Evaluating the effects of delivering integrated kinesthetic and tactile cues to individuals with unilateral hemiparetic stroke during overground walking

Useless. No mention of where to get the protocols used. 
https://jneuroengrehab.biomedcentral.com/articles/10.1186/s12984-018-0372-0

• Muhammad Raheel Afzal,
• Sanghun Pyo,
• Min-Kyun OhEmail author,
• Young Sook Park and
• Jungwon YoonEmail authorView ORCID ID profile

Journal of NeuroEngineering and Rehabilitation201815:33

https://doi.org/10.1186/s12984-018-0372-0

©  The Author(s). 2018

Received: 29 June 2017

Accepted: 27 March 2018

Published: 16 April 2018

Abstract

Background

Integration of kinesthetic and tactile cues for application to post-stroke gait rehabilitation is a novel concept which needs to be explored. The combined provision of haptic cues may result in collective improvement of gait parameters such as symmetry, balance and muscle activation patterns. Our proposed integrated cue system can offer a cost-effective and voluntary gait training experience for rehabilitation of subjects with unilateral hemiparetic stroke.

Methods

Ten post-stroke ambulatory subjects participated in a 10 m walking trial while utilizing the haptic cues (either alone or integrated application), at their preferred and increased gait speeds. In the system a haptic cane device (HCD) provided kinesthetic perception and a vibrotactile feedback device (VFD) provided tactile cue on the paretic leg for gait modification. Balance, gait symmetry and muscle activity were analyzed to identify the benefits of utilizing the proposed system.

Results

When using kinesthetic cues, either alone or integrated with a tactile cue, an increase in the percentage of non-paretic peak activity in the paretic muscles was observed at the preferred gait speed (vastus medialis obliquus: p<<  0.001, partial eta squared (η²) = 0.954; semitendinosus p <  0.001, partial η² = 0.793) and increased gait speeds (vastus medialis obliquus: p <  0.001, partial η² = 0.881; semitendinosus p = 0.028, partial η² = 0.399). While using HCD and VFD (individual and integrated applications), subjects could walk at their preferred and increased gait speeds without disrupting trunk balance in the mediolateral direction. The temporal stance symmetry ratio was improved when using tactile cues, either alone or integrated with a kinesthetic cue, at their preferred gait speed (p <  0.001, partial η² = 0.702).

Conclusions

When combining haptic cues, the subjects walked at their preferred gait speed with increased temporal stance symmetry and paretic muscle activity affecting their balance. Similar improvements were observed at higher gait speeds. The efficacy of the proposed system is influenced by gait speed. Improvements were observed at a 20% increased gait speed, whereas, a plateau effect was observed at a 40% increased gait speed. These results imply that integration of haptic cues may benefit(not will benefit) post-stroke gait rehabilitation by inducing simultaneous improvements in gait symmetry and muscle activity.