RESUMO
BACKGROUND: The objectives of this study were twofold: (1) to compare gait characteristics between cerebral small vessel disease (CSVD) patients with low-risk oral frailty (OF) and high-risk OF, particularly during dual-task walking (DTW); (2) to investigate the association of OF, the gait characteristics of DTW, and falls among older adults patients with CSVD. METHODS: A total of 126 hospitalized patients diagnosed with CSVD were recruited and classified into a low-risk group (n = 90) and a high-risk group (n = 36) based on OF status in our study. Comprehensive data pertaining to basic parameters (cadence, as well as stride time, velocity and length), variability, asymmetry, and coordination were gathered during both single-task walking (STW) and DTW. Additionally, the number of falls was calculated. Subsequently, t-test or chi-squared test was used for comparison between the two groups. Furthermore, linear regression analysis was employed to elucidate the association of the OF index-8 score and gait parameters during cognitive DTW. Also, logistic regression models were utilized to assess the independent association of OF risk and falls. RESULTS: During cognitive DTW, the high-risk group demonstrated inferior performance in terms of basic parameters (p < 0.01), coefficient of variation (CV) of velocity and stride length (p < 0.05), as well as phase coordination index (PCI) when compared with the low-risk group (p < 0.05). Notably, differences in basic gait parameters were observed in cognitive DTW and STW conditions between the two groups (p < 0.01). However, only the high-risk group evinced significant variations in CV and PCI during cognitive DTW, as opposed to those during STW (p < 0.05). Furthermore, our findings also revealed the association of OF, the gait characteristics of cognitive DTW, (p < 0.01) and falls (p < 0.05). CONCLUSION: CSVD patients with a high risk of OF need to pay more attention to their gait variability or coordination. Also, they are recommended to undergo training involving dual-task activities while walking in daily life, thereby reducing the deterioration and mitigating the risk of falls. Besides, this study has confirmed an association of OF and DTW gait as well as falls in patients with CSVD.
Assuntos
Doenças de Pequenos Vasos Cerebrais , Fragilidade , Marcha , Humanos , Masculino , Doenças de Pequenos Vasos Cerebrais/complicações , Doenças de Pequenos Vasos Cerebrais/epidemiologia , Doenças de Pequenos Vasos Cerebrais/fisiopatologia , Feminino , Idoso , Fragilidade/epidemiologia , Fragilidade/fisiopatologia , Marcha/fisiologia , Acidentes por Quedas/estatística & dados numéricos , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Transtornos Neurológicos da Marcha/fisiopatologia , Transtornos Neurológicos da Marcha/epidemiologia , Transtornos Neurológicos da Marcha/etiologia , Caminhada/fisiologiaRESUMO
Careful evaluation of symptom progression and radiographic findings are essential tools when approaching cases of suspected chronic myelopathies. In this case, a 26-year-old woman presented with progressive ambulatory and bladder dysfunction for 4 years. Her examination was marked by bilateral lower-extremity upper motor neuron signs and distal large-fiber sensory loss. Neurologic workup for acquired causes of this presentation was unrevealing. MRI of the brain revealed a characteristic radiologic finding. Guided genetic testing ultimately yielded the final diagnosis. In this clinical vignette, we review the approach to chronic myelopathy including consideration of genetic etiologies and pursuit of targeted gene testing. We further discuss the typical clinical and radiographic findings of a rare diagnosis.
Assuntos
Transtornos Neurológicos da Marcha , Humanos , Feminino , Adulto , Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/fisiopatologia , Raciocínio Clínico , Doenças da Medula Espinal/diagnóstico por imagem , Progressão da Doença , Imageamento por Ressonância MagnéticaRESUMO
BACKGROUND: People with incomplete spinal cord injury (iSCI) often have gait impairments that negatively affect daily life gait performance (i.e., ambulation in the home and community setting) and quality of life. They may benefit from light-weight lower extremity exosuits that assist in walking, such as the Myosuit (MyoSwiss AG, Zurich, Switzerland). A previous pilot study showed that participants with various gait disorders increased their gait speed with the Myosuit in a standardized environment. However, the effect of a soft exosuit on daily life gait performance in people with iSCI has not yet been evaluated. OBJECTIVE: The primary study objective is to test the effect of a soft exosuit (Myosuit) on daily life gait performance in people with iSCI. Second, the effect of Myosuit use on gait capacity and the usability of the Myosuit in the home and community setting will be investigated. Finally, short-term impact on both costs and effects will be evaluated. METHODS: This is a two-armed, open label, randomized controlled trial (RCT). Participants will be randomized (1:1) to the intervention group (receiving the Myosuit program) or control group (initially receiving the conventional program). Thirty-four people with chronic iSCI will be included. The Myosuit program consists of five gait training sessions with the Myosuit at the Sint Maartenskliniek. Thereafter, participants will have access to the Myosuit for home use during 6 weeks. The conventional program consists of four gait training sessions, followed by a 6-week home period. After completing the conventional program, participants in the control group will subsequently receive the Myosuit program. The primary outcome is walking time per day as assessed with an activity monitor at baseline and during the first, third, and sixth week of the home periods. Secondary outcomes are gait capacity (10MWT, 6MWT, and SCI-FAP), usability (D-SUS and D-QUEST questionnaires), and costs and effects (EQ-5D-5L). DISCUSSION: This is the first RCT to investigate the effect of the Myosuit on daily life gait performance in people with iSCI. TRIAL REGISTRATION: Clinicaltrials.gov NCT05605912. Registered on November 2, 2022.
Assuntos
Marcha , Ensaios Clínicos Controlados Aleatórios como Assunto , Traumatismos da Medula Espinal , Humanos , Traumatismos da Medula Espinal/fisiopatologia , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/reabilitação , Resultado do Tratamento , Fatores de Tempo , Exoesqueleto Energizado , Qualidade de Vida , Recuperação de Função Fisiológica , Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/reabilitação , Transtornos Neurológicos da Marcha/fisiopatologia , Fenômenos Biomecânicos , Atividades Cotidianas , Análise Custo-Benefício , Feminino , Adulto , Masculino , Desenho de Equipamento , Custos de Cuidados de Saúde , Pessoa de Meia-IdadeRESUMO
BACKGROUND: The loss of gait automaticity is a key cause of motor deficits in Parkinson's disease (PD) patients, even at the early stage of the disease. Action observation training (AOT) shows promise in enhancing gait automaticity. However, effective assessment methods are lacking. We aimed to propose a novel gait normalcy index based on dual task cost (NIDTC) and evaluate its validity and responsiveness for early-stage PD rehabilitation. METHODS: Thirty early-stage PD patients were recruited and randomly assigned to the AOT or active control (CON) group. The proposed NIDTC during straight walking and turning tasks and clinical scale scores were measured before and after 12 weeks of rehabilitation. The correlations between the NIDTCs and clinical scores were analyzed with Pearson correlation coefficient analysis to evaluate the construct validity. The rehabilitative changes were assessed using repeated-measures ANOVA, while the responsiveness of NIDTC was further compared by t tests. RESULTS: The turning-based NIDTC was significantly correlated with multiple clinical scales. Significant group-time interactions were observed for the turning-based NIDTC (F = 4.669, p = 0.042), BBS (F = 6.050, p = 0.022) and PDQ-39 (F = 7.772, p = 0.011) tests. The turning-based NIDTC reflected different rehabilitation effects between the AOT and CON groups, with the largest effect size (p = 0.020, Cohen's d = 0.933). CONCLUSION: The turning-based NIDTC exhibited the highest responsiveness for identifying gait automaticity improvement by providing a comprehensive representation of motor ability during dual tasks. It has great potential as a valid measure for early-stage PD diagnosis and rehabilitation assessment. Trial registration Chinese Clinical Trial Registry: ChiCTR2300067657.
Assuntos
Marcha , Doença de Parkinson , Humanos , Doença de Parkinson/reabilitação , Doença de Parkinson/diagnóstico , Doença de Parkinson/fisiopatologia , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Marcha/fisiologia , Transtornos Neurológicos da Marcha/reabilitação , Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/fisiopatologia , Transtornos Neurológicos da Marcha/diagnósticoRESUMO
BACKGROUND: Robot-Assisted Gait Training (RAGT) is a novel technology widely employed in the field of neurological rehabilitation for patients with subacute stroke. However, the effectiveness of RAGT compared to conventional gait training (CGT) in improving lower extremity function remains a topic of debate. This study aimed to investigate and compare the effects of RAGT and CGT on lower extremity movement in patients with subacute stroke. METHODS: Comprehensive search was conducted across multiple databases, including PubMed, Web of Science, Cochrane Library, EBSCO, Embase, Scopus, China National Knowledge Infrastructure, Wan Fang, SinoMed and Vip Journal Integration Platform. The database retrieval was performed up until July 9, 2024. Meta-analysis was conducted using RevMan 5.4 software. RESULTS: A total of 24 RCTs were included in the analysis. The results indicate that, compared with CGT, RAGT led to significant improvements in the Fugl-Meyer Assessment for Lower Extremity [MD = 2.10, 95%CI (0.62, 3.59), P = 0.005], Functional Ambulation Category[MD = 0.44, 95%CI (0.23, 0.65), P < 0.001], Berg Balance Scale [MD = 4.55, 95%CI (3.00, 6.11), P < 0.001], Timed Up and Go test [MD = -4.05, 95%CI (-5.12, -2.98), P < 0.001], and 6-Minute Walk Test [MD = 30.66, 95%CI (22.36, 38.97), P < 0.001] for patients with subacute stroke. However, it did not show a significant effect on the 10-Meter Walk Test [MD = 0.06, 95%CI (-0.01, 0.14), P = 0.08]. CONCLUSIONS: This study provides evidence that RAGT can enhance lower extremity function, balance function, walking ability, and endurance levels compared to CGT. However, the quality of evidence for improvements in gait speed remains low.
Assuntos
Extremidade Inferior , Robótica , Reabilitação do Acidente Vascular Cerebral , Humanos , Reabilitação do Acidente Vascular Cerebral/métodos , Reabilitação do Acidente Vascular Cerebral/instrumentação , Robótica/métodos , Robótica/instrumentação , Marcha/fisiologia , Terapia por Exercício/métodos , Terapia por Exercício/instrumentação , Acidente Vascular Cerebral/fisiopatologia , Transtornos Neurológicos da Marcha/reabilitação , Transtornos Neurológicos da Marcha/fisiopatologia , Transtornos Neurológicos da Marcha/etiologiaRESUMO
Post-stroke gait control is a complex, often fail to account for the heterogeneity and continuity of gait in existing gait models. Precisely evaluating gait speed adjustability and gait instability in free-living environments is important to understand how individuals with post-stroke gait dysfunction approach diverse environments and contexts. This study aimed to explore individual causal interactions in the free-living gait control of persons with stroke. To this end, fifty persons with stroke wore an accelerometer on the fifth lumbar vertebra (L5) for 24 h in a free-living environment. Individually directed acyclic graphs (DAGs) were generated based on the spatiotemporal gait parameters at contemporaneous and temporal points calculated from the acceleration data. Spectral clustering and Bayesian model comparison were used to characterize the DAGs. Finally, the DAG patterns were interpreted via Bayesian logistic analysis. Spectral clustering identified three optimal clusters from the DAGs. Cluster 1 included persons with moderate stroke who showed high gait asymmetry and gait instability and primarily adjusted gait speed based on cadence. Cluster 2 included individuals with mild stroke who primarily adjusted their gait speed based on step length. Cluster 3 comprised individuals with mild stroke who primarily adjusted their gait speed based on both step length and cadence. These three clusters could be accurately classified based on four variables: Ashman's D for step velocity, Fugl-Meyer Assessment, step time asymmetry, and step length. The diverse DAG patterns of gait control identified suggest the heterogeneity of gait patterns and the functional diversity of persons with stroke. Understanding the theoretical interactions between gait functions will provide a foundation for highly tailored rehabilitation.
Assuntos
Teorema de Bayes , Transtornos Neurológicos da Marcha , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Humanos , Masculino , Feminino , Transtornos Neurológicos da Marcha/fisiopatologia , Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/reabilitação , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/fisiopatologia , Idoso , Pessoa de Meia-Idade , Reabilitação do Acidente Vascular Cerebral/métodos , Análise por Conglomerados , Algoritmos , Acelerometria , Velocidade de Caminhada , Marcha/fisiologia , Adulto , Fenômenos Biomecânicos , Vértebras Lombares/fisiopatologiaRESUMO
Patients with advanced Parkinson's disease often suffer from severe gait and balance problems, impacting quality of live and persisting despite optimization of standard therapies. The aim of this review was to systematically review the efficacy of STN-DBS programming techniques in alleviating gait disturbances in patients with advanced PD. Searches were conducted in PubMed, Embase, and Lilacs databases, covering studies published until May 2024. The review identified 36 articles that explored five distinct STN-DBS techniques aimed at addressing gait and postural instability in Parkinson's patients: low-frequency stimulation, ventral STN stimulation for simultaneous substantia nigra activation, interleaving, asymmetric stimulation and a short pulse width study. Among these, 21 articles were included in the meta-analysis, which revealed significant heterogeneity among studies. Notably, low-frequency STN-DBS demonstrated positive outcomes in total UPDRS-III score and FOG-Q, especially when combined with dopaminergic therapy. The most favorable results were found for low-frequency STN stimulation. The descriptive analysis suggests that unconventional stimulation approaches may be viable for gait problems in patients who do not respond to standard therapies.
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Estimulação Encefálica Profunda , Transtornos Neurológicos da Marcha , Doença de Parkinson , Núcleo Subtalâmico , Humanos , Estimulação Encefálica Profunda/métodos , Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/fisiopatologia , Transtornos Neurológicos da Marcha/terapia , Doença de Parkinson/terapia , Doença de Parkinson/complicações , Núcleo Subtalâmico/fisiopatologia , Resultado do TratamentoRESUMO
INTRODUCTION: Ankle-foot orthoses (AFOs) are commonly prescribed for people with Charcot-Marie-Tooth disease (CMT) to improve gait efficiency and reduce the occurrence of tripping and falls. The aim of this study was to systematically review evidence on the effects of AFOs on gait kinematics and kinetics and postural stability/balance in people with CMT. METHODS: Studies were identified from electronic databases and screened for inclusion online using Rayyan. Data from all eligible studies were extracted into a standardised Excel spreadsheet. Methodological quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklists. Where available, continuous outcomes were pooled to estimate standardised mean differences in random-effects meta-analyses. RESULTS: A total of 15 studies were included with variable methodological quality. Sample sizes ranged from 1 to 32 with significant variability in participant characteristics, AFO designs and testing procedures. Data from eight studies were available for meta-analysis. Although AFOs impacted walking velocity, stride length, step length, cadence, ankle dorsiflexion, plantarflexion, knee and hip flexion and ankle plantarflexion and dorsiflexion moments, the effect sizes were small-to-moderate and non-significant. There were insufficient data available for pooled analyses of outcomes related to postural stability/balance. CONCLUSION: Although AFOs positively affect a number of gait and balance parameters, the small participant numbers, variability in participant characteristics, AFO designs and testing procedures adopted by the available studies resulted in the absence of statistically significant effects when data were pooled. The results from this review also highlight the importance of device customisation based on the individual needs of people with CMT and their degree of gait impairment.
Assuntos
Doença de Charcot-Marie-Tooth , Órtoses do Pé , Marcha , Humanos , Articulação do Tornozelo/fisiopatologia , Fenômenos Biomecânicos , Doença de Charcot-Marie-Tooth/fisiopatologia , Doença de Charcot-Marie-Tooth/complicações , Doença de Charcot-Marie-Tooth/reabilitação , Marcha/fisiologia , Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/fisiopatologia , Transtornos Neurológicos da Marcha/reabilitação , Equilíbrio Postural/fisiologiaRESUMO
OBJECTIVE: Gait disturbance is one of the features of normal pressure hydrocephalus (NPH) and decompensated long-standing overt ventriculomegaly (LOVA). The timed-up-and-go (TUG) test and the timed-10-m-walking test (10MWT) are frequently used assessments tools for gait and balance disturbances in NPH and LOVA, as well as several other disorders. We aimed to make smart-phone apps which perform both the 10MWT and the TUG-test and record the results for individual patients, thus making it possible for patients to have an objective assessment of their progress. Patients with a suitable smart phone can perform repeat assessments in their home environment, providing a measure of progress for them and for their clinical team. METHODS: 10MWT and TUG-test were performed by 50 healthy adults, 67 NPH and 10 LOVA patients, as well as 5 elderly patients as part of falls risk assessment using the Watkins2.0 app. The 10MWT was assessed with timed slow-pace and fast-pace. Statistical analysis used SPSS (version 25.0, IBM) by paired t-test, comparing the healthy and the NPH cohorts. Level of precision of the app as compared to a clinical observer using a stopwatch was evaluated using receiver operating characteristics curve. RESULTS: As compared to a clinical observer using a stopwatch, in 10MWT the app showed 100% accuracy in the measure of time taken to cover distance in whole seconds, 95% accuracy in the number of steps taken with an error ± 1-3 steps, and 97% accuracy in the measure of total distance covered with error of ± 0.25-0.50 m. The TUG test has 100% accuracy in time taken to complete the test in whole seconds, 97% accuracy in the number of steps with an error of ± 1-2 steps and 87.5% accuracy in the distance covered with error of ± 0.50 m. In the measure of time, the app was found to have equal sensitivity as an observer. In measure of number of steps and distance, the app demonstrated high sensitivity and precision (AUC > 0.9). The app also showed significant level of discrimination between healthy and gait-impaired individuals. CONCLUSION: 'Watkins' and 'Watkins2.0' are efficient apps for objective performance of 10MWT and the TUG-test in NPH and LOVA patients and has application in several other pathologies characterised by gait and balance disturbance.
Assuntos
Hidrocefalia de Pressão Normal , Hidrocefalia , Aplicativos Móveis , Smartphone , Humanos , Hidrocefalia de Pressão Normal/cirurgia , Hidrocefalia de Pressão Normal/diagnóstico , Idoso , Feminino , Masculino , Pessoa de Meia-Idade , Hidrocefalia/diagnóstico , Idoso de 80 Anos ou mais , Adulto , Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/diagnóstico , Transtornos Neurológicos da Marcha/fisiopatologia , Marcha/fisiologia , Análise da Marcha/métodosRESUMO
BACKGROUND: Gait analysis aids in evaluation, classification, and follow-up of gait pattern over time in children with cerebral palsy (CP). The analysis of sagittal plane joint kinematics is of special interest to assess flexed knee gait and ankle joint deviations that commonly progress with age and indicate deterioration of gait. Although most children with CP are ambulatory, no objective quantification of gait is currently included in any of the known international follow-up programs. Is video-based 2-dimensional markerless (2D ML) gait analysis with automated processing a feasible and useful tool to quantify deviations, evaluate and classify gait, in children with CP? METHODS: Twenty children with bilateral CP with Gross Motor Function Classification Scale (GMFCS) levels I-III, from five regions in Sweden, were included from the national CP registry. A single RGB-Depth video camera, sensitive to depth and contrast, was positioned laterally to a green walkway and background, with four light sources. A previously validated markerless method was employed to estimate sagittal plane hip, knee, ankle kinematics, foot orientation and spatio-temporal parameters including gait speed and step length. RESULTS: Mean age was 10.4 (range 6.8-16.1) years. Eight children were classified as GMFCS level I, eight as II and four as III. Setup of the measurement system took 15 min, acquisition 5-15 min and processing 50 min per child. Using the 2D ML method kinematic deviations from normal could be determined and used to implement the classification of gait pattern, proposed by Rodda et al. 2001. CONCLUSION: 2D ML assessment is feasible, since it is accessible, easy to perform and well tolerated by the children. The 2D ML adds consistency and quantifies objectively important gait variables. It is both relevant and reasonable to include 2D ML gait assessment in the evaluation of children with CP.
Assuntos
Paralisia Cerebral , Estudos de Viabilidade , Análise da Marcha , Gravação em Vídeo , Humanos , Paralisia Cerebral/fisiopatologia , Paralisia Cerebral/diagnóstico , Paralisia Cerebral/complicações , Criança , Masculino , Feminino , Análise da Marcha/métodos , Adolescente , Gravação em Vídeo/métodos , Fenômenos Biomecânicos , Marcha/fisiologia , Suécia , Transtornos Neurológicos da Marcha/diagnóstico , Transtornos Neurológicos da Marcha/fisiopatologia , Transtornos Neurológicos da Marcha/etiologiaRESUMO
OBJECTIVE: This study aims to assess how enhancing upper limb function on the affected side of stroke influences the gait of the lower limb. METHODS: Forty eligible stroke patients were randomly assigned to either a control group or a treatment group, with 20 patients in each group. Both groups underwent dynamic evaluation using artificial intelligence and computer vision before treatment. This evaluation focused on analyzing the range of motion of the shoulder and elbow during the gait cycle, as well as various gait parameters (such as step length, step speed, and percentage of stance phase) on the affected side. Following evaluation, the control group received routine rehabilitation treatment. RESULTS: The results indicated that there was no significant difference between the two groups before treatment. However, following treatment, there was a notable improvement in the motion of the shoulder and elbow joints on the affected side among patients in the treatment group (p<0.05), whereas the control group showed only slight improvement, which was not statistically significant (p>0.05). CONCLUSION: The improvement in upper limb function on the affected side also appears to positively influence gait recovery. However, it's important to note that the observation period was relatively short. Further studies are needed to confirm whether this effect is sustained over the long term.
Assuntos
Inteligência Artificial , Terapia por Exercício , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Extremidade Superior , Humanos , Masculino , Feminino , Reabilitação do Acidente Vascular Cerebral/métodos , Pessoa de Meia-Idade , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/complicações , Extremidade Superior/fisiopatologia , Idoso , Terapia por Exercício/métodos , Marcha/fisiologia , Amplitude de Movimento Articular/fisiologia , Adulto , Recuperação de Função Fisiológica/fisiologia , Transtornos Neurológicos da Marcha/reabilitação , Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/fisiopatologiaRESUMO
Individuals with diminished walking performance caused by neuromuscular impairments often lack plantar flexion muscle activity. Robotic devices have been developed to address these issues and increase walking performance. While these devices have shown promise in their ability to increase musculature engagement of the lower limbs when used on a treadmill, most have not been developed or validated for overground walking and community use. Overground walking may limit the effectiveness of robotic devices due to differences in gait characteristics between walking terrains and reduced user engagement. The purpose of this study was to validate our multimodal robotic gait training system for overground walking in individuals with neuromuscular gait impairments. This untethered wearable robotic device can provide an ankle resistive torque proportional to the users' biological ankle torque. The device can also provide audio biofeedback based on users' plantar pressure intending to increase ankle power and muscle activity of the plantar flexors. Seven individuals with cerebral palsy participated. Participants walked overground and on a treadmill with our robotic gait training system in a single testing session. Results showed all seven participants to increase peak plantar flexor muscle activity, 10.3% on average, when walking with the gait trainer overground compared to treadmill. When compared to typical baseline overground walking, overground gait trainer use caused individuals to have slightly less knee joint excursion (3°) and moderately more ankle joint excursion (7°). This work supports our vision of using the wearable robotic device as a gait aid and rehabilitation tool in the home and community settings.
Assuntos
Robótica , Caminhada , Humanos , Masculino , Caminhada/fisiologia , Feminino , Robótica/instrumentação , Robótica/métodos , Biorretroalimentação Psicológica/métodos , Biorretroalimentação Psicológica/instrumentação , Adulto , Articulação do Tornozelo/fisiologia , Articulação do Tornozelo/fisiopatologia , Marcha/fisiologia , Paralisia Cerebral/fisiopatologia , Paralisia Cerebral/reabilitação , Músculo Esquelético/fisiologia , Músculo Esquelético/fisiopatologia , Tornozelo/fisiologia , Adolescente , Transtornos Neurológicos da Marcha/reabilitação , Transtornos Neurológicos da Marcha/fisiopatologia , Adulto Jovem , Fenômenos Biomecânicos , Teste de Esforço/métodosRESUMO
Background: Asymmetric gait patterns are mostly observed in hemiplegic stroke patients. These abnormal gait patterns resulting in abnormal speed, and decreased ability in daily of activity living. Objective: This study aimed to determine the immediate changes in gait parameters and plantar pressure during elevation by wearing an insole on the sound side lower extremity of patients with hemiplegia. Methods: Thirty-six participants were recruited, comprising those with a post-stroke follow-up of ≥3 months and a functional ambulation category score of ≥2. The participants were asked to walk with and without a 1âcm insole in the shoe of their sound side, and the order of wearing or not wearing the insole was randomized. Gait parameters, bilateral gait parameters, and dynamic plantar pressure were measured using the GAITRite Walkway System. Results: Paired t-test was used to examine immediate changes in gait parameters and plantar pressure with and without insoles during walking in the same group. Overall, gait velocity and step length significantly decreased (pâ<â0.05), whereas step time significantly increased (pâ<â0.05). The swing phase of the affected sidelower extremities significantly increased (pâ<â0.05), and the stance phase significantly decreased (pâ<â0.05). Double-support unloading phase (pre-swing phase) significantly increased (pâ<â0.05). The changes in plantar pressure were significantly increased in some lateral zones and significantly decreased in the medial zone of the mid-hindfoot, both in terms of pressure per time and peak pressure (pâ<â0.05). Conclusion: Although this study did not show immediate positive effects on gait parameters and gait cycle, it is expected that sensory input from the sole of the foot through changes in plantar pressure may help improve gait asymmetry and regulate postural symmetry.
Assuntos
Hemiplegia , Extremidade Inferior , Caminhada , Humanos , Masculino , Feminino , Hemiplegia/reabilitação , Hemiplegia/fisiopatologia , Hemiplegia/etiologia , Hemiplegia/terapia , Pessoa de Meia-Idade , Caminhada/fisiologia , Idoso , Extremidade Inferior/fisiopatologia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/fisiopatologia , Órtoses do Pé , Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/reabilitação , Transtornos Neurológicos da Marcha/terapia , Transtornos Neurológicos da Marcha/fisiopatologia , Marcha/fisiologia , Sapatos , Adulto , Fenômenos Biomecânicos/fisiologia , Pé/fisiopatologia , Doença Crônica , Reabilitação do Acidente Vascular Cerebral/métodosRESUMO
Stiff knee gait (SKG) occurrence after a stroke is associated with various abnormal muscle activities; however, the interactions among these muscles are unclear. This study aimed to elucidate the muscle synergy characteristics during walking in patients with SKG after a stroke. This cross-sectional study included 20 patients with poststroke SKG (SKG group), 16 patients without poststroke SKG (non-SKG group), and 15 healthy adults (control group). Participants walked a 10-m distance at a comfortable speed, and electromyographic data were recorded from six lower-limb muscles. Non-negative matrix factorization was employed to derive time-varying activity (C), muscle weights (W), and the percentage of total variance accounted for (tVAF) for muscle synergies. The SKG group showed a higher tVAF than the control group. The initial stance module (including knee extensors) showed increased activity during the swing phase. The initial swing module (including hip flexors and ankle dorsiflexors) exhibited a higher activity during the single-support phase but a lower activity during the swing phase. The synergy structure in patients with SKG after stroke was simplified, with specific abnormalities in synergy activities. SKG may arise from several synergy alterations involving multiple muscles, indicating that approaches focused on controlling individual muscle activities are unsuitable.
Assuntos
Eletromiografia , Marcha , Articulação do Joelho , Músculo Esquelético , Acidente Vascular Cerebral , Humanos , Masculino , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/complicações , Feminino , Pessoa de Meia-Idade , Músculo Esquelético/fisiopatologia , Marcha/fisiologia , Estudos Transversais , Articulação do Joelho/fisiopatologia , Idoso , Caminhada/fisiologia , Adulto , Fenômenos Biomecânicos , Transtornos Neurológicos da Marcha/fisiopatologia , Transtornos Neurológicos da Marcha/etiologia , Joelho/fisiopatologiaRESUMO
BACKGROUND: Walking impairment represents a relevant symptom in patients with neurological diseases often compromising social participation. Currently, mixed methods studies on robot-assisted gait training (RAGT) in patients with rare neurological diseases are lacking. This study aimed to explore the feasibility, acceptability, goal attainment and preliminary effects of RAGT in patients with common and rare neurological diseases and understand the intervention context and process. METHODS: A mixed-methods feasibility study was conducted at an Austrian rehabilitation centre. Twenty-eight inpatients after stroke in the subacute and chronic phases, with multiple sclerosis, Parkinson's disease, spinal cord injury, spinocerebellar ataxia, acute/chronic inflammatory demyelinating polyneuropathy and motor neuron disease were included. Patients received RAGT for 45 minutes, 4x/week, for 4 weeks. Baseline and post-intervention assessments included gait parameters, walking and balance, and questionnaires. Semi-structured observations were conducted twice during the intervention period and analysed using thematic analysis. Descriptive statistics within the respective disease groups and calculation of effect sizes for the total sample were performed. Triangulation was employed to develop a deeper understanding of the research topic. RESULTS: Data from 26 patients (mean age 61.6 years [standard deviation 13.2]) were analysed. RAGT was highly accepted by patients and feasible, indicated by recruitment, retention, and adherence rates of 84.8% (95% confidence interval, CI 0.7-0.9), 92.2% (95% CI 0.7-1.0) and 94.0% (95% CI 91.4-96.2), respectively. Goal attainment was high, and only mild adverse events occurred. Improvements in walking speed (10-Metre Walk Test, effect size r = 0.876), walking distance (6-Minute Walk Test, r = 0.877), functional mobility (Timed Up and Go, r = 0.875), gait distance (r = 0.829) and number of steps (r = 0.834) were observed. Four themes were identified: familiarising with RAGT; enjoyment and acceptance through a trusting therapeutic relationship; actively interacting; and minimising dissatisfaction. DISCUSSION: Sufficiently powered randomised controlled trials are needed to validate our results. TRIAL REGISTRATION: German Clinical Trials Register, DRKS00027887.
Assuntos
Estudos de Viabilidade , Marcha , Robótica , Humanos , Pessoa de Meia-Idade , Masculino , Feminino , Robótica/métodos , Idoso , Marcha/fisiologia , Doenças do Sistema Nervoso/reabilitação , Doenças do Sistema Nervoso/fisiopatologia , Terapia por Exercício/métodos , Adulto , Transtornos Neurológicos da Marcha/reabilitação , Transtornos Neurológicos da Marcha/fisiopatologia , CaminhadaRESUMO
BACKGROUND: Gait disturbances are exacerbated in people with Parkinson's disease (PD) during dual-task walking (DTW). Transcranial direct current stimulation (tDCS) has been shown to exert beneficial effects on gait performance and cortical excitability in PD; however, its combined effects with treadmill training (TT) remain undetermined. OBJECTIVE: To investigate the effects of tDCS followed by TT on DTW performance and cortical excitability in individuals with PD. METHODS: Thirty-four PD participants were randomized to dorsal lateral prefrontal cortex (DLPFC) tDCS and TT group (DLPFC tDCS + TT group) or sham tDCS and TT group (sham tDCS + TT group) for 50 minutes per session (20 minutes tDCS followed by 30 minutes TT), 12 sessions within 5 weeks (2-3 sessions each week). Outcome measures included cognitive dual-task walking (CDTW), motor dual-task walking (MDTW), usual walking performance, cortical excitability, functional mobility, cognitive function, and quality of life. RESULTS: The DLPFC tDCS + TT group exerted significantly greater improvement in CDTW velocity (P = .046), cadence (P = .043), and stride time (P = .041) compared to sham tDCS + TT group. In addition, DLPFC tDCS + TT group demonstrated a significant increase in resting motor threshold of stimulated hemisphere compared with sham tDCS + TT group (P = .026). However, no significant differences between groups were found in MDTW performance and other outcomes. CONCLUSION: Twelve-session DLPFC tDCS followed by TT significantly improved CDTW performance and decreased cortical excitability more than TT alone in individuals with PD. Applying DLPFC tDCS prior to TT could be suggested for gait rehabilitation in individuals with PD. CLINICAL TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry ACTRN12622000101785.
Assuntos
Excitabilidade Cortical , Córtex Pré-Frontal Dorsolateral , Terapia por Exercício , Doença de Parkinson , Estimulação Transcraniana por Corrente Contínua , Humanos , Doença de Parkinson/reabilitação , Doença de Parkinson/fisiopatologia , Doença de Parkinson/terapia , Masculino , Feminino , Idoso , Pessoa de Meia-Idade , Excitabilidade Cortical/fisiologia , Terapia por Exercício/métodos , Córtex Pré-Frontal Dorsolateral/fisiologia , Transtornos Neurológicos da Marcha/reabilitação , Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/fisiopatologia , Avaliação de Resultados em Cuidados de Saúde , Marcha/fisiologia , Terapia Combinada , Caminhada/fisiologia , Desempenho Psicomotor/fisiologiaRESUMO
BACKGROUND: Although pose estimation algorithms have been used to analyze videos of patients with Parkinson's disease (PD) to assess symptoms, their feasibility for differentiating PD from other neurological disorders that cause gait disturbances has not been evaluated yet. We aimed to determine whether it was possible to differentiate between PD and spinocerebellar degeneration (SCD) by analyzing video recordings of patient gait using a pose estimation algorithm. METHODS: We videotaped 82 patients with PD and 61 patients with SCD performing the timed up-and-go test. A pose estimation algorithm was used to extract the coordinates of 25 key points of the participants from these videos. A transformer-based deep neural network (DNN) model was trained to predict PD or SCD using the extracted coordinate data. We employed a leave-one-participant-out cross-validation method to evaluate the predictive performance of the trained model using accuracy, sensitivity, and specificity. As there were significant differences in age, weight, and body mass index between the PD and SCD groups, propensity score matching was used to perform the same experiment in a population that did not differ in these clinical characteristics. RESULTS: The accuracy, sensitivity, and specificity of the trained model were 0.86, 0.94, and 0.75 for all participants and 0.83, 0.88, and 0.78 for the participants extracted by propensity score matching. CONCLUSION: The differentiation of PD and SCD using key point coordinates extracted from gait videos and the DNN model was feasible and could be used as a collaborative tool in clinical practice and telemedicine.
Assuntos
Algoritmos , Estudos de Viabilidade , Transtornos Neurológicos da Marcha , Doença de Parkinson , Degenerações Espinocerebelares , Humanos , Doença de Parkinson/diagnóstico , Doença de Parkinson/complicações , Doença de Parkinson/fisiopatologia , Masculino , Feminino , Idoso , Pessoa de Meia-Idade , Transtornos Neurológicos da Marcha/diagnóstico , Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/fisiopatologia , Degenerações Espinocerebelares/diagnóstico , Degenerações Espinocerebelares/fisiopatologia , Degenerações Espinocerebelares/complicações , Gravação em Vídeo/métodos , Diagnóstico Diferencial , Marcha/fisiologiaRESUMO
BACKGROUND: Homolateral Imitative Synkinesis (HIS) is a rare form of associative movement between the ipsilateral upper and lower limbs. The incidence of HIS or its correlation with various movements remains uninvestigated. This study expounds on the characteristics of HIS, the frequency at which it occurs, and its relationship with movement, particularly walking. METHODS: This study included 1328 patients with acute stroke admitted to our healthcare facility between October 2019 and February 2022. We evaluated the severity of motor paralysis and sensory impairment in instances where HIS manifested, and assessed the relationship between HIS, basic activities, and gait. RESULTS: HIS was observed in 13/1328 patients. Motor paralysis was mild in all the cases. Each patient displayed a degree of sensory impairment, albeit of varying severity. HIS did not manifest during basic activities but was evident during walking movements in five instances. These patients displayed involuntary repetitive lifting of their upper limbs during the swing phase of their gait. Some individuals expressed discontent with involuntary upper-limb movements, citing them as contributors to a suboptimal gait. CONCLUSIONS: This study identified HIS as a rare syndrome, manifesting at a rate of 0.9%. Focus was more common in patients with damage to the thalamus and parietal lobe. No manifestations of the HIS occurred during basic activities, suggesting a weak correlation between the HIS and such activities. Certain patients exhibit HIS during gait, report suboptimal gait, and have an increased risk of falls, potentially influencing their gait proficiency.
Assuntos
Marcha , Sincinesia , Humanos , Masculino , Idoso , Pessoa de Meia-Idade , Sincinesia/fisiopatologia , Sincinesia/diagnóstico , Sincinesia/etiologia , Feminino , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/complicações , Índice de Gravidade de Doença , Idoso de 80 Anos ou mais , Adulto , Transtornos Neurológicos da Marcha/fisiopatologia , Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/diagnóstico , Extremidade Superior/inervação , Estudos RetrospectivosRESUMO
BACKGROUND: Wearable technologies using inertial sensors are an alternative for gait assessment. However, their psychometric properties in evaluating post-stroke patients are still being determined. This systematic review aimed to evaluate the psychometric properties of wearable technologies used to assess post-stroke gait and analyze their reliability and measurement error. The review also investigated which wearable technologies have been used to assess angular changes in post-stroke gait. METHODS: The present review included studies in English with no publication date restrictions that evaluated the psychometric properties (e.g., validity, reliability, responsiveness, and measurement error) of wearable technologies used to assess post-stroke gait. Searches were conducted from February to March 2023 in the following databases: Cochrane Central Registry of Controlled Trials (CENTRAL), Medline/PubMed, EMBASE Ovid, CINAHL EBSCO, PsycINFO Ovid, IEEE Xplore Digital Library (IEEE), and Physiotherapy Evidence Database (PEDro); the gray literature was also verified. The Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) risk-of-bias tool was used to assess the quality of the studies that analyzed reliability and measurement error. RESULTS: Forty-two studies investigating validity (37 studies), reliability (16 studies), and measurement error (6 studies) of wearable technologies were included. Devices presented good reliability in measuring gait speed and step count; however, the quality of the evidence supporting this was low. The evidence of measurement error in step counts was indeterminate. Moreover, only two studies obtained angular results using wearable technology. SIGNIFICANCE: Wearable technologies have demonstrated reliability in analyzing gait parameters (gait speed and step count) among post-stroke patients. However, higher-quality studies should be conducted to improve the quality of evidence and to address the measurement error assessment. Also, few studies used wearable technology to analyze angular changes during post-stroke gait.
Assuntos
Análise da Marcha , Transtornos Neurológicos da Marcha , Psicometria , Dispositivos Eletrônicos Vestíveis , Humanos , Marcha/fisiologia , Análise da Marcha/instrumentação , Transtornos Neurológicos da Marcha/diagnóstico , Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/fisiopatologia , Transtornos Neurológicos da Marcha/reabilitação , Psicometria/instrumentação , Reprodutibilidade dos Testes , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/fisiopatologia , Reabilitação do Acidente Vascular Cerebral/métodosRESUMO
Crouch gait is one of the most common compensatory walking patterns found in individuals with neurological disorders, often accompanied by their limited physical capacity. Notable kinematic characteristics of crouch gait are excessive knee flexion during stance and reduced range of motion during swing. Knee exoskeletons have the potential to improve crouch gait by providing precisely controlled torque assistance directly to the knee joint. In this study, we implemented a finite-state machine-based impedance controller for a powered knee exoskeleton to provide assistance during both stance and swing phases for five children and young adults who exhibit chronic crouch gait. The assistance provided a strong orthotic effect, increasing stance phase knee extension by an average of 12 deg. Additionally, the knee range of motion during swing was increased by an average of 15 deg. Changes to spatiotemporal outcomes, such as preferred walking speed and percent stance phase, were inconsistent across subjects and indicative of the underlying intricacies of user response to assistance. This study demonstrates the potential of knee exoskeletons operating in impedance control to mitigate the negative kinematic characteristics of crouch gait during both stance and swing phases of gait.