Physical Therapy Korea (한국전문물리치료학회지)

Korean Research Society of Physical Therapy (한국전문물리치료학회)
권호 표지
DOI QR코드

DOI QR Code

Knee Strength and Ankle Range of Motion Influencing Gait Velocity and Gait Asymmetry in Patients With Chronic Stroke

만성 뇌졸중 환자의 보행속도와 보행 비대칭에 영향을 미치는 무릎근력과 발목 관절가동범위

  • Won, Jong-Im (Dept. of Physical Therapy, College of Medical Science, Jeonju University) ;
  • An, Chang-Man (Dept. of Physical Therapy, Chonbuk National University Hospital)
  • 원종임 (전주대학교 의과학대학 물리치료학과) ;
  • 안창만 (전북대학교병원 물리치료실)
  • Received : 2015.02.10
  • Accepted : 2015.03.25
  • Published : 2015.05.21
Download PDF
⟨ Previous Next ⟩

Abstract

The common features of walking in patients with stroke include decreased gait velocity and increased asymmetrical gait pattern. The purpose of this study was to identify important factors related to impairments in gait velocity and asymmetry in chronic stroke patients. The subjects were 30 independently ambulating subjects with chronic stroke. The subjects' impairments were examined, including the isokinetic peak torque of knee extensors, knee flexors, ankle plantarflexors, and ankle dorsiflexors. Passive and active ranges of motion (ROM) of the ankle joint, ankle plantarflexor spasticity, joint position senses of the knee and ankle joint, and balance were examined together. In addition, gait velocity and temporal and spatial asymmetry were evaluated with subjects walking at their comfortable speed. Pearson correlations and multiple regressions were used to measure the relationships between impairments and gait speed and impairments and asymmetry. Regression analyses revealed that ankle passive ROM and peak torque of knee flexors were important factors for gait velocity ($R^2=.41$), while ankle passive ROM was the most important determinant for temporal asymmetry ($R^2=.35$). In addition, knee extensor peak torque was the most significant factor for gait spatial asymmetry ($R^2=.17$). Limitation in ankle passive ROM and weakness of the knee flexor were major contributors to slow gait velocity. Moreover, limited passive ROM in the ankle influenced the level of temporal gait asymmetry in chronic stroke patients. Our findings suggest that stroke rehabilitation programs aiming to improve gait velocity and temporal asymmetry should include stretching exercise for the ankle joint.

Keywords

References

  1. Bijleveld-Uitman M, van de Port I, Kwakkel G. Is gait speed or walking distance a better predictor for community walking after stroke? J Rehabil Med. 2013;45(6):535-540. http://dx.doi.org/10.2340/16501977-1147
  2. Bilney B, Morris M, Webster K. Concurrent related validity of the gaitrite walkway system for quantification of the spatial and temporal parameters of gait. Gait Posture. 2003;17(1):68-74. https://doi.org/10.1016/S0966-6362(02)00053-X
  3. Bohannon RW, Andrews AW. Correlation of knee extensor muscle torque and spasticity with gait speed in patients with stroke. Arch Phys Med Rehabil. 1990;71(5):330-333.
  4. Bohannon RW, Andrews AW, Smith MB. Rehabilitation goals of patients with hemiplegia. Int J Rehabil Res. 1988;11(2):181-184. https://doi.org/10.1097/00004356-198806000-00012
  5. Bohannon RW, Walsh S. Nature, reliability, and predictive value of muscle performance measures in patients with hemiparesis following stroke. Arch Phys Med Rehabil. 1992;73(8):721-725.
  6. Davis RB, Deluca PA. Gait characterization via dynamic joint stiffness. Gait Posture. 1996;4(3):224-231. https://doi.org/10.1016/0966-6362(95)01045-9
  7. De Quervain IA, Simon SR, Leurgans S, et al. Gait pattern in the early recovery period after stroke. J Bone Joint Surg Am. 1996;78(10):1506-1514. https://doi.org/10.2106/00004623-199610000-00008
  8. Dettmann MA, Linder MT, Sepic SB. Relationships among walking performance, postural stability, and functional assessments of the hemiplegic patient. Am J Phys Med. 1987;66(2):77-90.
  9. Flansbjer UB, Downham D, Lexell J. Knee muscle strength, gait performance, and perceived participation after stroke. Arch Phys Med Rehabil. 2006;87(7):974-980. https://doi.org/10.1016/j.apmr.2006.03.008
  10. Forrester LW, Roy A, Krebs HI, et al. Ankle training with a robotic device improves hemiparetic gait after a stroke. Neurorehabil Neural Repair. 2011;25(4):369-377. http://dx.doi.org/10.1177/1545968310388291
  11. Friedman PJ. Spatial neglect in acute stroke: The line bisection test. Scand J Rehabil Med. 1990;22 (2):101-106.
  12. Gao F, Grant TH, Roth EJ, et al. Changes in passive mechanical properties of the gastrocnemius muscle at the muscle fascicle and joint levels in stroke survivors. Arch Phys Med Rehabil 2009;90(5):819-826. http://dx.doi.org/10.1016/j.apmr.2008.11.004
  13. Holden MK, Gill KM, Magliozzi MR, et al. Clinical gait assessment in the neurologically impaired. Reliability and meaningfulness. Phys Ther. 1984; 64(1):35-40. https://doi.org/10.1093/ptj/64.1.35
  14. Hsu AL, Tang PF, Jan MH. Analysis of impairments influencing gait velocity and asymmetry of hemiplegic patients after mild to moderate stroke. Arch Phys Med Rehabil. 2003;84(8): 1185-1193. https://doi.org/10.1016/S0003-9993(03)00030-3
  15. Jorgensen HS, Nakayama H, Raaschou HO, et al. Recovery of walking function in stroke patients: The copenhagen stroke study. Arch Phys Med Rehabil. 1995;76(1):27-32. https://doi.org/10.1016/S0003-9993(95)80038-7
  16. Kim CM, Eng JJ. The relationship of lower-extremity muscle torque to locomotor performance in people with stroke. Phys Ther. 2003;83(1):49-57.
  17. Knutsson E. Gait control in hemiparesis. Scand J Rehabil Med. 1981;13(2-3):101-108.
  18. Ko SU, Stenholm S, Metter EJ, et al. Age-associated gait patterns and the role of lower extremity strength-results from the baltimore longitudinal study of aging. Arch Gerontol Geriatr. 2012;55 (2):474-479. http://dx.doi.org/10.1016/j.archger.2012.04.004
  19. Lin PY, Yang YR, Cheng SJ, et al. The relation between ankle impairments and gait velocity and symmetry in people with stroke. Arch Phys Med Rehabil. 2006;87(4):562-568. https://doi.org/10.1016/j.apmr.2005.12.042
  20. Lin SI. Motor function and joint position sense in relation to gait performance in chronic stroke patients. Arch Phys Med Rehabil. 2005;86(2): 197-203. https://doi.org/10.1016/j.apmr.2004.05.009
  21. Menz HB, Latt MD, Tiedemann A, et al. Reliability of the gaitrite walkway system for the quantification of temporo-spatial parameters of gait in young and older people. Gait Posture. 2004;20(1): 20-25. https://doi.org/10.1016/S0966-6362(03)00068-7
  22. Nadeau S, Arsenault AB, Gravel D, et al. Analysis of the clinical factors determining natural and maximal gait speeds in adults with a stroke. Am J Phys Med Rehabil. 1999;78(2):123-130. https://doi.org/10.1097/00002060-199903000-00007
  23. Nasciutti-Prudente C, Oliveira FG, Houri SF, et al. Relationships between muscular torque and gait speed in chronic hemiparetic subjects. Disabil Rehabil. 2009;31(2):103-108. http://dx.doi.org/10.1080/09638280701818055
  24. Olney SJ, Griffin MP, Monga TN, et al. Work and power in gait of stroke patients. Arch Phys Med Rehabil. 1991;72(5):309-314.
  25. Petterson KK, Parafianowicz I, Danells CJ, et al. Gait asymmetry in community-ambulating stroke survivors. Arch Phys Med Rehabil. 2008;89(2): 304-310. http://dx.doi.org/10.1016/j.apmr.2007.08.142
  26. Roy A, Forrester LW, Macko RF, et al. Changes in passive ankle stiffness and its effects on gait function in people with chronic stroke. J Rehabil Res Dev. 2013;50(4):555-572. https://doi.org/10.1682/JRRD.2011.10.0206
  27. Sekiguchi Y, Muraki T, Kuramatsu Y, et al. The contribution of quasi-joint stiffness of the ankle joint to gait in patients with hemiparesis. Clin Biomech (Bristol Avon). 2012;27(5):495-499. http://dx.doi.org/10.1016/j.clinbiomech.2011.12.005
  28. Sekir U, Yildiz Y, Hazneci B, et al. Reliability of a functional test battery evaluating functionality, proprioception, and strength in recreational athletes with functional ankle instability. Eur J Phys Rehabil Med. 2008;44(4):407-415.
  29. Studenski S, Perera S, Patel K, et al. Gait speed and survival in older adults. JAMA. 2011;305(1):50-58. http://dx.doi.org/10.1001/jama.2010.1923
  30. Suzuki K, Imada G, Iwaya T, et al. Determinants and predictors of the maximum walking speed during computer-assisted gait training in hemiparetic stroke patients. Arch Phys Med Rehabil. 1999;80(2):179-182. https://doi.org/10.1016/S0003-9993(99)90117-X
  31. Taylor-Piliae RE, Latt LD, Hepworth JT, et al. Predictors of gait velocity among community -dwelling stroke survivors. Gait Posture. 2012;35(3): 395-399. http://dx.doi.org/10.1016/j.gaitpost.2011.10.358
  32. Titianova EB, Tarkka IM. Asymmetry in walking performance and postural sway in patients with chronic unilateral cerebral infarction. J Rehabil Res Dev. 1995;32(3):236-244.
  33. van de Port IG, Kwakkel G, Lindeman E. Community ambulation in patients with chronic stroke: How is it related to gait speed? J Rehabil Med. 2008; 40(1):23-27. http://dx.doi.org/10.2340/16501977-0114

Cited by

  1. Effect of backward walking training using an underwater treadmill on muscle strength, proprioception and gait ability in persons with stroke vol.6, pp.3, 2017, https://doi.org/10.14474/ptrs.2017.6.3.120
  2. Immediate Effects of Real-Time Visual Bio-feedback Using Ground Reaction Forces on Gait Symmetry in Elderly Males vol.21, pp.1, 2020, https://doi.org/10.1007/s12541-019-00234-6