Biofeedback, Gait, Hemiplegic, Gait Training, Hemiparesis, Stroke
Conditions
Keywords
stroke; hemiparesis; gait; rehabilitation; biofeedback
Brief summary
Single-blinded controlled clinical trial. Biofeedback training courses based on target biomechanical gait parameters are being studied. For targeted biofeedback training, various biomechanical parameters are used: parameters of the gait cycle, EMG or kinematics of joint movements. The number of sessions is 8-11 for each patient. Clinical gain analysis is carried out before and after a course of training. Changes in biomechanical parameters that occurred at the end of the training course are assessed in comparison with those before training, and both statuses (before and after training) are compared with similar gait parameters in a group of healthy adults.
Detailed description
Walking function disorders are typical for patients after cerebral stroke. A cerebral stroke normally affects one hemisphere and causes a hemiplegic syndrome. The gait of hemiplegic patients has very specific features: reduced walking speed, increased double stance phase, and reduced amplitude of movement in the leg joints. Biofeedback technology (BFB) is currently considered effective and promising for training walking function, including in patients after cerebral stroke. The technology is based on capturing a physiological parameter and presenting it to the patient in a perceivable form, so that the subject can understand its changes and respond appropriately. BFB can be used independently or as part of rehabilitation therapy. Nevertheless, efficiency, as noted by most authors, remains the subject of discussion. This is due to the fact, that at the previous stage of development of these systems, there was no technical capability to use the specific biomechanical gait parameters as targets for training. Therefore, more general parameters-such as walking speed, step frequency, etc.-were and are still used. This circumstance is attributable to the very nature of the main biomechanical gait parameters, which require special means of recording. One of the significant technical difficulties in BFB implementation is the need for accurate and fast registration of the gait parameters in real-time to use them for biofeedback. At the same time, the use of portable sensors for BFB training goals can represent a certain solution to technical problems. In recent years, owing to its important advantages, wearable IMU technology (systems using inertial measurement units) has been widely applied for capturing biomechanical gait parameters. Investigators used a system that was originally developed with our participation for targeted training based on biofeedback according to the biomechanical parameters of gait. The use of inertial technology and artificial intelligence technology has made it possible to use biomechanical parameters of gait (time and general gait parameters, EMG and kinematics of leg's joints) for biofeedback in a very low-cost and practically convenient way. Biofeedback training courses based on target biomechanical gait parameters are being studied. For targeted biofeedback training, various biomechanical parameters are used: parameters of the gait cycle, EMG or kinematics of joint movements. The number of sessions is 8-11 for each patient. Clinical gait analysis is carried out before and after a course of training. Changes in biomechanical parameters that occurred at the end of the training course are assessed in comparison with those before training, and both statuses (before and after training) are compared with similar gait parameters in a group of healthy adults. Stroke patients participated in the study in Federal Center of Cerebrovascular Pathology and Stroke FMBA in Moscow, Russia. The study was approved by a local ethic committee and followed principles of the Declaration of Helsinki. Single-blinded controlled clinical trial. The study involved stroke patients with hemiparesis (no more than 3 points on a scale Rankin). Experimental groups are determined by the target training parameter (time and general gait parameters, EMG and kinematics of leg's joints). One target parameter is using for one group. The number of sessions is 8-11 for each patient during three weeks of hospital stay. The duration of each session for each patient on each training day varies according to his well-being and current exercise tolerance, but does not exceed 30 minutes of training in one session. . Changes in biomechanical parameters that occurred at the end of the training course are assessed in comparison with those before training, and both statuses (before and after training) are compared with similar gait parameters in a group of healthy adults.
Interventions
OTHERBiofeedback gait training by biomechanical target parameter
The patient walks using a treadmill at a comfortable speed until he gets tired. The patient is instructed that when performing a virtual task (in a virtual environment on the screen), his walking will be harmonized (without informing him on what parameter). If it fails to cope, then the zones of permissible changes (on the information columns) will expand, and the virtual task will signal its incomplete completion.
Sponsors
Federal Center of Cerebrovascular Pathology and Stroke, Russian Federation Ministry of Health
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Masking description
Clinicians involved in the measurements and researchers that worked with data results did not know which group each patient was in.
Intervention model description
Parallel-group, single-blinded controlled clinical trial.
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
Yes
Inclusion criteria
* Age - \< 75 years; * type of stroke - ischemic; * structure of the lesion - cerebral hemisphere; * disease type - primary; * functional ability to walk for at least 5 minutes without using external means of support; * absence of reduced higher mental functions, * sensorimotor aphasia, * muscle tone in the limbs above 2 points according to Ashworth (Modified Ashworth Scale); * no history of orthopedic and neurological pathology; absence of pronounced pain syndrome
Exclusion criteria
* Signs of orthostatic hypotension during training, * patient desire to withdraw from the study, * neurological deficit worsening.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| EMG amplitude of Hamstring muscle | Change from baseline at 3 weeks | envelope EMG amplitude of the hamstring muscle at mkV |
| Knee joint amplitude | Change from baseline at 3 weeks | knee joint range of motion at degree |
| Ankle joint amplitude | Change from baseline at 3 weeks | ankle joint range of motion at degree |
| EMG amplitude of tibialis anterior muscle | Change from baseline at 3 weeks | envelope EMG amplitude of the tibialis anterior muscle at mkV |
| EMG amplitude of gastrocnemus muscle | Change from baseline at 3 weeks | envelope EMG amplitude of the gastrocnemus muscle at mkV |
| EMG amplitude of quadriceps femoris muscle | Change from baseline at 3 weeks | envelope EMG amplitude of the quadriceps femoris muscle at mkV |
| Gait cycle | Change from baseline at 3 weeks | gait cycle duration - at seconds; |
| Foot clearance | Change from baseline at 3 weeks | foot clearance at centimeters; |
| Speed of walking | Change from baseline at 3 weeks | walking speed - km/h; |
| Stance phase | Change from baseline at 3 weeks | stance phase at percent of gait cycle duration, |
| Single support phase | Change from baseline at 3 weeks | single support phase at percent of gait cycle duration |
| Hip joint amplitude | Change from baseline at 3 weeks | hip joint range of motion at degree |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Muscle strength | Change from baseline at 3 weeks | Muscle strength was assessed using the MRC (Medical Research Council Weakness Scale). MRC is a commonly used scale for assessing muscle strength from Grade 5 (normal) to Grade 0 (no visible contraction). Paresis is defined as light at compliance with strength 4 points, moderate - 3 points, pronounced - 2 points, rough - 1 point and with - 0 points. |
| Activities of Daily Living | Change from baseline at 3 weeks | The Barthel Index for Activities of Daily Living where 0 is no activity and score 100 is normal activity. |
| The Timed Up and Go Test | Change from baseline at 3 weeks | Mobility is assessed based on time to complete the test: where \< 10 seconds = normal, \< 30 seconds = walking and balance problems; cannot walk outside alone; requires walking aid. |
| The Medical Research Council Weakness Scale | Change from baseline at 3 weeks | The Medical Research Council Weakness Scale where grades: 0 is paralysis;5 - is normal. |
| Modified Rankin Scale for Neurologic Disability | Change from baseline at 3 weeks | Measures the degree of disability or dependence in the daily activities of people who have suffered a stroke or other causes of neurological disability and ranged from 0 (no symptoms) to +6 - dead. |
Countries
Russia
Contacts
Primary ContactDmitry V Skvortsov, PhD
Backup ContactSergey N Kaurkin, PhD
Outcome results
None listed