Stroke patients often have a disrupted walking pattern, walking asymmetrically and at a slower pace. In normal walking, several elements come into play. One factor is our strength as we push ourselves forward with our toes (also known as push-off). Stroke patients often suffer from reduced push-off strength, which contributes to the difficulties in walking and may also add to muscle weakness.
Since push-off seems to influence gait strongly, researchers from Atlanta were curious if improving the push-off force through biofeedback could lead to improvements in walking among stroke patients. They conducted a proof-of-concept study involving nine stroke patients. The patients, aged 31-72, all suffered a stroke more than six months before the study.
About the Study
The study put the patients in three 6-minute bouts of treadmill walking, with a 5-minute seated break between rounds.
To find out if the 6-minute rounds without biofeedback could result in changes in the patients’ gait, the patients did the training at their self-selected speed.
Data from the patients’ walking pattern and force were collected and measured using a 7-camera motion capture system. Each foot of the patient was on a separate treadmill belt.
Patients received visual and auditory feedback through the screen and speaker in front of the treadmill. The visual display had a horizontal line with a cursor (X) that represented their initial push-off force. A green line displayed the target force on the screen. Each time the strength of the affected leg during push-off exceeded the threshold, the cursor went into the green zone, and a distinct sound alerted the patient. This feedback indicated success.
Biofeedback was provided intermittently with an alternating 1-minute on and 1-minute off to reduce dependence on biofeedback and foster motor learning.
At the end of the gait training, results showed that patients demonstrated an increased push-off force on the affected leg. There was also an improvement in the walking pattern. The affected limb had a more substantial degree of swing to the back while the unaffected leg showed an increase in the step length.
Patients did not report any adverse effects or discomfort during the biofeedback training.
Although this study is interesting and the results are promising, only nine patients participated. Therefore, the results don’t necessarily apply to other patients with similar conditions. Researchers estimated the results after the biofeedback session. And since there is no data about long-term effects, further research is needed.
What does this study mean to you?
Some stroke rehabilitation programs incorporate biofeedback into their therapy. Take advantage of it primarily if your rehabilitation facility offers it.
There are biofeedback devices that you can purchase online to help improve the functionality of your affected limb. The most common ones are the electromyographic (EMG) biofeedback devices. Just like in the study, these devices make use of visual or audio signals to monitor muscle activity. Researchers believe that these devices can help patients learn how to use their affected leg more efficiently.
Many of these EMG devices can cost over $400. Major insurance providers like Aetna don’t cover them for post-stroke rehabilitation as they are considered experimental and investigational. Be sure to ask your provider for specific details about your coverage.
The lead author of this study is Katlin Genthe from the Division of Physical Therapy of the Emory University, Atlanta, GA.