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Erschienen in: Journal of NeuroEngineering and Rehabilitation 1/2014

Open Access 01.12.2014 | Research

Relation between abnormal synergy and gait in patients after stroke

verfasst von: Kaoru Sakuma, Koji Ohata, Keisuke Izumi, Yu Shiotsuka, Tadashi Yasui, Satoko Ibuki, Noriaki Ichihashi

Erschienen in: Journal of NeuroEngineering and Rehabilitation | Ausgabe 1/2014

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Abstract

Background

The abnormal synergy seen in patients after stroke is considered to limit the ability of these patients. However, in the lower extremity, antigravity torque generation rather than precise movement is needed for functions such as sit-to-stand movement and gait. Therefore, the ability to generate torque may be important either as a primary movement or as an abnormal synergy. We attempted to quantify the torque generation in the lower limb, selectively and as an abnormal synergy, and its relation with gait.

Methods

Selectively generated plantar flexion torque in the ankle and plantar flexion torque secondarily generated accompanying maximal hip extension (i.e., torque generated with abnormal synergy) were measured in subjects after stroke and control subjects. In subjects after stroke, secondary torque generation while controlling hip extension torque as 25%, 50%, and 75% of the maximal hip extension was also measured. The relation of torque generation with the gait speed and timed-up-and go test (TUG) was also analyzed.

Results

In subjects after stroke, there was no difference between the amount of plantar flexion torque generated secondarily and the selectively generated torque, whereas the selective torque was significantly greater in control subjects. Pearson product–moment correlation coefficient analysis revealed that TUG speed is related to secondarily generated torque accompanying maximal hip extension but not with selectively generated torque.

Conclusion

Secondarily generated torque was found to be a factor that affects TUG speed, and the ability to generate torque even through abnormal synergy may help for gait ability in subjects after stroke.
Literatur
1.
Zurück zum Zitat Norrving B, Kissela B: The global burden of stroke and need for a continuum of care. Neurology 2013, 80: S5-S12. 10.1212/WNL.0b013e3182762397CrossRefPubMed Norrving B, Kissela B: The global burden of stroke and need for a continuum of care. Neurology 2013, 80: S5-S12. 10.1212/WNL.0b013e3182762397CrossRefPubMed
2.
Zurück zum Zitat Dobkin BH: Impairments, disabilities, and bases for neurological rehabilitation after stroke. J Stroke Cerebrovasc Dis 1997, 6: 221-226. 10.1016/S1052-3057(97)80015-8CrossRefPubMed Dobkin BH: Impairments, disabilities, and bases for neurological rehabilitation after stroke. J Stroke Cerebrovasc Dis 1997, 6: 221-226. 10.1016/S1052-3057(97)80015-8CrossRefPubMed
3.
Zurück zum Zitat Nadeau S, Arsenault AB, Gravel D, Bourbonnais D: Analysis of the clinical factors determining natural and maximal gait speeds in adults with a stroke. Am J Phys Med Rehabil 1999, 78: 123-130. 10.1097/00002060-199903000-00007CrossRefPubMed Nadeau S, Arsenault AB, Gravel D, Bourbonnais D: Analysis of the clinical factors determining natural and maximal gait speeds in adults with a stroke. Am J Phys Med Rehabil 1999, 78: 123-130. 10.1097/00002060-199903000-00007CrossRefPubMed
4.
Zurück zum Zitat Mayo NE, Wood-Dauphinee S, Cote R, Durcan L, Carlton J: Activity, participation, and quality of life 6 months poststroke. Arch Phys Med Rehabil 2002, 83: 1035-1042. 10.1053/apmr.2002.33984CrossRefPubMed Mayo NE, Wood-Dauphinee S, Cote R, Durcan L, Carlton J: Activity, participation, and quality of life 6 months poststroke. Arch Phys Med Rehabil 2002, 83: 1035-1042. 10.1053/apmr.2002.33984CrossRefPubMed
5.
Zurück zum Zitat Aprile I, Piazzini DB, Bertolini C, Caliandro P, Pazzaglia C, Tonali P, Padua L: Predictive variables on disability and quality of life in stroke outpatients undergoing rehabilitation. Neurol Sci 2006, 27: 40-46. 10.1007/s10072-006-0563-5CrossRefPubMed Aprile I, Piazzini DB, Bertolini C, Caliandro P, Pazzaglia C, Tonali P, Padua L: Predictive variables on disability and quality of life in stroke outpatients undergoing rehabilitation. Neurol Sci 2006, 27: 40-46. 10.1007/s10072-006-0563-5CrossRefPubMed
6.
Zurück zum Zitat Flansbjer UB, Downham D, Lexell J: Knee muscle strength, gait performance, and perceived participation after stroke. Arch Phys Med Rehabil 2006, 87: 974-980. 10.1016/j.apmr.2006.03.008CrossRefPubMed Flansbjer UB, Downham D, Lexell J: Knee muscle strength, gait performance, and perceived participation after stroke. Arch Phys Med Rehabil 2006, 87: 974-980. 10.1016/j.apmr.2006.03.008CrossRefPubMed
7.
Zurück zum Zitat Patterson SL, Forrester LW, Rodgers MM, Ryan AS, Ivey FM, Sorkin JD, Macko RF: Determinants of walking function after stroke: differences by deficit severity. Arch Phys Med Rehabil 2007, 88: 115-119. 10.1016/j.apmr.2006.10.025CrossRefPubMed Patterson SL, Forrester LW, Rodgers MM, Ryan AS, Ivey FM, Sorkin JD, Macko RF: Determinants of walking function after stroke: differences by deficit severity. Arch Phys Med Rehabil 2007, 88: 115-119. 10.1016/j.apmr.2006.10.025CrossRefPubMed
8.
Zurück zum Zitat Twitchell TE: The restoration of motor function following hemiplegia in man. Brain 1951, 74: 443-480. 10.1093/brain/74.4.443CrossRefPubMed Twitchell TE: The restoration of motor function following hemiplegia in man. Brain 1951, 74: 443-480. 10.1093/brain/74.4.443CrossRefPubMed
9.
Zurück zum Zitat Brunnstrom S: Movement therapy in hemiplegia: a neurophysiological approach. New York, NY: Harper & Row; 1970:7-33. Brunnstrom S: Movement therapy in hemiplegia: a neurophysiological approach. New York, NY: Harper & Row; 1970:7-33.
10.
Zurück zum Zitat Levin MF: Interjoint coordination during pointing movements is disrupted in spastic hemiparesis. Brain 1996, 119: 281-293. 10.1093/brain/119.1.281CrossRefPubMed Levin MF: Interjoint coordination during pointing movements is disrupted in spastic hemiparesis. Brain 1996, 119: 281-293. 10.1093/brain/119.1.281CrossRefPubMed
11.
Zurück zum Zitat Chen CL, Wong MK, Chen HC, Cheng PT, Tang FT: Correlation of polyelectromyographic patterns and clinical upper motor neuron syndrome in hemiplegic stroke patients. Arch Phys Med Rehabil 2000, 81: 869-875. 10.1053/apmr.2000.6284CrossRefPubMed Chen CL, Wong MK, Chen HC, Cheng PT, Tang FT: Correlation of polyelectromyographic patterns and clinical upper motor neuron syndrome in hemiplegic stroke patients. Arch Phys Med Rehabil 2000, 81: 869-875. 10.1053/apmr.2000.6284CrossRefPubMed
12.
Zurück zum Zitat Beer RF, Dewald JPA, Rymer WZ: Deficits in the coordination of multijoint arm movements in patients with hemiparesis: evidence for disturbed control of limb dynamics. Exp Brain Res 2000, 131: 305-319. 10.1007/s002219900275CrossRefPubMed Beer RF, Dewald JPA, Rymer WZ: Deficits in the coordination of multijoint arm movements in patients with hemiparesis: evidence for disturbed control of limb dynamics. Exp Brain Res 2000, 131: 305-319. 10.1007/s002219900275CrossRefPubMed
13.
Zurück zum Zitat Neckel N, Pelliccio M, Nichols D, Hidler J: Quantification of functional weakness and abnormal synergy patterns in the lower limb of individuals with chronic stroke. J Neuroeng Rehabil 20 2006, 3: 17. 10.1186/1743-0003-3-17CrossRef Neckel N, Pelliccio M, Nichols D, Hidler J: Quantification of functional weakness and abnormal synergy patterns in the lower limb of individuals with chronic stroke. J Neuroeng Rehabil 20 2006, 3: 17. 10.1186/1743-0003-3-17CrossRef
14.
Zurück zum Zitat Cruz TH, Dhaher YY: Evidence of abnormal lower-limb torque coupling after stroke: an isometric study. Stroke 2008, 39: 139-147. 10.1161/STROKEAHA.107.492413CrossRefPubMedPubMedCentral Cruz TH, Dhaher YY: Evidence of abnormal lower-limb torque coupling after stroke: an isometric study. Stroke 2008, 39: 139-147. 10.1161/STROKEAHA.107.492413CrossRefPubMedPubMedCentral
15.
Zurück zum Zitat Hutin E, Pradon D, Barbier F, Gracies JM, Bussel B, Roche N: Lower limb coordination patterns in hemiparetic gait: factors of knee flexion impairment. Clin Biomech (Bristol, Avon) 2011, 26: 304-311. 10.1016/j.clinbiomech.2010.10.007CrossRef Hutin E, Pradon D, Barbier F, Gracies JM, Bussel B, Roche N: Lower limb coordination patterns in hemiparetic gait: factors of knee flexion impairment. Clin Biomech (Bristol, Avon) 2011, 26: 304-311. 10.1016/j.clinbiomech.2010.10.007CrossRef
16.
Zurück zum Zitat Barela JA, Whitall J, Black P, Clark JE: An examination of constraints affecting the intralimb coordination of hemiparetic gait. Hum Mov Sci 2000, 19: 251-273. 10.1016/S0167-9457(00)00014-2CrossRef Barela JA, Whitall J, Black P, Clark JE: An examination of constraints affecting the intralimb coordination of hemiparetic gait. Hum Mov Sci 2000, 19: 251-273. 10.1016/S0167-9457(00)00014-2CrossRef
17.
Zurück zum Zitat Rinaldi LA, Monaco V: Spatio-temporal parameters and intralimb coordination patterns describing hemiparetic locomotion at controlled speed. J Neuroeng Rehabil 2013, 10: 9. 10.1186/1743-0003-10-9CrossRef Rinaldi LA, Monaco V: Spatio-temporal parameters and intralimb coordination patterns describing hemiparetic locomotion at controlled speed. J Neuroeng Rehabil 2013, 10: 9. 10.1186/1743-0003-10-9CrossRef
18.
Zurück zum Zitat Kwakkel G, Wagenaar RC: Effect of duration of upper- and lower-extremity rehabilitation sessions and walking speed on recovery of interlimb coordination in hemiplegic gait. Phys Ther 2002, 82: 432-448.PubMed Kwakkel G, Wagenaar RC: Effect of duration of upper- and lower-extremity rehabilitation sessions and walking speed on recovery of interlimb coordination in hemiplegic gait. Phys Ther 2002, 82: 432-448.PubMed
19.
Zurück zum Zitat Chen CL, Chen HC, Tang SFT, Wu CY, Cheng PT, Hong WH: Gait performance with compensatory adaptations in stroke patients with different degrees of motor recovery. Am J Phys Med Rehabil 2003, 82: 925-935. 10.1097/01.PHM.0000098040.13355.B5CrossRefPubMed Chen CL, Chen HC, Tang SFT, Wu CY, Cheng PT, Hong WH: Gait performance with compensatory adaptations in stroke patients with different degrees of motor recovery. Am J Phys Med Rehabil 2003, 82: 925-935. 10.1097/01.PHM.0000098040.13355.B5CrossRefPubMed
20.
Zurück zum Zitat von Schroeder HP, Coutts RD, Lyden PD, Billings E Jr, Nickel VL: Gait parameters following stroke: a practical assessment. J Rehabil Res Dev 1995, 32: 25-31.PubMed von Schroeder HP, Coutts RD, Lyden PD, Billings E Jr, Nickel VL: Gait parameters following stroke: a practical assessment. J Rehabil Res Dev 1995, 32: 25-31.PubMed
21.
Zurück zum Zitat Huitema RB, Hof AL, Mulder T, Brouwer WH, Dekker R, Postema K: Functional recovery of gait and joint kinematics after right hemispheric stroke. Arch Phys Med Rehabil 2004, 85: 1982-1988. 10.1016/j.apmr.2004.04.036CrossRefPubMed Huitema RB, Hof AL, Mulder T, Brouwer WH, Dekker R, Postema K: Functional recovery of gait and joint kinematics after right hemispheric stroke. Arch Phys Med Rehabil 2004, 85: 1982-1988. 10.1016/j.apmr.2004.04.036CrossRefPubMed
22.
Zurück zum Zitat Allen JL, Kautz SA, Neptune RR: Step length asymmetry is representative of compensatory mechanisms used in post-stroke hemiparetic walking. Gait Posture 2011, 33: 538-543. 10.1016/j.gaitpost.2011.01.004CrossRefPubMedPubMedCentral Allen JL, Kautz SA, Neptune RR: Step length asymmetry is representative of compensatory mechanisms used in post-stroke hemiparetic walking. Gait Posture 2011, 33: 538-543. 10.1016/j.gaitpost.2011.01.004CrossRefPubMedPubMedCentral
23.
Zurück zum Zitat Bowden MG, Clark DJ, Kautz SA: Evaluation of abnormal synergy patterns poststroke: relationship of the Fugl-Meyer Assessment to hemiparetic locomotion. Neurorehabil Neural Repair 2010, 24: 328-337. 10.1177/1545968309343215CrossRefPubMedPubMedCentral Bowden MG, Clark DJ, Kautz SA: Evaluation of abnormal synergy patterns poststroke: relationship of the Fugl-Meyer Assessment to hemiparetic locomotion. Neurorehabil Neural Repair 2010, 24: 328-337. 10.1177/1545968309343215CrossRefPubMedPubMedCentral
24.
Zurück zum Zitat Neckel ND, Blonien N, Nichols D, Hidler J: Abnormal joint torque patterns exhibited by chronic stroke subjects while walking with a prescribed physiological gait pattern. J Neuroeng Rehabil 2008, 5: 19. 10.1186/1743-0003-5-19CrossRefPubMedPubMedCentral Neckel ND, Blonien N, Nichols D, Hidler J: Abnormal joint torque patterns exhibited by chronic stroke subjects while walking with a prescribed physiological gait pattern. J Neuroeng Rehabil 2008, 5: 19. 10.1186/1743-0003-5-19CrossRefPubMedPubMedCentral
25.
Zurück zum Zitat Sulzer JS, Gordon KE, Dhaher YY, Peshkin MA, Patton JL: Preswing knee flexion assistance is coupled with hip abduction in people with stiff-knee gait after stroke. Stroke 2010, 41: 1709-1714. 10.1161/STROKEAHA.110.586917CrossRefPubMedPubMedCentral Sulzer JS, Gordon KE, Dhaher YY, Peshkin MA, Patton JL: Preswing knee flexion assistance is coupled with hip abduction in people with stiff-knee gait after stroke. Stroke 2010, 41: 1709-1714. 10.1161/STROKEAHA.110.586917CrossRefPubMedPubMedCentral
26.
Zurück zum Zitat Kim CM, Eng JJ: Magnitude and pattern of 3D kinematic and kinetic gait profiles in persons with stroke: relationship to walking speed. Gait Posture 2004, 20: 140-146. 10.1016/j.gaitpost.2003.07.002CrossRefPubMedPubMedCentral Kim CM, Eng JJ: Magnitude and pattern of 3D kinematic and kinetic gait profiles in persons with stroke: relationship to walking speed. Gait Posture 2004, 20: 140-146. 10.1016/j.gaitpost.2003.07.002CrossRefPubMedPubMedCentral
27.
Zurück zum Zitat 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: 813-820. 10.1016/j.clinbiomech.2007.03.006CrossRef 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: 813-820. 10.1016/j.clinbiomech.2007.03.006CrossRef
28.
Zurück zum Zitat Beer RF, Given JD, Dewald JP: Task-dependent weakness at the elbow in patients with hemiparesis. Arch Phys Med Rehabil 1999, 80: 766-772. 10.1016/S0003-9993(99)90225-3CrossRefPubMed Beer RF, Given JD, Dewald JP: Task-dependent weakness at the elbow in patients with hemiparesis. Arch Phys Med Rehabil 1999, 80: 766-772. 10.1016/S0003-9993(99)90225-3CrossRefPubMed
29.
Zurück zum Zitat Dewald JP, Beer RF: Abnormal joint torque patterns in the paretic upper limb of subjects with hemiparesis. Muscle Nerve 2001, 24: 273-283. 10.1002/1097-4598(200102)24:2<273::AID-MUS130>3.0.CO;2-ZCrossRefPubMed Dewald JP, Beer RF: Abnormal joint torque patterns in the paretic upper limb of subjects with hemiparesis. Muscle Nerve 2001, 24: 273-283. 10.1002/1097-4598(200102)24:2<273::AID-MUS130>3.0.CO;2-ZCrossRefPubMed
30.
Zurück zum Zitat Ohata K, Yasui T, Tsuboyama T, Ichihashi N: Effects of an ankle-foot orthosis with oil damper on muscle activity in adults after stroke. Gait Posture 2011, 33: 102-107. 10.1016/j.gaitpost.2010.10.083CrossRefPubMed Ohata K, Yasui T, Tsuboyama T, Ichihashi N: Effects of an ankle-foot orthosis with oil damper on muscle activity in adults after stroke. Gait Posture 2011, 33: 102-107. 10.1016/j.gaitpost.2010.10.083CrossRefPubMed
31.
Zurück zum Zitat Gemperline JJ, Allen S, Walk D, Rymer WZ: Characteristics of motor unit discharge in subjects with hemiparesis. Muscle Nerve 1995, 18: 1101-1114. 10.1002/mus.880181006CrossRefPubMed Gemperline JJ, Allen S, Walk D, Rymer WZ: Characteristics of motor unit discharge in subjects with hemiparesis. Muscle Nerve 1995, 18: 1101-1114. 10.1002/mus.880181006CrossRefPubMed
32.
Zurück zum Zitat Hara Y, Masakado Y, Chino N: The physiological functional loss of single thenar motor units in the stroke patients: when does it occur? Does it progress? Clin Neurophysiol 2004, 115: 97-103. 10.1016/j.clinph.2003.08.002CrossRefPubMed Hara Y, Masakado Y, Chino N: The physiological functional loss of single thenar motor units in the stroke patients: when does it occur? Does it progress? Clin Neurophysiol 2004, 115: 97-103. 10.1016/j.clinph.2003.08.002CrossRefPubMed
33.
Zurück zum Zitat Lum PS, Burgar CG, Shor PC: Evidence for strength imbalances as a significant contributor to abnormal synergies in hemiparetic subjects. Muscle Nerve 2003, 27: 211-221. 10.1002/mus.10305CrossRefPubMed Lum PS, Burgar CG, Shor PC: Evidence for strength imbalances as a significant contributor to abnormal synergies in hemiparetic subjects. Muscle Nerve 2003, 27: 211-221. 10.1002/mus.10305CrossRefPubMed
34.
Zurück zum Zitat Gerachshenko T, Rymer WZ, Stinear JW: Abnormal corticomotor excitability assessed in biceps brachii preceding pronator contraction post-stroke. Clin Neurophysiol 2008, 119: 683-692. 10.1016/j.clinph.2007.11.004CrossRefPubMedPubMedCentral Gerachshenko T, Rymer WZ, Stinear JW: Abnormal corticomotor excitability assessed in biceps brachii preceding pronator contraction post-stroke. Clin Neurophysiol 2008, 119: 683-692. 10.1016/j.clinph.2007.11.004CrossRefPubMedPubMedCentral
35.
Zurück zum Zitat Yao J, Chen A, Carmona C, Dewald JP: Cortical overlap of joint representations contributes to the loss of independent joint control following stroke. Neuroimage 2009, 45: 490-499. 10.1016/j.neuroimage.2008.12.002CrossRefPubMedPubMedCentral Yao J, Chen A, Carmona C, Dewald JP: Cortical overlap of joint representations contributes to the loss of independent joint control following stroke. Neuroimage 2009, 45: 490-499. 10.1016/j.neuroimage.2008.12.002CrossRefPubMedPubMedCentral
36.
Zurück zum Zitat Krishnan C, Dhaher Y: Corticospinal responses of quadriceps are abnormally coupled with hip adductors in chronic stroke survivors. Exp Neurol 2012, 233: 400-407. 10.1016/j.expneurol.2011.11.007CrossRefPubMedPubMedCentral Krishnan C, Dhaher Y: Corticospinal responses of quadriceps are abnormally coupled with hip adductors in chronic stroke survivors. Exp Neurol 2012, 233: 400-407. 10.1016/j.expneurol.2011.11.007CrossRefPubMedPubMedCentral
37.
Zurück zum Zitat Daubney ME, Culham EG: Lower-extremity muscle force and balance performance in adults aged 65 years and older. Phys Ther 1999, 79: 1177-1185.PubMed Daubney ME, Culham EG: Lower-extremity muscle force and balance performance in adults aged 65 years and older. Phys Ther 1999, 79: 1177-1185.PubMed
38.
Zurück zum Zitat Janssen WGM, Bussmann HBJ, Stam HJ: Determinants of the sit-to-stand movement: a review. Phys Ther 2002, 82: 866-879.PubMed Janssen WGM, Bussmann HBJ, Stam HJ: Determinants of the sit-to-stand movement: a review. Phys Ther 2002, 82: 866-879.PubMed
Metadaten
Titel
Relation between abnormal synergy and gait in patients after stroke
verfasst von
Kaoru Sakuma
Koji Ohata
Keisuke Izumi
Yu Shiotsuka
Tadashi Yasui
Satoko Ibuki
Noriaki Ichihashi
Publikationsdatum
01.12.2014
Verlag
BioMed Central
Erschienen in
Journal of NeuroEngineering and Rehabilitation / Ausgabe 1/2014
Elektronische ISSN: 1743-0003
DOI
https://doi.org/10.1186/1743-0003-11-141

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