The purpose of this proof-of-principle study was to show that virtual reality (VR) technology cou... more The purpose of this proof-of-principle study was to show that virtual reality (VR) technology could be coupled with a self-paced treadmill to further improve walking competency in individuals with chronic stroke. A 62-year-old man with a chronic right hemispheric stroke participated in a treadmill walking programme involving first a control (CTL) protocol, then VR training. In CTL training, he walked without time constraints while viewing still pictures and reacting to treadmill movements similar to those that he would have experienced later in VR training. In VR training, he experienced treadmill movements programmed to simulate changes encountered in five virtual environments rear-projected onto a large screen. Training difficulty in nine sessions over 3 weeks was increased by varying the time constraints, terrain surface changes, and obstacles to avoid. Effects on walking competency were assessed using clinical measures (5 m walk test, 6 min walk test, Berg Balance Scale, Activit...
This study creates a baseline clinical portrait of sensorimotor rehabilitation in three stroke re... more This study creates a baseline clinical portrait of sensorimotor rehabilitation in three stroke rehabilitation units (SRUs) as a first step in implementing a multi-centre clinical research platform. Participants in this cross-sectional, descriptive study were the patients and rehabilitation teams in these SRUs. Prospective (recording of therapy time and content and a Web-based questionnaire) and retrospective (chart audit) methods were combined to characterize the practice of the rehabilitation professionals. The 24- to 39-bed SRUs admitted 100-240 inpatients in the year audited. The mean combined duration of individual occupational and physical therapy was 6.3-7.5 hours/week/patient. When evening hours and the contributions of other professionals as well as group therapy and self-practice were included, the total amount of therapy was 13.0 (SD 3) hours/patient/week. Chart audit and questionnaire data revealed the Berg Balance Scale was the most often used outcome measure (98%-100%),...
Cerebral palsy is the most common cause of childhood physical disability, with multiple associate... more Cerebral palsy is the most common cause of childhood physical disability, with multiple associated comorbidities. Administrative claims data provide population-level prevalence estimates for cerebral palsy surveillance; however, their diagnostic accuracy has never been validated in Quebec. This study aimed to assess the accuracy of administrative claims data for the diagnosis of cerebral palsy. We conducted a retrospective cohort study of children with cerebral palsy born between 1999 and 2002 within 6 health administrative regions of Quebec. Provincial cerebral palsy registry data (reference standard) and administrative physician claims were linked. We explored differences between true-positive and false-negative cases using subgroup sensitivity analysis. A total of 301 children were identified with confirmed cerebral palsy from the provincial registry, for an estimated prevalence of 1.8 (95% confidence interval [CI] 1.6-2.1) per 1000 children 5 years of age. The sensitivity and sp...
The Stroke Canada Optimization of Rehabilitation by Evidence-Implementation Trial (SCORE-IT) show... more The Stroke Canada Optimization of Rehabilitation by Evidence-Implementation Trial (SCORE-IT) showed that a facilitated knowledge translation (KT) approach to implementing a stroke rehabilitation guideline was more likely than passive strategies to improve functional walking capacity, but not gross manual dexterity, among patients in rehabilitation hospitals. This paper presents the results of a planned process evaluation designed to assess whether the type and number of recommended treatments implemented by stroke teams in each group would help to explain the results related to patient outcomes. As part of a cluster randomized trial, 20 rehabilitation units were stratified by language and allocated to a facilitated or passive KT intervention group. Sites in the facilitated group received the guideline with treatment protocols and funding for a part-time nurse and therapist facilitator who attended a 2-day training workshop and promoted guideline implementation for 16 months. Sites i...
The Stroke Canada Optimization of Rehabilitation by Evidence Implementation Trial (SCORE-IT) was ... more The Stroke Canada Optimization of Rehabilitation by Evidence Implementation Trial (SCORE-IT) was a cluster randomized controlled trial that evaluated two knowledge translation (KT) interventions for the promotion of the uptake of best practice recommendations for interventions targeting upper and lower extremity function, postural control, and mobility. Twenty rehabilitation centers across Canada were randomly assigned to either the facilitated or passive KT intervention. The objective of the current study was to understand the factors influencing the implementation of the recommended treatments and KT interventions from the perspective of nurses, occupational therapists and physical therapists, and clinical managers following completion of the trial. A qualitative descriptive approach involving focus groups was used. Thematic analysis was used to understand the factors influencing the implementation of the recommended treatments and KT interventions. The Clinical Practice Guideline...
Disability and Rehabilitation: Assistive Technology, 2016
This proof of concept study tested the ability of a dual task walking protocol using a recently d... more This proof of concept study tested the ability of a dual task walking protocol using a recently developed avatar-based virtual reality (VR) platform to detect differences between military personnel post mild traumatic brain injury (mTBI) and healthy controls. The VR platform coordinated motion capture, an interaction and rendering system, and a projection system to present first (participant-controlled) and third person avatars within the context of a specific military patrol scene. A divided attention task was also added. A healthy control group was compared to a group with previous mTBI (both groups comprised of six military personnel) and a repeated measures ANOVA tested for differences between conditions and groups based on recognition errors, walking speed and fluidity and obstacle clearance. The VR platform was well tolerated by both groups. Walking fluidity was degraded for the control group within the more complex navigational dual tasking involving avatars, and appeared greatest in the dual tasking with the interacting avatar. This navigational behaviour was not seen in the mTBI group. The present findings show proof of concept for using avatars, particularly more interactive avatars, to expose differences in executive functioning when applying context-specific protocols (here for the military). Implications for rehabilitation Virtual reality provides a means to control context-specific factors for assessment and intervention. Adding human interaction and agency through avatars increases the ecologic nature of the virtual environment. Avatars in the present application of the Virtual Reality avatar interaction platform appear to provide a better ability to reveal differences between trained, military personal with and without mTBI.
Archives of Physical Medicine and Rehabilitation, Dec 1, 2001
Objectives: To study the stretch reflex excitability (spasticity) of the plantarflexor muscles du... more Objectives: To study the stretch reflex excitability (spasticity) of the plantarflexor muscles during gait in patients with hemiparesis and to study the relationships of spasticity during gait with spasticity at rest and gait speed. Design: Cross-sectional, descriptive. Setting: Rehabilitation center. Participants: Convenience sample of 30 patients (58 Ϯ 11yr) with hemiparesis (Ͻ6mo poststroke) and 15 healthy controls (59 Ϯ 8yr). Interventions: Patients walked at natural speed, healthy subjects at very slow speed for 10 gait cycles. Electromyographic activation of the medial gastrocremius was recorded by using surface electrodes. A 2-dimensional video camera system with reflective markers was used to acquire kinematics of the lower limbs. Main Outcome Measures: Electromyography-lengthening velocity slopes, calculated from measures obtained during the lengthening periods of the medial gastrocnemius muscle during the stance and the swing phases. Measured spatisticity (Modified Ashworth Scale [MAS]), static strength (ankle clonus), and motor control (Fugl-Meyer test). Results: Velocity-sensitive electromyographic responses, indicative of hyperactive stretch reflexes, were found on the paretic side during the stance phase of gait (in 66% of the patients), but not on the nonparetic side or in controls. In many patients, velocity-sensitive responses coexisted with low plantarflexor activation levels during the stance phase. No clear patterns of response were measured during the swing phase in either group. Spasticity during gait in the patients was found to be positively related (r ϭ .47, p Ͻ .01; r ϭ .57, p Ͻ .001) to spasticity at rest (MAS; ankle clonus), whereas it was found to be negatively related to gait speed (r ϭ Ϫ.47 to Ϫ.53, p Ͻ .01). Conclusions: The validity of the present method is supported by the fact that it is locomotor-specific and that it allowed for a good discrimination between spastic and nonspastic limbs, as well as between stance and swing phases of the gait cycle. The results also support plantarflexor spasticity as a factor contributing to the poor locomotor performance after stroke.
Objective: To examine the relationship between working memory and motor improvement obtained afte... more Objective: To examine the relationship between working memory and motor improvement obtained after a single training session combining mental and physical practice. Design: Before-after trial. Setting: Laboratory of a university-affiliated research rehabilitation center. Participants: A sample of 12 patients with stroke and 14 age-and gender-matched healthy subjects. Intervention: In a single session, patients were trained with combined mental and physical practice to increase the loading on the affected leg while standing up and sitting down. Main Outcome Measures: Motor improvement as measured by the percentage change in limb loading on the affected limb after training and 24 hours later (follow-up), and the relationship between working memory and percentage motor improvement. Results: The loading on the affected leg was improved after training (PϽ.01) and at follow-up (PϽ.05), and working memory scores at follow-up correlated significantly (PϽ.004 to PϽ.007) with the level of improvement. The visuospatial domain yielded the strongest correlation (rϭ.83), followed by the verbal (rϭ.62) and kinesthetic (rϭ.59) domains. Conclusions: These results suggest that the outcome (improved limb loading) of mental rehearsal with motor imagery depends on the ability to maintain and manipulate information in working memory.
Many common activities such as walking in a shopping mall, moving in a busy subway station, or ev... more Many common activities such as walking in a shopping mall, moving in a busy subway station, or even avoiding opponents during sports, all require different levels of navigational skills. Obstacle circumvention is beginning to be understood across age groups, but studying trained athletes with greater levels of motor ability will further our understanding of skilful adaptive locomotor behavior. The objective of this work was to compare navigational skills during fast walking between elite athletes (e.g. soccer, field hockey, basketball) and aged-matched nonathletes under different levels of environmental complexity in relation to obstacle configuration and visibility. The movements of eight women athletes and eight women non-athletes were measured as they walked as fast as possible through different obstacle courses in both normal and low lighting conditions. Results showed that athletes, despite similar unobstructed maximal speeds to non-athletes, had faster walking times during the navigation of all obstructed environments. It appears that athletes can process visuo-spatial information faster since both groups can make appropriate navigational decisions, but athletes can navigate through complex, novel, environments at greater speeds. Athletes' walking times were also more affected by the low lighting conditions suggesting that they normally scan the obstructed course farther ahead. This study also uses new objective measures to assess functional locomotor capacity in order to discriminate individuals according to their level of navigational ability. The evaluation paradigm and outcome measures developed may be applicable to the evaluation of skill level in athletic training and selection, as well as in gait rehabilitation following impairment.
To examine 10-m comfortable walking speed and 6-minute distance in healthy individuals and indivi... more To examine 10-m comfortable walking speed and 6-minute distance in healthy individuals and individuals after stroke and to assess the level of disability associated with poor walking endurance after stroke. Design: Descriptive study in which comfortable walking speed over 10 m and distance covered in 6 minutes (6-minute walk test) were compared between healthy subjects and subjects after stroke. Subjects: Twelve healthy subjects and 14 subjects after stroke. Main outcome measures: Walking speed and 6-minute distances were compared between groups. In addition, for each group, actual distance walked in 6 minutes was compared with the distance predicted by the 10-m walking speed test and the distance predicted by normative reference equations. Results: Subjects after stroke had significant reductions in 10-m speed and 6-minute distance compared with healthy subjects (p < 0.05). Subjects after stroke were not able to maintain their comfortable walking speed for 6 minutes, whereas healthy subjects walked in excess of their comfortable speed for 6 minutes. The average distance walked in 6 minutes by individuals after stroke was only 49.8 ± 23.9% of the distance predicted for healthy individuals with similar physical characteristics. Conclusion: In our subjects after stroke, walking speed over a short distance overestimated the distance walked in 6 minutes. Both walking speed and endurance need to be measured and trained during rehabilitation. form of independent ambulation 1,2 few achieve a level of skill that matches the challenges imposed in the community. For example, Hill and colleagues 2 reported that only 7% of patients discharged from rehabilitation met the criteria for community ambulation which included the ability to walk 500 m continuously and at speeds that would enable them to cross the road safely. Walking speed is used both in clinical practice and research as the variable of choice to measure
The task of stepping over obstacles is known to be particularly risky for persons post stroke. A ... more The task of stepping over obstacles is known to be particularly risky for persons post stroke. A kinetic analysis informing on the movement strategies used to ensure clearance of the leading limb over an obstacle is, however, lacking. We examined obstacle avoidance strategies in six community dwelling stroke survivors comparing the use of paretic and non-paretic limb as the leading limb for clearance over obstacles measuring 7.5% and 15% of their total leg length. Subjects were able to increase foot clearance height in both limbs in order to avoid the two obstacles. Obstacle clearance with the non-paretic limb leading was associated with positive knee flexor work that increased when stepping over each obstacle, thus showing a normal knee strategy that flexes both the knee and the hip for foot clearance. There was also slightly increased hip flexor contribution for non-paretic obstacle clearance that was the same for both obstacle heights. When the paretic limb led during obstacle clearance, there was also evidence of an increased knee flexor moment, suggesting a residual knee strategy, but it was less pronounced than for the non-paretic limb and was assisted by greater vertical hip elevation and additional positive hip flexor work that both gained greater importance with increased obstacle height. These findings suggest that rehabilitation should explore the ability to improve the residual, but less powerful, knee flexor strategy in the paretic limb in specific patients, with further promotion of a hip flexor and limb elevation strategy depending on patient deficits and obstacle height.
This chapter reviews the evolution of stroke rehabilitation in the last 20 years. It begins by de... more This chapter reviews the evolution of stroke rehabilitation in the last 20 years. It begins by describing the different types of stroke that can occur in adults, their potential consequences on a person&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s capacity to function in daily life and statistics on the number of strokes and their burden on families and the economy. The assessment of stroke severity, recovery of function over time, and the impact of initial stroke severity and age on potential recovery are then addressed as well as the concept of rehabilitation to enhance recovery. Fueled by the synthesis of an ever-increasing research knowledge base and the creation of stroke rehabilitation recommendations for optimal delivery of rehabilitation services and of therapeutic interventions, stroke rehabilitation has changed dramatically. Examples of improvements in stroke rehabilitation in Canada are given with emphasis on the &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;best practices&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; inspired stroke rehabilitation continuum recently recommended for the Province of Quebec. The need for an improved community-based rehabilitation approach that includes regular follow-ups and community-based programs promoting reintegration is emphasized. The importance of knowledge translation strategies to promote the uptake of best-practice recommendations is illustrated by describing the activities of the Sensorimotor Rehabilitation Research Team. Over the past 3 years, the researchers of this team and clinicians in three rehabilitation centers, two in Montreal and one in Quebec City, have collaborated to adopt standardized assessment tools, create a common stroke registry, a best-practice recommended approach to interventions and the participation of clinicians in the research process.
... REHABILITATION STRATEGIES FOR THE TREATMENT OF SPASTIC GAIT DISORDERS Carol L. RICHARDS* 1, F... more ... REHABILITATION STRATEGIES FOR THE TREATMENT OF SPASTIC GAIT DISORDERS Carol L. RICHARDS* 1, Francine MALOUIN1, Francine DUMAS1, and ... and 6 months post-stroke functional (qualitative) evaluations using the Barthel, Fugl-Meyer and Berg Balance (Berg ...
The purpose of this proof-of-principle study was to show that virtual reality (VR) technology cou... more The purpose of this proof-of-principle study was to show that virtual reality (VR) technology could be coupled with a self-paced treadmill to further improve walking competency in individuals with chronic stroke. A 62-year-old man with a chronic right hemispheric stroke participated in a treadmill walking programme involving first a control (CTL) protocol, then VR training. In CTL training, he walked without time constraints while viewing still pictures and reacting to treadmill movements similar to those that he would have experienced later in VR training. In VR training, he experienced treadmill movements programmed to simulate changes encountered in five virtual environments rear-projected onto a large screen. Training difficulty in nine sessions over 3 weeks was increased by varying the time constraints, terrain surface changes, and obstacles to avoid. Effects on walking competency were assessed using clinical measures (5 m walk test, 6 min walk test, Berg Balance Scale, Activit...
This study creates a baseline clinical portrait of sensorimotor rehabilitation in three stroke re... more This study creates a baseline clinical portrait of sensorimotor rehabilitation in three stroke rehabilitation units (SRUs) as a first step in implementing a multi-centre clinical research platform. Participants in this cross-sectional, descriptive study were the patients and rehabilitation teams in these SRUs. Prospective (recording of therapy time and content and a Web-based questionnaire) and retrospective (chart audit) methods were combined to characterize the practice of the rehabilitation professionals. The 24- to 39-bed SRUs admitted 100-240 inpatients in the year audited. The mean combined duration of individual occupational and physical therapy was 6.3-7.5 hours/week/patient. When evening hours and the contributions of other professionals as well as group therapy and self-practice were included, the total amount of therapy was 13.0 (SD 3) hours/patient/week. Chart audit and questionnaire data revealed the Berg Balance Scale was the most often used outcome measure (98%-100%),...
Cerebral palsy is the most common cause of childhood physical disability, with multiple associate... more Cerebral palsy is the most common cause of childhood physical disability, with multiple associated comorbidities. Administrative claims data provide population-level prevalence estimates for cerebral palsy surveillance; however, their diagnostic accuracy has never been validated in Quebec. This study aimed to assess the accuracy of administrative claims data for the diagnosis of cerebral palsy. We conducted a retrospective cohort study of children with cerebral palsy born between 1999 and 2002 within 6 health administrative regions of Quebec. Provincial cerebral palsy registry data (reference standard) and administrative physician claims were linked. We explored differences between true-positive and false-negative cases using subgroup sensitivity analysis. A total of 301 children were identified with confirmed cerebral palsy from the provincial registry, for an estimated prevalence of 1.8 (95% confidence interval [CI] 1.6-2.1) per 1000 children 5 years of age. The sensitivity and sp...
The Stroke Canada Optimization of Rehabilitation by Evidence-Implementation Trial (SCORE-IT) show... more The Stroke Canada Optimization of Rehabilitation by Evidence-Implementation Trial (SCORE-IT) showed that a facilitated knowledge translation (KT) approach to implementing a stroke rehabilitation guideline was more likely than passive strategies to improve functional walking capacity, but not gross manual dexterity, among patients in rehabilitation hospitals. This paper presents the results of a planned process evaluation designed to assess whether the type and number of recommended treatments implemented by stroke teams in each group would help to explain the results related to patient outcomes. As part of a cluster randomized trial, 20 rehabilitation units were stratified by language and allocated to a facilitated or passive KT intervention group. Sites in the facilitated group received the guideline with treatment protocols and funding for a part-time nurse and therapist facilitator who attended a 2-day training workshop and promoted guideline implementation for 16 months. Sites i...
The Stroke Canada Optimization of Rehabilitation by Evidence Implementation Trial (SCORE-IT) was ... more The Stroke Canada Optimization of Rehabilitation by Evidence Implementation Trial (SCORE-IT) was a cluster randomized controlled trial that evaluated two knowledge translation (KT) interventions for the promotion of the uptake of best practice recommendations for interventions targeting upper and lower extremity function, postural control, and mobility. Twenty rehabilitation centers across Canada were randomly assigned to either the facilitated or passive KT intervention. The objective of the current study was to understand the factors influencing the implementation of the recommended treatments and KT interventions from the perspective of nurses, occupational therapists and physical therapists, and clinical managers following completion of the trial. A qualitative descriptive approach involving focus groups was used. Thematic analysis was used to understand the factors influencing the implementation of the recommended treatments and KT interventions. The Clinical Practice Guideline...
Disability and Rehabilitation: Assistive Technology, 2016
This proof of concept study tested the ability of a dual task walking protocol using a recently d... more This proof of concept study tested the ability of a dual task walking protocol using a recently developed avatar-based virtual reality (VR) platform to detect differences between military personnel post mild traumatic brain injury (mTBI) and healthy controls. The VR platform coordinated motion capture, an interaction and rendering system, and a projection system to present first (participant-controlled) and third person avatars within the context of a specific military patrol scene. A divided attention task was also added. A healthy control group was compared to a group with previous mTBI (both groups comprised of six military personnel) and a repeated measures ANOVA tested for differences between conditions and groups based on recognition errors, walking speed and fluidity and obstacle clearance. The VR platform was well tolerated by both groups. Walking fluidity was degraded for the control group within the more complex navigational dual tasking involving avatars, and appeared greatest in the dual tasking with the interacting avatar. This navigational behaviour was not seen in the mTBI group. The present findings show proof of concept for using avatars, particularly more interactive avatars, to expose differences in executive functioning when applying context-specific protocols (here for the military). Implications for rehabilitation Virtual reality provides a means to control context-specific factors for assessment and intervention. Adding human interaction and agency through avatars increases the ecologic nature of the virtual environment. Avatars in the present application of the Virtual Reality avatar interaction platform appear to provide a better ability to reveal differences between trained, military personal with and without mTBI.
Archives of Physical Medicine and Rehabilitation, Dec 1, 2001
Objectives: To study the stretch reflex excitability (spasticity) of the plantarflexor muscles du... more Objectives: To study the stretch reflex excitability (spasticity) of the plantarflexor muscles during gait in patients with hemiparesis and to study the relationships of spasticity during gait with spasticity at rest and gait speed. Design: Cross-sectional, descriptive. Setting: Rehabilitation center. Participants: Convenience sample of 30 patients (58 Ϯ 11yr) with hemiparesis (Ͻ6mo poststroke) and 15 healthy controls (59 Ϯ 8yr). Interventions: Patients walked at natural speed, healthy subjects at very slow speed for 10 gait cycles. Electromyographic activation of the medial gastrocremius was recorded by using surface electrodes. A 2-dimensional video camera system with reflective markers was used to acquire kinematics of the lower limbs. Main Outcome Measures: Electromyography-lengthening velocity slopes, calculated from measures obtained during the lengthening periods of the medial gastrocnemius muscle during the stance and the swing phases. Measured spatisticity (Modified Ashworth Scale [MAS]), static strength (ankle clonus), and motor control (Fugl-Meyer test). Results: Velocity-sensitive electromyographic responses, indicative of hyperactive stretch reflexes, were found on the paretic side during the stance phase of gait (in 66% of the patients), but not on the nonparetic side or in controls. In many patients, velocity-sensitive responses coexisted with low plantarflexor activation levels during the stance phase. No clear patterns of response were measured during the swing phase in either group. Spasticity during gait in the patients was found to be positively related (r ϭ .47, p Ͻ .01; r ϭ .57, p Ͻ .001) to spasticity at rest (MAS; ankle clonus), whereas it was found to be negatively related to gait speed (r ϭ Ϫ.47 to Ϫ.53, p Ͻ .01). Conclusions: The validity of the present method is supported by the fact that it is locomotor-specific and that it allowed for a good discrimination between spastic and nonspastic limbs, as well as between stance and swing phases of the gait cycle. The results also support plantarflexor spasticity as a factor contributing to the poor locomotor performance after stroke.
Objective: To examine the relationship between working memory and motor improvement obtained afte... more Objective: To examine the relationship between working memory and motor improvement obtained after a single training session combining mental and physical practice. Design: Before-after trial. Setting: Laboratory of a university-affiliated research rehabilitation center. Participants: A sample of 12 patients with stroke and 14 age-and gender-matched healthy subjects. Intervention: In a single session, patients were trained with combined mental and physical practice to increase the loading on the affected leg while standing up and sitting down. Main Outcome Measures: Motor improvement as measured by the percentage change in limb loading on the affected limb after training and 24 hours later (follow-up), and the relationship between working memory and percentage motor improvement. Results: The loading on the affected leg was improved after training (PϽ.01) and at follow-up (PϽ.05), and working memory scores at follow-up correlated significantly (PϽ.004 to PϽ.007) with the level of improvement. The visuospatial domain yielded the strongest correlation (rϭ.83), followed by the verbal (rϭ.62) and kinesthetic (rϭ.59) domains. Conclusions: These results suggest that the outcome (improved limb loading) of mental rehearsal with motor imagery depends on the ability to maintain and manipulate information in working memory.
Many common activities such as walking in a shopping mall, moving in a busy subway station, or ev... more Many common activities such as walking in a shopping mall, moving in a busy subway station, or even avoiding opponents during sports, all require different levels of navigational skills. Obstacle circumvention is beginning to be understood across age groups, but studying trained athletes with greater levels of motor ability will further our understanding of skilful adaptive locomotor behavior. The objective of this work was to compare navigational skills during fast walking between elite athletes (e.g. soccer, field hockey, basketball) and aged-matched nonathletes under different levels of environmental complexity in relation to obstacle configuration and visibility. The movements of eight women athletes and eight women non-athletes were measured as they walked as fast as possible through different obstacle courses in both normal and low lighting conditions. Results showed that athletes, despite similar unobstructed maximal speeds to non-athletes, had faster walking times during the navigation of all obstructed environments. It appears that athletes can process visuo-spatial information faster since both groups can make appropriate navigational decisions, but athletes can navigate through complex, novel, environments at greater speeds. Athletes' walking times were also more affected by the low lighting conditions suggesting that they normally scan the obstructed course farther ahead. This study also uses new objective measures to assess functional locomotor capacity in order to discriminate individuals according to their level of navigational ability. The evaluation paradigm and outcome measures developed may be applicable to the evaluation of skill level in athletic training and selection, as well as in gait rehabilitation following impairment.
To examine 10-m comfortable walking speed and 6-minute distance in healthy individuals and indivi... more To examine 10-m comfortable walking speed and 6-minute distance in healthy individuals and individuals after stroke and to assess the level of disability associated with poor walking endurance after stroke. Design: Descriptive study in which comfortable walking speed over 10 m and distance covered in 6 minutes (6-minute walk test) were compared between healthy subjects and subjects after stroke. Subjects: Twelve healthy subjects and 14 subjects after stroke. Main outcome measures: Walking speed and 6-minute distances were compared between groups. In addition, for each group, actual distance walked in 6 minutes was compared with the distance predicted by the 10-m walking speed test and the distance predicted by normative reference equations. Results: Subjects after stroke had significant reductions in 10-m speed and 6-minute distance compared with healthy subjects (p < 0.05). Subjects after stroke were not able to maintain their comfortable walking speed for 6 minutes, whereas healthy subjects walked in excess of their comfortable speed for 6 minutes. The average distance walked in 6 minutes by individuals after stroke was only 49.8 ± 23.9% of the distance predicted for healthy individuals with similar physical characteristics. Conclusion: In our subjects after stroke, walking speed over a short distance overestimated the distance walked in 6 minutes. Both walking speed and endurance need to be measured and trained during rehabilitation. form of independent ambulation 1,2 few achieve a level of skill that matches the challenges imposed in the community. For example, Hill and colleagues 2 reported that only 7% of patients discharged from rehabilitation met the criteria for community ambulation which included the ability to walk 500 m continuously and at speeds that would enable them to cross the road safely. Walking speed is used both in clinical practice and research as the variable of choice to measure
The task of stepping over obstacles is known to be particularly risky for persons post stroke. A ... more The task of stepping over obstacles is known to be particularly risky for persons post stroke. A kinetic analysis informing on the movement strategies used to ensure clearance of the leading limb over an obstacle is, however, lacking. We examined obstacle avoidance strategies in six community dwelling stroke survivors comparing the use of paretic and non-paretic limb as the leading limb for clearance over obstacles measuring 7.5% and 15% of their total leg length. Subjects were able to increase foot clearance height in both limbs in order to avoid the two obstacles. Obstacle clearance with the non-paretic limb leading was associated with positive knee flexor work that increased when stepping over each obstacle, thus showing a normal knee strategy that flexes both the knee and the hip for foot clearance. There was also slightly increased hip flexor contribution for non-paretic obstacle clearance that was the same for both obstacle heights. When the paretic limb led during obstacle clearance, there was also evidence of an increased knee flexor moment, suggesting a residual knee strategy, but it was less pronounced than for the non-paretic limb and was assisted by greater vertical hip elevation and additional positive hip flexor work that both gained greater importance with increased obstacle height. These findings suggest that rehabilitation should explore the ability to improve the residual, but less powerful, knee flexor strategy in the paretic limb in specific patients, with further promotion of a hip flexor and limb elevation strategy depending on patient deficits and obstacle height.
This chapter reviews the evolution of stroke rehabilitation in the last 20 years. It begins by de... more This chapter reviews the evolution of stroke rehabilitation in the last 20 years. It begins by describing the different types of stroke that can occur in adults, their potential consequences on a person&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s capacity to function in daily life and statistics on the number of strokes and their burden on families and the economy. The assessment of stroke severity, recovery of function over time, and the impact of initial stroke severity and age on potential recovery are then addressed as well as the concept of rehabilitation to enhance recovery. Fueled by the synthesis of an ever-increasing research knowledge base and the creation of stroke rehabilitation recommendations for optimal delivery of rehabilitation services and of therapeutic interventions, stroke rehabilitation has changed dramatically. Examples of improvements in stroke rehabilitation in Canada are given with emphasis on the &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;best practices&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; inspired stroke rehabilitation continuum recently recommended for the Province of Quebec. The need for an improved community-based rehabilitation approach that includes regular follow-ups and community-based programs promoting reintegration is emphasized. The importance of knowledge translation strategies to promote the uptake of best-practice recommendations is illustrated by describing the activities of the Sensorimotor Rehabilitation Research Team. Over the past 3 years, the researchers of this team and clinicians in three rehabilitation centers, two in Montreal and one in Quebec City, have collaborated to adopt standardized assessment tools, create a common stroke registry, a best-practice recommended approach to interventions and the participation of clinicians in the research process.
... REHABILITATION STRATEGIES FOR THE TREATMENT OF SPASTIC GAIT DISORDERS Carol L. RICHARDS* 1, F... more ... REHABILITATION STRATEGIES FOR THE TREATMENT OF SPASTIC GAIT DISORDERS Carol L. RICHARDS* 1, Francine MALOUIN1, Francine DUMAS1, and ... and 6 months post-stroke functional (qualitative) evaluations using the Barthel, Fugl-Meyer and Berg Balance (Berg ...
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