Effect of lower limb exproprioception training in virtual environment on locomotion performance in stroke patients

Abstract

Introduction: Stroke is the most common reason causing adults losing their locomotion ability Motor impairment caused by stroke is one of the reasons affecting lower limb motor function In addition sensory deficit would limit the recovery of stroke patients’ motor function One of the sensory information needed for locomotion was rarely discussed in the past: exproprioception which is the ability to detect relative position orientation and movement of the body or an object in the environment This information is mainly obtained from vision which means that before conducting any locomotion activities in order to walk or cross an obstacle smoothly without looking at the feet one would need to obtain environmental information from vision first and then use exproprioception to locate our position in space However in clinical it can often be observed that the stroke patients look at their feet to avoid an obstacle or walk with a more symmetrical gait pattern It may be because that stroke patients usually use their visual exproprioception but not non-visual exproprioception to conduct locomotion activities Therefore the study was designed to investigate the effect of visual or non-visual exproprioception training on exproprioception ability and functional mobility such as walking crossing and targeted walking ability in stroke patients Methods: Twenty-six chronic stroke patients were recruited from National Cheng Kung University Hospital and Tainan Hospital They were randomized into experimental group (non-visual exproprioception training) or control group (visual exproprioception training) to receive 4-time training in two weeks The participants were required to perform exproprioception tests including pointing and foot-matched tasks and functional movement tests including walking crossing and targeted walking tasks before after and two weeks after post-test The toe error distance and toe variation were calculated in the exproprioception test and targeted walking test; the toe clearance post distance and toe variation were calculated in crossing tests; and the symmetry index of step length single limb support time swing time and double limb support time gait speed and step width were calculated in walking tests Mann-Whitney test was used to compare the differences of baseline performance between the two groups at pre-test Wilcoxon signed rank test was used to examine the within group difference: post-test perform compared to pre-test and follow-up performance compared to pre-test Results: The results showed that the experimental group significantly improved the performance of pointing test crossing and targeted walking on horizontal plane at post-test compared to pre-test In addition the symmetry index of the step length single limb support time and swing time during walking were significantly decreased in the experimental group at post-test compared to pre-test The control group significantly improved only in non-affected toe error distance of looking down targeted walking and error distance of eye close sagittal pointing test Conclusion: Stroke patients’ non-visual exproprioception ability of the non-affected foot on the horizontal plane could be trained and can effectively improve their functional activities ability

Date of Award	2020
Original language	English
Supervisor	Pei-Yun Lee (Supervisor)