The effects of action observation training as an add-on rehabilitation strategy on the walking ability of patients with chronic stroke

ObjectiveStroke is one of the most debilitating neurological disorders that commonly results in both cognitive and motor dysfunctions. Although the recovery of gait is one of the main goals of patients with stroke, only 50–60% of the patients commonly reach this target. This study aimed to evaluate the effects of action observation training, based on mirror neurons, as an add-on therapy to the conventional physical rehabilitation on the gait performance of patients with stroke.MethodsFourteen patients with chronic stroke were randomly assigned to the sham or the experimental group. Both groups received a 40-min conventional physical training following a 12-min observation training depicting exercises for the experimental group but nature pictures for the sham group each session. The patients’ walking was recorded using a motion analysis system at baseline and after the 12-session intervention. Spatiotemporal parameters of gait and ground reaction forces were measured.ResultsSignificant improvements were found in most measured spatiotemporal parameters of gait on the unaffected side of the patients in the experimental group, while in the sham group, the recovery was observed only in the percentage of the stance phase. Regarding the affected side, the stride and step length of the patients in the experimental group were parameters with a significant amelioration.ConclusionThe results of this study showed that the action observation training had the potential to improve the walking quality of the patients with hemiplegia in the chronic phase of stroke.     

下肢康复训练机器人对缺血性脑卒中偏瘫患者平衡及步行功能的影响

目的:观察下肢康复训练机器人对缺血性脑卒中(早期)偏瘫患者平衡功能以及步行功能的影响。方法:将40例偏瘫患者随机分为对照组(20例)和Lokomat组(20例)。两组均给予常规肢体功能训练,对照组采用常规康复疗法,每周进行3次,每次30min,共治疗10周。Lokomat组给予下肢康复机器人为主的运动训练,辅以常规康复训练,每次30min,3次/周,共10周(2个疗程)。采用Berg平衡量表及单项评分(测定平衡功能)、踝-后足评分量表(AOFAS)及其中的异常步态、前足活动(屈/伸)、后足活动(内翻加外翻)、踝-后足稳定性和足部对线(评价踝关节的功能恢复和异常步态)和步长、步宽、步频、步速(评价患者每天活动时实际步行功能的变化)进行疗效评价。结果:治疗前,两组在Berg平衡量表,踝-后足功能评分以及异常步态、前足活动(屈/伸)、后足活动(内翻加外翻)、踝-后足稳定性和足部对线,步长、步宽、步速和步频的评测差异均无显著性(P>0.05),均具有可比性。治疗后,Berg平衡量表,踝-后足功能评分及异常步态、前足活动(屈/伸)、后足活动(内翻加外翻)、踝-后足稳定性和足部对线,步长、步宽、步速和步频的评测较治疗前均有明显改善(P<0.05);与对照组相比,Lokomat组改善均更明显(P<0.05);Berg平衡功能单项评分比较:训练后,Lokomat组从坐到站、无支撑站位、无支撑坐位、站到坐、转移、闭眼站立、并脚站立、前后脚成直线以及单脚站等方面评分均高于对照组(P<0.05)。结论:下肢康复训练机器人能改善缺血性脑卒中偏瘫患者的踝背屈功能,对改善其平衡和步行功能具有积极作用。     

Effects of robot-assisted gait training on the balance and gait of chronic stroke patients: focus on dependent ambulators

[Purpose] The purpose of this study was to confirm the effect of robot-assisted gait training on the balance and gait ability of stroke patients who were dependent ambulators. [Subjects and Methods] Twenty stroke patients participated in this study. The participants were allocated to either group 1, which received robot-assisted gait training for 4 weeks followed by conventional physical therapy for 4 weeks, or group 2, which received the same treatments in the reverse order. Robot-assisted gait training was conducted for 30 min, 3 times a week for 4 weeks. The Berg Balance Scale, Modified Functional Reach Test, Functional Ambulation Category, Modified Ashworth Scale, Fugl-Meyer Assessment, Motricity Index, and Modified Barthel Index were assessed before and after treatment. To confirm the characteristics of patients who showed a significant increase in Berg Balance Scale after robot-assisted gait training as compared with physical therapy, subgroup analysis was conducted. [Results] Only lateral reaching and the Functional Ambulation Category were significantly increased following robot-assisted gait training. Subscale analyses identified 3 patient subgroups that responded well to robot-assisted gait training: a subgroup with hemiplegia, a subgroup in which the guidance force needed to be decreased to needed to be decreased to ≤45%, and a subgroup in which weight bearing was decreased to ≤21%. [Conclusion] The present study showed that robot-assisted gait training is not only effective in improving balance and gait performance but also improves trunk balance and motor skills required by high-severity stroke patients to perform activities daily living. Moreover, subscale analyses identified subgroups that responded well to robot-assisted gait training.Key words: Stroke, Robotics, Gait     

Effect of space balance 3D training using visual feedback on balance and mobility in acute stroke patients

[Purpose] The purpose of the study was to determine the effects of balance training with Space Balance 3D, which is a computerized measurement and visual feedback balance assessment system, on balance and mobility in acute stroke patients. [Subjects and Methods] This was a randomized controlled trial in which 52 subjects were assigned randomly into either an experimental group or a control group. The experimental group, which contained 26 subjects, received balance training with a Space Balance 3D exercise program and conventional physical therapy interventions 5 times per week during 3 weeks. Outcome measures were examined before and after the 3-week interventions using the Berg Balance Scale (BBS), Timed Up and Go (TUG) test, and Postural Assessment Scale for Stroke Patients (PASS). The data were analyzed by a two-way repeated measures ANOVA using SPSS 19.0. [Results] The results revealed a nonsignificant interaction effect between group and time period for both groups before and after the interventions in the BBS score, TUG score, and PASS score. In addition, the experimental group showed more improvement than the control group in the BBS, TUG and PASS scores, but the differences were not significant. In the comparisons within the groups by time, both groups showed significant improvement in BBS, TUG, and PASS scores. [Conclusion] The Space Balance 3D training with conventional physical therapy intervention is recommended for improvement of balance and mobility in acute stroke patients.Key words: Balance training, Visual feedback, Acute stroke patients     

强制性运动疗法对脑卒中患者步行能力及平衡功能的影响

目的：探讨强制性运动疗法(CIMT)对脑卒中患者步行能力及平衡功能的影响。方法：选择2007年2月—2008年6月在承德医学院附属医院康复医学科住院的脑卒中偏瘫患者60例,随机分为试验组和对照组,每组30例。试验组采用改良CIMT对下肢功能进行强化训练,对照组给予常规康复治疗,连续治疗8周。采用Berg平衡量表测定治疗前后两组患者的平衡功能;用“起立-行走”计时测定（TUGT）及最大步行速度（MWS）分别测定起立行走和10m最大步行速度来评价患者的步行能力。结果：经“CIMT”治疗后,试验组Berg平衡量表的评分显著高于对照组（P＜0.05）;TUGT的时间显著小于对照组（P＜0.05）; MWS则显著高于对照组（P＜0.05）。结论：CIMT能够显著改善脑卒中患者的步行能力及平衡功能,是有效的康复治疗方法。     

减重步行机器人训练对脑卒中患者步行能力的影响

目的：观察外源性磷酸肌酸对一次性力竭运动小鼠的影响,探讨其抗疲劳的作用机制。方法：采用小鼠负重游泳建立力竭运动小鼠模型。将小鼠分为力竭给药组（A组）、力竭不给药组（B组）、游泳8min不给药组（c组）、游泳8min给药组（D组）。实验前20min,A、D组小鼠按1000mg／Kg体质量腹腔注射磷酸肌酸钠,B、C、绀腹腔注射同等剂量的生理盐水。力竭游泳实验按每只小鼠体质量的6％负重进行。用生化比色法检测血清超氧化物歧化酶（SOD）活性和丙二醛（MDA）含量,并记录小鼠的力竭时问。结果：A、C、D组的SOD活性较B组显著升高（P〈0．05,0．01）,I）组较A组明显升高（P〈0．05）。B组的MDA含量较c组明显升高（P〈0．01）,A组较D组明显升高（P〈0．05）。B组游泳至力竭的时间明显短于A组（P〈0．05）。结论：外源性磷酸肌酸增强机体抗疲劳的机制可能与其增强SOD活性、降低MDA含量有关,通过增强自由基的清除来提高机体的抗疲劳能力。     

反重力跑台系统在老年脑卒中患者平衡及步行训练中的疗效

目的:观察反重力跑台训练系统在老年脑卒中患者平衡及步行训练中的应用效果.方法:选取我院60例老年卒中住院患者,随机分为研究组和对照组各30例.2组均予常规康复训练及步行训练,研究组加用反重力跑台步行训练,连续治疗12周,并在治疗前后采用Berg平衡量表、Tinetti步态评估量表、10m最大步行速度测试评估患者平衡及步...     

The effect of modified trampoline training on balance,gait, and falls efficacy of stroke patients

[Purpose] This research was conducted to investigate the effects of modified trampoline training on the balance, gait, and falls efficacy of stroke patients. [Subjects] Twenty-four stroke patients participated in this study. The subjects were randomly allocated to one of two groups: the trampoline group (n=12) or the control group (n=12). [Methods] Both groups participated in conventional physical therapy for thirty minutes per day, three times a week for six weeks. The trampoline group also took part in trampoline training for thirty minutes per day, three times a week for six weeks. We evaluated balance (Berg balance scale, timed up and go test), gait (dynamic gait index), and falls efficacy (falls efficacy scale-K) to confirm the effects of the intervention. [Results] Both the trampoline and the control group showed significant improvements in balance, gait, and falls efficacy compared to before the intervention, and the improvements were significantly greater in the trampoline group than in the control group. [Conclusion] Modified trampoline training resulted in significantly improved balance, dynamic gait, and falls efficacy of stroke patients compared to the control group. These results suggest that modified trampoline training is feasible and effective at improving balance, dynamic gait, and falls efficacy after stroke.Key words: Trampoline, Stroke, Rehabilitation     

电子助行仪对脑卒中患者平衡和步行能力的影响

目的:探讨电子助行仪对脑卒中患者平衡和步行能力的影响。方法:将60例脑卒中患者随机分为观察组和对照组各30例,2组患者均进行常规运动治疗,对照组和观察组在此基础上分别佩戴动态踝足矫形器和电子助行仪进行训练。治疗前后采用Berg平衡量表（BBS）和10m 最大步行速度（10m MWS）对患者进行评估。结果:治疗前,佩戴装备后,2组患者组内比较,10m MWS较未佩戴装备时均明显提高(均P＜0.05)。治疗2周后,无论是否佩戴装备,2组患者BBS评分及10m MWS较治疗前均明显提高(均P＜0.05);未佩戴装备时,观察组10m MWS较对照组明显提高(P＜0.01)。结论:佩戴踝足矫形器或电子助行仪均能改脑卒中患者的平衡功能,但电子助行仪在提高患者步行速度方面效果更显著。     

Effects of Nordic walking and walking on spatiotemporal gait parameters and ground reaction force

[Purpose] The purpose of this study was to investigate the effects of Nordic walking and walking on spatiotemporal gait parameters and ground reaction force. [Subjects] The subjects of this study were 30 young adult males, who were divided into a Nordic walking group of 15 subjects and a walking group of 15 subjects. [Methods] To analyze the spatiotemporal parameters and ground reaction force during walking in the two groups, the six-camera Vicon MX motion analysis system was used. The subjects were asked to walk 12 meters using the more comfortable walking method for them between Nordic walking and walking. After they walked 12 meters more than 10 times, their most natural walking patterns were chosen three times and analyzed. To determine the pole for Nordic walking, each subject’s height was multiplied by 0.68. We then measured the spatiotemporal gait parameters and ground reaction force. [Results] Compared with the walking group, the Nordic walking group showed an increase in cadence, stride length, and step length, and a decrease in stride time, step time, and vertical ground reaction force. [Conclusion] The results of this study indicate that Nordic walking increases the stride and can be considered as helping patients with diseases affecting their gait. This demonstrates that Nordic walking is more effective in improving functional capabilities by promoting effective energy use and reducing the lower limb load, because the weight of the upper and lower limbs is dispersed during Nordic walking.Key words: Nordic walking, Ground reaction force, Spatiotemporal gait parameters     

Association of performance of standing turns with physical impairments and walking ability in patients with hemiparetic stroke

[Purpose] The effect of turn direction and relation between turn performance and walking ability in patients with hemiparetic stroke is not clear. The purpose of this study was to determine the effect of turn direction on the performance of standing turns and to examine the relations between turn performance and walking ability in patients with hemiparetic stroke. [Subject and Methods] The participants were 38 outpatients with chronic hemiparesis due to stroke. Turn performance was evaluated using the time and number of steps required to complete a 360° standing turn, and was evaluated for turns toward the paretic side and the non-paretic side. Walking ability was assessed using gait speed in the 10-m walk test, the Timed Up and Go test, and the Functional Ambulation Category. [Results] Thirty-six participants were analyzed, and the time needed for turns and number of steps were similar for turns to the paretic and non-paretic sides. The time needed for turns was correlated walking ability. A turn time of 10.0 s distinguished FAC 5 (independent ambulation in the community) from FAC ≤4 with a sensitivity of 0.94 and specificity of 0.85. [Conclusion] The performance of standing turns was not affected by the turning direction and was closely correlated with walking ability.Key words: Standing turn, Stroke, Walking     

The effect of gait training with shoe inserts on the improvement of pain and gait in sacroiliac joint patients

[Purpose] The purpose of the current research was to identify how gait training with shoe inserts affects the pain and gait of sacroiliac joint dysfunction patients. [Subjects and Methods] Thirty subjects were randomly selected and assigned to be either the experimental group (gait training with shoe insert group) or control group. Each group consisted of 15 patients. Pain was measured by Visual Analogue Scale, and foot pressure in a standing position and during gait was measured with a Gateview AFA-50 system (Alpus, Seoul, Republic of Korea). A paired sample t-test was used to compare the pain and gait of the sacroiliac joint before and after the intervention. Correlation between pain and walking after gait training with shoe inserts was examined by Pearson test. The level of significance was set at α=0.05. [Results] It was found that application of the intervention to the experimental group resulted in a significant decrease in sacroiliac joint pain. It was also found that there was a significant correlation between Visual Analogue Scale score and dynamic asymmetric index (r= 0.796) and that there was a negative correlation between Visual Analogue Scale score and forefoot/rear foot peak pressure ratio (r=-0.728). [Conclusion] The results of our analysis lead us to conclude that the intervention with shoe inserts had a significant influence on the pain and gait of sacroiliac joint patients.Key words: Sacroiliac joint, Shoe inserts, Gait     

水中步行训练对偏瘫患者下肢肌肉形态、平衡和步行能力的影响

目的:探讨水中步行对偏瘫患者下肢肌肉厚度、羽状角、平衡和步行能力的影响。方法:选取偏瘫患者30例,随机分为观察组和对照组各15例,均接受常规运动训练。在此基础上,观察组接受水下平板训练,对照组接受陆上步行训练。治疗前后测量患侧下肢主要肌群厚度、羽状角,Berg平衡量表(BBS)评分,Holden步行功能分级。结果:治疗4周后,2组内侧腓肠肌羽状角较治疗前减小(均P<0.05),且观察组小于对照组(P<0.05);2组其他下肢肌肉厚度及羽状角均较治疗前显著增加(均P<0.05),且观察组股直肌、胫骨前肌、外侧腓肠肌肌肉厚度较对照组均显著增加(均P<0.05),2组间内侧腓肠肌厚度比较差异无统计学意义;2组患者BBS评分及Holden步行功能分级均较治疗前有显著提高(均P<0.05),2组间BBS评分及Holden步行功能分级比较差异无统计学意义。结论:水中步行运动可以提高患侧下肢肌肉厚度、羽状角角度,对平衡功能和步行独立性有积极影响。     

双重任务训练对脑卒中后共济失调患者的平衡及步行能力的影响

目的:为了探索双重任务(DT)训练对脑卒中后共济失调患者的平衡及步行能力的影响.方法:40例脑卒中后共济失调患者随机分为DT组和单一任务(ST)组各20例,ST组接受常规运动训练,DT组在常规训练里的步行训练时接受DT训练.治疗前及治疗4周后对2组患者进行以下评定:单一任务模式的计时起立-走测试(TUG-S)、运动双重...     

Effects of treadmill training with the eyes closed on gait and balance ability of chronic stroke patients

[Purpose] The purpose of this study was to compare the effect of treadmill walking with the eyes closed and open on the gait and balance abilities of chronic stroke patients. [Subjects and Methods] Thirty patients with chronic stroke participated in this study. The treadmill gait training for each group lasted 40 minutes, and sessions were held 3 times a week for 4 weeks. Gait ability was measured using a Biodex Gait Trainer Treadmill System. Balance ability was measured using a Biodex Balance System. [Results] After the treadmill training‚ the treadmill training with eyes closed (TEC) group showed significant improvements in walking distance‚ step length‚ coefficient of variation‚ and limit of stability (overall‚ lateral affected‚ forward lateral unaffected) compared to the treadmill training with eyes open (TEO) group. [Conclusion] The walking and balance abilities of the TEC participants showed more improvement after the treadmill walking sessions than those of the TEO participants. Therefore‚ treadmill walking with visual deprivation may be useful for the rehabilitation of patients with chronic stroke.Key words: Stroke, Treadmill training, Visual blocking     

The effects of symmetric center of pressure displacement training with feedback on the gait of stroke patients

[Purpose] This study investigated the effects of COP displacement training using visual feedback had on the gait of patients with hemiplegia due to stroke. [Subjects and Methods] This study was conducted with 20 patients with hemiplegia due to stroke. The training consisted of five training sets repeated 10 times and the activity was conducted for 15 minutes each session, three times per week for six weeks immediately after completion of central nervous system developmental treatment. [Results] A comparison of the results of before and after the experiment found that the COP displacement training group showed significant improvements in step length, stride length, gait velocity, and the functional reach test, while the control group showed significant improvement only in the functional reach test. In the intergroup comparison, the COP displacement training group showed significant improvements in paretic side step length, paretic side stride length, gait velocity, and the functional reach test compared to the control group. [Conclusion] In conclusion, according to the results of this study, visual feedback training for COP displacement is more effective at enhancing the gait and balance of hemiplegic patients due to stroke than only performing feedback training for even weight distribution.Key words: Stroke, Center of pressure, Feedback     

The effects of ankle joint taping on gait and balance ability of healthy adults

[Purpose] This study examined the effects of the application of elastic taping over the ankle joints of healthy subjects on their gait, balance ability, and muscle strength. [Subjects] Fifty healthy subjects with no orthopedic history of the ankle joint were selected and elastic taping was applied to their ankle joints. [Methods] Before and after application of the elastic taping, gait and balance ability of the subjects were evaluated. [Results] After the taping application, gait velocity significantly increased and there were significant differences in all variables of balance ability. [Conclusion] Application of elastic taping aimed at improving stability of the ankle joint had a positive effect on gait speed and balance ability.Key words: Elastic taping, Ankle joint, Gait     

The effects of balance training and ankle training on the gait of elderly people who have fallen

[Purpose] The aim of this study was to examine the effects of balance training and muscle training around the ankle joints on the gait of elderly people who have experienced a fall. [Subjects] Twenty-six elderly people with a risk of falling and a Berg Balance Scale score of 37 to 50 points who had experienced a fall in the last year were randomly and equally assigned to either a balance training group or an ankle training group. The balance training group received training on a hard floor, training while maintaining balance on a cushion ball in a standing position, and training while maintaining balance on an unstable platform in a standing position; the ankle training group received training to strengthen the muscles around the ankle joints and conducted stretch exercise for the muscles around the ankle joints. [Results] There were significant changes in gait velocity, step length, and stride length in the balance training group after the intervention; there were significant changes in gait velocity, cadence, step time, cycle time, step length, and stride length in the ankle training group after the intervention. In a between-group comparison, the gait velocity of the balance training group showed a significant improvement compared with the ankle training group. [Conclusion] Both balance training and ankle joint training are effective in enhancing the gait ability of elderly people with a risk of falling; in particular, balance training is effective in improving the gait velocity of elderly people who have experienced a fall compared with ankle joint training.Key words: Elderly people, Balance training, Ankle training     

Effect of handrail use while performing treadmill walking on the gait of stroke patients

[Purpose] The purpose of this study was to investigate how the use of handrails during treadmill walking affects the gait parameters of stroke patients. [Subjects and Methods] The participants, 30 hemiplegic stroke patients, were randomly allocated to one of three groups: the NHG group (No Handrail group, n=10), the FHG group (Front handrail group, n=10), and BHG group (Bilateral Handrail group, n=10). All the subjects’ performed treadmill walking for 30 min, five days a week, for a period of eight weeks. Gait parameters were evaluated using the RS-scan system. [Results] A statistically significant difference in the HM (heel-medial) area of plantar foot pressure was observed between BHG and NHG. Statistically significant difference in the HL (heel-lateral) area of plantar foot pressure was observed between BHG and NHG, and between FHG and NHG. A statistically significant difference in contact area of the rear foot was observed between BHG and NHG. [Conclusion] The results of this study show that holding handrails during treadmill training may enhance the improvement in the quality of patients’ gait (plantar foot pressure, contact area of foot).Key words: Treadmill training, Handrails, Stroke     

Effect of gait training with constrained-induced movement therapy (CIMT) on the balance of stroke patients

[Purpose] The purpose of the present study was to examine the effect of intensive gait training using a constrained induced movement therapy (CIMT) technique applied to the non-paretic upper extremity on the balance ability of stroke patients. [Subjects and Methods] Twenty stroke patients were randomly assigned to an experimental group or a control group. The experimental group received gait training with CIMT for 30 minutes per session, three sessions per week for four weeks, and the control group received gait training alone. [Results] The experimental group showed improvements in dynamic balance and the degree of improvement in this group was greater than that observed in the control group. Furthermore, the experimental group showed improvements in movement distances to the paretic side. On the other hand, the control group showed no significant improvements in balance indices after the intervention. [Conclusion] Gait training of stroke patients using CIMT techniques should be regarded as a treatment that can improve the balance of stroke patients.Key words: Constrained-induced movement therapy, Gait training, Balance