Reliability of two methods for identifying the postural phase of gait initiation in healthy and post-stroke subjects

This study aims to compare two methods of assessing the postural phase of gait initiation as to intrasession reliability, in healthy and post-stroke subjects. As a secondary aim, this study aims to analyse anticipatory postural adjustments during gait initiation based on the centre of pressure (CoP) displacements in post-stroke participants. The CoP signal was acquired during gait initiation in fifteen post-stroke subjects and twenty-three healthy controls. Postural phase was identified through a baseline-based method and a maximal displacement based method. In both healthy and post-stroke participants higher intra-class correlation coefficient and lower coefficient of variation values were obtained with the baseline-based method when compared to the maximal displacement based method. Post-stroke participants presented decreased CoP displacement backward and toward the first swing limb compared to controls when the baseline-based method was used. With the maximal displacement based method, there were differences between groups only regarding backward CoP displacement. Postural phase duration in medial-lateral direction was also increased in post-stroke participants when using the maximal displacement based method. The findings obtained indicate that the baseline-based method is more reliable detecting the onset of gait initiation in both groups, while the maximal displacement based method presents greater sensitivity for post-stroke participants

A case study of product usability of a pelvic device used by children with neuromotor impairments

On assistive technology targeted for people with activity limitations and participation, usability issues becomes an essential tool to ensure that the product has the appropriate ergonomics characteristics, in other words, ensure that it fits the specific user´s needs. The aim of this study was to analyze the usability of an adaptive seating device for children with neuromotor impairments, by using kinematic indicators of the reaching movement. The study sample consisted of 13 children with associated neurologic conditions. The tests were developed by using a wooden bench height adjustable, integrated with the adaptive seating device under study, and a system to capture three-dimensional image, called Qualisys Track Manager. The following reaching kinematics variables were measured: maximum reaching velocity, movement duration, index of curvature, and unit movements. It was found that the use of the adaptive seating device had a positive impact on upper limb function in children with neuromotor impairments. It was also noticed an improvement in the reaching movement kinematics, which was statistical significant for the index of curvature and unit movements. As main conclusions, it is possible to point out some positive effects that the product under study seems to have on users' movements, such as the improved movement quality of the upper limb, which could mean a better postural adjustments and higher trunk postural control. By identifying new measures of usability in terms of effectiveness and efficiency for the analyzeddevice, the results obtained may serve also as performance indicators, providing new data that may help to improve the product and eventually modifying it, in order to turn it more compatible with the needs of the considered target population

Towards an efficient and robust foot classification from pedobarographic images

O documento em anexo encontra-se na versão post-print (versão corrigida pelo editor).This paper presents a new computational framework for automatic foot classification from digital plantar pressure images. It classifies the foot as left or right and simultaneously calculates two well-known footprint indices: the Cavanagh's arch index and the modified arch index. The accuracy of the framework was evaluated using a set of plantar pressure images from two common pedobarographic devices. The results were outstanding, since all feet under analysis were correctly classified as left or right and no significant differences were observed between the footprint indices calculated using the computational solution and the traditional manual method. The robustness of the proposed framework to arbitrary foot orientations and to the acquisition device was also tested and confirmed

Spatio-temporal alignment of pedobarographic image sequences

O documento em anexo encontra-se na versão post-print (versão corrigida pelo editor).This paper presents a methodology to align plantar pressure image sequences simultaneously in time and space. The spatial position and orientation of a foot in a sequence are changed to match the foot represented in a second sequence. Simultaneously with the spatial alignment, the temporal scale of the first sequence is transformed with the aim of synchronizing the two input footsteps. Consequently, the spatial correspondence of the foot regions along the sequences as well as the temporal synchronizing is automatically attained, making the study easier and more straightforward. In terms of spatial alignment, the methodology can use one of four possible geometric transformation models: rigid, similarity, affine or projective. In the temporal alignment, a polynomial transformation up to the 4th degree can be adopted in order to model linear and curved time behaviors. Suitable geometric and temporal transformations are found by minimizing the mean squared error (MSE) between the input sequences. The methodology was tested on a set of real image sequences acquired from a common pedobarographic device. When used in experimental cases generated by applying geometric and temporal control transformations, the methodology revealed high accuracy. Additionally, the intra-subject alignment tests from real plantar pressure image sequences showed that the curved temporal models produced better MSE results (p<0.001) than the linear temporal model. This paper represents an important step forward in the alignment of pedobarographic image data, since previous methods can only be applied on static images

Influence of an unstable shoe on compensatory postural adjustments: An experimental evaluation

This study attempted to evaluate the influence of using an unstable shoe in muscle recruitment strategies and center of pressure (CoP) displacement after the application of an external perturbation. Fourteen healthy female subjects participated in this study. The electromyographic activity of medial gastrocnemius, tibialis anterior, rectus femoris, biceps femoris, rectus abdominis and erector spinae muscles and the kinetic values to calculate the CoP were collected and analyzed after the application of an external perturbation with the subject in standing position, with no shoes and using unstable footwear. The results showed increased in medial gastrocnemius activity during the first compensatory postural adjustments and late compensatory postural adjustments when using an unstable shoe. There were no differences in standard deviation and maximum peak of anteroposterior displacement of CoP between measurements. From the experimental findings, one can conclude that the use of an unstable shoe leads to an increase in gastrocnemius activity with no increase in CoP displacement following an unexpected external perturbation

Interlimb coordination during the stance phase of gait in subjects with stroke

To analyze the relation between contralesional and ipsilesional limbs in subjects with stroke during step-to-step transition of walking. Observational, transversal, analytical study with a convenience sample. Physical medicine and rehabilitation clinic. Participants: Subjects (nZ16) with poststroke hemiparesis with the ability to walk independently and healthy controls (nZ22). Interventions: Not applicable. Main Outcome Measures: Bilateral lower limbs electromyographic activity of the soleus (SOL), gastrocnemius medialis, tibialis anterior, biceps femoris, rectus femoris, and vastus medialis (VM) muscles and the ground reaction force were analyzed during double-support and terminal stance phases of gait. The propulsive impulse of the contralesional trailing limb was negatively correlated with the braking impulse of the leading limb during double support (rZ .639, PZ.01). A moderate functional relation was observed between thigh muscles (rZ .529, PZ.035), and a strong and moderate dysfunctional relation was found between the plantar flexors of the ipsilesional limb and the vastus medialis of the contralesional limb, respectively (SOL-VM, rZ .80, P<.001; gastrocnemius medialis-VM, rZ .655, PZ.002). Also, a functional moderate negative correlation was found between the SOL and rectus femoris muscles of the ipsilesional limb during terminal stance and between the SOL (rZ .506, PZ.046) and VM (rZ .518, PZ.04) muscles of the contralesional limb during loading response, respectively. The trailing limb relative impulse contribution of the contralesional limb was lower than the ipsilesional limb of subjects with stroke (PZ.02) and lower than the relative impulse contribution of the healthy limb (PZ.008) during double support. The findings obtained suggest that the lower performance of the contralesional limb in forward propulsion during gait is related not only to contralateral supraspinal damage but also to a dysfunctional influence of the ipsilesional limb

Análise da sequência do movimento de levantar/sentar, em indivíduos pós AVE: Estudo da relação da activação dos músculos vasto medial oblíquo e vasto lateral

O objectivo deste estudo foi comparar o rácio dos músculos Vasto Medial Oblíquo (VMO) e Vasto Lateral (VL), na sequência de movimento de levantar e sentar, em indivíduos sem patologia e em indivíduos com Acidente Vascular Encefálico (AVE). Pretendeu-se também verificar a sequência de activação de alguns músculos do membro inferior na sequência de movimento de levantar. Verificou-se existir diferenças significativas para afirmar que, no movimento de levantar, indivíduos com sequelas de AVE apresentam menor rácio VMO/VL no membro predominantemente atingido em relação aos indivíduos sem patologia. Diferentes sequências de activação muscular durante o movimento de levantar foram observadas.The purpose of this study was to compare the ratio of the Vastus medialis oblique (VMO) and vastus lateralis (VL), in sit-to-stand movement in subjects without pathology and in individuals with stroke. The article tries to verify the sequence of activation of some muscles of the lower limb during standing up. There are significant differences to argue that, in standing up movement, subjects with sequelae of stroke have a lower ratio VMO / VL in predominantly affected limb compared to subjects without pathology. Different sequences of muscle activation during standing up movement were observed

Postural control during turn on the light task assisted by functional electrical stimulation in post stroke subjects

Postural control mechanisms have a determinant role in reaching tasks and are typically impaired in post-stroke patients. Functional electrical stimulation (FES) has been demonstrated to be a promising therapy for improving upper limb (UL) function. However, according to our knowledge, no study has evaluated FES infuence on postural control. This study aims to evaluate the infuence of FES UL assistance, during turning on the light task, in the related postural control mechanisms. An observational study involving ten post-stroke subjects with UL dysfunction was performed. Early and anticipatory postural adjustments (EPAs and APAs, respectively), the weight shift, the center of pressure and the center of mass (CoM) displacement were analyzed during the turning on the light task with and without the FES assistance. FES parameters were adjusted to improve UL function according to a consensus between physiotherapists’ and patients’ perspectives. The ANOVA repeated measures, Paired sample t and McNemar tests were used to compare postural control between the assisted and non-assisted conditions. When the task was assisted by FES, the number of participants that presented APAs increased (p= 0.031). UL FES assistance during turning on the light task can improve postural control in neurological patients with UL impairments.info:eu-repo/semantics/publishedVersio

Usability of functional electrical stimulation in upper limb rehabilitation in post-stroke patients: A narrative review

Stroke leads to significant impairment in upper limb (UL) function. The goal of rehabilitation is the reestablishment of pre-stroke motor stroke skills by stimulating neuroplasticity. Among several rehabilitation approaches, functional electrical stimulation (FES) is highlighted in stroke rehabilitation guidelines as a supplementary therapy alongside the standard care modalities. The aim of this study is to present a comprehensive review regarding the usability of FES in post-stroke UL rehabilitation. Specifically, the factors related to UL rehabilitation that should be considered in FES usability, as well a critical review of the outcomes used to assess FES usability, are presented. This review reinforces the FES as a promising tool to induce neuroplastic modifications in post-stroke rehabilitation by enabling the possibility of delivering intensive periods of treatment with comparatively less demand on human resources. However, the lack of studies evaluating FES usability through motor control outcomes, specifically movement quality indicators, combined with user satisfaction limits the definition of FES optimal therapeutical window for different UL functional tasks. FES systems capable of integrating postural control muscles involving other anatomic regions, such as the trunk, during reaching tasks are required to improve UL function in post-stroke patients.info:eu-repo/semantics/publishedVersio

Ankle antagonist coactivation in the double-support phase of walking: stroke vs. healthy subjects

Lesions at ipsilateral systems related to postural control atipsilesional side, may justify the lower performance of stroke subjects duringwalking. Purpose: To analyse bilateral ankle antagonist coactivation duringdouble-support in stroke subjects. Methods: Sixteen (8 females; 8 males)subjects with a first isquemic stroke, and twenty two controls (12 females; 10males) participated in this study. The double support phase was assessedthrough ground reaction forces and electromyography of ankle muscles wasassessed in both limbs. Results: Ipsilesional limb presented statisticalsignificant differences from control when assuming specific roles during doublesupport, being the tibialis anterior and soleus pair the one in which this atypicalbehavior was more pronounced. Conclusion: The ipsilesional limb presents adysfunctional behavior when a higher postural control activity was demanded