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Development of a Balance Recovery Performance Measure for Gait Perturbation Training Based on the Center of Pressure.

ABSTRACT: Background: The availability of instrumented treadmills that can apply unexpected perturbations during walking has made gait perturbation training more popular in clinical practice. To quantify and monitor balance recovery while training, easy to use measures are needed and may be based on integrated force plate data. Therefore, we aimed to quantify and evaluate different implementations of the recovery performance measure based on center of pressure data. Methods: Recovery performance was calculated based on differences in center of pressure trajectories between unperturbed walking and balance recovery after a perturbation. Five methodological choices leading to 36 different implementations were evaluated. Test-retest reliability, effect sizes, and concurrent validity were evaluated against trunk velocity measures. Results: Differences in measures of (dis-)similarity, time normalization and reference data affected reliability, sensitivity and validity and none of the performance measure implementations based on center of pressure trajectories was superior on all criteria. Measures assessing perturbation effects on trunk velocities provided more reliable and sensitive recovery outcomes. Discussion: Different implementations of the recovery performance measure can be chosen dependent on constraints imposed in the clinical setting. Conclusion: Quantifying recovery performance based on center of pressure data is possible and may be suitable to monitor improvement in recovery performance after gait perturbations in specific clinical setups. Validity of performance measures in general requires further attention.

SUBMITTER: Rieger MM

PROVIDER: S-EPMC7917114 | biostudies-literature | 2021

REPOSITORIES: biostudies-literature

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Development of a Balance Recovery Performance Measure for Gait Perturbation Training Based on the Center of Pressure.

Rieger Markus M MM Papegaaij Selma S Steenbrink Frans F Pijnappels Mirjam M van Dieën Jaap H JH

Frontiers in sports and active living 20210215

<b>Background:</b> The availability of instrumented treadmills that can apply unexpected perturbations during walking has made gait perturbation training more popular in clinical practice. To quantify and monitor balance recovery while training, easy to use measures are needed and may be based on integrated force plate data. Therefore, we aimed to quantify and evaluate different implementations of the recovery performance measure based on center of pressure data. <b>Methods:</b> Recovery perform ...[more]

PMID: 33659894

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Project description:Degenerative cervical myelopathy (DCM) is a common aging condition caused by spinal cord compression. Individuals with DCM often presented with residual balance and functional impairments postoperatively. Perturbation-based balance training (PBT) has been shown to have positive effects on populations with neurological disorders but has yet to be investigated in DCM. The objective of this study was therefore to evaluate the effects of PBT on balance and functional performance in postoperative individuals with DCM. Fifteen postoperative individuals with DCM (DCM group) and 14 healthy adults (healthy control group) were recruited. The DCM group received a 4-weeks PBT using a perturbation treadmill. The outcome measures included mean velocity of center of pressure (COP) during quiet standing; center of mass (COM) variance and reaction time to balance perturbation during standing with forward and backward perturbation; gait speed during level ground walking; Timed Up and Go Test (TUG) and disability questionnaire scores including Visual Analog Scale, Neck Disability Index, and Lower Extremity Function of Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire. The assessments were conducted pre- and post-training postoperatively for the DCM group but only once for the healthy control group. Significant improvements were observed in the mean velocity of COP, COM variance, reaction time, gait speed, and TUG in the DCM group. Disability questionnaire scores were not significantly different after training in DCM group. For between-group comparisons, significant differences that were observed pre-training were not observed post-training. The 4-weeks PBT is a potential rehabilitation strategy for addressing balance and functional impairment in postoperative individuals with DCM. In addition, the post-training performance in the DCM group exhibited trends comparable to those of age-matched healthy controls. Furthermore, the training regimens offer a practical reference for future studies on populations with balance disorders. Future studies complemented with neurophysiological assessments could reveal more information of the underlying mechanisms of PBT.

Project description:BackgroundTreadmill training shows advantages in the specificity, amount, and intensity of gait and balance practice for the rehabilitation of stroke patients.ObjectiveTo investigate the feasibility and effectiveness of challenging treadmill speed-dependent gait and perturbation-induced balance training in chronic stroke patients with low ambulation ability.MethodsFor this randomized controlled trial (Chinese Clinical Trials.gov registration number ChiCTR-IOR-16009536) with blinded testers, we recruited 33 ambulatory stroke participants with restricted community ambulation capacity and randomly assigned them into two groups: the experimental group with 2 week treadmill speed-dependent gait training combined with 2 week treadmill perturbation-induced balance training (EXP) or the control group with traditional gait and balance training (CON). Various variables were recorded during EXP training, including the rating of perceived exertion, heart rate, causes of pauses, treadmill speed, and perturbation intensity. Outcome measures were examined before training and at 2 and 4 weeks after training. They included gait velocity during five-meter walk test at comfortable and fast speed and reactive balance ability in the compensatory stepping test as primary outcome measures, as well as dynamic balance ability (timed up-and-go test and 5 times sit-to-stand test) and balance confidence as secondary outcome measures.ResultsAll participants completed the study. The treadmill speed and perturbation intensity significantly increased across training sessions in the EXP group, and no adverse effects occurred. The normal and fast gait velocities showed significant time and group interaction effects. They significantly increased after 2 and 4 weeks of training in the EXP group (p < 0.05) but not in the CON group (p > 0.05). Likewise, dynamic balance ability measured using the timed up-and-go test at a fast speed significantly improved after 2 and 4 weeks of training in the EXP group (p < 0.05) but not in the CON group (p > 0.05), although without a significant time and group interaction effect. Surprisingly, the reactive balance ability did not show improvement after treatment in the EXP group (p > 0.05).ConclusionChallenging treadmill speed-dependent gait and treadmill perturbation-induced balance training is feasible and effective to improve ambulation function in chronic stroke patients with low ambulation ability.

Project description:BACKGROUND:A robotic exoskeleton device is an intelligent system designed to improve gait performance and quality of life for the wearer. Robotic technology has developed rapidly in recent years, and several robot-assisted gait devices were developed to enhance gait function and activities of daily living in elderly adults and patients with gait disorders. In this study, we investigated the effects of the Gait-enhancing Mechatronic System (GEMS), a new wearable robotic hip-assist device developed by Samsung Electronics Co, Ltd., Korea, on gait performance and foot pressure distribution in elderly adults. METHODS:Thirty elderly adults who had no neurological or musculoskeletal abnormalities affecting gait participated in this study. A three-dimensional (3D) motion capture system, surface electromyography and the F-Scan system were used to collect data on spatiotemporal gait parameters, muscle activity and foot pressure distribution under three conditions: free gait without robot assistance (FG), robot-assisted gait with zero torque (RAG-Z) and robot-assisted gait (RAG). RESULTS:We found increased gait speed, cadence, stride length and single support time in the RAG condition. Reduced rectus femoris and medial gastrocnemius muscle activity throughout the terminal stance phase and reduced effort of the medial gastrocnemius muscle throughout the pre-swing phase were also observed in the RAG condition. In addition, walking with the assistance of GEMS resulted in a significant increase in foot pressure distribution, specifically in maximum force and peak pressure of the total foot, medial masks, anterior masks and posterior masks. CONCLUSION:The results of the present study reveal that GEMS may present an alternative way of restoring age-related changes in gait such as gait instability with muscle weakness, reduced step force and lower foot pressure in elderly adults. In addition, GEMS improved gait performance by improving push-off power and walking speed and reducing muscle activity in the lower extremities. TRIAL REGISTRATION:NCT02843828 .

Dataset Information

Development of a Balance Recovery Performance Measure for Gait Perturbation Training Based on the Center of Pressure.

Publications

Development of a Balance Recovery Performance Measure for Gait Perturbation Training Based on the Center of Pressure.

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