Birgit Tine Larsen

Methods for gait event detection and analysis in ambulatory systems

After stroke, hemiparesis is a common problem resulting in very individual needs for walking assistance. Often patients suffer from foot drop, i.e. inability to lift the foot from the ground during the swing phase of walking. Functional electrical stimulation is commonly used to correct foot drop. For all supporting stimulation devices, it is vital to adequately detect the gait events, which is traditionally obtained by a foot switch placed under the heel. To investigate present methods of gait analysis and detection for use in ambulatory rehabilitation systems, we carried out a meta-analysis on research studies. We found various sensors and sensor combinations capable of analyzing gait in ambulatory settings, ranging form simple force based binary switches to complex setups involving multiple inertial sensors and advanced algorithms. However additional effort is needed to minimize donning/doffing efforts, to overcome cosmetical aspects, and to implement those systems into closed loop ambulatory devices.

PHASE II TRIAL TO EVALUATE THE ACTIGAIT IMPLANTED DROP-FOOT STIMULATOR IN ESTABLISHED HEMIPLEGIA

OBJECTIVE To evaluate a selective implantable drop foot stimulator (ActiGait) in terms of effect on walking and safety. DESIGN A phase II trial in which a consecutive sample of participants acted as their own controls. SUBJECTS People who had suffered a stroke at least 6 months prior to recruitment and had a drop-foot that affected walking were recruited from 3 rehabilitation centres in Denmark. METHODS Stimulators were implanted into all participants. Outcome measures were range of ankle dorsiflexion with stimulation and maximum walking speed and distance walked in 4 minutes. Measurements were applied before implantation, at 90 days and at a long-term follow-up assessment. Changes over time and with and without stimulation are reported. Safety was evaluated by nerve conduction velocity and adverse events. RESULTS Fifteen participants were implanted and 13 completed the trial. Long-term improvements were detected in walking speed and distance walked in 4 minutes when stimulated, and the orthotic effect of stimulation showed statistically significant improvement. The device did not compromise nerve conduction velocity and no serious device-related adverse events were reported. Technical problems were resolved by the long-term follow-up assessment at which further improvement in walking was observed. CONCLUSION This trial has evaluated the safety and performance of the device, which was well accepted by patients and did not compromise safety.

The amplitude modulation of the quadriceps H-reflex in relation to the knee joint action during walking

Previously the modulation of the quadriceps H-reflex has only been investigated in the initial part of the gait cycle, and it was suggested that the quadriceps H-reflex modulates with relative high reflex gain at heel contact and decreases during the subsequent part of stance (Dietz et al. 1990b). The objectives of the present study was to elaborate on the previous results by increasing the measurement resolution around heel contact and include additional measures in order to relate the H-reflex modulation to the mechanical function of the knee extensors throughout the gait cycle. EMG profiles were measured in quadriceps and the antagonistic hamstring muscles simultaneously with the knee joint kinematics in ten subjects during treadmill walking at preferred speed. H-reflex excitability was measured in vastus lateralis (VL) and rectus femoris (RF) at 11 selected positions during the gait cycle. The resulting excitability curves showed a significant modulation of the quadriceps H-reflex during the gait cycle. The H-reflex amplitude increases shortly after heel contact and reflex inhibition is present in the remaining part of stance and most of the swing phase. The modulation of the quadriceps H-reflex during walking does not follow the classical pattern of reciprocal inhibition between antagonistic muscles. It is suggested that at least during the stance phase the modulation of the quadriceps H-reflex is controlled by presynaptic inhibition. The present results confirm the idea that the excitability of the quadriceps H-reflex is controlled to comply with the different mechanical demands on the muscle during the gait cycle in humans.