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Effects of Treadmill Incline and Speed on Ankle Muscle Activity in Subjects After a Stroke

  • Roghayeh Mohammadi
    Affiliations
    Physical Therapy Department, Rehabilitation Faculty, Tehran University of Medical Sciences, Tehran, Iran
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  • Saeed Talebian
    Affiliations
    Physical Therapy Department, Rehabilitation Faculty, Tehran University of Medical Sciences, Tehran, Iran
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  • Chetan P. Phadke
    Affiliations
    Spasticity Research Program, West Park Healthcare Centre, York, Ontario, Canada

    Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada

    Faculty of Health, York University, Toronto, Ontario, Canada
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  • Mir Saeed Yekaninejad
    Affiliations
    Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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  • Mohammad-Reza Hadian
    Correspondence
    Corresponding author Mohammad-Reza Hadian, PhD, Professor, Faculty of Rehabilitation, Brain and Spinal Injury Research Center, Imam Hospital, Tehran University of Medical Sciences, PO Box 16535-188, Piche Shemiran, Enghelab Ave, Tehran, Iran.
    Affiliations
    Physical Therapy Department, Rehabilitation Faculty, Tehran University of Medical Sciences, Tehran, Iran

    Faculty of Rehabilitation, Brain and Spinal Injury Research Center, Imam Hospital, Tehran University of Medical Sciences, International Campus, Tehran, Iran
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Published:October 27, 2015DOI:https://doi.org/10.1016/j.apmr.2015.10.088

      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)
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