Visual cue training to improve walking and turning after stroke: a study protocol for a multi-centre, single blind randomised pilot trial

FYI.

Visual cue training to improve walking and turning after stroke: a study protocol for a multi-centre, single blind randomised pilot trial

2013, Trials

 
STUDY PROTOCOL Open Access
Visual cue training to improve walking andturning after stroke: a study protocol for amulti-centre, single blind randomised pilot trial
Kristen L Hollands
1*
, Trudy Pelton
2
, Andrew Wimperis
3
, Diane Whitham
4
, Sue Jowett
2
, Catherine Sackley
5
,Wing Alan
2
and Paulette van Vliet
6

Abstract

Background:
 Visual information comprises one of the most salient sources of information used to control walkingand the dependence on vision to maintain dynamic stability increases following a stroke. We hypothesize,therefore, that rehabilitation efforts incorporating visual cues may be effective in triggering recovery and adaptability of gait following stroke
.
 This feasibility trial aims to estimate probable recruitment rate, effect size,treatment adherence and response to gait training with visual cues in contrast to conventional overground walking practice following stroke.
Methods/design:
 A 3-arm, parallel group, multi-centre, single blind, randomised control feasibility trial will compare overground visual cue training (O-VCT), treadmill visual cue training (T-VCT), and usual care (UC). Participants(n = 60) will be randomly assigned to one of three treatments by a central randomisation centre using computer generated tables to allocate treatment groups. The research assessor will remain blind to allocation. Treatment,delivered by physiotherapists, will be twice weekly for 8 weeks at participating outpatient hospital sites for the O-VCT or UC and in a University setting for T-VCT participants.Individuals with gait impairment due to stroke, with restricted community ambulation (gait speed <0.8m/s), residual lower limb paresis and who are able to take part in repetitive walking practice involving visual cues (i.e., no severe visual impairments, able to walk with minimal assistance and no comorbid medical contraindications for walking practice) will be included. The primary outcomes concerning participant enrolment, recruitment, retention, and health and social care resource use data will be recorded over a recruitment period of 18 months. Secondary outcome measures will be up). Outcome measures will include gait speed and step length symmetry; time and steps taken to complete a 180° turn; assessment of gait adaptability (success rate in target stepping); timed up and go; Fugl-Meyerlower limb motor assessment; Berg balance scale; falls efficacy scale; SF-12; and functional ambulation category.
Discussion:
 Participation and compliance measured by treatment logs, accrual rate, attrition, and response variation will determine sample sizes for an early phase randomised controlled trial and indicate whether a definitive late phase efficacy trial is justified.
Trial registration:
 Clinicaltrials.gov, NCT01600391.
Keywords:
 Gait, Rehabilitation, Stroke, Vision
* Correspondence: k.hollands@salford.ac.uk
1
Research Fellow School of Health Sciences, University of Salford, AllertonBuilding, Salford M6 6PU, UK Full list of author information is available at the end of the article
TRIALS
© 2013 Hollands et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the CreativeCommons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, andreproduction in any medium, provided the original work is properly cited.
Hollands
 et al. Trials
 2013,
 14
:276http://www.trialsjournal.com/content/14/1/276
 

 

STUDY PROTOCOL Open Access

Turning-Based Treadmill Training Improves Turning Performance and Gait Symmetry After Stroke

 Since nothing was done with this from 6 years ago.  Why don't you ask your board of directors why nothing was done and incompetence was allowed to fester and never will be fixed until survivors run things.

The latest here:

Turning-Based Treadmill Training Improves Turning Performance and Gait Symmetry After Stroke

 2014, Neurorehabilitation and Neural Repair
 I-Hsuan Chen, PhD 1, 

Yea-Ru Yang, PhD 1,2, 

Rai-Chi Chan, MD 3, 

and Ray-Yau Wang, PhD 1

Abstract

Background
. Turning is a challenging task for stroke patients. Programs that effectively target turning, however, have not been established.
Objective
. This study examined the effects of a novel turning-based treadmill training on turning performance, gait symmetry, balance, and muscle strength in patients with chronic stroke.
 Methods
. Thirty participants were randomly assigned to the experimental group that received 30 minutes of turning-based treadmill training or to the control group that received 30 minutes of regular treadmill training, followed by a 10-minute general exercise program for 12 sessions over 4 weeks. Primary outcomes (overground turning speed and temporal–spatial characteristics of straight walking) and secondary outcomes (balance and muscle strength) were assessed at baseline, after training, and at 1-month follow-up.
Results
. Fifteen participants per group were 54.2± 9.6 years old, poststroke 2.6± 1.9 years, and walked overground at 0.59± 0.28 m/s. Sixteen had an ischemic and 14 a hemorrhagic stroke. There were significant interaction effects between groups and time on turning speed regardless of turning direction, straight-walking performance (speed and temporal symmetry), strength of hip muscles and ankle dorsiflexors, and balance control (Berg Balance Scale, weight shifting in the forward direction and vestibular function). Compared with the control group, the experimental group showed greater improvements in these measures following training. These improvements persisted at the 1-month follow-up evaluation.
Conclusions
. Turning-based treadmill training may be a feasible and effective strategy to improve turning ability, gait symmetry, muscle strength, and balance control for individuals with chronic stroke.

 Introduction

Gait recovery is critical for individuals who have suffered a stroke.¹
Approximately two thirds of stroke patients eventually walk with or without assistance¹.
However, many individuals still exhibit hemiplegic gait patterns and cannot achieve the walking dexterity required for all activities of daily living. Advanced gait training programs have there-fore been emphasized in recent years, including dual-task training², obstacle crossing in a virtual reality environment^3,4, and robotics-assisted practice of stair climbing⁵. Up to 40% of all steps taken in everyday walking are turns⁶. Turning requires the central nervous system to coordinate whole-body reorientation toward a new travel direc-tion⁷. Balance maintenance during turning involves complex integration of multiple sensory systems (vestibular, visual, somatosensory) and motor output⁸.

 Moreover, there are increased medial–lateral impulses during turning as compared with straight walking⁹. The outer limb requires relatively greater activation of the ankle dorsiflexors during the swing phase and greater activation of the ankle plantar flexors during the stance phase to provide body propulsion. The inner limb requires increased extensor muscle activity to generate supportive action and to maintain whole-body stability in the stance phase¹⁰. Turning is often compromised in individuals with stroke and is one of the most frequent activities leading to falls within this population¹¹. Following stroke, individuals demonstrate inadequate propulsion and weight shifting, along with insufficient extensor and ankle dorsiflexor strength^12-14. Abnormally large and disrupted sequences of gaze, head,  and body motion because of deficits in sensorimotor integration have also been observed during turning¹⁵.

 Kobayashi et al¹⁶ reported that patients with hemiplegia had difficulty walking along curvilinear paths. Recent studies also suggest that these patients turn more slowly because of the absence of kinematic and muscular modulations in the affected leg^17,18. Moreover, longer turn time were correlated with poor functional balance ability (indicated by Berg Balance Scale [BBS]) and temporal gait asymmetry¹⁷.As a result of these difficulties with turning, this activity has been indicated as a major target for gait rehabilitation¹⁹. Effective training programs specifically targeting turning characteristics, however, have not been established. Since motor learning involves repetition of desired movements (ie, specificity of training), “specific and repetitive” rehabilitation protocols that focus on turning may optimize turning-related outcomes²⁰. We therefore hypothesized that a novel treatment turning based treadmill training would lead to greater improvement in turning performance as compared with regular treadmill training in subjects with chronic stroke. In addition, as turning requires side-specific muscle modulation of the lower limbs and medial–lateral  balance control¹⁸,
we hypothesized that the turning-based treadmill training would improve gait symmetry during straight walking, muscle strength of the lower extremities and standing balance.

Actual description of treadmill at link. 

Axial Segmental Coordination During Turning: Effects of Stroke and Attentional Loadings

No clue what this is trying to say or how it might be used in your rehab.
http://journals.humankinetics.com/doi/abs/10.1123/mc.2015-0040

Haidzir Manaf¹* Maria Justine¹* Hui-Ting Goh²* Affiliations¹Universiti Teknologi MARA ²University of Malaya

*Manaf and Justine are with the Dept. of Physiotherapy, Faculty of Health Sciences, Universiti Teknologi MARA, Puncak Alam Campus, Selangor, Malaysia. Goh is with the Dept. of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.

Address author correspondence to Hui-Ting Goh at huitinggoh76@gmail.com.

Volume: 21 Issue: 1 Pages: 42-57
doi: http://dx.doi.org/10.1123/mc.2015-0040

DOI: http://dx.doi.org/10.1123/mc.2015-0040

• ABSTRACT
• PDF

Attentional loadings deteriorate straight walking performance for individuals poststroke, but its effects on turning while walking remain to be determined. Here we compared turning kinematics under three attentional loading conditions (single, dual-motor, and dual-cognitive task) between stroke survivors and healthy controls. Nine chronic stroke survivors and 10 healthy controls performed the Timed Upand- Go test while their full-body kinematics were recorded. Onset times of yaw rotation of the head, thorax and pelvis segments and head anticipation distance were used to quantify turning coordination. Results showed that stroke survivors reoriented their body segments much earlier than the controls, but they preserved the similar segmental reorientation sequence under the single-task condition. For the healthy controls, attentional loading led to an earlier axial segment reorientation, but the reorientation sequence was preserved. In contrast, the dual-cognitive task condition led to a disrupted reorientation sequence in stroke. The results indicate that turning coordination was altered in individuals poststroke, especially under the dual-task interference.

Kinematics of turning during walking over ground and on a rotating treadmill post-stroke

This seems like it would be incredibly important on preventing falls. So what does your therapist have as a protocol for turning other than never do it?
http://www.jneuroengrehab.com/content/11/1/127/abstract
anez Pav¿i¿, Zlatko Matja¿i¿ and Andrej Olen¿ek

Author Affiliations

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Journal of NeuroEngineering and Rehabilitation 2014, 11:127  doi:10.1186/1743-0003-11-127
Published: 23 August 2014

Abstract (provisional)

Background

After neurological injury, gait rehabilitation typically focuses on task oriented training with many repetitions of a particular movement. Modern rehabilitation devices, including treadmills, augment gait rehabilitation. However, they typically provide gait training only in the forward direction of walking, hence the mechanisms associated with changing direction during turning are not practiced. A regular treadmill extended with the addition of rotation around the vertical axis is a simple device that may enable the practice of turning during walking. The objective of this study was to investigate to what extent pelvis and torso rotations in the transversal plane, as well as stride lengths while walking on the proposed rotating treadmill, resemble those in over ground turning.

Methods

Ten neurologically and orthopedically intact subjects participated in the study. We recorded pelvis and torso rotations in the transversal plane and the stride lengths during over ground turning and while walking on a rotating treadmill in four experimental conditions of turning. The similarity between pelvis and torso rotations in over ground turning and pair-matching walking on the rotating treadmill was assessed using intra-class correlation coefficient (ICC - two-way mixed single measure model). Finally, left and right stride lengths in over ground turning as well as while walking on the rotating treadmill were compared using a paired t-test for each experimental condition.

Results

An agreement analysis showed average ICC ranging between 0.9405 and 0.9806 for pelvis and torso rotation trajectories respectively, across all experimental conditions and directions of turning. The results of the paired t-tests comparing left and right stride lengths showed that the stride of the outer leg was longer than the stride of the inner leg during over ground turning as well as when walking on the rotating treadmill. In all experimental conditions these differences were statistically significant.

Conclusions

In this study we found that pelvis rotation and torso rotation are similar when turning over ground as compared to walking on a rotating treadmill. Additionally, in both modes of turning, we found that the stride length of the outer leg is significantly longer than the stride length of the inner leg.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

Turning-Based Treadmill Training Improves Turning Performance and Gait Symmetry After Stroke

No idea, so ask your therapist to get the research protocols from the authors. Conveniently listed here.
http://nnr.sagepub.com/content/28/1/45.abstract?etoc

1. I-Hsuan Chen, PhD1
2. Yea-Ru Yang, PhD1,2
3. Rai-Chi Chan, MD3
4. Ray-Yau Wang, PhD1

1. ¹National Yang-Ming University, Taipei, Taiwan
2. ²Taipei City Hospital, Taipei, Taiwan
3. ³Taipei Veterans General Hospital, Taipei, Taiwan

1. Ray-Yau Wang, PhD, Department of Physical Therapy and Assistive Technology, National Yang-Ming University, 155, Sec. 2, Li-Nong Street, Beitou District, Taipei 112, Taiwan. Email: rywang@ym.edu.tw

Abstract

Background. Turning is a challenging task for stroke patients. Programs that effectively target turning, however, have not been established. Objective. This study examined the effects of a novel turning-based treadmill training on turning performance, gait symmetry, balance, and muscle strength in patients with chronic stroke. Methods. Thirty participants were randomly assigned to the experimental group that received 30 minutes of turning-based treadmill training or to the control group that received 30 minutes of regular treadmill training, followed by a 10-minute general exercise program for 12 sessions over 4 weeks. Primary outcomes (overground turning speed and temporal–spatial characteristics of straight walking) and secondary outcomes (balance and muscle strength) were assessed at baseline, after training, and at 1-month follow-up. Results. Fifteen participants per group were 54.2 ± 9.6 years old, poststroke 2.6 ± 1.9 years, and walked overground at 0.59 ± 0.28 m/s. Sixteen had an ischemic and 14 a hemorrhagic stroke. There were significant interaction effects between groups and time on turning speed regardless of turning direction, straight-walking performance (speed and temporal symmetry), strength of hip muscles and ankle dorsiflexors, and balance control (Berg Balance Scale, weight shifting in the forward direction and vestibular function). Compared with the control group, the experimental group showed greater improvements in these measures following training. These improvements persisted at the 1-month follow-up evaluation. Conclusions. Turning-based treadmill training may be a feasible and effective strategy to improve turning ability, gait symmetry, muscle strength, and balance control for individuals with chronic stroke.