Pre-swing deficits in forward propulsion, swing initiation and power generation by individual muscles during hemiparetic walking.
Clinical studies of hemiparetic walking have shown pre-swing abnormalities in the paretic leg suggesting that paretic muscle contributions to important biomechanical walking subtasks are different than those of non-disabled individuals. Three-dimensional forward dynamics simulations of two representative hemiparetic subjects with different levels of walking function classified by self-selected walking speed (i.e., limited community=0.4-0.8 m/s and community walkers = or > 0.8m/s) and a speed-matched control were generated to quantify individual muscle contributions to forward propulsion, swing initiation and power generation during the pre-swing phase (i.e., double support phase proceeding toe-off). Simulation analyses identified decreased paretic soleus and gastrocnemius contributions to forward propulsion and power generation as the primary impairment in the limited community walker compared to the control subject. The non-paretic leg did not compensate for decreased forward propulsion by paretic muscles during pre-swing in the limited community walker. Paretic muscles had the net effect to absorb energy from the paretic leg during pre-swing in the community walker suggesting that deficits in swing initiation are a primary impairment. Specifically, the paretic gastrocnemius and hip flexors (i.e., iliacus, psoas and sartorius) contributed less to swing initiation and the paretic soleus and gluteus medius absorbed more power from the paretic leg in the community walker compared to the control subject. Rehabilitation strategies aimed at diminishing these deficits have much potential to improve walking function in these hemiparetic subjects and those with similar deficits.
Peterson
Carrie L
CL
Department of Mechanical Engineering, The University of Texas at Austin, TX, USA.
Hall
Allison L
AL
Kautz
Steven A
SA
Neptune
Richard R
RR
D000054:Acceleration; D001696:Biomechanical Phenomena; D016022:Case-Control Studies; D005260:Female; D005684:Gait / Q000502:physiology; D020233:Gait Disorders, Neurologic / Q000503:physiopathology* / Q000534:rehabilitation; D006801:Humans; D007866:Leg / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D018482:Muscle, Skeletal / Q000503:physiopathology*; D010291:Paresis / Q000503:physiopathology* / Q000534:rehabilitation; D016138:Walking / Q000502:physiology*
Gait Posture. 2004 Apr;19(2):194-205
15013508
J Bone Joint Surg Am. 1996 Oct;78(10):1506-14
8876578
IEEE Trans Biomed Eng. 1990 Aug;37(8):757-67
2210784
Brain. 1979 Jun;102(2):405-30
455047
Crit Rev Biomed Eng. 1989;17(4):359-411
2676342
J Biomech. 2004 Sep;37(9):1447-53
15275854
Arch Phys Med Rehabil. 2007 Jan;88(1):43-9
17207674
J Biomech. 1988;21(12):1027-41
2577949
Gait Posture. 2004 Jun;19(3):270-8
15125916
J Appl Physiol (1985). 2008 Aug;105(2):486-94
18556431
J Biomech. 1996 Jan;29(1):81-90
8839020
Comput Methods Biomech Biomed Engin. 2000;3(4):321-334
11264857
J Biomech. 1997 Jun;30(6):595-602
9165393
Stroke. 1995 Jun;26(6):982-9
7762050
Gait Posture. 2002 Jun;15(3):244-55
11983499
Gait Posture. 2005 Aug;22(1):51-6
15996592
Gait Posture. 2003 Feb;17(1):1-17
12535721
Gait Posture. 2009 Jan;29(1):129-37
18789692
Phys Ther. 1994 Sep;74(9):872-85
8066114
Gait Posture. 2008 Jul;28(1):135-43
18158246
Gait Posture. 2002 Dec;16(3):215-32
12443946
Gait Posture. 2007 Mar;25(3):342-52
16750632
Arch Phys Med Rehabil. 2003 Aug;84(8):1185-93
12917858
Clin Biomech (Bristol, Avon). 1999 Feb;14(2):125-35
10619100
Scand J Rehabil Med. 1995 Mar;27(1):37-42
7792548
J Biomech. 1993;26 Suppl 1:109-24
8505346
Stroke. 2006 Mar;37(3):872-6
16456121
J Biomech. 2001 Nov;34(11):1387-98
11672713