Early study shows shoe attachment can help stroke patients improve their gait

December 14, 2017, University of South Florida
Dr. Kim helps a patient try the GEMS shoe attachment. Credit: University of South Florida

A new device created at the University of South Florida – and including a cross-disciplinary team of experts from USF engineering, physical therapy and neurology – is showing early promise for helping correct the signature limp experienced by many stroke survivors.

Called the Gait Enhancing Mobile Shoe (GEMS), the shoe attachment is the result of multidisciplinary work and expertise in USF's engineering, , and neurology programs.

In addition to offering good outcomes for improving their gait and balance, a preliminary study is showing the shoe also provides several advantages over a current rehabilitation tool – the split-belt treadmill – including lower cost, greater convenience, and mobility.

"This is early in the process but we're seeing the benefits we expected so it's very promising," said Kyle Reed, PhD, associate professor in the Department of Mechanical Engineering in the USF College of Engineering and principal investigator for the preliminary study on GEMS.

"We really want to help people who are limited in their walking ability to improve enough so they can return to the activities of their daily lives. The long-term hope is that this shoe attachment could be less expensive and safe enough that, once trained on how to use it, patients could take the GEMS home for therapy."

Credit: University of South Florida

Reed developed the GEMS shoe along with Seok Hun Kim, PT, PhD, associate professor in the School of Physical Therapy and Rehabilitation Sciences in the USF Health Morsani College of Medicine and co-principal investigator for the GEMS study. In 2010, Dr. Reed received funding from the National Institutes of Health to conduct a clinical trial of a small group of trying the GEMS; the study is not for severe stroke survivors, but mild to moderate stroke survivors.

The study also includes USF Health stroke expert David Z. Rose, MD, associate professor in the Department of Neurology in the USF Health Morsani College of Medicine, who said he sees the GEMS as a great potential option for stroke patients to improve their mobility.

"Many stroke patients are devastated that their ability to walk on their own can be so limited, even around their own homes," Dr. Rose said. "Early data for the GEMS is very promising and the next phases of study will really help us see its true potential."

Many stroke patients develop an asymmetric gait because of damage to their central nervous system, resulting in difficulty moving their affected leg – they can't extend their foot backward enough, which prevents natural pushing off into the swing phase experienced in an unaffected walk.

Credit: University of South Florida

Typical stroke rehabilitation to improve gait symmetry involves using a split-belt treadmill that offers two independent belts operating at different speeds to exaggerate the asymmetry of the patient's gait.

But an odd yet natural thing happens when patients leave the treadmill – their brain returns to a fixed-floor state and they regress, with many finding it difficult to recreate the gait correction on solid ground, a regression that is called an after effect.

While generally successful for improving stroke patients' gaits, the split-belt treadmill is expensive, requires a dedicated space to house and a qualified staff to monitor sessions and, because of after effect, can require more time for patients to master the correction, said Seok Hun Kim, PT, PhD, associate professor in the School of Physical Therapy and Rehabilitation Sciences in the USF Health Morsani College of Medicine.

"The GEMS allows movement across any safe surface, thus 'rewiring' the brain to learn the new compensation technique for everyday walking, not just for when they are on the treadmill," Dr. Kim said.

Credit: University of South Florida
"The GEMS is generally worn on the unaffected side, helping the patient use their affected side to compensate for the irregular footing."

While early results of this preliminary study are showing strong support for a successful approach to improving the of stroke patients, more detailed study with more will be necessary. Dr. Kim said a full study, one that compares to the current approach with the split-belt treadmill, is critical before clinicians adjust their approach.

Explore further: American Stroke Association offers new stroke rehabilitation toolkits

Related Stories

American Stroke Association offers new stroke rehabilitation toolkits

September 19, 2017
The American Heart Association/American Stroke Association (AHA/ASA), the world's leading voluntary organization dedicated to building healthier lives, free of cardiovascular diseases and stroke, has developed new stroke ...

Aquatic treadmill walking may increase exercise capacity after stroke

August 23, 2016
For patients in rehabilitation after a stroke, walking on an underwater treadmill produces better measures of exercise performance compared to conventional treadmill walking, reports a study in the American Journal of Physical ...

Post-stroke patients reach terra firma with new exosuit technology

July 26, 2017
Upright walking on two legs is a defining trait in humans, enabling them to move very efficiently throughout their environment. This can all change in the blink of an eye when a stroke occurs. In about 80% of patients post-stroke, ...

Clinicians should pay attention to stroke patients who cannot walk at 3-6 month after onset

July 11, 2013
Gait dysfunction is one of the most serious disabling sequelae of stroke. Regaining gait ability in stroke is a primary goal of neurorehabilitation. Furthermore, gait is a less demanding motor function than hand function.

High-intensity interval training benefits chronic stroke patients

February 12, 2015
High-intensity interval training is a promising rehabilitation strategy for chronic stroke patients and may be superior to the current guidelines of moderate-intensity continuous exercise, new research from the University ...

Recommended for you

Higher risk of heart attack on Christmas Eve

December 12, 2018
The risk of heart attack peaks at around 10pm on Christmas Eve, particularly for older and sicker people, most likely due to heightened emotional stress, finds a Swedish study in this week's Christmas issue of The BMJ.

Your weight history may predict your heart failure risk

December 12, 2018
In a medical records analysis of information gathered on more than 6,000 people, Johns Hopkins Medicine researchers conclude that simply asking older adult patients about their weight history at ages 20 and 40 could provide ...

Age is the biggest risk for heart disease, but lifestyle and meds have impact

December 12, 2018
Of all the risk factors for heart disease, age is the strongest predictor of potential trouble.

New understanding of mysterious 'hereditary swelling'

December 12, 2018
For the first time ever, biomedical researchers from Aarhus University, Denmark, report cellular defects that lead to a rare disease, hereditary angioedema (HAE), in which patients experience recurrent episodes of swelling ...

Macrophage cells key to helping heart repair—and potentially regenerate, new study finds

December 11, 2018
Scientists at the Peter Munk Cardiac Centre have identified the type of cell key to helping the heart repair and potentially regenerate following a heart attack.

Research team traces pathway to cardioprotection in post-ischemic heart failure

December 11, 2018
During an ischemic attack, the heart is temporarily robbed of its blood supply. The aftermath is devastating: reduced heart contractility, heart cell death, and heart failure. Contributing to these detrimental changes is ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.