title: Increased H(max):M(max) ratio in community walkers poststroke without increase in ankle plantarflexion during walking.
abstract: OBJECTIVE
  To investigate whether changes in H-reflex response at midswing and midstance are related to excessive plantarflexion during walking in community walkers poststroke compared with control subjects without stroke.
  
  
  METHODS
  Survey of functional walking handicap in a random sample of an annual stroke cohort followed by H-reflex and M(max) testing of a smaller sample.
  
  
  METHODS
  Community and laboratory testing.
  
  
  METHODS
  Forty individuals with stroke (IWS group) completed the functional walking handicap survey, 10 of whom agreed (with 10 age-matched controls) to enroll in a study of of the H(max):M(max) ratio in soleus during walking.
  
  
  METHODS
  Electromyography during treadmill walking.
  
  
  METHODS
  Functional Walking Handicap Scale, soleus H(max):M(max) ratio, and the ankle joint's angle of displacement.
  
  
  RESULTS
  Nine of the 10 stroke patients were community walkers. All had significantly (p <.05) more variable ankle movement during walking than the controls. The H(max):M(max) ratio was significantly (p <.01) increased in the IWS group because of a decrease in M(max) response without significant (p >.05) increase in H(max) response.
  
  
  CONCLUSIONS
  Individuals with community-level walking ability after stroke have significantly (p <.05) less repeatability of ankle joint movement than controls at both midswing and midstance. Simultaneous soleus H(max) and M(max) testing showed a significant (p <.01) reduction in the H(max) and H(max):M(max) ratio at midswing in controls only. This inhibition at midswing was lost by the IWS group without significant increase in H(max), suggesting that central synaptic excitability was within the normal range, and possibly accounting for the absence of excessive ankle plantarflexion during walking in the IWS group with community level walking ability.
authors.affiliation: Clinical Movement Analysis Laboratory, University College Dublin School of Physiotherapy, Mater Misericordiae Hospital, Dublin, Ireland. m.garrett@ucd.ie
authors.forename: M
authors.initials: M
authors.lastname: Garrett
authors.forename: B
authors.initials: B
authors.lastname: Caulfield
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D004558:Electric Stimulation; D004576:Electromyography; D005260:Female; D006181:H-Reflex / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000502:physiology*; D000071939:Stroke Rehabilitation; D016138:Walking / Q000502:physiology*