Medicine and Health Sciences Commons^™

Kinematic Assessment Of Turning And Walking Tasks Among Stroke Survivors By Employing Wearable Sensors And Pressure Platform, Masoud Abdollahi, Pranav Madhav Kuber, Christopher Hoang, Michael Shiraishi, Rahul Soangra, Ehsan Rashedi

Physical Therapy Faculty Articles and Research

Stroke survivors often experience reduced movement capabilities due to alterations in their neuromusculoskeletal systems. Modern sensor technologies and motion analyses can facilitate the determination of these changes. Our work aims to assess the potential of using wearable motion sensors to analyze the movement of stroke survivors and identifying the affected functions. We recruited 10 participants (5 stroke survivors, 5 healthy individuals) and conducted a controlled laboratory evaluation for two of the most common daily activities: turning and walking. Among the extracted kinematic parameters, range of trunk and sacrum lateral bending in turning were significantly larger in stroke survivors (p-value<0.02). However, no statistical difference in mean angular velocity and range of motion for trunk/sacrum/shank flexion-extension were obtained in the turning task. Our results also indicated that during walking, while there was no difference in swing time, double support portion of gait among the stroke group was significantly larger (p-value = 0.001). Outcomes of this investigation may help in designing new rehabilitation programs for stroke and other neurological disorders and/or in improving the efficacy of such programs.Clinical Relevance— This study may provide a better insight on the detailed functional differences between stroke survivors and healthy individuals which in turn could be used to develop a more efficient rehabilitation program for stroke community.

Prediction Of Fall Risk Among Community-Dwelling Older Adults Using A Wearable System, Thurmon Lockhart, Rahul Soangra, Hyunsoo Yoon, Teresa Wu, Christopher W. Frames, Raven Weaver, Karen A. Roberto

Physical Therapy Faculty Articles and Research

Falls are among the most common cause of decreased mobility and independence in older adults and rank as one of the most severe public health problems with frequent fatal consequences. In the present study, gait characteristics from 171 community-dwelling older adults were evaluated to determine their predictive ability for future falls using a wearable system. Participants wore a wearable sensor (inertial measurement unit, IMU) affixed to the sternum and performed a 10-m walking test. Measures of gait variability, complexity, and smoothness were extracted from each participant, and prospective fall incidence was evaluated over the following 6-months. Gait parameters were refined …

Self-Paced Treadmills Do Not Allow For Valid Observation Of Linear And Nonlinear Gait Variability Outcomes In Patients With Parkinson’S Disease, Maryam Rohafza, Rahul Soangra, Jo Armour Smith, Niklas König Ignasiak

Physical Therapy Faculty Articles and Research

Background

Due to the imposed constant belt speed, motorized treadmills are known to affect linear and nonlinear gait variability outcomes. This is particularly true of patients with Parkinson’s Disease where the treadmill can act as an external pacemaker. Self-paced treadmills update the belt speed in response to the subject's walking speed and might, therefore, be a useful tool for measurement of gait variability in this patient population. This study aimed to compare gait variability during walking at self-paced and constant treadmill speeds with overground walking in individuals with PD and individuals with unimpaired gait.

Methods

Thirteen patients with Parkinson’s Disease …

Mobile Phone Sensors Can Discern Medication-Related Gait Quality Changes In Parkinson's Patients In The Home Environment, Albert Pierce, Niklas König Ignasiak, Wilford K. Eiteman-Pang, Cyril Rakovski, Vincent Berardi

Psychology Faculty Articles and Research

Patients with Parkinson's Disease (PD) experience daytime symptom fluctuations, which result in small amplitude, slow and unstable walking during times when medication attenuates. The ability to identify dysfunctional gait patterns throughout the day from raw mobile phone acceleration and gyroscope signals would allow the development of applications to provide real-time interventions to facilitate walking performance by, for example, providing external rhythmic cues. Patients (n = 20, mean Hoehn and Yahr: 2.25) had their ambulatory data recorded and were directly observed twice during one day: once after medication abstention, (OFF) and once approximately 30 min after intake of their medication …

Effects Of Rucksack Military Accessory On Gait Dynamic Stability, Seong H. Moon, Christopher W. Frames, Rahul Soangra, Thurmon Lockhart

Physical Therapy Faculty Articles and Research

Various factors are responsible for injuries that occur in the U.S. Army soldiers. In particular, rucksack load carriage equipment influences the stability of the lower extremities and possibly affects gait balance. The objective of this investigation was to assess the gait and local dynamic stability of the lower extremity of five subjects as they performed a simulated rucksack march on a treadmill. The Motek Gait Real-time Interactive Laboratory (GRAIL) was utilized to replicate the environment of the rucksack march. The first walking trial was without a rucksack and the second set was executed with the All-Purpose Lightweight Individual Carrying Equipment …

Different Biomechanical Variables Explain Within-Subjects Versus Between-Subjects Variance In Step Length Asymmetry Post-Stroke, Natalia Sánchez, Nicolas Schweighofer, James M. Finley

Physical Therapy Faculty Articles and Research

Step length asymmetry (SLA) is common in most stroke survivors. Several studies have shown that factors such as paretic propulsion can explain between-subjects differences in SLA. However, whether the factors that account for between-subjects variance in SLA are consistent with those that account for within subjects, stride-by-stride variance in SLA has not been determined. SLA direction is heterogeneous, and different impairments likely contribute to differences in SLA direction. Here, we identified common predictors between-subjects that explain within-subjects variance in SLA using sparse partial least squares regression (sPLSR). We determined whether the SLA predictors differ based on SLA direction and whether …

Using Biofeedback To Reduce Spatiotemporal Asymmetry Impairs Dynamic Balance In People Post-Stroke, Sungwoo Park, Chang Liu, Natalia Sánchez, Julie K. Tilson, Sara J. Mulroy, James M. Finley

Physical Therapy Faculty Articles and Research

Background. People poststroke often walk with a spatiotemporally asymmetric gait, due in part to sensorimotor impairments in the paretic lower extremity. Although reducing asymmetry is a common objective of rehabilitation, the effects of improving symmetry on balance are yet to be determined. Objective. We established the concurrent validity of whole-body angular momentum as a measure of balance, and we determined if reducing step length asymmetry would improve balance by decreasing whole-body angular momentum. Methods. We performed clinical balance assessments and measured wholebody angular momentum during walking using a full-body marker set in a sample of 36 people with …

Lost In Translation: Simple Steps In Experimental Design Of Neurorehabilitation-Based Research Interventions To Promote Motor Recovery Post-Stroke, Natalia Sánchez, Carolee J. Winstein

Physical Therapy Faculty Articles and Research

Stroke continues to be a leading cause of disability. Basic neurorehabilitation research is necessary to inform the neuropathophysiology of impaired motor control, and to develop targeted interventions with potential to remediate disability post-stroke. Despite knowledge gained from basic research studies, the effectiveness of researchbased interventions for reducing motor impairment has been no greater than standard of practice interventions. In this perspective, we offer suggestions for overcoming translational barriers integral to experimental design, to augment traditional protocols, and re-route the rehabilitation trajectory toward recovery and away from compensation. First, we suggest that researchers consider modifying task practice schedules to focus on …

Foot Contact Dynamics And Fall Risk Among Children Diagnosed With Idiopathic Toe Walking, Rahul Soangra, Michael Shiraishi, Richard Beuttler, Michelle Gwerder, Louanne Boyd, Venkateswaran Muthukumar, Mohamed Trabia, Afshin Aminian, Marybeth Grant-Beuttler

Physical Therapy Faculty Articles and Research

Children that are diagnosed with Idiopathic Toe walking (cITW) are characterized by persistent toe-to-toe contacts. The objective of this study was to explore whether typical foot contact dynamics during walking predisposes cITW to a higher risk of falling. Twenty cITW and agematched controls performed typical and toe walking trials. The gait parameters related to foot contact dynamics, vertical force impulses during stance, slip, and trip risk were compared for both groups. We found that cITW manifest less stable gait and produced significantly higher force impulses during push-off. Additionally, we found that cITW had a higher slip-initiation risk that was associated …

Reliability Of A Barre-Mounted Dynamometer-Stabilizing Device In Measuring Dance-Specific Muscle Performance, Melissa Strzelinksi, Lori Thein Brody, Jo Armour Smith, Shaw Bronner

Physical Therapy Faculty Articles and Research

BACKGROUND: Hand-held dynamometry is considered an efficient, effective, and portable means of objectively measuring lower extremity strength; however, it has yet to be studied specific to dance-relevant muscle performance. Also, dynamometry is often criticized for variability in results based on tester strength and sex. Use of an external stabilizing device has been suggested to minimize differences in outcomes between male and female testers by reducing variability associated with tester strength limitations. Therefore, this study used a barre-mounted, portable dynamometer stabilizing device to improve consistency of results among different testers for assessing hip and lower extremity muscle performance in dance-relevant positions. …

Effects Of Auditory Cueing On Cadence And Gait Pattern, Andrew Carballo, Matthew Chang, Brian Hirmiz, Nicolette Lambright, Vivian Lee, Marla Lewis, Martin Nguyen, Matthew Gothong, Rahul Soangra

Physical Therapy Faculty Articles and Research

A large portion of the population participate in gait rehabilitation, especially those with conditions such as increased fall risk such as stroke, or Parkinson’s Disease. Some studies have shown that auditory cues help improve gait and reduce fall risk, but relationship with gait patterns is missing. In this study, eight participants walked at their preferred cadence and at increased and reduced cadence by 20%. We found that step length and step width were not significantly different in all walking conditions. Decreased cadence resulted in an increase of swing time, stance time, stride time, and stance to swing ratio, and a …

Surface Inclination Influences Fall Risk And Lower Extremity Joint Moments During Walking, Rachel Kling, Alex Chung, Courtney Cox, Emily Kimbro, Jim Grodzielanek, Stephen Ayres, Shireen Hosseini, Michael Shiraishi, Rahul Soangra

Physical Therapy Faculty Articles and Research

Falls present a large danger to the geriatric population, with one in three individuals over the age of 65 experiencing at least one fall annually. With most falls occurring while walking, the relationship between inclined walking and fall risk has not been fully explored. In this study, 16 healthy young participants (age: 26.8 ±5.4 years, height: 175.0±11.0 cm, weight: 68.2 ±19.9 kg) walked on a treadmill with level surface and 10 degrees incline/decline in a virtual environment laboratory. We found that gait parameters and lower extremity joint moments were affected by surface inclination. These observed changes in joint moments and …

Load Carriage Affects Kinematics During Ingress And Egress On Simulated Travelators, Alex Charbonneau, Ben Garson, Fiona Bisoffi, Stephanie Esparza, Miral Bhakta, Luke Bailey, Rahul Soangra

Physical Therapy Faculty Articles and Research

Technology advancements has impacted the quality of life in the modern world. Nowadays travelators found popularly as conveyers in airports have been widely used but it is not known how load carriage affects Ingress/egress on travelators. Ten healthy young adults stepped off a metal platform onto a forward moving treadmill belt at a given speed and then stepped on to a second platform. Data was collected to understand how load carriage could influence ingress and egress in participants. Participants were tested for four conditions (load, No load, speed of 0.3 m/s and 0.6 m/s). Load carriage at speed 0.6 m/s …

Asymmetric Load Carriage At Shoulder Height Affects Temporal Gait Characteristics Among Food Service Workers, Christopher Espino, Robin Faustino, Tiffany Franco, Angel Reign Galvan, Matthew Gothong, Ennis Khaleq, Cody Occhino, Rahul Soangra

Physical Therapy Faculty Articles and Research

Slips and falls are common injuries among restaurant and food service workers. It is estimated that food service workers have 60% higher rate of occupational injury or illness than workers in other industry. This study investigates effects of asymmetric load carriage at shoulder level on gait characteristics. Each participant walked with a service tray held at shoulder height. Each participant’s gait was analyzed under 3 different load walking conditions, no load walking (NLW), intermediate load walking (ILW) (2.5% BW), and maximum load walking (MLW) (5% BW). We found that participants walked significantly slower with gait cycle time 1.125s versus 1.150 …

A Feasibility Study Of Expanded Home-Based Telerehabilitation After Stroke, Steven C. Cramer, Lucy Dodakian, Vu Le, Alison Mckenzie, Jill See, Renee Augsburger, Robert J. Zhou, Sophia M. Raefsky, Thalia Nguyen, Benjamin Vanderschelden, Gene Wong, Daniel Bandak, Laila Nazarzai, Amar Dhand, Walt Scacchi, Jutta Heckhausen

Physical Therapy Faculty Articles and Research

Introduction: High doses of activity-based rehabilitation therapy improve outcomes after stroke, but many patients do not receive this for various reasons such as poor access, transportation difficulties, and low compliance. Home-based telerehabilitation (TR) can address these issues. The current study evaluated the feasibility of an expanded TR program.

Methods: Under the supervision of a licensed therapist, adults with stroke and limb weakness received home-based TR (1 h/day, 6 days/week) delivered using games and exercises. New features examined include extending therapy to 12 weeks duration, treating both arm and leg motor deficits, patient assessments performed with no therapist supervision, adding sensors …

Using Asymmetry To Your Advantage: Learning To Acquire And Accept External Assistance During Prolonged Split-Belt Walking, Natalia Sánchez, Surabhi N. Simha, J. Maxwell Donelan, James M. Finley

Physical Therapy Faculty Articles and Research

People can learn to exploit external assistance during walking to reduce energetic cost. For example, walking on a split-belt treadmill affords the opportunity for people to redistribute the mechanical work performed by the legs to gain assistance from the difference in belts’ speed and reduce energetic cost. Though we know what people should do to acquire this assistance, this strategy is not observed during typical adaptation studies. We hypothesized that extending the time allotted for adaptation would result in participants adopting asymmetric step lengths to increase the assistance they can acquire from the treadmill. Here, participants walked on a split-belt …

Social Network Structure Is Related To Functional Improvement From Home-Based Telerehabilitation After Stroke, Archana Podury, Sophia M. Raefsky, Lucy Dodakian, Liam Mccafferty, Vu Le, Alison Mckenzie, Jill See, Robert J. Zhou, Thalia Nguyen, Benjamin Vanderschelden, Gene Wong, Laila Nazarzai, Jutta Heckhausen, Steven C. Cramer, Amar Dhand

Physical Therapy Faculty Articles and Research

Objective: Telerehabilitation (TR) is now, in the context of COVID-19, more clinically relevant than ever as a major source of outpatient care. The social network of a patient is a critical yet understudied factor in the success of TR that may influence both engagement in therapy programs and post-stroke outcomes. We designed a 12-week home-based TR program for stroke patients and evaluated which social factors might be related to motor gains and reduced depressive symptoms.

Methods: Stroke patients (n = 13) with arm motor deficits underwent supervised home-based TR for 12 weeks with routine assessments of motor function and …