Efficacy of anterioposterior weight-shift training with visual biofeedback for step length asymmetry and functional mobility in chronic stroke: a randomized controlled trial

 Have your competent? doctor set this up as a protocol to be used while still in the hospital! AND JUST WHY CAN'T YOUR DOCTOR DO THAT?

Do you prefer your doctor, hospital and board of director's incompetence NOT KNOWING? OR NOT DOING? Your choice; let them be incompetent or demand action!

Efficacy of anterioposterior weight-shift training with visual biofeedback for step length asymmetry and functional mobility in chronic stroke: a randomized controlled trial

• Jong Weon Lee,
• Yea Jin Jo,
• Yoon Su Baek,
• Seeun Kim,
• Jung Hoon Kim,
• Dae Hyun Kim,
• Jong Hyun Choi,
• Jong Bum Park &
• Deog Young Kim 

We are providing an unedited version of this manuscript to give early access to its findings. Before final publication, the manuscript will undergo further editing. Please note there may be errors present which affect the content, and all legal disclaimers apply.

Abstract

Background

Step length asymmetry is a specific and persistent characteristic of hemiparetic gait in patients with chronic stroke, typically resulting from impaired weight bearing and reduced propulsive force on the paretic side. This asymmetry leads to reduced walking efficiency and an increased risk of musculoskeletal complications. This study investigated the efficacy of an anterioposterior weight-shift training (AP training) system utilizing visual biofeedback to improve gait asymmetry in patients with chronic stroke.

Methods

This randomized controlled trial enrolled 34 patients with chronic hemiplegic stroke who exhibited step-length asymmetry (step-length ratio > 1.1). Participants were randomized into an AP training group or a control group. Both groups received conventional gait training for 6 weeks, and the experimental group received additional AP training sessions (30 min, 3 times/week). The AP training system provided real-time visual biofeedback on the Center of Pressure trajectory and weight distribution. The primary outcome was the Step Length Asymmetry Index (SLAI). The secondary outcomes included plantar pressure distribution, temporospatial parameters, 3D kinematic/kinetic gait analysis, and energy consumption.

Results

The AP training group demonstrated significant improvements in the SLAI compared with the control group (p < 0.05). Significant between-group differences favoring the intervention were also observed for swing time asymmetry, forefoot contact area, and pressure (p < 0.05). Three-dimensional gait analysis revealed an increased ankle dorsiflexion angle and hip extension moment on the affected side in the training group. While the self-selected walking speed showed no significant difference, the maximum safe walking speed significantly improved in the training group (p < 0.05). No significant between-group differences were observed in energy consumption (oxygen cost or oxygen rate).

Conclusion

AP training may effectively improve step length asymmetry and paretic limb mechanics in patients with chronic stroke. By enhancing the anterior weight transfer and propulsive force, this intervention offers a targeted strategy for addressing established asymmetric gait patterns in the chronic phase of recovery.

Trial details ClinicalTrial.gov Identifier NCT02207933.

Step Length Asymmetry Predicts Rehabilitation Length in Subacute Post Stroke Patients

NO, NO, NO. We don't need this type of useless prediction. Create protocols that fix step length asymmetry.

 I'd have you all fired for not understanding that the only goal in stroke research is getting survivors to 100% recovery. This does nothing for that.

 Step Length Asymmetry Predicts Rehabilitation Length in Subacute Post Stroke Patients

Isabella Schwartz 1,2, Yonah Ofran 1,2 , Naama Karniel 2,3 , Martin Seyres 2 and Sigal Portnoy 3, *
1 Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190501, Israel
2 Department of Physical Medicine & Rehabilitation, Hadassah Medical Center, Jerusalem 9765418, Israel
3 Department of Occupational Therapy, Sackler Faculty of Medicine, Tel Aviv University,
Tel Aviv 6997801, Israel
* Correspondence: portnoys@tauex.tau.ac.il

Abstract:  

Background:  

 

During the rehabilitation of individuals post stroke, evaluations are performed in order to discern the patient’s prognosis and optimize the treatment plan. However, these tests do not focus on gait symmetry, which might be a predictor for rehabilitation outcomes. We aimed to correlate gait symmetry measures of subacute post stroke patients with rehabilitation outcome and find the symmetry measure that best predicts the variability of the rehabilitation duration. A secondary aim was to compare these measures between patients with right and left brain lesions.
Methods:  

 

We recruited 30 subacute post stroke patients (14 with right side lesion). We collected the following measures: National Institutes of Health Stroke Scale (NIHSS), Functional Independence Measure (FIM), the 10 m walk test (10MWT), Functional Ambulation Categories (FAC), spatial‐temporal gait measures, and gait symmetry and variability. Results: We found moderate correlations between the step length symmetry and the length of rehabilitation, NIHSS, FIM, FAC and 10MWT. The symmetry index of the step length predicted the length of the rehabilitation period as it explained 32.1% of its variance (p = 0.001). Discussion: We conclude that a simple test of the step length symmetry might be informative in predicting rehabilitation length in subacute post stroke patients.

Using Biofeedback to Reduce Step Length Asymmetry Impairs Dynamic Balance in People Poststroke

So what the fuck does this mean? If stroke survivors can't explain this to their doctors and therapists it is totally useless.

Using Biofeedback to Reduce Step Length Asymmetry Impairs Dynamic Balance in People Poststroke

Show all authors

Sungwoo Park, PhD, Chang Liu, PhD, Natalia Sánchez, PhD, ...

First Published June 1, 2021 Research Article Find in PubMed 

https://doi.org/10.1177/15459683211019346

Article information

Abstract

Background

People poststroke often walk with a spatiotemporally asymmetric gait, due in part to sensorimotor impairments in the paretic lower extremity. Although reducing asymmetry is a common objective of rehabilitation, the effects of improving symmetry on balance are yet to be determined.

Objective

We established the concurrent validity of whole-body angular momentum as a measure of balance, and we determined if reducing step length asymmetry would improve balance by decreasing whole-body angular momentum.

Methods

We performed clinical balance assessments and measured whole-body angular momentum during walking using a full-body marker set in a sample of 36 people with chronic stroke. We then used a biofeedback-based approach to modify step length asymmetry in a subset of 15 of these individuals who had marked asymmetry and we measured the resulting changes in whole-body angular momentum.

Results

When participants walked without biofeedback, whole-body angular momentum in the sagittal and frontal plane was negatively correlated with scores on the Berg Balance Scale and Functional Gait Assessment supporting the validity of whole-body angular momentum as an objective measure of dynamic balance. We also observed that when participants walked more symmetrically, their whole-body angular momentum in the sagittal plane increased rather than decreased.

Conclusions

Voluntary reductions of step length asymmetry in people poststroke resulted in reduced measures of dynamic balance. This is consistent with the idea that after stroke, individuals might have an implicit preference not to deviate from their natural asymmetry while walking because it could compromise their balance. Clinical Trials Number: NCT03916562.

Keywords

stroke, gait, asymmetry, balance, biofeedback, validation, angular momentum

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Persons post-stroke improve step length symmetry by walking asymmetrically

Useless. NO PROTOCOL. And they called for further research meaning their research wasn't properly defined to create good results. 

 Persons post-stroke improve step length symmetry by walking asymmetrically

Journal of NeuroEngineering and Rehabilitation , Volume 17(105)

NARIC Accession Number: J84310.  What's this?
ISSN: 1743-0003.
Author(s): Padmanabhan, Purnima Rao, Keerthana S. ; Gulhar, Shivam ; Cherry-Allen, Kendra M. ; Leech, Kristan A. ; Roemmich, Ryan T..
Publication Year: 2020.
Number of Pages: 14.

Abstract: 

Study investigated how stroke survivors generate symmetric steps and explored how the resulting gait pattern may relate to the metabolic cost of transport. Kinematic, kinetic, and metabolic data were recorded as nine individuals with stroke walked on an instrumented treadmill under two conditions: preferred walking and symmetric stepping (using visual feedback). Gait kinematics and kinetics remained markedly asymmetric even when stroke survivors improved step-length symmetry. Impaired paretic propulsion and aberrant movement of the center of mass (COM) were evident during both preferred walking and symmetric stepping. These deficits contributed to diminished positive work performed by the paretic limb on the COM in both conditions. Within each condition, decreased positive paretic work correlated with increased metabolic cost of transport and decreased walking speed across participants. It is critical to consider the mechanics used to restore symmetric steps when designing interventions to improve walking after stroke. Future research should consider the many dimensions of asymmetry in post-stroke gait, and additional within-participant manipulations of gait parameters are needed to better understand the elevated metabolic cost of walking after stroke.
Descriptor Terms: AMBULATION, BIOENGINEERING, FEEDBACK, METABOLISM, MOBILITY IMPAIRMENTS, REHABILITATION TECHNOLOGY, STROKE.


Can this document be ordered through NARIC's document delivery service*?: Y.
Get this Document: https://jneuroengrehab.biomedcentral.com/articles/10.1186/s12984-020-00732-z.

Citation: Padmanabhan, Purnima Rao, Keerthana S. , Gulhar, Shivam , Cherry-Allen, Kendra M. , Leech, Kristan A. , Roemmich, Ryan T.. (2020). Persons post-stroke improve step length symmetry by walking asymmetrically.  Journal of NeuroEngineering and Rehabilitation , 17(105) Retrieved 9/19/2020, from REHABDATA database.