Posts Tagged walking ability

[Abstract] Ergometer training in stroke rehabilitation: systematic review and meta-analysis

Abstract

Objective

Ergometer training is routinely used in stroke rehabilitation. How robust is the evidence of its effects?

Data source

The PubMed database and PEDro database were reviewed prior to 22/01/2019.

Study selection

Randomized controlled trials investigating the effects of ergometer training on stroke recovery were selected.

Data extraction

Two reviewers independently selected the studies, performed independent data extraction, and assessed the risk of bias.

Data synthesis

A total of 28 studies (including 1115 stroke subjects) were included. The data indicates that

(1) ergometer training leads to a significant improvement of walking ability, cardiorespiratory fitness, motor function and muscular force of lower limbs, balance and postural control, spasticity, cognitive abilities, as well as the brain’s resistance to damage and degeneration,

(2) neuromuscular functional electrical stimulation assisted ergometer training is more efficient than ergometer training alone,

(3) high-intensity ergometer training is more efficient that low-intensity ergometer training, and

(4) ergometer training is more efficient than other therapies in supporting cardiorespiratory fitness, independence in activities of daily living, and balance and postural control, but less efficient in improving walking ability.

Conclusion

Ergometer training can support motor recovery after stroke. However, current data is insufficient for evidence-based rehabilitation. More data is required about the effects of ergometer training on cognitive abilities, emotional status, and quality of life in stroke subjects.

via Ergometer training in stroke rehabilitation: systematic review and meta-analysis – Archives of Physical Medicine and Rehabilitation

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[Abstract] Action observation therapy for improving arm function, walking ability, and daily activity performance after stroke: a systematic review and meta-analysis

This study was to investigate the effectiveness of action observation therapy on arm and hand motor function, walking ability, gait performance, and activities of daily living in stroke patients.

Systematic review and meta-analysis of randomized controlled trials.

Searches were completed in January 2019 from electronic databases, including PubMed, Scopus, the Cochrane Library, and OTseeker.

Two independent reviewers performed data extraction and evaluated the study quality by the PEDro scale. The pooled effect sizes on different aspects of outcome measures were calculated. Subgroup analyses were performed to examine the impact of stroke phases on treatment efficacy.

Included were 17 articles with 600 patients. Compared with control treatments, the action observation therapy had a moderate effect size on arm and hand motor outcomes (Hedge’s g = 0.564; P < 0.001), a moderate to large effect size on walking outcomes (Hedge’s g = 0.779; P < 0.001), a large effect size on gait velocity (Hedge’s g = 0.990; P < 0.001), and a moderate to large effect size on activities of daily function (Hedge’s g = 0. 728; P = 0.004). Based on subgroup analyses, the action observation therapy showed moderate to large effect sizes in the studies of patients with acute/subacute stroke or those with chronic stroke (Hedge’s g = 0.661 and 0.783).

This review suggests that action observation therapy is an effective approach for stroke patients to improve arm and hand motor function, walking ability, gait velocity, and daily activity performance.

via Action observation therapy for improving arm function, walking ability, and daily activity performance after stroke: a systematic review and meta-analysis – Tzu-Hsuan Peng, Jun-Ding Zhu, Chih-Chi Chen, Ruei-Yi Tai, Chia-Yi Lee, Yu-Wei Hsieh, 2019

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[WEB SITE] Effects of Mirror Therapy on Walking Ability, Balance and Lower Limb Motor Recovery After Stroke

Leanne Loranger, PT, Manager Policy and Practice    August 2, 2018

Full Citation

Li Y, Wei Q, Gou W, He C. Effects of mirror therapy on walking ability, balance and lower limb recovery after stroke: A systematic review and meta-analysis of randomized controlled trials. Clinical Rehabilitation 2018; DOI: 10.1177/0269215518766642.1

Background

“Stroke is the leading cause of death and disability in Canada.”2 Up to half of people with stroke-related hemiplegia cannot walk independently after rehabilitation;1 however, independent mobility is often a priority for people following stroke.

Mirror therapy involves the use of a mirror placed in the mid-sagittal plane to create the illusion that the affected limb is performing the movements that the unaffected limb is performing. It has been theorized that the visual feedback can help to prevent or reduce learned non-use of the affected limb. Mirror therapy first became common in the rehabilitation of stroke-related upper extremity dysfunction, but more recently has been used in the rehabilitation of lower limbs.

The authors conducted a systematic review and meta-analysis of randomized controlled trials of the use of mirror therapy in the rehabilitation of stroke-related lower-limb impairments.

Methods

  • Systematic search of MEDLINE, EMBASE, Web of Science, CENTRAL, Physiotherapy Evidence Database, CNKI, VIP, Wan Fang, ClinicalTrials.gov, and Current Controlled Trials, conducted according to PRISMA guidelines.
  • Study Inclusion Criteria:
    • Randomized Controlled Trials
    • Patients > 18 years of age with stroke
    • More than five subjects in the study
    • Compared mirror to no intervention, a different intervention, or a control group with the same therapeutic intervention minus mirror therapy
    • Provided original data or sufficient information about at least one outcome to allow inclusion in Meta-analysis
    • Published in English or Chinese
  • The PEDro Scale was used to assess quality of included studies.
    • Scores ranged from five to eight points
    • Six studies were rated “good quality” while seven were rated “fair quality”
  • Meta-analysis was conducted using RevMan 5.3.
  • Subgroup analysis was conducted to establish the effectiveness of treatment depending on recovery stage (acute, subacute, or chronic) and nature of the treatment intervention (movement of unaffected limb only, or bilateral movement).
  • A total of 13 studies, representing 572 patients were included in the meta-analysis.
  • Timing of interventions ranged from six days to 16 months post-stroke.
  • Six studies involved bilateral movements, while in seven only the unaffected side was moved.
  • Frequency ranged from three to six days per week.
  • Duration of treatment ranged from two weeks to three months.

Findings

  • Significant improvement in walking speed compared with control group, measured by 10-meter walk test.
    • Both bilateral and unilateral movements led to improved walking speed.
  • No significant improvement in mobility, measured by Timed Up and Go or Functional Ambulatory Category.
  • Significant treatment effect for balance, measured by the Berg Balance Scale or Brunnel Balance Assessment.
  • Significant effect on lower limb motor recovery, measured by the Fugl-Meyer or Brunnstrom Scale.
  • No significant effect on spasticity of ankle muscles.
  • Significant improvement in PROM of ankle dorsiflexion.

Discussion

The main finding of this systematic review and meta-analysis was that “patients with stroke who received mirror therapy had significant improvements in walking speed, balance, lower limb motor recovery and passive range of motion of ankle dorsiflexion.”1 However, although the findings were statistically significant, they “seemed to have little clinical significance.” For example, the average improvement in walking speed after mirror therapy treatment would not lead to a change in patient categorization from “house-hold ambulator” to “limited community ambulator.”

Limitations

  • Considerable study heterogeneity regarding treatment frequency and duration may have impacted on the strength of the study findings.
  • Relatively small number of studies and total patients included.

Relevance to physiotherapy practice in Alberta

Mirror therapy shows some promise for lower limb rehabilitation of people who have experienced a stroke, leading to statistically significant changes in gait speed, balance, motor recovery and range of motion. However, current research findings show that effects may have limited clinically significance. More research is needed to determine the frequency, duration, timing and parameters of mirror therapy that may result in clinically significant effects, and the patient populations that derive greatest benefit from the intervention, if any.

Disclaimer

The purpose of this summary is to highlight recently published research findings that are not openly accessible. Every effort is made to ensure accuracy and clarity of the summary. Readers are encouraged to review the published article in full for further information.


Sources

  1. Li Y, Wei Q, Gou W, He C. Effects of mirror therapy on walking ability, balance and lower limb recovery after stroke: A systematic review and meta-analysis of randomized controlled trials. Clinical Rehabilitation 2018; DOI: 10.1177/0269215518766642
  2. Physiotherapy Alberta – College + Association. Physiotherapy Works for Stroke. Available at https://www.physiotherapyalberta.ca/files/physioworks_stroke.pdf. Accessed July 13, 2018.

via Physiotherapy Alberta College + Association : The Movement Specialists: Research in Focus: Effects of Mirror Therapy on Walking Ability, Balance and Lower Limb Motor Recovery After Stroke

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[WEB SITE] FootFlexor for Patients with Foot Drop

 

Core Products International introduces the FootFlexor, described as a functional and comfortable AFO that allows the foot to perform naturally while walking. Designed to work with most lace-up shoes and boots, the FootFlexor works by incorporating the FootFlexor Wrap, eyelet clips, and a tension cord to help lift the toe during gait. This comfortable product allows for the use of one’s own muscles, increasing mobility and regular movement, unlike a rigid AFO. Using a product that is comfortable to wear helps increase compliance for those who require dorsal flexion support and/or assistance. When properly maintained and used, the FootFlexor helps improve gait, increases confidence in walking ability, and helps reduce the incidence of falls.

via FootFlexor for Patients with Foot Drop | Lower Extremity Review Magazine

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[Abstract] Effects of Electromechanical Exoskeleton-assisted Gait Training on Walking Ability of Stroke Patients: A Randomized Controlled Trial

Abstract

Objective

To assess the efficacy of electromechanical exoskeleton-assisted gait training on walking ability of stroke patients based on ambulatory function, muscle strength, balance, gait speed and capacity.

Design

Randomized controlled trial.

Setting

University rehabilitation hospital

Participants

Individuals with stroke who could stand alone.

Interventions

Forty patients were randomly assigned to control and experimental groups. The control group underwent physical therapist-assisted gait training by conventional method. The experimental group underwent electromechanical gait training assisted by an exoskeleton device. Both types of gait training were performed for 30 min each day. The therapeutic interventions were provided for 5 days a week for a period of 4 weeks in both groups.

Main Outcome Measures

Functional ambulatory category (FAC) before and after gait training. Changes in FAC were the primary outcomes to evaluate the efficacy of electromechanical exoskeleton-assisted assisted gait training. Changes in mobility, walking speed, walking capacity, leg muscle strength, daily activity and balance were secondary outcomes.

Results

FAC in the control group was 2.44±1.55 in the pre-training and 2.75±1.53 in the post-training. FAC in the experimental group was 3.22±1.31 in the pre-training and 3.78±1.44 in the post-training. Although FAC between pre- and post-training sessions improved in both groups, the changes in FAC were statistically significant in the experimental group alone. Most secondary outcomes in both groups also showed improvement after gait training. However, the differential outcomes were not varied between the two groups after adjusting the data for age and stroke duration. We did not exclude patients based on time since stroke onset. The average stroke duration was 530.11±389.21 days in the experimental group. The changes in FAC of the experimental group were negatively correlated with stroke duration. No adverse events were noticed during gait training in either group.

Conclusions

Electromechanical exoskeleton-assisted gait training is as effective as conventional gait training by physical therapist when as administered by a gait trainer. As an over-ground walking system without harness, electromechanical exoskeleton replaced a physical therapist in assisted gait training for patients who stand alone. Because the ambulatory function of stroke patients was affected negatively by stroke duration, the effect of electromechanical-assisted gait training might decline with increased stroke duration.

via Effects of Electromechanical Exoskeleton-assisted Gait Training on Walking Ability of Stroke Patients: A Randomized Controlled Trial – Archives of Physical Medicine and Rehabilitation

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[WEB SITE] FootFlexor for Patients with Foot Drop

 

Core Products International introduces the FootFlexor, described as a functional and comfortable AFO that allows the foot to perform naturally while walking. Designed to work with most lace-up shoes and boots, the FootFlexor works by incorporating the FootFlexor Wrap, eyelet clips, and a tension cord to help lift the toe during gait. This comfortable product allows for the use of one’s own muscles, increasing mobility and regular movement, unlike a rigid AFO. Using a product that is comfortable to wear helps increase compliance for those who require dorsal flexion support and/or assistance. When properly maintained and used, the FootFlexor helps improve gait, increases confidence in walking ability, and helps reduce the incidence of falls.

Core Products International, Inc.

via FootFlexor for Patients with Foot Drop | Lower Extremity Review Magazine

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[Abstract] Novel multi-pad functional electrical stimulation in stroke patients: A single-blind randomized study

via Novel multi-pad functional electrical stimulation in stroke patients: A single-blind randomized study – IOS Press

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[WEB SITE] Arm Exercise May Help Improve Walking Ability After a Stroke

Crumpled paper shaped as a human head and STROKE concept on whit

A study testing the influence of arm exercise on post-stroke leg function suggests that such exercise may help improve stroke survivors’ walking ability months and even years after having a stroke.

In the study, published in the Journal of Neurophysiology, researchers from the University of Victoria in British Columbia, Canada, worked with a group of older adults who had had a stroke between 7 months and 17 years beforehand. The volunteers participated in three 30-minute, moderate-intensity arm cycling training sessions each week for 5 weeks.

During the training sessions, the research team measured the volunteers’ physical abilities before and after arm training using several standardized scales and tests of physical function. They also tested the electrical activity in the muscles and the stretch reflexes in the lower legs and wrists.

Several standardized scales and tests of physical function were used, including Six Minute Walk, Timed 10 Meter Walk, and Timed Up and Go.

The participants improved their performance significantly on all of the walking tests—as much as 28% in the Timed Up and Go test. Several volunteers had less tightness in their muscles after completing the arm cycling trial, but there was no significant change in grip strength. Nerve activity increased during arm cycling as well, according to a media release from American Physiological Society.

“Arm cycling training activated interlimb networks that contribute to the coordination of rhythmic walking,” the researchers wrote. In other words, nerves in the arms activated and adapted to improve function of the spinal cord in other areas of the body, such as the legs, affected by stroke.

These results could have a large impact on stroke rehabilitation, even years after injury. “Although improvements in walking may not be as robust as those from other training modalities, they do highlight the integral role that training the arms can have on rehabilitation of human locomotion,” the research team wrote, in the release.

[Source(s): American Physiological Society, Science Daily]

 

via Arm Exercise May Help Improve Walking Ability After a Stroke – Rehab Managment

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[Abstract] Effects of mirror therapy combined with neuromuscular electrical stimulation on motor recovery of lower limbs and walking ability of patients with stroke: a randomized controlled study

 

To investigate the effectiveness of mirror therapy combined with neuromuscular electrical stimulation in promoting motor recovery of the lower limbs and walking ability in patients suffering from foot drop after stroke.

Randomized controlled study.

Inpatient rehabilitation center of a teaching hospital.

Sixty-nine patients with foot drop.

Patients were randomly divided into three groups: control, mirror therapy, and mirror therapy + neuromuscular electrical stimulation. All groups received interventions for 0.5 hours/day and five days/week for four weeks.

10-Meter walk test, Brunnstrom stage of motor recovery of the lower limbs, Modified Ashworth Scale score of plantar flexor spasticity, and passive ankle joint dorsiflexion range of motion were assessed before and after the four-week period.

After four weeks of intervention, Brunnstrom stage (P = 0.04), 10-meter walk test (P < 0.05), and passive range of motion (P < 0.05) showed obvious improvements between patients in the mirror therapy and control groups. Patients in the mirror therapy + neuromuscular electrical stimulation group showed better results than those in the mirror therapy group in the 10-meter walk test (P < 0.05). There was no significant difference in spasticity between patients in the two intervention groups. However, compared with patients in the control group, patients in the mirror therapy + neuromuscular electrical stimulation group showed a significant decrease in spasticity (P < 0.001).

Therapy combining mirror therapy and neuromuscular electrical stimulation may help improve walking ability and reduce spasticity in stroke patients with foot drop.

via Effects of mirror therapy combined with neuromuscular electrical stimulation on motor recovery of lower limbs and walking ability of patients with stroke: a randomized controlled study – Qun Xu, Feng Guo, Hassan M Abo Salem, Hong Chen, Xiaolin Huang, 2017

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[Abstract] Effects of mirror therapy combined with neuromuscular electrical stimulation on motor recovery of lower limbs and walking ability of patients with stroke: a randomized controlled study 

To investigate the effectiveness of mirror therapy combined with neuromuscular electrical stimulation in promoting motor recovery of the lower limbs and walking ability in patients suffering from foot drop after stroke.

Randomized controlled study.

Inpatient rehabilitation center of a teaching hospital.

Sixty-nine patients with foot drop.

Patients were randomly divided into three groups: control, mirror therapy, and mirror therapy + neuromuscular electrical stimulation. All groups received interventions for 0.5 hours/day and five days/week for four weeks.

10-Meter walk test, Brunnstrom stage of motor recovery of the lower limbs, Modified Ashworth Scale score of plantar flexor spasticity, and passive ankle joint dorsiflexion range of motion were assessed before and after the four-week period.

After four weeks of intervention, Brunnstrom stage (P = 0.04), 10-meter walk test (P < 0.05), and passive range of motion (P < 0.05) showed obvious improvements between patients in the mirror therapy and control groups. Patients in the mirror therapy + neuromuscular electrical stimulation group showed better results than those in the mirror therapy group in the 10-meter walk test (P < 0.05). There was no significant difference in spasticity between patients in the two intervention groups. However, compared with patients in the control group, patients in the mirror therapy + neuromuscular electrical stimulation group showed a significant decrease in spasticity (P < 0.001).

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Source: Effects of mirror therapy combined with neuromuscular electrical stimulation on motor recovery of lower limbs and walking ability of patients with stroke: a randomized controlled studyClinical Rehabilitation – Qun Xu, Feng Guo, Hassan M Abo Salem, Hong Chen, Xiaolin Huang, 2017

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