Strength of lower limb related to gait velocity and cadence in stroke patients
TL;DR: Correlations were significant between both gait variables and the standardized strength of the hip extensor, knee flexor, ankle dorsiflexor, and ankle plantar flexor muscle groups, suggesting that the strength of some muscle groups following cerebrovascular accidents may be underestimated.
Abstract: This study was undertaken to determine the relationship between two temporal components of gait (velocity and cadence) and the standardized static strength of seven lower extremity muscle groups of the paretic side of 20 patients who were hemiplegic following cerebrovascular accidents. Velocity and cadence were calculated from a timed gait trial over an eight-metre expanse of floor. Static strength was tested by a hand-held dynamometer, and the scores standardized against body weight. The muscles tested were hip flexors, extensors and abductors; the knee flexors and extensors; and the ankle dorsiflexors and plantar flexors. Correlations were significant (p < 0.05) between both gait variables and the standardized strength of the hip extensor, knee flexor, ankle dorsiflexor, and ankle plantar flexor muscle groups. Also significant were the correlations between cadence and the standardized strength of the hip abductor and knee extensor muscles. These relationships suggest that the strength of some muscle gro...
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TL;DR: The results suggest that experimental studies are needed to assess the effects of treatment aimed at increasing ankle power and hip power and at decreasing the stance time on the affected side, and that these studies should be directed at obtaining a larger hip flexion moment and a larger ankle moment range on the unaffected side.
Abstract: Background and Purpose. The gait speed that a patient selects is a well-known indicator of overall gait performance. The purpose of this study was to use multiple linear regression to assess the strength of association of temporal, kinematic, and kinetic gait variables with high walking speeds in patients with hemiplegia. Subjects. Thirty-two subjects (20 male, 12 female) with an average age of 61 years took part in a sagittal-plane gait study of both sides of the body. Methods. Data from cinematographic film and a force plate obtained during multiple walking trials were used in a seven-segment link-segment kinetic model of the walking subject to yield temporal, kinematic, and kinetic variables. Results. Variables correlating significantly with self-selected speed included the maximum hip extension angle and the maximum hip flexion moment on the affected side, and the maximum ankle and hip powers on both sides. A stepwise regression identified variables most useful in predicting stride speed. For the affected side, these variables were the hip flexion moment, the ankle moment range, the knee moment range, and the proportion of double support. Together these variables explained 94% of the variation in gait speed. On the unaffected side, the variables were the percentage of stance phase, the maximum ankle power (push-off), and the maximum hip power (pull-off). They explained 92% of the variation in gait speed. Conclusion and Discussion. These results suggest that experimental studies are needed to assess the effects of treatment aimed at increasing ankle power and hip power and at decreasing the stance time on the affected side, and that these studies should be directed at obtaining a larger hip flexion moment and a larger ankle moment range on the unaffected side.
399 citations
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TL;DR: Whether plantarflexor weakness is among the factors preventing stroke subjects from walking at faster speeds is investigated using the Muscular Utilization Ratio (MUR) method.
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TL;DR: The 5mWT at a comfortable pace is recommended as the measure of choice for clinicians and researchers who need to detect longitudinal change in walking disability in the first 5 weeks poststroke.
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TL;DR: Muscle performance measurements of both limbs should be included in the evaluation of locomotion and treatment of people following a stroke, and Muscle force could explain 66% to 72% of the variability in gait and stair-climbing speeds.
Abstract: Background and Purpose . Improved walking is a common goal after stroke. The purpose of this study was to examine the relationship between the torque generated by the muscles of both lower extremities and 2 locomotor tasks: gait on level surfaces and stair climbing in people who had strokes. Subjects . Twenty community-dwelling individuals (mean age=61.2 years, SD=8.4, range=52-82) who had strokes and who were able to walk independently participated in the study. The mean time since stroke was 4.0 years (SD=2.6, range=1.5-10.0). Methods . Pearson correlations and multiple regression were used to measure the relationship between concentric isokinetic torque of the flexor and extensor muscles of the hip, knee, and ankle bilaterally and locomotor performance (gait on level surfaces and stair-climbing speed). Results . The isokinetic torques of the paretic ankle plantar flexors, hip flexors, and knee flexors had moderate to high correlations ( r =.5-.8) with gait and stair-climbing speeds. Muscle force could explain 66% to 72% of the variability in gait and stair-climbing speeds. Correlations for the nonparetic side were as high as or higher than those for the paretic side for some muscle groups. Discussion and Conclusion . Muscle performance measurements of both limbs should be included in the evaluation of locomotion and treatment of people following a stroke.
284 citations
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TL;DR: The present results suggest that strength and sensation at the lower limb are important factors to consider in determining the gait capacity of chronic stroke subjects.
Abstract: The objective of this study was to identify the most important clinical variables determining gait speed in persons with stroke. Sixteen chronic stroke subjects (mean age, 47.9 (±15.6) yr; mean time post-stroke, 43.9 (±36.5) mo) able to walk independently without a brace participated in the study. The impairments in motor function, sensation of the paretic lower limb, and balance were evaluated with the Fugl-Meyer Assessment. A spasticity index was used to assess the muscle tone of the plantarflexors. The maximal strengths in plantarflexion and hip flexion were measured with a Biodex dynamometric system. Cinematography and foot-contact data collected on the paretic side were used to determine the comfortable and maximal gait speeds. The level of association between gait speeds and the clinical variables were first examined with Pearson's correlation coefficients and, then, with multiple linear regression analyses using the stepwise method. Results revealed that the motor function of the lower limb, balance, and hip flexion strength were significantly related to comfortable and maximal gait speeds (0.5 < r < 0.88; P < 0.05). For the comfortable gait speed, the regression analysis selected only the hip flexor strength as a significant variable (R 2 = 0.69). For maximal gait speed, the variables retained were hip flexor strength, sensation at the lower limb, and plantarflexor strength (R 2 = 0.85). The present results suggest that strength and sensation at the lower limb are important factors to consider in determining the gait capacity of chronic stroke subjects.
261 citations