Replacing canes with an elasticated orthotic-garment in chronic stroke patients - The influence on gait and balance. A series of N-of-1 trials.

OBJECTIVE: To investigate the effect of replacing canes with an elasticated orthotic-garment on balance and gait-function in chronic stroke survivors. DESIGN: Experimental, N-of-1 series with a replicated, ABC design with randomised phase duration in a home setting. PARTICIPANTS: Four cane using chronic stroke survivors (P1-4). INTERVENTIONS: Phase A (9-12 weeks) cane-walking "as usual" to establish baseline values; Phase B (9-16 weeks) intervention: orthotic-garment worn throughout the day with maximal cane-use reduction; Phase C (9-10 weeks) participant-determined follow-up: either no walking-aid, orthotic-garment or cane. OUTCOME MEASURES: Primary: Functional-Gait-Assessment (FGA), Secondary: Trunk-sway during walking measured as Total-Angle-Area (TAA°2) in frontal and sagittal-planes, both measured weekly. RESULTS: Visual and statistical analysis of results showed significant improvements in FGA from phase A to B in all participants. Improvement continued in phase C in P2, stabilized in P1 and P4 and deteriorated in P3. A Minimal-Clinical-Important-Difference of 6 points-change was achieved in P2 & P4. Trunk-sway reduced during walking, indicating increased stability, in two participants from phase A to B and in three participants from A to C but no TAA changes were statistically significant. In phase C participant-selected walking-aids were: P1 cane-usage reduced by 25%, P2 independent-walking with no assistive-device, S3 usual cane-usage, P4 orthotic-garment with reduced cane-usage 2-3 days-a-week, usual cane-usage 4-5 days. CONCLUSIONS: Although walking ability is multifactorial these results indicate that the choice of walking-aids can have a specific and clinically relevant impact on gait following stroke. "Hands-free" assistive-devices may be more effective than canes in improving gait-function in some patients. CLINICALTRIALS. GOV ID: NCT03642444.

Movement goals encoded within the cortex and muscle synergies to reduce redundancy pre and post-stroke. The relevance for gait rehabilitation and the prescription of walking-aids. A literature review and scholarly discussion.

Current knowledge of neural and neuromuscular processes controlling gait and movement as well as an understanding of how these mechanisms change following stroke is an important basis for the development of effective rehabilitation interventions. To support the translation of findings from basic research into useful treatments in clinical practice, up-to-date neuroscience should be presented in forms accessible to all members of the multidisciplinary team. In this review we discuss aspects of cortical control of gait and movement, muscle synergies as a way of translating cortical commands into specific muscle activity and as an efficient means of reducing neural and musculoskeletal redundancy. We discuss how these mechanisms change following stroke, potential consequences for gait rehabilitation, and the prescription and use of walking-aids as well as areas requiring further research.

The influence of walking-aids on the plasticity of spinal interneuronal networks, central-pattern-generators and the recovery of gait post-stroke. A literature review and scholarly discussion.

BACKGROUND: Many aspects of post-stroke gait-rehabilitation are based on low-level evidence or expert opinion. Neuroscientific principles are often not considered when evaluating the impact of interventions. The use of walking-aids including canes and rollators, although widely used for long periods, has primarily been investigated to assess the immediate kinetic, kinematic or physiological effects. The long-term impact on neural structures und functions remains unclear. METHODS: A literature review of the function of and factors affecting plasticity of spinal interneuronal-networks and central-pattern-generators (CPG) in healthy and post-stroke patients. The relevance of these mechanisms for gait recovery and the potential impact of walking-aids is discussed. RESULTS: Afferent-input to spinal-networks influences motor-output and spinal and cortical plasticity. Disrupted input may adversely affect post-stroke plasticity and functional recovery. Joint and muscle unloading and decoupling from four-limb CPG control may be particularly relevant. CONCLUSIONS: Canes and rollators disrupt afferent-input and may negatively affect the recovery of gait.