Neuromuscular control of curved walking in people with stroke: Case report

Cautious Gait during Navigational Tasks in People with Hemiparesis: An Observational Study

Locomotor and balance disorders are major limitations for subjects with hemiparesis. The Timed Up and Go (TUG) test is a complex navigational task involving oriented walking and obstacle circumvention. We hypothesized that subjects with hemiparesis adopt a cautious gait during complex locomotor tasks. The primary aim was to compare spatio-temporal gait parameters, indicators of cautious gait, between the locomotor subtasks of the TUG (Go, Turn, Return) and a Straight-line walk in people with hemiparesis. Our secondary aim was to analyze the relationships between TUG performance and balance measures, compare spatio-temporal gait parameters between fallers and non-fallers, and identify the biomechanical determinants of TUG performance. Biomechanical parameters during the TUG and Straight-line walk were analyzed using a motion capture system. A repeated measures ANOVA and two stepwise ascending multiple regressions (with performance variables and biomechanical variables) were conducted. Gait speed, step length, and % single support phase (SSP) of the 29 participants were reduced during Turn compared to Go and Return and the Straight-line walk, and step width and % double support phase were increased. TUG performance was related to several balance measures. Turn performance (R2 = 63%) and Turn trajectory deviation followed by % SSP on the paretic side and the vertical center of mass velocity during Go (R2 = 71%) determined TUG performance time. People with hemiparesis adopt a cautious gait during complex navigation at the expense of performance.

Characteristics of muscle synergy extracted using an autoencoder in patients with stroke during the curved walking in comparison with healthy controls

BACKGROUND AND OBJECTIVE

This study investigated the spatial and temporal features of muscle synergy during two types of curved walking (CW), according to whether the analyzed legs were located on the outside (OCW) or inside (ICW) on the basis of the curve direction during CW, in patients with stroke.

METHODS

Thirteen patients with stroke and seven age-matched healthy controls participated in this study. Using the autoencoder technique, four muscle synergies were extracted from eight muscles of the paretic legs in patients with stroke and the dominant legs in healthy controls. Walking speed, variance accounted for (VAF) of the four synergies, and each synergy with the same number were compared. Pearson's correlation and activation peak timing calculation were used to identify spatial and temporal features, respectively.

RESULTS

Regarding walking speed in patients with stroke, ICW was significantly faster than OCW (P = 0.027). Regarding spatial features, muscle weighting values of patients with stroke in synergy 3 that were mainly involved in the early swing phase had the lowest similarity [r = 0.30] during OCW, and synergy 4 that was mainly involved in the late swing phase had the lowest similarity [r = 0.39] during ICW compared to the healthy group. Meanwhile, in terms of temporal features, activation peak timings of patients with stroke in synergy 1, which was mainly involved in the early stance phase, and synergy 2, which was mainly involved in the mid-late stance phase, were significantly delayed during OCW (P < .001, P = 0.003), while peak timings of synergy 1 and synergy 3 were delayed during ICW (P = .004, P = .002).

SIGNIFICANCE

Based on distinctive features of spatial synergy during the swing phase of CW and temporal synergy during the swing-stance transition phase of CW in patients with stroke in gait rehabilitation, specific approaches need to be considered depending on the curve direction and each gait phase.

Robot controlled, continuous passive movement of the ankle reduces spinal cord excitability in participants with spasticity: a pilot study

Spasticity of the ankle reduces quality of life by impeding walking and other activities of daily living. Robot-driven continuous passive movement (CPM) is a strategy for lower limb spasticity management but effects on spasticity, walking ability and spinal cord excitability (SCE) are unknown. The objectives of this experiment were to evaluate (1) acute changes in SCE induced by 30 min of CPM at the ankle joint, in individuals without neurological impairment and those with lower limb spasticity; and, (2) the effects of 6 weeks of CPM training on SCE, spasticity and walking ability in those with lower limb spasticity. SCE was assessed using soleus Hoffmann (H-) reflexes, collected prior to and immediately after CPM for acute assessments, whereas a multiple baseline repeated measures design assessed changes following 18 CPM sessions. Spasticity and walking ability were assessed using the Modified Ashworth Scale, the 10 m Walk test, and the Timed Up and Go test. Twenty-one neurologically intact and nine participants with spasticity (various neurological conditions) were recruited. In the neurologically intact group, CPM caused bi-directional modulation of H-reflexes creating 'facilitation' and 'suppression' groups. In contrast, amongst participants with spasticity, acute CPM facilitated H-reflexes. After CPM training, H-reflex excitability on both the more-affected and less-affected sides was reduced; on the more affected side H@Thres, H@50 and H@100 all significantly decreased following CPM training by 96.5 ± 7.7%, 90.9 ± 9.2%, and 62.9 ± 21.1%, respectively. After training there were modest improvements in walking and clinical measures of spasticity for some participants. We conclude that CPM of the ankle can significantly alter SCE. The use of CPM in those with spasticity can provide a temporary period of improved walking, but efficacy of treatment remains unknown.