Mechanical and energetic determinants of impaired gait following stroke: segmental work and pendular energy transduction during treadmill walking

Balbinot, Gustavo; Schuch, Clarissa Pedrini; Oliveira, Henrique Bianchi; Peyré‐Tartaruga, Leonardo Alexandre

doi:10.1242/bio.051581

Cited by 13 publications

(14 citation statements)

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“…Furthermore, increased and asymmetric internal work production from lower limbs hamper the mobility of people with neurological disorders, as in stroke, but with substantial compensations between paretic and non-paretic sides (Balbinot et al, 2020), thus reducing the expected increase in (overall) W TOT and CoT in this population.…”

Section: Discussionmentioning

confidence: 99%

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Mechanical work as a (key) determinant of energy cost in human locomotion: recent findings and future directions

Peyré‐Tartaruga

Dewolf

Prampero

et al. 2021

Experimental Physiology

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During locomotion, muscles use metabolic energy to produce mechanical work (in a more or less efficient way), and energetics and mechanics can be considered as two sides of the same coin, the latter being investigated to understand the former. A mechanical approach based on König's theorem (Fenn's approach) has proved to be a useful tool to elucidate the determinants of the energy cost of locomotion (e.g., the pendulum-like model of walking and the bouncing model of running) and has resulted in many advances in this field. During the past 60 years, this approach has been refined and applied to explore the determinants of energy cost and efficiency in a variety of conditions (e.g., low gravity, unsteady speed). This narrative review aims to summarize current knowledge of the role that mechanical work has played in our understanding of energy cost to date, and to underline how recent developments in analytical methods and their applications in specific locomotion modalities (on a gradient, at low gravity and in unsteady conditions) and in pathological gaits (asymmetric gait pathologies, obese subjects and in the elderly) could continue to push this understanding further. The recent in vivo quantification of new aspects that should be included in the assessment of mechanical work (e.g., frictional internal work and elastic contribution) deserves future research that would improve our knowledge of the

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Section: Discussionmentioning

confidence: 99%

“…In the first article (Fábrica et al, 2019), the pendular mechanism's alteration was associated with a longer duration of the double support phase. In Balbinot et al (2020),…”

Section: Subjects With Unilateral Lower Limb Amputation Present a Highmentioning

confidence: 99%

Mechanical work as a (key) determinant of energy cost in human locomotion: recent findings and future directions

Peyré‐Tartaruga

Dewolf

Prampero

et al. 2021

Experimental Physiology

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“…Movements in the pitch direction reflect the body pendular motion in the sagittal plane, where the lower limbs support step-to-step transitions efficiently [ 57 ]. In post-stroke individuals, the lower limb is thought to act as a rigid shaft supporting the pendular transduction during walking, which is maintained to some extent despite the motor compromise [ 5 ]. We suggest that individuals sustaining a chronic stroke learn to adapt the walking dynamics to maintain an efficient gait.…”

Section: Discussionmentioning

confidence: 99%

“…Individuals with chronic stroke often display reduced motor control, muscle weakness, and spasticity in the lower limbs [ 1 , 2 ]. This may lead to asymmetries while standing or walking [ 3 ], slower gait with poor coordination [ 4 ], greater metabolic consumption while walking [ 5 ], and postural instability, ultimately leading to reduced community ambulation [ 6 ]. In the clinic, gait assessments often include the quantification of gait speed, which is easily and reliably measured using a chronometer and a fixed distance.…”

Section: Introductionmentioning

confidence: 99%

Movement smoothness in chronic post-stroke individuals walking in an outdoor environment—A cross-sectional study using IMU sensors

et al. 2021

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Background Walking speed is often used in the clinic to assess the level of gait impairment following stroke. Nonetheless, post-stroke individuals may employ the same walking speed but at a distinct movement quality. The main objective of this study was to explore a novel movement quality metric, the estimation of gait smoothness by the spectral arc length (SPARC), in individuals with a chronic stroke displaying mild/moderate or severe motor impairment while walking in an outdoor environment. Also, to quantify the correlation between SPARC, gait speed, motor impairment, and lower limb spasticity focused on understanding the relationship between the movement smoothness metric and common clinical assessments. Methods Thirty-two individuals with a chronic stroke and 32 control subjects participated in this study. The 10 meters walking test (10 MWT) was performed at the self-selected speed in an outdoor environment. The 10 MWT was instrumented with an inertial measurement unit system (IMU), which afforded the extraction of trunk angular velocities (yaw, roll, and pitch) and subsequent SPARC calculation. Results Movement smoothness was not influenced by gait speed in the control group, indicating that SPARC may constitute an additional and independent metric in the gait assessment. Individuals with a chronic stroke displayed reduced smoothness in the yaw and roll angular velocities (lower SPARC) compared with the control group. Also, severely impaired participants presented greater variability in smoothness along the 10 MWT. In the stroke group, a smoother gait in the pitch angular velocity was correlated with lower limb spasticity, likely indicating adaptive use of spasticity to maintain the pendular walking mechanics. Conversely, reduced smoothness in the roll angular velocity was related to pronounced spasticity. Conclusions Individuals with a chronic stroke displayed reduced smoothness in the yaw and roll angular velocities while walking in an outdoor environment. The quantification of gait smoothness using the SPARC metric may represent an additional outcome in clinical assessments of gait in individuals with a chronic stroke.

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“…As walking speed is a key indicator of functional independence (Fulk et al, 2017 ), improving walking speed is a top priority during post-stroke rehabilitation (Bohannon et al, 1988 ); however, compensations within and between limbs may allow functional walking speeds despite persisting impairments in paretic propulsion (Bowden et al, 2006 ; Cruz et al, 2009 ). That is, focusing only on increasing walking speed during gait training is not sufficient to facilitate paretic limb neuromotor recovery (Roelker et al, 2019 ); the benefits of faster walking may be overshadowed by persisting metabolically-expensive and unstable gait patterns (Mahon et al, 2015 ; Vistamehr et al, 2016 ; Balbinot et al, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

Targeting Paretic Propulsion and Walking Speed With a Soft Robotic Exosuit: A Consideration-of-Concept Trial

et al. 2021

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Background: Soft robotic exosuits can facilitate immediate increases in short- and long-distance walking speeds in people with post-stroke hemiparesis. We sought to assess the feasibility and rehabilitative potential of applying propulsion-augmenting exosuits as part of an individualized and progressive training program to retrain faster walking and the underlying propulsive strategy.Methods: A 54-yr old male with chronic hemiparesis completed five daily sessions of Robotic Exosuit Augmented Locomotion (REAL) gait training. REAL training consists of high-intensity, task-specific, and progressively challenging walking practice augmented by a soft robotic exosuit and is designed to facilitate faster walking by way of increased paretic propulsion. Repeated baseline assessments of comfortable walking speed over a 2-year period provided a stable baseline from which the effects of REAL training could be elucidated. Additional outcomes included paretic propulsion, maximum walking speed, and 6-minute walk test distance.Results: Comfortable walking speed was stable at 0.96 m/s prior to training and increased by 0.30 m/s after training. Clinically meaningful increases in maximum walking speed (Δ: 0.30 m/s) and 6-minute walk test distance (Δ: 59 m) were similarly observed. Improvements in paretic peak propulsion (Δ: 2.80 %BW), propulsive power (Δ: 0.41 W/kg), and trailing limb angle (Δ: 6.2 degrees) were observed at comfortable walking speed (p's < 0.05). Likewise, improvements in paretic peak propulsion (Δ: 4.63 %BW) and trailing limb angle (Δ: 4.30 degrees) were observed at maximum walking speed (p's < 0.05).Conclusions: The REAL training program is feasible to implement after stroke and capable of facilitating rapid and meaningful improvements in paretic propulsion, walking speed, and walking distance.

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Mechanical and energetic determinants of impaired gait following stroke: segmental work and pendular energy transduction during treadmill walking

Cited by 13 publications

References 55 publications

Mechanical work as a (key) determinant of energy cost in human locomotion: recent findings and future directions

Mechanical work as a (key) determinant of energy cost in human locomotion: recent findings and future directions

Movement smoothness in chronic post-stroke individuals walking in an outdoor environment—A cross-sectional study using IMU sensors

Targeting Paretic Propulsion and Walking Speed With a Soft Robotic Exosuit: A Consideration-of-Concept Trial

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