Bilateral Level of Effort of the Plantar Flexors, Hip Flexors, and Extensors During Gait in Hemiparetic and Healthy Individuals

Abstract

Background and Purpose-Muscle weakness is recognized as a key factor in gait performance of poststroke individuals, but its impact on lower-limb muscular effort has been scarcely studied. The aims of this study were to compare the level of effort of the lower limbs of hemiparetic and able-bodied individuals and to assess the effect of side, cadence, and muscle group. Methods-Seventeen chronic hemiparetic participants (7 females and 10 males) with a mean age of 60.5Ϯ13.4 years were assessed when walking. They were compared with a group of 14 able-bodied individuals. The level of effort was estimated from the muscular utilization ratio (MUR), which relates the walking moment of a given muscle group to its maximal potential moment. Peak MUR and MUR area were used as main outcome measures. Results-Hemiparetic individuals showed greater peak MUR values (45% to 78%) than the able-bodied subjects matched for cadence (24% to 63%). For both groups, the peak MUR values were similar between sides and increased with cadence. At self-selected cadence, the plantar flexors showed greater peak MUR values, whereas at maximal cadence, levels of effort for all muscles were equivalent. The MUR area values at the hip joint were greater for the hemiparetic group, and both groups had values that increased with cadence. Differences between sides and muscle groups were noted for the hemiparetic and healthy individuals, respectively. Large peak MUR values were associated with high MUR area values. Conclusions-For a similar cadence, the levels of effort of hemiparetic individuals were greater than those of the able-bodied.In the presence of muscle weakness, similar bilateral levels of effort could mean that hemiparetic individuals relied on their sense of effort while walking.

Perception of Weight-Bearing Distribution During Sit-to-Stand Tasks in Hemiparetic and Healthy Individuals

“…Also, Simon and Ferris 21 demonstrated in hemiparetic subjects that, during an isometric force-matching task on a leg press machine, there was no significant difference between limbs when normalizing the forces produced by those obtained in bilateral maximum voluntary contractions. In addition, Milot et al 23 found that poststroke individuals during gait presented similar bilateral levels of effort estimated by a muscular utilization ratio, an index that expresses the relative involvement of a muscle in a functional task according to its maximal strength. These results suggest that the effort rather than the loading could be a dominant factor guiding muscle activation in hemiparetic individuals during functional tasks.…”

The role of the ipsilesional side in the rehabilitation of post-stroke subjects

“…Although some authors have already reported neuromotor dysfunctions in the ipsilesional limbs when compared to healthy controls (Hall et al, 2011;Lamontagne et al, 2002;Lamontagne et al, 2000;Milot et al, 2006), they explained the dysfunction as a compensatory strategy rather than as a consequence of the lesion (Higginson et al, 2006;Lamontagne et al, 2002;Lamontagne et al, 2000).…”

“…Although this line of reasoning is supported by neuroscientific knowledge, the research involving stroke subjects has given little attention to the comprehension of the behaviour of the ipsilesional side, usually referred to as the non-affected side (Hall et al, 2011;Lamontagne et al, 2002;Lamontagne et al, 2000;Milot et al, 2006;Peterson et al, 2010). Although some authors have already reported neuromotor dysfunctions in the ipsilesional limbs when compared to healthy controls (Hall et al, 2011;Lamontagne et al, 2002;Lamontagne et al, 2000;Milot et al, 2006), they explained the dysfunction as a compensatory strategy rather than as a consequence of the lesion (Higginson et al, 2006;Lamontagne et al, 2002;Lamontagne et al, 2000).…”

Figure-of-Eight Bandaging Technique Effects on Gait and Balance of Neurological Patients: Sistematic Review

“…In hemiparetic patients, this limitation is characterized by the equinovarus foot and inadequate muscular activation, leading to a compromise in support of the calcaneus in the initial support. This causes side support plant to increase and reduction in the boost phase, which leads to an abnormal pattern in the balance phase, characterized by the necessity for excessive hip flexion to keep the foot away from the floor (1,6,7) . The functional limitations developed by patients affected by upper and lower motor neuron injuries, directly interfere in their social and work life, thus reducing their abilities to perform them.…”