Tamaya Van Criekinge

Trunk biomechanics during hemiplegic gait after stroke: A systematic review

Stroke commonly results in trunk impairments that are associated with decreased trunk coordination and limited trunk muscle strength. These impairments often result in biomechanical changes during walking. Additionally, the so-called pelvic step might be influenced by these impairments. Therefore, the aim of this review was twofold. First, to gain more insight into trunk biomechanics during walking in stroke patients compared to healthy individuals. Second, to investigate the influence of walking speed on trunk biomechanics. The search strategy was performed by the PRISMA guidelines and registered in the PROSPERO database (no. CRD42016035797). Databases MEDLINE, Web of Science, Cochrane Library, ScienceDirect, and Rehabdata were systematically searched until December 2016. Sixteen of the 1099 studies met the eligibility criteria and were included in this review. Risk of bias was assessed by the Newcastle-Ottawa Scale. The majority of studies reported on trunk kinematics during walking, data on trunk kinetics and muscle activity is lacking. Following stroke, patients walk with increased mediolateral trunk sway and larger sagittal motion of the lower trunk. Although rotation of the upper trunk is increased, the trunk shows a more in-phase coordination. Acceleration of the trunk diminishes while instability and asymmetry increase as there are less movement towards the paretic side. However, it is of great importance to differentiate between compensatory trunk movements and intrinsic trunk control deficits. Specific exercise programs, assistive devices and orthoses might be of help in controlling these deficits. Importantly, studies suggested that more natural trunk movements were observed when walking speed was increased.

Are unstable support surfaces superior to stable support surfaces during trunk rehabilitation after stroke? A systematic review

Abstract Objective: To investigate the effect of trunk rehabilitation using unstable support surfaces compared to stable support surfaces, on static and dynamic balance after stroke. Materials and methods: A systematic review was conducted to identify relevant articles from the following databases: Medline (PubMed), Web of Science, PEDro, REHAB+, Rehabdata, Science Direct, CIRRIE, and Cochrane library. Studies were included when they involved adult stroke patients; were controlled clinical trials; assessed static and dynamic balance; and incorporated trunk exercises on stable or unstable support surfaces. Databases were systematically screened until April 2017. Risk of bias assessment was performed by means of the PEDro scale. Results: Seven studies met the inclusion criteria, of which one had a low risk of bias and six a high risk. In total, 184 stroke patients were evaluated. Unstable support surfaces used during therapy were physio balls, balance pads, air cushions, tilting boards, and slings. Trunk training was provided either as additional therapy or without conventional therapy. All modalities, except for the sling, showed larger improvements compared to stable support surfaces on balance performance. Conclusions: Trunk training on unstable support surfaces seemed to be superior to stable support surfaces in improving static and dynamic balance. However, more research is necessary, since the risk of bias of the included studies was high. Implications for Rehabilitation Trunk training on unstable surfaces seems to be superior to stable surfaces in improving static and dynamic balance. Physio balls, air cushions, balance pads, and unstable boards are appropriate supports to enhance balance during stroke rehabilitation. Implementing unstable supports early in rehabilitation might be more beneficial.

Peripheral somatosensory stimulation and postural recovery after stroke – a systematic review

ABSTRACT Purpose It is hypothesized that peripheral somatosensory stimulation (PSS) can promote postural recovery after stroke by increasing afferent input and postural contribution of the paretic leg. Therefore, this systematic review aims to investigate which PSS approaches are documented and investigated on effectiveness. Methods Five databases (PubMed, Web of Science, PEDro, Cochrane Library Trials, RehabData) have been searched on clinical studies in stroke rehabilitation, investigating PSS, which is defined as a non-motor and focal stimulation to the paretic leg aiming an increase in somatosensory input. Results Twenty studies present different PSS approaches (mainly electrical and vibration stimulation) and following results: (I) There is an immediate effect after a single session of PSS on postural stability. In contrast, (II) repetitive sessions of isolated PSS led to highly inconsistent results. Finally, (III) PSS as an adjuvant to exercises did promote long-term postural recovery. Conclusion PSS is found to be effective immediately and on a long-term as an adjuvant therapy only in improving postural stability in a chronic stroke population. However, if PSS enhances paretic leg postural contribution remains unclear. Future research is warranted considering promising results and high prevalence of postural instability impacting daily life of stroke survivors.

Age-related differences in muscle activity patterns during walking in healthy individuals

OBJECTIVE To examine how muscle activity over the entire gait cycle changes with increasing age. METHODS Electromyography data of the erector spinae, rectus femoris, vastus lateralis, biceps femoris, tibialis anterior and gastrocnemius muscles were collected by an instrumented gait analysis during over ground walking in healthy adults aged between 20 and 89 years. Participants were categorized per decade (n = 105, 15 per decade, decades 3-9). Normalized integrated linear envelopes of the electromyographic signal were calculated for one stride. A one way ANOVA using spm1d statistics explored the differences between age groups, followed by a post hoc analysis. RESULTS While initiation of decline commenced at the age of 60 for erector spinae and tibialis anterior, age-related changes are most pronounced after the age of 80. Concerning timing of muscle activity, subjects in decade 7-9 had prolonged activity and/or early activity of the erector spinae, vastus lateralis, biceps femoris, tibialis anterior and gastrocnemius compared to other decades. Regarding amplitude of muscle activity, decreased peak amplitudes of the erector spinae, rectus femoris, vastus lateralis and gastrocnemius were observed in decades 7-9 compared to other decades. CONCLUSION Both timing and amplitude of muscle activation patterns need to be considered to understand the aging process. Regarding the erector spinae, tibialis anterior and vastus lateralis, a decrease in muscle activation coincides with prolonged activity, compared to the gastrocnemius where decreased muscle activation is associated with early activation.

Age-related changes in arm motion during typical gait

BACKGROUND When toddlers learn to walk, they do so with a typical high guard position of the arms. As gait matures, children develop a reciprocal arm swing. So far, there have been no attempts to describe age-related changes of arm movements during walking after this first rapid development. RESEARCH QUESTION The purpose of this study was to investigate age-related changes in arm movement during typical gait. METHODS All participants (n = 102) received gait analysis using a full-body marker set (Plug-in Gait). Participants were divided into five age-groups: young children (G1: n = 20; 3.0-5.9y), children (G2: n = 24; 6.0-9.9y), pubertal children (G3: n = 26; 10.0-13.9y), adolescents (G4: n = 16; 14.0-18.9y) and adults (G5: n = 16; 19.0-35.2y). Age-related changes in arm movements were investigated by comparing continuous joint angular waveforms (spm1d) between all groups, as well as by comparing the mean joint angle and range of motion of the different joints between age-groups. RESULTS The overall shape of movement patterns was comparable across all age groups. Nevertheless, with advancing age, consistency increased. At the shoulder, G1&2 showed a larger mean extension angle compared to older children and adults. The range of shoulder axial rotation was significantly larger in adults compared to all other age groups. In the youngest groups (G1-G2), an increased mean elbow flexion and mean wrist extension angle was found. SIGNIFICANCE Determining an exact age of maturation of arm swing remains difficult as parameter specific adult-like values were not reached at the same age but should not be set before the age of ten to fourteen years for any parameter.

Dynamic Visual Acuity test while walking or running on treadmill: Reliability and normative data

BACKGROUND This study aimed to report normative reference data for a Dynamic Visual Acuity test while walking on treadmill. The protocols suitability was assessed by investigating its test-retest reliability and its validity through the drop-out rate and verification of the frequency of head movements. Furthermore, the influence of age on visual acuity loss (VAL) was determined to reveal the need for age-specific reference data. METHODS Visual acuity was measured in 171 healthy adult participants (age range: 20.0-77.3 years; mean age: 40.1 years) with the head stationary (SVA) and in a dynamic condition (DVA) while walking on treadmill at 3, 4, 6 and 9 km/h. Relative test-retest reliability on SVA and DVA was investigated with intraclass correlation coefficients (ICC). The measurement errors of SVA, DVA and VAL were calculated for absolute reliability. Influence of age on VAL was investigated with regression analysis, followed by an ANOVA to investigate decade-related differences. The drop-out rate during DVA was mapped using a frequency table. Head frequencies were monitored using 3D motion tracking software. RESULTS Strong consistency (ICC ≥ 0.89) was found for SVA and DVA values. Measurement errors for VAL were less than 0.1 logMAR. Younger participants (decade 3-4) showed less VAL at 3 and 4 km/h. The drop-out rate increased with increasing walking speed (0-18.8%), especially in older adults. Although head frequency increased with increasing speed, the dominant frequency ranged around 2 Hz for all walking speeds. CONCLUSION This DVA protocol is reliable and normative data have been established. To facilitate its use in clinical practice, further validation of the protocol in patients with bilateral vestibulopathy is needed.BACKGROUND This study aimed to report normative reference data for a Dynamic Visual Acuity test while walking on treadmill. The protocols suitability was assessed by investigating its test-retest reliability and its validity through the drop-out rate and verification of the frequency of head movements. Furthermore, the influence of age on visual acuity loss (VAL) was determined to reveal the need for age-specific reference data. METHODS Visual acuity was measured in 171 healthy adult participants (age range: 20.0-77.3 years; mean age: 40.1 years) with the head stationary (SVA) and in a dynamic condition (DVA) while walking on treadmill at 3, 4, 6 and 9 km/h. Relative test-retest reliability on SVA and DVA was investigated with intraclass correlation coefficients (ICC). The measurement errors of SVA, DVA and VAL were calculated for absolute reliability. Influence of age on VAL was investigated with regression analysis, followed by an ANOVA to investigate decade-related differences. The drop-out rate during DVA was mapped using a frequency table. Head frequencies were monitored using 3D motion tracking software. RESULTS Strong consistency (ICC ≥ 0.89) was found for SVA and DVA values. Measurement errors for VAL were less than 0.1 logMAR. Younger participants (decade 3-4) showed less VAL at 3 and 4 km/h. The drop-out rate increased with increasing walking speed (0-18.8%), especially in older adults. Although head frequency increased with increasing speed, the dominant frequency ranged around 2 Hz for all walking speeds. CONCLUSION This DVA protocol is reliable and normative data have been established. To facilitate its use in clinical practice, further validation of the protocol in patients with bilateral vestibulopathy is needed.

Combining the benefits of tele-rehabilitation and virtual reality-based balance training: a systematic review on feasibility and effectiveness

Abstract Purpose: A motivational surrounding is desirable in stroke rehabilitation considering the need to train repetitively to improve balance, even after discharge from rehabilitation facilities. This review aims to investigate whether it is feasible to combine virtual reality (VR) which allows exercising in game-like environments with tele-rehabilitation in a community-dwelling stroke population. Methods: Literature searches were conducted in five databases, for example, PubMed and the Cochrane Library. Randomized controlled trial (RCT) and non-RCT investigating feasibility and effectiveness of VR-based tele-rehabilitation were included. Based on the risk of bias and study design, methodological quality is ranked according to the GRADE guidelines. Results: Seven studies (n = 120) were included, of which four are RCTs. Evidence regarding therapy adherence and perceived enjoyment of VR, as well as a cost–benefit of tele-rehabilitation emphasizes feasibility. Equal effects are reported comparing this approach to a therapist-supervised intervention in the clinical setting on balance and functional mobility. Conclusions: Tele-rehabilitation could be a promising tool to overcome burdens that restrict accessibility to rehabilitation in the future. VR can increase motivation allowing longer and more training sessions in community-dwelling stroke survivors. Therefore, combining the benefits of both approaches seems convenient. Although evidence is still sparse, functional improvements seem to be equal compared to a similar intervention with therapist-supervision in the clinic, suggesting that for cost-efficient rehabilitation parts of therapy can be transferred to the homes. Implications for rehabilitation The use of tele-rehabilitation could be a promising tool to overcome burdens that restrict the access of stroke survivors to long-term rehabilitative care. VR-based interventions are game-like and therefore seem to provide a motivational environment which allows longer exercise sessions and greater adherence to therapy.

The effect of trunk training on muscle thickness and muscle activity: a systematic review

Abstract Objective: A systematic review to examine the effect of static or dynamic trunk training compared to standard care or control therapy on muscle activity and muscle thickness of the trunk and lower limb muscles in stroke survivors. Materials and methods: This review was registered on PROSPERO (no: CRD42017063771) and was written according to the PRISMA guidelines. The search strategy included studies from the first indexed article until September 2017 and was performed in the electronical databases PubMed, Web of Science, Cochrane Library, Ovid Medline and PEDro. Two independent reviewers screened, assessed risk of bias by means of the PEDro scale and extracted data. Results: Eight studies were included of which three investigated the effects of trunk training on muscle thickness, the remaining five investigated muscle activity. The following muscles were investigated: erector spinae, multifidi, paravertebralis, transversus abdominis, internal and external oblique abdominis, rectus abdominis, quadriceps femoris, hamstrings, soleus and tibialis anterior. Trunk exercises significantly improved the muscle activity of the internal oblique abdominis and increased muscle thickness of transversus abdominis. Conclusions: Trunk training is effective in restoring symmetry in muscle thickness to improve muscle strength. The gain in muscle thickness is specific to the applied exercise program, suggesting that therapeutic goal setting is of great importance. However, no conclusion could be made concerning changes in muscle activity due to a high risk of bias. Implications for rehabilitation: Trunk training seems to be effective in restoring symmetry in trunk muscle thickness. Not all muscle groups benefit from specific trunk exercises. Patients suffering from chronic stroke are still capable of restoring muscle function.