http://www.sciencedirect.com/science/article/pii/S1877042814019223
Abstract
Hemiparetic
gait due to stroke is characterized by temporal asymmetry and
variability. Research shows this can be improved by auditory cueing,
whereby participants train to step in time and space with a visual or
auditory cue. This particular method is effective in training a
symmetrical gait and helps to improve coordination and speed. We
describe a pilot study that investigates the possibility of training
with an auditory rhythmical metronome embedded in music, during stepping
in place within a home- based setting. Stepping in place incorporates
aspects of movements that are also important for a successful gait, such
as reciprocal flexion and extension of the legs in timely coordination
and synchronization, creating a step frequency, a swing phase and single
limb support. Stepping in place may also provide a valuable method for
home-based training, as little space in the home is required and,
therefore, participants are less likely to fall. This case study seeks
to obtain proof of the concept that stepping in place within a home
setting may be a useful tool for locomotor training after stroke.
A
hemiparetic stroke patient, PF, successfully completed 6 weeks of
home-based training for 15 minutes a day, 5 days a week (with 5% weekly
increments in music tempo). PF (aged 58) is a male, right handed,
chronic stroke survivor, who presented left sided hemiparesis. He was
recruited from a local stroke club based on the inclusion criteria that
he was able to walk independently without supervision (but able to use a
gait aid such as a cane or walker) and was free from hearing
impairments. Finally, PF was also able to complete a 3 m Timed Up and
Go, which is typically used as an indicator of falls and provides an
indication of the patient's ability during turns. He was assessed five
times during the 12 week period of the study, which included baseline,
three weeks of training, three weeks of rest (used to measure resting
effects), a second three-week training period and finally after another
three weeks of rest. During each assessment, PF was tested for his gait
speed during a 10 m walking task. During these tests, we also captured
the spatiotemporal parameters of his gait using six accelerometer
sensors (OPAL, APDM). The sensors were placed around the trunk, the
lumbar, and the left and right shins and feet and have been designed to
measure walking. The use of such motion capture systems is intended to
provide a more sensitive and objective measure of the changes in
movement that might occur following gait rehabilitation, compared to the
use of standard clinical measures. We also used the following clinical
assessments: The Dynamic Gait Index (which measures balance during
walking), and The Rivermead Motor Scale (measuring general walking
ability).
The results showed significant
improvements in all spatiotemporal aspects of PF's gait. There was a 10 s
speed increase in his 10 m walking, between his baseline and final
assessment. Furthermore, changes in PF's gait cycle were shown after 6
weeks of training stepping in place, suggesting improvements towards a
more symmetrical gait pattern. For example, an increase in cadence was
revealed, which likely follows increases in the gait speed during 10 m
walking. A decrease in the overall gait cycle time, decreases in double
support, and further decreases in stride length asymmetry and swing
asymmetry were also observed. These findings might be expected based on
previous work investigating changes in spatiotemporal parameters after
gait rehabilitation and suggest that training stepping in place
generalizes to walking ability. Furthermore, no changes were observed in
any of the clinical assessments, suggesting the need for more sensitive
measures of functional ability in capturing improvements of lower limb
function after training stepping in place. These preliminary data show
promising results for stepping in place in the home, as a method of
training a symmetrical gait after stroke. This method also provides a
cheap addition to other rehabilitation techniques such as physiotherapy,
as it can be conducted within the home, without the need for a
therapist and will provide patients with more intensive rehabilitation
after stroke. Lastly, it is important to note, based on patient feedback
that presenting the rhythmical beat in a music context was likely a key
factor in motivating the patient to complete his training. As
compliance is of high importance in rehabilitation, incorporating music
should be taken into consideration for future investigations whereby the
training provided may be repetitive in nature.
My ST, who was completely amazing had me download a metronome on my phone to improve my walking. She was right, it helped a lot....and she wasn't even the person in charge of my walking.
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