Abstract
Methods Twenty-two community-dwelling patients with chronic hemiplegia participated in this study. Eight participants performed only discrete-skill step training during the loading response phase, focusing on paretic hip extension movement (LR group). Another eight performed only discrete-skill step training during the preswing phase, focusing on paretic swing movement (PSw group). The remaining six were trained using both training methods, with at least 6 months in each group to washout the influence of previous training. Therefore, the final number of participants in each group was 14. The braking and propulsive forces of GRFs were measured during gait before and after 30 repetitions of the discrete-skill step training. Results Although both groups showed a significant increase in stride length, walking speed was increased only in the LR group. The PSw group showed an increase in braking forces of both sides without any change in propulsion. In the LR group, paretic braking impulse did not change, while nonparetic propulsion increased. Conclusion The discrete-skill step training during loading response phase induced an increase in nonparetic propulsion, resulting in increased walking speed. This study provides a clear understanding of immediate effects of the discrete-skill step training in patients with chronic stroke and helps improve interventions in long-term rehabilitation.
Highlights
Stroke is a leading cause of long-term dysfunctionality in daily living due to motor paralysis, muscle weakness, abnormal muscle tone, and sensory impairments
Two participants in the LR group and one participant in the PSw group were excluded from the analysis because it was difficult for them to walk by placing the affected limb properly on the force plates
Six participants in the LR group and ten participants in the PSw group were not able to walk without ankle-foot orthosis (AFO), so they were allowed to use the AFO during step training and gait evaluation
Summary
Stroke is a leading cause of long-term dysfunctionality in daily living due to motor paralysis, muscle weakness, abnormal muscle tone, and sensory impairments. Previous studies reported that gait function recovery, 3-6 months after onset, is a plateau in individuals with chronic stroke [2, 3]. Patterson et al concluded that individuals with a longer recovery period after stroke tend to be more dependent on the nonparalyzed lower limb during gait [4, 5]. Dependence on the nonparetic lower limb can compensate for the paretic lower limb deficit to maintain locomotor functions. From a long-term perspective, Patterson et al pointed out that this compensation strategy induced several problems, such as loss of bone mineral density of the paretic lower limb
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