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Principal Investigator: Taniel Solarnge Winner
Organization: EMORY UNIVERSITY
Fiscal Year: 2024
Award: $23,079
Funding agency: Eunice Kennedy Shriver National Institute of Child Health and Human Development
PROJECT SUMMARY/ABSTRACT
Stroke gait deficits are complex and marked by adverse effects on kinematics, kinetics, gait symmetry, and inter-
and intra- limb joint coordination across different phases of the gait cycle. One intervention simply cannot target
the high inter-individual variability of deficits observed in post-stroke gait. Approximately 2/3 of stroke survivors
have persistent gait impairments despite being discharged from rehabilitation, and one reason could be the lack
of tailored rehabilitation approaches to address their individual-specific impairments. The development of tailored
rehabilitation approaches, however, is limited by the lack of robust metrics to identify and analyze individual-
specific differences in gait. The objective of this work is to develop a sensitive, data-driven, consistent
characterization of gait using continuous, multi-joint gait dynamics. The dynamics of gait will be extracted from
measured kinematics (joint angles) and used to develop individual-specific gait characterizations, which we
coined the ‘gait signature.’ We will use these gait signatures to probe the mechanisms underlying stroke gait
impairment using rehabilitation techniques, specifically Fast functional electrical stimulation (FastFES). FastFES
is a gait rehabilitation intervention that targets ankle dorsiflexor muscles to address foot drop, and ankle
plantarflexor muscles to improve ankle torque at push-off. The literature suggests that response to FastFES
depends on the precise alignment between a specific muscle coordination deficit and the gait rehabilitation
modality. This suggests that knowledge of an individual’s specific gait impairment before rehabilitation can
predict their response to therapy. Since FastFES is known to target ankle deficits related to ankle push-off, I will
probe this theory and evaluate whether gait signatures can encode ankle push-off corrections in response to a
single session exposure to FastFES. I predict that stroke individuals with ankle-related push-off deficits will show
the greatest response or change in their gait signature towards normative (able-bodied) gait. Preliminary findings
show that gait signatures accurately discriminate between different stroke individuals. A noteworthy finding is
that our gait signatures do not appear to cluster according to walking speed, leading to our hypothesis that gait
signatures distinguish individual-specific differences in stroke gait corresponding to what we know about
heterogeneity in stroke gait impairments. We aim to determine the functional biomechanical relevance of various
clusters of gait signatures, and we will determine whether FastFES targets a specific cluster of individuals
depending on the biomechanical features, characteristics, or deficits that they have. Furthermore, we will
determine whether gait signatures before FastFES exposure can predict whether stroke-survivor will be a
potential responder to FastFES. If successful, gait signatures will prove to be a robust marker of specific gait
impairments and have important implications for the development of future tailored rehabilitation strategies for
stroke survivors.
Terms: <2-dimensional><3-Dimensional Euclidean Space><Abnormal gait><Address><Adverse effects><Affect><Ankle><Ankle dorsiflexor><Apoplexy><Ataxia><Ataxy><Bilateral><Biomechanics><Brain Vascular Accident><Case Series><Cerebral Stroke><Cerebrovascular Apoplexy><Cerebrovascular Stroke><Characteristics><Coin><Complex><Connectionist Models><Coordination Impairment><Coxa><Cross Sectional Analysis><Cross-Sectional Analyses><Cross-Sectional Studies><Cross-Sectional Survey><Data><Descriptor><Development><Disease Frequency Surveys><Dropfoot><Dyssynergia><Euclidean 3D Distance><Euclidean 3D Space><Euclidean Distance><Euclidean Feature Space><Euclidean Space><Exposure to><Extremities><Flexor><Foot-drop><Footdrop><Future><Gait><Gait abnormality><Gait disorder><Gait disturbances><Gait dysfunction><Gait impairment><Gait speed><Goals><Heterogeneity><Hip><Hip region structure><Impairment><Individual><Intervention><Intervention Strategies><Investigators><Joints><Kinetics><Knee><Knee joint><Knowledge><Learning><Limb structure><Limbs><Literature><Lower Extremity><Lower Limb><Maps><Measures><Medical Rehabilitation><Membrum inferius><Mentors><Modality><Modeling><Movement><Muscle><Muscle Paresis><Muscle Tissue><Muscular Paresis><Neural Network Models><Neural Network Simulation><Neuromechanics><Non-Trunk><Paresis><Perceptrons><Phase><Physics><Regio tarsalis><Rehabilitation><Rehabilitation therapy><Research><Research Personnel><Researchers><Sampling><Stroke><Study Subject><System><Techniques><Testing><Time><Torque><Training><Variant><Variation><Walking><Walking impairment><Work><after stroke><ankle joint dorsiflexor><biomechanic modeling><biomechanic simulation><biomechanical><biomechanical model><biomechanical modeling><biomechanical simulation><body movement><brain attack><cerebral vascular accident><cerebrovascular accident><chronic stroke><developmental><functional electrical stimulation><functional electrostimulation><gait recovery><gait rehab><gait rehabilitation><gait retraining><gait symmetry><gait training><improved><inter-individual variability><inter-individual variation><interindividual variability><interindividual variation><interventional strategy><kinematic model><kinematics><muscular><neural control><neural regulation><neuromechanical><neuromodulation><neuromodulatory><neuroregulation><paretic><paretic muscle><post stroke><poststroke><recurrent neural network><rehab strategy><rehab therapy><rehabilitation after stroke><rehabilitation strategy><rehabilitative><rehabilitative therapy><responders and non-responders><responders from non-responders><responders or non-responders><responders versus non-responders><responders vs non-responders><responders/nonresponders><response><response to therapy><response to treatment><stroke rehab><stroke rehabilitation><stroke survivor><stroked><strokes><support vector machine><theories><therapeutic response><therapy response><tool><treatment response><treatment responsiveness><two-dimensional><unsupervised clustering><walking pace><walking speed>