Post-Stroke Walking Behaviors Consistent with Altered Ground Reaction Force Direction Control Advise New Approaches to Research and Therapy

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• 作者：Wendy L. Boehm ; Kreg G. Gruben
• 关键词：Gait ; Rehabilitation ; Coordination ; Posture ; Cerebrovascular accidents
• 刊名：Translational Stroke Research
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：7
• 期：1
• 页码：3-11
• 全文大小：460 KB
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• 作者单位：Wendy L. Boehm (1)
  Kreg G. Gruben (1)
  
  1. Department of Kinesiology and Biomedical Engineering, University of Wisconsin-Madison, 2000 Observatory Drive, Madison, WI, 53706, USA
  
• 刊物主题：Neurosciences; Neurology; Cardiology; Neurosurgery; Vascular Surgery;
• 出版者：Springer US
• ISSN：1868-601X

文摘

Recovery of walking after stroke requires an understanding of how motor control deficits lead to gait impairment. Traditional therapy focuses on removing specific observable gait behaviors that deviate from unimpaired walking; however, those behaviors may be effective compensations for underlying problematic motor control deficits rather than direct effects of the stroke. Neurological deficits caused by stroke are not well understood, and thus, efficient interventions for gait rehabilitation likely remain unrealized. Our laboratory has previously characterized a post-stroke control deficit that yields a specific difference in direction of the ground reaction force (F, limb endpoint force) exerted with the hemiplegic limb of study participants pushing on both stationary and moving pedals while seated. That task was not dependent on F to retain upright posture, and thus, the task did not constrain F direction. Rather, the F direction was the product of neural preference. It is not known if this specific muscle coordination deficit causes the observed walking deviations, but if present during walking, the deficit would prevent upright posture unless counteracted by compensatory behaviors. Compensations are presented that mechanically counteract the F misdirection to allow upright posture. Those compensations are similar to behaviors observed in stroke patients. Based on that alignment between predictions of this theory and clinical observations, we theorize that post-stroke gait results from the attempt to compensate for the underlying F misdirection deficit. Limb endpoint force direction has been shown to be trainable in the paretic upper limb, making it a feasible goal in the lower limb. If this F misdirection theory is valid, these ideas have tremendous promise for advancing the field of post-stroke gait rehabilitation. Keywords Gait Rehabilitation Coordination Posture Cerebrovascular accidents