Posts Tagged gait

[WEB SITE] Bioness Begins Shipping L300 Go Systems for Foot Drop 

Published on August 30, 2017

Bioness announces it has begun shipping the L300 Go Systems, cleared by the FDA in early 2017 and available in four configurations for use in patients with foot drop and/or muscle weakness related to upper motor neuron disease/injury.

The L300 Go System succeeds the NESS L300 Foot Drop System and NESS L300 Plus System, and includes numerous advancements designed to optimize therapy sessions and promote functional gains at home.

Among these is comprehensive 3D motion detection of gait events, via a learning algorithm that analyzes patient movement and offers electrical stimulation precisely when needed during the gait cycle.

Additional features, according to a media release from Valencia, Calif-based Bioness, include adaptive motion detection and onboard controls that eliminate dependence on foot sensors or remote controls; multi-channel stimulation, which enables clinicians to adjust dorsiflexion and inversion/eversion with a novel new electrode options; and myBioness, a new mobile iOS application designed to empower home users to extend rehabilitative gains through setting goals and tracking recovery progress.

“Today’s value-based healthcare model demands that rehabilitative professionals keep patients motivated through superior, more personalized care,” says Todd Cushman, president and CEO of Bioness, in the release. “With the introduction of the L300 Go, clinicians now have access to technological innovations that keep patients engaged during the recovery process while improving mobility in the clinic and community.”

Current users of the L300 Foot Drop System and the L300 Plus System will be eligible for a Customer Loyalty Upgrade Program, which is designed to make the L300 Go more accessible for users in the clinic and community.

[Source(s): Bioness, PR Newswire]

Source: Bioness Begins Shipping L300 Go Systems for Foot Drop – Rehab Managment


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[ARTICLE] Feasibility and Effectiveness of Virtual Reality Training on Balance and Gait Recovery Early after Stroke: A Pilot Study – Full Text


Objective: To investigate the feasibility and effectiveness of virtual reality training for improving balance and/or gait during inpatient rehabilitation of patients within 12 weeks after stroke.

Methods: Sixteen patients within 12 weeks after stroke and dependent gait as categorised with a Functional Ambulation Category score of 2 or 3 were included in this longitudinal pilot study. Participants received eight 30-min sessions of virtual reality training during four weeks as part of the regular inpatient rehabilitation program. Feasibility was assessed using compliance with the training, adverse events, experiences of the participants and the physiotherapists; and effectiveness with the Berg Balance Scale, centre of pressure velocity, Functional Ambulation Category and 10-meter walking test.

Results: Participants positively evaluated the intervention and enjoyed the training sessions. Also, physiotherapists observed the training as feasible and beneficial for improving balance or gait. Compliance with the training was 88% and no serious adverse events occurred. The Berg Balance Scale, anterior-posterior centre of pressure velocity, Functional Ambulation Category and 10-meter walking test showed significant improvement after four weeks of training (p<0.05).

Conclusion: This study demonstrates that virtual reality training in patients early after stroke is feasible and may be effective in improving balance and/or gait ability.


Balance and gait recovery are considered as key aspects in stroke rehabilitation [13]. To date, physiotherapy and occupational therapy focus on high intensity, repetitive and task-specific practice, which are important principles of motor learning, to elicit improvements in the early rehabilitation phase [1,4,5]. In addition to high intensity, repetitive and task-specific training, variability in practice is important for motor learning. Also, cognitive involvement, functional relevance and the presence of feedback enhance learning [5]. In current physiotherapy or occupational therapy it is difficult to meet all of these above-mentioned training characteristics as therapy may be tedious and resource-intensive [69]. In addition, the frequency and intensity of current therapies have been indicated as insufficient to achieve maximum recovery in the early phase of rehabilitation [8,10]. There is need for engaging, motivating and varied therapy that achieves maximal recovery [11].

In recent years, virtual reality (VR) is introduced in the field of balance and gait rehabilitation after stroke [12]. Since VR training is characterised by individualised, high intensity training in a variety of virtual environments with a high amount of real-time feedback [1315] it might be valuable in stroke rehabilitation. This is confirmed by recent studies [12,1518]. However, almost all studies on the effect of VR on balance and/or gait ability were conducted in the chronic phase after brain injury [9,12,16,17,1923]. Because of the potential relevant characteristics of VR for motor learning and neuroplasticity [14], VR may be of even more added value during the earlier rehabilitation phase. Three studies [2426] that investigated the effect of VR in this time period after stroke indicated a positive effect of commercially available VR systems (Nintendo Wii Fit or IREX) on balance and/or gait recovery. However, the results of these studies cannot be generalised to the whole population of patients with stroke because included participants had a relatively high functional level regarding balance and gait at the start of the VR intervention. A lack of studies including patients with lower functional status after stroke might be caused by the idea that the feasibility of using advanced VR technology may be restricted because of visual, cognitive and/or endurance impairments. These impairments are more often present in the more impaired patients early after stroke [2729]. Because of the expected promising effects of VR training for the recovery of balance and gait in patients with low functional level early after stroke, it is important to investigate the feasibility of this innovative form of training and to determine whether the above-mentioned impairments interfere with the use of VR training early after stroke.

Therefore, the aim of the present study was to investigate the feasibility and effectiveness of VR training for improving balance and/or gait during the inpatient rehabilitation of patients with stroke. The specific research questions were:

• What is the feasibility, from the perspective of patients and physiotherapists, of VR training aimed to improve balance and gait ability?

• What is the effectiveness of VR training, embedded within an inpatient rehabilitation program, on balance and gait ability in people with impaired balance and dependent gait within 12 weeks after stroke?


Study design

This longitudinal pilot study involved two assessments, one before and one after a four-week VR training intervention, performed within the inpatient rehabilitation program of patients with stroke at (Revant Rehabilitation Centres, Breda, the Netherlands).


Patients with stroke who were following an inpatient rehabilitation program with a treatment goal to improve balance and/or gait. They received balance and/or gait training with VR as part of their regular rehabilitation program. Besides the VR training, the regular rehabilitation program could include therapy given by a physiotherapist, occupational therapist, speech therapist, psychomotor therapist, psychologist and social worker, depending on the goals of the patient with stroke. Inclusion criteria consisted of hemiplegia resulting from a stroke, a time since stroke of less than 12 weeks, a Berg Balance Scale (BBS) score of at least 20, i.e. the minimum level of balance deemed safe for balance interventions [30], and a Functional Ambulation Category (FAC) score of 2 or 3 out of 5 [31]. Exclusion criteria were patients with stroke with terminal diseases, lower-limb impairments not related to stroke, severe cognitive impairments, severe types of expressive or receptive aphasia, visual impairments, age over 80 years and experiencing epileptic seizures. All participants provided written consent to use data obtained during the rehabilitation program for research, and anonymity was assured. The study procedures follow the principles of the Declaration of Helsinki.

VR training intervention

The intervention consisted of balance and gait training using the recently developed treadmill based Gait Real-time Analysis Interactive Lab (GRAIL, Motekforce Link, Amsterdam, The Netherlands). The GRAIL comprises a dual-belt treadmill with force platform, a motion-capture system (Vicon, Oxford, UK) and speed-matched virtual environments projected on a 180° semi-cylindrical screen (Figure 1) [32].


Continue —> Feasibility and Effectiveness of Virtual Reality Training on Balance and Gait Recovery Early after Stroke: A Pilot Study | Open Access Journals

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[WEB SITE] Bioness Announces Commercial Availability of the L300 Go™ System to Healthcare Professionals

Source: Bioness Announces Commercial Availability of the L300 Go™ System to Healthcare Professionals

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[ARTICLE] Effects of inclined treadmill walking training with rhythmic auditory stimulation on balance and gait in stroke patients – Full Text PDF


[Purpose] The purpose of this study was to determine if an inclined treadmill with rhythmic auditory stimulation gait training can improve balance and gait ability in stroke patients.

[Subjects and Methods] Thirty participants were randomly divided into three groups: inclined treadmill with rhythmic auditory stimulation training group (n=10), inclined treadmill training group (n=10), and treadmill training group (n=10). For all groups, the training was conducted for 4 weeks, 30 minutes per session, 5 times per week. Two subjects dropped out before study completion.

[Results] All variables of balance and gait, except for the timed up and go test in the treadmill group, significantly improved in all groups. Moreover, all variables showed a more significant improvement in the inclined treadmill with rhythmic auditory stimulation group when compared with the other groups. Timed up and go test, Berg balance scale, 6 m walking test, walking speed, and symmetric index were significantly improved in the inclined treadmill group when compared with the treadmill group.

[Conclusion] Thus, for stroke patients receiving gait training, inclined treadmill with rhythmic auditory stimulation training was more effective in maintaining balance and gait than inclined treadmill without rhythmic auditory stimulation or only treadmill training.

Patients with stroke show various muscle abnormalities, including a combination of denervation, disuse, remodeling, and spasticity1). These reduce their balance ability and lead to gait disorders2). Abnormal gaits cause flexion and extension synergy patterns due to compensatory actions of muscles, etc., on the unaffected side, impairment of proprioceptive sensibility, and abnormal coordination of stiffened muscles of the lower limb3). As a substitute of stair climbing exercise, inclined treadmill walking training, which is aimed at improving these gait disorders, is being considered as an essential means for indoor and outdoor movements of the disabled, the elderly, or pregnant women who are unable to use stairs4). However, Rhea et al.5) stated that treadmill walking training, compared with walking on flat ground, is characterized by a shorter step length. Oh, Kim, and Woo6) argued that treadmill walking training has negative effects on gait asymmetry. Sensory elements play an important part in compensating for these weaknesses7), and rhythmic auditory stimulation (RAS) can be used as a complementing intervention8). In this intervention, the external auditory sense of rhythms generates rhythmic and more symmetrical alternate movements in the lower limbs of stroke patients who show gait asymmetry6, 9). Existing studies have not shown consistent results regarding the effects of treadmill walking training on the gait of stroke patients. In particular, with regard to balance and gait, which are essential for the activity and participation of stroke patients, there are no systematic studies showing the effects of inclined treadmill walking training with RAS thus far.[…]

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[Abstract+References] Interventions to improve real-world walking after stroke: a systematic review and meta-analysis

This study aimed to determine the effectiveness of current interventions to improve real-world walking for people with stroke and specifically whether benefits are sustained.

EBSCO Megafile, AMED, Cochrane, Scopus, PEDRO, OTSeeker and Psychbite databases were searched to identify relevant studies.

Proximity searching with keywords such as ambulat*, walk*, gait, mobility*, activit* was used. Randomized controlled trials that used measures of real-world walking were included. Two reviewers independently assessed methodological quality using the Cochrane Risk of Bias Tool and extracted the data.

Nine studies fitting the inclusion criteria were identified, most of high quality. A positive effect overall was found indicating a small effect of interventions on real-world walking (SMD 0.29 (0.17, 0.41)). Five studies provided follow-up data at >3–6 months, which demonstrated sustained benefits (SMD 0.32 (0.16, 0.48)). Subgroup analysis revealed studies using exercise alone were not effective (SMD 0.19 (–0.11, 0.49)), but those incorporating behavioural change techniques (SMD 0.27 (0.12, 0.41)) were.

A small but significant effect was found for current interventions and benefits can be sustained. Interventions that include behaviour change techniques appear more effective at improving real-world walking habits than exercise alone.

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Source: Interventions to improve real-world walking after stroke: a systematic review and meta-analysisClinical Rehabilitation – Caroline M Stretton, Suzie Mudge, Nicola M Kayes, Kathryn M McPherson, 2017

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[Abstract] Effect of reciprocal pedaling exercise on cortical reorganization and gait in stroke patients



Functional impairment of the lower limb is a major complication in stroke patients. The involvement of the cortex in pedaling has critical clinical implications to control of cyclical motor functions in patients with damaged cortical structures or cortical pathways.The study aimed at determining the effect of reciprocal pedaling exercise (RPE) on the gait and cortical reorganization in the stroke patients.


Forty patients suffering from stroke with hemiparesis will be included in this study. They were divided to Group I treated by training for lower limb muscles of the affected side. While Group II were treated by the same program as group I in addition to RPE. Quantitative EEG (QEEG) was carried for all patients before and after the treatment programs. The midline frontal, central and parietal regions (Fz, Cz and Pz) were studied for evidence of plasticity induced by RPE.


Neuroplasticity was noticed among patients of group II in the midline frontal region (Fz) and to a lesser extent the midline central region (Cz).


The rhythmic and reciprocal nature of cycling motion permits patients to generate timely symmetrical and reciprocal powers from both limbs required for locomotion.


Leg cycling exercise, and thus RPE, is a rehabilitation program that improves the function of ambulation in stroke patients.


Post stroke physical therapy can utilize RPE for better rehabilitation.

Source: S186 Effect of reciprocal pedaling exercise on cortical reorganization and gait in stroke patients – Clinical Neurophysiology

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[Abstract] Towards an ankle neuroprosthesis for hybrid robotics: Concepts and current sources for functional electrical stimulation


Hybrid rehabilitation robotics combine neuro-prosthetic devices (close-loop functional electrical stimulation systems) and traditional robotic structures and actuators to explore better therapies and promote a more efficient motor function recovery or compensation. Although hybrid robotics and ankle neuroprostheses (NPs) have been widely developed over the last years, there are just few studies on the use of NPs to electrically control both ankle flexion and extension to promote ankle recovery and improved gait patterns in paretic limbs. The aim of this work is to develop an ankle NP specifically designed to work in the field of hybrid robotics. This article presents early steps towards this goal and makes a brief review about motor NPs and Functional Electrical Stimulation (FES) principles and most common devices used to aid the ankle functioning during the gait cycle. It also shows a current sources analysis done in this framework, in order to choose the best one for this intended application.

Source: Towards an ankle neuroprosthesis for hybrid robotics: Concepts and current sources for functional electrical stimulation – IEEE Xplore Document

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[VIDEO] WalkAide® Demonstration – YouTube

Published on Mar 29, 2012

WalkAide® patient Connie Fowble demonstrates how the Walkaide® benefits her daily life. She shows the previous orthotic device that she used prior to being fit with the Walkaide®. For more information call 877-4HANGER or visit

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[WHITE PAPER] Virtual and augmented reality based balance and gait training – Full Text PDF

The use of virtual and augmented reality for rehabilitation has become increasingly popular and has received much attention in scientific publications (over 1,000 papers). This white paper aims to summarize the scientific background and efficacy of using virtual and augmented reality for balance and gait training. For many patients with movement disorders, balance and gait training is an important aspect of their rehabilitation process and physical therapy treatment. Indications for such training include, among others, stroke, Parkinson’s disease, multiple sclerosis, cerebral palsy, vestibular disorders, neuromuscular diseases, low back pain, and various orthopedic complaints, such as total hip or knee replacement. Current clinical practice for balance training include exercises, such as standing on one leg, wobble board exercises and standing with eyes closed. Gait is often trained with a treadmill or using an obstacle course. Cognitive elements can be added by asking the patient to simultaneously perform a cognitive task, such as counting down by sevens. Although conventional physical therapy has proven to be effective in improving balance and gait,1,2 there are certain limitations that may compromise treatment effects. Motor learning research has revealed some important concepts to optimize rehabilitation: an external focus of attention, implicit learning, variable practice, training intensity, task specificity, and feedback on performance.3 Complying with these motor learning principles using conventional methods is quite challenging. For example, there are only a limited number of exercises, making it difficult to tailor training intensity and provide sufficient variation. Moreover, performance measures are not available and thus the patient usually receives little or no feedback. Also, increasing task specificity by simulating everyday tasks, such as walking on a crowded street, can be difficult and time consuming. Virtual and augmented reality could provide the tools needed to overcome these challenges in conventional therapy. The difference between virtual and augmented reality is that virtual reality offers a virtual world that is separate from the real world, while augmented reality offers virtual elements as an overlay to the real world (for example virtual stepping stones projected on the floor). In the first part of this paper we will explain the different motor learning principles, and how virtual and augmented reality based exercise could help to incorporate these principles into clinical practice. In the second part we will summarize the scientific evidence regarding the efficacy of virtual reality based balance and gait training for clinical rehabilitation.

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[WEB SITE] Research report explores the foot drop implants market

Foot drop can be defined as an abnormality in the gait where the forefoot drops due to factors such as weakness of the ankle and toe dorsiflexion. The abnormality is also caused by paralysis of the muscles in the anterior portion of the lower leg or damage to the fibular nerve.

Foot drop can be associated with various conditions, including peripheral nerve injuries, neuropathies, drug toxicities, dorsiflexor injuries, and diabetes. Anatomic, muscular, and neurologic are the three categories of foot drop.

Functional electrical stimulation technology is employed in the foot drop implant to improve the gait of patients and avoid foot drop or tripping while walking. Functional electric stimulators (FES) can either be implanted within the patient’s body or employed externally.External FES is tested on the patient prior to its implantation. Implant FES involves a surgery in which the electrodes are directly placed on the nerves of the patient, which are controlled by the implant placed under the skin.

The FES device activates the implant through a wireless antenna that is worn outside the body. Sensors are also associated with FES which trigger events in the walking pattern such as lifting of the heel, thereby stimulating the nerves.

Obtain Report Details at

The advantages of implant FES include reduction in sensation that is associated with external stimulation. In addition, it eliminates the need to adjust the electrodes on the skin on a daily basis.

Rise in number of foot drop disorders due to nerve injuries, growth in knee and hip replacement therapies that lead to foot drop disorders, and increase in the number of sports related injuries contribute to the growth of the foot drop implants market. Foot drop disorders are commonly observed in diabetic retinopathy patients and this prevalence is growing due to increase in incidence of diabetes, which is propelling the growth of the market.

Furthermore, the market players are focus on research and development to increase the number of foot drop implant products available in the market, driving the market growth. However, lack of reimbursement, high cost of the implants, and low awareness among the people are likely to hinder the growth of the foot drop implants market in the near future.

The global foot drop implants market can be segmented on the basis of product, end-user, and region. On the basis of product, the market is categorized into functional electrical stimulators and internal fixation devices.

The internal fixation devices segment is anticipated to record a significant growth during the forecast period owing to increasing demand for the devices and advantages offered by these devices such as elimination of the need to stimulate the electrodes daily. Based on end-user, the market can be segmented into hospitals, orthopedic centers, and palliative care centers, among others.

The orthopedic centers segment is anticipated to record a high growth during the forecast period due to the increasing number of foot drop cases due to injuries.

Geographically, the foot drop implants market is distributed over North America, Latin America, Europe, Asia Pacific, and Middle East & Africa. North America dominated the market in 2016 and is anticipated to continue its dominance during the forecast period.

The significant growth of the market in the region can be attributed to the strong focus on research and development, increase in health care spending, and growth in awareness about the abnormality. The sluggish economy might have a negative impact on the market growth of Europe.

Asia Pacific is anticipated to record a high CAGR during the forecast period, primarily driven by India and China. The rising disposable income is anticipated to contribute to the growth of the Asia Pacific market.

In addition, a factor contributing to the market growth is rise in prevalence of diabetes that leads to diabetic retinopathy, which is one of the primary causes of foot drop.

Key players operating in the foot drop implants market include Finetech Medical, Arthrex, Inc., Zimmer Biomet, Bioness Inc., Stryker Corporation, Wright Medical Group N.V., Ottobock, Narang Medical Limited, PONTiS Orthopaedics, LLC, and Shanghai MicroPort Orthopedics.

The report offers a comprehensive evaluation of the market. It does so via in-depth qualitative insights, historical data, and verifiable projections about market size.

The projections featured in the report have been derived using proven research methodologies and assumptions. By doing so, the research report serves as a repository of analysis and information for every facet of the market, including but not limited to: Regional markets, technology, types, and applications.


Source: Research report explores the foot drop implants market – WhaTech

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