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Case Reports
. 2012 May;92(5):748-56.
doi: 10.2522/ptj.20110206. Epub 2012 Jan 6.

Use of Visual and Proprioceptive Feedback to Improve Gait Speed and Spatiotemporal Symmetry Following Chronic Stroke: A Case Series

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Free PMC article
Case Reports

Use of Visual and Proprioceptive Feedback to Improve Gait Speed and Spatiotemporal Symmetry Following Chronic Stroke: A Case Series

Michael D Lewek et al. Phys Ther. .
Free PMC article

Abstract

Background and purpose: Persistent deficits in gait speed and spatiotemporal symmetry are prevalent following stroke and can limit the achievement of community mobility goals. Rehabilitation can improve gait speed, but has shown limited ability to improve spatiotemporal symmetry. The incorporation of combined visual and proprioceptive feedback regarding spatiotemporal symmetry has the potential to be effective at improving gait.

Case description: A 60-year-old man (18 months poststroke) and a 53-year-old woman (21 months poststroke) each participated in gait training to improve gait speed and spatiotemporal symmetry. Each patient performed 18 sessions (6 weeks) of combined treadmill-based gait training followed by overground practice. To assist with relearning spatiotemporal symmetry, treadmill-based training for both patients was augmented with continuous, real-time visual and proprioceptive feedback from an immersive virtual environment and a dual belt treadmill, respectively.

Outcomes: Both patients improved gait speed (patient 1: 0.35 m/s improvement; patient 2: 0.26 m/s improvement) and spatiotemporal symmetry. Patient 1, who trained with step-length symmetry feedback, improved his step-length symmetry ratio, but not his stance-time symmetry ratio. Patient 2, who trained with stance-time symmetry feedback, improved her stance-time symmetry ratio. She had no step-length asymmetry before training.

Discussion: Both patients made improvements in gait speed and spatiotemporal symmetry that exceeded those reported in the literature. Further work is needed to ascertain the role of combined visual and proprioceptive feedback for improving gait speed and spatiotemporal symmetry after chronic stroke.

Figures

Figure 1.
Figure 1.
The Integrated Virtual Environment Rehabilitation Treadmill (IVERT) system couples an instrumented dual-belt treadmill with an immersive virtual environment for real-time, congruent proprioceptive and visual feedback of gait asymmetries.
Figure 2.
Figure 2.
Symmetry ratios for step length (A and C) and stance time (B and D) for patient 1 (A and B) and patient 2 (C and D). Symmetry ratios were calculated as paretic/nonparetic and inverted, if necessary, to be >1.0., Patient 1 trained to improve his step length symmetry ratio. Symmetry ratios are provided for him at pretraining, posttraining, and 10-week follow-up with (black) and without (white) his cane. Patient 2 trained to improve her stance time symmetry ratio. She walked exclusively without a cane at pretraining, posttraining, and at 10-week follow-up. For both patients, the normal ratio is shaded in gray (step length: 1.00–1.08; stance time: 1.00–1.05).

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