Necessity and Content of Swing Phase Gait Coordination Training Post Stroke; A Case Report

Background/Problem: Standard neurorehabilitation and gait training has not proved effective in restoring normal gait coordination for many stroke survivors. Rather, persistent gait dyscoordination occurs, with associated poor function, and progressively deteriorating quality of life. One difficulty...

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Autores principales:	Jessica P. McCabe, Kristen Roenigk, Janis J. Daly
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	stroke gait coordination motor learning body weight supported treadmill training functional electrical stimulation (FES) Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571
Acceso en línea:	https://doaj.org/article/7a530c7bbfca4617b4d981fdc0f10160
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id	oai:doaj.org-article:7a530c7bbfca4617b4d981fdc0f10160
record_format	dspace
institution	DOAJ
collection	DOAJ
language	EN
topic	stroke gait coordination motor learning body weight supported treadmill training functional electrical stimulation (FES) Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571
spellingShingle	stroke gait coordination motor learning body weight supported treadmill training functional electrical stimulation (FES) Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Jessica P. McCabe Kristen Roenigk Janis J. Daly Necessity and Content of Swing Phase Gait Coordination Training Post Stroke; A Case Report
description	Background/Problem: Standard neurorehabilitation and gait training has not proved effective in restoring normal gait coordination for many stroke survivors. Rather, persistent gait dyscoordination occurs, with associated poor function, and progressively deteriorating quality of life. One difficulty is the array of symptoms exhibited by stroke survivors with gait deficits. Some researchers have addressed lower limb weakness following stroke with exercises designed to strengthen muscles, with the expectation of improving gait. However, gait dyscoordination in many stroke survivors appears to result from more than straightforward muscle weakness. Purpose: Thus, the purpose of this case study is to report results of long-duration gait coordination training in an individual with initial good strength, but poor gait swing phase hip/knee and ankle coordination. Methods: Mr. X was enrolled at >6 months after a left hemisphere ischemic stroke. Gait deficits included a ‘stiff-legged gait’ characterized by the absence of hip and knee flexion during right mid-swing, despite the fact that he showed good initial strength in right lower limb quadriceps, hamstrings, and ankle dorsiflexors. Treatment was provided 4 times/week for 1.5 h, for 12 weeks. The combined treatment included the following: motor learning exercises designed for coordination training of the lower limb; functional electrical stimulation (FES) assisted practice; weight-supported coordination practice; and over-ground and treadmill walking. The FES was used as an adjunct to enhance muscle response during motor learning and prior to volitional recovery of motor control. Weight-supported treadmill training was administered to titrate weight and pressure applied at the joints and to the plantar foot surface during stance phase and pre-swing phase of the involved limb. Later in the protocol, treadmill training was administered to improve speed of movement during the gait cycle. Response to treatment was assessed through an array of impairment, functional mobility, and life role participation measures. Results: At post-treatment, Mr. X exhibited some recovery of hip, knee, and ankle coordination during swing phase according to kinematic measures, and the stiff-legged gait was resolved. Muscle strength measures remained essentially constant throughout the study. The modified Ashworth scale showed improved knee extensor tone from baseline of 1 to normal (0) at post-treatment. Gait coordination overall improved by 12 points according to the Gait Assessment and Intervention Tool, Six Minute Walk Test improved by 532′, and the Stroke Impact Scale improved by 12 points, including changes in daily activities; mobility; and meaningful activities. Discussion: Through the combined use of motor learning exercises, FES, weight-support, and treadmill training, coordination of the right lower limb improved sufficiently to exhibit a more normal swing phase, reducing the probability of falls, and subsequent downwardly spiraling dysfunction. The recovery of lower limb coordination during swing phase illustrates what is possible when strength is sufficient and when coordination training is targeted in a carefully titrated, highly incrementalized manner. Conclusions/Contribution to the Field: This case study contributes to the literature in several ways: (1) illustrates combined interventions for gait training and response to treatment; (2) provides supporting case evidence of relationships among knee flexion coordination, swing phase coordination, functional mobility, and quality of life; (3) illustrates that strength is necessary, but not sufficient to restore coordinated gait swing phase after stroke in some stroke survivors; and (4) provides details regarding coordination training and progression of gait training treatment for stroke survivors.
format	article
author	Jessica P. McCabe Kristen Roenigk Janis J. Daly
author_facet	Jessica P. McCabe Kristen Roenigk Janis J. Daly
author_sort	Jessica P. McCabe
title	Necessity and Content of Swing Phase Gait Coordination Training Post Stroke; A Case Report
title_short	Necessity and Content of Swing Phase Gait Coordination Training Post Stroke; A Case Report
title_full	Necessity and Content of Swing Phase Gait Coordination Training Post Stroke; A Case Report
title_fullStr	Necessity and Content of Swing Phase Gait Coordination Training Post Stroke; A Case Report
title_full_unstemmed	Necessity and Content of Swing Phase Gait Coordination Training Post Stroke; A Case Report
title_sort	necessity and content of swing phase gait coordination training post stroke; a case report
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/7a530c7bbfca4617b4d981fdc0f10160
work_keys_str_mv	AT jessicapmccabe necessityandcontentofswingphasegaitcoordinationtrainingpoststrokeacasereport AT kristenroenigk necessityandcontentofswingphasegaitcoordinationtrainingpoststrokeacasereport AT janisjdaly necessityandcontentofswingphasegaitcoordinationtrainingpoststrokeacasereport
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spelling	oai:doaj.org-article:7a530c7bbfca4617b4d981fdc0f101602021-11-25T16:58:31ZNecessity and Content of Swing Phase Gait Coordination Training Post Stroke; A Case Report10.3390/brainsci111114982076-3425https://doaj.org/article/7a530c7bbfca4617b4d981fdc0f101602021-11-01T00:00:00Zhttps://www.mdpi.com/2076-3425/11/11/1498https://doaj.org/toc/2076-3425Background/Problem: Standard neurorehabilitation and gait training has not proved effective in restoring normal gait coordination for many stroke survivors. Rather, persistent gait dyscoordination occurs, with associated poor function, and progressively deteriorating quality of life. One difficulty is the array of symptoms exhibited by stroke survivors with gait deficits. Some researchers have addressed lower limb weakness following stroke with exercises designed to strengthen muscles, with the expectation of improving gait. However, gait dyscoordination in many stroke survivors appears to result from more than straightforward muscle weakness. Purpose: Thus, the purpose of this case study is to report results of long-duration gait coordination training in an individual with initial good strength, but poor gait swing phase hip/knee and ankle coordination. Methods: Mr. X was enrolled at >6 months after a left hemisphere ischemic stroke. Gait deficits included a ‘stiff-legged gait’ characterized by the absence of hip and knee flexion during right mid-swing, despite the fact that he showed good initial strength in right lower limb quadriceps, hamstrings, and ankle dorsiflexors. Treatment was provided 4 times/week for 1.5 h, for 12 weeks. The combined treatment included the following: motor learning exercises designed for coordination training of the lower limb; functional electrical stimulation (FES) assisted practice; weight-supported coordination practice; and over-ground and treadmill walking. The FES was used as an adjunct to enhance muscle response during motor learning and prior to volitional recovery of motor control. Weight-supported treadmill training was administered to titrate weight and pressure applied at the joints and to the plantar foot surface during stance phase and pre-swing phase of the involved limb. Later in the protocol, treadmill training was administered to improve speed of movement during the gait cycle. Response to treatment was assessed through an array of impairment, functional mobility, and life role participation measures. Results: At post-treatment, Mr. X exhibited some recovery of hip, knee, and ankle coordination during swing phase according to kinematic measures, and the stiff-legged gait was resolved. Muscle strength measures remained essentially constant throughout the study. The modified Ashworth scale showed improved knee extensor tone from baseline of 1 to normal (0) at post-treatment. Gait coordination overall improved by 12 points according to the Gait Assessment and Intervention Tool, Six Minute Walk Test improved by 532′, and the Stroke Impact Scale improved by 12 points, including changes in daily activities; mobility; and meaningful activities. Discussion: Through the combined use of motor learning exercises, FES, weight-support, and treadmill training, coordination of the right lower limb improved sufficiently to exhibit a more normal swing phase, reducing the probability of falls, and subsequent downwardly spiraling dysfunction. The recovery of lower limb coordination during swing phase illustrates what is possible when strength is sufficient and when coordination training is targeted in a carefully titrated, highly incrementalized manner. Conclusions/Contribution to the Field: This case study contributes to the literature in several ways: (1) illustrates combined interventions for gait training and response to treatment; (2) provides supporting case evidence of relationships among knee flexion coordination, swing phase coordination, functional mobility, and quality of life; (3) illustrates that strength is necessary, but not sufficient to restore coordinated gait swing phase after stroke in some stroke survivors; and (4) provides details regarding coordination training and progression of gait training treatment for stroke survivors.Jessica P. McCabeKristen RoenigkJanis J. DalyMDPI AGarticlestrokegaitcoordinationmotor learningbody weight supported treadmill trainingfunctional electrical stimulation (FES)Neurosciences. Biological psychiatry. NeuropsychiatryRC321-571ENBrain Sciences, Vol 11, Iss 1498, p 1498 (2021)

Necessity and Content of Swing Phase Gait Coordination Training Post Stroke; A Case Report

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