Human treadmill walking needs attention Regnaux, Jean Philippe; Roberston, Johanna; Smail, Djamel Ben ...
Journal of neuroengineering and rehabilitation,
08/2006, Letnik:
3, Številka:
1
Journal Article
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The aim of the study was to assess the attentional requirements of steady state treadmill walking in human subjects using a dual task paradigm. The extent of decrement of a secondary (cognitive) RT ...task provides a measure of the attentional resources required to maintain performance of the primary (locomotor) task. Varying the level of difficulty of the reaction time (RT) task is used to verify the priority of allocation of attentional resources.
11 healthy adult subjects were required to walk while simultaneously performing a RT task. Participants were instructed to bite a pressure transducer placed in the mouth as quickly as possible in response to an unpredictable electrical stimulation applied on the back of the neck. Each subject was tested under five different experimental conditions: simple RT task alone and while walking, recognition RT task alone and while walking, walking alone. A foot switch system composed of a pressure sensitive sensor was placed under the heel and forefoot of each foot to determine the gait cycle duration.
Gait cycle duration was unchanged (p > 0.05) by the addition of the RT task. Regardless of the level of difficulty of the RT task, the RTs were longer during treadmill walking than in sitting conditions (p < 0.01) indicating that an increased amount of resources are required for the maintainance of walking performance on a treadmill at a steady state. No interaction (p > 0.05) was found between the attentional demand of the walking task and the decrement of performance found in the RT task under varying levels of difficulty. This finding suggests that the healthy subjects prioritized the control of walking at the expense of cognitive performance.
We conclude that treadmill walking in young adults is not a purely automatic task. The methodology and outcome measures used in this study provide an assessment of the attentional resources required by walking on the treadmill at a steady state.
Upper-limb impairment after stroke is caused by weakness, loss of individual joint control, spasticity, and abnormal synergies. Upper-limb movement frequently involves abnormal, stereotyped, and ...fixed synergies, likely related to the increased use of sub-cortical networks following the stroke. The flexible coordination of the shoulder and elbow joints is also disrupted. New methods for motor learning, based on the stimulation of activity-dependent neural plasticity have been developed. These include robots that can adaptively assist active movements and generate many movement repetitions. However, most of these robots only control the movement of the hand in space. The aim of the present text is to analyze the potential of robotic exoskeletons to specifically rehabilitate joint motion and particularly inter-joint coordination. First, a review of studies on upper-limb coordination in stroke patients is presented and the potential for recovery of coordination is examined. Second, issues relating to the mechanical design of exoskeletons and the transmission of constraints between the robotic and human limbs are discussed. The third section considers the development of different methods to control exoskeletons: existing rehabilitation devices and approaches to the control and rehabilitation of joint coordinations are then reviewed, along with preliminary clinical results available. Finally, perspectives and future strategies for the design of control mechanisms for rehabilitation exoskeletons are discussed.
Background: . Commercial gaming systems are increasingly being used for stroke rehabilitation; however, their effect on upper-limb recovery versus compensation is unknown.Objectives: . We aimed to ...compare the effect of upper-limb rehabilitation using interactive gaming (Nintendo Wii) with dose-matched conventional therapy on elbow extension (recovery) and forward trunk motion (compensation) in individuals with chronic stroke. Secondary aims were to compare the effect on 1) clinical tests of impairment and activity, pain and effort, and 2) trajectory kinematics. We also explored arm and trunk motion (acceleration) during Wii sessions to understand how participants performed movements during Wii gaming.Methods: . This single-centre, randomized controlled trial compared 12 hourly sessions over 4 weeks of upper-limb Wii therapy to conventional therapy. Outcomes were evaluated at baseline and 4 weeks. The change in elbow extension and trunk motion during a reaching task was evaluated by electromagnetic sensors. Secondary outcomes were change in Fugl-Meyer assessment, Box and Block test, Action Research Arm Test, Motor Activity Log, and Stroke Impact Scale scores. Arm and trunk acceleration during Wii therapy was evaluated by using inertial sensors. A healthy control group was included for reference data.Results: . Nineteen participants completed Wii therapy and 21 conventional therapy (mean SD time post-stroke 66.4 57.2 months). The intervention and control groups did not differ in mean change in elbow extension angle (Wii: +4.5°, 95% confidence interval CI 0.1; 9.1; conventional therapy: +6.4°, 95%CI 0.6; 12.2) and forward trunk position (Wii: -3.3 cm, 95%CI -6.2;-0.4; conventional therapy: -4.1 cm, 95%CI -6.6; -1.6) (effect size: elbow, d=0.16, p=0.61; trunk, d=0.13, p=0.65). Clinical scores improved similarly but to a small extent in both groups. The amount of arm but not trunk acceleration produced during Wii sessions increased with training.Conclusions: . Supervised upper-limb gaming therapy induced similar recovery of elbow extension as conventional therapy and did not enhance the development of compensatory forward trunk movement in individuals with chronic stroke. More sessions may be necessary to induce greater improvements.
Highlights • This study assessed for the first time the gait pattern of adults with CP. • It showed that five different gait patterns can be identified. • Each gait pattern identified was related to ...specific kinematic parameters. • These specific kinematic parameters can be easily checked in clinical practice. • Results may permit to follow changes throughout growth, aging or after treatments.
To evaluate the effects of a 20-min gait training session using the Lokomat® combined with a negative kinematic constraint on the non-paretic limb and a positive kinematic constraint on the paretic ...limb, on peak knee flexion and other biomechanical parameters in chronic hemiparetic subjects.
Preliminary study, before-after design.
Fifteen hemiparetic subjects.
Subjects were evaluated using 3-dimensional gait analysis before, immediately after the end of the training, and after a 20-min rest period. The positive constraint increased the range of motion of the paretic limb (hip and knee), while the negative constraint reduced the range of motion of the non-paretic limb (hip and knee).
Peak knee flexion and other, kinematic, kinetic and spatiotemporal, parameters were significantly improved following the training session. These positive effects occurred predominantly in the paretic limb. Moreover, there was no worsening of biomechanical parameters of the non-paretic limb despite the use of negative constraint on this limb. These effects persisted for at least 20 min following the end of the gait training session.
This type of training may be effective to improve gait in hemiparetic patients. A larger investigation of the training programme is justified.
Background. The velocity of reaching movements is often reduced in patients with stroke-related hemiparesis; however,they are able to voluntarily increase paretic hand velocity. Previous studies have ...proposed that faster speed improvesmovement quality. Objective. To investigate the combined effects of reaching distance and speed instruction on trunk andparetic upper-limb coordination. The hypothesis was that increased speed would reduce elbow extension and increasecompensatory trunk movement. Methods. A single session study in which reaching kinematics were recorded in a groupof 14 patients with spastic hemiparesis. A 3-dimensional motion analysis system was used to track the trajectories of 5reflective markers fixed on the finger, wrist, elbow, acromion, and sternum. The reaching movements were performedto 2 targets at 60% and 90% arm length, respectively, at preferred and maximum velocity. The experiment was repeatedwith the trunk restrained by a strap. Results. All the patients were able to voluntarily increase reaching velocity. In thetrunk free, faster speed condition, elbow extension velocity increased but elbow extension amplitude decreased and trunkmovement increased. In the trunk restraint condition, elbow extension amplitude did not decrease with faster speed.Seven patients scaled elbow extension and elbow extension velocity as a function of reach distance, the other 7 mainlyincreased trunk compensation with increased task constraints. There were no clear clinical characteristics that couldexplain this difference. Conclusions. Faster speed may encourage some patients to use compensation. Individual indicationsfor therapy could be based on a quantitative analysis of reaching coordination.
Introduction Le défaut de flexion de genou en phase oscillante est une source fréquente de gêne à la marche associée à la parésie spastique. Il est souvent lié dans ce cas à une activité inappropriée ...du muscle rectus femoris en phase oscillante. Nous avons souhaité évaluer l’efficacité à court terme (3 mois) du traitement chirurgical de l’hyperactivité spastique du muscle rectus femoris par neurotomie fémorale sélective, chez des patients atteints d’hémiparésie et présentant un défaut de flexion de genou en phase oscillante lors de la marche. Matériels et méthodes Nous avons réalisé une étude interventionnelle (avant/après) au sein du service de MPR neurologique du CHU de Nantes. Sept patients présentant une hémiplégie secondaire à une lésion spinale ou cérébrale et présentant un défaut de flexion du genou en phase oscillante attribué à une spasticité du muscle droit fémoral ont été inclus. Tous avaient préalablement bénéficié d’une ou plusieurs injections de toxine botulique dans le droit fémoral avec une efficacité sur leur trouble de la marche. Une neurotomie fémorale sélective ciblant la branche du rectus femoris a été réalisée. L’évaluation réalisée avant et 3 mois après la chirurgie incluait des données fonctionnelles (périmètre de marche), cliniques (spasticité et force musculaire), et instrumentales (cinématiques, dynamiques et électromyographiques, obtenues par analyse quantifiée de marche en laboratoire). Résultats Une augmentation significative était observée en postopératoire pour le périmètre de marche, la vitesse de marche, la longueur de pas, tous les paramètres cinématiques associés à la flexion de genou en phase oscillante. La durée de la bouffée d’activation du rectus femoris en phase oscillante était diminuée en postopératoire, ainsi que le moment extenseur de genou en phase oscillante. Discussion–conclusion Il s’agit de la première étude mettant en évidence que la neurotomie du rectus femoris permet de normaliser l’activation musculaire pendant la marche. Elle améliore les paramètres dynamiques et cinématiques, et les performances de patients présentant une marche genou raide par spasticité du rectus femoris.
Information technology plays a very important role in society. People with disabilities are often limited by slow text input speed despite the use of assistive devices. This study aimed to evaluate ...the effect of a dynamic on-screen keyboard (Custom Virtual Keyboard) and a word-prediction system (Sibylle) on text input speed in participants with functional tetraplegia. Ten participants tested four modes at home (static on-screen keyboard with and without word prediction and dynamic on-screen keyboard with and without word prediction) for 1 mo before choosing one mode and then using it for another month. Initial mean text input speed was around 23 characters per minute with the static keyboard and 12 characters per minute with the dynamic keyboard. The results showed that the dynamic keyboard reduced text input speed by 37% compared with the standard keyboard and that the addition of word prediction had no effect on text input speed. We suggest that current forms of dynamic keyboards and word prediction may not be suitable for increasing text input speed, particularly for subjects who use pointing devices. Future studies should evaluate the optimal ergonomic design of dynamic keyboards and the number and position of words that should be predicted.
Celotno besedilo
Dostopno za:
DOBA, FSPLJ, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Background: Timed Up and Go (TUG) performance is reduced following stroke. Gait training improves gait-related activities in hemiparetic patients. However, no study has compared the impact of a ...single overground training session with a treadmill training session on gait-related activities (assessed by TUG). Objective: To compare the immediate effect of a single overground training session versus a single treadmill training session on TUG performance in hemiparetic patients. Methods: In this randomized controlled clinical trial, 56 hemiparetic patients were randomized to 1 or 2 distinct groups: a single gait training session overground (O group) or on a treadmill (T group). Time taken to perform the TUG (in seconds) was assessed before and immediately after the completion of each session. Results: Time taken to perform the TUG decreased significantly, and to a similar extent, in both groups following the training session (O group, 5.9%; T group, 5.2%). Conclusions: An overground training session and a treadmill training session were equally effective in improving TUG performance in hemiparetic patients. Hemiparetic patients should be encouraged to walk regularly overground including turns for 20 minutes without stopping. This is an easy and inexpensive self-rehabilitation method to improve functional gait-related activities involved in the TUG test.
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