Effects of the Immobilization of the Upper Extremities on Spatiotemporal Gait Parameters during Walking in Stroke Patients: A Preliminary Study.

BACKGROUND: The purpose of this study was to investigate the effects of upper extremity immobilization and consequent walking speed on spatiotemporal gait parameters in stroke patients with hemiparesis. METHODS: The following variables were assessed or measured in 29 stroke patients: age, height, weight, disease duration, Korean version of the Mini-Mental State Examination (MMSE-K), Berg balance scale (BBS-K), functional gait assessment (FGA-K), cause of the disease (type of lesion), and hemiparetic side. The measurement of gait was performed using two pressure plates of 1.5 m to create a 3 m walking distance and leaving 1.5 m of extension at both start and end, to ultimately create a 6 m walking distance that the patient could walk through. The following gait patterns were randomly selected based on card draws: self-selected walk speed (SW), self-selected walk speed with immobilized upper extremities (SWI), fast walking (FW), and fast walking with immobilized upper extremities (FWI). Each patient was assessed for four different gait patterns, with three measurements per pattern (12 gait measurements in total). RESULTS: While there were significant differences in the stride length, step width, velocity, and step length of the paretic side between self-selected walk speed (SW) and SWI, FWI did not show significant changes in any of the tested parameters. CONCLUSIONS: Immobilization of the upper extremities may affect walking at self-selected walk speeds. A comprehensive training program including upper extremity movement should be established for gait rehabilitation. Clinical Trial Registration. This trial is registered at http://cris.nih.go.kr/cris.

The effect of ankle and knee immobilization on postural control during standing.

BACKGROUND: This study examined the effects of ankle and knee joint immobilization on postural control in healthy young adults while standing. METHODS: The 24 participants included in this study participated in postural standing tests under four different constraint conditions: free joints, ankle immobilization only, knee immobilization only, and ankle-knee immobilization. Tests were performed using a commercial balancing equipment (Biodex(TM), Inc., NY, USA) and software. RESULTS: The overall limit-of-stability score and duration to completion of task were obtained at 75% limit-of-stability (moderate level of difficulty). The overall limit-of-stability score of free joints (34.5±9.1) were significantly different with the ankle immobilization only (26.0±11.6), and ankle-knee immobilization (26.4±7.4) conditions. The test duration increased in the following order: free joints (57.8±10.9), knee immobilization only (62.5±14.0), ankle immobilization only (68.0±14.9), and ankle-knee immobilization (69.4±17.7). The duration of the free joint condition greatly decreased than ankle immobilization only and ankle-knee immobilization conditions. CONCLUSIONS: The ankle and knee joints have sufficient range of motion to prevent falls related to decrease postural stability due to insufficient range of motion or to improve postural stability.

Effect of intensive training with a spring-assisted hand orthosis on movement smoothness in upper extremity following stroke: a pilot clinical trial.

BACKGROUND: A commercial splinting system is designed to permit quick training in opening and closing the affected hand in order to overcome the disadvantages of previous approaches. OBJECTIVE: The purpose of this study was to assess the feasibility of intensive training using a spring-assisted hand orthosis on upper extremity in individuals with chronic hemiparetic stroke. DESIGN: Five participants for the experimental group and 5 for the control group were recruited from a local rehabilitation hospital. Subjects in the experimental group participated in 4 weeks of training using a SaeboFlex orthosis for 1 hour per day, 5 times per week. Each subject in the control group wore the same orthosis for 1 hour per day without participating in upper extremity training. Outcome measures included the Fugl-Meyer Assessment, Box and Block Test, and Action Research Arm Test; kinematic parameters were collected using a 3-D motion analysis system. RESULTS: The Fugl-Meyer assessment and the Box and Block Test score were increased significantly in the experimental group after the intervention. The resultant velocity of the wrist joint for the reach-to-grasp task decreased significantly, and the resultant velocity of the shoulder joint while performing a reach-to-grasp task at acromion height decreased significantly in the experimental group. CONCLUSION: A pilot clinical study of spring-assisted dynamic hand orthosis training is feasible in recovering the movement of the hemiparetic upper extremity.