Healthy, Stroke
Conditions
Keywords
EMG, EEG, Gait, Arm swing, Kinematics
Brief summary
The upper limbs play an essential role for safe and efficient walking in healthy persons and persons post-stroke. Nevertheless, in current post-stroke gait rehabilitation (research) the upper limbs are barely targeted. To address this gap, my project aims to investigate the selective motor control of the upper limbs during walking and the contribution of the cortical activity to the arm swing in independent walkers after stroke. To gain insight in the direct effects of stroke on the arm swing, the primary motor control of the arm swing will be evaluated by determining muscle synergies (i.e group of muscles working together as a task-specific functional unit). Additionally, the cortical activity (EEG-analysis) during walking of persons post-stroke will be compared to healthy controls and the relationship between stroke-induced changes in cortical activity and arm swing deviations will be assessed. Furthermore, I will evaluate whether improvements in cortical activity relate to improvements in primary motor control of the arm swing. This innovative project will be the first to investigate the direct coupling between the cortex and the muscle synergies in persons post-stroke during independent walking to investigate the arm swing. These fundamental insights in the primary motor control of the arm swing and the contribution of the cortical activity will allow to develop targeted interventions aiming to improve arm swing and as such optimize post-stroke gait rehabilitation. Research questions: 1. How can muscle synergies explain arm swing alterations in independent walkers after stroke? 2. How do stroke-induced changes in cortical activity relate to arm swing deviations in persons after stroke? 3. Are changes in primary motor control of the upper limb during walking related to normalization of brain activity in independent walkers after stroke?
Interventions
Participants have to walk without holding handrails and without bodyweight support for at least 200 gait cycles. They are asked to walk at comfortable walking speed while watching forward to a screen without virtual reality projection. Arm should be next to the body to allow arm swing if possible.
Sponsors
University Ghent
VU University of Amsterdam
Vrije Universiteit Brussel
University Hospital, Ghent
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 70 Years
Healthy volunteers
Yes
Inclusion criteria
Stroke Inclusion Criteria: * First-ever and cerebral stroke * Able to walk at least 10 minutes (FAC ≥ 3) * Presence of upper limb paresis (NIHSS item 5a/b \> 0)
Exclusion criteria
* Other neurological disorders Healthy controls Inclusion criteria: * Older than 18 years * Able to walk at least 10 minutes Exlusion criteria: * Pregnancy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of muscle synergies | Single point of assessment at inclusion | The number of muscle synergies needed to account for 90% variance in muscle activity measured by surface EMG during walking in stroke survivors compared to healthy controls. Following muscles will be examined: * tibialis anterior, * gastrocnemius lateralis * soleus * vastus medialis * vastus lateralis * rectus femoris * biceps femoris * gluteus medius * erector spinae * latissimus dorsi * anterior deltoid * posterior deltoid * biceps brachii * triceps brachii |
| Brain symmetry index (BSI) | Single point of assessment at inclusion | The amount of cortical lateralization during walking in stroke survivors compared to healthy controls. The score ranges from -1 to +1 with BSI = 0 reprenting perfect symmetry. Positive values represent higher power in the right hemishere compared to the left hemisphere, vice versa for negative values. For left side lesions, BSI was multiplied by -1. |
| Weight of muscle synergies | Single point of assessment at inclusion | The number or distribution of muscle weightings within a synergy during walking in stroke survivors compared to healthy controls. The distribution of muscle activation averages over one gait cycle measured by surface EMG of following muscles: * tibialis anterior, * gastrocnemius lateralis * soleus * vastus medialis * vastus lateralis * rectus femoris * biceps femoris * gluteus medius * erector spinae * latissimus dorsi * anterior deltoid * posterior deltoid * biceps brachii * triceps brachii |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Upper limb kinematics | Single point of assessment at inclusion | Movements of the upper limb during walking measured by 3D kinematics and expressed as angles (°) |
| Cortico-synergy coherence | Single point of assessment at inclusion | The amount of coherence (i.e. phase locking) between the muscle synergies and cortical activity during walking in stroke survivors compared to healthy controls. Higher values (0-1) indicate a better linear association. |
Other
| Measure | Time frame | Description |
|---|---|---|
| National Institutes of Health Stroke Scale (NIHSS) | Single point of assessment at inclusion (only for stroke survivors) | Quantifies the impairment caused by a stroke. The NIHSS is composed of 11 items, each of which scores a specific ability between a 0 and 4. For each item, a score of 0 typically indicates normal function in that specific ability, while a higher score is indicative of some level of impairment. The highest score is 42. |
| Fugl-Meyer assesment - Upper limbs | Single point of assessment at inclusion (only for stroke survivors) | Assesses specifc motor impairments of the upper limbs of stroke survivors. The Fugl-Meyer Assessment scale is an ordinal scale that has 3 points for each item. A zero score is given for the item if the subject cannot do the task. A score of 1 is given when the task is performed partially and a score of 2 is given when the task is performed fully. However, reflex activity is measured using 2 points only, with a score of 0 or 2 for absence and presence of reflex respectively. |
| 10 Meter Walking Test | Single point of assessment at inclusion (only for stroke survivors) | Examins the walking capacity of a stroke survivor by measuring how long it takes to walk a distance of 10 meters (in seconds). |
| Tardieu scale | Single point of assessment at inclusion (only for stroke survivors) | Quantifies spasticity by assessing the muscle's response (0-5) to different stretch velocities (V1, V2 or V3) and by determining the spasticity angle (R1 or R2). |
| Fugl-Meyer assesment - Lower limbs | Single point of assessment at inclusion (only for stroke survivors) | Assesses specifc motor impairments of the lower limbs of stroke survivors. The Fugl-Meyer Assessment scale is an ordinal scale that has 3 points for each item. A zero score is given for the item if the subject cannot do the task. A score of 1 is given when the task is performed partially and a score of 2 is given when the task is performed fully. However, reflex activity is measured using 2 points only, with a score of 0 or 2 for absence and presence of reflex respectively. |
Countries
Belgium
Contacts
Primary ContactArne Defour, Msc.
Backup ContactAnke Van Bladel, PhD
Outcome results
None listed