Gait analysis of stroke subjects walking at different self-selected speed

Gait analysis of stroke subjects walking at different self-selected speed

SIAMOC 2006 Congress Abstracts / Gait & Posture 24S (2006) S1–S57 plegic) FES treatment (Group 2, paretics), or only Kinesis Therapy KT (Group 3, ple...

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SIAMOC 2006 Congress Abstracts / Gait & Posture 24S (2006) S1–S57

plegic) FES treatment (Group 2, paretics), or only Kinesis Therapy KT (Group 3, plegic; Group 4, paretic). Patients underwent 30’  15 ES sessions of wrist and fingers extensors. Several parameters – MI, ROMs (the addition of the active wrist ROMs and the joint of the metacarpusphalange and interphalange prossimali), Jebsen test, items of the Functional Independence Measure (FIM) related to the person’s cure – were evaluated before the treatment (TO) and after sessions (TI5). Collected data were statistically analysed by one-way ANOVA. 3. Results Averages and standard deviations of the examined parameters are reported in the table.

Group Group Group Group

1 2 3 4

Group 2 Group 4

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1. Introduction The recovery of an optimum walking function is a major goal of rehabilitation. A variety of human neurological deficits may cause a substantial decrease in walking speed. Normal walking speed in the ablebodied adult population is estimated to be 1.40 m/s (standard deviation [S.D.] of 0.20 m/s), while walking speeds of persons with hemiparesis following a stroke have been reported at approximately 0.40 m/s [1]. Olney and Richards considered 0.64 m/s to be fast for this population, 0.41 m/s to be average, and 0.25 m/s to be slow [2]. The study was aimed to assess stroke subjects’ ability in voluntary modifying gait speed and to study the sEMG correlates.

MI (T0)

MI (T15)

sROM (T0)

sROM(T15)

FIM(T0)

FIM(T15)

14.50  19.09 56.67  5.69 11.67  11.59 61.00  14.73

22.50  30.41 74.33  4.73 27.00  9.85 79.00  5.29

0.00  0.00 71.67  30.55 0.00  0.00 143.33  105.40

17.50  24.75 286.67  215.00 35.00  60.62 192.50  50

11.50  2.12 21.50  0.71 10.33  4.04 19.33  1.15

16.00  2.11 27.50  0.71 14.33  7.37 24.00  3.46

T0 unaffected side(s)

T0 affected side(s)

T15 unaffected side(s)

T15 affected side(s)

12.22  6.34 12.76  7.22

141.85  60.45 103.57  80.29

8.38  3.74 9.86  3.30

18.11  11.13 17.32  5.08

4. Discussion

2. Methods

An improvement of the parameters was observed in each group but the hand’s active ROM (metacarpophalangeal joints) increased significantly in Group 2, if compared with Group 4 (P = 0.011). We concluded, therefore, that FES is more useful than FKT as regards to the recovery of the active motricity of the paretic hand.

Thirteen stroke patients (seven suffering from right hemiparesis; without global aphasia, neglect or moderate/ severe dementia) performed five–eight 5-m over-ground walks at self-selected comfortable (C), fast (F) and slowest (S) speed, in a randomized sequence. EMGs, spatial and temporal gait data were recorded through TELEMG system (BTS-Italy). Selected outcome measures: gait cycle duration (GC), velocity, stride length, double support and swing time, GC time (as GC %) at start, peak and end moment of biceps femoris (BF), vastus lateralis (VL), gastrocnemious medialis (GCM) and tibialis anterior (TA) activity, recorded on the affected side. Ten healthy subjects provided control value.

Reference [1] Popovic MB, et al. J Rehabil Res Dev 2003;40(Sepember–October (5)):443–53. DOI: 10.1016/j.gaitpost.2006.09.060

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3. Results

Gait analysis of stroke subjects walking at different selfselected speed

Patients walked slowly with respect to controls, because of shorter stride length and decreased cadence (velocities: C: 0.59  0.2 m/s; F: 1.11  0.6 m/s; S: 0.32  0.1 m/s; versus CT). Differences between patients and controls were more marked for the C and F velocities. At the slowest speed, patients’ gait velocity did not differ from controls’, but patients showed a higher swing time. Patients’ BF and TA were overactive and did not show modification of the EMG profile at different speed. Patients’ GCm and VL were

M. Capecci, V.G. Bombace, V. Cardinali, V. Cecchetelli, F. Saltarelli, M. Coccia, G. Lagalla, L. Provinciali, M.G. Ceravolo Dipartimento di Neuroscienze, Universita` Politecnica delle Marche, Italy

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SIAMOC 2006 Congress Abstracts / Gait & Posture 24S (2006) S1–S57

overactive during stance with respect to controls’; EMG amplitude were significantly low. GCm anticipated and VL delayed the peak occurrence during stance at F velocity with respect to comfortable gait. A regression analysis, looking for predictors of patients’ maximum velocity, found out cognitive factors, hip flexors force and comfortable velocity.

upper extremities [1]. Wright et’al. described the gait kinematic and kinetic pattern of a group of patients with MD. In this study, a single case of a myotonic patient who underwent gait analysis for an orthosis prescription project was examined.

2. Methods 4. Discussion Gait parameters obtained at comfortable speed resume literature evidences about hemiparetic gait in moderately impaired stroke patients [2]. The assessment of voluntarily modified gait speed and, in particular, the slow walking speed evaluation are original study goals. Patients show spatial and temporal divergences, with respect to controls, that suggest differences in motor programming. Patients’ proximal muscles of lower limb show a close to normal activation when walking at maximum speed, instead distal muscles present a better preservation of distal synergies at the slowest speed. Finally, the ability in voluntarily modifying gait speed may be influenced by cognition. These preliminary results may provide cues for rehabilitation.

References [1] Nymark JR, et al. JRRD 2005;42:523–34. [2] Olney S, Richards C. Gait Posture 1996;4:136–48.

DOI: 10.1016/j.gaitpost.2006.09.061

P6 Gait analysis for an orthosis project in a patient with Steinert myotonic dystrophy E. Aiello a, A. Cereatti b, P. Fadda a, A. Fodde a, U. Della Croce c a

Motion Analysis Laboratory, C.C.R. Santa Maria Bambina, Oristano, Italy b Department of Human Movement and Sport Science, IUSM, Rome, Italy c Department of Biomedical Science, University of Sassari, Sassari, Italy

1. Introduction Steinert myotonic dystrophy (MD) is an autosomic dominant disorder characterized by musculoskeletal system involvement and by the phenomena of myotonia (delayed and prolonged muscle relaxation after activation), hyposthenia and hypotrophy, more distal and more pronounced in the

The patient (44 years), onset of symptoms at age 18 years, exhibited: lower extremities hypotonia, hyposthenia and hypotrophy, emphasized bilaterally in plantar-dorsi flexor ankle muscles, myotonic manifestation of distal muscles of upper and lower extremities and bilateral steppage walking. The kinematic analysis was carried out using a six-camera stereophotogrammetric system (Elite) and the Davis marker set. Two force plates were also used to record the ground reaction forces. The evaluation was performed for both extremities with shoes on, both with and without AFO with anterior support (toe off). Three trials for each condition were recorded.

3. Risultati Without orthoses, during the loading response (LR), few degrees of plantar flexion are present on the right ankle, whereas slight reduction to neutral dorsiflexion is present on the left. Afterwards, both extremities undergo a progressive and prolonged dorsiflexion. During terminal stance (TS), a dorsiflexion peak 278 is observed and is followed, bilaterally, by a steep plantarflexion in swing (Sw), particularly marked on the right side. The ankle internal moment exhibited bilaterally a double plantarflexion peak, the first in correspondence with LR whereas the second during the TSt and pre Sw phase. During LR, a small power absorption is observed on both sides. With the orthoses, the dorsiflexion in LR is reduced; the maximal dorsiflexion in St is limited to 188 and 208 on the right and left, respectively; on the right, the plantarflexion in Sw is more limited. The first plantarflexor moment peak is reduced with no power absorption during the LR phase. Difference in the temporal parameters of the gait cycle was not observed (Fig. 1).

4. Discussion AFO with anterior support (toe off) increased kinematics symmetry of the two limbs, decreased ankle dorsiflexion, with minimization of the first peak of the plantarflexion moment, and knee flexion in LR. As Cavazza et’al. [2] already observed in peripheral nerve disease, the kinetic and kinematic pattern, of a patient affected by a muscle disease with an important distal weakness, seem to improve using a toe off AFO.