Sujin Hwang

Locomotor imagery training improves gait performance in people with chronic hemiparetic stroke: a controlled clinical trial

Objective: The purpose of this study was to evaluate whether locomotor imagery training leads to clinical improvements in gait after stroke. Design: Pretest—posttest matched control design. Participants: A total of 24 people with chronic hemiparetic stroke (13 for experimental and 11 for control) were recruited in this study. Interventions: The subjects in the experimental group participated in videotape-based locomotor imagery training five days a week for four weeks. They also conducted regular physical therapy. Outcome measures: Kinematic gait parameters were collected using a three-dimensional motion analysis system. Functional gait performance was assessed using clinical measures: Activities-specific Balance Confidence Scale, Berg Balance Test, Dynamic Gait Index and modified Emory Functional Ambulation Profile. Results: After training, walking velocity increased 0.07 ± 0.06 m/s in the experimental group and 0.01 ± 0.07 m/s in the control group. In the experimental group, the affected and less affected limb stride lengths increased by 0.09 ± 0.12 m and 0.10 ± 0.07 m respectively, whereas in the control group they decreased by 0.00 ± 0.04 m and increased by 0.02 ± 0.06 m, respectively. Kinematic parameters in the lower extremity joints during walking were more improved after the training in the experimental group. Confidence in balance, postural control, dynamic balance and performance time for different environmental walking situations were also improved more in the experimental group. Conclusion: Locomotor imagery training can be considered as a useful option for restoration of ambulation for individuals with chronic hemiparetic stroke who are unable to participate in physical gait training.

Effects of treadmill training with optic flow on balance and gait in individuals following stroke: randomized controlled trials:

Objective: This study examined the effects of treadmill training with optic flow on the functional recovery of balance and gait in stroke patients. Design: Randomized controlled experimental study. Participants: Thirty patients following stroke were divided randomly into the treadmill with optic flow group (n = 10), treadmill group (n = 10) and control group (n = 10). Interventions: The subjects in the experimental group wore a head-mounted display to receive speed-modulated optic flow during treadmill training for 30 minutes, while those in the treadmill group and control group received treadmill training and regular therapy for the same time, three times a week for four weeks. Main measures: The data were collected using timed up-and-go test, functional reach test, 10-m walk test, and six-minute walk test before and after treatment. Results: The timed up-and-go test in the treadmill with optic flow group (5.55 ± 2.04) improved significantly greater than the treadmill (1.50 ± 0.93) and control (0.40 ± 0.84) groups. The functional reach test in the treadmill with optic flow group (2.78 ± 1.44) was significantly higher than the control group (0.20 ± 0.16) only. The gait velocity in the treadmill with optic flow group (0.21 ± 0.06) showed a significant decrease compared to the treadmill (0.03 ± 0.02) and control (0.01 ± 0.02) groups. Finally, the six-minute walk test in the treadmill with optic flow group (24.49 ± 11.00) showed significant improvement compared to the treadmill training (4.65 ± 3.25) and control (1.79 ± 3.08) groups. Conclusion: Treadmill using optic flow speed modulation improves the balance and gait significantly in patients with stroke who are able to participate in physical gait training.

Treadmill Training with Virtual Reality Improves Gait, Balance, and Muscle Strength in Children with Cerebral Palsy

Independent walking is an important goal of clinical and community-based rehabilitation for children with cerebral palsy (CP). Virtual reality-based rehabilitation therapy is effective in motivating children with CP. This study investigated the effects of treadmill training with virtual reality on gait, balance, muscular strength, and gross motor function in children with CP. Eighteen children with spastic CP were randomly divided into the virtual reality treadmill training (VRTT) group (9 subjects, mean age, 10.2 years) and treadmill training (TT) group (9 subjects, mean age, 9.4 years). The groups performed their respective programs as well as conventional physical therapy 3 times/week for 8 weeks. Muscle strength was assessed using a digitalized manual muscle tester. Gross motor function was assessed using the Gross Motor Functional Measure (GMFM). Balance was assessed using the Pediatric Balance Scale (PBS). Gait speed was assessed using the 10-meter walk test (10MWT), and gait endurance was assessed using the 2-minute walk test (2MWT). After training, gait and balance was improved in the VRTT compared to the TT group (P < 0.05). Muscular strength was significantly greater in the VRTT group than the TT group, except for right hamstring strength. The improvements in GMFM (standing) and PBS scores were greater in the VRTT group than the TT group (P < 0.05). Furthermore, the VRTT group showed the higher values of 10MWT and 2MWT compared to the TT group (P < 0.05). In conclusion, VRTT programs are effective for improving gait, balance, muscular strength, and gross motor function in children with CP.

Functional electrical stimulation applied to gluteus medius and tibialis anterior corresponding gait cycle for stroke

The purpose of this study was to determine the influence of functional electrical stimulation (FES) applied to the tibialis anterior and gluteus medius muscles on the improvement of the spatiotemporal parameters of gait in individuals with a hemiparetic stroke. Thirty-six patients who had suffered a hemiparesis post stroke were enrolled in this study. The participants walked at a self-selected velocity on three different FES applications: (1) FES-triggered gait on the gluteus medius in the stance phase and the tibialis anterior in the swing phase (GM+TA), (2) FES-triggered gait on the tibialis anterior in the swing phase (TA only), and (3) gait without FES-triggered (Non-FES). FES was triggered when the heel in the affected lower limb was placed in contact with an on or off foot switch sensor. The effect of FES applications was assessed using GAITRite for spatiotemporal data. The gait speed, cadence, and stride length were significantly higher under the GM+TA condition than under the TA only and None-FES conditions. The gait speed, cadence and stride length were increased significantly in the TA only condition compared with the Non-FES condition. The double support time and gait symmetry were significantly improved in the GM+TA condition compared to the TA only and Non-FES conditions. These findings suggest that walking with FES of the gluteus medius in the stance phase and tibialis anterior in the swing phase can improve the spatiotemporal parameters of gait in individuals with hemiparetic stroke.

Core stabilization exercise with real-time feedback for chronic hemiparetic stroke: a pilot randomized controlled trials.

OBJECTIVE The purpose of this study was to examine the feasibility of core stabilization exercise with real-time feedback on balance and gait function in patients with chronic hemiparetic stroke. METHODS Nineteen stroke subjects were enrolled in this study. The patients were randomly divided into the experimental (n = 10) and control groups (n = 9). Subjects in the experimental group performed core stabilization exercise with real-time feedback training for 30 minutes per day during a period of six weeks. Subjects in the control group performed core stabilization exercise during the same period. This study assessed the kinematic parameters using a portable walkway system, and timed up-and-go test. RESULTS Gait velocity showed significantly greater improvement in the experimental group (7.3 ± 5.0 sec) than in the control group (-0.7 ± 10.6). Stride length showed significantly greater increase in the experimental group (13.2 ± 7.9 on the affected side and 12.6 ± 8.0 on the less affected side) than the control group (3.5 ± 8.7 on the affected side and 3.4 ± 8.5 on the less affected side). After training, change in results on the timed up and go test was significantly greater in the experimental group than in the control group. CONCLUSION Core stabilization exercise using real-time feedback produces greater improvement in gait performance in chronic hemiparetic stroke patients than core stabilization exercise only.

Therapeutic effect of functional electrical stimulation-triggered gait training corresponding gait cycle for stroke

The purpose of this study was to determine the therapeutic effects of functional electrical stimulation (FES) applied to the gluteus medius and tibialis anterior muscles during the gait cycle in individuals with hemiparetic stroke. Eighteen patients who had suffered a stroke were enrolled in this study. The participants were divided into either the gluteus medius and tibialis anterior (GM + TA) training group (n = 9) or the control group (n = 9). The GM + TA group received FES-triggered gait training to the gluteus medius (GM) in the stance phase and the tibialis anterior (TA) in the swing phase for 30 min, 5 session a week over a 6-week period, and control group who received only gait training without FES-triggered for the same duration of time. A foot-switch sensor was used to trigger the device in the stance (GM) and swing (TA) phases of the gait cycle reciprocally. This study measured three types of outcome measures, including spatiotemporal gait parameters, muscles activities, and balance function. After 6 weeks training, there was a significant improvement in gait velocity, cadence, stride length, and gait symmetry in the GM + TA training group compared to the control group. Dynamic balance function was significantly improved in the GM + TA training group compared to the control group. The mean changeable values of the GM was significantly greater strength in the GM + TA training group than the control group. These findings suggest that FES-triggered gait training of the GM in the stance phase and TA in the swing phase may improve the spatiotemporal parameters of gait in persons with hemiparetic stroke.

Treadmill gait training combined with functional electrical stimulation on hip abductor and ankle dorsiflexor muscles for chronic hemiparesis

The purpose of this study was to investigate the effects of treadmill training (TT) with functional electrical stimulation (FES) applied to the gluteus medius (GM) and tibialis anterior (TA) muscles on gait and balance performance in individuals with chronic hemiparetic stroke. Thirty-six participants with chronic hemiparesis were recruited to this study and randomly distributed into three groups: TT with FES applied to the GM and TA muscles (TTFES-GM+TA group, 12 patients); TT with FES applied to the TA muscle (TTFES-TA group, 12 patients); and TT only (control group, 12 patients). All participants underwent 20 sessions of TT with a harness (30min five times per week for 4 weeks). They also received regular physical therapy for 1h five times per week for 4 weeks. All participants were assessed before and after training using digital muscle testing, the Medical Research Council (MRC) scale, the 6-min walk test (6MWT), and spatiotemporal parameters. After training, the TTFES-GM+TA group showed significant improvement in hip abductor strength, Berg Balance Scale score, 6MWT result, MRC scale score grade, gait velocity, and cadence compared to the TTFES-TA group and control group. These findings show that TT with FES applied to the GM and TA muscles increased lower limb muscle strength and improved balance and gait capacities. Therefore, TT with FES applied to the GM and TA could be a beneficial intervention in clinical settings for individuals with chronic hemiparetic stroke.

Intensive gait training with rhythmic auditory stimulation in individuals with chronic hemiparetic stroke: A pilot randomized controlled study

BACKGROUND Motor relearning protocols should involve task-oriented movement, focused attention, and repetition of desired movements. OBJECTIVES To investigate the effect of intensive gait training with rhythmic auditory stimulation on postural control and gait performance in individuals with chronic hemiparetic stroke. METHODS Twenty patients with chronic hemiparetic stroke participated in this study. Subjects in the Rhythmic auditory stimulation training group (10 subjects) underwent intensive gait training with rhythmic auditory stimulation for a period of 6 weeks (30 min/day, five days/week), while those in the control group (10 subjects) underwent intensive gait training for the same duration. Two clinical measures, Berg balance scale and stroke specific quality of life scale, and a 2-demensional gait analysis system, were used as outcome measure. To provide rhythmic auditory stimulation during gait training, the MIDI Cuebase musical instrument digital interface program and a KM Player version 3.3 was utilized for this study. RESULTS Intensive gait training with rhythmic auditory stimulation resulted in significant improvement in scores on the Berg balance scale, gait velocity, cadence, stride length and double support period in affected side, and stroke specific quality of life scale compared with the control group after training. CONCLUSIONS Findings of this study suggest that intensive gait training with rhythmic auditory stimulation improves balance and gait performance as well as quality of life, in individuals with chronic hemiparetic stroke.

The effects of body weight on the soleus H-reflex modulation during standing

OBJECTIVE We examined how the soleus H-reflex is affected by the changes in limb loading by testing subjects on a body weight support system during standing. DESIGN Twenty-two healthy subjects (10 males and 12 females) were recruited for this study. The size of the soleus H-reflex was measured in six different limb loading conditions: 100%, 90%, 80%, 70%, 60%, and 50%. One-way repeated measure ANOVA was used (p<0.05) to compare the H/M ratios among the six different load conditions. RESULTS The amplitudes of the soleus H-reflex decreased significantly as the amount of body weight load decreased. CONCLUSIONS Findings of this study suggest that the levels of body weight load in pre- and post-test conditions should be consistent when H-reflex testing is adapted as an outcome measure of rehabilitation intervention for patients with central nerve system lesion such as partial body weight supported gait training.

Multicomponent exercise for physical fitness of community-dwelling elderly women.

[Purpose] The purpose of this study was to identify whether a 4-week multicomponent exercise program could improve the level of physical fitness of community-dwelling elderly women. [Subjects and Methods] Twenty-two healthy community-dwelling elderly women were randomly allocated to either an experimental or a control group. Experimental subjects performed a multicomponent exercise program that consisted of balance, strengthening, and stretching exercises for 4 weeks, whereas the control subjects did not perform any specific exercise. The subjects’ level of physical fitness was assessed prior to and after training using the Senior Fitness Test which assesses muscle strength, flexibility, dynamic balance/agility, aerobic endurance, and body composition. [Results] Subjects in the experimental group showed significant improvements in lower and upper body strength, lower and upper body flexibility, dynamic balance/agility following training, but not in aerobic endurance or body composition. Significant group differences were shown in lower and upper body strength, lower body flexibility, and dynamic balance/agility. [Conclusion] The results suggest that a multicomponent training program that consists of balance, strengthening, and stretching exercises is a relevant intervention for the improvement of the level of physical fitness of community-dwelling elderly women.