Abstract
Objectives
To examine the effects of walking on a treadmill at varying gradients and speeds on
ankle muscle activation in stroke survivors, and to compare the effect of increasing
speed on plantarflexor muscle activity in participants grouped according to spasticity
severity.
Design
Within-subject and cross-sectional design. Participants walked on a standard treadmill
at 3 different inclines (0°, 3°, 6°) and speeds (self-selected, self-selected+20%,
self selected+40%).
Setting
University laboratory.
Participants
A convenience sample of stroke survivors (N=19; 13 men, 6 women) available in university
clinics.
Interventions
Not applicable.
Main Outcome Measures
Electromyographic activity of medial gastrocnemius (MG) and tibialis anterior (TA)
muscles at push-off phase of the gait.
Results
Paretic MG muscle activity increased (but TA did not change) at faster speeds irrespective
of the incline (P<.05). In contrast, MG muscle activity increased at a higher incline in the nonparetic
side (P<.05), but not in the paretic side (P>.05). In the high-spasticity subgroup (Tardieu Scale ≥2), paretic MG activity increased
as walking speed increased (P=.004).
Conclusions
Stroke survivors appear to use distinct muscle activation strategies on the paretic
and nonparetic sides in response to different walking speeds and inclines. Our data
indicates that individuals with stroke can be safely trained on a treadmill to walk
20% to 40% above the self-selected pace to improve MG output without adversely affecting
TA output. The speed-dependent characteristic of spasticity may help generate greater
MG activity during push-off.
Keywords
List of abbreviations:
LMM (linear mixed model), MCo (muscle cocontraction), MG (medial gastrocnemius), MVC (maximum voluntary contraction), RMS (root mean square), ROM (range of motion), sEMG (surface electromyography), SSS (self-selected speed), TA (tibialis anterior)To read this article in full you will need to make a payment
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References
- Distribution of muscle strength impairments following stroke.Clin Rehabil. 2000; 14: 79-87
- Motor and sensory deficits following a stroke: relevance to a comprehensive evaluation.Physiother Can. 1986; 38: 29-34
- Muscle volume as a predictor of maximum force generating ability in the plantar flexors post-stroke.Muscle Nerve. 2013; 48: 971-976
- Relationships between muscle activity and anteroposterior ground reaction forces in hemiparetic walking.Arch Phys Med Rehabil. 2007; 88: 1127-1135
- Comparison of motor control deficits during treadmill and overground walking poststroke.Neurorehabil Neural Repair. 2011; 25: 756-765
- Plantarflexor weakness as a limiting factor of gait speed in stroke subjects and the compensating role of hip flexors.Clin Biomech (Bristol, Avon). 1999; 14: 125-135
- Gait differences between individuals with post-stroke hemiparesis and non-disabled controls at matched speeds.Gait Posture. 2005; 22: 51-56
- Changes in muscle group work associated with changes in gait speed of persons with stroke.Clin Biomech (Bristol, Avon). 2007; 22: 813-820
- The effects of sloped surfaces on locomotion: an electromyographic analysis.J Biomech. 2007; 40: 1276-1285
- Postural adaptation to walking on inclined surfaces: I. Normal strategies.Gait Posture. 2002; 15: 64-74
- Interactions between the human gastrocnemius muscle and the Achilles tendon during incline, level and decline locomotion.J Exp Biol. 2006; 209: 4379-4388
- Gait dynamics on an inclined walkway.J Biomech. 2006; 39: 2491-2502
- Gait muscle activity during walking on an inclined icy surface.Ind Health. 2008; 46: 15-22
- Task-specific modulation of cutaneous reflexes expressed at functionally relevant gait cycle phases during level and incline walking and stair climbing.Exp Brain Res. 2006; 173: 185-192
- Postural after-effects of stepping on an inclined surface.Neurosci Lett. 2007; 413: 93-98
- Mechanics and energetics of incline walking with robotic ankle exoskeletons.J Exp Biol. 2009; 212: 32-41
- Electromyography activity across gait and incline: the impact of muscular activity on human morphology.Am J Phys Anthropol. 2010; 143: 601-611
- Electromyographic kinesiology of lower extremity muscles during slope walking.Arch Phys Med Rehabil. 1985; 66: 610-613
- The influence of treadmill inclination on the gait of ambulatory hemiparetic subjects.Neurorehabil Neural Repair. 2007; 21: 76-80
- Adaptation of the walking pattern to uphill walking in normal and spinal-cord injured subjects.Exp Brain Res. 1999; 126: 359-368
- The effects of grade and speed on leg muscle activations during walking.Gait Posture. 2012; 35: 143-147
- Immediate effects of a single inclined treadmill walking session on level ground walking in individuals after stroke.Am J Phys Med Rehabil. 2012; 91: 337-345
- Speed-dependent treadmill training in ambulatory hemiparetic stroke patients: a randomized controlled trial.Stroke. 2002; 33: 553-558
- Effects of treadmill walking speed on lateral gastrocnemius muscle firing.Am J Phys Med Rehabil. 2004; 83: 507-514
- Modulation of leg muscle activity and gait kinematics by walking speed and bodyweight unloading.Gait Posture. 2006; 24: 35-45
- A closer look at electromyographic correlates of locomotor performance after stroke.Clin Neurophysiol. 2006; 117: 1-3
- Speed related changes in muscle activity from normal to very slow walking speeds.Gait Posture. 2004; 19: 270-278
- Recovery of gait after stroke: what changes?.Neurorehabil Neural Repair. 2008; 22: 676-683
- Coactivation during gait as an adaptive behavior after stroke.J Electromyogr Kinesiol. 2000; 10: 407-415
- Mechanisms of disturbed motor control in ankle weakness during gait after stroke.Gait Posture. 2002; 15: 244-255
- Muscle co-activation in neurological conditions.Phys Ther Rev. 2005; 10: 247-253
- Trunk and hip muscle activation patterns are different during walking in young children with and without cerebral palsy.Phys Ther. 2010; 90: 986-997
- Free(z)ing degrees of freedom in skill acquisition.J Mot Behav. 1992; 24: 133-142
- On the reflex coactivation of ankle flexor and extensor muscles induced by a sudden drop of support surface during walking in humans.J Appl Physiol. 2004; 96: 604-611
- Energy cost, mechanical work, and efficiency of hemiparetic walking.Gait Posture. 2003; 18: 47-55
- The control of muscle tone, reflexes, and movement: Robert Wartenberg Lecture.Neurology. 1980; 30: 1303-1313
- Applied multiple regression/correlation analysis for the behavioral sciences.3rd ed. Lawrence Earlbaum, Mahwah2003
- The post-stroke hemiplegic patient. 1. A method for evaluation of physical performance.Scand J Rehabil Med. 1975; 7: 13-31
- Measures of muscle and joint performance in the lower limb of children with cerebral palsy.Dev Med Child Neurol. 2003; 45: 664-670
- Faster is better: implications for speed-intensive gait training after stroke.Stroke. 2004; 35: 2543-2548
- Hospitalization for stroke in U.S. hospitals, 1989–2009. NCHS data brief, No. 95.National Center for Health Statistics, Hyattsville2012
- Classification of walking handicap in the stroke population.Stroke. 1995; 26: 982-989
- A comparison of gait biomechanics and metabolic requirements of overground and treadmill walking in people with stroke.Clin Biomech (Bristol, Avon). 2009; 24: 729-734
- Sensorimotor system measurement techniques.J Athl Train. 2002; 37: 85-98
- Influence of systematic increases in treadmill walking speed on gait kinematics after stroke.Phys Ther. 2011; 91: 392-403
- Minimal clinically important difference for comfortable speed as a measure of gait performance in patients undergoing inpatient rehabilitation after stroke.J Phys Ther Sci. 2013; 25: 1223-1225
- Factors related to community ambulation in patients with chronic stroke.Top Stroke Rehabil. 2015; 22: 63-71
- Lower limb co-contraction during walking in subjects with stroke: a systematic review.J Electromyogr Kinesiol. 2014; 24: 1-10
- Analysis of impairments influencing gait speed and asymmetry of hemiplegic patients after mild to moderate stroke.Arch Phys Med Rehabil. 2003; 84: 1185-1193
- Relief of hemiparetic spasticity by TENS is associated with improvement in reflex and voluntary motor functions.Electroencephalogr Clin Neurophysiol. 1992; 85: 131-142
- Analysis of the clinical factors determining natural and maximal gait speeds in adults with a stroke.Am J Phys Med Rehabil. 1999; 78: 123-130
- Short-term electrical stimulation enhances the effectiveness of botulinum toxin in the treatment of lower limb spasticity in hemiparetic patients.Neurosci Lett. 1995; 201: 37-40
- Low-dose botulinum toxin with ankle taping for the treatment of spastic equinovarus foot after stroke.Arch Phys Med Rehabil. 1998; 79: 532-535
- Ankle muscle activity before and after botulinum toxin therapy for lower limb extensor spasticity in chronic hemiparetic patients.Stroke. 1996; 27: 455-460
- Botulinum toxin treatment for lower limb extensor spasticity in chronic hemiparetic patients.J Neurol Neurosurg Psychiatry. 1994; 57: 1321-1324
- Speed-dependent reference joint trajectory generation for robotic gait support.J Biomech. 2014; 47: 1447-1458
- Excellent test-retest and inter-rater reliability for Tardieu Scale measurements with inertial sensors in elbow flexors of stroke patients.Gait Posture. 2011; 33: 185-189
Article info
Publication history
Published online: October 27, 2015
Footnotes
Supported by Tehran University of Medical Sciences (grant no. 92/D/130/1486).
Disclosures: C.P.P. reports a grant from Merz outside the submitted work. The other authors have nothing to disclose.
Identification
Copyright
© 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
