Optimizing Gait Rehabilitation After Stroke

University Hospital, Ghent93 enrolled

Overview

Following a cerebrovascular accident (CVA, also known as a stroke), hemiparesis occurs on the side opposite to the brain injury. This can lead to problems with walking and balance, as well as with arm movements whilst walking. The arm swing serves several important functions whilst walking, such as improving your balance and energy efficiency, and a good arm swing helps to reduce the likelihood of falling if you lose your balance. That is why regaining the ability to walk independently with the best possible arm swing is a key goal during rehabilitation for people who have had a stroke. This ensures that the risk of falling is minimised and that people can resume their daily lives as effectively as possible. The aim of this study is to gain a better understanding of the abnormalities in arm swing whilst walking in people who have had a stroke, and how we can influence them. To identify these abnormalities, we use surface electromyography, a painless technique that allows us to measure muscle activity whilst walking. To do this, we attach sensors to the muscles whose activity we wish to record. During this study, we are measuring both people who have had a stroke and healthy adults, in order to detect the effects of a stroke on this muscle activity. The data from the healthy adults will be used to investigate whether we observe different muscle activity in people who have had a stroke.

Study Type

INTERVENTIONAL

Allocation

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Stroke Gait Rehabilitation

Eligibility

Sex: ALLMin age: 18 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria Stroke: * First-ever ischemic or haemorrhagic stroke * Able to walk independently (FAC ≥ 3) * Able to walk at least ten minutes * No full recovery of the paretic upper limb (FMA-UL \< 66) * Able to follow simple instructions during the assessment Exclusion Criteria Stroke: * Lesions located in the cerebellum * Pre-existing neurological disorders that affect motor function (e.g., Parkinson's disease, multiple sclerosis, dementia, etc.) * Pre-existing orthopaedic disorders of the upper and/or lower limbs (e.g., shoulder prosthesis, knee prosthesis, etc.) * Inability to provide written informed consent * Inability to understand instructions (AbilityQ: verbal \< 3/4 and VAS \< 3/3) Exclusion Criteria Healthy: * Pre-existing neurological disorders that affect motor function (e.g., Parkinson's disease, multiple sclerosis, dementia, etc.) * Pre-existing orthopaedic disorders of the upper and/or lower limbs (e.g., shoulder prosthesis, knee prosthesis, etc.) * Injuries of the upper and/or lower limbs that occurred six months or less prior to the time of testing * Current pain or ROM limitations at the time of testing * Inability to provide written informed consent

Outcomes

Primary Outcomes

Number of muscle synergies

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

Time frame: Baseline, during intervention and immediately after the intervention.

Weight of muscle synergies

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

Time frame: Baseline, during intervention and immediately after the intervention.

Upper and lower limb kinematics

Movements of the upper limb during walking measured by 3D kinematics.

Time frame: Baseline, during intervention and immediately after the intervention.

Physical Activity Enjoyment Scale (PACES)

The PACES is a questionnaire on patient enjoyment of physical activity. It consists of 18 items rated on a 7-point Likert scale, with total scores ranging from 18 to 126.