Advertisement

Motor Planning for Loading During Gait in Subacute Stroke

Published:November 26, 2015DOI:https://doi.org/10.1016/j.apmr.2015.11.003

      Abstract

      Objectives

      To determine the characteristics of motor planning surrounding initial contact during gait through examination of thigh muscle timing, amplitude, and co-contraction of the paretic and nonparetic limbs in people poststroke, and to investigate whether muscle timing, amplitude, and clinical performance measures of balance and mobility differ based on the level of co-contraction.

      Design

      Observational study.

      Setting

      University-based research laboratory.

      Participants

      Individuals (n=27) in the subacute phase after stroke and healthy controls (n=8) (N=35).

      Interventions

      Not applicable.

      Main Outcome Measures

      Timing (onset and offset) and normalized amplitude (percent electromyography maximum) of the biceps femoris (BF) and rectus femoris (RF) muscles were measured during terminal swing and early stance. A co-contraction index (CCI) was calculated for the BF and RF muscle activity. Individuals with CCI values equal to or below the mean of the healthy group were in the low CCI group, whereas those with values above the mean were in the high CCI group. Functional balance and mobility evaluation used the Community Balance and Mobility Scale (CB&M).

      Results

      For the paretic and nonparetic limbs, measures of timing, amplitude, and co-contraction were similar for both limbs. Compared with the healthy group, the high CCI group had lower CB&M scores, longer durations, and higher levels of RF and BF muscle activity, whereas the low CCI group had electromyographic measures statistically similar to healthy controls.

      Conclusions

      The motor control of gait after subacute stroke is characterized by symmetry of timing and amplitude of muscle recruitment at the knee. High co-contraction levels surrounding the knee were associated with lower functional balance and mobility. These findings suggest a compensatory strategy of increased co-contraction in those with more impairment while maintaining symmetry of lower-limb biomechanics between limbs.

      Keywords

      List of abbreviations:

      ANOVA (analysis of variance), BF (biceps femoris), CB&M (Community Balance and Mobility Scale), CCI (co-contraction index), CMSA (Chedoke-McMaster Stroke Assessment), iEMG (integrated electromyography), RF (rectus femoris)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Bowen A.
        • Wenman R.
        • Mickelborough J.
        • Foster J.
        • Hill E.
        • Tallis R.
        Dual-task effects of talking while walking on velocity and balance following a stroke.
        Age Ageing. 2001; 30: 319-323
        • Canning C.G.
        • Ada L.
        • Paul S.S.
        Is automaticity of walking regained after stroke?.
        Disabil Rehabil. 2006; 28: 97-102
        • Yang Y.R.
        • Chen Y.C.
        • Lee C.S.
        • Cheng S.J.
        • Wang R.Y.
        Dual-task-related gait changes in individuals with stroke.
        Gait Posture. 2007; 25: 185-190
        • Duncan P.W.
        • Goldstein L.B.
        • Matchar D.
        • Divine G.W.
        • Feussner J.
        Measurement of motor recovery after stroke. Outcome assessment and sample size requirements.
        Stroke. 1992; 23: 1084-1089
        • Dobkin B.H.
        Training and exercise to drive poststroke recovery.
        Nat Clin Pract Neurol. 2008; 4: 76-85
        • Weerdesteyn V.
        • de Niet M.
        • van Duijnhoven H.J.
        • Geurts A.C.
        Falls in individuals with stroke.
        J Rehabil Res Dev. 2008; 45: 1195-1213
        • Perry J.
        Gait analysis: normal and pathological function.
        SLACK Inc, Thorofare2010
        • Schmitz A.
        • Silder A.
        • Heiderscheit B.
        • Mahoney J.
        • Thelen D.G.
        Differences in lower-extremity muscular activation during walking between healthy older and young adults.
        J Electromyogr Kinesiol. 2009; 19: 1085-1091
        • Garland S.J.
        • Gray V.L.
        • Knorr S.
        Muscle activation patterns and postural control following stroke.
        Motor Control. 2009; 13: 387-411
        • Rosa M.C.
        • Marques A.
        • Demain S.
        • Metcalf C.D.
        Lower limb co-contraction during walking in subjects with stroke: a systematic review.
        J Electromyogr Kinesiol. 2014; 24: 1-10
        • Den Otter A.R.
        • Geurts A.C.
        • Mulder T.
        • Duysens J.
        Abnormalities in the temporal patterning of lower extremity muscle activity in hemiparetic gait.
        Gait Posture. 2007; 25: 342-352
        • Miller K.J.
        • Hunt M.A.
        • Pollock C.L.
        • Bryant D.
        • Garland S.J.
        Protocol for a randomized controlled clinical trial investigating the effectiveness of Fast muscle Activation and Stepping Training (FAST) for improving balance and mobility in sub-acute stroke.
        BMC Neurol. 2014; 14: 187
        • Gowland C.
        • Stratford P.
        • Ward M.
        • et al.
        Measuring physical impairment and disability with the Chedoke-McMaster Stroke Assessment.
        Stroke. 1993; 24: 58-63
        • Yavuzer G.
        • Selles R.
        • Sezer N.
        • et al.
        Mirror therapy improves hand function in subacute stroke: a randomized controlled trial.
        Arch Phys Med Rehabil. 2008; 89: 393-398
        • Bang D.H.
        • Shin W.S.
        • Choi S.J.
        The effects of modified constraint-induced movement therapy combined with trunk restraint in subacute stroke: a double-blinded randomized controlled trial.
        Clin Rehabil. 2015; 29: 561-569
        • Agrell B.
        • Dehlin O.
        Mini mental state examination in geriatric stroke patients. Validity, differences between subgroups of patients, and relationships to somatic and mental variables.
        Aging (Milano). 2000; 12: 439-444
        • Gray V.L.
        • Ivanova T.D.
        • Garland S.J.
        Effects of fast functional exercise on muscle activity after stroke.
        Neurorehabil Neural Repair. 2012; 26: 968-975
        • Portney L.
        • Watkins M.
        Foundations of clinical research: applications to practice.
        Julie Levin Alexander, Upper Saddle River2009
        • Pollock C.
        • Eng J.
        • Garland S.
        Clinical measurement of walking balance in people post stroke: a systematic review.
        Clin Rehabil. 2011; 25: 693-708
        • Knorr S.
        • Brouwer B.
        • Garland S.J.
        Validity of the Community Balance and Mobility Scale in community-dwelling persons after stroke.
        Arch Phys Med Rehabil. 2010; 91: 890-896
        • Kadaba M.P.
        • Ramakrishnan H.K.
        • Wootten M.E.
        • Gainey J.
        • Gorton G.
        • Cochran G.V.
        Repeatability of kinematic, kinetic, and electromyographic data in normal adult gait.
        J Orthop Res. 1989; 7: 849-860
      1. Orthotrak 6.6 gait analysis software user manual. Motion Analysis Corp, Santa Rosa2009
        • Sousa A.S.
        • Silva A.
        • Santos R.
        Ankle anticipatory postural adjustments during gait initiation in healthy and post-stroke subjects.
        Clin Biomech (Bristol, Avon). 2015; 30: 960-965
        • Rudolph K.S.
        • Axe M.J.
        • Snyder-Mackler L.
        Dynamic stability after ACL injury: who can hop?.
        Knee Surg Sports Traumatol Arthrosc. 2000; 8: 262-269
        • Kean C.O.
        • Birmingham T.B.
        • Garland J.S.
        • et al.
        Moments and muscle activity after high tibial osteotomy and anterior cruciate ligament reconstruction.
        Med Sci Sports Exerc. 2009; 41: 612-619
        • Ramsay J.W.
        • Barrance P.J.
        • Buchanan T.S.
        • Higginson J.S.
        Paretic muscle atrophy and non-contractile tissue content in individual muscles of the post-stroke lower extremity.
        J Biomech. 2011; 44: 2741-2746
        • Raja B.
        • Neptune R.R.
        • Kautz S.A.
        Coordination of the non-paretic leg during hemiparetic gait: expected and novel compensatory patterns.
        Clin Biomech (Bristol, Avon). 2012; 27: 1023-1030
        • Patterson K.K.
        • Mansfield A.
        • Biasin L.
        • Brunton K.
        • Inness E.L.
        • McIlroy W.E.
        Longitudinal changes in poststroke spatiotemporal gait asymmetry over inpatient rehabilitation.
        Neurorehabil Neural Repair. 2015; 29: 153-162
        • Semmler J.G.
        Motor unit synchronization and neuromuscular performance.
        Exerc Sport Sci Rev. 2002; 30: 8-14
        • Nelson-Wong E.
        • Appell R.
        • McKay M.
        • et al.
        Increased fall risk is associated with elevated co-contraction about the ankle during static balance challenges in older adults.
        Eur J Appl Physiol. 2012; 112: 1379-1389