Park, Hye-Kang
(Rehabilitation Center, Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital)
,
Yu, Ki-Gon
(Rehabilitation Center, Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital)
,
Shin, Jang-Hoon
(Department of Physical Therapy, The Graduate School, Sahmyook University)
,
Lee, Wan-Hee
(Department of Physical Therapy, College of Health Science and Social Welfare, Sahmyook University)
Objective: This study aimed to compare muscle structure, balance, and gait parameters between healthy adults and persons with stroke and to analyze the correlation among these variables. Design: Cross-sectional study. Methods: Twenty persons with stroke (11 male, 9 female) and twenty healthy partici...
Objective: This study aimed to compare muscle structure, balance, and gait parameters between healthy adults and persons with stroke and to analyze the correlation among these variables. Design: Cross-sectional study. Methods: Twenty persons with stroke (11 male, 9 female) and twenty healthy participants (9 male, 11 female) were included. Ultrasound images of the triceps surae and the tibialis anterior were acquired in sitting resting, sitting co-contraction, and standing resting positions and also during the functional reach test (FRT) and single leg anterior reaching test (SLART). Muscle thickness and fascicle length were measured. Spatiotemporal parameters of gait were measured using a pressure walkway. Gait speed, cadence, step length, stride length, stance time, and swing time were measured. Results: Changes in percent fascicle length were significantly greater in the gastrocnemius and soleus (SOL) muscles of healthy adults in the sitting co-contraction position (p<0.05). The percent fascicle length of the SOL in FRT and SLART were significantly greater in healthy adults (p<0.05). The mid-stance phase of stroke patients was shorter than healthy adults (p<0.05). A negative correlation was observed between percent fascicle length of the SOL in the sitting co-contraction position and the proportion of the mid-stance phase (p<0.05). Conclusions: The function of the triceps surae is affected in persons with stroke when compared with healthy adults. This can lead to difficulty in performing tasks that involve forward transfer of weight. If the triceps surae is not sufficiently secured, the possibility of compensation in the stance phase increases during gait.
Objective: This study aimed to compare muscle structure, balance, and gait parameters between healthy adults and persons with stroke and to analyze the correlation among these variables. Design: Cross-sectional study. Methods: Twenty persons with stroke (11 male, 9 female) and twenty healthy participants (9 male, 11 female) were included. Ultrasound images of the triceps surae and the tibialis anterior were acquired in sitting resting, sitting co-contraction, and standing resting positions and also during the functional reach test (FRT) and single leg anterior reaching test (SLART). Muscle thickness and fascicle length were measured. Spatiotemporal parameters of gait were measured using a pressure walkway. Gait speed, cadence, step length, stride length, stance time, and swing time were measured. Results: Changes in percent fascicle length were significantly greater in the gastrocnemius and soleus (SOL) muscles of healthy adults in the sitting co-contraction position (p<0.05). The percent fascicle length of the SOL in FRT and SLART were significantly greater in healthy adults (p<0.05). The mid-stance phase of stroke patients was shorter than healthy adults (p<0.05). A negative correlation was observed between percent fascicle length of the SOL in the sitting co-contraction position and the proportion of the mid-stance phase (p<0.05). Conclusions: The function of the triceps surae is affected in persons with stroke when compared with healthy adults. This can lead to difficulty in performing tasks that involve forward transfer of weight. If the triceps surae is not sufficiently secured, the possibility of compensation in the stance phase increases during gait.
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문제 정의
In addition, in the process of analyzing the spatiotemporal gait parameters, studies that have divided the stance phase into three sections were insufficient. Therefore, the purpose of this study was to compare the muscle structure, balance, and gait parameters between healthy adults and patients affected by stroke and to analyze the correlation among muscle structure, balance and the stance phase during the gait cycle.
제안 방법
An independent t-test was performed to compare the outcome between the healthy adults and the participants with stroke. Analysis of variance was used to compare the affected side, the non-affected side, and the healthy leg during gait. Pearson’s correlation analysis was performed to analyze the correlation between the variables.
GCM: gastrocnemius, SOL: soleus, TA: tibialis anterior, FRT: functional reach test, SLART: single leg anterior reaching test.
, Franklin, NJ, USA) equipment to investigate the spatiotemporal gait variables during the stance phase and the swing phase. The assessments were performed in randomized order to minimized bias of the procedure order.
The evaluation method began with a position wherein the participant’s feet were shoulder-width apart, the trunk was held vertically on the ground, and the fists were stretched forward comfortably (90 degrees’ flexion of the shoulder joint, elbow joint fully extended).
Muscle structure was measured while resting in the standing position and the change in muscle structure was measured during the functional reach test (FRT) and the single leg anterior reaching test (SLART). The gait ability was measured using (GAITRite; CIR Systems, Inc., Franklin, NJ, USA) equipment to investigate the spatiotemporal gait variables during the stance phase and the swing phase. The assessments were performed in randomized order to minimized bias of the procedure order.
The inclusion criteria for the participants with stroke were: (1) more than 6 months since the stroke episode, (2) ability to walk at least 10 m, and (3) participants who could understand and carry out the researcher’s instructions.
6 cm high, and consists of a flat floor with 16,128 pressure sensors. The measurement method was based on a walking board of 5 m, which takes into account the acceleration and the deceleration section of the gait with a margin of 2 m each. Altogether, 9 m of gait was measured three times and the average value was calculated [33].
The purpose of the present study was to compare the muscle structure, balance, and gait parameters of the triceps surae between stroke survivors and healthy adults and to analyze the correlation among these parameters.
This study was designed as a single-blind (subject masking) cross-sectional study to compare healthy adults with patients with stroke. Before beginning the study, the general characteristics of all subjects were examined.
대상 데이터
GAITRite equipment was used to analyze the spatiotemporal variables during the stance phase and the swing phase of the subjects’ gait. This equipment is 5 m long, 0.6 m wide, 0.6 cm high, and consists of a flat floor with 16,128 pressure sensors. The measurement method was based on a walking board of 5 m, which takes into account the acceleration and the deceleration section of the gait with a margin of 2 m each.
Twenty participants with stroke (11 male, 9 female) and twenty healthy participants (9 male, 11 female) were included in the study. The sample size of the study were calculated using the G*Power version 3.
데이터처리
All data were expressed as the mean (standard deviation). An independent t-test was performed to compare the outcome between the healthy adults and the participants with stroke. Analysis of variance was used to compare the affected side, the non-affected side, and the healthy leg during gait.
Pearson’s correlation analysis was performed to analyze the correlation between the variables.
이론/모형
, Chicago, IL, USA) was used for all statistical analyses. The Shapiro-Wilk test was performed to confirm the normality of participant characteristics. All data were expressed as the mean (standard deviation).
The stance phase included the contact phase, mid-stance phase, and propulsion phase. The criteria for dividing into three phases was set in the heel-to-toe progression method according to previous studies [34]. The ICC value of this equipment was 0.
성능/효과
A significant positive correlation was observed between the percent fascicle length of the GCM in the sitting co-contraction position and the proportion of the contact phase (r=0.326; p=0.004). A negative correlation was observed between percent fascicle length of the SOL in the sitting co-contraction phase and the proportion of the mid-stance phase (r=−0.
In conclusion, the function of the triceps surae is affected in the stroke population when compared with healthy adults, which can lead to difficulty in performing tasks that involve transfer of weight in a forward direction. If the triceps surae, especially the fascicle length of the SOL muscle, is not sufficiently secured, the possibility of compensation in the stance phase increases during gait.
The FRT distance of the participants with stroke were 7.79% lower than that of healthy adults and the SLART distance was 24.52% lower. These results are similar to previous research findings, which suggested that it is difficult for patients with chronic stroke to secure stability in a static and dynamic balanced environment when compared with young adults and healthy adults of similar age [39].
후속연구
These findings imply the application of a compensation mechanism such as knee hyperextension during gait [43]. However, since the present study did not measure the knee angle during gait, additional research is needed on this topic.
The groups were not well matched with respect to age, as the average age of the patients with stroke was greater than that of the healthy adults. Since variables other than the triceps surae can also affect the FRT, SLART, and the stance phase, future studies that apply various variables based on the results of the present study are needed.
참고문헌 (44)
Berenpas F, Martens AM, Weerdesteyn V, Geurts AC, van Alfen N. Bilateral changes in muscle architecture of physically active people with chronic stroke: a quantitative muscle ultrasound study. Clin Neurophysiol 2017;128:115-22.
Dias CP, Lanferdini FJ, Onzi EdS, Goulart NBA, Becker J, Gomes I, et al. The influence of hemiparesis on triceps surae morphological and mechanical properties in stroke survivors. Isokinet Exerc Sci 2016;24:157-64.
Cho JE, Cho KH, Yoo JS, Lee SJ, Lee WH. Reliability and validity of a dual-probe personal computer-based muscle viewer for measuring the pennation angle of the medial gastrocnemius muscle in patients who have had a stroke. Top Stroke Rehabil 2018;25:6-12.
Lee HJ, Ha HG, Hahn J, Lim S, Lee WH. Intra- and inter-rater reliabilities for novel muscle thickness assessment during Co-contraction with dual-rehabilitative ultrasound imaging. Phys Ther Sport 2018;32:109-14.
Jorgensen JR, Bech-Pedersen DT, Zeeman P, Sorensen J, Andersen LL, Schonberger M. Effect of intensive outpatient physical training on gait performance and cardiovascular health in people with hemiparesis after stroke. Phys Ther 2010;90:527-37.
Sanchez-Sanchez ML, Ruescas-Nicolau MA, Carrasco JJ, Espi-Lopez GV, Perez-Alenda S. Cross-sectional study of quadriceps properties and postural stability in patients with chronic stroke and limited vs. non-limited community ambulation. Top Stroke Rehabil 2019;26:503-10.
Pradines M, Ghedira M, Portero R, Masson I, Marciniak C, Hicklin D, et al. Ultrasound structural changes in triceps surae after a 1-year daily self-stretch program: a prospective randomized controlled trial in chronic hemiparesis. Neurorehabil Neural Repair 2019;33:245-59.
Francis CA, Lenz AL, Lenhart RL, Thelen DG. The modulation of forward propulsion, vertical support, and center of pressure by the plantarflexors during human walking. Gait Posture 2013;38:993-7.
Geremia JM, Baroni BM, Bini RR, Lanferdini FJ, de Lima AR, Herzog W, et al. Triceps surae muscle architecture adaptations to eccentric training. Front Physiol 2019;10:1456.
Decq P, Filipetti P, Cubillos A, Slavov V, Lefaucheur JP, Nguyen JP. Soleus neurotomy for treatment of the spastic equinus foot. Groupe d'Evaluation et de Traitement de la Spasticite et de la Dystonie. Neurosurgery 2000;47:1154-60; discussion 1160-1.
Sakanaka TE, Gill J, Lakie MD, Reynolds RF. Intrinsic ankle stiffness during standing increases with ankle torque and passive stretch of the Achilles tendon. PLoS One 2018;13:e0193850.
Masani K, Popovic MR, Nakazawa K, Kouzaki M, Nozaki D. Importance of body sway velocity information in controlling ankle extensor activities during quiet stance. J Neurophysiol 2003;90:3774-82.
Aaron SE, Hunnicutt JL, Embry AE, Bowden MG, Gregory CM. POWER training in chronic stroke individuals: differences between responders and nonresponders. Top Stroke Rehabil 2017;24:496-502.
Klamroth-Marganska V. Stroke rehabilitation: therapy robots and assistive devices. Adv Exp Med Biol 2018;1065:579-87.
Maggio MG, Latella D, Maresca G, Sciarrone F, Manuli A, Naro A, et al. Virtual reality and cognitive rehabilitation in people with stroke: an overview. J Neurosci Nurs 2019;51:101-5.
Ghasemi E, Khademi-Kalantari K, Khalkhali-Zavieh M, Rezasoltani A, Ghasemi M, Akbarzadeh Baghban A, et al. The effect of functional stretching exercises on neural and mechanical properties of the spastic medial gastrocnemius muscle in patients with chronic stroke: a randomized controlled trial. J Stroke Cerebrovasc Dis 2018;27:1733-42.
Dias CP, Freire B, Goulart NB, Onzi ES, Becker J, Gomes I, et al. Muscle architecture and torque production in stroke survivors: an observational study. Top Stroke Rehabil 2017;24:206-13.
Hagen M, Schwiertz G, Landorf KB, Menz HB, Murley GS. Selective activation of lower leg muscles during maximum voluntary isometric contractions. Hum Mov Sci 2016;50:30-7.
Kumagai K, Abe T, Brechue WF, Ryushi T, Takano S, Mizuno M. Sprint performance is related to muscle fascicle length in male 100-m sprinters. J Appl Physiol 2000;88:811-6.
McCreesh K, Egan S. Ultrasound measurement of the size of the anterior tibial muscle group: the effect of exercise and leg dominance. Sports Med Arthrosc Rehabil Ther Technol 2011;3:18.
Lariviere C, Gagnon DH, Henry SM, Preuss R, Dumas JP. The effects of an 8-week stabilization exercise program on lumbar multifidus muscle thickness and activation as measured with ultrasound imaging in patients with low back pain: an exploratory study. PM R 2018;10:483-93.
Jenkins ME, Johnson AM, Holmes JD, Stephenson FF, Spaulding SJ. Predictive validity of the UPDRS postural stability score and the Functional Reach Test, when compared with ecologically valid reaching tasks. Parkinsonism Relat Disord 2010;16:409-11.
Tanaka R, Ishikawa Y, Yamasaki T, Diez A. Accuracy of classifying the movement strategy in the functional reach test using a markerless motion capture system. J Med Eng Technol 2019;43:133-8.
Miller MM. Postural control task performance of individuals with femoroacetabular impingement syndrome [Master thesis]. Columbus: Ohio State University; 2017.
Shaffer SW, Teyhen DS, Lorenson CL, Warren RL, Koreerat CM, Straseske CA, et al. Y-balance test: a reliability study involving multiple raters. Mil Med 2013;178:1264-70.
Brown KC, Hanson HM, Firmani F, Liu D, McAllister MM, Merali K, et al. Gait speed and variability for usual pace and pedestrian crossing conditions in older adults using the GAITRite walkway. Gerontol Geriatr Med 2015;1:2333721415618858.
Psarakis M, Greene D, Moresi M, Baker M, Stubbs P, Brodie M, et al. Impaired heel to toe progression during gait is related to reduced ankle range of motion in people with Multiple Sclerosis. Clin Biomech (Bristol, Avon) 2017;49:96-100.
Webster KE, Wittwer JE, Feller JA. Validity of the GAITRite walkway system for the measurement of averaged and individual step parameters of gait. Gait Posture 2005;22:317-21.
Franchi MV, Reeves ND, Narici MV. Skeletal muscle remodeling in response to eccentric vs. concentric loading: morphological, molecular, and metabolic adaptations. Front Physiol 2017;8:447.
Horst R, Hummelsheim H, Renner CIE. Effects of increases in plantar flexor strength on gait impairment after stroke: study protocol of a randomized controlled trial. Austin Phys Med 2017;1:1004.
Freire B, Abou L, Dias CP. Equinovarus foot in stroke survivors with spasticity: a narrative review of muscle-tendon morphology and force production adaptation. Int J Ther Rehabil 2020;27:1-8.
Leung J, Moseley A. Impact of ankle-foot orthoses on gait and leg muscle activity in adults with hemiplegia: systematic literature review. Physiotherapy 2003;89:39-55.
Schmid S, Schweizer K, Romkes J, Lorenzetti S, Brunner R. Secondary gait deviations in patients with and without neurological involvement: a systematic review. Gait Posture 2013;37:480-93.
Tirupatamma NL, Kameshwari G, Kumari VS, Madhavi K. To know the effectiveness of Rocker Board training programe on trunk balance and gait in subjects with stroke. Indian J Physiother Occup Ther 2019;13:236-41.
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