Virtual Walking Training Program Using a Real-world Video Recording for Patients with Chronic Stroke

Hemiplegic individuals often exhibit gait impairments. Current technologies allow for simple and fast acquisition of spatiotemporal gait parameters and gait Symmetry Indices (SI). Gait SI have been associated with instability and fall risk. These data may therefore prove an important addition to the already common conventional clinical measures, e.g. the 10 Meter Walk Test (10MWT), Berg Balance Scale (BBS), Timed Up and Go Test (TUG), Six Minute Walk Test (6MWT) and the Motor Functional Independence Measure (MFIM). However, the prediction of these conventional clinical measures using spatiotemporal gait parameters and gait SI for individuals post stroke, has yet to be thoroughly investigated. We aimed to evaluate the correlation between spatiotemporal gait parameters and commonly-used clinical gait test scores, and to predict common clinical measures by spatiotemporal gait parameters in patients post stroke. In this cross-sectional retrospective study, spatiotemporal data were collected from files of adult patients (n = 70) post stroke, who performed one or more of the aforementioned functional evaluations within 1 year following stoke. Correlations were also performed for 53 of these subjects who performed all the tests in the subacute stage. High correlations (>0.7) were found between 10MWT, 6MWT and TUG and between diverse spatiotemporal parameters. Spatiotemporal parameters significantly predicted the 6MWT (R2 = .743), TUG (R2 = .668), 10MWT (R2 = .552), MFIM (R2 = .513), and the BBS (R2 = .556). An objective computerized evaluation producing spatiotemporal and symmetry gait parameters is compatible with common functional gait measures and might prove more advantageous in patient evaluation, since it provides additional multiple data, easily and quickly acquired.

The purpose of this study was to evaluate the effects of mobilization of the sciatic nerve on hamstring flexibility, lower limb strength, and gait performance in patients with chronic stroke. This study was a randomized clinical trial with a crossover design. Sixteen subjects were recruited for this study. The subjects were randomly divided into two intervention groups and underwent either of the following two interventions: sciatic nerve mobilization or static stretching of the hamstring. We assessed hamstring flexibility, lower limb strength, and gait performance using a digital inclinometer, a hand-held dynamometer, and the 10-meter walk test, respectively. Subjects had a 24-hour rest period between each session in order to minimize carryover effects. Measurements for each test were assessed prior to and immediately after the intervention sessions. Using a two-way analysis of variance test with repeated measures, data from the two trials were analyzed by comparing the differences between both techniques. The level of statistical significance was set at .05. Sciatic nerve mobilization resulted in significantly better knee extensor strength (p=.023, from 15.32±5.98 to 18.16±6.95 ㎏) and knee flexor strength (p=.011, from 7.80±4.80 to 8.15±4.24 ㎏) in the experimental group than in the control group. However, no significant effects of static stretching of the hamstring were observed on hamstring flexibility from the ankle plantar flexion (p=.966) and ankle neutral positions (p=.210) and on gait performance (p=.396). This study indicated that the sciatic nerve mobilization technique may be more effective in muscle activation of the knee extensor muscle and knee flexor muscle than hamstring static stretching technique in patients with chronic stroke.

Introduction: Diabetic Peripheral Neuropathy (DPN) clinically manifests as a sensorimotor disturbance that leads to complications in gait alteration and balance impairment. Balance and locomotion are the most critical aspects of an individual’s independence. Aim: To assess the effect of Retro walking with Lagos Neuropathy Protocol (LNP) on balance and spatiotemporal parameters of gait among patients with Diabetic neuropathy. Materials and Methods: The present prospective interventional Study was conducted in the Outpatient Department (OPD), Krupanidhi College of Physiotherapy, Bengaluru, Karnataka, India, from October 2022 to June 2023. The sample size was 60 individuals, 30 in each group (experimental and control group). Group 1, the control group, received the conventional LNP. Group 2, the experimental group, received the LNP combined with backward walking. The interventions were given to the patients four times/week for eight weeks. Subjects were assessed at the initial stage and following the end of the intervention. The parameters assessed were balance and spatiotemporal parameters of gait, in which balance was assessed by using the Mini Balance Evaluation Systems Test (Mini-BESTest) and gait speed using a 10 m walk test; other gait parameters cadence, step length, and stride length were measured individually using a stopwatch and inch tape. The statistical software used was Statistical Package for the Social Sciences (SPSS) software version 29.0, and the tests included were paired t-tests and independent t-tests for data analysis. Result: The mean±Standard Deviation (SD) age of the experimental group participants was 51±3.24 years, and the control group was 50.87±3.12 years. A significant improvement was seen in cadence, step length, stride length, gait speed, and balance in the control and experimental group (p-value<0.001) Greater improvement was found in the experimental group when compared with the control group in all the outcome measures. Significant improvement was seen in all parameters in the experimental group when compared to the control group at post-test (p-value <0.05). Conclusion: The study concluded that the LNP combined with backward walking had a significant positive effect on balance and spatiotemporal determinants of gait than the LNP alone among DPN patients.

The purpose of this study was to investigate the effects of treadmill training (TT) with functional electrical stimulation (FES) applied on the gluteus medius (GM) and tibialis anterior (TA) muscles on gait and balance performance in individuals with hemiparetic stroke. Thirty-six participants who had chronic hemiparetic stroke, were recruited in this study, and were randomly distributed into three groups: TT with FES applied on the GM and TA muscles (Experimental group 1,12 patients), TT with FES applied on the TA muscle (Experimental group 2, 12 patients), and TT only (Control group, 12 patients). All participants were involved in a total of 20 sessions of TT with harness, 30 minutes per day, five times per a week for four weeks. They also received the regular physical therapy for 1 hour per day, five times per a week for four weeks. All participants were measured the digital muscle test, Berg balance scale (BBS), 6 minute walk test (6MWT), and spatiotemporal parameters before and after training. After training, Experimental group 1 showed significant improvement in hip abductor strength, BBS scores, 6MWT scores, gait velocity, and cadence compared to the Experimental group 2 and control group. These findings show that TT with FES applied on the GM and TA muscles contributed to producing increased lower extremity muscle strength, and improvements of balance and gait capacities. Therefore, it is suggestive that TT with FES applied on GM and TA can be beneficial intervention within the clinical settings in individuals with chronic hemiparetic stroke.

Background and Purpose- The purpose of this study was to investigate the effects of gait training with a newly developed wearable hip-assist robot on locomotor function and efficiency in patients with chronic stroke. Methods- Twenty-eight patients with stroke with hemiparesis were initially enrolled, and 26 patients completed the randomized controlled trial (14 in the experimental and 12 in the control groups). The experimental group participated in a gait training program over a total of 10 sessions, including 5 treadmill sessions and 5 over-ground gait training sessions while wearing a hip-assist robot, the Gait Enhancing and Motivating System (GEMS, Samsung Advanced Institute of Technology, Suwon, Republic of Korea). The control group received gait training without Gait Enhancing and Motivating System. Primary outcome measured locomotor function and cardiopulmonary metabolic energy efficiency. Also, secondary outcome measured motor function and balance parameter. Results- Compared with the control group, the experimental group had significantly greater improvement in spatiotemporal gait parameters and muscle efforts after the training intervention (P<0.05). The net cardiopulmonary metabolic energy cost (mL·kg-1·min-1) was also reduced by 14.71% in the experimental group after the intervention (P<0.01). Significant group×time interactions were observed for all parameters (P<0.05). Cardiopulmonary metabolic efficiency was strongly correlated with gait symmetry ratio in the experimental group (P<0.01). Conclusions- Gait training with Gait Enhancing and Motivating System was effective for improving locomotor function and cardiopulmonary metabolic energy efficiency during walking in patients with stroke. These findings suggest that robotic locomotor training can be adopted for rehabilitation of patients with stroke with gait disorders. Clinical Trial Registration- URL: https://clinicaltrials.gov. Unique identifier: NCT02843828.

Improving spatiotemporal gait parameters in spastic diplegic children using treadmill gait training

Background:The effects of whole body vibration (WBV) on chronic stroke (CS) patients have been investigated by some previous studies. However, controversy still exists.Objective:The objective of this meta-analysis was to review existing studies that assess the effects of WBV training on CS patients.Methods:We searched Medline, Web of Science, EMBASE, and the Cochrane Library for papers published between January 2000 and January 2014.The meta-analyses were performed using Review Manage Version 5.2.Weighted mean difference (WMD) or standard mean difference (SMD) and its 95% confidence intervals (CI) were used as summary statistics. Funnel plot was used to assess the publication bias.Results:Seven studies with 298 CS patients (159 patients underwent WBV training in experimental group and 139 patients underwent nothing or the same exercise without vibration or with a “placebo” vibrating platform in control group) were included. No significant difference was found in muscle strength (isometric knee extension strength: SMD = − 0.15, 95% CI, − 0.43 to 0.13, P = 0.30; isometric knee flexion strength: WMD = − 0.05, 95% CI, − 0.13 to 0.03, P = 0.22), balance (berg balance scale, WMD = − 0.23, 95% CI, − 1.54 to 1.09; P = 0.74) and gait performance (6-min walk test, WMD = − 50.40, 95% CI, − 118.14 to 17.34; P = 0.14) between groups. No indication of publication bias was found in the funnel plot.Conclusions:WBV training had no beneficial effects in muscle strength, balance and gait performance of CS patients.

Gait speed is commonly used to assess walking ability in persons with stroke. Previous research related to the psychometric properties of gait speed has been conducted primarily with individuals who were able to walk independently and/or were in the later stages of recovery after stroke. The purpose of this research was to examine the test-retest reliability and minimal detectable change (MDC90) of gait speed in individuals with stroke who required varying levels of assistance to ambulate during rehabilitation. Patients who could ambulate with or without physical assistance and were undergoing inpatient rehabilitation were recruited. Gait speed was measured over the middle five meters of a nine-meter walk at a comfortable pace. Data were analyzed using the intraclass correlation coefficient (ICC2,1) and the MDC90. Thirty-five patients who were a mean 34.5 (standard deviation = 17.7) days post-stroke agreed to participate. For all the subjects combined, the ICC2,1 was 0.862 and MDC90 was 0.30 m/sec. For the 13 subjects who required physical assistance to walk, the ICC2,1 = 0.971 and MDC90 = 0.07 m/sec. For the 22 subjects who could walk without physical assistance, the ICC2,1 = 0.80 and MDC90 = 0.36 m/sec. Gait speed is a reliable measure of walking ability for a wide variety of patients undergoing rehabilitation after stroke. Gait speed is more sensitive to change in patients who require physical assistance to walk than in those who can walk without assistance. A change of more than 0.30 m/sec may be necessary in order to determine whether a change in gait speed exceeds measurement error and patient variability.

BackgroundBehavioral and psychological symptoms of dementia (BPSD) are associated with increased stress, burden, and depression among family caregivers of people with dementia. STAR-Caregivers Virtual Training and Follow-up (STAR-VTF) is adapted from an evidence-based, in-person program that trains family caregivers to manage BPSD. We used a human-centered design approach to obtain feedback from family caregivers about STAR-VTF. The program will be evaluated using a pragmatic randomized trial.ObjectiveThe objective of the study was to understand the needs of family caregivers for improving BPSD management and the extent to which caregivers perceived that STAR-VTF could address those needs.MethodsBetween July and September 2019, we conducted 15 semistructured interviews with family caregivers of people with dementia who receive care at Kaiser Permanente Washington in the Seattle metropolitan area. We identified participants from electronic health records, primarily based on a prescription for antipsychotic medication for the person with dementia (a proxy for caregivers dealing with BPSD). We showed caregivers low-fidelity prototypes of STAR-VTF online self-directed materials and verbally described potential design elements. We obtained caregiver feedback on these elements, focusing on their needs and preferences and perceived barriers to using STAR-VTF. We used a hybrid approach of inductive and deductive coding and aggregated codes to develop themes.ResultsThe idea of a virtual training program for learning to manage BPSD appealed to caregivers. They said health care providers did not provide adequate education in the early disease stages about the personality and behavior symptoms that can affect people with dementia. Caregivers found it unexpected and frustrating when the person with dementia began experiencing BPSD, symptoms they felt unprepared to manage. Accordingly, caregivers expressed a strong desire for the health care organization to offer programs such as STAR-VTF much sooner. Caregivers had already put considerable effort into problem solving challenging behaviors. They anticipated deriving less value from STAR-VTF at that point. Nonetheless, many were interested in the virtual aspect of the training due to the convenience of receiving help from home and the perception that help from a virtual program would be timelier than traditional service modalities (eg, face to face). Given caregivers’ limited time, they suggested dividing the STAR-VTF content into chunks to review as time permitted. Caregivers were interested in having a STAR-VTF provider for additional support in managing challenging behaviors. Caregivers reported a preference for having the same coach for the program duration.ConclusionsCaregivers we interviewed would likely accept a virtual training program such as STAR-VTF to obtain information about BPSD and receive help managing it. Family caregivers anticipated deriving more value if STAR-VTF was offered earlier in the disease course.

BackgroundGait disability affects the daily lives of patients with stroke in both home and community settings. An abnormal foot–ankle position can cause instability on the supporting surface and negatively affect gait. Our research team explored the ability of a portable peroneal nerve-targeting electrical stimulator to improve gait ability by adjusting the foot–ankle position during walking in patients with chronic stroke undergoing home-based rehabilitation.MethodsThis was a double-blinded, parallel-group randomized controlled trial. Thirty-one patients with chronic stroke and ankle–foot motor impairment were randomized to receive 3 weeks of gait training, which involved using the transcutaneous peroneal nerve stimulator while walking (tPNS group; n = 16, mean age: 52.25 years), or conventional home and/or community gait training therapy (CT group; n = 15, mean age: 54.8 years). Functional assessments were performed before and after the 3-week intervention. The outcome measures included spatiotemporal gait parameters, three-dimensional kinematic and kinetic data on the ankle–foot joint, and a clinical motor and balance function assessment based on the Fugl–Meyer Assessment of Lower Extremity (FMA-LE) and Berg Balance scales (BBS). Additionally, 16 age-matched healthy adults served as a baseline control of three-dimensional gait data for both trial groups.ResultsThe FMA-LE and BBS scores improved in both the tPNS groups (p = 0.004 and 0.001, respectively) and CT groups (p = 0.034 and 0.028, respectively) from before to after training. Participants in the tPNS group exhibited significant differences in spatiotemporal gait parameters, including double feet support, stride length, and walking speed of affected side, and the unaffected foot off within a gait cycle after training (p = 0.043, 0.017, 0.001 and 0.010, respectively). Additionally, the tPNS group exhibited significant differences in kinematic parameters, such as the ankle angle at the transverse plane (p = 0.021) and foot progression angle at the frontal plane (p = 0.009) upon initial contact, and the peak ankle joint angle at the transverse plane (p = 0.023) and foot progression angle (FPA) at the frontal and transverse planes (p = 0.032 and 0.046, respectively) during gait cycles after 3 weeks of training.ConclusionsUse of a portable tPNS device during walking tasks appeared to improve spatiotemporal gait parameters and ankle and foot angles more effectively than conventional home rehabilitation in patients with chronic stroke. Although guidelines for home-based rehabilitation training services and an increasing variety of market devices are available, no evidence for improvement of motor function and balance was superior to conventional rehabilitation.Trial registration Chictr, ChiCTR2000040137. Registered 22 November 2020, https://www.chictr.org.cn/showproj.aspx?proj=64424

Objective: The purpose of this study was conducted to compare the effects of progressively increasing patient engagement between robot-assisted gait training and active weight-supported treadmill training on chronic stroke patients and to identify an effective clinical approach. Design: A randomized controlled trial. Methods: A total of 34 participants with chronic stroke participated in this study. Random program was conducted and assigned to the experimental group (n=17) and the control group (n=17). Robot-assisted gait training was performed in the experimental group, and weight-supported treadmill training was performed in the control group. Fugl-Meyer Assessment-Lower Extremity (FMA-LE), Berg Balance Scale (BBS), Timed Up and Go (TUG), G-walk system, Falls Efficacy Scale (FES) were measured before and after the intervention to compare their effectiveness. Results: Both groups showed significant differences in FMA-LE, BBS, TUG, G-walk, FES before and after intervention (p 0.05). In addition, the experimental group showed significant differences in FMA-LE, BBS, TUG, G-walk, FES compared to the control group (p0.05). Conclusions: Robot-assisted gait training is an effective intervention method that is clinically significant for improving lower limb function, balance ability, gait ability, and fall efficacy in chronic stroke patients.

No Specific Effect of Whole-Body Vibration Training in Chronic Stroke: A Double-Blind Randomized Controlled Study

IntroductionMotor function after stroke may be facilitated by the application of task-oriented approach which provides both functional and neurological recovery than otherwise possible. Also, virtual reality training promotes the restoration of movements by immersing the patient in an entertaining trial of performance.MethodsTo compare between the effect of virtual reality training program and task-oriented training program on the paretic upper limb function post stroke. Twenty subacute stroke survivors participated in the study. Participants were randomly allocated into one of two equal groups of 10; experimental group (A) and control group (B). Experimental group (A) performed a virtual reality program and task-oriented program, while Control group (B) performed task-oriented program only. Assessment was done for all participants using upper limb function index and grip strength test before (pre testing) and after six weeks of intervention (post testing).ResultsPaired &lt;i&gt;t&lt;/i&gt;-test revealed that Virtual reality training group (Experimental group A) had statistical significant increases in the post testing mean values (after six weeks of intervention) of both upper limb functional index and hand grip strength compared to the pre testing values (&lt;i&gt;p&lt;/i&gt; &lt; 0.05). Furthermore, independent &lt;i&gt;t&lt;/i&gt;-test showed a statistical significant increases in their post testing mean values in the experimental group A compared to the control group B.ConclusionsThe virtual reality training has a vital role in improving upper limb function and augmenting hand grip strength post stroke. It can be considered more effective than task-oriented in such cases.

Hands-On Training in a Digital World: A Novel Simulation-Based Virtual Training Program for Placement and Removal of the Subdermal Contraceptive Implant

Purpose: This study was designed to evaluate the effectiveness of the compelled body weight shift (CBWS) therapy approach in the rehabilitation of individuals with chronic stroke. CBWS involves a forced shift of body weight toward a person’s affected side by means of a shoe insert that establishes a lift of the nonaffected lower extremity. Method: Eighteen individuals with chronic, unilateral stroke (mean age 57.7 ± 11.9 years, with a range of 35-75 years; mean time since stroke 6.7 ± 3.9 years, with a range of 1.1-14.1 years) who showed asymmetrical stance were randomly divided into 2 groups: the experimental group received 6 weeks of physical therapy combined with CBWS therapy, and the control group received only physical therapy. Both groups underwent a battery of identical tests (Fugl-Meyer Assessment, Berg Balance Scale, weight bearing, and gait velocity) before the start of the rehabilitation intervention, following its completion, and 3 months after the end of therapy. Results: After the intervention, weight bearing on the affected side (measured with the Balance Master) increased in the experimental group to a larger degree compared to the control group (9.7% vs 6.4%). Similarly, gait velocity increased 10.5% in the experimental group compared to the control group. Improvements in weight bearing and gait velocity were maintained in the experimental group after the 3-month retention period. Conclusion: The study outcome revealed that a 6-week intervention involving CBWS therapy could result in a long-lasting improvement of the symmetry of weight bearing and velocity of gait in individuals with chronic stroke.