Efficacy of gait training using a treadmill with and without visual biofeedback in patients after stroke: A randomized study

Drużbicki, Mariusz; Guzik, Agnieszka; Przysada, Grzegorz; Kwołek, Andrzej; Brzozowska-Magoń, Agnieszka

doi:10.2340/16501977-1949

Cited by 43 publications

(69 citation statements)

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“…Additionally, knowledge of performance provided by the AGRF-guided biofeedback may enhance the patient’s engagement during training, and increase the efficacy of rehabilitation. Similar to previous investigations employing biofeedback as a post-stroke gait training tool for targeting spatio-temporal parameters such as step length and stance time [14, 15], we believe that AGRF-based feedback may be a valuable gait training strategy worthy of investigation. Reduced AGRF has been demonstrated to be an important biomechanical impairment in people post-stroke, and has been associated with over ground gait speed, gait asymmetry, and stroke severity [1, 2, 12, 35].…”

Section: Discussionsupporting

confidence: 76%

“…Although there is a paucity of systematic investigations on the use of real-time biofeedback during post-stroke gait training, biofeedback during gait has been shown to be effective at modulating step asymmetry in post-stroke individuals [14, 15], trunk lean in able-bodied individuals [16], and knee adduction moment in individuals with varus knee alignment [17]. Force platform biofeedback during gait has been studied for improving limb loading symmetry following total hip arthroplasty [18] and gait asymmetry in trans-tibial amputees [19].…”

Section: Introductionmentioning

confidence: 99%

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Effects of unilateral real-time biofeedback on propulsive forces during gait

Schenck

Kesar

2017

J NeuroEngineering Rehabil

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BackgroundIn individuals with post-stroke hemiparesis, reduced push-off force generation in the paretic leg negatively impacts walking function. Gait training interventions that increase paretic push-off can improve walking function in individuals with neurologic impairment. During normal locomotion, push-off forces are modulated with variations in gait speed and slope. However, it is unknown whether able-bodied individuals can selectively modulate push-off forces from one leg in response to biofeedback. Here, in a group of young, neurologically-unimpaired individuals, we determined the effects of a real-time visual and auditory biofeedback gait training paradigm aimed at unilaterally increasing anteriorly-directed ground reaction force (AGRF) in the targeted leg.MethodsGround reaction force data during were collected from 7 able-bodied individuals as they walked at a self-selected pace on a dual-belt treadmill instrumented with force platforms. During 11-min of gait training, study participants were provided real-time AGRF biofeedback encouraging a 20–30% increase in peak AGRF generated by their right (targeted) leg compared to their baseline (pre-training) AGRF. AGRF data were collected before, during, and after the biofeedback training period, as well as during two retention tests performed without biofeedback and after standing breaks.ResultsCompared to AGRFs generated during the pre-training gait trials, participants demonstrated a significantly greater AGRF in the targeted leg during and immediately after training, indicating that biofeedback training was successful at inducing increased AGRF production in the targeted leg. Additionally, participants continued to demonstrate greater AGRF production in the targeted leg after two standing breaks, showing short-term recall of the gait pattern learned during the biofeedback training. No significant effects of training were observed on the AGRF in the non-targeted limb, showing the specificity of the effects of biofeedback toward the targeted limb.ConclusionsThese results demonstrate the short-term effects of using unilateral AGRF biofeedback to target propulsion in a specific leg, which may have utility as a training tool for individuals with gait deficits such as post-stroke hemiparesis. Future studies are needed to investigate the effects of real-time AGRF biofeedback as a gait training tool in neurologically-impaired individuals.Electronic supplementary materialThe online version of this article (doi:10.1186/s12984-017-0252-z) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 76%

Section: Introductionmentioning

confidence: 99%

Effects of unilateral real-time biofeedback on propulsive forces during gait

Schenck

Kesar

2017

J NeuroEngineering Rehabil

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“…Os achados do presente estudo corroboram com os achados de outros autores que tem estudado as repercussões de atividades terapêuticas para a melhora na funcionalidade de sujeitos pós AVE 27,28,29 , relatando melhoras após diferentes protocolos de intervenção, como o uso da dança, treino em esteira e mesmo a terapia convencional.…”

Section: Discussionunclassified

Fisioterapia em grupo melhora o equilíbrio e a funcionalidade de indivíduos com hemiparesia

et al. 2017

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Introdução: O treinamento em grupo parece ser uma opção eficaz na melhora de alterações de indivíduos acometidos pelo Acidente Vascular Encefálico. Objetivo: Avaliar a influência do tratamento fisioterapêutico em grupo na funcionalidade e no equilíbrio de sujeitos com hemiparesia. Métodos: 12 sujeitos com hemiparesia, de ambos os sexos, com média de idade de 59.85 (±7.24) anos foram avaliados quanto à funcionalidade e o equilíbrio utilizando o Índice de Barthel modificado e a Escala de Equilíbrio de Berg respectivamente, antes e após as sessões de tratamento. O tratamento foi realizado durante 90 dias, totalizando 36 sessões, três vezes por semana com duração de 60 minutos. O protocolo envolvia exercícios de fortalecimento, equilíbrio, coordenação motora fina e grosseira, e, alongamentos musculares. Resultados: Houve melhora significativa tanto da funcionalidade (p=0.019), quanto do equilíbrio (p=0.018) dos sujeitos. Conclusão: O tratamento em grupo foi capaz de melhorar a funcionalidade e o equilíbrio de indivíduos com hemiparesia.

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“…By using a force treadmill to quantitatively analyze gait patterns and detect gait abnormalities, medical therapists can adjust the intensity of treadmill training on an individual basis. In addition, previous studies have shown that the feedback of auditory, vibrotactile, and visual gait information can alter or improve gait features such as walking speed [30, 31], gait coordination [32], trunk sway [33], stride length [31], hip mechanics [34], cadence [31], step length symmetry [35], knee movement [36], gait cycle length [37], duration of gait [37], and swing phase speed [37]. With the capability of generating many important gait features, force treadmills represent an ideal platform for implementing such biofeedback systems.…”

Section: Introductionmentioning

confidence: 99%

Developing a Low-Cost Force Treadmill via Dynamic Modeling

Hong

Guo

Song

et al. 2017

Journal of Healthcare Engineering

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By incorporating force transducers into treadmills, force platform-instrumented treadmills (commonly called force treadmills) can collect large amounts of gait data and enable the ground reaction force (GRF) to be calculated. However, the high cost of force treadmills has limited their adoption. This paper proposes a low-cost force treadmill system with force sensors installed underneath a standard exercise treadmill. It identifies and compensates for the force transmission dynamics from the actual GRF applied on the treadmill track surface to the force transmitted to the force sensors underneath the treadmill body. This study also proposes a testing procedure to assess the GRF measurement accuracy of force treadmills. Using this procedure in estimating the GRF of “walk-on-the-spot motion,” it was found that the total harmonic distortion of the tested force treadmill system was about 1.69%, demonstrating the effectiveness of the approach.

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Efficacy of gait training using a treadmill with and without visual biofeedback in patients after stroke: A randomized study

Abstract: Gait training using a treadmill resulted in improvements in the gait and functional capacity of patients. The use of biofeedback gives better results in improving gait cycle length, duration of gait phases and swing phase speed compared with exercise on a treadmill alone.

Cited by 43 publications

References 35 publications

Effects of unilateral real-time biofeedback on propulsive forces during gait

Effects of unilateral real-time biofeedback on propulsive forces during gait

Fisioterapia em grupo melhora o equilíbrio e a funcionalidade de indivíduos com hemiparesia

Developing a Low-Cost Force Treadmill via Dynamic Modeling

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