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Clinical and instrumental assessment of compensative gait patterns in patient with chronic stroke
Abstracts / Gait & Posture 30S (2009) S26–S74
S33
Fig. 1. Example of kinematic pattern at hip, knee and ankle, sagittal plane, operated side pre op (left) and 6 months post op (right).
References
Table 2 Energetic Cost.
[1] [2] [3] [4] [5]
Costo energetico
Pci su tread (beats/min)
Media vel. tre.ad (cm/s)
Media vel, terra (cm/s)
Circumduz Non classificab Vaulting pelvic hike circumduz Vaulting pelvic hike Vaulting Pelvic hike
0.80 1.05 0.89 1.34 0.54 0.59
41.5 33.5 27.2 25.5 38.7 24.4
60.9 49.8 45.9 43.2 40.1 28
Gaines RW, et al. J Pediatr Orthop 1984;4(4):448–51. Orendurff MS, Aiona M, et al. Gait Posture 2002;15:130–5. Kerr Gram H, Fixsen JA. J Bone J Surg 1988;70-B:472–5. Katz K, et al. Foot Ankle Int 2000;21(12):1011–4. Engsberg JR, et al. J Appl Biomech 2005;21:322–33.
doi:10.1016/j.gaitpost.2009.07.018 Clinical and instrumental assessment of compensative gait patterns in patient with chronic stroke M.G. Benedetti 1,∗ , A. Taviani 2 , B. Nesi 2 , T. Sforza 1 , F. Benvenuti 2
Table 3 Range of motion.
1
ROM
Laboratorio di Analisi del Movimento, Istituto Ortopedico Rizzoli, Università di Bologna, Italy 2 Dipartimento della Riabilitazione, ASL 11, Empoli, Italy Introduction: The knowledge of compensative mechanisms related to impairments that are more effective from a functional point of view in patients with chronic stroke, is crucial in the optimization of rehabilitation planning and for functional prognosis. The present work is aimed at the identification of compensative gait patterns, and at establish possible relationships among the gait pattern and walking speed, muscular strength, joint range of motion and energy cost. Materials and method: Thirty consecutive hemiplegics patients, 17 males and 13 females (age: 52–84), were included in the study. In each of them the ROM at the hip, the knee and the ankle, the strength of the most important muscles at the lower limb by means of a dynamometer, were measured. The six-minutes-walk-distance test, observational gait (OGA) and gait analysis (Vicon 460, 8 TVC) were performed. Result: Three motion patterns, independent or in combination among them, adopted by individual patients in order to allow the progression of the plegic side during walking, were identified by means of OGA and gait analysis. These were: vaulting (3 patients), pelvic hike (5 patients), and circumduction of the plegic lower limb (2 patients). 4 patients presented vaulting plus pelvic hike; 5 patients vaulting plus pelvic hike plus circumduction. In 11 patients, there was no evidence of the above reported motion patterns. Circumduction revealed to be the most comfortable and beneficial during walking, both in normalized speed walking (Table 1) and muscular strength. No correlation between speed-walking based
Table 1 Speed of progression. Velocità
Circumduzione Non classificabili Vaulting pelvic hike e circumduzione Vaulting e pelvic hike Vaulting Pelvic hike
Velocitàmedia lato plegico (%h/s) 37.14 30.62 28.53 26.25 25.94 17.59
Velocitàmedia lato sano (%h/s) 39.61 31.26 28.36 26.27 26.32 17.18
ANC A Flex
ANC A Est
ANC A Abd
ANCA Add
GIN Flex
GIN Est T-T DFle X
T-T PFle X
−12.5 3.5
9.0 1.4
20.7 7.4
8.4 1.7
26.0 6.5
8.0 0.0
25.0 0.0
Vaulting MEDIA 113.3 DS 5.8
7.5 3.5
16.0 12.2
11.7 2.9
126.7 5.8
Pelvic hike MEDIA 102.0 DS 7.6
18.3 2.9
20.6 2.6
12.0 4.5
124.0 6.5
20.0
37.5 10.6
15.0 0.0
130.0 7.1
Circumduzione MEDIA 115.0 DS 7.1
3.3* 7.6 −10.0
classification and the energy cost values as obtained by the Physiological Cost Index of Walking (Table 2) was found. Circumduction pattern presented the highest degree of flexion and abduction at the hip, and the highest walking speed and muscular strength at the ileopsoas and gluteus medius (Table 3). Vaulting pattern presented lower hip extension and muscular strength at the gluteus maximum. Pelvic hike revealed to be associated to a lower spasticity of the plegic lower limb, not stiff and iper-extended knee, and to a reduced step. Conclusions: The identification of homogeneous walking patterns in patients with chronic stroke resulted to be difficult due to the heterogeneity of the clinical pictures [1–6]. These results support the hypothesis of a relationship among the emerging motion pattern, muscle force, residual selectivity and spasticity even if findings need to be confirmed on a higher number of patients in order to generalized. References [1] [2] [3] [4] [5] [6]
Witte US, et al. Scand J Rehabil Med 1997;29:161–5. Turnbull GI, et al. Scand J Rehab Med 1995;27:175–82. De Quervain K, et al. J Bone Joint Surg Am 1996;78-A:1506–14. Mulroy S, et al. Gait Posture 2003;18:114–25. Kinsella S, et al. Gait Posture 2008;27(1):144–51. Zamparo P, et al. Scand J Med Sci Sports 1995;5(6):348–52.
doi:10.1016/j.gaitpost.2009.07.019
S33
Fig. 1. Example of kinematic pattern at hip, knee and ankle, sagittal plane, operated side pre op (left) and 6 months post op (right).
References
Table 2 Energetic Cost.
[1] [2] [3] [4] [5]
Costo energetico
Pci su tread (beats/min)
Media vel. tre.ad (cm/s)
Media vel, terra (cm/s)
Circumduz Non classificab Vaulting pelvic hike circumduz Vaulting pelvic hike Vaulting Pelvic hike
0.80 1.05 0.89 1.34 0.54 0.59
41.5 33.5 27.2 25.5 38.7 24.4
60.9 49.8 45.9 43.2 40.1 28
Gaines RW, et al. J Pediatr Orthop 1984;4(4):448–51. Orendurff MS, Aiona M, et al. Gait Posture 2002;15:130–5. Kerr Gram H, Fixsen JA. J Bone J Surg 1988;70-B:472–5. Katz K, et al. Foot Ankle Int 2000;21(12):1011–4. Engsberg JR, et al. J Appl Biomech 2005;21:322–33.
doi:10.1016/j.gaitpost.2009.07.018 Clinical and instrumental assessment of compensative gait patterns in patient with chronic stroke M.G. Benedetti 1,∗ , A. Taviani 2 , B. Nesi 2 , T. Sforza 1 , F. Benvenuti 2
Table 3 Range of motion.
1
ROM
Laboratorio di Analisi del Movimento, Istituto Ortopedico Rizzoli, Università di Bologna, Italy 2 Dipartimento della Riabilitazione, ASL 11, Empoli, Italy Introduction: The knowledge of compensative mechanisms related to impairments that are more effective from a functional point of view in patients with chronic stroke, is crucial in the optimization of rehabilitation planning and for functional prognosis. The present work is aimed at the identification of compensative gait patterns, and at establish possible relationships among the gait pattern and walking speed, muscular strength, joint range of motion and energy cost. Materials and method: Thirty consecutive hemiplegics patients, 17 males and 13 females (age: 52–84), were included in the study. In each of them the ROM at the hip, the knee and the ankle, the strength of the most important muscles at the lower limb by means of a dynamometer, were measured. The six-minutes-walk-distance test, observational gait (OGA) and gait analysis (Vicon 460, 8 TVC) were performed. Result: Three motion patterns, independent or in combination among them, adopted by individual patients in order to allow the progression of the plegic side during walking, were identified by means of OGA and gait analysis. These were: vaulting (3 patients), pelvic hike (5 patients), and circumduction of the plegic lower limb (2 patients). 4 patients presented vaulting plus pelvic hike; 5 patients vaulting plus pelvic hike plus circumduction. In 11 patients, there was no evidence of the above reported motion patterns. Circumduction revealed to be the most comfortable and beneficial during walking, both in normalized speed walking (Table 1) and muscular strength. No correlation between speed-walking based
Table 1 Speed of progression. Velocità
Circumduzione Non classificabili Vaulting pelvic hike e circumduzione Vaulting e pelvic hike Vaulting Pelvic hike
Velocitàmedia lato plegico (%h/s) 37.14 30.62 28.53 26.25 25.94 17.59
Velocitàmedia lato sano (%h/s) 39.61 31.26 28.36 26.27 26.32 17.18
ANC A Flex
ANC A Est
ANC A Abd
ANCA Add
GIN Flex
GIN Est T-T DFle X
T-T PFle X
−12.5 3.5
9.0 1.4
20.7 7.4
8.4 1.7
26.0 6.5
8.0 0.0
25.0 0.0
Vaulting MEDIA 113.3 DS 5.8
7.5 3.5
16.0 12.2
11.7 2.9
126.7 5.8
Pelvic hike MEDIA 102.0 DS 7.6
18.3 2.9
20.6 2.6
12.0 4.5
124.0 6.5
20.0
37.5 10.6
15.0 0.0
130.0 7.1
Circumduzione MEDIA 115.0 DS 7.1
3.3* 7.6 −10.0
classification and the energy cost values as obtained by the Physiological Cost Index of Walking (Table 2) was found. Circumduction pattern presented the highest degree of flexion and abduction at the hip, and the highest walking speed and muscular strength at the ileopsoas and gluteus medius (Table 3). Vaulting pattern presented lower hip extension and muscular strength at the gluteus maximum. Pelvic hike revealed to be associated to a lower spasticity of the plegic lower limb, not stiff and iper-extended knee, and to a reduced step. Conclusions: The identification of homogeneous walking patterns in patients with chronic stroke resulted to be difficult due to the heterogeneity of the clinical pictures [1–6]. These results support the hypothesis of a relationship among the emerging motion pattern, muscle force, residual selectivity and spasticity even if findings need to be confirmed on a higher number of patients in order to generalized. References [1] [2] [3] [4] [5] [6]
Witte US, et al. Scand J Rehabil Med 1997;29:161–5. Turnbull GI, et al. Scand J Rehab Med 1995;27:175–82. De Quervain K, et al. J Bone Joint Surg Am 1996;78-A:1506–14. Mulroy S, et al. Gait Posture 2003;18:114–25. Kinsella S, et al. Gait Posture 2008;27(1):144–51. Zamparo P, et al. Scand J Med Sci Sports 1995;5(6):348–52.
doi:10.1016/j.gaitpost.2009.07.019