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PubMed2006

Gait training of patients after stroke using an electromechanical gait trainer combined with simultaneous functional electrical stimulation.

BACKGROUND AND PURPOSE: This case report describes the implementation of gait training intervention that used an electromechanical gait trainer with simultaneous functional electrical stimulation (FES) for 2 patients with acute ischemic stroke. CASE DESCRIPTION: Two individuals with post-stroke hemiplegia of less than 6 weeks' duration participated in a 4-week gait training program as an adjunct to physical therapy received at a hospital. After the 4-week intervention, both patients were discharged from the hospital, and they returned after 6 months for a follow-up evaluation. OUTCOMES: By the end of the 4-week intervention, both patients had shown improvements in scores on the Barthel Index, Berg Balance Scale, Functional Ambulation Categories Scale, 5-m timed walking test, and Motricity Index. In the 6-month follow-up evaluation, both patients continued to have improvements in all outcome measures. DISCUSSION: This case report shows that, following the use of an electromechanical gait trainer simultaneously with FES, patients after acute stroke had improvements in gait performance, functional activities, balance, and motor control in the long term.

Aged↗

PubMedDate not supplied

Mechanical instability as a cause of gait disturbance in high-grade spondylolisthesis: a pre- and postoperative three-dimensional gait analysis.

Mechanical instability of the spinopelvic junction is a suspected cause of abnormal gait in high-grade spondylolisthesis. Computerized three-dimensional gait analysis was performed on a 10-year-old with grade III spondylolisthesis at L-5. Preoperatively, the gait pattern was characterized by posterior pelvic tilt, decreased hip flexion, increased knee flexion, and decreased stride length and walking speed. All temporal and kinematic parameters of gait normalized after laminectomy and instrumented, in situ arthrodesis (L-4-S-1). The absence of any neurologic abnormalities on preoperative imaging, intraoperative somatosensory-evoked potentials (SSEP) monitoring, and nerve-root exploration, together with the observed improvement after stabilization of the spinopelvic junction, suggests a mechanical basis for the gait changes in high-grade spondylolisthesis.

Child↗

PubMed2001

[Gait disorders in Parkinson disease. Clinical description, analysis of posture, initiation of stabilized gait].

A WELL INFORMED DESCRIPTION: The parkinsonian posture is generally described as a stooped one. At the beginning of the disease, the gait troubles remain moderate; gradually the gait is composed of small steps without a wide base; the patient tends to run after his centre of gravity by accelerating the step (festination phenomenon). Difficulties occurs for starting up (delay of gait initiation), for about-turn or for clearing obstacles. Kinetic jammings and standing around (freezing) can last several seconds and be responsible for falls. POSTURAL INSTABILITY, A MAJOR SYMPTOM IN PARKINSON'S DISEASE: This symptom is little improved by therapies and is responsible for serious disability. Postural instability induces a disequilibrium and is partially due to a simultaneous antagonist muscles contraction and to the impossibility of modifying postural responses to changing support conditions. The passive viscoelastic properties of muscles and tendons constitute a first line of defence against the disequilibrium and contribute to postural stability in the case of medium disturbances. Automatic and voluntary postural responses which come into play in the case of major disturbances can also be impaired (delay or defect of the responses). GAIT INITIATION FAILURE ARE FREQUENT: They result from an increase of the postural phase and a decrease of the propulsion forces, depending on a deficit of the postural anticipation mechanisms and also the sequential organization and the integration of two different motor programs, postural and locomotor. They can be controlled partially with sensory stimuli, notably visual inputs. DATA CONCERNING STABILIZED WALKING AND ITS PATHOPHYSIOLOGY REMAINS TO BE CLARIFIED: Spatial and temporal parameters are impaired: speed, step length and swing phase are reduced, while cadence increases to compensate these troubles. These modifications are the consequence of an incapacity to produce internal marks to generate regular steps. When the parkinsonian patient is supplied with external marks, these parameters can be normalized. From a pathophysiological point of view, gait disorders could result from defective central integration of proprioceptive information during movement within the basal ganglia, associated with a visual perceptive deficit linked with a retinal dopaminergic cells dysfunction and finally from an impairment of the proprioceptive feedback of the load receptors in the leg extensor muscles.

Antiparkinson Agents↗

PubMed2001

[Development of gait in childhood: a systematic gait analysis].

To study the normal gait development in childhood, we performed a systematic gait analysis on 37 normal children (20 boys and 17 girls) aged between two and six years. The gait cycle, single support phase, ratio of stride length to body height, plantiflexor angles of the feet and propelling force increased with age, whereas the ratio of gait width to stride length and dorsiflexor angles of the feet decreased. The knee-flexion waves, heel-strikes were found in all subjects. From two to six years of age, balance-holding ability and feet plantiflexor forces developed, resulting in more efficient locomotion. The pattern of the lower limb movements on gait is considered to mature during the first three years of life.

Child↗

PubMed2005

Gait characteristics after gait-oriented rehabilitation in chronic stroke.

PURPOSE: To assess the effects of rehabilitation in thirty-seven ambulatory patients with chronic stroke during three weeks in-patient rehabilitation period. METHODS: In the intervention group, each patient received 75 min physiotherapy daily every workday including 20 minutes in the electromechanical gait trainer with body-weight support (BWS). In the control group, each patient participated in 45 min conventional physiotherapy daily. Motor ability was assessed with the first five items of the Modified Motor Assessment Scale (MMAS1-5) and ten meters walking speed. Spatio-temporal gait characteristics were recorded with an electrical walkway. RESULTS: The MMAS1-5 (p<0.0005 and p=0.005) and ten meters walking time (p<0.0005 and p=0.006) improved in both groups. The improvements in MMAS1-5 and ten meters walking time did not differ between the groups (p=0.217 and p=0.195). Specific gait characteristics improved only in the intervention group, as seen in increased Functional Ambulation Profile score (p=0.023), velocity (p=0.023), the step lengths (affected side, p=0.011, non-affected side p=0.040), the stride lengths (p=0.018, p=0.006) and decreased step-time differential (p=0.043). Furthermore, all gait characteristics and other motor abilities remained in the discharge level at the six months in the intervention group. CONCLUSIONS: It appears that BWS training gives a long-lasting benefit in gait qualities even in chronic stroke patients.

Adult↗

PubMed1995

Spatiotemporal gait parameters measured using the Bessou gait analyzer in 79 healthy subjects. Influence of age, stature, and gender. Study Group on Disabilities due to Musculoskeletal Disorders (Groupe de Recherche sur le Handicap de l'Appareil Locomoteur, GRHAL).

The Bessou gait analyzer provides quantitative measurements of spatiotemporal gait parameters. The purpose of this study was to determine whether and how these parameters are influenced by age, stature, and gender. Seventy-nine normal individuals (38 males aged 20 to 80 years and 41 females aged 20 to 80 years) were divided into ten-year age groups. Males and females were studied separately. In each subject, the Bessou gait analyzer was used to measure spatiotemporal gait parameters (spatial parameters: stride and step lengths; temporal parameters: cycle, stance and swing durations). Mean walking speed was calculated in each subgroup. In both males and females, all study parameter values were identical for the left and right sides. Females younger than 60 years had shorter stride and step lengths (M: 1.5 +/- 0.2 m; F: 1.3 +/- 0.1; p < 0.001) but faster pace values (M: 104.8 +/- 9.0 cycles/min; F: 115.6 +/- 7.6 cycles/min; p < 0.001) than males, and consequently mean walking speed was similar in females and males (M: 4.8 km/h +/- 0.8 km/h; F: 4.4 km/h +/- 0.6 km/h). In contrast, females older than 60 years walked at the same pace as males and consequently had slower walking speeds. Stride length was correlated with age, stature, and gender. However, age was correlated with stature, and only age and gender had independent effects on gait parameters in the multiple regression analysis. In subjects of similar age and gender, effects of stature may need to be taken into account.

Adult↗

PubMed2000

Gait disturbances in patients with pontine medial tegmental lesions: clinical characteristics and gait analysis.

OBJECTIVE: To determine the clinical characteristics of gait disorders in patients with pontine medial tegmental lesions. DESIGN: We compared features of gait disorders between patients with infarcts in the medial tegmentum and those with stroke in other areas of the pons (pathological control subjects) by measuring electromyographic results of lower limb muscles and several biomechanical parameters. PATIENTS: Two patients with infarcts in the rostral medial tegmentum and 4 control subjects. Two of the control patients had lesions in the pontine base, while the lesions in the other 2 were in the pontine tegmentum and base (combined lesions). RESULTS: Patients with rostral medial tegmental lesions and controls with pontine base lesions showed unstable walking characterized by irregular angular displacements and foot pressures. However, they differed by the following 3 features. (1) Rostral medial tegmental lesions elicited truncal ataxia without limb ataxia. In comparison, pontine base lesions elicited limb ataxia without truncal ataxia and caused hemiparesis. (2) Instability was more severe and persistent in patients with the former lesions than in those with the latter lesions. Slowness of walking speed and prolongation of the double-support period were clearly observed in the former group. (3) Electromyographic changes characteristic of cerebellar ataxia were clearly evident in patients with rostral medial tegmental lesions. The electromyographic amplitudes of the gastrocnemius and tibialis anterior muscles were almost constant throughout the gait cycle, resulting in the disappearance of the inherent periodic pattern of each muscle. CONCLUSION: Medial tegmental lesions in the rostral pons cause prolonged and severe unstable walking that resembles spinocerebellar ataxic pattern, and impairment of the spinocerebellar loop might be the pathomechanism underlying such a gait disturbance.

Aged↗

PubMed2001

Gait epilepsy. A case report of gait-induced seizures.

Reflex epilepsy includes a group of epileptic syndromes in which seizures are induced by a stimulus, either simple (visual, somatosensory, olfactory, auditory) or more complex (e.g., eating, thinking, reading). We document a case of reflex epilepsy in which focal seizures are triggered exclusively by gait. The patient is a young boy whose walking was impaired by abnormal motor phenomena on the left side. These phenomena were elicited by gait and were accompanied by a distinctive ictal pattern with centro-temporal discharges. After comparing this patient with others reported in the literature, we determined that he has an unusual type of reflex epilepsy for which we coined the term "gait epilepsy." This disorder must be considered when physicians are making a differential diagnosis in patients who have symptoms that suggest paroxysmal kinesigenic dystonia (PKD) or selective epileptic gait disorder.

Cerebral Cortex↗

PubMed2000

Effects of aerobic treadmill training on gait velocity, cadence, and gait symmetry in chronic hemiparetic stroke: a preliminary report.

It is widely assumed that only limited improvement in functional mobility is possible beyond the subacute period following ischemic stroke. Contrary to this notion, we studied "neurologically plateaued" stroke patients with chronic hemiparesis to assess whether a "task-oriented" treadmill-training regimen would improve walking speed, cadence, and gait cycle symmetry on a modified "Get-Up and Go" task. Five male patients with a mean age of 60.4 +/- 2.7 years (mean +/- S.D.) status post ischemic stroke (> 6 months prior) participated in this nonrandomized low-intensity treadmill exercise pilot study three times/week for 3 months. All patients had mild to moderate gait asymmetries due to residual hemiparesis. Patients were videotaped before and after 3 months of treadmill aerobic exercise (AEX) while performing a functional task consisting of arising from a chair, walking 3.1 m without an assistive device as fast as safely possible, and returning to sit. Gait events were timed using a 2-D Peak Motus video analysis system. After 3 months AEX training, times for the overall "get-up and return-to-sit" (GURS) task and the "straight-away walk" (SAW) segment decreased from 8.2 +/- 1.4 sec to 6.5 +/- 0.8 sec (mean +/- SEM) (p < 0.05), and from 3.7 +/- 1 sec to 2.8 +/- 0.7 sec (p < 0.05), respectively. These data represent improvements of 21% and 24% for the GURS and SAW segments, respectively. Mean velocity increased from 0.9 +/- 0.2 to 1.2 +/- 0.21 m/sec, a 33% improvement (p < 0.01). Mean cadence (steps/min) increased from 89 +/- 9 to 97 +/- 8, a 9% increase (p < 0.05). Mean stance and swing duration diminished for both paretic (P) and nonparetic (NP) limbs, and the intralimb stance/swing ratio values moved toward normal for both the paretic and nonparetic limbs. However, these latter changes reached significance only for the P limb. Interlimb stance symmetry was unchanged. The more impaired subjects experienced the greatest gains in gait velocity and temporal measures. Collectively, these findings indicate that treadmill exercise improves functional overground mobility in individuals with chronic, stable hemiparesis.

Aged↗

PubMed2026

The Effect of Robot-Assisted Gait Training on Balance, Gait and Kinesiophobia in Individuals With Post-Stroke Hemiparesis: A Randomized Controlled Trial.

BACKGROUND AND PURPOSE: Robot-assisted gait training (RAGT) is well established for post-stroke gait rehabilitation, but its potential effects on psychological and behavioral outcomes are less clear. This study investigated the effects of adding RAGT to conventional rehabilitation on balance, gait, kinesiophobia, and movement confidence in individuals with post-stroke hemiparesis. METHODS: This single-blind, parallel-group randomized controlled trial included 60 individuals with post-stroke hemiparesis (50-75 years), randomly allocated to an RAGT group (n = 30) or control group (n = 30). Ethical approval was obtained from the Clinical Research Ethics Committee of Istanbul Yeni Yüzyıl University (Approval No. 20.01.2022/05; approval date: 20 January 2022). Both groups received conventional rehabilitation for 8 weeks; the RAGT group additionally received 24 sessions of RAGT. Kinesiophobia was a prespecified study outcome assessed using the Kinesiophobia Causes Scale (KCS); balance, gait, and balance confidence were also assessed. All 60 randomized participants completed follow-up and were analyzed in their assigned groups. RESULTS: Significant group × time interactions were observed for several outcomes, including BBS, TUG duration, 10MWT walking speed, ABC, and KCS total score (p < 0.05). The between-group difference in change for KCS total score was -0.36 (95% CI: -0.51 to -0.21; partial eta squared = 0.292). In post hoc analyses adjusting each outcome for its baseline value, significant group effects remained for BBS, TUG duration, 10MWT walking speed, ABC, KCS biological domain, and KCS total score (p< = 0.031), whereas 10MWT step count and the KCS psychological domain were no longer statistically significant. DISCUSSION: Adding RAGT to conventional rehabilitation was associated with greater improvements in several balance, mobility, walking-speed, balance-confidence, and kinesiophobia outcomes compared with conventional rehabilitation alone. These findings suggest potential additional physical and psychological benefits of incorporating RAGT into post-stroke rehabilitation. However, because the RAGT group received greater overall treatment exposure, the observed between-group differences cannot be attributed solely to the robotic component. The principal contribution of this study is the concurrent evaluation of kinesiophobia and movement confidence alongside physical outcomes.

Aged↗

PubMed2005

Gait analysis in patients with advanced Parkinson disease: different or additive effects on gait induced by levodopa and chronic STN stimulation.

The aim of our study was to observe the effects on gait parameters induced by STN stimulation and levodopa medication in patients with advanced Parkinson's disease in order to determine different or additive effects. Therefore we examined 12 patients with advanced Parkinson disease after bilateral implantation of DBS into the STN. We assessed the motor score of the UPDRS and quantitative gait analysis under 4 treatment conditions: with and without stimulation as well as with and without levodopa. The mean improvement of the UPDRS motor score was almost the same with levodopa and DBS. Combining both therapies we saw a further improvement of the motor score. Gait parameters of patients with PD treated either with levodopa or STN stimulation were greatly improved. A significant difference between levodopa and STN stimulation could only be shown for the parameters velocity and step length. These parameters improved more with levodopa than with stimulation. The combination of both therapeutic methods showed the best results on the UPDRS motor score and gait parameters.

Aged↗

PubMed1989

Quantitative assessment of gait determinants during single stance via a three-dimensional model--Part 1. Normal gait.

In this two-part paper, a variety of three-dimensional, dynamical models are constructed for simulating the single support phases of normal and pathological human gait. A major objective of this work is to quantify the influence of individual gait determinants on the ground reaction forces generated during normal, level walking. To this end, Part 1 presents a three-dimensional, seven degree-of-freedom model incorporating five of the six fundamental determinants of gait. On the basis of crude muscle-force and/or joint-moment trajectories, body-segmental motions and ground reaction forces are synthesized open loop. Through a quantitative comparison with experimental gait data, the model's predictions are evaluated. Our simulation results suggest that pelvic list is not as dominant a dynamical determinant as either stance knee flexion-extension or foot and knee interaction. Transverse pelvic rotation, however, makes an important contribution by limiting the magnitude of the horizontal ground reaction prior to opposite heel-strike.

Adult↗

PubMed2005

The influence of spasticity in the lower limb muscles on gait pattern in children with sacral to mid-lumbar myelomeningocele: a gait analysis study.

Gait analysis and recording of standing position were performed in 38 ambulatory children with myelomeningocele. Thirty-four were independent ambulators and four required a walking aid. All subjects were assigned one of four muscle function groups based on muscle strength. They were also divided into subgroups based on the distinction between flaccid and spastic paresis in the lower limb joints. A comparison was made between the gait pattern of the children with spasticity and that of the children with flaccid paresis in each muscle function group. Spasticity in only the ankle joint muscles influenced the subject's gait and standing position compared to the subgroups with a flaccid paresis. Even larger deviations in gait and standing position were observed when spasticity occurred in muscles at the knee and hip joints. When setting ambulatory goals the presence of additional neurological symptoms such as spasticity and inadequate balance should be taken into consideration.

Adolescent↗

PubMed2002

[Asymmetries in dynamic plantar pressure distribution measurement in able-bodied gait: application to the study of the gait asymmetries in children with hemiplegic cerebral palsy].

OBJECTIVES: The aim of this study was to analyse, firstly, the plantar pressure distribution in healthy subjects in order to validate or invalidate the previous studies results on the asymmetrical profile of the stance phase. The studies of asymmetries was based on the identification of a propulsive foot and a loading foot from a concept introduced by Viel. Secondly, the approach was applied to the study of gait asymmetries in two children with hemiplegic cerebral plasy. MATERIAL AND METHOD: Thirty healthy control subjects and two hemiplegic children (H1 and H2) performed a walking test at self selected speed. The recordings of dynamic parameters were realized thanks to an in-shoe plantar pressure analysis system (Parotec, by Paromed Medizintechnik, GMBH, Germany). The pressure peaks were determined from the recording of pressures under eight footprint locations. A program calculated the sum of forces under the heel and determined the loading foot. By defect, the second foot is the propulsive foot. RESULTS: The asymmetrical profile of the human normal stance phase was validated. Under the heel, the pressure peaks lower by 28 % were noticed beneath the loading foot compared to the propulsive foot. Inversely, under the metatarsal heads and the hallux, the pressure peaks were greater by 32 % beneath the propulsive foot. For the two hemiplegic children, the plantar pressure profile equally highlighted significant differences between the unaffected and affected feet. The pressure peaks under the affected heel were respectively lower by 21 % and 97 % for H1 and H2. The loading function was found and associated to the affected limb. The propulsive function was not systematically found under the unaffected foot. DISCUSSION: The analysis of plantar pressure measurements during able-bodied gait showed differences between the two lower limbs. These dynamic asymmetries are the results of a natural functional organization of the supports differentiating a loading foot and a propulsive foot and corroborating the concept proposed by Viel. The hemiplegic gait also presented dynamic asymmetries partially agreement with a personalized functional logic of loading and propulsion. However, the asymmetrical profile can also result a gait self-optimization strategy compensating biomechanical, anatomical and physiological disorders linked to the cerebral deficiency.

Adolescent↗

PubMed2005

Changed gait pattern in patients with total knee arthroplasty but minimal influence of tibial insert design: gait analysis during level walking in 39 TKR patients and 18 healthy controls.

INTRODUCTION: Previous radiostereometric studies have revealed abnormal anterior-posterior translation of the femur in patients operated with AMK (DePuy, Johnson and Johnson, Leeds, UK) total knee arthroplasty (TKA). Based on these observations, we hypothesized that patients with TKA have an abnormal gait pattern, and that there are differences in kinematics depending on the design of the tibial joint area. METHOD: We used a gait analysis system to evaluate the influence of joint area design on the kinematics of the hip and knee during level walking. 39 TKA patients (42 knees) and 18 healthy age-matched controls were studied. Patients with 5 degrees varus/valgus alignment or less were randomized to receive either a relatively flat or a concave tibial insert with retention of the posterior cruciate ligament. Patients who had more than 5 degrees varus-valgus alignment and/or extension defect of 10 degrees or more were randomized to receive the concave or a posterior-stabilized tibial component with resection of the posterior cruciate ligament. RESULTS: Patients with TKA tended to have less hip and knee extension and decreased knee and hip extension moment than controls. They also tended to walk more slowly. TKA altered the gait pattern, but choice of implant design had little influence. INTERPRETATION: In patients with a similar degree of degenerative joint disease and within the limits of the constraints offered by the prostheses under study, the choice of joint area constraint has little influence on the gait pattern.

Aged↗

PubMedDate not supplied

A quantitative gait assessment method based on energy exchange analysis during walking: a normal gait study.

In this paper a gait efficiency assessment method, Gait Energy Efficiency Index (GEEI), which can be used in evaluation of the progress of the rehabilitation process in disabled persons, is proposed and described. The method is based on calculation of cross correlation between normalized time courses of kinetic and potential energy of the body's centre of mass (COM). We hypothesized that GEEI in energetically optimal normal walking should be high and invariable of gait speed. The method was tested on twelve healthy subjects walking at three different speeds and contrasted to five established gait energy consumption assessment methods. The results showed that GEEI in normal walking is close to 1 regardless of walking speed.

Adult↗

PubMed2002

Kinematic and kinetic gait analysis in the sagittal plane of trans-femoral amputees before and after special gait re-education.

A special gait-training programme, combining a psychological therapeutic approach with methods in physiotherapy and body awareness, was used to re-educate nine unilateral trans-femoral amputees. All were rehabilitated trauma or tumour amputees with an age of 16-60 years. They had worn prostheses for more than 18 months. The re-education aimed at integrating the prosthesis in normal movements and increasing body awareness. Gait was measured before and after treatment and at 6 months follow-up with a three-dimensional motion analysis system. Results showed almost normalised gait speed and increased symmetry in the hip joints with increased muscle work on the amputated side both immediately and at follow-up. At follow-up there were significant differences in almost all parameters between the two legs of the subjects and when compared to a reference group of 18 healthy volunteers of similar age. Thus, the intact leg compensates for loss of function in the amputated leg and thereby works differently compared to the reference group. For example, during shock absorption the extension moment in the intact knee increased from 0.6 Nm/kg before to 1.0 Nm/kg after treatment and at follow-up compared to 0.4 Nm/kg in the reference group. The eccentric power of quadriceps increased from 0.6 w/kg before to 1.8 w/kg after treatment and 1.7 w/kg at follow-up compared to 0.4 w/kg in the reference group. The limp of amputees is usually observed in the frontal plane, but the authors' special focus on the sagittal plane here illustrates gait propulsion influences. The positive training results remained after six months.

Adolescent↗

PubMedDate not supplied

Knee hyperextension gait abnormalities in unstable knees. Recognition and preoperative gait retraining.

Five patients with symptomatic knee hyperextension thrusting patterns due to posterolateral ligament complex injury underwent gait analysis before and after a gait retraining program. Patients were trained to avoid knee hyperextension by 1) walking with their knees slightly flexed throughout stance, 2) maintaining ankle dorsiflexion in early stance, and 3) maintaining an erect trunk-hip attitude during stance. Kinematic and kinetic measurements were obtained using automated gait analysis. Four of the five patients significantly reduced hyperextension at the knee and abnormal motion patterns at the hip and ankle. Patients showed increases in knee flexion throughout stance conversions of knee flexion-extension moments to more normal biphasic patterns with a 79% decrease in extension moments at terminal extension, and a 22% decrease in knee adduction moments. Posttraining values also showed a 30% decrease in the calculated medial tibiofemoral loads (P < 0.05). At the hip, there were significant decreases in abduction and adduction moments (36% and 18%, respectively, P < 0.01). Ankle plantar flexion motion decreased significantly by 42% (P < 0.01). Gait retraining can alter the biomechanics of hip, knee, and ankle function to approximately normal levels, and therefore is recommended before ligament reconstruction because abnormal knee motions, if resumed postoperatively, can stretch soft tissue reconstructions.

Adult↗