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Anterior fall-recovery training applied to individuals with chronic stroke.

ABSTRACT: BACKGROUND:To study the effects of the initial stepping limb on anterior fall-recovery performance and kinematics, as well as to determine the benefits of fall-recovery training on those outcomes in individuals with chronic stroke. METHODS:Single-group intervention of 15 individuals with chronic stroke who performed up to six sessions of fall-recovery training. Each session consisted of two progressions of treadmill-induced perturbations to induce anterior falls from a standing position. Progressions focused on initial steps with the paretic or non-paretic limb. Fall-recovery performance (the highest disturbance level achieved and the proportion of successful recoveries), as well as step and trunk kinematics were compared between the initial stepping limbs on the first session. Limb-specific outcomes were also compared between the first and last training sessions. FINDINGS:There were no between-limb differences in fall-recovery performance in the first session. With training, participants successfully recovered from a higher proportion of falls (p's?=?0.01, Cohen's d's?>?0.7) and progressed to larger perturbation magnitudes (p's??0.5). Initial steps with the paretic limb were wider and shorter relative to the center of mass (p's??0.5). With training, initial paretic-limb steps became longer relative to the CoM (p?=?0.03, d?=?0.7). Trunk forward rotation was reduced when first stepping with the non-paretic limb (p?=?0.03, d?=?0.6). INTERPRETATION:The initial stepping limb affects relevant step kinematics during anterior fall recovery. Fall-recovery training improved performance and select kinematic outcomes in individuals with chronic stroke.

SUBMITTER: Pigman J

PROVIDER: S-EPMC6823156 | biostudies-literature | 2019 Oct

REPOSITORIES: biostudies-literature

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Anterior fall-recovery training applied to individuals with chronic stroke.

Pigman Jamie J Reisman Darcy S DS Pohlig Ryan T RT Jeka John J JJ Wright Tamara R TR Conner Benjamin C BC Petersen Drew A DA Crenshaw Jeremy R JR

Clinical biomechanics (Bristol, Avon) 20190726

<h4>Background</h4>To study the effects of the initial stepping limb on anterior fall-recovery performance and kinematics, as well as to determine the benefits of fall-recovery training on those outcomes in individuals with chronic stroke.<h4>Methods</h4>Single-group intervention of 15 individuals with chronic stroke who performed up to six sessions of fall-recovery training. Each session consisted of two progressions of treadmill-induced perturbations to induce anterior falls from a standing po ...[more]

PMID: 31382163

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Project description:BackgroundExercise has failed to reduce falls in those with chronic stroke. A limitation of traditional exercise is that the motor responses needed to prevent a fall are not elicited (i.e. they lack processing specificity). Balance reactions often require compensatory steps. Therefore, interventions that target such steps have the potential to reduce falls. Computerized treadmills can deliver precise, repeatable, and challenging perturbations as part of a training protocol. The objective of this study was to develop and determine the feasibility of such training applied to those with chronic stroke. We developed the training to address specificity, appropriate duration and repetition, and progressive overloading and individualization. We hypothesized that our intervention would be acceptable, practical, safe, and demonstrate initial signs of efficacy.MethodsIn this single-arm study, thirteen individuals with chronic stroke (29-77 years old, 2-15 years post stroke) performed up to six training sessions using a computer-controlled treadmill. Each session had separate progressions focused on initial steps with the non-paretic or paretic limbs in response to anterior or posterior falls. Perturbation magnitudes were altered based on performance and tolerance. Acceptability was determined by adherence, or the number of sessions completed. Practicality was documented by the equipment, space, time, and personnel. Adverse events were documented to reflect safety. In order to determine the potential-efficacy of this training, we compared the proportion of successful recoveries and the highest perturbation magnitude achieved on the first and last sessions.ResultsThe training was acceptable, as evident by 12/13 participants completing all 6 sessions. The protocol was practical, requiring one administrator, the treadmill, and a harness. The protocol was safe, as evident by no serious or unanticipated adverse events. The protocol demonstrated promising signs of efficacy. From the first to last sessions, participants had a higher proportion of successful recoveries and progressed to larger disturbances.ConclusionsUsing a computerized treadmill, we developed an approach to fall-recovery training in individuals with chronic stroke that was specific, considered duration and repetition, and incorporated progressive overloading and individualization. We demonstrated that this training was acceptable, practical, safe, and potentially beneficial for high-functioning individuals with chronic stroke.Trial registrationRetrospectively registered at clinicaltrials.gov ( NCT03638089 ) August 20, 2018.

Project description:BackgroundFalls are more prevalent in stroke survivors than age-matched healthy older adults because of their functional impairment. Rapid balance recovery reaction with adequate range-of-motion and fast response and movement time are crucial to minimize fall risk and prevent serious injurious falls when postural disturbances occur. A Kinect-based Rapid Movement Training (RMT) program was developed to provide real-time feedback to promote faster and larger arm reaching and leg stepping distances toward targets in 22 different directions.ObjectiveTo evaluate the effectiveness of the interactive RMT and Conventional Balance Training (CBT) on chronic stroke survivors' overall balance and balance recovery reaction.MethodsIn this assessor-blinded randomized controlled trial, chronic stroke survivors were randomized to receive twenty training sessions (60-min each) of either RMT or CBT. Pre- and post-training assessments included clinical tests, as well as kinematic measurements and electromyography during simulated forward fall through a "lean-and-release" perturbation system.ResultsThirty participants were recruited (RMT = 16, CBT = 14). RMT led to significant improvement in balance control (Berg Balance Scale: pre = 49.13, post = 52.75; P = .001), gait control (Timed-Up-and-Go Test: pre = 14.66 s, post = 12.62 s; P = .011), and motor functions (Fugl-Meyer Assessment of Motor Recovery: pre = 60.63, post = 65.19; P = .015), which matched the effectiveness of CBT. Both groups preferred to use their non-paretic leg to take the initial step to restore stability, and their stepping leg's rectus femoris reacted significantly faster post-training (P = .036).ConclusionThe RMT was as effective as conventional balance training to provide beneficial effects on chronic stroke survivors' overall balance, motor function and improving balance recovery with faster muscle response.Trial registrationThe study was registered at Clinicaltrials.gov ( https://clinicaltrials.gov/ct2/show/NCT03183635 , NCT03183635) on 12 June 2017.

Project description:Stroke is a leading cause of motor disability worldwide, and robot-assisted therapies have been increasingly applied to facilitate the recovery process. However, the underlying mechanism and induced neuroplasticity change remain partially understood, and few studies have investigated this from a multimodality neuroimaging perspective. The current study adopted BCI-guided robot hand therapy as the training intervention and combined multiple neuroimaging modalities to comprehensively understand the potential association between motor function alteration and various neural correlates. We adopted EEG-informed fMRI technique to understand the functional regions sensitive to training intervention. Additionally, correlation analysis among training effects, nonlinear property change quantified by fractal dimension (FD), and integrity of M1-M1 (M1: primary motor cortex) anatomical connection were performed. EEG-informed fMRI analysis indicated that for iM1 (iM1: ipsilesional M1) regressors, regions with significantly increased partial correlation were mainly located in contralesional parietal, prefrontal, and sensorimotor areas and regions with significantly decreased partial correlation were mainly observed in the ipsilesional supramarginal gyrus and superior temporal gyrus. Pearson's correlations revealed that the interhemispheric asymmetry change significantly correlated with the training effect as well as the integrity of M1-M1 anatomical connection. In summary, our study suggested that multiple functional brain regions not limited to motor areas were involved during the recovery process from multimodality perspective. The correlation analyses suggested the essential role of interhemispheric interaction in motor rehabilitation. Besides, the underlying structural substrate of the bilateral M1-M1 connection might relate to the interhemispheric change. This study might give some insights in understanding the neuroplasticity induced by the integrated BCI-guided robot hand training intervention and further facilitate the design of therapies for chronic stroke patients.

Project description:OBJECTIVES:No intervention has been shown to prevent falls poststroke. We aimed to determine if perturbation-based balance training (PBT) can reduce falls in daily life among individuals with chronic stroke. DESIGN:Assessor-blinded randomised controlled trial. SETTING:Two academic hospitals in an urban area. INTERVENTIONS:Participants were allocated using stratified blocked randomisation to either 'traditional' balance training (control) or PBT. PBT focused on improving responses to instability, whereas traditional balance training focused on maintaining stability during functional tasks. Training sessions were 1 hour twice/week for 6 weeks. Participants were also invited to complete 2 'booster' training sessions during the follow-up. PARTICIPANTS:Eighty-eight participants with chronic stroke (>6 months poststroke) were recruited and randomly allocated one of the two interventions. Five participants withdrew; 42 (control) and 41 (PBT group) were included in the analysis. PRIMARY AND SECONDARY OUTCOME MEASURES:The primary outcome was rate of falls in the 12 months post-training. Negative binomial regression was used to compare fall rates between groups. Secondary outcomes were measures of balance, mobility, balance confidence, physical activity and social integration. RESULTS:PBT participants reported 53 falls (1.45 falls/person-year) and control participants reported 64 falls (1.72 falls/person-year; rate ratio: 0.85(0.42 to 1.69); p=0.63). Per-protocol analysis included 32 PBT and 34 control participants who completed at least 10/12 initial training sessions and 1 booster session. Within this subset, PBT participants reported 32 falls (1.07 falls/person-year) and control participants reported 57 falls (1.75 falls/person-year; rate ratio: 0.62(0.29 to 1.30); p=0.20). PBT participants had greater improvement in reactive balance control than the control group, and these improvements were sustained 12 months post-training. There were no intervention-related serious adverse effects. CONCLUSIONS:The results are inconclusive. PBT may help to prevent falls in daily life poststroke, but ongoing training may be required to maintain the benefits. TRIAL REGISTRATION NUMBER:ISRCTN05434601; Results.

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Anterior fall-recovery training applied to individuals with chronic stroke.

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Anterior fall-recovery training applied to individuals with chronic stroke.

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