title: Constraining movement reveals motor capability in chronic stroke: an initial study.
abstract: OBJECTIVE
  To determine if persons with chronic stroke and decreased hip and knee flexion during swing can walk with improved swing-phase kinematics when the task demands constrained gait to the sagittal plane.
  
  
  METHODS
  A one-day, within-subject design comparing gait kinematics under two conditions: Unconstrained treadmill walking and a constrained condition in which the treadmill walking space is reduced to limit limb advancement to occur in the sagittal plane.
  
  
  METHODS
  Outpatient physical therapy clinic.
  
  
  METHODS
  Eight individuals (mean age, 64.1 ±9.3, 2 F) with mild-moderate paresis were enrolled.
  
  
  METHODS
  Spatiotemporal gait characteristics and swing-phase hip and knee range of motion during unconstrained and constrained treadmill walking were compared using paired t-test and Cohen's d ( d) to determine effect size.
  
  
  RESULTS
  There was a significant, moderate-to-large effect of the constraint on hip flexion ( p < 0.001, d = -1.1) during initial swing, and hip ( p < 0.05, d = -0.8) and knee ( p < 0.001, d = -1.1) flexion during midswing. There was a moderate effect of constraint on terminal swing knee flexion ( p = 0.238, d = -0.6). Immediate and significant changes in step width ( p < 0.05, d = 0.9) and paretic step length ( p < 0.05, d = -0.5) were noted in the constrained condition compared with unconstrained.
  
  
  CONCLUSIONS
  Constraining the treadmill walking path altered the gait patterns among the study's participants. The immediate change during constrained walking suggests that patients with chronic stroke may have underlying movement capability that they do not preferentially utilize.
authors: 1 Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA.
authors: Clarisa A
authors: CA
authors: Martinez
authors: 2 Independent Scholar.
authors: Emily
authors: E
authors: Mintz
authors: 2 Independent Scholar.
authors: Andrea E
authors: AE
authors: Ecsedy
authors: 1 Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA.
authors: Beth E
authors: BE
authors: Fisher
mesh_terms: D000368:Aged; D001696:Biomechanical Phenomena; D002140:California; D002908:Chronic Disease; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D020233:Gait Disorders, Neurologic / Q000503:physiopathology / Q000534:rehabilitation*; D006429:Hemiplegia / Q000209:etiology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular / Q000502:physiology*; D012307:Risk Factors; D012494:Sampling Studies; D020521:Stroke / Q000150:complications* / Q000175:diagnosis; D000071939:Stroke Rehabilitation / Q000379:methods*; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology; D000072797:Walking Speed / Q000502:physiology*
keywords: Constraint; motor control; stroke; treadmill