Document Type : Original Articles
Authors
Assistant Professor, Department of Physical Therapy, Faculty of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
Abstract
Background: Gait disorder is a common motor complication after stroke. Studies have revealed that conventional physiotherapy cannot manage this disorder efficiently; therefore, more studies regarding efficient treatment protocols are crucial. The purpose of this study was to investigate the effect of compelled weight-bearing approach on muscle activation patterns during walking in individuals with stroke.Methods: 24 hemiparetic patients participated in this study. Patients were randomly divided into 2 groups: experimental and control. The experimental group received increased weight bearing on the paretic leg via a shoe lift in addition to physical therapy for 6 weeks. The control group received only physical therapy. Laboratory assessments included weight-bearing symmetry ratio and electromyographic parameters recored from the medial gastrocnemius, tibialis anterior, rectus femoris and biceps femoris. The amplitude and duration of electromyographic activity for each subject was then calculated during the stance and swing phases of their gait cycle. All measurements were compared within and between groups after the termination of treatment.Results: After treatment, weight-bearing symmetry ratio improved significantly in the experimental group. Additionally, the electromyographic activity of paretic medial gastrocnemius increased significantly during the stance phase while activity duration of paretic rectus femoris decreased significantly in swing phase. In the control group, the weight-bearing symmetry ratio didn’t change significantly. Only activity duration of non-paretic rectus femoris decreased significantly in swing phase.Conclusions: The results show that compelled weight bearing on the paretic side improve amplitude and the timing for activity of some muscles in the lower limbs during walking.
- Den Otter AR, Geurts AC, Mulder T, Duysens J. Abnormalities in the temporal patterning of lower extremity muscle activity in hemiparetic gait. Gait Posture. 2007;25(3):342-52.
- Den Otter AR, Geurts AC, Mulder T, Duysens J. Gait recovery is not associated with changes in the temporal patterning of muscle activity during treadmill walking in patients with post-stroke hemiparesis. Clin Neurophysiol. 2006;117(1):4-15.
- Patterson KK, Nadkarni NK, Black SE, McIlroy WE. Gait symmetry and velocity differ in their relationship to age. Gait Posture. 2012;35(4):590-4.
- Patterson KK, Gage WH, Brooks D, Black SE, McIlroy WE. Evaluation of gait symmetry after stroke: a comparison of current methods and recommendations for standardization. Gait Posture. 2010;31(2):241-6.
- Knutsson E, Richards C. Different types of disturbed motor control in gait of hemiparetic patients. Brain. 1979;102(2):405-30.
- Shiavi R, Bugle HJ, Limbird T. Electromyographic gait assessment, Part 2: Preliminary assessment of hemiparetic synergy patterns. J Rehabil Res Dev. 1987;24(2):24-30.
- Lamontagne A, Stephenson JL, Fung J. Physiological evaluation of gait disturbances post stroke. Clin Neurophysiol. 2007;118(4):717-29.
- Ricamato AL, Hidler JM. Quantification of the dynamic properties of EMG patterns during gait. J Electromyogr Kinesiol. 2005;15(4):384-92.
- Patterson KK, Parafianowicz I, Danells CJ, Closson V, Verrier MC, Staines WR, et al. Gait asymmetry in community-ambulating stroke survivors. Arch Phys Med Rehabil. 2008;89(2):304-10.
- Dietz V, Duysens J. Significance of load receptor input during locomotion: a review. Gait Posture. 2000;11(2):102-10.
- Dietz V. Evidence for a load receptor contribution to the control of posture and locomotion. Neurosci Biobehav Rev. 1998;22(4):495-9.
- Kamphuis JF, de Kam D, Geurts AC, Weerdesteyn V. Is weight-bearing asymmetry associated with postural instability after stroke? A systematic review. Stroke Res Treat.2013:692137.
- Aruin AS, Rao N, Sharma A, Chaudhuri G. Compelled body weight shift approach in rehabilitation of individuals with chronic stroke. Top Stroke Rehabil. 2012;19(6):556-63.
- Siebers A, Oberg U, Skargren E. The effect of modified constraint-induced movement therapy on spasticity and motor function of the affected arm in patients with chronic stroke. Physiother Can. 2010;62(4):388-96.
- Reiss AP, Wolf SL, Hammel EA, McLeod EL, Williams EA. Constraint-Induced Movement Therapy (CIMT): Current Perspectives and Future Directions. Stroke Res Treat.2012:159391.
- Rodriguez GM, Aruin AS. The effect of shoe wedges and lifts on symmetry of stance and weight bearing in hemiparetic individuals. Arch Phys Med Rehabil. 2002;83(4):478-82.
- Ganesan M, Lee YJ, Aruin AS. The effect of lateral or medial wedges on control of postural sway in standing. Gait Posture. 2014;39(3):899-903.
- Mohapatra S, Eviota AC, Ringquist KL, Muthukrishnan SR, Aruin AS. Compelled Body Weight Shift Technique to Facilitate Rehabilitation of Individuals with Acute Stroke. ISRN Rehabil. 2012.328018.
- Berg K, Wood-Dauphinee S, Williams JI. The Balance Scale: reliability assessment with elderly residents and patients with an acute stroke. Scand J Rehabil Med. 1995;27(1):27-36.
- Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther. 1987;67(2):206-7.
- Mansfield A, Danells CJ, Inness E, Mochizuki G, McIlroy WE. Between-limb synchronization for control of standing balance in individuals with stroke. Clin Biomech (Bristol, Avon). 2011;26(3):312-7.
- Chaudhuri S, Aruin AS. The effect of shoe lifts on static and dynamic postural control in individuals with hemiparesis. Arch Phys Med Rehabil. 2000;81(11):1498-503.
- Frigo C, Crenna P. Multichannel SEMG in clinical gait analysis: a review and state-of-the-art. Clin Biomech (Bristol, Avon). 2009;24(3):236-45.
- Davies PM. Steps to follow. 2 ed; Springer 2000: 236-65.
- Vearrier LA, Langan J, Shumway-Cook A, Woollacott M. An intensive massed practice approach to retraining balance post-stroke. Gait Posture. 2005;22(2):154-63.
- Raez MB, Hussain MS, Mohd-Yasin F. Techniques of EMG signal analysis: detection, processing, classification and applications. Biol Proced Online. 2006;8:11-35.
- Hwang IS, Lee HM, Cherng RJ, Chen JJ. Electromyographic analysis of locomotion for healthy and hemiparetic subjects--study of performance variability and rail effect on treadmill. Gait Posture. 2003;18(1):1-12.
- Higginson JS, Zajac FE, Neptune RR, Kautz SA, Delp SL. Muscle contributions to support during gait in an individual with post-stroke hemiparesis. J Biomech. 2006;39(10):1769-77.
- Peat M, Dubo HI, Winter DA, Quanbury AO, Steinke T, Grahame R. Electromyographic temporal analysis of gait: hemiplegic locomotion. Arch Phys Med Rehabil. 1976;57(9):421-5.
- Nielsen JB, Sinkjaer T. Afferent feedback in the control of human gait. J Electromyogr Kinesiol. 2002;12(3):213-7.
- Grey MJ, Mazzaro N, Nielsen JB, Sinkjaer T. Ankle extensor proprioceptors contribute to the enhancement of the soleus EMG during the stance phase of human walking. Can J Physiol Pharmacol. 2004;82(8-9):610-6.
- Mazzaro N, Nielsen JF, Grey MJ, Sinkjaer T. Decreased contribution from afferent feedback to the soleus muscle during walking in patients with spastic stroke. J Stroke Cerebrovasc Dis. 2007;16(4):135-44.
- Dietz V, Colombo G. Effects of body immersion on postural adjustments to voluntary arm movements in humans: role of load receptor input. J Physiol. 1996;497(3):849-56.
- Bastiaanse CM, Duysens J, Dietz V. Modulation of cutaneous reflexes by load receptor input during human walking. Exp Brain Res. 2000;135(2):189-98.
- Dietz V, Gollhofer A, Kleiber M, Trippel M. Regulation of bipedal stance: dependency on "load" receptors. Exp Brain Res. 1992;89(1):229-31.
- Nadeau S, Gravel D, Arsenault AB, Bourbonnais D. Plantarflexor weakness as a limiting factor of gait speed in stroke subjects and the compensating role of hip flexors. Clinical Biomechanics. 1999;14:125-35.
- Parvataneni K, Olney SJ, Brouwer B. Changes in muscle group work associated with changes in gait speed of persons with stroke. Clin Biomech (Bristol, Avon). 2007;22(7):813-20.
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