Academic literature on the topic 'Early gait rehabilitation'

Central nervous system diseases cause the gait disorder. Early rehabilitation of a patient with central nervous system disease is shown to be benefit. However, early gait training is difficult because of muscular weakness and those elderly patients who lose of leg muscular power. In the patient's walking training, therapists assist the movement of patient's lower limbs and control the movement of patient's lower limbs. However the assistance for the movement of the lower limbs is a serious hard labor for therapists. Therefore, research into and development of various gait rehabilitation devices is currently underway to identify methods to alleviate the physical burden on therapists. In this paper, we introduced the about gait rehabilitation devices in central nervous system disease.

Introduction: Physiotherapists routinely prescribe the use of two different early walking aids (EWAs) to individuals who have recently undergone unilateral transtibial amputation. No research to date has investigated the kinematic gait patterns of transtibial amputees walking with an EWA during early rehabilitation. The aim of the current RCT study was to compare gait patterns when walking with two different EWAs and whether either EWA provided patients with greater gait benefits.Methods: Patients were randomly assigned into one of two EWA groups, one group using the Amputee Mobility Aid and another using the Pneumatic Post-Amputation Aid, prior to receiving their functional prosthesis. A 3D motion capture system recorded kinematic data from their first steps up to discharge from rehabilitation.Results: Walking velocity increased significantly ( p < 0.01) during rehabilitation. Control of the prosthetic knee improved during rehabilitation in both groups. A lack of conclusive differences between EWAs was noted at discharge from rehabilitation.Discussion: Both groups displayed changes in gait patterns in different gait measures during rehabilitation. However, these changes were not the same for both groups. Gait adaptations occurred soon after walking with a functional prosthesis.Conclusion: The results from this study would suggest that neither EWA was more beneficial for gait retraining during rehabilitation.

Rehabilitation of walking is an essential element in the treatment of incomplete spinal cord injured (SCI) patients. During the early post injury period, patients find it challenging to practice upright walking. Simulating stepping movements in a supine posture may be easier and promote earlier rehabilitation. A robotic orthotic device for early intervention in spinal cord injury that does not require the patient to be in an upright posture has been modelled. The model comprises a two-bar mechanical system that is configured and powered to provide limb kinematics that approximate normal overground walking. The modelling work has been based on gait analysis performed on healthy subjects walking at 50 per cent, 75 per cent, and 100 per cent of normal cadence. Simulated angles of hip, knee, and ankle joints show a comparable range of motion (ROM) to the experimental walking data measured in healthy subjects. The model provides operating parameters for a prospective recumbent gait orthosis that could be used in early walking rehabilitation of incomplete SCI patients.

ABSTRACT Gait disorders and postural instability are the leading causes of falls and disability in Parkinson's disease (PD). Cognition plays an important role in postural control and may interfere with gait and posture assessment and treatment. It is important to recognize gait, posture and balance dysfunctions by choosing proper assessment tools for PD. Patients at higher risk of falling must be referred for rehabilitation as early as possible, because antiparkinsonian drugs and surgery do not improve gait and posture in PD.

Learning can be explicit or implicit. Explicit learning takes place intentionally, in the presence of factual task-relevant knowledge; whereas implicit learning takes place unintentionally, without concurrent acquisition of knowledge about task performance. The relative benefits of implicit learning have been well investigated within healthy populations. Research consistently demonstrates that skills learnt implicitly are more likely to be retained, and are more robust under secondary task load. However, study protocols tend to involve laboratory based activities, which do not take into account the complexities of motor learning in natural settings. Direct transferability of the findings to stroke rehabilitation is therefore questionable. Two factors in explicit and implicit learning are the concepts of attentional capacity and attentional focus. Attentional capacity refers to the ability to attend to and process incoming information, whereas attentional focus refers to the location of attention in relation to specific aspects of the task being performed. Theories propose that focussing on specific movements (internal focus) may actually constrain or interfere with automatic control processes that would normally regulate movement, whereas if attention is focussed towards the movement effect (external focus) the motor system is able to more naturally self-organize, resulting in more effective performance, and learning. An internal focus of attention is therefore allied to explicit learning; whilst an external focus of attention is allied to implicit learning. This research aimed to improve understanding of explicit and implicit learning within early gait rehabilitation post stroke; primarily through the development and testing of explicit and implicit models of learning interventions. It has comprised three phases; a review of the literature; an observational study to gain insight into current practice; and a feasibility study to test the ability of therapists to deliver interventions with a bias towards either an explicit or implicit approach. Therapists were found to favour the use of explicit techniques; internally focussed instructions and feedback statements were used in high quantities. Practice therefore appeared to be at odds with current evidence; albeit primarily from healthy populations. Guidance for the delivery of explicit and implicit learning models in clinical practice was developed, and then tested in a feasibility study. Therapists demonstrated the ability to change their practice to bias either explicit or implicit learning; both approaches were found to be acceptable to patients and therapists. Recommendations are made on the content and evaluation of explicit and implicit learning models in future research, and specifically, in a Phase II pilot study.

The study has investigated some load aspects of the gait of elderly, vascular, lower limb amputees in early stage of rehabilitation, in day to day realistic conditions. The aims were: 1) to understand the gait of recent vascular amputees better, 2) to quantify mechanical loads with two different assistive walking devices. To reach these targets: a removable novel pylon transducer was designed; a fully portable data acquisition system and instrumented canes were used. The new pylon transducer comprised two main parts so that the prosthesis did not need to be altered: 1) an valuminium. bell)) placed within the prosthetic shank tube, having a flange at its base on which the tube of the prosthesis comes to bear; 2) the body of the transducer located inside the bell with an upper contact flange and having clearance to allow the bonding of strain gauges in four levels. A full calibration of the six channels followed by static and dynamic validation tests has been undertaken. They showed a mean accuracy of 7% with a sufficient linearity to be confident in the provided results. Data were recorded through an eight channels 12-bit data acquisition system. At a sampling frequency of 6411z, the recording duration was I hour. Two series of patients have been included in the sample: 30 transtibial and 10 transfemoral amputees. A new pattern for the vertical ground reaction force is described: the second peak was absent, evidently transmitted by the load on the walking devices. The mean load on the walking devices was 35 percent of the body weight. It was also shown that the walking devices not only transmitted axial load but also assisted in the forward acceleration of the body. Three typical gait patterns have been found in the temporal parameters of the gait but none could be discerned for the load distribution.

Thesis (M.S.M.E.)--University of Delaware, 2006
Principal faculty advisors: Sun, Jian-Qiao, Dept. of Mechanical Engineering; Katherine Rudolph, Dept. of Physical Therapy. Includes bibliographical references.

Walking is a fundamental human activity [1]. Rehabilitation of walking is one of the essential goals for patients with spinal cord injury (SCI) or other neurological impairments [2, 3]. Early rehabilitation is desirable to maximise the beneficial effects, so training programmes should be initiated even when patients are still on bed rest. In order to promote early rehabilitation of patients with incomplete spinal cord injury who cannot maintain an upright posture, a Gait Orthosis for Early Rehabilitation (GOER) of walking was designed [2] and evaluated in this PhD work. This research started with a gait analysis experiment, through which the kinematics and kinetics of overground walking were investigated. Based on experimental walking data from able-bodied subjects, a least squares algorithm was developed to approximate the foot trajectories with circles. The determination of the best-fit circle for the toe trajectory over the whole gait cycle provided the basis for inducing toe movement by a rigid bar. Therefore a model of a two-bar mechanism was developed in Matlab/SimMechanics to simulate supine stepping. The simulated kinematics, including the angles of the hip, knee and ankle joints, showed comparable ranges of motion (ROMs) to the experimental walking performance in able-bodied subjects. This two-bar model provided the basis for the development of the GOER system. The intersegmental kinetics of the lower limb motion during supine stepping were investigated through computer simulation. A model of a leg linkage was firstly developed to simulate upright walking. After the model was validated by successful simulation of dynamic performance similar to experimental overground walking, the model was rotated by 90o to simulate stepping movement in a supine posture. It was found that the dynamics of the hip joint were significantly influenced by the position change from upright to supine, which highlighted the importance of a leg-weight support during supine stepping. In contrast, the kinetics of the ankle joint were much influenced by the forces applied on the foot sole which mimicked the ground reaction occurring during overground walking. Therefore a suitable force pattern was required on the foot sole in order to train the ankle joint during supine stepping. The simulated kinematic and kinetic results provided the basis for the design process of the GOER system. A GOER prototype with mechanisms for one leg was manufactured, which included a bar linkage to move the leg frame upwards and downwards and a cam-roller mechanism to rotate the shoe platform. The bar-cam GOER prototype achieved coordinated movements in the leg frame through constant rotation of an electric motor. Preliminary tests were carried out in three able-bodied subjects who followed the movements produced by the GOER prototype. The subjects felt walking-like stepping movement in the lower limb. Synchronised motion in the hip, knee and ankle joints was obtained, with the ROMs in the physiological ranges of motion during overground walking. The experimentally obtained joint profiles during supine stepping matched the simulated supine stepping and were close to the profiles during overground walking. Apart from inducing proprioceptive feedback from the lower limb joints, the GOER system required dynamic stimulation from the shoe platform to mimic load occurring during the stance phase of overground walking. Activated by pneumatic components, the shoe platform managed to apply forces on the foot sole with adjustable amplitudes. The pneumatic shoe platform was evaluated in ten able-bodied subjects and managed to induce walking-like pressure sensation on the foot sole with physiological responses from the leg muscles. In summary, this thesis developed and evaluated a new gait training robotic system targeting supine stepping for patients who are still restricted to a lying position. The conceptual design process was developed through computer modelling and it was implemented as a prototype. Evaluation tests on able-bodied subjects proved the technical feasibility of the robotic system for supine stepping and led to recommendations for further development.

Background: Following a stroke the ability to walk is often impaired due to compromised motor-control, muscle weakness and spasticity, resulting in deviations during gait. Ankle-foot orthoses (AFO) can be used for people with hemiparesis to improve stability during stance phase and clearance during swing phase. There has been much discussion whether AFOs have a positive effect during early rehabilitation post stroke (in this study defined as six weeks from the initial stroke onset).Objectives: The aim was to describe the level of involvement of Danish Certified Prosthetists and Orthotists (CPO) in early rehabilitation of stroke patients in Denmark, and to describe danish orthotists view on their involvement in early rehabilitation of stroke patients.Method: A cross-sectional survey, in form of a self-administered questionnaire, was conducted during March and April 2021 in Denmark. The survey was sent to Danish CPOs who were currently members of the Danish professional organization for prosthetists/orthotists. A total of 110 members received the questionnaire by e-mail, 80 of which were registered as certified. The questionnaire consisted of 43 items (of which a minimum of 26 questions needed answering) with mainly closed ended questions. Descriptive statistics were used for data analysis, with frequencies, percentage and summarizing tables.Results: The response rate was 31.25 % (n=25). The survey demonstrated that only few participants (n=3) were involved in early gait rehabilitation, stroke patients were seen as out-patients in orthotic clinics (92%, n=23), usually 4–6-month post stoke (44%, n=11) and often with a referral from another member of the multidisciplinary team (MDT) (56%, n=14). Danish CPOs believed that orthotic assessment was an essential part of gait re-education (80% n=20), and that the orthotist should be part of the early gait rehabilitation (88%, n=22). Most of the orthotists (72%, n=18) were confident in recommending a treatment plan including lower extremity orthosis and were confident in advising the multidisciplinary team (MDT) in the use of orthosis (80%, n=20).Conclusion: It is uncommon for danish CPOs to be involved in the early rehabilitation of stroke patients and the Danish CPOs often first meet the patient late in the rehabilitation process. The CPOs believe that they should be part of early gait rehabilitation and that orthotic assessment should be part of gait re-education.

Intensive care unit-acquired weakness (ICUAW) is a significant and common complication with major implications for survivors of critical illness. ICUAW is a clinical diagnosis made in the presence of generalized muscle weakness that occurs in the setting of critical illness when other causes of muscle weakness have been excluded. Critical illness polyneuropathy and myopathy are the most common causes of ICUAW. Short-term implications of ICUAW include alveolar hypoventilation and an increased risk of pulmonary aspiration, atelectasis, and pneumonia—factors which may contribute to acute respiratory failure and ICU re-admission. In the long term, ICUAW has been associated with physical disturbances, including unsteady gait, sensory loss, foot drop, and, in more severe cases, persistent quadriparesis and ventilator dependency. ICUAW appears to heavily influence the failure of ICU patients to return to baseline health status post-discharge. There is a paucity of evidenced-based therapeutic strategies to reduce the incidence of ICUAW; however, early rehabilitative therapy might represent an effective measure in improving functional status.

Virtual reality (VR) is a powerful tool to motivate its participants to active participation, while providing augmented feedback to instruct the subject and improve task performance. This chapter presents the technical prerequisites of different recording, display, and rendering technologies. VR does not replace the real environment, but is a tool for setting up automatic training schedules. VR can be a good solution to train dangerous or difficult tasks. VR is being applied in physiotherapy, occupational therapy to recover limb functionality after disease or accident, and to enhance cognitive learning. VR technologies can also be applied to provide feedback as assistance during activities of daily living. Despite the many technological achievements and positive results in many therapeutic and assistive applications, the field of VR rehabilitation is still in an early phase. VR technologies will continue to grow, gain further mainstream acceptance and, eventually, have a significant positive effect on therapeutic outcome.

Virtual reality (VR) is a powerful tool to motivate its participants to active participation, while providing augmented feedback to instruct the subject and improve task performance. This chapter presents the technical prerequisites of different recording, display, and rendering technologies. VR does not replace the real environment, but is a tool for setting up automatic training schedules. VR can be a good solution to train dangerous or difficult tasks. VR is being applied in physiotherapy, occupational therapy to recover limb functionality after disease or accident, and to enhance cognitive learning. VR technologies can also be applied to provide feedback as assistance during activities of daily living—this is then typically called augmented reality (AR). Despite the many technological achievements and positive results in many therapeutic and assistive applications, the field of VR rehabilitation is still in an early phase. VR technologies will continue to grow, gain further mainstream acceptance and, eventually, have a significant positive effect on therapeutic outcome.

According to the Arthritis Foundation, 66 million Americans (or nearly 1 in 3 adults) currently suffer from arthritis, with osteoarthritis (OA) being the most common form, and the knee being the joint most commonly affected. Despite the need for early treatment, few clinical interventions slow the progression of knee OA. Since articular cartilage is responsive to the amount of joint loading, reducing compressive loads in the diseased compartment may slow the rate of cartilage breakdown. Because medial compartment load cannot be measured non-invasively in vivo, an external measure to quantify the desired load reduction has been sought. The best candidate found thus far is the external knee adduction moment during gait [1]. This moment exhibits two peaks during the gait cycle, one during early stance phase and the other during late stance. A high peak knee adduction moment has been correlated with increased disease severity [2] and an increased rate of disease progression [3].

There is a growing demand for quantifying the performance and efficacy of rehabilitation programs. Researchers are advocating home based rehabilitation devices and continuous monitoring of patients status in real time through wearable sensors. This paper investigates the use of inertial measurement sensors for recording the dynamic gait status. In order to facilitate long term recording and minimal interface of recording devices, these MEMS sensors are advantageous in many ways over the conventional laboratory methods. Portable Harness Ambulatory System (PHAS) can be effectively used in home environments with minimal assistance for gait rehabilitation. This paper addresses the stages of mechatronic integration of a prototype of PHAS with an aim for early gait rehabilitation of elderly and stroke survivors without fear of falling. Sensors modules comprised of accelerometer and gyroscope were developed. X-bee wireless communication protocol is used for transmitting the gait data for computer storage. Gait experiments with wireless sensor modules attached to shoulder, wrist, thigh and ankle joints of normal human subjects were conducted for slow and fast walking speed. The inertial measurement sensors provide information on the range of motion, gait speed, and orientation. Experimental results prove that sensor modules were successfully able to acquire and record the gait information wirelessly. These sensor modules can also be integrated in the PHAS prototype. The paper outlines the results of initial research and discusses possible alternatives.

Nearly half of individuals with stroke experience some form of long-term disability and stroke is one of the main causes of wheelchair use in the United States [1]. Early rehabilitation in the acute phase of stroke has been shown critical to promoting motor plasticity and patient outcomes. However, research shows that only 32% of the time during inpatient rehabilitation is spent in active therapy, while the rest of the time is spent on other activities around the ward [2]. For walking impairment, it is especially important for patients to experience similar force loading and practice the patterning of gait in order to recover [3]. However, in a typical therapy session focused on gait rehabilitation patients only will take about 300 steps on average. This is far below what has been thought needed for humans to learn how to walk [4].

The automated sensing scheme described in this paper has the potential to automatically capture, discriminate and classify transients in gait. The mechanical simplicity of the walking platform offers advantages over standard force plates. There is less restriction on dimensions offering the opportunity for multi-contact and multiple steps. This addresses the challenge of patient targeting and the evaluation of patients in a variety of ambulatory applications. In this work the sensitivity of the distributive tactile sensing method has been investigated experimentally. Using coupled time series data from a small number of sensors, gait patterns are compared with stored templates using a pattern recognition algorithm. By using a neural network these patterns were interpreted classifying normal and affected walking events with an accuracy of just under 90%. This system has potential in gait analysis and rehabilitation as a tool for early diagnosis in walking disorders, for determining response to therapy and for identifying changes between pre and post operative gait.

Abstract The analysis of human gait represents a valuable tool for an early and timely identification of diseases and pathologies, as well as to follow up treatments and rehabilitation programs. However, although several research works in the literature have addressed the assessment of human gait as a diagnostic tool, few works have focused on the biomechanical parameters and metrics needed for such practice. This work presents the results of an investigation carried out to identify and analyze the biomechanical parameters used in the literature to assess the human walking, both pathological and normal. For this purpose, a literature review was conducted to detect and analyze the biomechanical parameters. A classification of these parameters based on the application area is proposed and comprises clinical, sport and exploration. These parameters are also classified according to the origin of the problem into musculoskeletal, neurological and circulatory. The biomechanical parameters identified are analyzed and discussed using set theory. The results indicate that the analysis of the spatiotemporal parameters of the gait allows a detailed and economic study of this mode of locomotion. The most used gait parameters are: step length, stride length, step width, gait speed, gait phases, cadence, swing time and stance time. On the other hand, the study of gait in the clinical area makes use of nearly all the gait parameters reported in the literature, i.e. spatial, temporal, angular, force and other specific parameters according to the type of pathology being analyzed.

For the purpose of developing robot-assisted human walking systems, human and robot walking dynamics are modeled using models of different complexity depending on simulation scenarios in different phases of robotic system development and selected walking parameters to be analyzed. This paper addresses the early modeling and simulation phase of the development of a novel mobile robot-assisted gait rehabilitation system to be used as a demonstrator for a cognitive robot control architecture currently under development. For simulation purposes dynamical models of walking human and powered orthosis are developed in multi-body simulation software (MSC Adams) using the LifeMod plug-in while the control algorithms are developed in Matlab. The paper introduces a novel ROS (Robot Operating System) based communication established between the real system software modules and the simulation environment. The performance evaluation was performed by running the simulation with motion data which were obtained using marker-based motion capture system and which were implemented as ROS node.

Abstract Human’s motion and its mechanisms had become interesting in the last years, where the medecine’s field search for rehabilitation methods for handicapped persons. Other fields, like sport sciences, professional or military world, search to distinguish profiles and ways to train them with specific purposes. Besides, recent findings in neuroscience try to describe these mechanisms from an organic point of view. Until now, different researchs had given a model about control motor that describes how the union between the senses’s information allows adaptable movements. One of this sense is the proprioception, the sense which has a quite big factor in the orientation and position of the body, its members and joints. For this reason, research for new strategies to explore proprioception and improve the theories of human motion could be done by three different vias. At first, the sense is analysed in a case-study where three groups of persons are compared in a controlled enviroment with three experimental tasks. The subjects belong to each group by the kind of sport they do: sedentary, normal sportsmen (e.g. athletics, swimming) and martial sportmen (e.g. karate, judo). They are compared thinking about the following hypothesis: “Martial Sportmen have a better proprioception than of the other groups’s subjects: It could be due to the type of exercises they do in their sports as empirically, a contact sportsman shows significantly superior motor skills to the members of the other two groups. The second via are records from encephalogram (EEG) while the experimental tasks are doing. These records are analised a posteriori with a set of processing algorithms to extract characteristics about brain’s activity of the proprioception and motion control. 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