Biomechanical analysis of an unpowered hip flexion orthosis on individuals with and without multiple sclerosis.

BACKGROUND: Gait impairment is a common complication of multiple sclerosis (MS). Gait limitations such as limited hip flexion, foot drop, and knee hyperextension often require external devices like crutches, canes, and orthoses. The effects of mobility-assistive technologies (MATs) prescribed to people with MS are not well understood, and current devices do not cater to the specific needs of these individuals. To address this, a passive unilateral hip flexion-assisting orthosis (HFO) was developed that uses resistance bands spanning the hip joint to redirect energy in the gait cycle. The purpose of this study was to investigate the short-term effects of the HFO on gait mechanics and muscle activation for people with and without MS. We hypothesized that (1) hip flexion would increase in the limb wearing the device, and (2) that muscle activity would increase in hip extensors, and decrease in hip flexors and plantar flexors. METHODS: Five healthy subjects and five subjects with MS walked for minute-long sessions with the device using three different levels of band stiffness. We analyzed peak hip flexion and extension angles, lower limb joint work, and muscle activity in eight muscles on the lower limbs and trunk. Single-subjects analysis was used due to inter-subject variability. RESULTS: For subjects with MS, the HFO caused an increase in peak hip flexion angle and a decrease in peak hip extension angle, confirming our first hypothesis. Healthy subjects showed less pronounced kinematic changes when using the device. Power generated at the hip was increased in most subjects while using the HFO. The second hypothesis was not confirmed, as muscle activity showed inconsistent results, however several subjects demonstrated increased hip extensor and trunk muscle activity with the HFO. CONCLUSIONS: This exploratory study showed that the HFO was well-tolerated by healthy subjects and subjects with MS, and that it promoted more normative kinematics at the hip for those with MS. Future studies with longer exposure to the HFO and personalized assistance parameters are needed to understand the efficacy of the HFO for mobility assistance and rehabilitation for people with MS.

Description of novel instrumented analysis of the Four Square Step Test with clinical application: A pilot study.

BACKGROUND: Falls are a common problem for adults in the United States raising concerns about injuries and the resulting economic burden. As a result, it is critical to develop objective measures to assess dynamic balance and the track progress related to interventions or disease progression over time. RESEARCH QUESTION: Are there differences in balance between individuals in the community, individuals post-stroke, persons with Multiple Sclerosis (MS), and individuals living with Parkinson's Disease (PD) as measured with a new instrumented Four Square Step Test (i-FSST)? METHODS: The i-FSST was utilized to assess dynamic balance in 41 individuals (11 community dwelling adults and 10 individuals in each group of persons post stroke, with PD, and with MS). Outcome data including the overall duration of the FSST as well unique temporal-spatial stepping patterns through the test, timing of transitions between each quadrant, and the time in each quadrant prior to transitioning. RESULTS: One-way ANOVAs were conducted to determine whether i-FSST duration, Over Double Support (ODS), and Changes in Main Support (CMS) differed by participants' groups. There was a significant difference between groups in test Duration (F = 9.56, P =  .000), ODS (F = 15.71, P =  .001), and CMS (F = 7.03, P =  .001). Further differences in these variables were found between various groups using Bonferroni post-hoc testing. SIGNIFICANCE: The i-FSST is an innovative and potentially beneficial tool for quantitatively measuring the dynamics that occur in the traditional FSST including a general measure of dynamic balance as well as transition times and stability during the test. This technology can provide objective data on stability, weight shifting, and weight acceptance that may guide interventions and further assessment.

Gait recovery in a girl with ischemic spinal cord stroke.

BACKGROUND AND PURPOSE: This case report describes an aggressive, task-specific program for the recovery of gait in a girl with a spinal cord stroke. CASE DESCRIPTION: The 11-year-old girl sustained a spinal cord stroke resulting in a T4 motor-incomplete lesion. Therapy was initiated 6 months after onset when she was not ambulating. INTERVENTION: The focus of all interventions was on the restoration of gait. Locomotor treadmill training and over ground walking were the primary practice interventions. Walking was facilitated by orthoses, neuromuscular electrical stimulation, laser treatments, and strengthening. Treatment continued for 18 months. OUTCOMES: At the conclusion of therapy, the client was able to walk independently in the community with a single ankle foot orthosis and reverse rolling walker. DISCUSSION: The outcome was not anticipated for this client, given the type and level of her injury and the delay in starting gait training.

Excellent outcomes for adults who experienced early standardized treadmill training during acute phase of recovery from stroke: a case series.

OBJECTIVE: To describe gait outcomes, including assistive device use and incidence of falls, in a group of adults post stroke who received early standardized treadmill training (ESTT) in the acute phase of rehabilitation. DESIGN: A case series of 18 individuals post stroke with varied lesion size, location, and comorbidities. SETTING: Inpatient rehabilitation unit. INTERVENTION: Daily 30-minute sessions of ESTT initiated before overground training in the acute rehabilitation period. OUTCOME MEASURES: Three-dimensional gait analysis, 6-minute walk test (6MWT), assistive device inventory, and fall history. RESULTS: Gait analysis revealed better temporal and spatial symmetry than have been previously documented. Twelve participants walked at speeds of greater than 0.80 m/s and 10 walked without the use of an assistive device or orthoses. Mean 6MWT distance was 322.42 m (±114.33). Thirteen participants (72%) reported no falls over a 6-month period. CONCLUSION: These outcomes far surpass the current data reported in the literature for this patient population and were achieved by the application of an intervention that was feasible in the acute rehabilitation setting.

Locomotor treadmill training with partial body-weight support before overground gait in adults with acute stroke: a pilot study.

OBJECTIVE: To investigate the impact of locomotor treadmill training with partial body-weight support (BWS) before the initiation of overground gait for adults less than 6 weeks poststroke. DESIGN: Parallel group, posttest only. SETTING: Inpatient rehabilitation center. PARTICIPANTS: Adults after first stroke admitted to an inpatient rehabilitation unit: treadmill group (n=7) and comparison group (n=7). INTERVENTIONS: Locomotor treadmill training with partial BWS or traditional gait training methods. MAIN OUTCOME MEASURES: Gait kinematics, symmetry, velocity, and endurance at least 6 months postinsult. RESULTS: Data from 3-dimensional gait analysis and 6-minute walk test (6MWT) supported improved gait for adults postacute stroke who practiced gait on a treadmill before walking over ground. Gait analysis showed increased knee flexion during swing and absence of knee hyperextension in stance for the treadmill group. In addition, more normal ankle kinematics at initial contact and terminal stance were observed in the treadmill group. Improved gait symmetry in the treadmill group was confirmed by measures of single support time, hip flexion at initial contact, maximum knee flexion, and maximum knee extension during stance. The treadmill group also walked further and faster in the 6MWT than the comparison group. CONCLUSIONS: Application of locomotor treadmill training with partial BWS before overground gait training may be more effective in establishing symmetric and efficient gait in adults postacute stroke than traditional gait training methods in acute rehabilitation.

Locomotor treadmill training with body-weight support prior to over-ground gait: promoting symmetrical gait in a subject with acute stroke.

BACKGROUND AND PURPOSE: An asymmetrical gait pattern is frequently observed in persons recovering from stroke. Locomotor training with partial body-weight support (BWS) has been demonstrated to be effective for restoring ambulation abilities in persons poststroke. However, the optimal treatment parameters for this intervention have not been defined. The purpose of this case study was to report outcomes for a person in the acute period poststroke who experienced locomotor treadmill training with BWS prior to walking over ground. METHOD: The subject of this report was a 60-year-old male with a large right-sided infarct extending into the basal ganglia. Locomotor training with BWS began on day 10 following the infarct. The subject had five sessions, totaling 40 minutes of walking practice, prior to starting gait training over ground. RESULTS: The subject walked with a single-point cane (contact guard to standby assistance) for a total of 1,000 feet at a speed of 0.94 m/s (185 ft/min) when discharged on day 25 of rehabilitation. He demonstrated comparable stance time and step length bilaterally. DISCUSSION/CONCLUSION: The subject of this case report experienced a good outcome using a combination of early locomotor treadmill training and traditional therapeutic activities. Further investigation of early treadmill training may be warranted in subjects with acute stroke.