Effect of biomechanical footwear on upper and lower leg muscle activity in comparison with knee brace and normal walking

AimTo evaluate the activity of knee stabilizing muscles while using custom-made biomechanical footwear (BF) and to compare it when walking barefoot and with a knee brace (Unloader®).MethodsSeventeen healthy working-aged (mean age: 29 years; standard deviation: 8 years) individuals participated. The knee brace was worn on the right knee and BF in both legs. Surface electromyography (sEMG) data was recorded bilaterally from vastus medialis (VM), semitendinosus (ST), tibialis anterior (TA) and lateral gastrocnemius (LG) muscles during walking, and repeated-measures ANOVA with a post-hoc t-test was used to determine differences between the different walking modalities (barefoot, brace and BF).ResultsAveraged sEMG was significantly higher when walking with BF than barefoot or knee brace in the ST muscles, in the right LG, and left TA muscle. It was significantly lower when walking with the brace compared to barefoot in the right ST and LG muscles, and left TA muscle. Analysis of the ensemble-averaged sEMG profiles showed earlier activation of TA muscles when walking with BF compared to other walking modalities.ConclusionBF produced greater activation in evaluated lower leg muscles compared to barefoot walking. Thus BF may have an exercise effect in rehabilitation and further studies about its effectiveness are warranted.     

The influence of increasing steady-state walking speed on muscle activity in below-knee amputees

The goal of this study was to identify changes in muscle activity in below-knee amputees in response to increasing steady-state walking speeds. Bilateral electromyographic (EMG) data were collected from 14 amputee and 10 non-amputee subjects during four overground walking speeds from eight intact leg and five residual leg muscles. Using integrated EMG measures, we tested three hypotheses for each muscle: (1) there would be no difference in muscle activity between the residual and intact legs, (2) there would be no difference in muscle activity between the intact leg and non-amputee legs, and (3) muscle activity in the residual and intact legs would increase with speed. Most amputee EMG patterns were similar between legs and increased in magnitude with speed. Differences occurred in the residual leg biceps femoris long head, vastus lateralis and rectus femoris, which increased in magnitude during braking compared to the intact leg. These adaptations were consistent with the need for additional body support and forward propulsion in the absence of the plantar flexors. With the exception of the intact leg gluteus medius, all intact leg muscles exhibited similar EMG patterns compared to the control leg. Finally, the residual, intact and control leg EMG all had a significant speed effect that increased with speed with the exception of the gluteus medius.     

Dynamic stability of superior vs. inferior body segments in individuals with transtibial amputation walking in destabilizing environments

Interestingly, young and highly active people with lower limb amputation appear to maintain a similar trunk and upper body stability during walking as able-bodied individuals. Understanding the mechanisms underlying how this stability is achieved after lower-leg amputation is important to improve training regimens for improving walking function in these patients. This study quantified how superior (i.e., head, trunk, and pelvis) and inferior (i.e., thigh, shank, and feet) segments of the body respond to continuous visual or mechanical perturbations during walking. Nine persons with transtibial amputation (TTA) and 12 able-bodied controls (AB) walked on a 2 m×3 m treadmill in a Computer Assisted Rehabilitation Environment (CAREN). Subjects were perturbed by continuous pseudo-random mediolateral movements of either the treadmill platform or the visual scene. TTA maintained a similar local and orbital stability in their superior body segments as AB throughout both perturbation types. However, for their inferior body segments, TTA subjects exhibited greater dynamic instability during perturbed walking. In TTA subjects, these increases in instability were even more pronounced in their prosthetic limb compared to their intact leg. These findings demonstrate that persons with unilateral lower leg amputation maintain upper body stability in spite of increased dynamic instability in their impaired lower leg. Thus, transtibial amputation does significantly impair sensorimotor function, leading to substantially altered dynamic movements of their lower limb segments. However, otherwise relatively healthy patients with unilateral transtibial amputation appear to retain sufficient remaining sensorimotor function in their proximal and contralateral limbs to adequately compensate for their impairment.     

The shear modulus of lower-leg muscles correlates to intramuscular pressure

Shear wave elastography (SWE) is emerging as an innovative tool to evaluate muscle properties and function. It has been shown to correlate with both passive and active muscle forces, and is sensitive to physiological processes and pathological conditions. Similarly, intramuscular pressure (IMP) is an important parameter that changes with passive and active muscle contraction, body position, exercise, blood pressure, and several pathologies. Therefore, the objective of this study was to quantify the dependency of shear modulus within the lower-leg muscles on IMP in healthy individuals. Nineteen healthy individuals (age: Mean age ± SD, 23.84 ± 6.64 years) were recruited. Shear modulus was measured using ultrasound SWE on the tibialis anterior (TA) and peroneus longus (PL) muscles using pressure cuff inflation around the thigh at 40 mmHg, 80 mmHg, and 120 mmHg. Changes in IMP were verified using a catheter connected to a blood pressure monitor. It was found that IMP was correlated to TA and PL shear modulus (spearman's rank correlation = 0.99 and 0.99, respectively). Applying a gradual increase of cuff pressure from 0 to 120 mmHg increased the shear modulus of the TA and PL muscles from 15.83 (2.46) kPa to 21.88 (4.33) kPa and from 9.64 (1.97) kPa to 12.88 (5.99) kPa, respectively. These results demonstrate that changes of muscle mechanical properties are dependent on IMP. This observation is important to improve interpretation of ultrasound elastograms and to potentially use it as a biomarker for more accurate diagnosis of pathologies related to increased IMP.     

Stance phase control of above-knee prostheses: knee control versus SACH foot design

The mobility of above-knee amputees (A/K) is limited, in part, due to the performance of A/K prostheses during the stance phase. Currently stance phase control of most conventional A/K prostheses can only be achieved through leg alignment and choice of the SACH (Solid Ankle Cushioned Heel) foot. This paper examines the role of the knee controller in relation to a SACH foot during the stance phase of level walking. The three-dimensional gait mechanics were measured under two stance phase conditions. In the first set of trials, the amputee used a prosthesis with a conventional knee controller that allowed the amputee to maintain the knee joint in full extension during the stance phase. In the second set of trials, the prosthetic knee, during stance, echoed the modified kinematics of the amputee's sound (intact) knee that had been recorded during the previous sound stance phase. Analysis and interpretation of the data indicate the following: (1) SACH foot design can strongly influence the walking mechanics independent of the knee controller; (2) knee controller design and SACH foot design are mutually interdependent; and (3) normal kinematics imposed on the prosthetic knee does not necessarily produce normal hip kinematics (e.g. reduce the abnormal rise in the prosthetic side hip trajectory). Future research is necessary to explore and exploit the interdependency of prosthetic knee control and foot design.     

Trunk-Pelvis motions and spinal loads during upslope and downslope walking among persons with transfemoral amputation

Larger trunk and pelvic motions in persons with (vs. without) lower limb amputation during activities of daily living (ADLs) adversely affect the mechanical demands on the lower back. Building on evidence that such altered motions result in larger spinal loads during level-ground walking, here we characterize trunk-pelvic motions, trunk muscle forces, and resultant spinal loads among sixteen males with unilateral, transfemoral amputation (TFA) walking at a self-selected speed both up (“upslope”; 1.06 ± 0.14 m/s) and down (“downslope”; 0.98 ± 0.20 m/s) a 10-degree ramp. Tri-planar trunk and pelvic motions were obtained (and ranges-of-motion [ROM] computed) as inputs for a non-linear finite element model of the spine to estimate global and local muscle (i.e., trunk movers and stabilizers, respectively) forces, and resultant spinal loads. Sagittal- (p = 0.001), frontal- (p = 0.004), and transverse-plane (p < 0.001) trunk ROM, and peak mediolateral shear (p = 0.011) and local muscle forces (p = 0.010) were larger (respectively 45, 35, 98, 70, and 11%) in upslope vs. downslope walking. Peak anteroposterior shear (p = 0.33), compression (p = 0.28), and global muscle (p = 0.35) forces were similar between inclinations. Compared to previous reports of persons with TFA walking on level ground, 5–60% larger anteroposterior and mediolateral shear observed here (despite ∼0.25 m/s slower walking speeds) suggest greater mechanical demands on the low back in sloped walking, particularly upslope. Continued characterization of trunk motions and spinal loads during ADLs support the notion that repeated exposures to these larger-than-normal (i.e., vs. level-ground walking in TFA and uninjured cohorts) spinal loads contribute to an increased risk for low back injury following lower limb amputation.     

Leg intramuscular pressures during locomotion in humans

To assess the usefulness of intramuscularpressure (IMP) measurement for studying muscle function during gait,IMP was recorded in the soleus and tibialis anterior muscles of 10 volunteers during treadmill walking and running by usingtransducer-tipped catheters. Soleus IMP exhibited single peaks duringlate-stance phase of walking [181 ± 69 (SE) mmHg] andrunning (269 ± 95 mmHg). Tibialis anterior IMP showed a biphasicresponse, with the largest peak (90 ± 15 mmHg during walking and151 ± 25 mmHg during running) occurring shortly after heel strike.IMP magnitude increased with gait speed in both muscles. Linearregression of soleus IMP against ankle joint torque obtained by adynamometer produced linear relationships (n = 2, r = 0.97 for both). Application ofthese relationships to IMP data yielded estimated peak soleus momentcontributions of 0.95-1.65 N · m/kgduring walking, and 1.43-2.70 N · m/kg during running. Phasic elevations of IMP during exercise are probably generated by local muscle tissue deformations due to muscle force development. Thus profiles of IMP provide a direct, reproducible indexof muscle function during locomotion in humans.

     

Assessment of neuromuscular activity during maximal isometric contraction in supine vs standing body positions

BackgroundWhen comparing neuromuscular activity between different individuals or different conditions by use of surface electromyography (sEMG) it is necessary to apply standardized assessment protocol. Most frequently used method is the maximum voluntary isometric contraction (MVIC). However, the influence of body posture on sEMG activity during MVIC testing remains largely unknown.AimTo evaluate the MVIC method for sEMG normalization in supine versus standing positions for selected muscles of the lower extremity and trunk.MethodsTwelve healthy individuals participated; five females and seven males (age 22–51 yrs). sEMG signals were recorded bilaterally from mm tibialis anterior, gluteus medius, adductor longus, rectus abdominus, external oblique and internal oblique/transversus abdominus according to standardized test protocol. Two different body positions were used: supine and standing position.ResultsMVIC peak sEMG signal amplitudes did not differ systematically between supine and standing test positions. Pronounced inter-subject variability in MVIC reference sEMG activity were observed between participants, during both supine and standing test positions.ConclusionPresent data demonstrate that MVIC EMG normalization is a biomechanically stable procedure that can be performed in a reproducible manner for the major leg and trunk muscles when comparing supine vs. standing test positions.     

Recovering from Laboratory-Induced slips and trips causes high levels of lumbar muscle activity and spine loading

Slips, trips, and falls are some of the most substantial and prevalent causes of occupational injuries and fatalities, and these events may contribute to low-back problems. We quantified lumbar kinematics (i.e., lumbar angles relative to pelvis) and kinetics during unexpected slip and trip perturbations, and during normal walking, among 12 participants (6F, 6 M). Individual anthropometry, lumbar muscle geometry, and lumbar angles, along with electromyography from 14 lumbar muscles were used as input to a 3D, dynamic, EMG-based model of the lumbar spine. Results indicated that, in comparison with values during normal walking, lumbar range of motion, lumbosacral (L5/S1) loads, and lumbar muscle activations were all significantly higher during the slip and trip events. Maximum L5/S1 compression forces exceeded 2700 N during slip and trip events, compared with ∼ 1100 N during normal walking. Mean values of L5/S1 anteroposterior (930 N), and lateral (800 N) shear forces were also substantially larger than the shear force during the normal walking (230 N). These observed levels of L5/S1 reaction forces, along with high levels of bilateral lumbar muscle activities, suggest the potential for overexertion injuries and tissue damage during unexpected slip and trip events, which could contribute to low back injuries. Outcomes of this study may facilitate the identification and control of specific mechanisms involved with low back disorders consequent to slips or trips.     

Treatment with electrical stimulation of sensory nerves improves motor function and disability status in persons with multiple sclerosis: A pilot study

Declines in motor function are closely associated with decreases in sensory function in multiple sclerosis (MS). The purpose of our study was to assess the changes in motor function and disability status elicited by transcutaneous electrical nerve stimulation (TENS) to limb muscles of individuals with MS. Fifteen persons with MS and 11 age-matched healthy controls were evaluated before and after receiving 9 treatment sessions during which TENS was applied over the tibialis anterior and rectus femoris muscles of each leg, and over the median nerve and the thenar eminence of each hand. Each evaluation session involved completing two questionnaires (fatigue and walking limitations) and assessing walking performance (2-min test and 25-ft test), dynamic balance (chair-rise test), manual dexterity (grooved pegboard test), and muscle function of hands and legs (strength and force steadiness tests). The MS group exhibited improvements in the 25-ft test (P = 0.001), 2-min test (P = 0.002), chair-rise test (P = 0.008), grooved pegboard test (P = 0.008), and reductions in the self-reported levels of fatigue and walking limitation scores (P = 0.02, d = 0.52; P = 0.008, r = 0.50 respectively). In contrast, there were no statistically significant changes in the Control group. There were no significant changes in either muscle strength or force steadiness for either group. TENS elicited significant improvements in motor function and self-reported disability status in persons with MS. Some improvements reached clinically meaningful levels.     

Influence of foam thickness on the control of EMG activity during a step-down task in females

Compliant foams can be used to mitigate ground reaction forces. However, it is unknown how foam surfaces influence the modulation of leg muscle activity. Thus, the current study aimed to investigate how the neuromuscular system managed changes in expected loading due to various thickness of foam placed on the landing surface during a step down task. The surface electromyographic signal (sEMG) pre-activation duration and the root mean square (RMS) amplitude of tibialis anterior (TA), lateral gastrocnemius (LG), and vastus medialis (VM) of 10 active females were measured as they stepped-down with a single leg onto polyurethane foam slabs of varying thickness (0–50 mm). Pre-activation duration was not affected by the thickness of the foam padding. LG RMS amplitude was less in the foam conditions than the control (no– foam) condition, with the greatest reduction observed for the 50 mm foam condition. In some trials, the muscles remained active throughout the step-down task. In such instances, a sEMG onset time and thus a pre-activation duration could not be determined. All foam conditions significantly increased the odds of continuous muscle activity above that of the no-foam condition. The results indicate that foam surfaces may alter the modulation of muscle activity during step-down tasks.     

Muscle contributions to support during gait in an individual with post-stroke hemiparesis

Walking requires coordination of muscles to support the body during single stance. Impaired ability to coordinate muscles following stroke frequently compromises walking performance and results in extremely low walking speeds. Slow gait in post-stroke hemiparesis is further complicated by asymmetries in lower limb muscle excitations. The objectives of the current study were: (1) to compare the muscle coordination patterns of an individual with flexed stance limb posture secondary to post-stroke hemiparesis with that of healthy adults walking very slowly, and (2) to identify how paretic and non-paretic muscles provide support of the body center of mass in this individual. Simulations were generated based on the kinematics and kinetics of a stroke survivor walking at his self-selected speed (0.3 m/s) and of three speed-matched, healthy older individuals. For each simulation, muscle forces were perturbed to determine the muscles contributing most to body weight support (i.e., height of the center of mass during midstance). Differences in muscle excitations and midstance body configuration caused paretic and non-paretic ankle plantarflexors to contribute less to midstance support than in healthy slow gait. Excitation of paretic ankle dorsiflexors and knee flexors during stance opposed support and necessitated compensation by knee and hip extensors. During gait for an individual with post-stroke hemiparesis, adequate body weight support is provided via reorganized muscle coordination patterns of the paretic and non-paretic lower limbs relative to healthy slow gait.     

Activation of walking by electrical stimulation in humans under the conditions of muscle unloading and its variations under the effect of afferent influences

The possibility of initiating an involuntary walking rhythm in a suspended human leg by electrical stimulation was studied. The subjects lay on the side with one leg suspended in an exoskeleton allowing horizontal rotation in three joints: the hip, knee, and ankle ones. To evoke involuntary walking of the suspended leg, two methods were used: continuous vibration of the quadriceps muscle of the hip and electrical stimulation of the cutaneous nerves innervating the foot of the immobile leg. The hip and ankle were involved in the involuntary movements, with reciprocal bursts of electromyographic activity being also observed in the antagonistic muscles of the hip. The application of an external load (4 N or 8 N) to the foot caused a perceptible intensification of its movements. An additional weight (0.5 kg) or a rubber band wrapped around the foot caused no substantial change in the pattern of stimulated walking. Electrical stimulation is an effective means of activating walking movements, and their characteristics confirm the assumption that the walking rhythm is of central origin. Additional afferentation from the sole’s receptors plays an important role in the modulation of the induced movements and the modification of the general walking pattern under the conditions of muscle unloading.     

Reflex response of antagonist muscles during elicitation of the tendon reflex

Reflex responses of the triceps surae and tibialis anterior muscles were recorded electro-myographically and mechanographically in healthy persons during elicitation of the tendon reflexes from these muscles. Elicitation of the tendon reflex from one muscle was found to be accompanied by simultaneous contraction of the antagonists of the ankle. It is suggested that monosynaptic connections of afferent fibers of the antagonist muscles of the leg play an important role in the mechanism of their simultaneous activity which is a characteristic feature of human standing and walking.Institute of Problems of Information Transmission, Academy of Sciences of the USSR, Moscow. Translated from Neirofiziologyia, Vol. 5, No. 1, pp. 70–76, January–February, 1973.     

中华绒螯蟹蜕壳过程中肌肉的组织学、超微结构及主要蛋白质含量的变化

为探讨中华绒螯蟹(Eriocheir sinensis)蜕壳前后肌肉组织的形态特征变化, 采用石蜡切片、电镜及生物化学方法, 研究了中华绒螯蟹蜕皮过程中步行足和腹部肌肉的组织学、超微结构及主要蛋白质含量的变化。结果显示: 相对于蜕皮间期, 步行足在蜕皮前后组织学形态特征无明显变化; 超微结构在蜕皮前无明显变化, 蜕皮后可见肌原纤维纵裂及肌小节横裂现象, 表明蜕皮后外骨骼硬化的过程伴随着肌肉的生长。相对于蜕皮间期, 腹部肌肉在蜕皮前后组织学特征变化明显: 蜕皮前肌束间隙增大, 蜕皮后肌束内肌纤维间隙增大。电子显微镜观察显示, 蜕皮前肌原纤维在内部降解, 出现空洞, 肌原纤维边缘降解, 导致肌原纤维间隙增大; 蜕皮后肌原纤维重新组装、重建, 恢复到间期正常形态。生物化学研究发现, 蜕皮前后步行足和腹部肌肉中肌原纤维蛋白和可溶性蛋白含量的变化同其结构特征的变化相一致。以上研究结果表明, 中华绒螯蟹肌肉组织的结构特征同蜕皮周期密切相关。     

Energy cost and muscular activity required for leg swing during walking.

To investigate the metabolic cost and muscular actions required for the initiation and propagation of leg swing, we applied a novel combination of external forces to subjects walking on a treadmill. We applied a forward pulling force at each foot to assist leg swing, a constant forward pulling force at the waist to provide center of mass propulsion, and a combination of these foot and waist forces to evaluate leg swing. When the metabolic cost and muscle actions were at a minimum, the condition was considered optimal. We reasoned that the difference in energy consumption between the optimal combined waist and foot force trial and the optimal waist force-only trial would reflect the metabolic cost of initiating and propagating leg swing during normal walking. We also reasoned that a lower muscle activity with these assisting forces would indicate which muscles are normally responsible for initiating and propagating leg swing. With a propulsive force at the waist of 10% body weight (BW), the net metabolic cost of walking decreased to 58% of normal walking. With the optimal combination, a propulsive force at the waist of 10% BW plus a pulling force at the feet of 3% BW the net metabolic cost of walking further decreased to 48% of normal walking. With the same combination, the muscle activity of the iliopsoas and rectus femoris muscles during the swing phase was 27 and 60% lower, respectively, but the activity of the medial gastrocnemius and soleus before swing did not change. Thus our data indicate that approximately 10% of the net metabolic cost of walking is required to initiate and propagate leg swing. Additionally, the hip flexor muscles contribute to the initiation and propagation leg swing.     

Biomechanics of overground vs. treadmill walking in healthy individuals.

The goal of this study was to compare treadmill walking with overground walking in healthy subjects with no known gait disorders. Nineteen subjects were tested, where each subject walked on a split-belt instrumented treadmill as well as over a smooth, flat surface. Comparisons between walking conditions were made for temporal gait parameters such as step length and cadence, leg kinematics, joint moments and powers, and muscle activity. Overall, very few differences were found in temporal gait parameters or leg kinematics between treadmill and overground walking. Conversely, sagittal plane joint moments were found to be quite different, where during treadmill walking trials, subjects demonstrated less dorsiflexor moments, less knee extensor moments, and greater hip extensor moments. Joint powers in the sagittal plane were found to be similar at the ankle but quite different at the knee and hip joints. Differences in muscle activity were observed between the two walking modalities, particularly in the tibialis anterior throughout stance, and in the hamstrings, vastus medialis and adductor longus during swing. While differences were observed in muscle activation patterns, joint moments and joint powers between the two walking modalities, the overall patterns in these behaviors were quite similar. From a therapeutic perspective, this suggests that training individuals with neurological injuries on a treadmill appears to be justified.     

Altered EMG patterns in diabetic neuropathic and not neuropathic patients during step ascending and descending

Diabetic peripheral neuropathy (DPN) causes motor control alterations during daily life activities. Tripping during walking or stair climbing is the predominant cause of falls in the elderly subjects with DPN and without (NoDPN). Surface Electromyography (sEMG) has been shown to be a valid tool for detecting alterations of motor functions in subjects with DPN. This study aims at investigating the presence of functional alterations in diabetic subjects during stair climbing and at exploring the relationship between altered muscle activation and temporal parameter. Lower limb muscle activities, temporal parameters and speed were evaluated in 50 subjects (10 controls, 20 with DPN, 20 without DPN), while climbing up and down a stair, using sEMG, three-dimentional motion capture and force plates. Magnitude and timing of sEMG linear envelopes peaks were extracted. Level walking was used as reference condition for the comparison with step negotiation. sEMG, speed and temporal parameters revealed significant differences among all groups of patients. Results showed an association between earlier activation of lower limb muscles and reduced speed in subjects with DPN. Speed and temporal parameters significantly correlated with sEMG (p < 0.05). The findings of this study are encouraging and could be used to improve rehabilitation programs aiming at reducing falls risk in diabetic subjects.     

Trunk muscle activation during stabilization exercises with single and double leg support

The aim of this study was to analyze trunk muscle activity during bridge style stabilization exercises, when combined with single and double leg support strategies. Twenty-nine healthy volunteers performed bridge exercises in 3 different positions (back, front and side bridges), with and without an elevated leg, and a quadruped exercise with contralateral arm and leg raise ("bird-dog"). Surface EMG was bilaterally recorded from rectus abdominis (RA), external and internal oblique (EO, IO), and erector spinae (ES). Back, front and side bridges primarily activated the ES (approximately 17% MVC), RA (approximately 30% MVC) and muscles required to support the lateral moment (mostly obliques), respectively. Compared with conventional bridge exercises, single leg support produced higher levels of trunk activation, predominantly in the oblique muscles. The bird-dog exercise produced greatest activity in IO on the side of the elevated arm and in the contralateral ES. In conclusion, during a common bridge with double leg support, the antigravity muscles were the most active. When performed with an elevated leg, however, rotation torques increased the activation of the trunk rotators, especially IO. This information may be useful for clinicians and rehabilitation specialists in determining appropriate exercise progression for the trunk stabilizers.     

Pre-swing deficits in forward propulsion,swing initiation and power generation by individual muscles during hemiparetic walking

Clinical studies of hemiparetic walking have shown pre-swing abnormalities in the paretic leg suggesting that paretic muscle contributions to important biomechanical walking subtasks are different than those of non-disabled individuals. Three-dimensional forward dynamics simulations of two representative hemiparetic subjects with different levels of walking function classified by self-selected walking speed (i.e., limited community=0.4–0.8 m/s and community walkers=>0.8 m/s) and a speed-matched control were generated to quantify individual muscle contributions to forward propulsion, swing initiation and power generation during the pre-swing phase (i.e., double support phase proceeding toe-off). Simulation analyses identified decreased paretic soleus and gastrocnemius contributions to forward propulsion and power generation as the primary impairment in the limited community walker compared to the control subject. The non-paretic leg did not compensate for decreased forward propulsion by paretic muscles during pre-swing in the limited community walker. Paretic muscles had the net effect to absorb energy from the paretic leg during pre-swing in the community walker suggesting that deficits in swing initiation are a primary impairment. Specifically, the paretic gastrocnemius and hip flexors (i.e., iliacus, psoas and sartorius) contributed less to swing initiation and the paretic soleus and gluteus medius absorbed more power from the paretic leg in the community walker compared to the control subject. Rehabilitation strategies aimed at diminishing these deficits have much potential to improve walking function in these hemiparetic subjects and those with similar deficits.