Journal Club CEU Approval
Contact Hours: 1
AR | FL CE26-803266 | ID
Bilateral coordination and gait symmetry after body-weight supported treadmill training
JC13Q3
On-demand
$10
On-demand
$10
Webinar Description
Combs SA, Dugan EL, Ozimek EN, Curtis AB (2013). Bilateral coordination and gait symmetry after body-weight supported treadmill training for persons with chronic stroke. Clin Biomech Apr;28(4):448-53
SUMMARY:
Evidence indicates that gait symmetry worsens over time in stroke survivors. In this prospective, repeated-measures within-group design study, Dr. Combs and colleagues investigated the relationship between gait symmetry and interlimb coordination changes as well as walking speed changes, following BWS GT in individuals in the chronic stage of stroke recovery. Measures were taken 1 week prior to intervention, immediately post-intervention and at 6 months post-intervention. Data from the other trials indicate that meaningful change can be driven in individuals post-stroke at 6 months post-injury, but that more change is seen when intervention is performed earlier, supporting the intervention in this study being performed at 6 months or greater post-stroke.
A convenience sample with a total of 19 subjects with chronic hemiplegia and 22 participants without disability between 40-80 years of age, without current musculoskeletal conditions or recent orthopedic surgeries, no complications from other health conditions that could influence walking, and able to travel to/from research sessions were recruited for participation. Stroke survivors were at least 6 months post a single stroke, and ambulatory with or without use of an assistive device or orthotics, and able to walk up to 14m without using an assistive device (with supervision), with a self-selected gait speed between .4 and .8 m/s, who were not currently receiving physical therapy services or Botox injections to the LEs, medically stable (with clearance to participate in exercise) and able to follow 2-step verbal instructions. Non-disabled participants were able to walk independently at home and in the community with no known neurological condition or deficits. 16 of the stroke participants completed enough of the study for inclusion in statistical analysis. 22 participants without disability participated as a comparison for describing changes in symmetry and coordination. Final data analysis included a total of 15 stroke survivors and 18 non-disabled subjects, and comprised well-matched groups for age and gender. Intervention was provided 3x/week for 8 weeks, for a total of 24 sessions (participation in 20 sessions required for inclusion in statistical analysis). Total walking time per session was 20 minutes (higher than average in inpatient rehabilitation settings), with intermittent rest breaks (not included in walking time). Specific interventions included verbal and manual assistance (facilitation of weight shift at the pelvis, paretic limb facilitation of movement) to provide optimal gait pattern. AFOs and UE support on handrail were not used during training. BWS began at 30% in static standing, and was progressed by decreasing BWS only when the following conditions were met (per previous article): speed increase per session of .2 mph (until minimum norms for community walking speed were met, or maximum tolerated was achieved), the subject required only a single rest period in the training session, demonstrated optimal step and stance length symmetry, upright trunk alignment and consistent heel-strike with adequate limb-loading without manual assistance for at least 5 minutes of the session (25% success rate). BWS progression was from 30% BWS to 15% BWS when these parameters were met. The next increment of change was from 15% BWS to 0, when these parameters were met again. Walking speed was increased in increments of .2mph during each subsequent training session until age and gender norms were achieved.
OUTCOME MEASURES:
were performed one week before and one week after the intervention period, and six months after completion of the intervention.
- Bilateral 3D instrumented gait analysis for bilateral coordination (continuous relative phase: thigh-thigh, shank-shank and foot-foot) and gait symmetry (spatiotemporal ratios: step length, swing time , stance time);
- Gait symmetry via spatiotemporal symmetry ratios: ratio of paretic to non-paretic values for step length, stance time and swing time (right to left for non-disabled group).
- Bilateral coordination via continuous relative phase (CRP) analysis: using mean sagittal plane segmental angular positions and velocities, normalized phase plots were constructed for thigh, shank and foot segments from each participant. Phase angle were calculated at 1% intervals of the gait cycle, and CRP calculated for interlimb couplings (thighs, shanks, feet), defined as the difference between the normalized phase angles of contralateral segments (non-paretic minus paretic for stroke group, right minus left for control group). The mean CRP was displayed as a continuous curve, averaged at each 1% of the gait cycle, with 0ï‚° representing in-phase relationship between 2 limb segments.) Single value representation of the CRP was calculated by averaging the mean absolute CRP (i.e. deviation from 0ï‚°) (MARP) over each 1% interval of the gait cycle.
- Comfortable walking speed test (CWT) for gait speed (10m walk test at comfortable walking speed): average of 3 trials
CEU Information
Webinar Information
Contact Hours: 1
Price: $10
Instructor: Nechama Karman
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