Statistical Parametric Mapping (SPM 1D) for Stroke and Trans-tibial Amputation

Study Overview
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Brief Summary
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Gait analysis is commonly performed in clinical practice. However, it is complex and requires an understanding of the activation of muscles in lower limbs, trunk, and upper limbs in a specific spatiotemporal pattern and the appropriate joint positions which support and advance the body weight in different phases of gait cycles. In study, we plan to pilot the application of 3D gait analysis with statistical modelling in 2 common causes of gait deviation: unilateral hemiplegic stroke and unilateral lower limb amputation.

Detailed Description
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This is a pilot study on the use of 3D gait analysis using motion capture in combination with Statistical Parametric Mapping in patients with unilateral hemiplegic stroke and unilateral lower limb amputation. Data collected will then be compared against a normative dataset. The findings from this study will then be used to build a decision support tool in combination with clinical analysis which could focus clinical recommendations for gait training, physical therapy, exercise and orthotics prescription to reduce unnecessary joint forces in affected and unaffected segments.

Official Title
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Guiding Best Practice Clinical Care With In-Silico Rehabilitation and Statistical Parametric Mapping (SPM 1D) for Unilateral Chronic Hemiparetic Stroke and Trans-tibial Amputation: An Exploratory Clinical Study

Conditions
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Stroke, Amputation

Intervention / Treatment
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* Diagnostic Test: 3D Gait Analysis with Statistical Parametric Mapping


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria for stroke patients: First ever chronic unilateral hemiparetic stroke subjects, with stroke diagnosed by a physician and confirmed via CT/MRI >6 months post stroke ambulant with at most contact guard/standby supervision with/without walking aid during the study 10m Walk Test >/=0.2m/s and 6min Walking test walking distance of >/=50m without rest stop, with Functional Ambulation Category of >/=4 ((Holden et al, 1994) AMT>6 able to understand study procedures and sign informed consent able to attend a single 2.5h session of research data collection. Inclusion Criteria for amputee patients: First ever chronic unilateral transtibial amputee subjects intact residual limb > 6 months post amputation ambulant with at most contact guard/standby supervision with/without walking aid during the study 10m Walk Test >/=0.2m/s and 6min Walking test walking distance of >/=50m without rest stop with Medicare K level of >1 AMT>6 able to understand study procedures and sign informed consent able to attend a single 2.5h session of research data collection. Exclusion Criteria: Unstable recent cardiorespiratory conditions including uncontrolled hypertension/ hypotension, angina pectoris, myocardial infarction, active congestive cardiac failure, untreated cardiac arrhythmias (e.g. atrial fibrillation), untreated pulmonary embolism or deep vein thrombosis, presence of cardiac pacemaker. Functional status: severe aphasia or neglect (inability to obey 1 steps command), communication disorder precluding understanding of instructions, cognitive impairment, dementia, untreated depression or psychiatric disorder. End stage conditions such as medical instability or orthostatic insufficiency, organ, renal, liver, heart failure and life expectancy <6 months or on haemodialysis. Pregnancy. Local limb conditions which could be exacerbated by research interventions such as open wounds, ulcers, stump pain or stump wounds/ulcers, neuromas in amputees, active arthritis or joint or limb pain. Skin conditions which could be worsened by application of adhesive skin markers such as uncontrolled eczema, psoriasis, fungal or bacterial infections etc.

Ages Eligible for Study
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Minimum Age: 21 Years

Sexes Eligible for Study
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All

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Stroke<br>Unilateral hemiplegic stroke patients | Diagnostic Test: 3D Gait Analysis with Statistical Parametric Mapping<br>* A 3D motion capture system will be used for gait analysis. Vector field statistics will be used to simplify the clinical interpretation of time varying movement patterns.<br>|
| Amputee<br>Unilateral transtibial amputee patients | Diagnostic Test: 3D Gait Analysis with Statistical Parametric Mapping<br>* A 3D motion capture system will be used for gait analysis. Vector field statistics will be used to simplify the clinical interpretation of time varying movement patterns.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Body movement assessed by a motion capture system | Direction and magnitude of each body movement will be combined to provide graphical data on a motion capture system | Assessed within 1 year after patient recruitment | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Fugl Meyer Assessment | Functional score for stroke patients. Minimum: 0, Maximum: 226, with higher score indicating better function | Assessed within 1 year after patient recruitment | 
| Stroke Impact Scale | Functional score for stroke patients. Minimum:1, Maximum: 5, with higher score indicating higher impairment | Assessed within 1 year after patient recruitment | 
| Amputee Mobility Predictor with prosthesis | Functional score for amputation patients. Minimum: 0, Maximum: 47, with higher score indicating better function. | Assessed within 1 year after patient recruitment |