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Fujita K, Tsushima Y, Hayashi K, Kawabata K, Ogawa T, Hori H, Kobayashi Y. Altered muscle synergy structure in patients with poststroke stiff knee gait. Sci Rep 2024; 14:20295. [PMID: 39217201 PMCID: PMC11365932 DOI: 10.1038/s41598-024-71083-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 08/23/2024] [Indexed: 09/04/2024] Open
Abstract
Stiff knee gait (SKG) occurrence after a stroke is associated with various abnormal muscle activities; however, the interactions among these muscles are unclear. This study aimed to elucidate the muscle synergy characteristics during walking in patients with SKG after a stroke. This cross-sectional study included 20 patients with poststroke SKG (SKG group), 16 patients without poststroke SKG (non-SKG group), and 15 healthy adults (control group). Participants walked a 10-m distance at a comfortable speed, and electromyographic data were recorded from six lower-limb muscles. Non-negative matrix factorization was employed to derive time-varying activity (C), muscle weights (W), and the percentage of total variance accounted for (tVAF) for muscle synergies. The SKG group showed a higher tVAF than the control group. The initial stance module (including knee extensors) showed increased activity during the swing phase. The initial swing module (including hip flexors and ankle dorsiflexors) exhibited a higher activity during the single-support phase but a lower activity during the swing phase. The synergy structure in patients with SKG after stroke was simplified, with specific abnormalities in synergy activities. SKG may arise from several synergy alterations involving multiple muscles, indicating that approaches focused on controlling individual muscle activities are unsuitable.
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Affiliation(s)
- Kazuki Fujita
- Graduate School of Health Science, Fukui Health Science University, 55-13-1 Egami, Fukui, 910-3190, Japan.
| | - Yuichi Tsushima
- Department of Physical Therapy Rehabilitation, Fukui General Hospital, Fukui, Japan
| | - Koji Hayashi
- Department of Rehabilitation Medicine, Fukui General Hospital, Fukui, Japan
| | - Kaori Kawabata
- Graduate School of Health Science, Fukui Health Science University, 55-13-1 Egami, Fukui, 910-3190, Japan
| | - Tomoki Ogawa
- Department of Physical Therapy Rehabilitation, Fukui General Hospital, Fukui, Japan
| | - Hideaki Hori
- Graduate School of Health Science, Fukui Health Science University, 55-13-1 Egami, Fukui, 910-3190, Japan
| | - Yasutaka Kobayashi
- Graduate School of Health Science, Fukui Health Science University, 55-13-1 Egami, Fukui, 910-3190, Japan
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Fujita K, Tsushima Y, Hayashi K, Kawabata K, Sato M, Kobayashi Y. Differences in causes of stiff knee gait in knee extensor activity or ankle kinematics: A cross-sectional study. Gait Posture 2022; 98:187-194. [PMID: 36166956 DOI: 10.1016/j.gaitpost.2022.09.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/20/2022] [Accepted: 09/19/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Stiff knee gait (SKG), a common occurrence after the onset of stroke, is caused by hyperactivity of the rectus femoris during the swing phase. Another cause of SKG is the weakness of push-off in hemiparetic gait. Prior research did not consider the effect of the magnitude of knee extensors in their subjects. RESEARCH QUESTION Does the cause of SKG differ between patients with high and low knee extensor activities during the swing phase? METHODS We examined 38 patients with chronic stroke hemiplegia who presented with SKG. After placing an inertia sensor and an electromyogram, patients walked 10 m at a comfortable speed. All patients were categorized per the sign of the principal component 2 (PC2) as a component with large factor loadings of knee extensors attained from the electromyographic amplitude during the early swing phase of the paretic limb. Then, the kinematic parameters of knee flexion and other gait parameters in each group were compared, and a correlation analysis was performed. RESULTS In the high PC2 group, the timing of peak knee flexion during the swing phase was early, and vastus lateralis activity during the preswing phase negatively correlated with the knee-flexion angle during the swing phase. In the low PC2 group, the angular velocity of ankle plantar flexion at the toe-off was slow, which positively correlated with the knee-flexion angle during the swing phase. SIGNIFICANCE The cause of SKG could be an inappropriate activity of the vastus lateralis rather than the rectus femoris in patients with high knee extensor activity and slow plantar-flexion velocity at toe-off in patients with low knee extensor activity. Not all causes of SKG in patients with hemiplegia are common, and different treatment strategies are needed per the individuality of spastic knee extensor activity.
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Affiliation(s)
- Kazuki Fujita
- Graduate School of Health Science, Fukui Health Science University, Fukui-city, Fukui, Japan.
| | - Yuichi Tsushima
- Department of Physical Therapy Rehabilitation, Fukui General Hospital, Fukui-city, Fukui, Japan
| | - Koji Hayashi
- Department of Rehabilitation Medicine, Fukui General Hospital, Fukui-city, Fukui, Japan
| | - Kaori Kawabata
- Graduate School of Health Science, Fukui Health Science University, Fukui-city, Fukui, Japan
| | - Mamiko Sato
- Department of Rehabilitation Medicine, Fukui General Hospital, Fukui-city, Fukui, Japan
| | - Yasutaka Kobayashi
- Graduate School of Health Science, Fukui Health Science University, Fukui-city, Fukui, Japan
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Das R, Paul S, Mourya GK, Kumar N, Hussain M. Recent Trends and Practices Toward Assessment and Rehabilitation of Neurodegenerative Disorders: Insights From Human Gait. Front Neurosci 2022; 16:859298. [PMID: 35495059 PMCID: PMC9051393 DOI: 10.3389/fnins.2022.859298] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/01/2022] [Indexed: 12/06/2022] Open
Abstract
The study of human movement and biomechanics forms an integral part of various clinical assessments and provides valuable information toward diagnosing neurodegenerative disorders where the motor symptoms predominate. Conventional gait and postural balance analysis techniques like force platforms, motion cameras, etc., are complex, expensive equipment requiring specialist operators, thereby posing a significant challenge toward translation to the clinics. The current manuscript presents an overview and relevant literature summarizing the umbrella of factors associated with neurodegenerative disorder management: from the pathogenesis and motor symptoms of commonly occurring disorders to current alternate practices toward its quantification and mitigation. This article reviews recent advances in technologies and methodologies for managing important neurodegenerative gait and balance disorders, emphasizing assessment and rehabilitation/assistance. The review predominantly focuses on the application of inertial sensors toward various facets of gait analysis, including event detection, spatiotemporal gait parameter measurement, estimation of joint kinematics, and postural balance analysis. In addition, the use of other sensing principles such as foot-force interaction measurement, electromyography techniques, electrogoniometers, force-myography, ultrasonic, piezoelectric, and microphone sensors has also been explored. The review also examined the commercially available wearable gait analysis systems. Additionally, a summary of recent progress in therapeutic approaches, viz., wearables, virtual reality (VR), and phytochemical compounds, has also been presented, explicitly targeting the neuro-motor and functional impairments associated with these disorders. Efforts toward therapeutic and functional rehabilitation through VR, wearables, and different phytochemical compounds are presented using recent examples of research across the commonly occurring neurodegenerative conditions [viz., Parkinson's disease (PD), Alzheimer's disease (AD), multiple sclerosis, Huntington's disease (HD), and amyotrophic lateral sclerosis (ALS)]. Studies exploring the potential role of Phyto compounds in mitigating commonly associated neurodegenerative pathologies such as mitochondrial dysfunction, α-synuclein accumulation, imbalance of free radicals, etc., are also discussed in breadth. Parameters such as joint angles, plantar pressure, and muscle force can be measured using portable and wearable sensors like accelerometers, gyroscopes, footswitches, force sensors, etc. Kinetic foot insoles and inertial measurement tools are widely explored for studying kinematic and kinetic parameters associated with gait. With advanced correlation algorithms and extensive RCTs, such measurement techniques can be an effective clinical and home-based monitoring and rehabilitation tool for neuro-impaired gait. As evident from the present literature, although the vast majority of works reported are not clinically and extensively validated to derive a firm conclusion about the effectiveness of such techniques, wearable sensors present a promising impact toward dealing with neurodegenerative motor disorders.
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Affiliation(s)
- Ratan Das
- Department of Biomedical Engineering, North-Eastern Hill University, Shillong, India
| | - Sudip Paul
- Department of Biomedical Engineering, North-Eastern Hill University, Shillong, India
| | - Gajendra Kumar Mourya
- Department of Biomedical Engineering, North-Eastern Hill University, Shillong, India
| | - Neelesh Kumar
- Biomedical Applications Unit, Central Scientific Instruments Organisation, Chandigarh, India
| | - Masaraf Hussain
- Department of Neurology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, India
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Bacca O, Celestino ML, Barela JA, Yakovenko S, de Lima AJS, Barela AMF. Compensatory Strategies Due to Knee Flexion Constraint during Gait of Non-Disabled Adults. J Mot Behav 2021; 54:281-290. [PMID: 34402739 PMCID: PMC10792986 DOI: 10.1080/00222895.2021.1955653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/24/2021] [Accepted: 07/09/2021] [Indexed: 10/20/2022]
Abstract
Constraining knee flexion of non-disabled individuals could further our understanding regarding the importance of knee joint during gait, which is a common disturbance in individuals with gait impairment. In this study we investigated whether a mechanical constraint of knee flexion in non-disabled adults would lead to compensatory strategies. Eleven non-disabled male adults walked without and with an orthosis that permitted full extension and limited knee flexion up to either 45° or 30°. We analyzed the temporal organization of lower limb kinematics and electromyograms of the rectus femoris, vastus medialis and lateralis, tibialis anterior, semitendinosus, biceps femoris, and gastrocnemius medialis and lateralis. Non-disabled adults compensated for the reduced knee flexion by increasing hip and ankle joint excursions and ankle flexor activation amplitude. Also, these adults shortened pre-swing and lengthened swing duration in the constrained limb and increased the activity of bifunctional hip extensor and knee flexor muscles in the constrained limb in relation to the unconstrained limb. The use of an orthosis that limited knee flexion in non-disabled adults leaded to compensatory strategies in the temporal organization of joint excursions and muscle activations in the constrained limb. The compensatory effects were correlated with the extent of knee flexion constraint.
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Affiliation(s)
- Odair Bacca
- Institute of Physical Activity and Sport Sciences, Cruzeiro do Sul University, São Paulo, SP, Brazil
| | - Melissa Leandro Celestino
- Institute of Physical Activity and Sport Sciences, Cruzeiro do Sul University, São Paulo, SP, Brazil
| | - José Angelo Barela
- Department of Physical Education, São Paulo State University, Rio Claro, SP, Brazil
| | - Sergiy Yakovenko
- Department of Human Performance – Exercise Physiology, School of Medicine, West Virginia University, Morgantown, WV, United States of America
- Department of Biomedical Engineering, Benjamin M. Statler College of Engineering and Mineral Resources, West Virginia University, Morgantown, WV, United States of America
- Rockefeller Neuroscience Institute, School of Medicine, West Virginia University, Morgantown, WV, United States of America
- Mechanical and Aerospace Engineering, Benjamin M. Statler College of Engineering and Mineral Resources, West Virginia University, Morgantown, WV, United States of America
- Department of Neuroscience, School of Medicine, West Virginia University, Morgantown, WV, United States of America
| | - Ana Júlia Silva de Lima
- Institute of Physical Activity and Sport Sciences, Cruzeiro do Sul University, São Paulo, SP, Brazil
| | - Ana Maria Forti Barela
- Institute of Physical Activity and Sport Sciences, Cruzeiro do Sul University, São Paulo, SP, Brazil
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Lattouf NA, Tomb R, Assi A, Maynard L, Mesure S. Eccentric training effects for patients with post-stroke hemiparesis on strength and speed gait: A randomized controlled trial. NeuroRehabilitation 2021; 48:513-522. [PMID: 33967063 DOI: 10.3233/nre-201601] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND In hemiparetic patients, the skeletal muscle is mainly affected with a combination of abnormalities (denervation, remodeling, spasticity, and eventually muscular atrophy). OBJECTIVE This study examined the role of eccentric exercise in strengthening muscles of the lower extremity and ultimately improving autonomy in patients with post-stroke hemiparesis during gait. METHODS Thirty-seven patients hemiparetic adults were recruited, randomized into a control group (n = 19) and an intervention group receiving eccentric muscle strengthening (n = 18). The protocol consisted of three sets of five repetitions of eccentric contraction of the paretic limb after determining the maximum repetition (1 MRI). Evaluation of the 1RM, 10 meters and 6WMT was performed before and after the exercise for each group. Manova test was used to compare the differences between the control and intervention groups. RESULTS The paretic limb showed significant increase in one-repetition maximum (1RM) between before and after rehabilitation (p≤0.00003). The two groups of Patients increased their walking speed (p≤0.0005), but we observed a significant difference between groups only for the 6MWT and not on the 10 meters Test. CONCLUSIONS Eccentric training can be useful in strengthening the muscles of the lower limbs, and promoting gait performance. Eccentric training could complement other methods of managing patients with post-stroke hemiparesis.
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Affiliation(s)
| | - Roland Tomb
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Ayman Assi
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Luc Maynard
- UGECAM-PACAC, Centre de Rééducation Fonctionnelle de Valmante, Marseille, France
| | - Serge Mesure
- Aix Marseille Université, CNRS, Institut des Sciences du Mouvement UMR, Marseille, France
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Fidalgo-Herrera A, Miangolarra-Page JC, Carratalá-Tejada M. Electromyographic traces of motor unit synchronization of fatigued lower limb muscles during gait. Hum Mov Sci 2020; 75:102750. [PMID: 33373857 DOI: 10.1016/j.humov.2020.102750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 12/14/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The study of the signal in the frequency domain has shown to be a good tool to identify muscular fatigue. Previous research has shown that the low frequency band and 40 Hz frequency band increase their relative intensity with the onset of fatigue. These findings were obtained in rectus femoris, but the behaviours of other muscles of the lower limb are unknown. In this article we explored the changes in the low frequency and 40 Hz frequency band of lower limb muscles with respect to fatigue. METHODS Thirty healthy subjects were recruited to analyse the electromyography (EMG) of biceps femoris, tibialis anterior and gastrocnemius medialis and lateralis of both legs during gait. Four two-minutes walks at a self-selected speed were recorded, the first two walks with a normal muscular function and the last two walks after a fatigue protocol. All the signals were decomposed using wavelet transformations. The signals were normalized in time and spectral intensities normalized to the sum of intensities in the frequency domain. Two frequency bands were studied in each walk: the 40-Hz (34-53 Hz) and the low frequency (< 25 Hz) bands. A ratio of the spectral intensities of those frequency bands at each walk was obtained by dividing the 40-Hz frequency band spectral intensity by the low frequency band spectral intensity. Statistical parametric mapping techniques were used to compare the ratios of the prefatigue walks against the postfatigue walks. RESULTS The results of the Statistical Non-Parametric Mapping (SnPM) analysis of all muscles depict a higher relative spectral intensity in the low frequency band in the comparison of fatigue versus prefatigue recordings except for the right gastrocnemius lateralis. The critical thresholds F* were exceeded by multiple suprathreshold clusters with p values <0.05, showing that the low frequency band increased its relative spectral intensity in the case of fatigue. CONCLUSION The obtained results suggest that the low frequency band increases its relative spectral intensity in all the studied muscles when fatigue onsets. This increase in relative spectral intensity may be linked to an increase in motor unit synchronization promoted by the central nervous system to ensure good motor control.
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Affiliation(s)
- A Fidalgo-Herrera
- LAMBECOM, Universidad Rey Juan Carlos, Alcorcón, calle Atenas S/N, Madrid, Spain.
| | - J C Miangolarra-Page
- LAMBECOM, Universidad Rey Juan Carlos, Alcorcón, calle Atenas S/N, Madrid, Spain; Fuenlabrada's Clinical University Hospital, Fuenalbrada, Camino del Molino, 2, Madrid, Spain.
| | - M Carratalá-Tejada
- LAMBECOM, Universidad Rey Juan Carlos, Alcorcón, calle Atenas S/N, Madrid, Spain.
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Fujita K, Kobayashi Y, Miaki H, Hori H, Tsushima Y, Sakai R, Nomura T, Ogawa T, Kinoshita H, Nishida T, Hitosugi M. Pedaling improves gait ability of hemiparetic patients with stiff-knee gait: fall prevention during gait. J Stroke Cerebrovasc Dis 2020; 29:105035. [PMID: 32807447 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/01/2020] [Accepted: 06/04/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE Stiff-knee gait, which is a gait abnormality observed after stroke, is characterized by decreased knee flexion angles during the swing phase, and it contributes to a decline in gait ability. This study aimed to identify the immediate effects of pedaling exercises on stiff-knee gait from a kinesiophysiological perspective. METHODS Twenty-one patients with chronic post-stroke hemiparesis and stiff-knee gait were randomly assigned to a pedaling group and a walking group. An ergometer was set at a load of 5 Nm and rotation speed of 40 rpm, and gait was performed at a comfortable speed; both the groups performed the intervention for 10 min. Kinematic and electromyographical data while walking on flat surfaces were immediately measured before and after the intervention. RESULTS In the pedaling group, activity of the rectus femoris significantly decreased from the pre-swing phase to the early swing phase during gait after the intervention. Flexion angles and flexion angular velocities of the knee and hip joints significantly increased during the same period. The pedaling group showed increased step length on the paralyzed side and gait velocity. CONCLUSIONS Pedaling increases knee flexion during the swing phase in hemiparetic patients with stiff-knee gait and improves gait ability.
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Affiliation(s)
- Kazuki Fujita
- Department of Rehabilitation, Faculty of Health Science, Fukui Health Science University, 55-13-1 Egami, Fukui-city 910-3190, Fukui, Japan.
| | - Yasutaka Kobayashi
- Department of Rehabilitation, Faculty of Health Science, Fukui Health Science University, 55-13-1 Egami, Fukui-city 910-3190, Fukui, Japan.
| | - Hiroichi Miaki
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa-city, Ishikawa, Japan.
| | - Hideaki Hori
- Department of Rehabilitation, Faculty of Health Science, Fukui Health Science University, 55-13-1 Egami, Fukui-city 910-3190, Fukui, Japan.
| | - Yuichi Tsushima
- Department of Physical Therapy Rehabilitation, Fukui General Hospital, Fukui-city, Fukui, Japan.
| | - Ryo Sakai
- Department of Rehabilitation, Faculty of Health Science, Fukui Health Science University, 55-13-1 Egami, Fukui-city 910-3190, Fukui, Japan.
| | - Tomomi Nomura
- Department of Physical Therapy Rehabilitation, Fukui General Hospital, Fukui-city, Fukui, Japan.
| | - Tomoki Ogawa
- Department of Physical Therapy Rehabilitation, Fukui General Hospital, Fukui-city, Fukui, Japan.
| | - Hirotaka Kinoshita
- Department of Physical Therapy Rehabilitation, Fukui General Hospital, Fukui-city, Fukui, Japan.
| | - Tomoko Nishida
- Department of Physical Therapy Rehabilitation, Fukui General Hospital, Fukui-city, Fukui, Japan.
| | - Masahito Hitosugi
- Department of Legal Medicine, Shiga University of Medical Science, Otsu-city, Shiga, Japan.
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Fidalgo-Herrera A, Miangolarra-Page J, Carratalá-Tejada M. Traces of muscular fatigue in the rectus femoris identified with surface electromyography and wavelets on normal gait. Physiother Theory Pract 2020; 38:211-225. [DOI: 10.1080/09593985.2020.1725945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Alberto Fidalgo-Herrera
- Laboratorio de Análisis del Movimiento, Biomecánica, Ergonomía y Control Motor (LAMBECOM), Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Juan Miangolarra-Page
- Laboratorio de Análisis del Movimiento, Biomecánica, Ergonomía y Control Motor (LAMBECOM), Universidad Rey Juan Carlos, Alcorcón, Spain
- Departamento de Medicina Física y Rehabilitación, Hospital Universitario de Fuenlabrada, Fuenlabrada, Spain
| | - Maria Carratalá-Tejada
- Laboratorio de Análisis del Movimiento, Biomecánica, Ergonomía y Control Motor (LAMBECOM), Universidad Rey Juan Carlos, Alcorcón, Spain
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Akbas T, Sulzer J. Musculoskeletal simulation framework for impairment-based exoskeletal assistance post-stroke. IEEE Int Conf Rehabil Robot 2020; 2019:1185-1190. [PMID: 31374790 DOI: 10.1109/icorr.2019.8779564] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Assistive technology for the lower extremities has shown great promise towards improving gait function in people following neuromuscular injuries. However, our previous work assisting knee flexion torque in post-stroke Stiff-Knee gait found that augmenting strength can induce secondary complications such as spasticity due to stretching of the rectus femoris. In this work we explore whether we could have obtained improved knee flexion but avoided a spastic response by simulating combinations of hip and knee flexion torques using musculoskeletal modeling and simulation. We explore previously collected data on a case-by-case basis to determine individual-specific quadriceps reflex thresholds based on estimated rectus femoris muscle fiber stretch velocities. We then implemented a forward simulation framework to identify the subject-specific hip-knee assistance prescription to improve knee range of motion without initiating a spastic response. The obtained subject-specific assistive prescription informs the development of new gait assistance strategies for post-stroke gait and could be extended to other neuromuscular gait impairments.
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Yuan H, Ge P, Du L, Xia Q. Co-Contraction of Lower Limb Muscles Contributes to Knee Stability During Stance Phase in Hemiplegic Stroke Patients. Med Sci Monit 2019; 25:7443-7450. [PMID: 31584038 PMCID: PMC6792518 DOI: 10.12659/msm.916154] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Knee stability has an important role in the gait of hemiplegic stroke patients. However, factors affecting knee stability have not been assessed concerning gait. The purpose of this study was to explore whether co-contraction of the lower limb muscles contributes to the knee stability during the stance phase of the gait cycle in hemiplegic stroke patients. Material/Methods A total of 30 hemiplegic stroke patients, ages 36–79 years, were instructed to walk at their natural speed. The root mean square of surface electromyography was used to measure activities of the biceps femoris and rectus femoris muscles, while the co-contraction ratio was computed based on the root mean squares. The peak angle of knee extension was acquired in the stance phase by 3D kinematic analyses. Lower limb function was evaluated using the Fugl-Meyer scale for lower limb motor assessment. Results A statistically significant increase of the muscle co-contraction ratio of the involved extremity was observed compared with that of the uninvolved extremity (t=−4.066, P<0.05). The muscle co-contraction ratio was significantly correlated with the peak angle of knee extension (r=0.387, P=0.035), Fugl-Meyer scale (r=−0.522, P=0.003), and Modified Ashworth Scale (r=0.404, P=0.027) during the stance phase of the gait cycle. Conclusions Our results showed that co-contraction of the rectus femoris muscle contributes to the stability of the knee and lower limb function in hemiplegic stroke patients, and suggests that co-contraction should be considered in the rehabilitation of knee stability during gait in hemiplegic stroke patients. Appropriate rehabilitation assessment planning with hemiplegic stroke patients, such as muscle co-contraction or knee stability of, might be created based on our results.
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Affiliation(s)
- Hai Yuan
- Department of Rehabilitation Medicine, The Second People's Hospital of Hefei City, Hefei, Anhui, China (mainland)
| | - Pingping Ge
- Department of Rehabilitation Medicine, The Second People's Hospital of Hefei City, Hefei, Anhui, China (mainland)
| | - Lingling Du
- Department of Rehabilitation Medicine, The Second People's Hospital of Hefei City, Hefei, Anhui, China (mainland)
| | - Qing Xia
- Department of Rehabilitation Medicine, The Second People's Hospital of Hefei City, Hefei, Anhui, China (mainland)
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Cattagni T, Geiger M, Supiot A, de Mazancourt P, Pradon D, Zory R, Roche N. A single session of anodal transcranial direct current stimulation applied over the affected primary motor cortex does not alter gait parameters in chronic stroke survivors. Neurophysiol Clin 2019; 49:283-293. [DOI: 10.1016/j.neucli.2019.07.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 07/10/2019] [Accepted: 07/10/2019] [Indexed: 01/20/2023] Open
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Geiger M, Supiot A, Pradon D, Do MC, Zory R, Roche N. Minimal detectable change of kinematic and spatiotemporal parameters in patients with chronic stroke across three sessions of gait analysis. Hum Mov Sci 2019; 64:101-107. [DOI: 10.1016/j.humov.2019.01.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 01/24/2019] [Accepted: 01/26/2019] [Indexed: 11/28/2022]
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Mazzoli D, Giannotti E, Manca M, Longhi M, Prati P, Cosma M, Ferraresi G, Morelli M, Zerbinati P, Masiero S, Merlo A. Electromyographic activity of the vastus intermedius muscle in patients with stiff-knee gait after stroke. A retrospective observational study. Gait Posture 2018; 60:273-278. [PMID: 28735780 DOI: 10.1016/j.gaitpost.2017.07.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 06/09/2017] [Accepted: 07/03/2017] [Indexed: 02/02/2023]
Abstract
Stiff-knee gait (SKG) in hemiplegic patients is often due to an inappropriate activity of the quadriceps femoris. However, there are no studies in literature addressing the vastus intermedius (VI) involvement in SKG. In this study, VI activity was analyzed in a sample of 46 chronic stroke patients with SKG, during spontaneous gait. VI activity was recorded by fine-wire electrodes inserted under ultrasound guidance then confirmed by electrical stimulation. The measured VI activity was compared to the normal reference pattern reported in literature and classified (e.g. premature, prolonged). The occurrences of abnormal activations during each sub-phase of the gait cycle were assessed. VI activity presented an abnormal timing in 96% of the sample. The most common pathological pattern (in 46% of the sample) was the combination of premature and prolonged VI activation. Nearly 20% of patients presented a continuous activity. A pathological activation in patients was found for 91% in mid stance, for more than 50% in terminal stance and pre-swing and for 37% and 70% in initial- and mid-swing. Results indicate that abnormal VI activity is frequent in patients with SKG. Hence, VI activity should be included in the assessment of SKG to assist in the clinical decision-making processes.
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Affiliation(s)
- Davide Mazzoli
- Gait & Motion Analysis Laboratory, Sol et Salus Hospital, Rimini, Italy
| | - Erika Giannotti
- Gait & Motion Analysis Laboratory, Sol et Salus Hospital, Rimini, Italy; Department of Orthopaedic Rehabilitation, University of Padova, Padova, Italy
| | - Mario Manca
- Motion Analysis Laboratory, Dep. of Neuroscience and Rehabilitation, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
| | - Maria Longhi
- Gait & Motion Analysis Laboratory, Sol et Salus Hospital, Rimini, Italy
| | - Paolo Prati
- Gait & Motion Analysis Laboratory, Sol et Salus Hospital, Rimini, Italy
| | - Michela Cosma
- Motion Analysis Laboratory, Dep. of Neuroscience and Rehabilitation, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
| | - Giovanni Ferraresi
- Motion Analysis Laboratory, Dep. of Neuroscience and Rehabilitation, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
| | - Monica Morelli
- Motion Analysis Laboratory, Dep. of Neuroscience and Rehabilitation, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
| | - Paolo Zerbinati
- Gait & Motion Analysis Laboratory, Sol et Salus Hospital, Rimini, Italy; Neuroorthopedic Service, Hand Surgery Unit, MultiMedica, Castellanza, Italy
| | - Stefano Masiero
- Department of Orthopaedic Rehabilitation, University of Padova, Padova, Italy
| | - Andrea Merlo
- Gait & Motion Analysis Laboratory, Sol et Salus Hospital, Rimini, Italy.
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14
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Geiger M, Supiot A, Zory R, Aegerter P, Pradon D, Roche N. The effect of transcranial direct current stimulation (tDCS) on locomotion and balance in patients with chronic stroke: study protocol for a randomised controlled trial. Trials 2017; 18:492. [PMID: 29061169 PMCID: PMC5654046 DOI: 10.1186/s13063-017-2219-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 09/29/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Following stroke, patients are often left with hemiparesis that reduces balance and gait capacity. A recent, non-invasive technique, transcranial direct current stimulation, can be used to modify cortical excitability when used in an anodal configuration. It also increases the excitability of spinal neuronal circuits involved in movement in healthy subjects. Many studies in patients with stroke have shown that this technique can improve motor, sensory and cognitive function. For example, anodal tDCS has been shown to improve motor performance of the lower limbs in patients with stroke, such as voluntary quadriceps strength, toe-pinch force and reaction time. Nevertheless, studies of motor function have been limited to simple tasks. Surprisingly, the effects of tDCS on the locomotion and balance of patients with chronic stroke have never been evaluated. In this study, we hypothesise that anodal tDCS will improve balance and gait parameters in patients with chronic stroke-related hemiparesis through its effects at cortical and spinal level. METHODS/DESIGN This is a prospective, randomised, placebo-controlled, double-blinded, single-centre, cross-over study over 36 months. Forty patients with chronic stroke will be included. Each patient will participate in three visits: an inclusion visit, and two visits during which they will all undergo either one 30-min session of transcranial direct current stimulation or one 30-min session of placebo stimulation in a randomised order. Evaluations will be carried out before, during and twice after stimulation. The primary outcome is the variability of the displacement of the centre of mass during gait and a static-balance task. Secondary outcomes include clinical and functional measures before and after stimulation. A three-dimensional gait analysis, and evaluation of static balance on a force platform will be also conducted before, during and after stimulation. DISCUSSION These results should constitute a useful database to determine the aspects of complex motor function that are the most improved by transcranial direct current stimulation in patients with hemiparesis. It is the first essential step towards validating this technique as a treatment, coupled with task-oriented training. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT02134158 . First received on 18 December 2013; last updated on 14 September 2016. Other study ID numbers: P120135 / AOM12126, 2013-A00952-43.
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Affiliation(s)
- M Geiger
- Inserm Unit 1179, Team 3: Technologies and Innovative Therapies Applied to Neuromuscular diseases, UVSQ, CIC 805, Physiology-Functional Testing Ward, AP-HP, Raymond Poincaré Teaching Hospital, Garches, France. .,CIAMS, Université Paris-Sud, Université Paris-Saclay, 91405, Orsay Cedex, France. .,CIAMS, Université d'Orléans, 45067, Orléans, France.
| | - A Supiot
- Inserm Unit 1179, Team 3: Technologies and Innovative Therapies Applied to Neuromuscular diseases, UVSQ, CIC 805, Physiology-Functional Testing Ward, AP-HP, Raymond Poincaré Teaching Hospital, Garches, France.,CIAMS, Université Paris-Sud, Université Paris-Saclay, 91405, Orsay Cedex, France.,CIAMS, Université d'Orléans, 45067, Orléans, France
| | - R Zory
- Laboratory of Human Motricity, Sport, Education and Health (EA 6312), University of Nice Sophia Antipolis, Nice, France
| | - P Aegerter
- Assistance Publique-Hôpitaux de Paris, Hôpital Ambroise Paré, Unité de Recherche Clinique (URC), Boulogne, France
| | - D Pradon
- Inserm Unit 1179, Team 3: Technologies and Innovative Therapies Applied to Neuromuscular diseases, UVSQ, CIC 805, Physiology-Functional Testing Ward, AP-HP, Raymond Poincaré Teaching Hospital, Garches, France
| | - N Roche
- Inserm Unit 1179, Team 3: Technologies and Innovative Therapies Applied to Neuromuscular diseases, UVSQ, CIC 805, Physiology-Functional Testing Ward, AP-HP, Raymond Poincaré Teaching Hospital, Garches, France
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15
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Associations between lower-limb muscle activation and knee flexion in post-stroke individuals: A study on the stance-to-swing phases of gait. PLoS One 2017; 12:e0183865. [PMID: 28886079 PMCID: PMC5590852 DOI: 10.1371/journal.pone.0183865] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 08/12/2017] [Indexed: 11/19/2022] Open
Abstract
Reduced knee flexion is a leading feature of post-stroke gait, but the causes have not been well understood. The purpose of this study was to investigate the relationship between the knee flexion and the lower-limb muscle activation within the stance-to-swing phases of gait cycle in the post-stroke hemiplegic patients. Ten stroke patients and 10 age- and gender-matched healthy subjects participated in the experiment. The lower-limb kinematic signals and the surface electromyography (sEMG) signals of the left and right rectus femoris (RF), biceps femoris (BF) and lateral gastrocnemius (GS) were recorded during walking. The angle range (AR) of knee flexion, the root mean square (RMS) and the mean frequency (MNF) of sEMG signals were calculated from the terminal stance (TSt) to the initial swing (ISw) phases of gait cycle. Stroke patients showed lower bilateral AR of knee flexion and lower RMS of GS on the paretic side, but higher MNF of RF on the non-paretic side compared with the controls. Within the stroke patients, significant differences were found between their paretic and non-paretic limbs in the AR of knee flexion, as well as in the RMS and MNF of GS (p < 0.05). Regression analysis showed that the RMS of BF, MNF of BF and MNF of GS explained 82.1% of variations in AR of knee flexion on paretic side (r2 = 0.821). But the RMS and MNF of all the muscles (including the RF, GS and BF) could explain 65.6% of AR of knee flexion variations on the non-paretic side (r2 = 0.656), and 45.2% of variations for the healthy subjects (r2 = 0.452). The reduced knee flexion during gait was associated with altered magnitude and frequency of muscle contractions and with simplified muscle synergy in the post-stroke hemiplegic patients. Identifying the muscles that are responsible for knee stiffness may facilitate improvement of rehabilitation strategy for post-stroke gait.
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Kristensen OH, Stenager E, Dalgas U. Muscle Strength and Poststroke Hemiplegia: A Systematic Review of Muscle Strength Assessment and Muscle Strength Impairment. Arch Phys Med Rehabil 2017; 98:368-380. [DOI: 10.1016/j.apmr.2016.05.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 05/26/2016] [Indexed: 12/17/2022]
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Yang DJ, Park SK, Uhm YH, Park SH, Chun DW, Kim JH. The correlation between muscle activity of the quadriceps and balance and gait in stroke patients. J Phys Ther Sci 2016; 28:2289-92. [PMID: 27630416 PMCID: PMC5011580 DOI: 10.1589/jpts.28.2289] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 05/14/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to examine the correlation between quadriceps
muscle activity and balance and gait in stroke patients. [Subjects and Methods] Fifty-five
stroke patients (30 males 25 females; mean age 58.7 years; stroke duration 4.82 months;
Korean mini-mental state examination score 26.4) participated in this study. MP100 surface
electromyography, BioRescue, and LUKOtronic were used to measure the quadriceps muscle
activity, balance, and gait, respectively. [Results] There was a significant correlation
between quadriceps muscle activity (vastus lateralis % reference voluntary contraction,
vastus medialis % reference voluntary contraction) and balance (limits of stability) and
gait (gait velocity) but there was none between vastus lateralis % reference voluntary
contraction, vastus medialis % reference voluntary contraction. [Conclusion] An increase
in quadriceps muscle activity will improve balance and gait ability. To improve function
in stroke patients, training is needed to strengthen the quadriceps muscles.
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Affiliation(s)
- Dae Jung Yang
- Department of Physical Therapy, Graduate School of Physical Therapy, Sehan University, Republic of Korea
| | - Seung Kyu Park
- Department of Physical Therapy, Graduate School of Physical Therapy, Sehan University, Republic of Korea
| | - Yo Han Uhm
- Department of Physical Therapy, Graduate School of Physical Therapy, Sehan University, Republic of Korea
| | - Sam Heon Park
- Department of Physical Therapy, Graduate School of Physical Therapy, Sehan University, Republic of Korea
| | - Dong Whan Chun
- Department of Physical Therapy, Graduate School of Physical Therapy, Sehan University, Republic of Korea
| | - Je Ho Kim
- Department of Physical Therapy, Graduate School of Physical Therapy, Sehan University, Republic of Korea
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Ishida S, Shibuya Y, Kobayashi M, Komori T. Assessing stomatognathic performance after mandibulectomy according to the method of mandibular reconstruction. Int J Oral Maxillofac Surg 2015; 44:948-55. [DOI: 10.1016/j.ijom.2015.03.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 01/13/2015] [Accepted: 03/16/2015] [Indexed: 01/08/2023]
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