Changes in Predicted Muscle Coordination with Subject-Specific Muscle Parameters for Individuals after Stroke

Muscle weakness is commonly seen in individuals after stroke, characterized by lower forces during a maximal volitional contraction. Accurate quantification of muscle weakness is paramount when evaluating individual performance and response to after stroke rehabilitation. The objective of this study was to examine the effect of subject-specific muscle force and activation deficits on predicted muscle coordination when using musculoskeletal models for individuals after stroke. Maximum force generating ability and central activation ratio of the paretic plantar flexors, dorsiflexors, and quadriceps muscle groups were obtained using burst superimposition for four individuals after stroke with a range of walking speeds. Two models were created per subject: one with generic and one with subject-specific activation and maximum isometric force parameters. The inclusion of subject-specific muscle data resulted in changes in the model-predicted muscle forces and activations which agree with previously reported compensation patterns and match more closely the timing of electromyography for the plantar flexor and hamstring muscles. This was the first study to create musculoskeletal simulations of individuals after stroke with subject-specific muscle force and activation data. The results of this study suggest that subject-specific muscle force and activation data enhance the ability of musculoskeletal simulations to accurately predict muscle coordination in individuals after stroke

Mechanisms to increase propulsive force for individuals poststroke

Background: Propulsive force generation is critical to walking speed. Trialing limb angle and ankle moment are major contributors to increases in propulsive force during gait. For able-bodied individuals, trailing limb angle contributes twice as much as ankle moment to increases in propulsive force during speed modulation. The aim of this study was to quantify the relative contribution of ankle moment and trailing limb angle to increases in propulsive force for individuals poststroke. Methods: A biomechanical-based model previously developed for able-bodied individuals was evaluated and enhanced for individuals poststroke. Gait analysis was performed as subjects (N = 24) with chronic poststroke hemiparesis walked at their self-selected and fast walking speeds on a treadmill. Results: Both trailing limb angle and ankle moment increased during speed modulation. In the paretic limb, the contribution from trailing limb angle versus ankle moment to increases in propulsive force is 74% and 17%. In the non-paretic limb, the contribution from trailing limb angle versus ankle moment to increases in propulsive force is 67% and 22%. Conclusions: Individuals poststroke increase propulsive force mainly by changing trailing limb angle in both the paretic and non-paretic limbs. This strategy may contribute to the inefficiency in poststroke walking patterns. Future work is needed to examine whether these characteristics can be modified via intervention

Changes in the activation and function of the ankle plantar flexor muscles due to gait retraining in chronic stroke survivors

Background A common goal of persons post-stroke is to regain community ambulation. The plantar flexor muscles play an important role in propulsion generation and swing initiation as previous musculoskeletal simulations have shown. The purpose of this study was to demonstrate that simulation results quantifying changes in plantar flexor activation and function in individuals post-stroke were consistent with (1) the purpose of an intervention designed to enhance plantar flexor function and (2) expected muscle function during gait based on previous literature. Methods Three-dimensional, forward dynamic simulations were created to determine the changes in model activation and function of the paretic ankle plantar flexor muscles for eight patients post-stroke after a 12-weeks FastFES gait retraining program. Results An median increase of 0.07 (Range [−0.01,0.22]) was seen in simulated activation averaged across all plantar flexors during the double support phase of gait from pre- to post-intervention. A concurrent increase in walking speed and plantar flexor induced forward center of mass acceleration by the plantar flexors was seen post-intervention for seven of the eight subject simulations. Additionally, post-training, the plantar flexors had an simulated increase in contribution to knee flexion acceleration during double support. Conclusions For the first time, muscle-actuated musculoskeletal models were used to simulate the effect of a gait retraining intervention on post-stroke muscle model predicted activation and function. The simulations showed a new pattern of simulated activation for the plantar flexor muscles after training, suggesting that the subjects activated these muscles with more appropriate timing following the intervention. Functionally, simulations calculated that the plantar flexors provided greater contribution to knee flexion acceleration after training, which is important for increasing swing phase knee flexion and foot clearance

Assessment of subacromial space and its relationship with scapular upward rotation in college baseball players.

CONTEXT: Subacromial impingement is a common injury in baseball players and has been linked to a reduction in the subacromial space. In addition, it has been suggested that decreases in scapular upward rotation will lead to decreases in the subacromial space and ultimately impingement syndrome. OBJECTIVE: The objective of this study was to evaluate the relationship between acromiohumeral distance and scapular upward rotation in healthy college baseball players. DESIGN: Posttest-only study design. SETTING: Controlled laboratory setting. PARTICIPANTS: 24 healthy college baseball players. Intervention: Participants were measured for all dependent variables at preseason. MAIN OUTCOME MEASURES: Acromiohumeral distance at rest and 90° of abduction was measured with a diagnostic ultrasound unit. Scapular upward rotation at rest and 90° of abduction was measured with a digital inclinometer. RESULTS: Dominant-arm acromiohumeral distance at rest and 90° of abduction (P = .694, P = .840) was not significantly different than in the nondominant arm. In addition, there was not a significant correlation between acromiohumeral distance and scapular upward rotation at rest and 90° of abduction for either the dominant or the nondominant arm. CONCLUSIONS: These results indicate that the acromiohumeral distance is not adapting in the dominant arm in healthy throwing athletes. In addition, a relationship was not identified between acromiohumeral distance and scapular upward rotation, which was previously suggested. These results may suggest that changes that are typically seen in an injured population may be occurring due to the injury and are not preexisting. In addition, scapular upward rotation may not be the only contributing factor to acromiohumeral distance

Baseline predictors of treatment gains in peak propulsive force in individuals poststroke

Publisher's PDFBackground: Current rehabilitation for individuals poststroke focuses on increasing walking speed because it is an indicator of community walking ability and quality of life. Propulsive force generated from the paretic limb is critical to walking speed and may reflect actual neural recovery that restores the affected neural systems. A wide variation across individuals in the improvements in paretic propulsive force was observed following an intervention that targeted paretic propulsive force. This study aimed to determine if specific baseline characteristics can be used to predict patients who would respond to the intervention. Methods: Participants (N = 19) with chronic poststroke hemiparesis walked at their self-selected and maximal walking speeds on a treadmill before and after a 12-week gait training program. Propulsive forces from the paretic limb were analyzed. Pearson correlation coefficient was used to determine the relationships between (1) treatment gains in walking speed and propulsive force following intervention, and (2) treatment gains in propulsive force and baseline propulsive forces. Results: Treatment gains in self-selected walking speed were correlated to treatment gains in paretic propulsive force following intervention. In addition, changes in paretic propulsive force between self-selected and maximal walking speeds at baseline were strongly correlated to treatment gains in paretic propulsive force. Conclusions: The capacity to modulate paretic propulsive force, rather than the absolute propulsive force during self-selected or maximal walking speed, predicted treatment gains in propulsive force following the intervention. Findings from this research could help to inform clinicians and researchers to target the appropriate patient population for rehabilitation interventions.University of Delaware, Department of Mechanical Engineering University of Delaware, Department of Physical Therap

Static and Dynamic Correlates of the Knee Adduction Moment in Healthy Knees Ranging from Normal to Varus-aligned

Background: Individuals with medial knee osteoarthritis often present with varus knee alignment and ambulate with increased knee adduction moments. Understanding the factors that relate to the knee adduction moment in healthy individuals may provide insight into the development of this disease. Thus, this study aimed to examine the relationships of both static and dynamic lower extremity measures with the knee adduction moment. We hypothesized that the dynamic measures would be more closely related to this moment. Methods: Arch height index, hip abduction strength and two static measures of knee alignment were recorded for 37 young asymptomatic knees that varied from normal to varus-aligned. Overground gait analyses were also performed. Correlation coefficients were used to assess the relationships between the static and dynamic variables to the knee adduction moment. Hierarchical regression analyses were then conducted using the static measures, the dynamic measures, and the static and dynamic measures together. Results: Among the static measures, the tibial mechanical axis and the distance between the medial knee joint lines were correlated with the knee adduction moment. The best predictive static model (R2 = 0.53) included only the tibial mechanical axis. Among the dynamic variables, knee adduction and rearfoot eversion angles were correlated with the knee adduction moment. Knee adduction and rearfoot eversion, together, were the best dynamic model (R2 = 0.53). The static and dynamic measures together created the strongest of the three models (R2 = 0.59). Conclusions: These results suggest that dynamic measures slightly enhance the predictive strength of static measures when explaining variation in the knee adduction moment

Lower Extremity Walking Mechanics of Young Individuals with Asymptomatic Varus Knee Alignment

Varus knee alignment is associated with an increased risk for developing medial knee osteoarthritis (OA). Medial knee OA is commonly associated with altered walking mechanics in the frontal and sagittal planes, as well as altered ground reaction forces. It is unknown whether these mechanics are present in young, asymptomatic individuals with varus knees. We expected that varus‐aligned individuals would generally present with frontal plane mechanics that were similar to those reported for individuals with medial knee OA. The gait mechanics of 17 asymptomatic individuals with varus knees and 17 healthy, normally aligned controls were recorded. Gait parameters associated with medial knee OA were compared between groups. The individuals with varus knees exhibited greater knee external adduction moments, knee adduction, eversion, and lateral ground reaction force than the normally aligned individuals. In addition, those with varus knees also demonstrated increased knee flexion and external knee flexor moments during midstance. These results suggest that individuals with varus knees exhibit some, but not all, of the altered mechanics seen in medial knee OA

Cellular Telephone Dialing Influences Kinematic and Spatiotemporal Gait Parameters in Healthy Adults

Gait speed is typically reduced when individuals simultaneously perform other tasks. However, the impact of dual tasking on kinetic and kinematic gait parameters is unclear because these vary with gait speed. The objective of this study was to identify whether dual tasking impacts gait in healthy adults when speed is constant. Twenty-two healthy adults dialed a cell phone during treadmill walking at a self-selected speed while kinetic, kinematic, and spatial parameters were recorded. Results indicated that dual tasking did not impact phone dialing speed, but increased stride width, peak knee flexion during stance, and peak plantarflexion, and decreased knee and ankle range of motion. Dual tasking appears to influence kinematic gait variables in a manner consistent with promotion of stability