Effects of real-time gait biofeedback on paretic propulsion and gait biomechanics in individuals post-stroke

• Type of Material: Article
• Authors: Katlin Genthe, Emory University; Christopher Schenck, Georgia Institute of Technology; Steven Eicholtz, Emory University; Laura Zajac-Cox, Emory University; Steven Wolf, Emory University; Trisha Kesar, Emory University
• Language: English
• Date: 2018-01-01
• Publisher: Taylor & Francis: STM, Behavioural Science and Public Health Titles
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2018 Informa UK Limited, trading as Taylor & Francis Group.
• Final Published Version (URL): http://dx.doi.org/10.1080/10749357.2018.1436384
• Title of Journal or Parent Work: Topics in Stroke Rehabilitation
• ISSN: 1074-9357
• Volume: 25
• Issue: 3
• Start Page: 186
• End Page: 193
• Grant/Funding Information: This work was supported by National Institute of Child Health and Human Development [grant number K01 HD079584]; and National Institutes of Health [grant numbers U10NS086607, U01 NS091951, R03 HD083727].
• Keywords: WALKING SPEED; IMPROVE GAIT; FUNCTIONAL STATUS; gait biomechanics; ANKLE MOMENT; GROUND REACTION FORCES; HEMIPARETIC WALKING; push-off; STEP LENGTH ASYMMETRY; HEMIPLEGIC PATIENT; TRAILING LIMB ANGLE; hemiparesis; walking; CHRONIC STROKE; Life Sciences & Biomedicine; locomotor training; Feedback; motor learning; Rehabilitation; Science & Technology
• Research Categories: Health Sciences, Rehabilitation and Therapy; Biology, Neuroscience; Engineering, Biomedical

Abstract

Objectives: Gait training interventions that target paretic propulsion induce improvements in walking speed and function in individuals post-stroke. Previously, we demonstrated that able-bodied individuals increase propulsion unilaterally when provided real-time biofeedback targeting anterior ground reaction forces (AGRF). The purpose of this study was to, for the first time, investigate short-term effects of real-time AGRF gait biofeedback training on post-stroke gait. Methods: Nine individuals with post-stroke hemiparesis (6 females, age = 54 ± 12.4 years 39.2 ± 24.4 months post-stroke) completed three 6-minute training bouts on an instrumented treadmill. During training, visual and auditory biofeedback were provided to increase paretic AGRF during terminal stance. Gait biomechanics were evaluated before training, and during retention tests conducted 2, 15, and 30 minutes post-training. Primary dependent variables were paretic and non-paretic peak AGRF; secondary variables included paretic and non-paretic peak trailing limb angle, plantarflexor moment, and step length. In addition to evaluating the effects of biofeedback training on these dependent variables, we compared effects of a 6-minute biofeedback training bout to a non-biofeedback control condition. Results: Compared to pre-training, significantly greater paretic peak AGRFs were generated during the 2, 15, and 30-minute retention tests conducted after the 18-minute biofeedback training session. Biofeedback training induced no significant effects on the non-paretic leg. Comparison of a 6-minute biofeedback training bout with a speed-matched control bout without biofeedback demonstrated a main effect for training type, with greater peak AGRF generation during biofeedback. Discussion: Our results suggest that AGRF biofeedback may be a feasible and promising gait training strategy to target propulsive deficits in individuals post-stroke.