Post-stroke Hemiplegic Gait: New Perspective and Insights

Frontiers in Physiology, Год журнала: 2018, Номер 9

Опубликована: Авг. 2, 2018

Walking dysfunction occurs at a very high prevalence in stroke survivors. Human walking is phenomenon often taken for granted, but it mediated by complicated neural control mechanisms. The automatic process includes the brainstem descending pathways (RST and VST) intraspinal locomotor network. It known that leg muscles are organized into modules to serve subtasks body support, posture locomotion. Major kinematic mechanisms recognized minimize center of gravity (COG) displacement. Stroke leads damage motor cortices their corticospinal tracts subsequent muscle weakness. On other hand, network disinhibited become hyperexcitable. Recent advances suggest they mediate post-stroke spasticity diffuse spastic synergistic activation. As result such changes, existing simplified merged, thus leading poor support performance. wide range hierarchy hemiplegic gait impairments reflection mechanical consequences weakness, abnormal activation interactions. Given role locomotion spasticity, new perspective understanding proposed. Its clinical implications management discussed. Two cases presented as application examples.

Язык: Английский

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

Frontiers in Neurology, Год журнала: 2021, Номер 12

Опубликована: Июнь 8, 2021

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

Язык: Английский

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A New Definition of Poststroke Spasticity and the Interference of Spasticity With Motor Recovery From Acute to Chronic Stages

Neurorehabilitation and neural repair, Год журнала: 2021, Номер 35(7), С. 601 - 610

Опубликована: Май 12, 2021

The relationship of poststroke spasticity and motor recovery can be confusing. “True” refers to return behaviors prestroke state with the same end-effectors temporo-spatial pattern. This requires neural repair, presumably occurs mainly in acute subacute stages. However, according International Classification Functioning, Disability Health, after stroke is also defined as “improvement performance functional tasks,” i.e., recovery, which mediated by compensatory mechanisms. Therefore, survivors execute tasks spite disordered control presence spasticity. Spasticity interferes execution normal (“true” recovery), throughout evolution from chronic reduction does not affect stages; however, appropriate management could lead improvement function, that is, during stage stroke. We assert results upregulation medial cortico-reticulo-spinal pathways are disinhibited due damage cortex or corticobulbar pathways. emerges a manifestation maladaptive plasticity early stages persist into stage. It coexists shares similar pathophysiological processes related impairments, such abnormal force control, muscle coactivation synergies, diffuse interlimb activation. Accordingly, we propose new definition better account for its pathophysiology complex nuances different definitions recovery.

Язык: Английский

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Randomized controlled trial of robot-assisted gait training with dorsiflexion assistance on chronic stroke patients wearing ankle-foot-orthosis

Journal of NeuroEngineering and Rehabilitation, Год журнала: 2018, Номер 15(1)

Опубликована: Июнь 19, 2018

Robot-assisted ankle-foot-orthosis (AFO) can provide immediate powered ankle assistance in post-stroke gait training. Our research team has developed a novel lightweight portable robot-assisted AFO which is capable of detecting walking intentions using sensor feedback wearer's pattern. This study aims to investigate the therapeutic effects training with dorsiflexion assistance.This was double-blinded randomized controlled trial. Nineteen chronic stroke patients motor impairment at participated 20-session for about five weeks, 30-min over-ground and stair ambulation practices. either provided active during swing phase Robotic Group (n = 9), or torque impedance joint as passive Sham 10). Functional assessments were performed before after 3-month Follow-up. Primary outcome measure independency assessed by Ambulatory Category (FAC). Secondary measures clinical scores including Fugl-Meyer Assessment (FMA), Modified Ashworth Scale (MAS), Berg Balance (BBS), Timed 10-Meter Walk Test (10MWT), Six-minute (SMWT), supplemented analysis. All unassisted had taken off AFO. Repeated-measures analysis covariance conducted test group differences referenced training.After assistance, induced changes pattern improved (all FAC ≥ 5 post-training follow-up), recovery, speed, greater confidence affected side loading response (vertical ground reaction force + 1.49 N/kg, peak braking 0.24 N/kg) heel strike instead flat foot touch-down initial contact (foot tilting 1.91°). reported reduction leg range motion (ankle - 2.36° knee flexion 8.48°) swing.Robot-assisted could improve help developing weight acceptance, but future development should consider more custom-fit design.ClinicalTrials.gov NCT02471248 . Registered 15 June 2015 retrospectively registered.

Язык: Английский

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Rehabilitation interventions for improving balance following stroke: An overview of systematic reviews

PLoS ONE, Год журнала: 2019, Номер 14(7), С. e0219781 - e0219781

Опубликована: Июль 19, 2019

Background The aim of this study was to synthesize evidence from systematic reviews, summarise the effects rehabilitation interventions for improving balance in stroke survivors. Methods We conducted an overview reviews (SRs). included Cochrane Systematic Reviews and non-Cochrane randomized-controlled clinical trials not-randomized trials, all types stroke, comparing interventions, control no on balance-related outcomes. a comprehensive search electronic databases, inception December 2017. Data extracted included: number type participants, intervention, method assessing risk bias primary studies, outcome measures results statistical meta-analyses. Methodological quality assessed using AMSTAR 2. A narrative description characteristics SRs provided meta-analyses summarised with reference their methodological quality. Results 51 (248 studies 10,638 participants) met inclusion criteria were overview. All participants adults stroke. wide variety different postural outcomes included. 61% focussed effectiveness physical therapy, 20% virtual reality, 6% electromechanical devices, 4% Tai-Chi, whole body vibration circuit training 2% cognitive rehabilitation. methodology 54% judged be “low or critically low” quality, 23% “moderate” 22% “high” Conclusions There are relating improve people but majority these poor limiting our ability draw clear implications. Only high highlighting need address important issues within research.

Язык: Английский

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The Effect of Robotic Assisted Gait Training With Lokomat® on Balance Control After Stroke: Systematic Review and Meta-Analysis

Frontiers in Neurology, Год журнала: 2021, Номер 12

Опубликована: Июль 6, 2021

Introduction: Disturbances of balance control are common after stroke, affecting the quality gait and increasing risk falls. Because disorders may persist also in chronic stage, reducing individual independence participation, they represent primary goals neurorehabilitation programs. For this purpose, recent years, numerous technological devices have been developed, among which one most widespread is Lokomat®, an actuated exoskeleton that guide patient's limbs, simulating a symmetrical bilateral gait. Preliminary evidence suggests beyond parameters, robotic assisted training improve balance. Therefore, aim systematic review was to summarize about effectiveness Lokomat® improving stroke patients. Methods: Randomized controlled trials published between January 1989 August 2020, comparing conventional therapy for patients, were retrieved from seven electronic databases. Balance, assessed by means validated clinical scales, considered as outcome measure. The Physiotherapy Evidence Database (PEDro) scale used evaluate methodological studies. study protocol registered on PROSPERO (no. CRD42020197531). Results: After removal duplicates, according inclusion criteria, 13 studies selected, involving 445 subacute or Eleven papers contributed three meta-analyses. Favorable results recovery survivors treated with shown using Timed Up Go (pooled mean difference = −3.40, 95% CI −4.35 −2.44; p < 0.00001) Rivermead Mobility Index measures 0.40, 0.26–0.55; 0.00001). Inconclusive found when measured Berg Balance Scale 0.17, −0.26 0.60; 0.44). Conclusions: Overall, beneficial effects survivors, at least comparable physical therapy. However, due limited number their high heterogeneity, further research needed draw more solid definitive conclusions.

Язык: Английский

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Walk the Talk: Current Evidence for Walking Recovery After Stroke, Future Pathways and a Mission for Research and Clinical Practice

Stroke, Год журнала: 2022, Номер 53(11), С. 3494 - 3505

Опубликована: Сен. 7, 2022

Achieving safe, independent, and efficient walking is a top priority for stroke survivors to enable quality of life future health. This narrative review explores the state science in recovery after potential development. The importance targeting capacity performance explored relation individual survivor gait recovery, applying common language, measurement, classification, prediction, current intervention development, health care delivery. Findings are summarized model research mission statement set researchers clinicians drive field forward improve lives their carers.

Язык: Английский

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Minimal Clinically Important Difference of Scales Reported in Stroke Trials: A Review

Brain Sciences, Год журнала: 2024, Номер 14(1), С. 80 - 80

Опубликована: Янв. 13, 2024

There is a growing awareness of the significance using minimum clinically important differences (MCIDs) in stroke research. An MCID smallest change an outcome measure that considered meaningful. This review first to provide comprehensive summary various scales and patient-reported measures (PROMs) used research their values reported literature, including concise overview concept methods for determining MCIDs Despite controversies limitations surrounding estimation MCIDs, importance modern clinical trials cannot be overstated. Anchor-based distribution-based are recommended estimating with patient self-evaluation being crucial component capturing patient's perspective on health. A combination can more understanding relevance treatment effects, incorporating enhance care patients.

Язык: Английский

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Advanced technology for gait rehabilitation: An overview

Advances in Mechanical Engineering, Год журнала: 2018, Номер 10(7), С. 168781401878362 - 168781401878362

Опубликована: Июль 1, 2018

Most gait training systems are designed for acute and subacute neurological inpatients. Many used relearning movements (nonfunctional training) or cycle (functional training). Each system presents its own advantages disadvantages in terms of functional outcomes. However, is not sufficient the rehabilitation ambulation. There a need new solutions to overcome limitations existing order ensure individually tailored conditions each potential users, no matter complexity his her condition. also new, integrative approach rehabilitation, one that encompasses addresses all aspects physical as well psychological ambulation real-life multitasking situations. In this respect, multidisciplinary multinational team performed an overview current technology reviewed principles training.

Язык: Английский

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Behavioral outcome measures to improve experimental stroke research

Behavioural Brain Research, Год журнала: 2017, Номер 352, С. 161 - 171

Опубликована: Июль 29, 2017

Язык: Английский

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