Dataset Information

Accommodating variable-resistance exercise enhance weight-bearing/gait symmetry and balance capability in children with hemiparetic cerebral palsy: a parallel-group, single-blinded randomized clinical trial.

ABSTRACT:

Background

Children with hemiparetic cerebral palsy (HCP) tend preferentially to bear their body weight on the non-paretic side, which leads to the emergence of asymmetrical walking patterns and limited ability to maintain balance. Therefore, improved and clearly effective intervention strategies to remedy these impairments are needed.

Aim

This study endeavored to evaluate the efficacy of an accommodating variable-resistance exercise (AVr-Ex) program on weight-bearing symmetry, gait symmetry, and dynamic balance in children with HCP.

Design

This study employed a parallel-group, single-blinded randomized controlled design.

Settings

Physical Therapy Outpatient Clinic and University Hospital, and a tertiary referral hospital.

Population

Thirty-six children with HCP aged between eight and 16 years were assigned randomly to the AVr-Ex group (N.=18) or control group (N.=18).

Methods

Children in the AVr-Ex group undergone an AVr-Ex program, three sessions/week over eight consecutive weeks, besides the usual physical therapy while children in the Control group received the usual physical therapy alone. Outcome measures were evaluated before and after intervention and included weight-bearing symmetry indices [rearfoot (RF-WbSI), and forefoot (FF-WbSI)], gait symmetry indices (spatial [GSIspatial], and temporal [GSItemporal]), and dynamic balance.

Results

The post-treatment RF-WbSI (P<0.001; ηp²=0.41), GSIspatial (P<0.001; ηp²=0.42), GSItemporal (P<0.001; ηp²=0.52), and dynamic balance variables (all P<0.05; ηp² ranged from 0.21 to 0.51) improved significantly in the AVr-Ex group compared to the control group, when controlled for the pre-treatment scores.

Conclusions

This study suggests that AVr-Ex can improve weight-bearing symmetry, gait symmetry, and dynamic balance in children with HCP when incorporated into the usual physical rehabilitation program.

Clinical rehabilitation impact

AVr-Ex is likely an effective training paradigm to address weight-bearing/gait asymmetry and balance issues in children with HCP, which provides the basis for its incorporation in rehabilitation programs for such a patient population.

SUBMITTER: Elnaggar RK

PROVIDER: S-EPMC9980524 | biostudies-literature | 2022 Jun

REPOSITORIES: biostudies-literature

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Publications

Accommodating variable-resistance exercise enhance weight-bearing/gait symmetry and balance capability in children with hemiparetic cerebral palsy: a parallel-group, single-blinded randomized clinical trial.

Elnaggar Ragab K RK Alhowimel Ahmed A Alotaibi Mazyad M Abdrabo Mohamed S MS Elshafey Mohammed A MA

European journal of physical and rehabilitation medicine 20211206 3

<h4>Background</h4>Children with hemiparetic cerebral palsy (HCP) tend preferentially to bear their body weight on the non-paretic side, which leads to the emergence of asymmetrical walking patterns and limited ability to maintain balance. Therefore, improved and clearly effective intervention strategies to remedy these impairments are needed.<h4>Aim</h4>This study endeavored to evaluate the efficacy of an accommodating variable-resistance exercise (AVr-Ex) program on weight-bearing symmetry, ga ...[more]

PMID: 34870387

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Project description:BackgroundSpasticity is an important complication after stroke, especially in the anti-gravity muscles, i.e. lower limb extensors. However the contribution of hyperexcitable muscle spindle reflex loops to gait impairments after stroke is often disputed. In this study a neuro-musculoskeletal model was developed to investigate the contribution of an increased length and velocity feedback and altered reflex modulation patterns to hemiparetic gait deficits.MethodsA musculoskeletal model was extended with a muscle spindle model providing real-time length and velocity feedback of gastrocnemius, soleus, vasti and rectus femoris during a forward dynamic simulation (neural control model). By using a healthy subject's base muscle excitations, in combination with increased feedback gains and altered reflex modulation patterns, the effect on kinematics was simulated. A foot-ground contact model was added to account for the interaction effect between the changed kinematics and the ground. The qualitative effect i.e. the directional effect and the specific gait phases where the effect is present, on the joint kinematics was then compared with hemiparetic gait deviations reported in the literature.ResultsOur results show that increased feedback in combination with altered reflex modulation patterns of soleus, vasti and rectus femoris muscle can contribute to excessive ankle plantarflexion/inadequate dorsiflexion, knee hyperextension/inadequate flexion and increased hip extension/inadequate flexion during dedicated gait cycle phases. Increased feedback of gastrocnemius can also contribute to excessive plantarflexion/inadequate dorsiflexion, however in combination with excessive knee and hip flexion. Increased length/velocity feedback can therefore contribute to two types of gait deviations, which are both in accordance with previously reported gait deviations in hemiparetic patients. Furthermore altered modulation patterns, in particular the reduced suppression of the muscle spindle feedback during swing, can contribute largely to an increased plantarflexion and knee extension during the swing phase and consequently to hampered toe clearance.ConclusionsOur results support the idea that hyperexcitability of length and velocity feedback pathways, especially in combination with altered reflex modulation patterns, can contribute to deviations in hemiparetic gait. Surprisingly, our results showed only subtle temporal differences between length and velocity feedback. Therefore, we cannot attribute the effects seen in kinematics to one specific type of feedback.

Project description:Hemiparesis, defined as unilateral muscle weakness, often occurs in people post-stroke or people with cerebral palsy, however it is difficult to understand how this hemiparesis affects movement patterns as it often presents alongside a variety of other neuromuscular impairments. Predictive musculoskeletal modeling presents an opportunity to investigate how impairments affect gait performance assuming a particular cost function. Here, we use predictive simulation to quantify the spatiotemporal asymmetries and changes to metabolic cost that emerge when muscle strength is unilaterally reduced and how reducing spatiotemporal symmetry affects metabolic cost. We modified a 2-D musculoskeletal model by uniformly reducing the peak isometric muscle force unilaterally. We then solved optimal control simulations of walking across a range of speeds by minimizing the sum of the cubed muscle excitations. Lastly, we ran additional optimizations to test if reducing spatiotemporal asymmetry would result in an increase in metabolic cost. Our results showed that the magnitude and direction of effort-optimal spatiotemporal asymmetries depends on both the gait speed and level of weakness. Also, the optimal speed was 1.25 m/s for the symmetrical and 20% weakness models but slower (1.00 m/s) for the 40% and 60% weakness models, suggesting that hemiparesis can account for a portion of the slower gait speed seen in people with hemiparesis. Modifying the cost function to minimize spatiotemporal asymmetry resulted in small increases (~4%) in metabolic cost. Overall, our results indicate that spatiotemporal asymmetry may be optimal for people with hemiparesis. Additionally, the effect of speed and the level of weakness on spatiotemporal asymmetry may help explain the well-known heterogenous distribution of spatiotemporal asymmetries observed in the clinic. Future work could extend our results by testing the effects of other neuromuscular impairments on optimal gait strategies, and therefore build a more comprehensive understanding of the gait patterns observed in clinical populations.

Project description:Introduction Robot-assisted gait training has been reported to improve gait in individuals with hemiparetic stroke. Ideally, the gait training program should be customized based on individuals’ gait characteristics and longitudinal changes. However, a gait robot that uses gait characteristics to provide individually tailored gait training has not been proposed. The new gait training robot, “Welwalk WW-2000,” permits modification of various parameters, such as time and load of mechanical assistance for a patient’s paralyzed leg. The robot is equipped with sensors and a markerless motion capture system to detect abnormal hemiparetic gait patterns during robot-assisted gait training. Thus, it can provide individually tailored gait training. This study aimed to investigate the criterion validity of the gait analysis system in the Welwalk WW-2000 in healthy adults. Materials and methods Twelve healthy participants simulated nine abnormal gait patterns that were often manifested in individuals with hemiparetic stroke while wearing the robot. Each participant was instructed to perform a total of 36 gait trials, with four levels of severity for each abnormal gait pattern. Fifteen strides for each gait trial were recorded using the markerless motion capture system in the Welwalk WW-2000 and a marker-based three-dimensional (3D) motion analysis system. The abnormal gait pattern index was then calculated for each stride from both systems. The correlation of the index values between the two methods was evaluated using Spearman’s rank correlation coefficients for each gait pattern in each participant. Results Using the participants’ index values for each abnormal gait pattern obtained using the two motion analysis methods, the median Spearman’s rank correlation coefficients ranged from 0.68 to 0.93, which corresponded to moderate to very high correlation. Conclusion The gait analysis system in the Welwalk WW-2000 for real-time detection of abnormal gait patterns during robot-assisted gait training was suggested to be a valid method for assessing gait characteristics in individuals with hemiparetic stroke. Clinical trial registration [https://jrct.niph.go.jp], identifier [jRCT 042190109].

Dataset Information

Accommodating variable-resistance exercise enhance weight-bearing/gait symmetry and balance capability in children with hemiparetic cerebral palsy: a parallel-group, single-blinded randomized clinical trial.

Background

Aim

Design

Settings

Population

Methods

Results

Conclusions

Clinical rehabilitation impact

Publications

Accommodating variable-resistance exercise enhance weight-bearing/gait symmetry and balance capability in children with hemiparetic cerebral palsy: a parallel-group, single-blinded randomized clinical trial.

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