- Email: [email protected]
Spastic cocontraction of triceps surae increases with the tension applied during swing phase of gait in chronic hemiparesis
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Stroke / Annals of Physical and Rehabilitation Medicine 60S (2017) e1–e8
ranging between 0.821 and 0.966. For the total score, intra-rater reliability was excellent (ICC = 0.91) with a MDC95 equal to 11.5, and the inter-rater reliability was good (ICC = 0.78) with a MDC95 equal to 13.7. Analysis of the hierarchical aspect of the tactile sensation subscale has found a relatively high error rate (up to 24%) suggesting the need for more systematic assessment. Discussion – conclusion The standardized French version of the EmNSA-S provides a valid and reliable scale. The study supports the use of the French version of this scale for comprehensive and accurate assessment of sensory modalities in adults post-stroke. Keywords Erasmus modified Nottingham Sensory Assessment; Stroke; Sensation; Somatosensory disorders; Upper limb Disclosure of interest The authors have not supplied their declaration of competing interest. http://dx.doi.org/10.1016/j.rehab.2017.07.022 CO056
Between and within-day reliability of spatiotemporal gait parameters following stroke: Why measurement at maximal gait speed is required? David Gasq 1,∗ , Yann Le Dean 2 , Marc Labrunee 3 , Evelyne Castel-Lacanal 4 , Caroline Terracol 4 , Xavier de Boissezon 4 , Philippe Marque 4 1 Inserm (UMR 1214), UPS – équipe iDREAM, Toulouse neuroimaging center, université de Toulouse, Toulouse, France 2 Explorations fonctionnelles physiologiques, Rangueil, CHU de Toulouse, Toulouse, France 3 Rééducation cardiovasculaire, Rangueil, CHU de Toulouse, Toulouse, France 4 Médecine physique et réadaptation, Rangueil, CHU de Toulouse, Toulouse, France ∗ Corresponding author. E-mail address: [email protected] (D. Gasq) Objective Assessment of the metrological properties of the spatiotemporal gait parameters is a key point because they are used as a monitoring criterion of post-stroke recovery and as outcome in interventional studies. The objective of the study was to explore the relevance of gait assessment at maximal gait speed (MGS) rather than spontaneous gait speed (SGS) for post-stroke subjects through (1) the study of between and within-day reliability data of spatiotemporal gait parameters at SGS and MGS; and (2) a comparison of the direct measurement of velocity at MGS versus its estimate. It was also designed to (3) highlight the importance of considering the distribution of the random error to use an adequate expression of the measurement error (MErr). Material/patients and methods Spatiotemporal gait parameters – velocity, walk ratio, span acceleration, and spatiotemporal asymmetries indexes – from 30 post-stroke subjects (mean ± SD age, 51.6 ± 16.2 years; median [range] time since stroke, 4.4 [1 to 101] months; 60% of male; 70% using a walking assistive device) were collected using the Locometer (Satel, Blagnac, France) on three times, about 7 days (between-day) and 30 minutes (within-day) apart, at SGS and MGS. The minimal metrically detectable change with a 95% confidence interval was computed in original unit, or in percentage (MDCp) if the distribution of random error was heteroscedastic. Results Reliability was better at MGS than at SGS, and for within than for between-day test-retest. MDCp for velocity were equal to 36.2%/16.2% at SGS for between/within-day test–retest, and 21.2% at MGS for between-day test-retest. Gait velocity at MGS should be measured and not estimated because of unacceptable error of prediction in 70% of cases. An inappropriate expression of MErr without taking into account the random error distribution leads to over-/underestimate of the significant modifications of gait parameters.
Discussion – conclusion Data from the present study allow for a suitable interpretation of spatiotemporal gait parameters modification for post-stroke subjects. We highlighted the necessary gait assessment at MGS, being the most likely to show differences related to therapeutic intervention for post-stroke subjects and showed that the velocity at MGS should be measured and not predicted. Keywords Stroke; Gait; Reproducibility of results; Statistical distributions; Evaluation studies as topic; Measurement error Disclosure of interest The authors have not supplied their declaration of competing interest. http://dx.doi.org/10.1016/j.rehab.2017.07.023 CO057
Spastic cocontraction of triceps surae increases with the tension applied during swing phase of gait in chronic hemiparesis
Emilie Hutin ∗ , Mouna Ghédira , Valentina Mardale , Catherine-Marie Loche , Caroline Gault-Colas , Jean-Michel Gracies , Nicolas Bayle Laboratoire ARM, BIOTN, EA 7377, UPEC, rééducation neurolocomotrice, hôpital Henri-Mondor, Créteil, France ∗ Corresponding author. E-mail address: [email protected] (E. Hutin) Objective The present study aimed to quantify the impact of the tension applied on triceps surae during the swing phase of gait on its cocontraction in chronic hemiparesis. Material/patients and methods Forty-one subjects with chronic hemiparesis (50 ± 15 years; time since lesion, 7 ± 7 years; mean ± SD) completed a kinematic gait analysis, barefoot at comfortable speed (10 opto-electronic cameras, 6 dynamometric force plates, 27 ± 13 cycles analyzed/subject), with electromyography of soleus (so) and gastrocnemius medialis (gm) on the paretic side. The Coefficients of Spastic Cocontraction, CSCso and CSCgm, were calculated over 3 periods of swing phase (T1, [0–33] %; T2, [34–66] %; T3, [67–100] %), by the ratio of the RMS of the electromyogram in the period of interest over the RMS of the electromyogram of the same muscle over 100 ms around the maximal agonist isometric activity (measured on standing position by a maximal effort against resistance). In addition, a coefficient of lengthening of triceps surae, CLts, was computed over each period in the sagittal plane, from the ankle/knee displacements recorded during the period of interest divided by the total range of ankle/knee movements measured across all gait cycles. CSCso, CSCgm and CLts were compared between the 3 periods (ANOVA, significant effect P < 0.05). Exploration of individual correlations were performed with all gait cycles of each patient, using univariate regression analysis with CLts as predictor and coefficients of spastic cocontraction (CSCso and CSCgm) as dependent variables. Results Between T2 et T3, CSCso increased by 233 ± 54% (mean ± SEM, P < 1E-5) and CSCgm by 67 ± 10% (P = 0.0017). CLts increased by 23 ± 7% in T2 (P = 0.009) and 52 ± 12% in T3 (P < 1E-5). CLts was positively correlated with CSCso in 63% of cases (n = 25, r = 0.63 ± 0.04, P < 0.1) and with CSCgm in 53% of cases (n = 21, r = 0.60 ± 0.04, P < 0.1). Discussion – conclusion In chronic hemiparesis, tension (lengthening) applied on triceps surae is associated with the increase of its spastic cocontraction during swing phase of gait at comfortable speed. Keywords Stroke; Electromyography; Coefficient of spastic cocontraction; Lengthening coefficient; Spasticity; Walk Disclosure of interest The authors have not supplied their declaration of competing interest. http://dx.doi.org/10.1016/j.rehab.2017.07.024
Stroke / Annals of Physical and Rehabilitation Medicine 60S (2017) e1–e8
ranging between 0.821 and 0.966. For the total score, intra-rater reliability was excellent (ICC = 0.91) with a MDC95 equal to 11.5, and the inter-rater reliability was good (ICC = 0.78) with a MDC95 equal to 13.7. Analysis of the hierarchical aspect of the tactile sensation subscale has found a relatively high error rate (up to 24%) suggesting the need for more systematic assessment. Discussion – conclusion The standardized French version of the EmNSA-S provides a valid and reliable scale. The study supports the use of the French version of this scale for comprehensive and accurate assessment of sensory modalities in adults post-stroke. Keywords Erasmus modified Nottingham Sensory Assessment; Stroke; Sensation; Somatosensory disorders; Upper limb Disclosure of interest The authors have not supplied their declaration of competing interest. http://dx.doi.org/10.1016/j.rehab.2017.07.022 CO056
Between and within-day reliability of spatiotemporal gait parameters following stroke: Why measurement at maximal gait speed is required? David Gasq 1,∗ , Yann Le Dean 2 , Marc Labrunee 3 , Evelyne Castel-Lacanal 4 , Caroline Terracol 4 , Xavier de Boissezon 4 , Philippe Marque 4 1 Inserm (UMR 1214), UPS – équipe iDREAM, Toulouse neuroimaging center, université de Toulouse, Toulouse, France 2 Explorations fonctionnelles physiologiques, Rangueil, CHU de Toulouse, Toulouse, France 3 Rééducation cardiovasculaire, Rangueil, CHU de Toulouse, Toulouse, France 4 Médecine physique et réadaptation, Rangueil, CHU de Toulouse, Toulouse, France ∗ Corresponding author. E-mail address: [email protected] (D. Gasq) Objective Assessment of the metrological properties of the spatiotemporal gait parameters is a key point because they are used as a monitoring criterion of post-stroke recovery and as outcome in interventional studies. The objective of the study was to explore the relevance of gait assessment at maximal gait speed (MGS) rather than spontaneous gait speed (SGS) for post-stroke subjects through (1) the study of between and within-day reliability data of spatiotemporal gait parameters at SGS and MGS; and (2) a comparison of the direct measurement of velocity at MGS versus its estimate. It was also designed to (3) highlight the importance of considering the distribution of the random error to use an adequate expression of the measurement error (MErr). Material/patients and methods Spatiotemporal gait parameters – velocity, walk ratio, span acceleration, and spatiotemporal asymmetries indexes – from 30 post-stroke subjects (mean ± SD age, 51.6 ± 16.2 years; median [range] time since stroke, 4.4 [1 to 101] months; 60% of male; 70% using a walking assistive device) were collected using the Locometer (Satel, Blagnac, France) on three times, about 7 days (between-day) and 30 minutes (within-day) apart, at SGS and MGS. The minimal metrically detectable change with a 95% confidence interval was computed in original unit, or in percentage (MDCp) if the distribution of random error was heteroscedastic. Results Reliability was better at MGS than at SGS, and for within than for between-day test-retest. MDCp for velocity were equal to 36.2%/16.2% at SGS for between/within-day test–retest, and 21.2% at MGS for between-day test-retest. Gait velocity at MGS should be measured and not estimated because of unacceptable error of prediction in 70% of cases. An inappropriate expression of MErr without taking into account the random error distribution leads to over-/underestimate of the significant modifications of gait parameters.
Discussion – conclusion Data from the present study allow for a suitable interpretation of spatiotemporal gait parameters modification for post-stroke subjects. We highlighted the necessary gait assessment at MGS, being the most likely to show differences related to therapeutic intervention for post-stroke subjects and showed that the velocity at MGS should be measured and not predicted. Keywords Stroke; Gait; Reproducibility of results; Statistical distributions; Evaluation studies as topic; Measurement error Disclosure of interest The authors have not supplied their declaration of competing interest. http://dx.doi.org/10.1016/j.rehab.2017.07.023 CO057
Spastic cocontraction of triceps surae increases with the tension applied during swing phase of gait in chronic hemiparesis
Emilie Hutin ∗ , Mouna Ghédira , Valentina Mardale , Catherine-Marie Loche , Caroline Gault-Colas , Jean-Michel Gracies , Nicolas Bayle Laboratoire ARM, BIOTN, EA 7377, UPEC, rééducation neurolocomotrice, hôpital Henri-Mondor, Créteil, France ∗ Corresponding author. E-mail address: [email protected] (E. Hutin) Objective The present study aimed to quantify the impact of the tension applied on triceps surae during the swing phase of gait on its cocontraction in chronic hemiparesis. Material/patients and methods Forty-one subjects with chronic hemiparesis (50 ± 15 years; time since lesion, 7 ± 7 years; mean ± SD) completed a kinematic gait analysis, barefoot at comfortable speed (10 opto-electronic cameras, 6 dynamometric force plates, 27 ± 13 cycles analyzed/subject), with electromyography of soleus (so) and gastrocnemius medialis (gm) on the paretic side. The Coefficients of Spastic Cocontraction, CSCso and CSCgm, were calculated over 3 periods of swing phase (T1, [0–33] %; T2, [34–66] %; T3, [67–100] %), by the ratio of the RMS of the electromyogram in the period of interest over the RMS of the electromyogram of the same muscle over 100 ms around the maximal agonist isometric activity (measured on standing position by a maximal effort against resistance). In addition, a coefficient of lengthening of triceps surae, CLts, was computed over each period in the sagittal plane, from the ankle/knee displacements recorded during the period of interest divided by the total range of ankle/knee movements measured across all gait cycles. CSCso, CSCgm and CLts were compared between the 3 periods (ANOVA, significant effect P < 0.05). Exploration of individual correlations were performed with all gait cycles of each patient, using univariate regression analysis with CLts as predictor and coefficients of spastic cocontraction (CSCso and CSCgm) as dependent variables. Results Between T2 et T3, CSCso increased by 233 ± 54% (mean ± SEM, P < 1E-5) and CSCgm by 67 ± 10% (P = 0.0017). CLts increased by 23 ± 7% in T2 (P = 0.009) and 52 ± 12% in T3 (P < 1E-5). CLts was positively correlated with CSCso in 63% of cases (n = 25, r = 0.63 ± 0.04, P < 0.1) and with CSCgm in 53% of cases (n = 21, r = 0.60 ± 0.04, P < 0.1). Discussion – conclusion In chronic hemiparesis, tension (lengthening) applied on triceps surae is associated with the increase of its spastic cocontraction during swing phase of gait at comfortable speed. Keywords Stroke; Electromyography; Coefficient of spastic cocontraction; Lengthening coefficient; Spasticity; Walk Disclosure of interest The authors have not supplied their declaration of competing interest. http://dx.doi.org/10.1016/j.rehab.2017.07.024