[논문]Compensations in lower limb joint work during walking in response to unilateral calf muscle weakness

Waterval, Niels F.J.; Brehm, Merel-Anne; Ploeger, Hilde E.; Nollet, Frans; Harlaar, Jaap

doi:10.1016/j.gaitpost.2018.08.016

Compensations in lower limb joint work during walking in response to unilateral calf muscle weakness 원문보기

Gait & posture, v.66, 2018년, pp.38 - 44

Waterval, Niels F.J. (Amsterdam UMC, University of Amsterdam, Department of Rehabilitation, Amsterdam Movement Sciences) , Brehm, Merel-Anne (Amsterdam UMC, University of Amsterdam, Department of Rehabilitation, Amsterdam Movement Sciences) , Ploeger, Hilde E. (Amsterdam UMC, University of Amsterdam, Department of Rehabilitation, Amsterdam Movement Sciences) , Nollet, Frans (Amsterdam UMC, University of Amsterdam, Department of Rehabilitation, Amsterdam Movement Sciences) , Harlaar, Jaap (Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences)

Abstract ▼ AI-Helper

Abstract Background Patients with calf muscle weakness due to neuromuscular disorders have a reduced ankle push-off work, which leads to increased energy dissipation at contralateral heel-strike. Consequently, compensatory positive work needs to be generated, which is mechanically less efficient. It is unknown whether neuromuscular disorder patients compensate with their ipsilateral hip and/or contralateral leg; and if such compensatory joint work is related to walking energy cost. Research question Do patients with calf muscle weakness compensate for the increase in negative joint work by increasing positive ipsilateral hip work and/or positive contralateral leg work? And is the total mechanical work related with walking energy cost? Methods Seventeen patients with unilateral flaccid calf muscle weakness and 10 healthy individuals performed the following two tests: i) a barefoot 3D gait analysis at comfortable speed and matched control speed (i.e. 0.4 non-dimensional) to assess lower limb joint work and ii) a 6-minute walk test at comfortable speed to assess walking energy cost. Results Patients had a lower comfortable walking speed compared to healthy individuals (1.05 vs 1.36 m/s, p < 0.001) and did not increase positive lower limb joint work at comfortable speed. At matched speed (1.25 m/s), patients showed increased positive work at their ipsilateral hip (0.38 ± 0.08 vs 0.27 ± 0.07, p = 0.001) and/or contralateral leg (0.99 ± 0.14 vs 0.69 ± 0.14, p < 0.001). Patients with weakest plantar flexors used both strategies. No relation between total positive work and walking energy cost was found (r = 0.43, p = 0.122). Significance Patients with unilateral calf muscle weakness compensated for reduced ankle push-off work by lowering their comfortable walking speed or, at matched speed, by generating additional positive joint work at the ipsilateral hip and/or contralateral leg. The additional positive joint work at matched speed did not explain the elevated walking energy cost at comfortable speed, which needs further exploration. Highlights Patients with reduced ankle power demonstrate a lower comfortable walking speed. At matched speed, patients compensate using hip work and/or contralateral leg work. Patients with weakest plantar flexors use both compensations. Mechanical work and walking energy cost are both increased but not related.

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Compensations in lower limb joint work during walking in response to unilateral calf muscle weakness 원문보기

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