Abstract
Stroke results in paretic limb disabilities, but few studies have investigated the impacts of stroke on muscle perception deficits in multiaxis movements and related functional changes. Therefore, this study aimed to investigate stroke-related changes in muscle perceptions using a multiaxis ankle haptic interface and analyze their relationships with various functions. Sixteen stroke patients and 22 healthy participants performed active reproduction tests in multiaxis movements involving the tibialis anterior (TA), extensor digitorum longus (EDL), peroneus longus, and flexor digitorum longus (FDL) of the ankle joint. The direction error (DE), absolute error (AE), and variable error (VE) were calculated. The lower extremity of Fugl-Meyer Assessment (FMA-LE), Barthel Index (BI), Postural Assessment Scale for Stroke Patients, Tinetti Performance-Oriented Mobility Assessment (POMA), and 10-m walk test (10MWT) were evaluated. VE of EDL for the paretic ankle was significantly lower than that for the nonparetic ankle (p = 0.009). AE of TA, EDL, and FDL and VE of EDL and FDL of muscle perceptions were significantly lower in healthy participants than in stroke patients (p < 0.05 for both). DE of TA for the paretic ankle was moderately correlated with FMA-LE (r = −0.509) and POMA (r = −0.619) scores. AE and VE of EDL for the paretic ankle were moderately correlated with the 10MWT score (r = 0.515 vs. 0.557). AE of FDL for the paretic ankle was also moderately correlated with BI (r = −0.562). This study indicated poorer accuracy and consistency in muscle perception for paretic ankles, which correlated with lower limb functions of stroke patients.
Highlights
We found that direction error (DE) scores in tibialis anterior (TA) of the paretic ankle joints were significantly correlated with FMA-LE (p = 0.04) and Performance-Oriented Mobility Assessment (POMA) scores (p = 0.011)
extensor digitorum longus (EDL) are the key muscles in activating ankle movements during walking [28], and POMA and 10-m walk test (10MWT) are commonly applied to validate the balance, gait, and walking performance in clinical settings; this study indicated that perception deficits of these muscles are correlated with motor and functional performances in stroke patients
This study indicated that muscle perception performances in the paretic ankle were correlated with motor and functional performances in the lower extremities of stroke patients, and we suggest that future studies should develop appropriate rehabilitation programs to improve muscle perceptions for these specific muscles, which may be helpful in enhancing the motor and functional recovery of paretic ankle joints of stroke patients
Summary
Stroke leads to central neurologic impairments and causes abnormal muscle tone and muscle weakness in the paretic limbs, which may impact perception inputs from muscles in movements and decrease motor and functional performances of lower extremities during daily activities [3,4,5,6,7,8,9]. Perception inputs can be affected when muscles contract and generate strength during dynamic functional activities of daily living for patients with stroke [10,11,12]. Appropriate measurements that evaluate deficits in muscle perceptions using active joint reproduction tests in ankle movements are crucial and could provide true reflections of functional performances of the ankle joint during daily activities in post-stroke patients [17]
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