Abstract
BackgroundThe effects of a stroke, such as hemiparesis, can severely hamper the ability to walk and to maintain balance during gait. Providing support to stroke survivors through a robotic exoskeleton, either to provide training or daily-life support, requires an understanding of the balance impairments that result from a stroke. Here, we investigate the differences between the paretic and non-paretic leg in making recovery steps to restore balance following a disturbance during walking.MethodsWe perturbed 10 chronic-stage stroke survivors during walking using mediolateral perturbations of various amplitudes. Kinematic data as well as gluteus medius muscle activity levels during the first recovery step were recorded and analyzed.ResultsThe results show that this group of subjects is able to modulate foot placement in response to the perturbations regardless of the leg being paretic or not. Modulation in gluteus medius activity with the various perturbations is in line with this observation. In general, the foot of the paretic leg was laterally placed further away from the center of mass than that of the non-paretic leg, while subjects spent more time standing on the non-paretic leg.ConclusionsThe findings suggest that, though stroke-related gait characteristics are present, the modulation with the various perturbations remains unaffected. This might be because all subjects were only mildly impaired, or because these stepping responses partly occur through involuntary pathways which remain unaffected by the complications after the stroke.
Highlights
The effects of a stroke, such as hemiparesis, can severely hamper the ability to walk and to maintain balance during gait
In a study by Balasubramanian et al subjects placed the paretic leg at Haarman et al Journal of NeuroEngineering and Rehabilitation (2017) 14:106 an increased lateral distance from the pelvis compared to the non-paretic leg in mediolateral (ML) foot placement during unperturbed walking [3]
We investigated the first recovery step following mediolateral pelvis perturbations in chronic-stage stroke survivors who walked at a self-selected speed
Summary
The effects of a stroke, such as hemiparesis, can severely hamper the ability to walk and to maintain balance during gait. We investigate the differences between the paretic and non-paretic leg in making recovery steps to restore balance following a disturbance during walking. A variety of neurological deficits can hamper balance control during walking, such as hemiparesis, sensory impairments, as well as cognitive problems such as fear of falling. Stroke survivors typically show differences in gait characteristics between the paretic and non-paretic leg during unperturbed walking, for example as a result of decreased motor control in the paretic leg. In a study by Balasubramanian et al subjects placed the paretic leg at Haarman et al Journal of NeuroEngineering and Rehabilitation (2017) 14:106 an increased lateral distance from the pelvis compared to the non-paretic leg in mediolateral (ML) foot placement during unperturbed walking [3]. For low fall-risk subjects the results suggest a stronger activity modulation in the non-paretic swing leg than in the paretic swing leg, though it did not show how both legs respond to actual destabilizing conditions such as external perturbations
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