Altered Sagittal- and Frontal-Plane Kinematics Following High-Intensity Stepping Training Versus Conventional Interventions in Subacute Stroke

Mahtani, Gordhan B.; Kinnaird, Catherine R.; Connolly, Mark W.; Holleran, Carey L.; Hennessy, Patrick; Woodward, Jane; Brazg, Gabrielle; Roth, Elliot J.; Hornby, T. George

doi:10.2522/ptj.20160281

Cited by 27 publications

(50 citation statements)

References 46 publications

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“…spatiotemporal kinematics, kinetics, and postural stability) which may have been affected by our study interventions. There are no studies evaluating the effect of HISTT on all these walking characteristics, but high-intensity stepping does result in changes in both kinematics and kinetics [ 51 , 52 ]. Additionally, the application of tDCS over 4 weeks improves postural control as assessed with the Tinetti test [ 53 ].…”

Section: Discussionmentioning

confidence: 99%

Cortical priming strategies for gait training after stroke: a controlled, stratified trial

Madhavan

Cleland

Sivaramakrishnan

et al. 2020

J NeuroEngineering Rehabil

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Background: Stroke survivors experience chronic gait impairments, so rehabilitation has focused on restoring ambulatory capacity. High-intensity speed-based treadmill training (HISTT) is one form of walking rehabilitation that can improve walking, but its effectiveness has not been thoroughly investigated. Additionally, cortical priming with transcranial direct current stimulation (tDCS) and movement may enhance HISTT-induced improvements in walking, but there have been no systematic investigations. The objective of this study was to determine if motor priming can augment the effects of HISTT on walking in chronic stroke survivors. Methods: Eighty-one chronic stroke survivors participated in a controlled trial with stratification into four groups: 1) control-15 min of rest (n = 20), 2) tDCS-15 min of stimulation-based priming with transcranial direct current stimulation (n = 21), 3) ankle motor tracking (AMT)-15 min of movement-based priming with targeted movements of the ankle and sham tDCS (n = 20), and 4) tDCS+AMT-15 min of concurrent tDCS and AMT (n = 20). Participants performed 12 sessions of HISTT (40 min/day, 3 days/week, 4 weeks). Primary outcome measure was walking speed. Secondary outcome measures included corticomotor excitability (CME). Outcomes were measured at pre, post, and 3-month follow-up assessments. Results: HISTT improved walking speed for all groups, which was partially maintained 3 months after training. No significant difference in walking speed was seen between groups. The tDCS+AMT group demonstrated greater changes in CME than other groups. Individuals who demonstrated up-regulation of CME after tDCS increased walking speed more than down-regulators. Conclusions: Our results support the effectiveness of HISTT to improve walking; however, motor priming did not lead to additional improvements. Upregulation of CME in the tDCS+AMT group supports a potential role for priming in enhancing neural plasticity. Greater changes in walking were seen in tDCS up-regulators, suggesting that responsiveness to tDCS might play an important role in determining the capacity to respond to priming and HISTT. Trial registration: ClinicalTrials.gov, NCT03492229. Registered 10 April 2018retrospectively registered, https:// clinicaltrials.gov/ct2/show/NCT03492229.

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Section: Discussionmentioning

confidence: 99%

Cortical priming strategies for gait training after stroke: a controlled, stratified trial

Madhavan

Cleland

Sivaramakrishnan

et al. 2020

J NeuroEngineering Rehabil

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“…Task-specific rehabilitation that emphasizes the direct practice of walking has emerged as a preferred approach to impairment-based training [117,118]; however, walking practice that is not specifically structured to facilitate the recovery of a more physiological gait is likely to produce improvements via gait compensations [30,119]. The current rehabilitation environment emphasizes the rapid attainment of walking independence, not gait restoration.…”

Section: Conventional Interventions Do Not Target Propulsionmentioning

confidence: 99%

“…During the propulsion locomotor subtask, positive work by the trailing limb accelerates the body into the next gait cycle [7]. To walk faster, people with intact neural control symmetrically increase the positive work performed by each Conventional post-stroke rehabilitation efforts have had limited effectiveness in restoring the propulsion function inherent to a healthy bipedal gait, with functional improvements often being the product of compensatory mechanisms [26,28,30,31]. The propulsion deficits that persist across the months and years post-stroke constrain long-term outcomes and contribute to a sedentary lifestyle, physical inactivity, and poor health [15,[32][33][34][35][36][37].…”

Section: Introductionmentioning

confidence: 99%

These legs were made for propulsion: advancing the diagnosis and treatment of post-stroke propulsion deficits

Awad

Lewek

Kesar

et al. 2020

J NeuroEngineering Rehabil

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Advances in medical diagnosis and treatment have facilitated the emergence of precision medicine. In contrast, locomotor rehabilitation for individuals with acquired neuromotor injuries remains limited by the dearth of (i) diagnostic approaches that can identify the specific neuromuscular, biomechanical, and clinical deficits underlying impaired locomotion and (ii) evidence-based, targeted treatments. In particular, impaired propulsion by the paretic limb is a major contributor to walking-related disability after stroke; however, few interventions have been able to target deficits in propulsion effectively and in a manner that reduces walking disability. Indeed, the weakness and impaired control that is characteristic of post-stroke hemiparesis leads to heterogeneous deficits that impair paretic propulsion and contribute to a slow, metabolically-expensive, and unstable gait. Current rehabilitation paradigms emphasize the rapid attainment of walking independence, not the restoration of normal propulsion function. Although walking independence is an important goal for stroke survivors, independence achieved via compensatory strategies may prevent the recovery of propulsion needed for the fast, economical, and stable gait that is characteristic of healthy bipedal locomotion. We posit that post-stroke rehabilitation should aim to promote independent walking, in part, through the acquisition of enhanced propulsion. In this expert review, we present the biomechanical and functional consequences of post-stroke propulsion deficits, review advances in our understanding of the nature of post-stroke propulsion impairment, and discuss emerging diagnostic and treatment approaches that have the potential to facilitate new rehabilitation paradigms targeting propulsion restoration.

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“…A surprising kinematic finding was the lack of improvements in hip-knee angular consistency following training. Previous data in participants with stroke 24 or incomplete SCI 46,47 following higher intensity stepping protocols demonstrate improvements in ACC, although other stepping protocols that may not focus on high cardiovascular intensities elicit variable changes in intralimb consistency 47 . The inconsistent changes in ACC do not appear to be due to limited changes in speed, as participants with similar speed improvements demonstrated both positive and negative ACC changes (e.g., S2 and S3).…”

Section: Discussionmentioning

confidence: 96%

“…Application of this training paradigm without focusing on normalizing gait kinematics resulted in substantial gains in locomotor function in participants who were post-stroke, with additional improvements in strength, balance, transfers 14,19 , aerobic capacity 22 and selected kinematic patterns. 23,24 Despite the positive findings of prior locomotor training studies, the feasibility and efficacy of this intervention in individuals with other neurological diagnoses, including iSCI, have not been assessed. To date, previous studies have assessed the effects of variable task practice of skilled walking tasks in iSCI, although with less attention towards intensity 17,25 .…”

Section: Introductionmentioning

confidence: 99%

High-Intensity Variable Stepping Training in Patients With Motor Incomplete Spinal Cord Injury: A Case Series

Holleran¹,

Hennessey

Leddy

et al. 2018

Journal of Neurologic Physical Therapy

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Altered Sagittal- and Frontal-Plane Kinematics Following High-Intensity Stepping Training Versus Conventional Interventions in Subacute Stroke

Cited by 27 publications

References 46 publications

Cortical priming strategies for gait training after stroke: a controlled, stratified trial

Cortical priming strategies for gait training after stroke: a controlled, stratified trial

These legs were made for propulsion: advancing the diagnosis and treatment of post-stroke propulsion deficits

High-Intensity Variable Stepping Training in Patients With Motor Incomplete Spinal Cord Injury: A Case Series

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