Dataset Information

Can prior exposure to repeated non-paretic slips improve reactive responses on novel paretic slips among people with chronic stroke?

ABSTRACT: This study examined if people with chronic stroke (PwCS) could adapt following non-paretic overground gait-slips and whether such prior exposure to non-paretic slips could improve reactive responses on novel paretic slip. Forty-nine PwCS were randomly assigned to either adaptation group, which received eight unexpected, overground, nonparetic-side gait-slips followed by two paretic-side slips or a control group, which received two paretic-side slips. Slip outcome, recovery strategies, center of mass (CoM) state stability, post-slip stride length and slipping kinematics were analyzed. The adaptation group demonstrated fall-reduction from first to eighth non-paretic slips, along with improved stability, stride length and slipping kinematics (p < 0.05). Within the adaptation group, on comparing novel slips, paretic-side demonstrated comparable pre-slip stability (p > 0.05); however, lower post-slip stability, increased slip velocity and falls was noted (p < 0.05). There was no difference in any variables between the novel paretic slips of adaptation and control group (p > 0.01). However, there was a rapid improvement on the 2nd slip such that adaptation group demonstrated improved performance from the first to second paretic slip compared to that in the control group (p < 0.01). PwCS demonstrated immediate proactive and reactive adaptation with overground, nonparetic-side gait-slips. However, PwCS did not demonstrate any inter-limb performance gain on the paretic-side after prior nonparetic-side adaptation when exposed to a novel paretic-side slip; but they did show significant positive gains with single slip priming on the paretic-side compared to controls without prior adaptation.Clinical registry number: NCT03205527.

SUBMITTER: Dusane S

PROVIDER: S-EPMC9290783 | biostudies-literature | 2022 Apr

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Can prior exposure to repeated non-paretic slips improve reactive responses on novel paretic slips among people with chronic stroke?

Dusane Shamali S Bhatt Tanvi T

Experimental brain research 20220201 4

This study examined if people with chronic stroke (PwCS) could adapt following non-paretic overground gait-slips and whether such prior exposure to non-paretic slips could improve reactive responses on novel paretic slip. Forty-nine PwCS were randomly assigned to either adaptation group, which received eight unexpected, overground, nonparetic-side gait-slips followed by two paretic-side slips or a control group, which received two paretic-side slips. Slip outcome, recovery strategies, center of ...[more]

PMID: 35106605

Similar Datasets

Project description:BackgroundIndividualized, targeted, and intense training is the hallmark of successful gait rehabilitation in people post-stroke. Specifically, increasing use of the impaired ankle to increase propulsion during the stance phase of gait has been linked to higher walking speeds and symmetry. Conventional progressive resistance training is one method used for individualized and intense rehabilitation, but often fails to target paretic ankle plantarflexion during walking. Wearable assistive robots have successfully assisted ankle-specific mechanisms to increase paretic propulsion in people post-stroke, suggesting their potential to provide targeted resistance to increase propulsion, but this application remains underexamined in this population. This work investigates the effects of targeted stance-phase plantarflexion resistance training with a soft ankle exosuit on propulsion mechanics in people post-stroke.MethodsWe conducted this study in nine individuals with chronic stroke and tested the effects of three resistive force magnitudes on peak paretic propulsion, ankle torque, and ankle power while participants walked on a treadmill at their comfortable walking speeds. For each force magnitude, participants walked for 1 min while the exosuit was inactive, 2 min with active resistance, and 1 min with the exosuit inactive, in sequence. We evaluated changes in gait biomechanics during the active resistance and post-resistance sections relative to the initial inactive section.ResultsWalking with active resistance increased paretic propulsion by more than the minimal detectable change of 0.8 %body weight at all tested force magnitudes, with an average increase of 1.29 ± 0.37 %body weight at the highest force magnitude. This improvement corresponded to changes of 0.13 ± 0.03 N m kg- 1 in peak biological ankle torque and 0.26 ± 0.04 W kg- 1 in peak biological ankle power. Upon removal of resistance, propulsion changes persisted for 30 seconds with an improvement of 1.49 ± 0.58 %body weight after the highest resistance level and without compensatory involvement of the unresisted joints or limb.ConclusionsTargeted exosuit-applied functional resistance of paretic ankle plantarflexors can elicit the latent propulsion reserve in people post-stroke. After-effects observed in propulsion highlight the potential for learning and restoration of propulsion mechanics. Thus, this exosuit-based resistive approach may offer new opportunities for individualized and progressive gait rehabilitation.

Project description:Background:A better understanding of the neural changes associated with paresis in stroke patients could have important implications for therapeutic approaches. Dynamic Causal Modeling (DCM) for functional magnetic resonance imaging (fMRI) is commonly used for analyzing effective connectivity patterns of brain networks due to its significant property of modeling neural states behind fMRI signals. We applied this technique to analyze the differences between motor networks (MNW) activated by continuous passive movement (CPM) of paretic and non-paretic ankles in subacute stroke patients. This study aimed to identify CPM induced connectivity characteristics of the primary sensory area (S1) and the differences in extrinsic directed connections of the MNW and to explain the hemodynamic differences of brain regions of MNW. Methods:For the network analysis, we used ten stroke patients' task fMRI data collected under CPMs of both ankles. Regions for the MNW, the primary motor cortex (M1), the premotor cortex (PM), the supplementary motor area (SMA) and the S1 were defined in a data-driven way, by independent component analysis. For the network analysis of both CPMs, we compared twelve models organized into two model-families, depending on the S1 connections and input stimulus modeling. Using DCM, we evaluated the extrinsic connectivity strengths and hemodynamic parameters of both stimulations of all patients. Results:After a statistical comparison of the extrinsic connections and their modulations of the "best model", we concluded that three contralateral self-inhibitions (cM1, cS1 and cSMA), one contralateral inter-regional connection (cSMA?cM1), and one interhemispheric connection (cM1?iM1) were significantly different. Our research shows that hemodynamic parameters can be estimated with the Balloon model using DCM but the parameters do not change with stroke. Conclusions:Our results confirm that the DCM-based connectivity analyses combined with Bayesian model selection may be a useful technique for quantifying the alteration or differences in the characteristics of the motor network in subacute stage stroke patients and in determining the degree of MNW changes.

Project description:BackgroundRoughly 800,000 people experience a stroke every year in the United States, and about 30% of people require walking assistance (walker, cane, etc.) after a stroke. Gait training on a treadmill is a common rehabilitation activity for individuals post-stroke and handrails are typically used to assist with walking during this training, however individual interaction with these handrails are not usually considered and quantitatively reported. Individuals may exert force onto the handrails to aid with propulsive force, but the relationship between limb propulsive force and handrail propulsive force are not known.Research questionHow do individuals post-stroke alter paretic propulsive force when using an assistive device, such as handrails on a treadmill?MethodsTwenty-one individuals post-stroke (eight current assistive device users and thirteen individuals who do not use an assistive device) walked on a treadmill for 3 min during three conditions: no handrail use, light handrail use (<5% BW) and self-selected handrail use. Three multilevel models were used to compare percent handrail, paretic and nonparetic propulsion between handrail conditions and assistive device groups.ResultsThe handrail propulsive impulse was more during the self-selected handrail condition compared to the light handrail condition (p = 0.002). The assistive device use group and the handrail condition fixed effects significantly improved the model fit for paretic propulsive impulse (p = 0.01). The interaction between assistive device use group and handrail condition significantly improved the model fit for nonparetic propulsive impulse (p < 0.001).SignificanceThese results suggest that handrail use may impact paretic propulsive impulse. Our initial results suggest that if the goal of rehabilitation treadmill training is to increase the paretic propulsive impulse, having the clinician encourage walking with the handrails may be optimal to promote paretic propulsion.

Dataset Information

Can prior exposure to repeated non-paretic slips improve reactive responses on novel paretic slips among people with chronic stroke?

Publications

Can prior exposure to repeated non-paretic slips improve reactive responses on novel paretic slips among people with chronic stroke?

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets