Effects of gait training with a cane and an augmented pressure sensor for enhancement of weight bearing over the affected lower limb in patients with stroke: a randomized controlled pilot study

Jung, Kyoung-Sim; Kim, Young; Cha, Yun‐Yeop; In, Tae-Sung; Hur, Young-Goo; Chung, Yijung

doi:10.1177/0269215514540923

Cited by 33 publications

(91 citation statements)

References 18 publications

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“…Study interventions included: BWSTT, 73,78,80 treadmill training without body weight support, 39 body weight support over ground walking, 71 turning-based treadmill training, 44 backward walking training, 75 walking exercise on a ramp, 57 and gait training with a cane. 65 Change in gait speed effect sizes that resulted range from 0.25 to 3.00.…”

Section: Resultsmentioning

confidence: 99%

A systematic review of mechanisms of gait speed change post-stroke. Part 1: spatiotemporal parameters and asymmetry ratios

Wonsetler

Bowden

2017

Topics in Stroke Rehabilitation

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Background In walking rehabilitation trials, self-selected walking speed has emerged as the dominant outcome measure to assess walking ability. However, this measure cannot differentiate between recovery of impaired movement and compensation strategies. Spatiotemporal variables and asymmetry ratios are frequently used to quantify gait deviations and are hypothesized markers of recovery. Objectives The purpose of this review is to investigate spatiotemporal variables and asymmetry ratios as mechanistic recovery measures in physical therapy intervention studies post-stroke. Methods A systematic literature search was performed to identify physical therapy intervention studies with a statistically significant change in self-selected walking speed post intervention and concurrently collected spatiotemporal variables. Methodological quality was assessed using the Cochrane Collaboration’s tool. Walking speed, spatiotemporal, and intervention data were extracted. Results 46 studies met the inclusion criteria, 41 of which reported raw spatiotemporal measures and 19 reported asymmetry ratio calculations. Study interventions included: aerobic training (n=2), functional electrical stimulation (n=5), hippotherapy (n=2), motor dual task training (n=2), multidimensional rehabilitation (n=4), robotics (n=4), sensory stimulation training (n=8), strength/resistance training (n=4), task specific locomotor rehabilitation (n=9), and visually guided training (n=6). Conclusions Spatiotemporal variables help describe gait deviations, but scale to speed, so consequently, may not be an independent factor in describing functional recovery and gains. Therefore, these variables are limited in explaining mechanistic changes involved in improving gait speed. Use of asymmetry measures provides additional information regarding the coordinative requirements for gait and can potentially indicate recovery. Additional laboratory-based mechanistic measures may be required to truly understand how walking speed improves.

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Section: Resultsmentioning

confidence: 99%

A systematic review of mechanisms of gait speed change post-stroke. Part 1: spatiotemporal parameters and asymmetry ratios

Wonsetler

Bowden

2017

Topics in Stroke Rehabilitation

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“…Study interventions included: Body weight support treadmill training (BWSTT), 39 BWSTT with incline, 31 BWSTT and over ground walking, 22 BWSTT with usual care, 40 body weight support (BWS) over ground walking, 35 and gait training with a cane. 25 Change in gait speed effect sizes that resulted range from 0.5 to 1.11.…”

Section: Resultsmentioning

confidence: 99%

“…It can be used to determine the relationship of the neuromuscular activation signal to joint movements and to the gait cycle. Five of the included studies examined EMG activity either during isokinetic dynamometer strength testing, 29,44 during gait, 25,33 or while performing active dorsiflexion in sitting. 42 …”

Section: Resultsmentioning

confidence: 99%

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A systematic review of mechanisms of gait speed change post-stroke. Part 2: exercise capacity, muscle activation, kinetics, and kinematics

Wonsetler

Bowden

2017

Topics in Stroke Rehabilitation

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Background Regaining locomotor ability is a primary goal in stroke rehabilitation and is most commonly measured using changes in self-selected walking speed. However, walking speed cannot identify the mechanisms by which an individual recovers. Laboratory-based mechanistic measures such as exercise capacity, muscle activation, force production, and movement analysis variables may better explain neurologic recovery. Objectives The objectives of this systematic review are to examine changes in mechanistic gait outcomes and describe motor recovery as quantified by changes in laboratory-based mechanistic variables in rehabilitation trials. Methods Following a systematic literature search (in PubMed, Ovid, and CINAHL), we included rehabilitation trials with a statistically significant change in self-selected walking speed post-intervention that concurrently collected mechanistic variables. Methodological quality was assessed using the Cochrane Collaboration's tool. Walking speed changes, mechanistic variables, and intervention data were extracted. Results 25 studies met the inclusion criteria and examined: cardiorespiratory function (n=5), muscle activation (n=5), force production (n=11), and movement analysis (n=10). Interventions included: aerobic training, functional electrical stimulation, multidimensional rehabilitation, robotics, sensory stimulation training, strength/resistance training, task-specific locomotor rehabilitation, and visually-guided training. Conclusions Following this review, no set of outcome measures to mechanistically explain changes observed in walking speed was identified. Nor is there a theoretical basis to drive the complicated selection of outcome measures, as many of these outcomes are not independent of walking speed. Since rehabilitation literature has yet to support a causal, mechanistic link for functional gains post stroke, a systematic, multi-modal approach to stroke rehabilitation will be necessary in doing so.

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“…In particular, activation of the hip abductor is important for moving the center of mass over the stance leg when transitioning from double leg support to single leg support (Kirker et al, 2000; Pai et al, 1994). The increased hip abductor muscle activity in our study may improve the pelvis stability for single leg stance on the paretic leg (Jung et al, 2015; Mercer et al, 2009). …”

Section: Discussionmentioning

confidence: 74%

Applying a pelvic corrective force induces forced use of the paretic leg and improves paretic leg EMG activities of individuals post-stroke during treadmill walking

Hsu

Kim

Tang

et al. 2017

Clinical Neurophysiology

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Objective To determine whether applying a mediolateral corrective force to the pelvis during treadmill walking would enhance muscle activity of the paretic leg and improve gait symmetry in individuals with post-stroke hemiparesis Methods Fifteen subjects with post-stroke hemiparesis participated in this study. A customized cable-driven robotic system based over a treadmill generated a mediolateral corrective force to the pelvis toward the paretic side during early stance phase. Three different amounts of corrective force were applied. Electromyographic (EMG) activity of the paretic leg, spatiotemporal gait parameters and pelvis lateral displacement were collected. Results Significant increases in integrated EMG of hip abductor, medial hamstrings, soleus, rectus femoris, vastus medialis and tibialis anterior were observed when pelvic corrective force was applied, with pelvic corrective force at 9% of body weight inducing greater muscle activity than 3% or 6% of body weight. Pelvis lateral displacement was more symmetric with pelvic corrective force at 9% of body weight. Conclusions Applying a mediolateral pelvic corrective force toward the paretic side may enhance muscle activity of the paretic leg and improve pelvis displacement symmetry in individuals post-stroke. Significance Forceful weight shift to the paretic side could potentially force additional use of the paretic leg and improve the walking pattern.

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Effects of gait training with a cane and an augmented pressure sensor for enhancement of weight bearing over the affected lower limb in patients with stroke: a randomized controlled pilot study

Abstract: Gait training using a cane with an augmented pressure sensor to enhance weight bearing over the affected lower limb is beneficial and effective in improving the peak force of cane, muscle activation, and gait in stroke patients.

Cited by 33 publications

References 18 publications

A systematic review of mechanisms of gait speed change post-stroke. Part 1: spatiotemporal parameters and asymmetry ratios

A systematic review of mechanisms of gait speed change post-stroke. Part 1: spatiotemporal parameters and asymmetry ratios

A systematic review of mechanisms of gait speed change post-stroke. Part 2: exercise capacity, muscle activation, kinetics, and kinematics

Applying a pelvic corrective force induces forced use of the paretic leg and improves paretic leg EMG activities of individuals post-stroke during treadmill walking

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