A dynamic model for predicting locomotor

recovery in patients with chronic stroke

Simisola O. Oludare
PT 563: Research Methods
4/21/2016
 Locomotion in patients with stroke
Locomotor dysfunction
• 700,000 stroke occurrences
annually (States et al 2009)
• 50% of patients do not regain
the ability to ambulate at
community level
Locomotor training
• Task-specific training
– Repeated locomotion (Kleim
and Jones 2008)
– Treadmill and overground
• Most patients plateau (Duncan
et al 2000, Jorgensen et al 1995)
• Advancements
– Increasing the amounts of steps
taken during training
(Lang et al 2007, Lang et al 2009, Loshe
et al 2014)
Dynamics of locomotion
Dynamics affect recovery
• Therapist-aided
intervention is more
effective than robot-aided
intervention (Hornby et al 2008)
• Changing the environment
and increasing the demands
on the patient improves
locomotor recovery
(Hornby et al 2008, Pohl et al 2002,
Barbeau et al 2003)
Quantifying locomotor dynamics
• Dynamic walking
– The goal of locomotion is
control of the center of mass
velocity (Kuo 2002)
– This is affected by push-off
force and braking force during
double support
• Nonlinear variability
– Low variability is indicative of
frailty and poor ambulation
– High variability is indicative of
flexibility and control
(Lipsitz 2009)
Purpose
• To compare the efficacy of a dynamic and static measure of
walking performance as predictors of locomotor recovery in
patients recovering from a stroke

Aims
• Implement a locomotor training intervention
and measure it’s efficacy over a 12-week period

• Predict locomotor recovery using dynamic

and static variables
Hypothesis
• The dynamic measure of walking performance
will be a better predictor of locomotor
recovery in patients recovering from a stroke
than a static measure
 Protocol Recruitment

Screening

Randomization

Baseline Locomotor Follow up Baseline No Follow up

Assessment Training Assessment Assessment training Assessment

Assessment

12 weeks,
Intervention Assessment three
sessions/ week
Intervention
• Locomotor Experience Applied Post Stroke (LEAPS)
• Treadmill stepping
• Partial body weight support
• 40 minutes at 0.89 m/s
• Manual assistance

(Duncan et al. 2011)

Locomotor recovery
Data Analysis Data collection

1.2
1
Speed (m/s)

0.8
0.6
0.4
0.2
10 meter walk way
0 Stop watch
0 1 2 3 4 5 6 7 8 9 101112
Weeks

Two -way Repeated measures ANOVA (α=0.05)

Static and Dynamic models
Data Analysis Data Collection
• Static model:
– Regression
– Number of gait cycles
– Heel strike to toe off
W+ W-
(Perry 1999)

• Dynamic model:
– Multiple regression
– Net mechanical work (Kuo 2002)
– Nonlinear Variability of net
mechanical work
• Detrended Fluctuation Analysis
(Peng et al 1999)
Instrumented treadmill (1080 Hz)

• Paired T-test (α = 0.05)

Conclusions

• This study is highly dependent on the efficacy of the

locomotor training

• This is a novel study which uses mechanical principles

of motor control to study locomotor recovery

• The results will provide insight into the variables which

control locomotor recovery due to task-specific
locomotor training

– Development of tools and guidelines