The purpose of this study is to gain insight into the effects of auditory pacing on the stability and flexibility of hemiplegic gait coordination. It will be examined how auditory pacing can be best administered to improve the quality of hemiplegic…
ID
Source
Brief title
Condition
- Central nervous system vascular disorders
- Vascular haemorrhagic disorders
Synonym
Research involving
Sponsors and support
Intervention
Outcome measures
Primary outcome
- Mean and variability of the discrete relative phase between instants of heel
strike and auditory stimuli;
- Adjustment time to the sudden change in auditory pacing stimuli as an index
of flexibility (i.e., an inverse measure of gait flexibility);
- largest Lyapunov exponent of the continuous relative Hilbert phase between
the feet (a measure of gait stability);
- gait parameters (e.g., steplength, steptime, temporal and spatial asymmetry)
based on kinematics of the feet;
Secondary outcome
Standard clinical measurement scales
Background summary
In gait rehabilitation following stroke, the use of external auditory rhythms
is a particular expedient means to improve the speed and appearance of
hemiplegic walking. However, hemiplegic gait patterns still remain asymmetric
with auditory pacing. Consequently, a perfect bilateral synchronization between
auditory stimuli and footfalls is inherently impossible. Previous studies
observed that stroke patients synchronized or timed the footfalls of their
non-paretic limb to the auditory stimuli. However, it remains open how the
auditory stimuli should be applied in order to obtain the best results, that
is, auditory stimuli can be provided according to the step or stride frequency.
For example, instructing hemiplegics to time or synchronize the heel strikes of
their paretic instead of their non-paretic leg to the pacing signal might
tentatively lead to a reduced gait asymmetry by increasing step length of the
paretic limb. Gait stability and flexibility might also be affected by auditory
pacing. With respect to the latter, it entails that the gait pattern can be
adjusted quick and adequately to sudden changes in the environment, such as
avoiding an obstacle on the side walk. Paced treadmill walking is ideally
suited to study (and practice) gait flexibility by suddenly changing the
consecutive interbeat interval of the pacing stimuli. The stroke patient is
instructed to adjust his gait to the altered pacing signal, for example, by
elongating step lengths or step intervals
Study objective
The purpose of this study is to gain insight into the effects of auditory
pacing on the stability and flexibility of hemiplegic gait coordination. It
will be examined how auditory pacing can be best administered to improve the
quality of hemiplegic gait. We expect that the results will contribute to a
better understanding of auditory-paced walking which might ultimately lead to
both evidence- and theory-based rehabilitation goals.
Study design
Hemiplegic gait patterns in treadmill walking with and without auditory stimuli
will be assessed in three sessions. The first session is used to accommodate to
treadmill walking and auditory-paced walking. The preferred walking speed and
the corresponding stride frequency will be determined. In addition, a physician
will assess standard clinical measurements. In the second session, gait
coordination will be studied in four experimental conditions: 1) bilateral
auditory pacing, 2) unilateral auditory pacing on the paretic side, 3)
unilateral auditory pacing on the non-paretic side and 4) no auditory pacing,
under the instruction to synchronize footfalls with pacing stimuli on the same
side. Besides these four conditions, the third session will also assess gait
flexibility in trials in which the temporal ordering of auditory stimuli is
suddenly changed. Participants are instructed to adjust to the altered rhythm
as soon as possible. All sessions take place at the Duyvensz-Nagel Research
Laboratory at the Rehabilitation Centre Amsterdam. The three sessions are
planned within three weeks.
Intervention
External auditory pacing during treadmill walking
Study burden and risks
The risks associated with participation are limited and comparable to normal
every-day walking. Participants will be allowed sufficient time and help to
practice and become acquainted with treadmill walking and auditory-paced
walking. For safety purposes, participants will wear a safety belt and are
accompanied by two persons alongside the treadmill (at least one physician).
Furthermore, an emergency button can be used by both the investigator and the
participant to immediately stop the treadmill. There are three sessions to
limit physical stress. During each session as many breaks are allowed as
desired by the participants. The total session time is about 1.5h, including
breaks.
van der Boechorststraat 9
1081 BT Amsterdam
Nederland
van der Boechorststraat 9
1081 BT Amsterdam
Nederland
Listed location countries
Age
Inclusion criteria
- Age 18+
- Ischemic or hemorage stroke (established by means of CT or MRI);
- Hemiplegic gait pattern
- Able to walk independently without aids; Functional Ambulation Score * 3. (FAC 3 <= supervision: patients requires for safety reasons verbal assitance of one person but can walk without physical assistance
- Able to walk for 3 minutes without walking aid such as a cane. However, ankle-foot ortheses are allowed.
Exclusion criteria
- Orthodpedic impairments of the lower extremity or other neurological impairments (not related to the Stroke) that may influence walking.
- Cognitive or mental impairments that undermine the understanding of the task instructions. Note that (light) neglect and afasia are not perse exclusion criteria as long as the patient is able to fully understand the instructions.
- Hearing deficit
Design
Recruitment
Followed up by the following (possibly more current) registration
No registrations found.
Other (possibly less up-to-date) registrations in this register
No registrations found.
In other registers
| Register | ID |
|---|---|
| CCMO | NL13293.029.06 |