gait restoration. In this training paradigm, mechanical loading on the sole of the foot is required to mimic the ground reaction forces that occur during overground walking. A pneumatic shoe platform was developed to produce adjustable forces on the heel and the forefoot with an adaptable timing. This study aimed to investigate the stimulation parameters of the shoe platform to generate walking-like loading on the foot sole, while avoiding strong reflexes.

Methods: This study evaluated this platform in ten able-bodied subjects in a supine position. The platform firstly produced single-pulse stimulation on the heel or on the forefoot to determine suitable stimulation parameters, then it produced cyclic stimulation on the heel and the forefoot to simulate the ground reaction forces that occur at different walking speeds. The ankle angle and electromyography (EMG) in the tibialis anterior (TA) and soleus (SOL) muscles were recorded. User feedback was collected.

Results: When the forefoot or/and the heel were stimulated, reflexes were observed in the lower leg muscles, and the amplitude increased with force. Single-pulse stimulation showed that a fast-rising force significantly increased the reflex amplitudes, with the possibility of inducing ankle perturbation. Therefore a slow-rising force pattern was adopted during cyclic stimulation for walking. The supine subjects perceived loading sensation on the foot sole which was felt to be similar to the ground reaction forces during upright walking. The EMG generally increased with force amplitude, but no reflex-induced ankle perturbations were observed. The mean change in the ankle joint induced by the stimulation was about 1[degree sign].

Conclusions: The rate of force increase should be carefully adjusted for simulation of walking-like loading on the foot sole. It is concluded that the dynamic shoe platform provides adjustable mechanical stimulation on the heel and the forefoot in a supine position and has technical potential for simulation of ground reaction forces that occur during walking.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

via JNER | Abstract | Mechanical stimulation of the foot sole in a supine position for ground reaction force simulation.

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