Abnormalities in the temporal patterning of lower extremity muscle activity in hemiparetic gait.

Following hemiparetic stroke, the timing of lower extremity muscle activity during gait often undergoes radical changes. In the present study, we compared the duration of activity in Biceps femoris (BF), Rectus femoris (RF), Tibialis anterior (TA) and Gastrocnemius medialis (GM) for four subphases of the gait cycle: the first double support phase (DS1), the single support phase (SS), the second double support phase (DS2) and the swing phase (SW) and compared these between 24 hemiparetic stroke patients and 14 healthy controls. In the upper leg, durations of BF and RF activity during SS were significantly longer on the paretic side (70% for BF, and 78% for RF) as well as on the nonparetic side (71% for BF, and 81% for RF), when compared to controls (45% and 53% for BF and RF, respectively). As a result, the duration of BF-RF coactivity during SS was longer in both legs of patients with stroke (61% in the paretic and 62% in the nonparetic leg) relative to control values (25%). In addition, during DS1 of the paretic leg, the total amount of BF-RF coactivity was abnormally long (82% versus 57% in controls). In the lower leg, longer total durations of GM activity were found during DS1 on the paretic side in people with stroke (51%) than in controls (38%). In the paretic TA, longer durations of activity were observed during SW (73% versus 60% in controls), whereas smaller total durations of activity were found during SS (28% versus 48% in controls). No statistically significant differences were found between the paretic and nonparetic leg within patients, except for the mean total duration of TA activity during DS1 (50% and 69% for the paretic and nonparetic leg, respectively). Overall, these results suggest that, despite large interindividual differences, some common disturbances can be observed in the temporal layout of muscle activity and coactivity associated with hemiparetic gait. Although these disturbances are more pronounced in the paretic leg, muscle activation patterns of the nonparetic leg also display some clear abnormalities.

[1]  G. Hirschberg,et al.  Electromyographic recording of muscular activity in normal and spastic gaits. , 1952, Archives of physical medicine and rehabilitation.

[2]  S. Simon Gait Analysis, Normal and Pathological Function. , 1993 .

[3]  S Hesse,et al.  Treadmill walking with partial body weight support versus floor walking in hemiparetic subjects. , 1999, Archives of physical medicine and rehabilitation.

[4]  Luciano Fasotti,et al.  Recovery of standing balance in postacute stroke patients: a rehabilitation cohort study. , 2004, Archives of physical medicine and rehabilitation.

[5]  J. MacQueen Some methods for classification and analysis of multivariate observations , 1967 .

[6]  H. Barbeau,et al.  Adaptation of the walking pattern to uphill walking in normal and spinal-cord injured subjects , 1999, Experimental Brain Research.

[7]  S. Brunnstrom,et al.  Motor testing procedures in hemiplegia: based on sequential recovery stages. , 1966, Physical therapy.

[8]  Tsutomu Okamoto,et al.  Electromyographic developmental changes in one individual from newborn stepping to mature walking. , 2003, Gait & posture.

[9]  F. Zajac,et al.  Muscle contributions to support during gait in an individual with post-stroke hemiparesis. , 2006, Journal of biomechanics.

[10]  Hermanus J. Hermens,et al.  The recommendations for sensors and sensor placement procedures for surface electromyography , 1999 .

[11]  I. bonan,et al.  A clinical guide to assess the role of lower limb extensor overactivity in hemiplegic gait disorders. , 1999, Stroke.

[12]  H. Hermens,et al.  European recommendations for surface electromyography: Results of the SENIAM Project , 1999 .

[13]  F. Lacquaniti,et al.  Interactions between posture and locomotion: motor patterns in humans walking with bent posture versus erect posture. , 2000, Journal of neurophysiology.

[14]  E. Roth,et al.  Hemiplegic gait. Relationships between walking speed and other temporal parameters. , 1997, American journal of physical medicine & rehabilitation.

[15]  S. Olney,et al.  Hemiparetic gait following stroke. Part I: Characteristics , 1996 .

[16]  G. Hirschberg,et al.  Gait analysis in hemiplegia. , 1951, Transactions of the American Neurological Association.

[17]  C. Snijders,et al.  Peroneus longus and tibialis anterior muscle activity in the stance phase. A quantified electromyographic study of 10 controls and 25 patients with chronic ankle instability. , 1995, Acta orthopaedica Scandinavica.

[18]  R. Waters,et al.  Electromyographic analysis of equinovarus following stroke. , 1978, Clinical orthopaedics and related research.

[19]  D A Winter,et al.  Treadmill versus walkway locomotion in humans: an EMG study. , 1986, Ergonomics.

[20]  C. Richards,et al.  Coactivation during gait as an adaptive behavior after stroke. , 2000, Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology.

[21]  J. Duysens,et al.  Speed related changes in muscle activity from normal to very slow walking speeds. , 2004, Gait & posture.

[22]  E Knutsson,et al.  Different types of disturbed motor control in gait of hemiparetic patients. , 1979, Brain : a journal of neurology.

[23]  Gerald V. Smith,et al.  Hemiparetic Gait Parameters in Overground Versus Treadmill Walking , 2001, Neurorehabilitation and neural repair.

[24]  P. Hodges,et al.  A comparison of computer-based methods for the determination of onset of muscle contraction using electromyography. , 1996, Electroencephalography and clinical neurophysiology.

[25]  Michael J. Mueller,et al.  Comparison of muscle activity during walking in subjects with and without diabetic neuropathy. , 2003, Gait & posture.

[26]  J. Lehmann,et al.  Gait abnormalities in hemiplegia: their correction by ankle-foot orthoses. , 1987, Archives of physical medicine and rehabilitation.

[27]  J. Perry Determinants of Muscle Function in the Spastic Lower Extremity , 1993, Clinical orthopaedics and related research.

[28]  J. Perry,et al.  Toe walking: muscular demands at the ankle and knee. , 2003, Archives of physical medicine and rehabilitation.

[29]  S. Olney,et al.  Work and power in gait of stroke patients. , 1991, Archives of physical medicine and rehabilitation.

[30]  T Limbird,et al.  Electromyographic gait assessment, Part 2: Preliminary assessment of hemiparetic synergy patterns. , 1987, Journal of rehabilitation research and development.

[31]  Murray Mp,et al.  Treadmill vs. floor walking: kinematics, electromyogram, and heart rate. , 1985, Journal of applied physiology.

[32]  T. Kepple,et al.  Relative contributions of the lower extremity joint moments to forward progression and support during gait , 1997 .

[33]  J H Burridge,et al.  Indices to describe different muscle activation patterns, identified during treadmill walking, in people with spastic drop-foot. , 2001, Medical engineering & physics.

[34]  C Peham,et al.  Limb locomotion--speed distribution analysis as a new method for stance phase detection. , 1999, Journal of biomechanics.

[35]  S. Gandevia,et al.  The distribution of muscle weakness in upper motoneuron lesions affecting the lower limb. , 1990, Brain : a journal of neurology.

[36]  V. L. Nickel,et al.  Gait parameters following stroke: a practical assessment. , 1995, Journal of rehabilitation research and development.

[37]  J. Duysens,et al.  Gait recovery is not associated with changes in the temporal patterning of muscle activity during treadmill walking in patients with post-stroke hemiparesis , 2006, Clinical Neurophysiology.

[38]  J Quintern,et al.  Electrophysiological studies of gait in spasticity and rigidity. Evidence that altered mechanical properties of muscle contribute to hypertonia. , 1981, Brain : a journal of neurology.

[39]  T. Schenkenberg,et al.  Line bisection and unilateral visual neglect in patients with neurologic impairment , 1980, Neurology.

[40]  Peggy Arnell,et al.  The Biomechanics and Motor Control of Human Gait , 1988 .

[41]  D A Winter,et al.  Electromyographic temporal analysis of gait: hemiplegic locomotion. , 1976, Archives of physical medicine and rehabilitation.

[42]  H. L. Le Roy,et al.  Proceedings of the Fifth Berkeley Symposium on Mathematical Statistics and Probability; Vol. IV , 1969 .

[43]  L. Gauthier,et al.  The Bells Test: A quantitative and qualitative test for visual neglect. , 1989 .

[44]  A. Hof,et al.  Speed dependence of averaged EMG profiles in walking. , 2002, Gait & posture.