Damage to the upper motor neuron, gait, apparatus systems

Address of the IT system with evidence of the contribution of the research activity and evidence of social impact

Free access to articles:

The use of a treadmill with biofeedback function in learning to walk in patients after stroke in the chronic period:

The use of a treadmill with biofeedback function in learning to walk in patients after stroke in the subacute period:

https://www.hindawi.com/journals/bmri/2018/3812602/

Relationships between walking speed, gait efficiency and symmetry of space-time parameters in people after stroke in the chronic period:

http://www.actabio.pwr.wroc.pl/Vol19No3/16.pdf

Evaluation of two post-stroke gait training models: conventional therapy and treadmill exercises:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6548526/

The use the Wisconsin Gait Scale Observational Scale:

The use of a robot (Lokomat) in learning to walk in children and adolescents with cerebral palsy

The use of exoskeleton robots in learning to walk in people with multiple sclerosis

https://www.archives-pmr.org/article/S0003-9993(20)31224-7/fulltext - in press

Social impact description title

Apparatus systems in the improvement and learning of gait of persons after damage to the central nervous system

1.Contribution of scientific activity

In the years 2010-2013, a research project of the Ministry of Science and Higher Education entitled “Study of the effectiveness of rehabilitation of patients with post-stroke hemiparesis treated in late period with the use of biofeedback methods” (Reg. No. N N 404 249639). The research team consisted of the Project Manager: prof. dr hab. n. med. Andrzej Kwolek, Contractors: dr Mariusz Drużbicki, dr Grzegorz Przysada, and mgr Agnieszka Guzik, mgr Agnieszka Brzozowska-Magoń. The implementation of the project made it possible to evaluate the effectiveness of exercises with the use of biological feedback in learning gait and balance in patients with paresis after stroke, to assess the level and durability of the effects achieved depending on the intensity of the stimulus used, and to develop methodological principles of gait training with the use of biological feedback.

The results of the research showed that people after a stroke can improve their mobility also in the period after the onset of a stroke, if they receive an intensified gait and balance re-education program supplemented with training using biological feedback. The biofeedback method has been shown to be an effective form and complement to the rehabilitation program. In 2011, two contractors of the research project were approved for the opening of doctoral dissertations: Agnieszka Guzik, MA, thesis entitled "Evaluation of the effectiveness of treadmill training with biological feedback in patients with paresis after stroke"; Agnieszka Brzozowska-Magoń, MA, thesis entitled "The impact of rehabilitation using a signal cane and a static-dynamic parapodium with a biofeedback function on the functional fitness of walking and balance in people after stroke”. Research results have been presented at international conferences and published in prestigious scientific journals. The study assessing the effects of learning to walk in children with cerebral palsy using the Lokomat robot was one of the first randomized trials. The obtained results did not show a higher improvement in gait compared to conventional physiotherapy, but indicated that the method is acceptable and feasible in this group of disabled people. The results of the study were published in prestigious journals Drużbicki et al. (H-index - 8 according to Scopus). Published in 2013 in the Journal of Rehabilitation Medicine "Functional effects of robotic-assisted locomotor treadmill therapy in children with cerebral palsy", it was cited around the world (Cited by 51 documents, Scopus).

Conferences:

1st European NeuroRehabilitation Congress The Kurhaus Meran, Merano, Italy October 20-22, 2011. 7th Scientific Conference of the Department of Physiotherapy at the Higher School of Management and Administration in Zamość, “Modern clinimetry and methods of objective evaluation of the effects of rehabilitation”, Zamość, November 18, 2011.
XIV Scientific and Training Symposium PTReh, Chorzów / Katowice, September 16-17, 2011.
IX Scientific Conference of the Institute of Physiotherapy of the University of Rzeszów, Myczkowce, June 18-19, 2011.
4th International Rehabilitation Days "Needs and standards of rehabilitation in diseases and after injuries of the central nervous system", February 16-17, 2012 Rzeszów.
VIII International Congress of the Polish Rehabilitation Society "Contemporary trends in rehabilitation after multi-organ injuries", Poznań, 5-7 September 2013.
World Congress of International Society of Physical and Rehabilitation Medicine (ISPRM 2013), Beijing, China June 16-20, 2013.

2.Evidences of the contribution of scientific activity

Drużbicki M, Guzik A, Przysada G, Kwolek A, Brzozowska-Magoń A. Efficacy of gait training using a treadmill with and without visual biofeedback in patients after stroke: A randomized study. Journal of Rehabilitation Medicine 2015; 47(5):419-25. DOI:10.2340/16501977-1949 (MNiSW: 35; IF: 1,595)
Drużbicki M, Guzik G, Przysada G, Kwolek A, Brzozowska-Magoń A, Sobolewski M. Changes in Gait Symmetry After Training on a Treadmill with Biofeedback in Chronic Stroke Patients: A 6-Month Follow-Up From a Randomized Controlled Trial. Med Sci Monit 2016; 22: 4859-4868. DOI: 10.12659/MSM.898420 (MNiSW: 20; IF: 1,585)
Drużbicki M, Przysada G, Guzik A, Kwolek A, Brzozowska-Magoń A, Sobolewski M. Evaluation of the impact of exercise of gait on a treadmill on balance of people who suffered from cerebral stroke. Acta of Bioengineering and Biomechanics 2016; 18,4: 41-48. (MNiSW 15; IF 0,914)
Drużbicki M, Przysada G, Guzik A, Brzozowska-Magoń A, Kołodziej K, Wolan-Nieroda A, Majewska J, Kwolek A. The Efficacy of Gait Training Using a Body Weight Support Treadmill and Visual Biofeedback in Patients with Subacute Stroke: A Randomized Controlled Trial. Biomed Res Int. 2018;5;2018:3812602. doi: 10.1155/2018/3812602. (MNiSW 25; IF 2,197)
Drużbicki M, Rusek W, Snela S, Dudek J, Szczepanik M, Zak E, Durmala J, Czernuszenko A, Bonikowski M, Sobota G. Functional effects of robotic-assisted locomotor treadmill thearapy in children with cerebral palsy. Journal of Rehabilitation Medicine 2013; 45(4):358-63. (MNISW 35; IF 1,895)

3.Characteristics of the social impact

In Poland, a stroke affects about 80,000 persons every year. It is estimated that two-thirds of stroke survivors will have functional limitations and will need rehabilitation. One of the most serious consequences of a stroke is the loss of gait function. The lack of independent, safe walking eliminates or significantly limits the patient in the implementation of basic and complex daily activities. In people with paresis after stroke, while standing and walking, asymmetry and shift of the load on the limbs and the center of gravity of the body towards the unaffected limb are observed. Lower extremity load asymmetry significantly increases the risk of falls, osteoporotic lesions and fractures. Limb load symmetry disturbance and stride length asymmetry are one of the main disturbances in the symmetry of the gait pattern in people with hemiparesis after stroke. The foundation of rehabilitation programs for people after stroke is achieving maximum functional fitness, which directly depends on safe and effective walking. Recreating the gait function is a basic physiotherapy, but also modern apparatus systems and techniques supporting motor learning, such as biofeedback. Additional external information provided directly or indirectly during movement learning allows for better programming and planning of a pattern close to the correct one. Training with the use of biofeedback makes it easier to activate and control movement. Through a clear form of additional visual or acoustic information, archiving and easy comparison of results, it is possible to effectively strengthen the patient's motivation to continue participating in the therapy.

The presented research presents the methodology of gait training with the use of a treadmill with the biofeedback function. Its main points are the duration of a single session not shorter than 30 to 45 minutes, the frequency of 5 times a week and the total duration of not less than 2 weeks. The series of the above works complements the knowledge about the methods of physiotherapy used in learning to walk in people after stroke. The results of the presented studies on people after stroke clearly indicate that the method of learning to walk on a treadmill with visual biofeedback function is an effective method of re-education of gait function in people in the chronic period after stroke. It should be emphasized that the results refer only to people with the ability to walk independently. Thus, the method facilitates the improvement of gait in terms of its speed and distance, and the quality expressed by the reduction of the asymmetry of time and space parameters, mainly the asymmetry of the stride length, which may be important in reducing the risk of falls and bone fractures in people with hemiparesis after stroke.

It has been shown that the assessment of the asymmetry of the gait patterns of people after stroke in terms of time-space, kinetic and kinematic parameters is an objective method of describing the level of motor control, gait disturbances and the evaluation of rehabilitation progress. Observational gait rating scales such as the Wisconsin Gait Scale provide a qualitative gait assessment based on the assessment of differences in gait pattern. The result of the assessment on the WGS scale is repeatable, the scale is easy to apply and, importantly, the result is consistent with the instrumental assessment, including the 3D assessment. The scale can therefore be a simple replacement for expensive systems used in everyday rehabilitation practice. The methodological principles of walking learning with the use of biological feedback after a stroke developed as part of the project were implemented (as standard) in the Rehabilitation Clinic of the Provincial Hospital No. 2 in Rzeszów. The results of the published studies closely correspond and are proactive with the recommendation of the POLKARD program, which recommends equipping neurological rehabilitation departments with devices for balance exercises and gait training, equipped with visual and acoustic biofeedback systems.

Robots are used in rehabilitation to provide the practitioner with well-defined motor stimuli (movements) that are repetitive and precise. The robots cooperating with the treadmill and the relief system allow you to walk at higher speeds and over longer distances with a much higher number of repetitions compared to conventional procedure. Gait training conducted with the use of a robot and with the active participation of the patient can induce plasticity of the central nervous system. Robots are a new, promising technological solution in neurorehabilitation. Conclusions from the conducted study helped in making decisions regarding the planning of a rehabilitation program for children with cerebral palsy. Multi-year therapeutic programs for children with cerebral palsy in which gait robots are used are currently being implemented. One of the centers is a rehabilitation center headed by one of the authors of the pioneering research carried out in 2013. The results of the research, both evaluating the biofeedback method and gait support robots, were included in systematic reviews and meta-analyzes, which were implemented in clinical applications.

4.Evidences of social impact (up to 5 evidences from 2017-2020) with the date of the evidence

Tabea Aurich-Schuler, Birgit Warken, Judith V Graser, Thilo Ulrich, Ingo Borggraefe, Florian Heinen 1, Andreas Meyer-Heim 2, Hubertus J A van Hedel 2, A Sebastian Schroeder 1Practical Recommendations for Robot-Assisted Treadmill Therapy (Lokomat) in Children with Cerebral Palsy: Indications, Goal Setting, and Clinical Implementation within the WHO-ICF Framework Neuropediatrics 2015;46(4):248-60. doi: 10.1055/s-0035-1550150. https://pubmed.ncbi.nlm.nih.gov/26011438/

Rosalyn Stanton, Louise Ada, Catherine M Dean, Elisabeth Preston. Biofeedback improves performance in lower limb activities more than usual therapy in people following stroke: a systematic review. Journal of Physiotherapy 2017;63,1:11-16.DOI: 10.1016/j.jphys.2016.11.006 https://www.sciencedirect.com/science/article/pii/S1836955316300881

Sophie Lefmann, Remo Russo, Susan Hillie. The effectiveness of robotic-assisted gait training for paediatric gait disorders: systematic review. J Neuroeng Rehabil. 2017;14,1. doi: 10.1186/s12984-016-0214-x

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5217646/

Mehrholz J, Simone Thomas, Bernhard Elsner. Treadmill training and body weight support for walking after stroke. Cochrane Database Syst Rev. 2017; 2017(8): CD002840. doi: 10.1002/14651858.CD002840.pub4

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6483714/

Guzik A, Drużbicki M, Wolan-Nieroda A. Assessment of two gait training models: conventional physical therapy and treadmill exercise, in terms of their effectiveness after stroke Hippokratia 2018, 22(2):51-59, ISSN: 1108-4189 (MNiSW 20; IF 0.520).

5.Justification of the interdisciplinary nature of scientific activity of groundbreaking importance for the development of science

The research activity undertaken by the team is an interdisciplinary activity. Teams representing medical sciences and health sciences defined the need to introduce a diagnostic and therapeutic tool into practice based on their clinical experience and the latest knowledge. The clinical trial was carried out by scientists representing medical sciences and health sciences, and the obtained solution has features of interdisciplinarity, as it covers 3 scientific disciplines: health sciences, medical sciences and physical culture sciences. The team of researchers in terms of professional practice is also interdisciplinary. Scientists are also practitioners. Working in rehabilitation clinics and working with patients with neurological dysfunctions allows us to transfer scientifically proven results to practice. A strong example is the biofeedback method used in learning to walk in people after stroke, which is included in the standard of rehabilitation procedures at the Rehabilitation Clinic, which is managed by one of the members of the scientific team.