[Abstract+References] Forced Use of the Paretic Leg Induced by a Constraint Force Applied to the Nonparetic Leg in Individuals Poststroke During Walking

Abstract

Background. Individuals with stroke usually show reduced muscle activities of the paretic leg and asymmetrical gait pattern during walking. Objective. To determine whether applying a resistance force to the nonparetic leg would enhance the muscle activities of the paretic leg and improve the symmetry of spatiotemporal gait parameters in individuals with poststroke hemiparesis. Methods. Fifteen individuals with chronic poststroke hemiparesis participated in this study. A controlled resistance force was applied to the nonparetic leg using a customized cable-driven robotic system while subjects walked on a treadmill. Subjects completed 2 test sections with the resistance force applied at different phases of gait (ie, early and late swing phases) and different magnitudes (10%, 20%, and 30% of maximum voluntary contraction [MVC] of nonparetic leg hip flexors). Electromyographic (EMG) activity of the muscles of the paretic leg and spatiotemporal gait parameters were collected. Results. Significant increases in integrated EMG of medial gastrocnemius, medial hamstrings, vastus medialis, and tibialis anterior of the paretic leg were observed when the resistance was applied during the early swing phase of the nonparetic leg, compared with baseline. Additionally, resistance with 30% of MVC induced the greatest level of muscle activity than that with 10% or 20% of MVC. The symmetry index of gait parameters also improved with resistance applied during the early swing phase. Conclusion. Applying a controlled resistance force to the nonparetic leg during early swing phase may induce forced use on the paretic leg and improve the spatiotemporal symmetry of gait in individuals with poststroke hemiparesis.

References

1.	Roger, VL, Go, AS, Lloyd-Jones, DM. Heart disease and stroke statistics—2011 update: a report from the American Heart Association. Circulation. 2011;123:e18–e209. Google Scholar, Crossref, Medline
2.	Haghgoo, HA, Pazuki, ES, Hosseini, AS, Rassafiani, M. Depression, activities of daily living and quality of life in patients with stroke. J Neurol Sci. 2013;328:87–91. Google Scholar, Crossref, Medline
3.	Jørgensen, HS, Nakayama, H, Raaschou, HO, Olsen, TS. Recovery of walking function in stroke patients: the Copenhagen Stroke Study. Arch Phys Med Rehabil. 1995;76:27–32. Google Scholar, Crossref, Medline
4.	Lamontagne, A, Stephenson, JL, Fung, J. Physiological evaluation of gait disturbances post stroke. Clin Neurophysiol. 2007;118:717–729. Google Scholar, Crossref, Medline
5.	Burridge, JH, Wood, DE, Taylor, PN, McLellan, DL. Indices to describe different muscle activation patterns, identified during treadmill walking, in people with spastic drop-foot. Med Eng Phys. 2001;23:427–434. Google Scholar, Crossref, Medline
6.	Patterson, KK, Parafianowicz, I, Danells, CJ. Gait asymmetry in community-ambulating stroke survivors. Arch Phys Med Rehabil. 2008;89:304–310. Google Scholar, Crossref, Medline
7.	Chen, G, Patten, C, Kothari, DH, Zajac, FE. Gait deviations associated with post-stroke hemiparesis: improvement during treadmill walking using weight support, speed, support stiffness, and handrail hold. Gait Posture. 2005;22:57–62. Google Scholar, Crossref, Medline
8.	Olney, SJ, Richards, C. Hemiparetic gait following stroke. Part I: characteristics. Gait Posture. 1996;4:136–148. Google Scholar, Crossref
9.	Jørgensen, HS, Nakayama, H, Raaschou, HO, Vive-Larsen, J, Støier, M, Olsen, TS. Outcome and time course of recovery in stroke. Part II: time course of recovery. The Copenhagen Stroke Study. Arch Phys Med Rehabil. 1995;76:406–412. Google Scholar, Crossref, Medline
10.	Page, SJ, Sisto, S, Levine, P, McGrath, RE. Efficacy of modified constraint-induced movement therapy in chronic stroke: a single-blinded randomized controlled trial. Arch Phys Med Rehabil. 2004;85:14–18. Google Scholar, Crossref, Medline
11.	Wolf, SL, Winstein, CJ, Miller, JP. Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial. JAMA. 2006;296:2095–2104. Google Scholar, Crossref, Medline
12.	Wolf, SL, Blanton, S, Baer, H, Breshears, J, Butler, AJ. Repetitive task practice: a critical review of constraint-induced movement therapy in stroke. Neurologist. 2002;8:325–338. Google Scholar, Crossref, Medline
13.	Wolf, SL, Winstein, CJ, Miller, JP. Retention of upper limb function in stroke survivors who have received constraint-induced movement therapy: the EXCITE randomised trial. Lancet Neurol. 2008;7:33–40. Google Scholar, Crossref, Medline
14.	Stevenson, T, Thalman, L, Christie, H, Poluha, W. Constraint-induced movement therapy compared to dose-matched interventions for upper-limb dysfunction in adult survivors of stroke: a systematic review with meta-analysis. Physiother Can. 2012;64:397–413. Google Scholar, Crossref, Medline
15.	Bonnyaud, C, Zory, R, Boudarham, J, Pradon, D, Bensmail, D, Roche, N. Effect of a robotic restraint gait training versus robotic conventional gait training on gait parameters in stroke patients. Exp Brain Res. 2014;232:31–42. Google Scholar, Crossref, Medline
16.	Regnaux, JP, Pradon, D, Roche, N, Robertson, J, Bussel, B, Dobkin, B. Effects of loading the unaffected limb for one session of locomotor training on laboratory measures of gait in stroke. Clin Biomech (Bristol, Avon). 2008;23:762–768. Google Scholar, Crossref, Medline
17.	Bonnyaud, C, Pradon, D, Zory, R. Effects of a gait training session combined with a mass on the non-paretic lower limb on locomotion of hemiparetic patients: a randomized controlled clinical trial. Gait Posture. 2013;37:627–630. Google Scholar, Crossref, Medline
18.	Dietz, V, Quintern, J, Boos, G, Berger, W. Obstruction of the swing phase during gait: phase-dependent bilateral leg muscle coordination. Brain Res. 1986;384:166–169. Google Scholar, Crossref, Medline
19.	Yang, JF, Stephens, MJ, Vishram, R. Transient disturbances to one limb produce coordinated, bilateral responses during infant stepping. J Neurophysiol. 1998;79:2329–2337. Google Scholar, Medline
20.	Savin, DN, Tseng, SC, Morton, SM. Bilateral adaptation during locomotion following a unilaterally applied resistance to swing in nondisabled adults. J Neurophysiol. 2010;104:3600–3611. Google Scholar, Crossref, Medline
21.	Zehr, EP, Loadman, PM. Persistence of locomotor-related interlimb reflex networks during walking after stroke. Clin Neurophysiol. 2012;123:796–807. Google Scholar, Crossref, Medline
22.	Folstein, MF, Folstein, SE, McHugh, PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–198. Google Scholar, Crossref, Medline
23.	Yen, SC, Landry, JM, Wu, M. Size of kinematic error affects retention of locomotor adaptation in human spinal cord injury. J Rehabil Res Dev. 2013;50:1187–1200. Google Scholar, Crossref, Medline
24.	Wu, M, Hornby, TG, Landry, JM, Roth, H, Schmit, BD. A cable-driven locomotor training system for restoration of gait in human SCI. Gait Posture. 2011;33:256–260. Google Scholar, Crossref, Medline
25.	Yen, SC, Schmit, BD, Landry, JM, Roth, H, Wu, M. Locomotor adaptation to resistance during treadmill training transfers to overground walking in human SCI. Exp Brain Res. 2012;216:473–482. Google Scholar, Crossref, Medline
26.	Zeni, JA, Richards, JG, Higginson, JS. Two simple methods for determining gait events during treadmill and overground walking using kinematic data. Gait Posture. 2008;27:710–714. Google Scholar, Crossref, Medline
27.	Yen, SC, Schmit, BD, Wu, M. Using swing resistance and assistance to improve gait symmetry in individuals post-stroke. Hum Mov Sci. 2015;42:212–224. Google Scholar, Crossref, Medline
28.	Patterson, KK, Gage, WH, Brooks, D, Black, SE, McIlroy, WE. Evaluation of gait symmetry after stroke: a comparison of current methods and recommendations for standardization. Gait Posture. 2010;31:241–246. Google Scholar, Crossref, Medline
29.	Duysens, J, Pearson, KG. Inhibition of flexor burst generation by loading ankle extensor muscles in walking cats. Brain Res. 1980;187:321–332. Google Scholar, Crossref, Medline
30.	Pearson, KG, Collins, DF. Reversal of the influence of group Ib afferents from plantaris on activity in medial gastrocnemius muscle during locomotor activity. J Neurophysiol. 1993;70:1009–1017. Google Scholar, Medline
31.	Duysens, J, Pearson, KG. The role of cutaneous afferents from the distal hindlimb in the regulation of the step cycle of thalamic cats. Exp Brain Res. 1976;24:245–255. Google Scholar, Crossref, Medline
32.	Guertin, P, Angel, MJ, Perreault, MC, McCrea, DA. Ankle extensor group I afferents excite extensors throughout the hindlimb during fictive locomotion in the cat. J Physiol. 1995;487:197–209. Google Scholar, Crossref, Medline
33.	Stephens, MJ, Yang, JF. Loading during the stance phase of walking in humans increases the extensor EMG amplitude but does not change the duration of the step cycle. Exp Brain Res. 1999;124:363–370. Google Scholar, Crossref, Medline
34.	Winter, DA, MacKinnon, CD, Ruder, GK, Wieman, C. An integrated EMG/biomechanical model of upper body balance and posture during human gait. Prog Brain Res. 1993;97:359–367. Google Scholar, Crossref, Medline
35.	Mercer, VS, Chang, SH, Williams, CD, Noble, K, Vance, AW. Effects of an exercise program to increase hip abductor muscle strength and improve lateral stability following stroke: a single subject design. J Geriatr Phys Ther. 2009;32:50–59. Google Scholar, Crossref, Medline
36.	Ghori, GM, Luckwill, RG. Phase-dependent responses in locomotor muscles of walking man. J Biomed Eng. 1990;12:75–78. Google Scholar, Crossref, Medline
37.	Rossignol, S, Gauthier, L. An analysis of mechanisms controlling the reversal of crossed spinal reflexes. Brain Res. 1980;182:31–45. Google Scholar, Crossref, Medline
38.	Sherrington, CS. Flexion-reflex of the limb, crossed extension-reflex, and reflex stepping and standing. J Physiol. 1910;40:28–121. Google Scholar, Crossref, Medline
39.	Mazzaro, N, Grey, MJ, do Nascimento, OF, Sinkjaer, T. Afferent-mediated modulation of the soleus muscle activity during the stance phase of human walking. Exp Brain Res. 2006;173:713–723. Google Scholar, Crossref, Medline
40.	Duysens, J, Clarac, F, Cruse, H. Load-regulating mechanisms in gait and posture: comparative aspects. Physiol Rev. 2000;80:83–133. Google Scholar, Medline
41.	Herr, H, Popovic, M. Angular momentum in human walking. J Exp Biol. 2008;211(pt 4):467–481. Google Scholar, Crossref, Medline
42.	Neptune, RR, McGowan, CP. Muscle contributions to whole-body sagittal plane angular momentum during walking. J Biomech. 2011;44:6–12. Google Scholar, Crossref, Medline
43.	Adler, S, Beckers, D, Buck, M. PNF in Practice: An Illustrated Guide. 3rd ed. Heidelberg, Germany: Springer; 2008. Google Scholar
44.	Ribeiro, T, Britto, H, Oliveira, D, Silva, E, Galvão, E, Lindquist, A. Effects of treadmill training with partial body weight support and the proprioceptive neuromuscular facilitation method on hemiparetic gait: a randomized controlled study. Eur J Phys Rehabil Med. 2013;49:451–461. Google Scholar, Medline
45.	Ribeiro, TS, de Sousa e Silva, EM, Sousa Silva, WH. Effects of a training program based on the proprioceptive neuromuscular facilitation method on post-stroke motor recovery: a preliminary study. J Bodyw Mov Ther. 2014;18:526–532. Google Scholar, Crossref, Medline
46.	Balasubramanian, CK, Bowden, MG, Neptune, RR, Kautz, SA. Relationship between step length asymmetry and walking performance in subjects with chronic hemiparesis. Arch Phys Med Rehabil. 2007;88:43–49. Google Scholar, Crossref, Medline
47.	Hsu, AL, Tang, PF, Jan, MH. Analysis of impairments influencing gait velocity and asymmetry of hemiplegic patients after mild to moderate stroke. Arch Phys Med Rehabil. 2003;84:1185–1193. Google Scholar, Crossref, Medline
48.	Kim, CM, Eng, JJ. Symmetry in vertical ground reaction force is accompanied by symmetry in temporal but not distance variables of gait in persons with stroke. Gait Posture. 2003;18:23–28. Google Scholar, Crossref, Medline
49.	Turns, LJ, Neptune, RR, Kautz, SA. Relationships between muscle activity and anteroposterior ground reaction forces in hemiparetic walking. Arch Phys Med Rehabil. 2007;88:1127–1135. Google Scholar, Crossref, Medline
50.	Wu, M, Gordon, K, Kahn, JH, Schmit, BD. Prolonged electrical stimulation over hip flexors increases locomotor output in human SCI. Clin Neurophysiol. 2011;122:1421–1428. Google Scholar, Crossref, Medline
51.	Lam, T, Pearson, KG. Proprioceptive modulation of hip flexor activity during the swing phase of locomotion in decerebrate cats. J Neurophysiol. 2001;86:1321–1332. Google Scholar, Medline
52.	Perry, J, Garrett, M, Gronley, JK, Mulroy, SJ. Classification of walking handicap in the stroke population. Stroke. 1995;26:982–989. Google Scholar, Crossref, Medline

via Forced Use of the Paretic Leg Induced by a Constraint Force Applied to the Nonparetic Leg in Individuals Poststroke During WalkingNeurorehabilitation and Neural Repair – Chao-Jung Hsu, Janis Kim, Elliot J. Roth, William Z. Rymer, Ming Wu, 2017