Stepping strategies used by post-stroke individuals to maintain margins of stability during walking

AbstractBackgroundPeople recovering from a stroke are less stable during walking compared to able-bodied controls. The purpose of this study was to examine whether and how post-stroke individuals adapt their steady-state gait pattern to maintain or increase their margins of stability during walking, and to examine how these strategies differ from strategies employed by able-bodied people.MethodsTen post-stroke individuals and 9 age-matched able-bodied individuals walked on the Computer Assisted Rehabilitation Environment. Medio-lateral translations of the walking surface were imposed to manipulate gait stability. To provoke gait adaptations, a gait adaptability task was used, in which subjects occasionally had to hit a virtual target with their knees. We measured medio-lateral and backward margins of stability, and the associated gait parameters walking speed, step length, step frequency, and step width.FindingsPost-stroke participants showed similar medio-lateral margins of stability as able-bodied people in all conditions. This was accomplished by a larger step width and a relatively high step frequency. Post-stroke participants walked overall slower and decreased walking speed and step length even further in response to both manipulations compared to able-bodied participants, resulting in a tendency towards an overall smaller backward margins of stability, and a significantly smaller backward margin of stability during the gait adaptability task.InterpretationPost-stroke individuals have more difficulties regulating their walking speed, and the underlying parameters step frequency and step length, compared to able-bodied controls. These quantities are important in regulating the size of the backward margin of stability when walking in complex environments

Introducing a quality label for ‘Validated Serious Games’ in healthcare

Background and aims: Serious games are praised for their attractive and motivating nature, with promising reports about their effectiveness in healthcare. Yet, although development of medical serious games is booming, only few are successfully implemented in clinical practice, due to quality issues and lack of transparency about relevance and scientific validity. Therefore, a transparent quality label for medical serious games was developed to help developers showcase their games’ strengths and scientific validity, while simultaneously assisting healthcare specialists distinguishing high-quality from low-quality games. Methods: The quality label is based on a 5-star rating system. where higher numbers of stars represent higher quality games. Applications are made through an application form, divided in five categories (i.e. game description, rationale, functionality, validity and data safety) and reviewed by serious game specialists from various backgrounds. Evaluation criteria are based on an established framework and range from simple to hard-to-achieve, in an incremental way. Results: Out of fourteen applications, twelve have been awarded: three entries met the minimal requirements (i.e. clear game characteristics; safe data storage and plausible working mechanism), while three games received a second star (i.e. face validity). Three-star (i.e. user tests and involvement of relevant experts) and four-star ratings (i.e. concurrent validity) were awarded to two applications each. Two games were awarded the highest rating (i.e. peer-reviewed publication of effectiveness). Conclusions: Serious games for healthcare are potentially useful, but often lack proof of effectiveness and validity, hampering implementation. A quality label was successfully introduced to stimulate production of well-developed, scientifically supported games and aid policymakers in their choices

How to Systematically Assess Serious Games Applied to Health Care

The usefulness and effectiveness of specific serious games in the medical domain is often unclear. This is caused by a lack of supporting evidence on validity of individual games, as well as a lack of publicly available information. Moreover, insufficient understanding of design principles among the individuals and institutions that develop or apply a medical serious game compromises their use. This article provides the first consensus-based framework for the assessment of specific medical serious games. The framework provides 62 items in 5 main themes, aimed at assessing a serious game's rationale, functionality, validity, and data safety. This will allow caregivers and educators to make balanced choices when applying a serious game for healthcare purposes. Furthermore, the framework provides game manufacturers with standards for the development of new, valid serious game

How to systematically assess serious games applied to health care

The usefulness and effectiveness of specific serious games in the medical domain is often unclear. This is caused by a lack of supporting evidence on validity of individual games, as well as a lack of publicly available information. Moreover, insufficient understanding of design principles among the individuals and institutions that develop or apply a medical serious game compromises their use. This article provides the first consensus-based framework for the assessment of specific medical serious games. The framework provides 62 items in 5 main themes, aimed at assessing a serious game's rationale, functionality, validity, and data safety. This will allow caregivers and educators to make balanced choices when applying a serious game for healthcare purposes. Furthermore, the framework provides game manufacturers with standards for the development of new, valid serious games

Walking in an Unstable Environment:Strategies Used by Transtibial Amputees to Prevent Falling During Gait

<p>Objective: To investigate which strategies transtibial amputees use to cope with challenges of gait stability and gait adaptability, and how these strategies differ from strategies used by able-bodied controls.</p><p>Design: Cross-sectional study.</p><p>Setting: An instrumented treadmill mounted onto a 6 degrees-of-freedom motion platform in combination with a virtual environment. Participants: Transtibial amputees (n=10) and able-bodied controls (n=9).</p><p>Interventions: Mediolateral (ML) translations of the walking surface were imposed to manipulate gait stability. To provoke an adaptive gait pattern, a gait adaptability task was used in which subjects had to hit virtual targets with markers guided by their knees.</p><p>Main Outcome Measures: Walking speed, step length, step frequency, step width, and selected measures of gait stability (short-term Lyapunov exponents and backward and ML margins of stability [MoS]).</p><p>Results: Amputees walked slower than able-bodied people, with a lower step frequency and wider steps. This resulted in a larger ML MoS but a smaller backward MoS for amputees. In response to the balance perturbation, both groups decreased step length and increased step frequency and step width. Walking speed did not change significantly in response to the perturbation. These adaptations induced an increase in ML and backward MoS. To perform the gait adaptability task, both groups decreased step length and increased step width, but did not change step frequency and walking speed. ML and backward MoS were maintained in both groups.</p><p>Conclusions: Transtibial amputees have the capacity to use the same strategies to deal with challenges of gait stability and adaptability, to the same extent as able-bodied people. (C) 2013 by the American Congress of Rehabilitation Medicine</p>

Speeding up or slowing down?: Gait adaptations to preserve gait stability in response to balance perturbations

0.01) direction. In conclusion, not a lower walking speed, but a combination of decreased step length and increased step frequency and step width seems to be the strategy of choice to cope with medio-lateral balance perturbations, which increases MoS and thus decreases the risk of falling