Objective: To determine whether external feedback to promote symmetrical weight distribution during standing and walking would improve gait performance and balance in people with stroke.
Setting: Rehabilitation unit and physical therapy department.
Subjects: Thirty-five individuals with stroke (mean (SD) age = 53.0 (9.3) years) were randomly assigned to an experimental (n = 17) or control group (n = 18). Time post stroke was less than six months for most subjects (n = 27, 77%).
Interventions: Subjects participated in 15 rehabilitation sessions including 30 minutes of gait retraining per session. During gait retraining, the experimental group used an insole shoe wedge and sensors set-up (I-ShoWS) while the control group received a conventional programme. The I-ShoWS set-up consisted of a wedge insole and a footswitch for the non-paretic leg and a pressure sensor on the paretic leg.
Outcome measures: Gait speed, step length and single support time asymmetry ratio, balance and amount of load on paretic leg during stance were evaluated twice: one day before and after training.
Results: The experimental group demonstrated significant increase in standing and gait symmetry compared with the control group (P < 0.05). They demonstrated 3 times greater improvement in gait speed than the control group (P = 0.02). Balance improvement was significantly greater for the experimental than for the control group (P < 0.05).
Conclusion: Gait retraining using the I-ShoWS set-up was more effective in restoration of gait speed, standing and walking symmetry and balance than a conventional treatment programme. These results indicate the benefit of implementing feedback during gait retraining.
Get full access to this article
View all access options for this article.
References
1.
JørgensenHSNakayamaHRaaschouHOOlsenTS. Recovery of walking function in stroke patients: The Copenhagen Stroke Study. Arch Phys Med Rehabil 1995; 76: 27–32.
2.
StatesRAPappasESalemY. Overground physical therapy gait training for chronic stroke patients with mobility deficits. Cochrane Database Syst Rev 2009; (3): CD006075.
3.
GehlsenGMWhaleyMH. Falls in the elderly: Part I, Gait. Arch Phys Med Rehabil 1990; 71: 735–38.
4.
TitianovaEBTarkkaIM. Asymmetry in walking performance and postural sway in patients with chronic unilateral cerebral infarction. J Rehabil Res Dev 1995; 32: 236–44.
5.
ChengPTLiawMYWongMKTangFTLeeMYLinPS. The sit-to-stand movement in stroke patients and its correlation with falling. Arch Phys Med Rehabil 1998; 79: 1043–46.
6.
PerryJGarrettMGronleyJKMulroySJ. Classification of walking handicap in the stroke population. Stroke 1995; 26: 982–89.
7.
LordSEMcPhersonKMcNaughtonHKRochesterLWeatherallM. Community ambulation after stroke: how important and obtainable is it and what measures appear predictive?Arch Phys Med Rehabil 2004; 85: 234–39.
8.
DobkinBH. Strategies for stroke rehabilitation. Lancet Neurol 2004; 3: 528–36.
9.
De QuervainIASimonSRLeurgansSPeaseWSMcAllisterD. Gait pattern in the early recovery period after stroke. J Bone Joint Surg Am 1996; 78: 1506–14.
10.
BalasubramanianCKBowdenMGNeptuneRRKautzSA. Relationship between step length asymmetry and walking performance in subjects with chronic hemiparesis. Arch Phys Med Rehabil 2007; 88: 43–9.
11.
van VlietPMWulfG. Extrinsic feedback for motor learning after stroke: what is the evidence?Disabil Rehabil 2006; 28: 831–40.
12.
RodriguezGMAruinAS. The effect of shoe wedges and lifts on symmetry of stance and weight bearing in hemiparetic individuals. Arch Phys Med Rehabil 2002; 83: 478–82.
13.
AruinASHankeTChaudhuriGHarveyRRaoN. Compelled weightbearing in persons with hemiparesis following stroke: the effect of a lift insert and goal-directed balance exercise. J Rehabil Res Dev 2000; 37: 65–72.
14.
LauferYDicksteinRResnikSMarcovitzE. Weight-bearing shifts of hemiparetic and healthy adults upon stepping on stairs of various heights. Clin Rehabil 2000; 14: 125–29.
15.
FowlerVCarrJ. Auditory feedback: effects on vertical force production during standing up following stroke. Int J Rehabil Res 1996; 19: 265–69.
16.
CelikCAkselJKaraoglanB. Comparison of the Orpington Prognostic Scale (OPS) and the National Institutes of Health Stroke Scale (NIHSS) for the prediction of the functional status of patients with stroke. Disabil Rehabil 2006; 28: 609–12.
17.
PierrynowskiMRSmithSB. Rear foot inversion/eversion during gait relative to the subtalar joint neutral position. Foot Ankle Int 1996; 17: 406–12.
18.
HsuALTangPFJanMH. Analysis of impairments influencing gait velocity and asymmetry of hemiplegic patients after mild to moderate stroke. Arch Phys Med Rehabil 2003; 84: 1185–93.
19.
BergKWood-DauphineeSWilliamJIGraytoD. Measuring balance in the elderly: Preliminary development of an instrument. Physiother Can 1989; 41: 304–11.
20.
PodsiadloDRichardsonS. The timed ‘Up & Go’: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991; 39: 142–48.
21.
BlumLKorner-BitenskyN. Usefulness of the Berg Balance Scale in stroke rehabilitation: a systematic review. Phys Ther 2008; 88: 559–66.
22.
Bogle ThorbahnLDNewtonRA. Use of the Berg Balance Test to predict falls in elderly persons. Phys Ther 1996; 76: 576–83.
23.
Shumway-CookABrauerSWoollacottM. Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. Phys Ther 2000; 80: 896–903.
24.
OsborneJ. Notes on the use of data transformations. Pract Assess Res Eval 2002; 8: 6–6.
25.
WinsteinCJMeriansASSullivanKJ. Motor learning after unilateral brain damage. Neuropsychologia 1999; 37: 975–87.
26.
BoydLAWinsteinCJ. Implicit motor-sequence learning in humans following unilateral stroke: the impact of practice and explicit knowledge. Neurosci Lett 2001; 298: 65–9.
27.
Van PeppenRPKortsmitMLindemanEKwakkelG. Effects of visual feedback therapy on postural control in bilateral standing after stroke: a systematic review. J Rehabil Med 2006; 38: 3–9.
28.
GoldiePAMatyasTAEvansOMGaleaMBachTM. Maximum voluntary weight-bearing by the affected and unaffected legs in standing following stroke. Clin Biomech (Bristol, Avon) 1996; 11: 333–42.
29.
KimCMEngJJ. Symmetry in vertical ground reaction force is accompanied by symmetry in temporal but not distance variables of gait in persons with stroke. Gait Posture 2003; 18: 23–8.
30.
BohannonRWHortonMGWikholmJB. Importance of four variables of walking to patients with stroke. Int J Rehabil Res 1991; 14: 246–50.
31.
DicksteinR. Rehabilitation of gait speed after stroke: a critical review of intervention approaches. Neurorehabil Neural Repair 2008; 22: 649–60.
32.
StevensonTJ. Detecting change in patients with stroke using the Berg Balance Scale. Aust J Physiother 2001; 47: 29–38.
33.
ChengPTWuSHLiawMYWongAMKTangFT. Symmetrical body-weight distribution training in stroke patients and its effect on fall prevention. Arch Phys Med Rehabil 2001; 82: 1650–54.
34.
de HaartMGeurtsACDaultMCNienhuisBDuysensJ. Restoration of weight-shifting capacity in patients with postacute stroke: a rehabilitation cohort study. Arch Phys Med Rehabil 2005; 86: 755–62.
35.
SullivanKJKnowltonBJDobkinBH. Step training with body weight support: effect of treadmill speed and practice paradigms on poststroke locomotor recovery. Arch Phys Med Rehabil 2002; 83: 683–91.
