4.Johnson, C.A., Burridge, J.H., Strike, P.W., Wood, D.E., Swain, I.D.: The effect of combined use of botulinum toxin type A and functional electric stimulation in the treatment of spastic drop foot after stroke: a preliminary investigation. Arch. Phys. Med. Rehabil. 85(June), 902–909 (2004)CrossRefGoogle Scholar
6.Luzio de Melo, P.: A novel functional electrical stimulation system and strategies for motor rehabilitation. Ph.D thesis, Universidade de Lisboa – Instituto Superior Técnico (2014)Google Scholar
8.Science, I., Hospital, M.N.: Learning control of hand posture with neural network in FES for hemiplegics, vol. 20, no. 5, pp. 2588–2589 (1998)Google Scholar
9.Imatz-ojanguren, E., Irigoyen, E., Valencia-blanco, D., Keller, T.: Electrical Stimulation in Able-bodied and Hemiplegic Subjects, vol. 0, pp. 1–9 (2016)Google Scholar
14.Azura, N., Bin, S., Kamaruddin, A., Mohamed, N., Mohamed, N.B.: The Quadriceps Muscle of Knee Joint Modelling Using Neural Network Approach: Part 1, pp. 52–57 (2016)Google Scholar
15.Yassin, I.M., Jailani, R., Syahirul, M., Megat, A., Baharom, R., Huzaifah, A.: Comparison Between Cascade Forward and Multi-Layer Perceptron Neural Networks for NARX Functional Electrical Stimulation (FES) -Based Muscle Model, vol. 7, no. 1, pp. 215–221 (2017)Google Scholar
16.Yilei, W., Qing, S., Xulei, Y., Li, L.: Recurrent Neural Network Control of Functional Electrical Stimulation Systems, pp. 400–404 (2006)Google Scholar
17.Ferrarin, M., D’Acquisto, E.: An experimental PID controller for knee movement restoration with closed loop FES system. In: Proceedings of 18th Annual International Conference of the IEEE Engineering in Medicine and Biology Society, pp. 453–454 (1996)Google Scholar
18.Qiu, S., He, F., Tang, J., Xu, J., Zhang, L., Zhao, X., Qi, H., Zhou, P., Cheng, X., Wan, B., Ming, D.: Intelligent algorithm tuning PID method of function electrical stimulation using knee joint angle. In: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society, Annual Conference, vol. 2014, pp. 2561–2564 (2014)Google Scholar
19.Basith, A.L., Arifin, A., Arrofiqi, F., Watanabe, T., Nuh, M.: Embedded fuzzy logic controller for functional electrical stimulation system. In: 2016 International Seminar on Intelligent Technology and Its Applications (ISITIA), pp. 89–94 (2016)Google Scholar
Posts Tagged gait
[Abstract] A Method for Self-Service Rehabilitation Training of Human Lower Limbs – IEEE Conference Publication
[Abstract] The influence of virtual reality on rehabilitation of upper limbs and gait after stroke: a systematic review – Full Text PDF
Stroke is the leading cause of functional disability in adults. Its neurovascular origin and injury location indicates the possible functional consequences. Virtual rehabilitation (VR) using patient’s motion control is a new technological tool for conventional rehabilitation, allowing patterns of movements in varied environments, involving the patient in therapy through the playful components offered by VR applications. The objective of this systematic review is to collect data regarding the influence promoted by VR in upper limb and hemiparetic gait. Full articles published between 2009 and 2015 in english were searched and selected in PubMed, Cochrane and Pedro databases. Eleven articles included (5 for VR and upper limbs; 4 for VR, gait and balance; and 2 for VR and neural mechanisms). The articles included demonstrate efficacy in VR treatment in hemiparetic patients in the variables analyzed.
[Abstract] Stepping training with external feedback relating to lower limb support ability effectively improved complex motor activity in ambulatory patients with stroke: a randomized controlled trial
[Abstract] Effect of functional electrical stimulation plus body weight-supported treadmill training for gait rehabilitation in patients with poststroke – a retrospective case-matched study.
Functional electrical stimulation (FES) plus body weight-supported treadmill training (BWSTT) provide effective gait training for poststroke patients with abnormal gait. These features promote a successful active motor relearning of ambulation in stroke survivors.
This is a retrospective study to assess the effect of FES plus BWSTT for gait rehabilitation in patients poststroke.
A retrospective case-matched study.
Participants were recruited from a rehabilitation department in an acute university-affiliated hospital.
Ninety patients poststroke from Yue Bei People’s Hospital underwent BWSTT (A: control group) were compared to an equal number of cross-matched patients who received FES plus BWSTT (B: FES plus BWSTT group).
While B group received FES for 45 minutes plus BSWTT for 30 minutes in the program, group A received time-matched BWSTT alone. The walking speed, step length, step cadence, Fugl-Meyer lower-limb scale (LL-FMA), composite spasticity scale (CSS), 10-Meter Walk Test (10MWT), Tinetti Balance Test (TBT) and nerve physiology testing were collected before and after intervention.
One hundred and eighty patients with poststroke abnormal gait were chosen. There were significant differences in walking speed, step length, step cadence, LL-FMA, CSS, TBT, and 10MWT between baseline and post-intervention (P<0.05). There were significant differences in walking speed, step length, step cadence, LL-FMA, CSS, TBT, and 10MWT between two groups at the end of the eighth week (P<0.05), but not at baseline (P>0.05). In comparison with group A, the peak of somatosensory evoked potential (SEP) and motor evoked potential (MEP) amplitude increased, the latency was shortened, and the conduction velocity of sensory nerve (SCV) and motor nerve (MCV) was significantly increased in the group B (P < 0.05). No adverse events occurred during the study.
This study suggests that FES plus BWSTT could be more effective than BWSTT alone in the improvement of gait, balance, spasticity, and function of the lower limb in patients poststroke.
CLINICAL REHABILITATION IMPACT:
Introduce effective rehabilitation strategies for poststroke patients with abnormal gait.
What are walking problems?
If you are like most people, you walk thousands of steps each day. You walk to do your daily activities, get around, and exercise. It’s something that you usually don’t think about. But for those people who have a problem with walking, daily life can be more difficult.
Walking problems may cause you to
- Walk with your head and neck bent over
- Drag, drop, or shuffle your feet
- Have irregular, jerky movements when walking
- Take smaller steps
- Walk more slowly or stiffly
What causes walking problems?
The pattern of how you walk is called your gait. Many different diseases and conditions can affect your gait and lead to problems with walking. They include
- Abnormal development of the muscles or bones of your legs or feet
- Arthritis of the hips, knees, ankles, or feet
- Cerebellar disorders, which are disorders of the area of the brain that controls coordination and balance
- Foot problems, including corns and calluses, sores, and warts
- Injuries, such as broken bones, sprains, and tendinitis
- Movement disorders, such as Parkinson’s disease
- Neurologic diseases, including multiple sclerosis and peripheral nerve disorders
- Vision problems
How is the cause of a walking problem diagnosed?
To make a diagnosis, your health care provider will ask about your medical history and do a physical exam. This will include checking your bones and muscles and doing a neurological exam. In some cases, you may have other tests, such as lab or imaging tests.
What are the treatments for walking problems?
Treatment of walking problems depends on the cause. Some common types of treatments include
- Mobility aids
- Physical therapy
Diagnosis and Tests
- Foot Problems (American Academy of Family Physicians)Also in Spanish
- Foot Push-Up Test (American College of Foot and Ankle Surgeons)
- That Pain in Your Back Could be Linked to Your Feet (American College of Foot and Ankle Surgeons)
Prevention and Risk Factors
- How to “Read” Your Footprint (American Orthopaedic Foot and Ankle Society)
- Cavus Foot (High-Arched Foot) (American College of Foot and Ankle Surgeons)Also in Spanish
- Chronic Ankle Instability (American College of Foot and Ankle Surgeons)Also in Spanish
- Equinus (American College of Foot and Ankle Surgeons)Also in Spanish
- Flexible Flatfoot (American College of Foot and Ankle Surgeons)Also in Spanish
- Foot Drop (National Institute of Neurological Disorders and Stroke)
- Gait or Walking Problems (National Multiple Sclerosis Society) – PDF
- Hallux Rigidus (American College of Foot and Ankle Surgeons)Also in Spanish
- Posterior Tibial Tendon Dysfunction (American Academy of Orthopaedic Surgeons)
- Tarsal Coalition (American College of Foot and Ankle Surgeons)Also in Spanish
- Walking (Gait), Balance, and Coordination Problems (National Multiple Sclerosis Society)
Journal ArticlesReferences and abstracts from MEDLINE/PubMed (National Library of Medicine)
Find an Expert
- Find a Physical Therapist (American Physical Therapy Association)
- National Institute of Arthritis and Musculoskeletal and Skin Diseases Also in Spanish
- Developmental Dislocation (Dysplasia) of the Hip (DDH) (American Academy of Orthopaedic Surgeons)
- Don’t Ignore Your Kid’s Heel Pain (American College of Foot and Ankle Surgeons)
- In-Toeing and Out-Toeing in Toddlers (Nemours Foundation)
- Intoeing (American Academy of Family Physicians)Also in Spanish
- Legg-Calvé-Perthes Disease (For Parents) (Nemours Foundation)
- Sever’s Disease (Nemours Foundation)Also in Spanish
- Toe Walking in Children (Mayo Foundation for Medical Education and Research)Also in Spanish
- Eldercare at Home: Mobility Problems (AGS Foundation for Health in Aging)
[Abstract] Advantages of virtual reality in the rehabilitation of balance and gait: Systematic review
Virtual reality (VR) has emerged as a therapeutic tool facilitating motor learning for balance and gait rehabilitation. The evidence, however, has not yet resulted in standardized guidelines. The aim of this study was to systematically review the application of VR-based rehabilitation of balance and gait in 6 neurologic cohorts, describing methodologic quality, intervention programs, and reported efficacy.
This study follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. VR-based treatments of Parkinson disease, multiple sclerosis, acute and chronic poststroke, traumatic brain injury, and cerebral palsy were researched in PubMed and Scopus, including earliest available records. Therapeutic validity (CONTENT scale) and risk of bias in randomized controlled trials (RCT) (Cochrane Collaboration tool) and non-RCT (Newcastle-Ottawa scale) were assessed.
Ninety-seven articles were included, 68 published in 2013 or later. VR improved balance and gait in all cohorts, especially when combined with conventional rehabilitation. Most studies presented poor methodologic quality, lacked a clear rationale for intervention programs, and did not utilize motor learning principles meticulously. RCTs with more robust methodologic designs were widely recommended.
Our results suggest that VR-based rehabilitation is developing rapidly, has the potential to improve balance and gait in neurologic patients, and brings additional benefits when combined with conventional rehabilitation. This systematic review provides detailed information for developing theory-driven protocols that may assist overcoming the observed lack of argued choices for intervention programs and motor learning implementation and serves as a reference for the design and planning of personalized VR-based treatments.
[Abstract + References] Functional Electrical Stimulation for Gait Rehabilitation – Conference paper
Conditions that can lead to a full or partial motor function loss, such as stroke or multiple sclerosis, leave people with disabilities that may interfere severely with lower body movements, such as gait. Drop Foot (DF) is a gait disorder that results in a reduced ability or total inability to contract the Tibialis Anterior (TA) muscle, causing an inability to raise the foot during gait. One of the most effective methods to correct DF is Functional Electrical Stimulation (FES). FES is a technique used to reproduce the activation patterns of functional muscles, in order to create muscular contractions through electrical stimulation of the muscle’s nervous tissue.
FES has first been introduced in 1961. However, the available commercial FES systems still do not take into account the fact that the gait differs from subject to subject, depending on their physical condition, muscular fatigue and rehabilitation stage. Therefore, they are unable to provide a personalized assistance to the user, delivering constant stimulation pulses that are only based on gait events. Consequently, they promote the early onset of fatigue and generate coarse movements. This dissertation aims to tackle the aforementioned issues by developing a FES system for personalized DF correction, tailored to each individual user’s needs through the use of a Neural Network (NN).
A Non-Linear Autoregressive Neural Network with Exogenous inputs (NARX Neural Network) was used to model the dynamics of the electrically stimulated TA muscle, in a novel approach that uses both the foot angle and the foot velocity. The model was combined with a Proportional Derivative controller to help compensate for any external disturbances. In order to create more natural movements, reference trajectories were obtained by recording the foot angle and velocity of healthy subjects walking at different speeds.
The system has been validated with a healthy subject walking at 3 different speeds on a treadmill: 1 km/h, 1.5 km/h and 2 km/h. It was able to track the desired trajectory for every speed, thus creating a more natural movement and effectively correcting DF gait.
[ARTICLE] Combining transcranial direct-current stimulation with gait training in patients with neurological disorders: a systematic review – Full Text
Transcranial direct-current stimulation (tDCS) is an easy-to-apply, cheap, and safe technique capable of affecting cortical brain activity. However, its effectiveness has not been proven for many clinical applications.
The aim of this systematic review was to determine whether the effect of different strategies for gait training in patients with neurological disorders can be enhanced by the combined application of tDCS compared to sham stimulation. Additionally, we attempted to record and analyze tDCS parameters to optimize its efficacy.
A search in Pubmed, PEDro, and Cochrane databases was performed to find randomized clinical trials that combined tDCS with gait training. A chronological filter from 2010 to 2018 was applied and only studies with variables that quantified the gait function were included.
A total of 274 studies were found, of which 25 met the inclusion criteria. Of them, 17 were rejected based on exclusion criteria. Finally, 8 trials were evaluated that included 91 subjects with stroke, 57 suffering from Parkinson’s disease, and 39 with spinal cord injury. Four of the eight assessed studies did not report improved outcomes for any of its variables compared to the placebo treatment.
There are no conclusive results that confirm that tDCS can enhance the effect of the different strategies for gait training. Further research for specific pathologies, with larger sample sizes and adequate follow-up periods, are required to optimize the existing protocols for applying tDCS.
Difficulty to walk is a key feature of neurological disorders , so much so that recovering and/or maintaining the patient’s walking ability has become one of the main aims of all neurorehabilitation programs . Additionally, the loss of this ability is one of the most significant factors negatively impacting on the social and professional reintegration of neurological patients .
Strategies for gait rehabilitation traditionally focus on improving the residual ability to walk and compensation strategies. Over the last years, a new therapeutic paradigm has been established based on promoting neuroplasticity and motor learning, which has led to the development of different therapies employing treadmills and partial body-weight support, as well as robotic-assisted gait training . Nevertheless, these new paradigms have not demonstrated superior results when compared to traditional therapies [5,6,7], and therefore recent studies advise combining therapies to enhance their therapeutic effect via greater activation of neuroplastic mechanisms .
Transcranial direct-current stimulation (tDCS) is an intervention for brain neuromodulation consisting of applying constant weak electric currents on the patient’s scalp in order to stimulate specific brain areas. The application of the anode (positive electrode) to the primary motor cortex causes an increase in neuron excitability whereas stimulation with the cathode (negative electrode) causes it to decrease .
The effectiveness of tDCS has been proven for treating certain pathologies such as depression, addictions, fibromyalgia, or chronic pain . Also, tDCS has shown to improve precision and motor learning  in healthy volunteers. Improvements in the functionality of upper limbs and fine motor skills of the hand with paresis have been observed in patients with stroke using tDCS, although the results were somewhat controversial [12, 13]. Similarly, a Cochrane review on the effectiveness of tDCS in treating Parkinson’s disease highlights the great potential of the technique to improve motor skills, but the significance level of the evidence was not enough to clearly recommend it . In terms of gait rehabilitation, current studies are scarce and controversial .
Furthermore, tDCS is useful not only as a therapy by itself but also in combination with other rehabilitation strategies to increase their therapeutic potential; in these cases, the subjects’ basal activity and the need for combining the stimulation with the behavior to be enhanced have been highlighted. Several studies have combined tDCS with different modalities of therapeutic exercising, such as aerobic exercise to increase the hypoalgesic effect in patients with fibromyalgia  or muscle strengthening to increase functionality in patients suffering from knee osteoarthritis . Along these lines, various studies have combined tDCS with gait training in patients with neurological disorders, obtaining rather disparate outcomes [17,18,19,20]. As a result, the main aim of this systematic review was to determine whether the application of tDCS can enhance the effectiveness of other treatment strategies for gait training. Additionally, as a secondary objective, we attempted to record and identify the optimal parameters of the applied current since they are key factors for its effectiveness. […]
Continue —> Combining transcranial direct-current stimulation with gait training in patients with neurological disorders: a systematic review | Journal of NeuroEngineering and Rehabilitation | Full Text
The study in brief
Foot drop can be treated using two types of device. Functional electrical stimulation (FES) uses small electrical charges to the muscles of the lower leg to force the foot into a more natural position for walking. An ankle-foot orthosis (AFO) is a device made of plastic or carbon fibre that holds the foot and ankle in a correct position to prevent the foot from dropping down during walking.
There’s been very little research comparing the two devices, so this study aimed to compare the effectiveness and relative costs of AFO and FES in people with MS.
Seventy nine people were recruited from seven centres in Scotland and randomly assigned to be fitted with an AFO or an FES. The impact of the device was measured at the start, 3, 6 and 12 months.
The relatively small number of participants and the high drop out rate (38%) made it difficult to draw firm conclusions from the study. Both groups walked faster when wearing their devices at 12 months, with neither of the devices showing a clear advantage over the other. There was no evidence that either device had a therapeutic effect, that is, improved unassisted walking performance. Overall, results suggested that AFO devices were less acceptable to people with MS; the researchers conclude that both the physical and psychological impact of a device needs to be taken into account as both these contribute to someone’s willingness to keep using a device.[…]
Continue —> Treatments for foot drop compared | MS Trust