Enhanced life-role participation in response to comprehensive gait training in chronic-stroke survivors

Purpose: Intensive gait training can produce improvements in gait and function (>6 months after stroke); however, findings are mixed for enhanced life-role participation. Therefore, it is unclear if improved gait and function translate into life-role participation gain. Our objective was to evaluate whether intensive gait therapy can produce improvements in life-role participation for chronic-stroke survivors, according to a comprehensive measure dedicated to life-role participation. Methods: In conjunction with a clinical gait-training trial, we conducted a secondary analysis for a 44-member cohort with stroke (>6 months). Gait-training interventions included functional neuromuscular stimulation, body-weight supported treadmill training, over-ground gait training and exercise for 1.5 hours/day, 4 days/week for 12 weeks. Study measures included Tinetti Gait (gait impairment), Functional Independence Measure (FIM, function), Stroke Impact Scale subscale of life-role participation (SIS part) and Craig Handicap Assessment and Reporting Technique (CHART, life-role participation). Analysis included Wilcoxon signed rank test and polytomous universal regression model. Results: Gait interventions produced significant improvement in CHART (p = 0.020), SIS part (p = 0.011), FIM (p < 0.0001), and Tinetti Gait (p < 0.0001). Age, gender and time since stroke did not predict response to treatment. Conclusions: Intensive gait therapy resulted in significant gain in life-role participation, according to a comprehensive measure, so dedicated.

Implications for Rehabilitation

• It is important to measure life-role participation in rehabilitation intervention studies, and using a homogeneous measure of life-role participation provides clear results.

• Intensive gait training produced a significant improvement in life-role participation in the chronic phase after stroke.

• Functional electrical stimulation (FES) had no significant additive effect on life-role participation during the treatment phase, but FES did have an additive effect during the follow-up period in enhancing life-role participation beyond that obtained using an identical comprehensive gait-training intervention without FES.

     

Enhanced life-role participation in response to comprehensive gait training in chronic stroke survivors*

Purpose: Intensive gait training can produce improvements in gait and function (> 6 months after stroke); findings are mixed for enhanced life role participation. Therefore, it is unclear if improved gait and function translate into life role participation gain. Our objective was to evaluate whether intensive gait therapy can produce significant improvements in life role participation for chronic stroke survivors. Methods: In conjunction with a clinical gait training trial, we conducted a secondary analysis for a 44-member cohort with stroke (>6 months). Gait training interventions included exercise, body weight supported treadmill training (BWSTT), over-ground gait training, and functional electrical stimulation (FES) for 1.5 h/day, 4 days/wk for 12 weeks. Study measures included Tinetti Gait (TG) (gait impairment), Functional Independence Measure (FIM, function), Stroke Impact Scale Subscale of Life Role Participation (SISpart), and Craig Handicap Assessment & Reporting Technique (CHART, life-role participation). Analyses included Wilcoxon Signed Rank Test and PLUM Regression Model. Results: Gait interventions produced significant improvement in CHART (p = 0.020), SISpart (p = 0.011), FIM (p < 0.0001), and Tinetti Gait (p < 0.0001). Age, gender and time since stroke did not predict response to treatment. Conclusions: Intensive, multi-modal, long-duration gait therapy resulted in significant gain in life-role participation, according to a relatively comprehensive, homogeneous measure.

Implications for Rehabilitation

• It is important to measure life role participation in rehabilitation intervention studies, and using a homogenous measure of life role participation provides clear results.

• Intensive gait training produced a significant improvement in life role participation in the chronic phase after stroke.

• Functional electrical stimulation (FES) had no significant additive effect on life role participation during the treatment phase, but FES did have an additive effect during the follow-up period, in enhancing life role participation beyond that obtained using an identical comprehensive gait training intervention without FES.

     

Controlling patient participation during robot-assisted gait training

Background  

The overall goal of this paper was to investigate approaches to controlling active participation in stroke patients during robot-assisted gait therapy. Although active physical participation during gait rehabilitation after stroke was shown to improve therapy outcome, some patients can behave passively during rehabilitation, not maximally benefiting from the gait training. Up to now, there has not been an effective method for forcing patient activity to the desired level that would most benefit stroke patients with a broad variety of cognitive and biomechanical impairments.     

Capability of 2 gait measures for detecting response to gait training in stroke survivors: Gait Assessment and Intervention Tool and the Tinetti Gait Scale

Zimbelman J, Daly JJ, Roenigk KL, Butler K, Burdsall R, Holcomb JP. Capability of 2 gait measures for detecting response to gait training in stroke survivors: Gait Assessment and Intervention Tool and the Tinetti Gait Scale.ObjectiveTo characterize the performance of 2 observational gait measures, the Tinetti Gait Scale (TGS) and the Gait Assessment and Intervention Tool (G.A.I.T.), in identifying improvement in gait in response to gait training.DesignIn secondary analysis from a larger study of multimodal gait training for stroke survivors, we measured gait at pre-, mid-, and posttreatment according to G.A.I.T. and TGS, assessing their capability to capture recovery of coordinated gait components.SettingLarge medical center.ParticipantsCohort of stroke survivors (N=44) greater than 6 months after stroke.InterventionsAll subjects received 48 sessions of a multimodal gait-training protocol. Treatment consisted of 1.5 hours per session, 4 sessions per week for 12 weeks, receiving these 3 treatment aspects: (1) coordination exercise, (2) body weight–supported treadmill training, and (3) overground gait training, with 46% of subjects receiving functional electrical stimulation.Main Outcome MeasuresAll subjects were evaluated with the G.A.I.T. and TGS before and after completing the 48-session intervention. An additional evaluation was performed at midtreatment (after session 24).ResultsFor the total subject sample, there were significant pre-/post-, pre-/mid-, and mid-/posttreatment gains for both the G.A.I.T. and the TGS. According to the G.A.I.T., 40 subjects (91%) showed improved scores, 2 (4%) no change, and 2 (4%) a worsening score. According to the TGS, only 26 subjects (59%) showed improved scores, 16 (36%) no change, and 1 (2%) a worsening score. For 1 treatment group of chronic stroke survivors, the TGS failed to identify a significant treatment response to gait training, whereas the G.A.I.T. measure was successful.ConclusionsThe G.A.I.T. is more sensitive than the TGS for individual patients and group treatment response in identifying recovery of volitional control of gait components in response to gait training.     

Cardiovascular response to gait training and ambulation in a hemiparetic heart recipient

Little has been reported about the rehabilitation of heart recipients who experience disabling neurologic complications. This is of particular interest to physiatrists because the number of cardiac transplants is increasing and the cardiovascular response of the denervated heart to exercise is altered. The case reported here describes a 42-year-old woman who underwent heart transplantation for ischemic cardiomyopathy. One year after transplantation, the patient was hospitalized for evaluation of headaches and mental status changes. A lymphoma involving the left basal ganglia was diagnosed and the patient underwent a course of radiation therapy. She was transferred for rehabilitation of a left hemiparesis and made functional gains in mobility and self-care skills. Weekly recordings of heart rate and blood pressure were obtained before and after ambulation. Small increases in both heart rate and blood pressure were recorded after ambulation to the point of fatigue. In both parameters, the patient's maximum response was below that reported for nondisabled cardiac recipients, highlighting the need for symptom-oriented exercise guidelines in these patients.     

Patient-cooperative control increases active participation of individuals with SCI during robot-aided gait training

Background  

Manual body weight supported treadmill training and robot-aided treadmill training are frequently used techniques for the gait rehabilitation of individuals after stroke and spinal cord injury. Current evidence suggests that robot-aided gait training may be improved by making robotic behavior more patient-cooperative. In this study, we have investigated the immediate effects of patient-cooperative versus non-cooperative robot-aided gait training on individuals with incomplete spinal cord injury (iSCI).     

Human-centered robotics applied to gait training and assessment

Robot-aided gait training can increase the duration and number of training sessions while reducing the number of therapists required for each patient. However, current automated gait trainers do not adapt their movement to the patient's muscular efforts and passive musculoskeletal properties. Furthermore, robot-aided training without therapists lacks the feedback required for patient assessment. In this article, we present results from the literature and our research to provide an overview of novel human-centered strategies for robot behaviors that are patient-cooperative and support motor-function assessment. Combining robot-aided training with robot-aided assessment will likely make future gait therapy easier, more comfortable, and more efficient. Broad clinical testing is still required for proving this assumption.     

镜像视觉反馈训练联合下肢康复机器人对脑卒中患者下肢运动功能的影响

目的:探讨镜像视觉反馈训练联合下肢康复机器人对脑卒中患者下肢运动功能的影响。方法:将60例脑卒中患者按随机数字表法分为对照组、机器人组和联合组,每组20例。3组患者均接受康复科常规康复训练,机器人组在此基础上进行4周的下肢康复机器人辅助步行训练(每次30 min、每日1次、每周5 d),联合组在机器人组基础上增加镜像视...     

Improving spatiotemporal gait parameters in spastic diplegic children using treadmill gait training

BackgroundEven though several physiotherapy techniques help to improve the spatiotemporal gait parameters of diplegic children, the efficacy of treadmill gait training together with conventional treatment techniques on spatiotemporal parameter improvement needs more investigation.ObjectiveThis study's main purpose is to investigate the effect of treadmill gait training as an adjunct to conventional physiotherapy treatment on the spatiotemporal gait parameters of diplegic children.MethodsTwenty diplegic children were distributed randomly into two equal groups (a control group of ten children who received a traditional treatment and an experimental group of ten children who received the traditional treatment together with treadmill gait training). Gait data were collected using a Vicon three-dimensional motion analysis system during regular walking.ResultsWalking speed, cadence, step length, stride length, and single limb support were enhanced in both groups (p < 0.05). Cadence and walking speed increased by 6.5 steps/min and 0.2 m/sec respectively in the experimental group, compared to the control group. Also, step length, stride length and single limb support time increased by 0.13 m, 0.27 m, and 0.07 s respectively in the experimental group, compared to the control group.ConclusionThe use of treadmill gait training together with conventional physical therapy treatment enhances the walking performance of diplegic children by improving several spatiotemporal gait parameters. Furthermore, walking balance is improved by increasing the single-leg support time.     

Improvement of gait ability with a short-term intensive gait rehabilitation program using body weight support treadmill training in community dwelling chronic poststroke survivors

[Purpose] Most previous studies have shown that body weight support treadmill training (BWSTT) can improve gait speed poststroke patients. The purpose of this study was to evaluate effectiveness of a short-term intensive program using BWSTT among community dwelling poststroke survivors. [Subjects] Eighteen subjects participated in this study. The treatment group was composed of 10 subjects (2 women; 8 men; mean age, 59.1 ± 12.5 years; time since stroke onset, 35.3 ± 33.2 months), whereas the control group was made up of 8 subjects (3 women; 5 men; mean age, 59.8 ± 6.3 years; time since stroke onset, 39.3 ± 27.3 months). [Methods] The treatment group received BWSTT 3 times a week for 4 weeks (a total of 12 times), with each session lasting 20 minutes. The main outcome measures were maximum gait speed on a flat floor, cadence, and step length. [Results] No differences were observed in the baseline clinical data between the 2 groups. The gait speed in the treatment group was significantly improved compared with that in the control by 2-way ANOVA, while the other parameters showed no significant interaction. [Conclusion] These results suggested that short-term intensive gait rehabilitation using BWSTT was useful for improving gait ability among community dwelling poststroke subjects.Key words: Hemiparesis, Community-dwelling, Body weight support     

Sport participation in colorectal cancer survivors: an unexplored approach to promoting physical activity

Purpose

Physical activity improves health outcomes in colorectal cancer (CRC) survivors, but participation rates are low. One understudied strategy for increasing physical activity in CRC survivors may be sport participation. Here, we report the sport participation rate, sport preferences, and correlates of sport participation among CRC survivors.

Methods

A provincial, population-based mailed survey of CRC survivors in Alberta, Canada was performed and included measures of sport participation, sport preferences, sport benefits and barriers, and medical and demographic variables.

Results

A total of 600 CRC survivors completed the survey (34?% response rate). Almost a quarter (23.0?%) of CRC survivors reported participating in a sport in the past month, with the most common sport being golf (58.7?%). In multivariate regression analysis, 33.0?% (p?=?0.001) of the variance in sport participation was explained by being male (???=?0.12; p?=?0.006), in better general health (???=?0.12; p?=?0.006), and ???5?years post-diagnosis (???=?0.09; p?=?0.031). The most common barriers to sport participation were time, age/agility, and no interest/dislike of sports. The most common anticipated benefits of sport participation were improved physical fitness, meeting people, and improved health. Over half (57.2?%) of CRC survivors were possibly interested in learning about sport participation opportunities.

Conclusions

Promotion of sport participation may be a potentially fruitful strategy for increasing physical activity in CRC survivors.     

虚拟现实同步减重训练对脑梗死患者步态对称性及神经网络的影响

摘要 目的：评估亚急性期脑梗死患者虚拟现实同步减重训练（VR+BWSTT）后步态对称性的远期变化及其神经机制。 方法：8例亚急性期脑梗死患者在3周VR+BWSTT前后各做一次三维步态检查及弥散张量成像（DTI）,其中7例患者训练后3个月复查了三维步态和DTI。对以下参数进行前后对比：单腿支撑时间不对称性、步长不对称性、下肢各关节活动范围不对称性、下肢Fugl-Meyer评分、病灶中心的各向异性分数（FA）值、表观扩散系数（ADC）和FA指数（病灶中心FA值/健侧对应区FA值）、ADC指数（病灶中心ADC值/健侧对应区ADC值）。对FA指数、ADC指数与下肢Fugl-Meyer评分做相关性分析。 结果：单腿支撑时间不对称性和下肢Fugl-Meyer评分在训练后改善（P＜0.05）,且持续至训练后3个月。步长不对称性和下肢各关节活动范围不对称性在训练后无改善（P＞0.05）。训练前ADC指数与训练前后下肢Fugl-Meyer评分的变化值有相关性（P＜0.05）。 结论：VR+BWSTT可改善亚急性期脑梗死患者步态的时间不对称性和下肢Fugl-Meyer评分。ADC指数可预测患者下肢运动功能康复潜能。     

Virtual dual-task treadmill training using video recording for gait of chronic stroke survivors: a randomized controlled trial

[Purpose] The aim of this study was to examine the effects of virtual dual-task treadmill training using a real-world video recording of the gait of individuals with chronic stroke. [Subjects] Forty chronic stroke survivors were randomly divided into two groups of 20 subjects each. [Methods] The experimental group performed virtual dual-task treadmill training using a video recording for 30 minutes per session, three times a week for 4 weeks, whereas the control group performed only treadmill training for 30 minutes per session, three times a week for 4 weeks. A video recording was performed in a large supermarket, and the subjects could walk at their favorable speed on a treadmill. The temporospatial gait variables were measured to examine the training effect. [Results] The experimental and control groups showed statistically significant improvements in the gait variables after training. The enhancement of gait ability was statistically better in the experimental group than in the control group. [Conclusion] Our findings suggest that virtual dual-task treadmill training using a video recording can improve the gait parameters of chronic stroke survivors.Key words: Stroke, Gait, Video recording     

Progressive resistance training after stroke: effects on muscle strength, muscle tone, gait performance and perceived participation.

OBJECTIVE: To evaluate the effects of progressive resistance training on muscle strength, muscle tone, gait performance and perceived participation after stroke. DESIGN: A randomized controlled trial. SUBJECTS: Twenty-four subjects (mean age 61 years (standard deviation 5)) 6-48 months post-stroke. METHODS: The training group (n = 15) participated in supervised progressive resistance training of the knee muscles (80% of maximum) twice weekly for 10 weeks, and the control group (n = 9) continued their usual daily activities. Both groups were assessed before and after the intervention and at follow-up after 5 months. Muscle strength was evaluated dynamically and isokinetically (60 degrees /sec) and muscle tone by the Modified Ashworth Scale. Gait performance was evaluated by Timed "Up & Go", Fast Gait Speed and 6-Minute Walk tests, and perceived participation by Stroke Impact Scale. RESULTS: Muscle strength increased significantly after progressive resistance training with no increase in muscle tone and improvements were maintained at follow-up. Both groups improved in gait performance, but at follow-up only Timed "Up & Go" and perceived participation were significantly better for the training group. CONCLUSIONS: Progressive resistance training is an effective intervention to improve muscle strength in chronic stroke. There appear to be long-term benefits, but further studies are needed to clarify the effects, specifically of progressive resistance training on gait performance and participation.     

护士综合应急能力培训体系的构建和实践

目的构建一套护士综合应急能力培训体系,并评价其应用效果。方法采用德尔菲专家咨询法,构建护士综合应急能力培训体系。于2017年8月—2018年5月在福建省某三级甲等综合医院各科室护士中运用该培训体系,比较培训前后各项目的得分情况、护士职业价值认同感得分。结果构建的护士综合应急能力培训体系涵盖护士应急状态下应具备的抢救能力、评判性思维能力、沟通协调能力、人文关怀能力、职业防护能力,共44项课程内容、40课时。培训后各项目得分和护士职业价值认同感各维度得分均高于培训前,差异均有统计学意义(P<0.05)。结论本研究构建的护士综合应急能力培训体系设置科学、合理,可提升护士的综合应急能力和职业价值认同感,为护士培训提供参考和借鉴。     

Transfer and retention effects of gait training with anterior-posterior perturbations to postural responses after medio-lateral gait perturbations in older adults

BackgroundGait perturbations, occurring in any direction in daily life, may result in a fall. In fall prevention, gait perturbation training is a promising approach. Treadmill perturbations in anterior-posterior direction can easily be applied by accelerations or decelerations of the belt, but it is unknown whether training effects transfer to reactive recovery in medio-lateral direction. We aimed to evaluate the transfer and retention effects of gait training with treadmill perturbations in anterior-posterior direction to medio-lateral reactive recovery.Methods30 community dwelling older adults (>65 years) participated in this study. They were randomly assigned to a treadmill training session either with 16 anterior-posterior perturbations or with treadmill walking. The assessments contained a walking trial with 4 anterior-posterior and 4 medio-lateral perturbations. Deviations in trunk velocity from unperturbed walking were summed over the first three strides after perturbation as a measure of recovery.FindingsAn exposure to gait perturbations during the baseline assessment led to significant improvement of recovery responses. For anterior-posterior perturbations, both groups showed better recovery immediately and 1-week post-intervention, and no group x time interaction was found.. For medio-lateral perturbations, both groups showed better recovery immediately and 1-week post-intervention, and again no group × time interaction.InterpretationBaseline assessment with perturbations in anterior-posterior and medio-lateral directions caused significant improvements that were retained. Short-term training can be effective in dynamic stabilization of one's trunk, but our findings do not exclude that multi-directional perturbations may be needed.     

运动想象结合下肢康复机器人训练对脑卒中患者步行障碍的影响

摘要 目的：探讨运动想象结合Lokomat下肢康复机器人训练对脑卒中患者步行障碍的影响。 方法：40例脑卒中偏瘫患者随机分为两组,观察组和对照组各组20例,两组均进行基础康复治疗,包括神经发育疗法、主/被动牵伸、日常生活活动（ADL）训练、必要的矫形器应用、传统中医治疗等。观察组：第一疗程（4周）,在基础治疗的基础上进行Lokomat下肢康复机器人辅助步行训练,治疗强度和时间长度是40%的减重支持,75%的引导力量,1.5km/h的步行速度,步行持续时间30min/次,1次/d,5次/周;第二疗程（4周）,在基础治疗的基础上进行运动想象结合Lokomat下肢康复机器人辅助步行训练,治疗强度和时间长度是40%的减重支持,75%的引导力量,1.5km/h的步行速度,步行持续时间30min/次,1次/d,5次/周;对照组患者在基础治疗的基础上进行30min以提高步行能力为目标的治疗师辅助步行训练,1次/d,5次/周,为期8周。在治疗前、治疗4周后、治疗8周后分别采用Fugl-Meyer下肢评定表(FMA-LE)、改良Ashworth痉挛评价下肢肌痉挛（MAS）、功能性步行量表（FAC）和6min步行能力测试(6MWT)、采用Berg平衡量表（BBS）进行评定。 结果：治疗8周后,两组患者的FMA-LE评分、MAS、FAC、6MWT和BBS均较治疗前明显提高(P<0.05),观察组各项评定得分与对照组比较均具有显著差异(P<0.01);观察组第一、第二疗程各项评定得分与对照组比较均具有显著差异(P<0.01);此外,对照组患者2个疗程各项评定得分改善值差异无显著性（P＞0.05）,而观察组患者第二疗程的各项评定得分改善值高于第一疗程（P＜0.05）。 结论：应用运动想象结合Lokomat下肢康复机器人训练能更有效改善脑卒中患者的步行能力,且疗效高于单用Lokomat下肢康复机器人训练。     

Lokomat下肢康复机器人对改善帕金森病患者步行能力的疗效研究

目的:观察Lokomat下肢康复机器人对改善帕金森疾病患者步行能力的临床疗效。方法:将40例帕金森疾病患者随机分成对照组和观察组各20例。2组均接受常规康复训练,观察组在此基础上进行Lokomat下肢康复机器人步行训练,步行持续时间30min/次,1次/d,5次/周。在治疗前后分别采用Berg平衡量表(BBS)评定平衡功能、计时起立-行走测试(TUGT)评定功能性步行能力及预测跌倒风险、6min步行测试(6MWT)评价步行耐力。结果:治疗10周后,观察组BBS、6MWT较治疗前及对照组明显提高(P0.05),TUGT较治疗前及对照组明显降低(P0.05);对照组BBS评分较治疗前提高(P0.05),6MWT及TUGT评分治疗前后比较差异无统计学意义。结论:Lokomat下肢康复机器人辅助步行训练可提高帕金森疾病患者平衡能力和提高步行能力,是治疗帕金森病患者步行障碍的有效方法。