Plantarflexor weakness as a limiting factor of gait speed in stroke subjects and the compensating role of hip flexors

Nadeau, Sylvie; Gravel, Denis; Arsenault, André; Bourbonnais, Daniel

doi:10.1016/s0268-0033(98)00062-x

Cited by 351 publications

(314 citation statements)

References 28 publications

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“…In the involved side of stroke patients, the moment and power produced by the plantarflexors are highly related to gait performance [27,28]. In the present study, improvements of knee extensor and plantarflexor moments in the participants (except P2) were seen.…”

Section: Gait Performance -Kinetic Parameterssupporting

confidence: 54%

“…Knee extensor and plantarflexor muscles are important muscle groups responsible for generating a large part of the energy required to move the lower limbs forward during the push-off phase [26,27]. In the involved side of stroke patients, the moment and power produced by the plantarflexors are highly related to gait performance [27,28].…”

Section: Gait Performance -Kinetic Parametersmentioning

confidence: 99%

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Improved walking ability with wearable robot-assisted training in patients suffering chronic stroke

Chen

Mao

et al. 2015

BME

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Abstract. Wearable robotic devices provide safe and intensive rehabilitation, enabling repeated motions for motor function recovery in stroke patients. The aim of this small case series was to demonstrate the training effects of a three-week robotic leg orthosis, and to investigate possible mechanisms of the sensory-motor alterations and improvements by using gait analysis and EMG. Three survivors of chronic strokes participated in robot-assisted gait therapy for three weeks. EMG signals from the rectus femoris (RF), tibialis anterior (TA), biceps femoris (BF), and medial gastrocnemius (MG), as well as kinetics and kinematics data of the lower limb, were recorded before and after the training. The normalized root mean squared (RMS) values of the muscles, the joint moments, joint angles, and the results of two clinical scales (Berg Balance scale, BBS, and the lower extremity subscale of Fugl-Meyer assessment, LE-FMA) were used for analysis. All participants experienced improved balance and functional performances and increased BBS and LE-FMA scores. The EMG results showed there was an increase of the normalized RMS values of the MG and BF on the affected side. Additionally, EMG activities of the agonist and antagonist pair (i.e. RF and BF) appeared to return to similar levels after training. The peak moment of hip flexor, knee extensor, and plantar flexor, which all contributed to push-off power, were found to have increased after training. In summary, the three-week training period using the wearable RLO improved the three participants' gait performance by regaining push-off power and improved muscle activation and walking speed.

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Section: Gait Performance -Kinetic Parameterssupporting

confidence: 54%

Section: Gait Performance -Kinetic Parametersmentioning

confidence: 99%

Improved walking ability with wearable robot-assisted training in patients suffering chronic stroke

Chen

Mao

et al. 2015

BME

View full text Add to dashboard Cite

show abstract

“…For example, data examining the relative importance of lower extremity strength in persons after stroke demonstrate significant correlations between the strength of the paretic hip flexors (r ¼ 0.57), KE (r ¼ 0.41) and primarily the ankle PF (r ¼ 0.85), with maximal gait speed. 31,32 In addition, previous simulation work suggests that force production by the soleus and gastrocnemius is critical to trunk forward progression, swing initiation and power generation during gait. 13,18 Thus, one might predict slower gait speeds if force production by these muscles is abnormal during locomotion.…”

Section: Discussionmentioning

confidence: 99%

Resistance training and locomotor recovery after incomplete spinal cord injury: a case series

et al. 2007

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Study design: Longitudinal intervention case series. Objective: To determine if a 12-week resistance and plyometric training program results in improved muscle function and locomotor speed after incomplete spinal cord injury (SCI). Setting: University research setting. Methods: Three ambulatory individuals with chronic (18.772.2 months post injury) motor incomplete SCI completed 12 weeks of lower extremity resistance training combined with plyometric training (RPT). Muscle maximum cross-sectional area (max-CSA) of the knee extensor (KE) and plantar flexor (PF) muscle groups was determined using magnetic resonance imaging (MRI). In addition, peak isometric torque, time to peak torque (T 20-80 ), torque developed within the initial 220 ms of contraction (torque 220 ) and average rate of torque development (ARTD) were calculated as indices of muscle function. Maximal as well as selfselected gait speeds were determined pre-and post-RPT during which the spatio-temporal characteristics, kinematics and kinetics of gait were measured. Results: RPT resulted in improved peak torque production in the KE (28.974.4%) and PF (35.079.1%) muscle groups, as well as a decrease in T 20-80 , an increased torque 220 and an increase ARTD in both muscle groups. In addition, an increase in self-selected (pre-RPT ¼ 0.77 m/s; post-RPT ¼ 1.03 m/s) and maximum (pre-RPT ¼ 1.08 m/s; post-RPT ¼ 1.47 m/s) gait speed was realized. Increased gait speeds were accompanied by bilateral increases in propulsion and hip excursion as well as increased lower extremity joint powers. Conclusions: The combination of lower extremity RPT can attenuate existing neuromuscular impairments and improve gait speed in persons after incomplete SCI.

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“…Although the majority of AFO research is conducted using populations with myelomeningocele, spastic diplegia, hemiparesis, and multiple sclerosis, a common feature of AFO use in these populations and those with limb salvage is plantarflexor weakness. Gait is hindered by limited plantarflexor power [26,27] for which the hip generally compensates [24,26]. The resulting gait is mechanically inefficient [8,22] and leads to elevated energy cost [29,39].…”

Section: Introductionmentioning

confidence: 99%

How Does Ankle-foot Orthosis Stiffness Affect Gait in Patients With Lower Limb Salvage?

Esposito

Blanck

Harper

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Ankle-foot orthoses (AFOs) are commonly prescribed during rehabilitation after limb salvage. AFO stiffness is selected to help mitigate gait deficiencies. A new custom dynamic AFO, the Intrepid Dynamic Exoskeletal Orthosis (IDEO), is available to injured service members but prescription guidelines are limited. Questions/purposes In this study we ask (1) does dynamic AFO stiffness affect gait parameters such as joint angles, moments, and powers; and (2) can a given dynamic AFO stiffness normalize gait mechanics to noninjured control subjects? Methods Thirteen patients with lower limb salvage (ankle arthrodesis, neuropathy, foot/ankle reconstruction, etc) after major lower extremity trauma and 13 control subjects who had no lower extremity trauma and wore no orthosis underwent gait analysis at a standardized speed. Patients wore their custom IDEO with posterior struts of three different stiffnesses: nominal (clinically prescribed stiffness), compliant (20% less stiff), and stiff (20% stiffer). Joint angles, moments, powers, and ground reaction forces were compared across the varying stiffnesses of the orthoses tested and between the patient and control groups. Results An increase in AFO compliance resulted in 20% to 26% less knee flexion relative to the nominal (p = 0.003) and stiff (p = 0.001) conditions, respectively. Ankle range of motion and power generation were, on average, 56% (p \ 0.001) and 63% (p \ 0.001), respectively, less than controls as a result of the relatively fixed ankle position. Conclusions Patients with limb salvage readily adapted to different dynamic AFO stiffnesses and demonstrated few Support was provided by

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Plantarflexor weakness as a limiting factor of gait speed in stroke subjects and the compensating role of hip flexors

Cited by 351 publications

References 28 publications

Improved walking ability with wearable robot-assisted training in patients suffering chronic stroke

Improved walking ability with wearable robot-assisted training in patients suffering chronic stroke

Resistance training and locomotor recovery after incomplete spinal cord injury: a case series

How Does Ankle-foot Orthosis Stiffness Affect Gait in Patients With Lower Limb Salvage?

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