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Propulsive Forces Applied to the Body’s Center of Mass Affect Metabolic Energetics Poststroke

  • Author Footnotes
    ∗ Penke and Scott contributed equally to this work.
    Kelly Penke
    Footnotes
    ∗ Penke and Scott contributed equally to this work.
    Affiliations
    Department of Allied Health Sciences, Division of Physical Therapy, The University of North Carolina at Chapel Hill, Chapel Hill, NC
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  • Author Footnotes
    ∗ Penke and Scott contributed equally to this work.
    Korre Scott
    Footnotes
    ∗ Penke and Scott contributed equally to this work.
    Affiliations
    Department of Allied Health Sciences, Division of Physical Therapy, The University of North Carolina at Chapel Hill, Chapel Hill, NC
    Search for articles by this author
  • Yunna Sinskey
    Affiliations
    Department of Allied Health Sciences, Division of Physical Therapy, The University of North Carolina at Chapel Hill, Chapel Hill, NC
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  • Michael D. Lewek
    Correspondence
    Corresponding author Michael D. Lewek, PT, PhD, Department of Allied Health Sciences, Division of Physical Therapy, The University of North Carolina at Chapel Hill, 3043 Bondurant Hall, CB#7135, Chapel Hill, NC 27599-7135.
    Affiliations
    Department of Allied Health Sciences, Division of Physical Therapy, The University of North Carolina at Chapel Hill, Chapel Hill, NC
    Search for articles by this author
  • Author Footnotes
    ∗ Penke and Scott contributed equally to this work.
Published:November 01, 2018DOI:https://doi.org/10.1016/j.apmr.2018.10.010

      Abstract

      Objective

      To investigate the effect of timing and magnitude of horizontally directed propulsive forces to the center of mass (COM) on the metabolic cost of walking (COW) for individuals poststroke.

      Design

      Repeated-measures, within-subject design.

      Setting

      Research laboratory.

      Participants

      A total of 9 individuals with chronic hemiparesis poststroke and 7 unimpaired similarly aged controls (N=16).

      Intervention

      Individuals walked on a treadmill in 2 separate studies. First, we compared the metabolic COW with an anterior force applied to the COM that (1) coincided with paretic propulsion or (2) was applied throughout the gait cycle. Next, we compared the metabolic COW with anterior (assistive) or posterior (resistive) forces applied during paretic propulsion.

      Main Outcome Measure

      Metabolic COW.

      Results

      The COW was significantly greater in the Stroke group. Anterior (propulsive) assistance reduced the COW differently based on group. The Stroke group exhibited a 12% reduction in COW when assistance was provided only during paretic propulsion, but not when assistance was provided throughout the gait cycle. In contrast, the Control group demonstrated reduced COW during both anterior assistance conditions. In addition, we observed that resistance during paretic propulsion (simulated hemiparesis for Control group) significantly increased the COW.

      Conclusions

      Systematically manipulating propulsive forces at the body’s COM had a profound influence on metabolic cost. The timing of propulsive forces to the COM is important and needs to coincide with paretic terminal stance. Additional internally or externally generated propulsive forces applied to the body’s COM poststroke may produce a lower metabolic COW.

      Keywords

      List of abbreviations:

      BW (body weight), COM (center of mass), COW (cost of walking)
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