Gait characteristics of post-stroke hemiparetic patients with different walking speeds

Wang, Yiji; Mukaino, Masahiko; Ohtsuka, Kei; Otaka, Yohei; Tanikawa, Hiroki; Matsuda, Fumihiro; Tsuchiyama, Kazuhiro; Yamada, Junya; Saitoh, Eiichi

doi:10.1097/mrr.0000000000000391

Cited by 79 publications

(67 citation statements)

References 32 publications

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“…It has been reported that difference in spatiotemporal parameters could be influenced by gait speed, suggesting speed-matched trials for better post-stroke gait characterization. Consistent differences in the spatiotemporal parameters were noticed between stroke patients and healthy controls at speedmatched assessment (125,126).…”

Section: Spatiotemporal Parameterssupporting

confidence: 57%

Assessment Methods of Post-stroke Gait: A Scoping Review of Technology-Driven Approaches to Gait Characterization and Analysis

Mohan

Khandoker

Wasti³

et al. 2021

Front. Neurol.

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Background: Gait dysfunction or impairment is considered one of the most common and devastating physiological consequences of stroke, and achieving optimal gait is a key goal for stroke victims with gait disability along with their clinical teams. Many researchers have explored post stroke gait, including assessment tools and techniques, key gait parameters and significance on functional recovery, as well as data mining, modeling and analyses methods.Research Question: This study aimed to review and summarize research efforts applicable to quantification and analyses of post-stroke gait with focus on recent technology-driven gait characterization and analysis approaches, including the integration of smart low cost wearables and Artificial Intelligence (AI), as well as feasibility and potential value in clinical settings.Methods: A comprehensive literature search was conducted within Google Scholar, PubMed, and ScienceDirect using a set of keywords, including lower extremity, walking, post-stroke, and kinematics. Original articles that met the selection criteria were included.Results and Significance: This scoping review aimed to shed light on tools and technologies employed in post stroke gait assessment toward bridging the existing gap between the research and clinical communities. Conventional qualitative gait analysis, typically used in clinics is mainly based on observational gait and is hence subjective and largely impacted by the observer's experience. Quantitative gait analysis, however, provides measured parameters, with good accuracy and repeatability for the diagnosis and comparative assessment throughout rehabilitation. Rapidly emerging smart wearable technology and AI, including Machine Learning, Support Vector Machine, and Neural Network approaches, are increasingly commanding greater attention in gait research. Although their use in clinical settings are not yet well leveraged, these tools promise a paradigm shift in stroke gait quantification, as they provide means for acquiring, storing and analyzing multifactorial complex gait data, while capturing its non-linear dynamic variability and offering the invaluable benefits of predictive analytics.

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Section: Spatiotemporal Parameterssupporting

confidence: 57%

Assessment Methods of Post-stroke Gait: A Scoping Review of Technology-Driven Approaches to Gait Characterization and Analysis

Mohan

Khandoker

Wasti³

et al. 2021

Front. Neurol.

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“…9). The pattern of spatial symmetry vary greatly, while some individuals exhibit a longer step length on the non-paretic side, and others take longer steps on the paretic side [57,58]. A step lengthening strategy on the affected side detected for the RAGT group (see Fig.…”

Section: Discussionmentioning

confidence: 90%

Effect of robotic-assisted gait training on objective biomechanical measures of gait in persons post-stroke: a systematic review and meta-analysis

Nedergård

Arumugam

Sandlund

et al. 2021

J NeuroEngineering Rehabil

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Background Robotic-Assisted Gait Training (RAGT) may enable high-intensive and task-specific gait training post-stroke. The effect of RAGT on gait movement patterns has however not been comprehensively reviewed. The purpose of this review was to summarize the evidence for potentially superior effects of RAGT on biomechanical measures of gait post-stroke when compared with non-robotic gait training alone. Methods Nine databases were searched using database-specific search terms from their inception until January 2021. We included randomized controlled trials investigating the effects of RAGT (e.g., using exoskeletons or end-effectors) on spatiotemporal, kinematic and kinetic parameters among adults suffering from any stage of stroke. Screening, data extraction and judgement of risk of bias (using the Cochrane Risk of bias 2 tool) were performed by 2–3 independent reviewers. The Grading of Recommendations Assessment Development and Evaluation (GRADE) criteria were used to evaluate the certainty of evidence for the biomechanical gait measures of interest. Results Thirteen studies including a total of 412 individuals (mean age: 52–69 years; 264 males) met eligibility criteria and were included. RAGT was employed either as monotherapy or in combination with other therapies in a subacute or chronic phase post-stroke. The included studies showed a high risk of bias (n = 6), some concerns (n = 6) or a low risk of bias (n = 1). Meta-analyses using a random-effects model for gait speed, cadence, step length (non-affected side) and spatial asymmetry revealed no significant differences between the RAGT and comparator groups, while stride length (mean difference [MD] 2.86 cm), step length (affected side; MD 2.67 cm) and temporal asymmetry calculated in ratio-values (MD 0.09) improved slightly more in the RAGT groups. There were serious weaknesses with almost all GRADE domains (risk of bias, consistency, directness, or precision of the findings) for the included outcome measures (spatiotemporal and kinematic gait parameters). Kinetic parameters were not reported at all. Conclusion There were few relevant studies and the review synthesis revealed a very low certainty in current evidence for employing RAGT to improve gait biomechanics post-stroke. Further high-quality, robust clinical trials on RAGT that complement clinical data with biomechanical data are thus warranted to disentangle the potential effects of such interventions on gait biomechanics post-stroke.

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“…Despite improvements in walking speed, stroke survivors may continue to exhibit significant impairments in step variability. For example, a recent study in stroke survivors reported higher variability in step length and stance time, even with relatively high walking speeds of 0.83-1.25 m/s (10). Similarly, another study reported heightened variability in step length, swing time, and stride time even in independently ambulating stroke survivors (11).…”

Section: Introductionmentioning

confidence: 94%

Force-Control vs. Strength Training: The Effect on Gait Variability in Stroke Survivors

et al. 2021

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Purpose: Increased gait variability in stroke survivors indicates poor dynamic balance and poses a heightened risk of falling. Two primary motor impairments linked with impaired gait are declines in movement precision and strength. The purpose of the study is to determine whether force-control training or strength training is more effective in reducing gait variability in chronic stroke survivors.Methods: Twenty-two chronic stroke survivors were randomized to force-control training or strength training. Participants completed four training sessions over 2 weeks with increasing intensity. The force-control group practiced increasing and decreasing ankle forces while tracking a sinusoid. The strength group practiced fast ankle motor contractions at a percentage of their maximal force. Both forms of training involved unilateral, isometric contraction of the paretic, and non-paretic ankles in plantarflexion and dorsiflexion. Before and after the training, we assessed gait variability as stride length and stride time variability, and gait speed. To determine the task-specific effects of training, we measured strength, accuracy, and steadiness of ankle movements.Results: Stride length variability and stride time variability reduced significantly after force-control training, but not after strength training. Both groups showed modest improvements in gait speed. We found task-specific effects with strength training improving plantarflexion and dorsiflexion strength and force control training improving motor accuracy and steadiness.Conclusion: Force-control training is superior to strength training in reducing gait variability in chronic stroke survivors. Improving ankle force control may be a promising approach to rehabilitate gait variability and improve safe mobility post-stroke.

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Gait characteristics of post-stroke hemiparetic patients with different walking speeds

Cited by 79 publications

References 32 publications

Assessment Methods of Post-stroke Gait: A Scoping Review of Technology-Driven Approaches to Gait Characterization and Analysis

Assessment Methods of Post-stroke Gait: A Scoping Review of Technology-Driven Approaches to Gait Characterization and Analysis

Effect of robotic-assisted gait training on objective biomechanical measures of gait in persons post-stroke: a systematic review and meta-analysis

Force-Control vs. Strength Training: The Effect on Gait Variability in Stroke Survivors

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