Modular control of human walking: Adaptations to altered mechanical demands

Studies have suggested that the nervous system may adopt a control scheme in which synergistic muscle groups are controlled by common excitation patters, or modules, to simplify the coordination of movement tasks such as walking. A recent computer modeling and simulation study of human walking using experimentally derived modules as the control inputs provided evidence that individual modules are associated with specific biomechanical subtasks, such as generating body support and forward propulsion. The present study tests whether the modules identified during normal walking could produce simulations of walking when the mechanical demands were substantially altered. Walking simulations were generated that emulated human subjects who had their body weight and/or body mass increased and decreased by 25%. By scaling the magnitude of five module patterns, the simulations could emulate the subjects’ response to each condition by simply scaling the mechanical output from modules associated with specific biomechanical subtasks. Specifically, the modules associated with providing body support increased (decreased) their contribution to the vertical ground reaction force when body weight was increased (decreased) and the module associated with providing forward propulsion increased its contribution to the positive anterior–posterior ground reaction force and positive trunk power when the body mass was increased. The modules that contribute to controlling leg swing were unaffected by the perturbations. These results support the idea that the nervous system may use a modular control strategy and that flexible modulation of module recruitment intensity may be sufficient to meet large changes in mechanical demand.     

Dynamic balance during walking adaptability tasks in individuals post-stroke

Maintaining dynamic balance during community ambulation is a major challenge post-stroke. Community ambulation requires performance of steady-state level walking as well as tasks that require walking adaptability. Prior studies on balance control post-stroke have mainly focused on steady-state walking, but walking adaptability tasks have received little attention. The purpose of this study was to quantify and compare dynamic balance requirements during common walking adaptability tasks post-stroke and in healthy adults and identify differences in underlying mechanisms used for maintaining dynamic balance. Kinematic data were collected from fifteen individuals with post-stroke hemiparesis during steady-state forward and backward walking, obstacle negotiation, and step-up tasks. In addition, data from ten healthy adults provided the basis for comparison. Dynamic balance was quantified using the peak-to-peak range of whole-body angular-momentum in each anatomical plane during the paretic, nonparetic and healthy control single-leg-stance phase of the gait cycle. To understand differences in some of the key underlying mechanisms for maintaining dynamic balance, foot placement and plantarflexor muscle activation were examined. Individuals post-stroke had significant dynamic balance deficits in the frontal plane across most tasks, particularly during the paretic single-leg-stance. Frontal plane balance deficits were associated with wider paretic foot placement, elevated body center-of-mass, and lower soleus activity. Further, the obstacle negotiation task imposed a higher balance requirement, particularly during the trailing leg single-stance. Thus, improving paretic foot placement and ankle plantarflexor activity, particularly during obstacle negotiation, may be important rehabilitation targets to enhance dynamic balance during post-stroke community ambulation.     

Three-dimensional modular control of human walking

Recent studies have suggested that complex muscle activity during walking may be controlled using a reduced neural control strategy organized around the co-excitation of multiple muscles, or modules. Previous computer simulation studies have shown that five modules satisfy the sagittal-plane biomechanical sub-tasks of 2D walking. The present study shows that a sixth module, which contributes primarily to mediolateral balance control and contralateral leg swing, is needed to satisfy the additional non-sagittal plane demands of 3D walking. Body support was provided by Module 1 (hip and knee extensors, hip abductors) in early stance and Module 2 (plantarflexors) in late stance. In early stance, forward propulsion was provided by Module 4 (hamstrings), but net braking occurred due to Modules 1 and 2. Forward propulsion was provided by Module 2 in late stance. Module 1 accelerated the body medially throughout stance, dominating the lateral acceleration in early stance provided by Modules 4 and 6 (adductor magnus) and in late stance by Module 2, except near toe-off. Modules 3 (ankle dorsiflexors, rectus femoris) and 5 (hip flexors and adductors except adductor magnus) accelerated the ipsilateral leg forward in early swing whereas Module 4 decelerated the ipsilateral leg prior to heel-strike. Finally, Modules 1, 4 and 6 accelerated the contralateral leg forward prior to and during contralateral swing. Since the modules were based on experimentally measured muscle activity, these results provide further evidence that a simple neural control strategy involving muscle activation modules organized around task-specific biomechanical functions may be used to control complex human movements.     

Impairment in Task-Specific Modulation of Muscle Coordination Correlates with the Severity of Hand Impairment following Stroke

Significant functional impairment of the hand is commonly observed in stroke survivors. Our previous studies suggested that the inability to modulate muscle coordination patterns according to task requirements may be substantial after stroke, but these limitations have not been examined directly. In this study, we aimed to characterize post-stroke impairment in the ability to modulate muscle coordination patterns across tasks and its correlation with hand impairment. Fourteen stroke survivors, divided into a group with severe hand impairment (8 subjects) and a group with moderate hand impairment (6 subjects) according to their clinical functionality score, participated in the experiment. Another four neurologically intact subjects participated in the experiment to serve as a point of comparison. Activation patterns of nine hand and wrist muscles were recorded using surface electromyography while the subjects performed six isometric tasks. Patterns of covariation in muscle activations across tasks, i.e., muscle modules, were extracted from the muscle activation data. Our results showed that the degree of reduction in the inter-task separation of the multi-muscle activation patterns was indicative of the clinical functionality score of the subjects (mean value = 26.2 for severely impaired subjects, 38.1 for moderately impaired subjects). The values for moderately impaired subjects were much closer to those of the impaired subjects (mean value = 46.1). The number of muscle modules extracted from the muscle activation patterns of a subject across six tasks, which represents the degree of motor complexity, was found to be correlated with the clinical functionality score (R = 0.68). Greater impairment was also associated with a change in the muscle module patterns themselves, with greater muscle coactivation. A substantial reduction in the degrees-of-freedom of the multi-muscle coordination post-stroke was apparent, and the extent of the reduction, assessed by the stated metrics, was strongly associated with the level of clinical impairment.     

Modular control of human walking: A simulation study

Recent evidence suggests that performance of complex locomotor tasks such as walking may be accomplished using a simple underlying organization of co-active muscles, or “modules”, which have been assumed to be structured to perform task-specific biomechanical functions. However, no study has explicitly tested whether the modules would actually produce the biomechanical functions associated with them or even produce a well-coordinated movement. In this study, we generated muscle-actuated forward dynamics simulations of normal walking using muscle activation modules (identified using non-negative matrix factorization) as the muscle control inputs to identify the contributions of each module to the biomechanical sub-tasks of walking (i.e., body support, forward propulsion, and leg swing). The simulation analysis showed that a simple neural control strategy involving five muscle activation modules was sufficient to perform the basic sub-tasks of walking. Module 1 (gluteus medius, vasti, and rectus femoris) primarily contributed to body support in early stance while Module 2 (soleus and gastrocnemius) contributed to both body support and propulsion in late stance. Module 3 (rectus femoris and tibialis anterior) acted to decelerate the leg in early and late swing while generating energy to the trunk throughout swing. Module 4 (hamstrings) acted to absorb leg energy (i.e., decelerate it) in late swing while increasing the leg energy in early stance. Post-hoc analysis revealed an additional module (Module 5: iliopsoas) acted to accelerate the leg forward in pre- and early swing. These results provide evidence that the identified modules can act as basic neural control elements that generate task-specific biomechanical functions to produce well-coordinated walking.     

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.     

Control of lateral weight transfer is associated with walking speed in individuals post-stroke

Restoring functional gait speed is an important goal for rehabilitation post-stroke. During walking, transferring of one’s body weight between the limbs and maintaining balance stability are necessary for independent functional gait. Although it is documented that individuals post-stroke commonly have difficulties with performing weight transfer onto their paretic limbs, it remains to be determined if these deficits contributed to slower walking speeds. The primary purpose of this study was to compare the weight transfer characteristics between slow and fast post-stroke ambulators. Participants (N = 36) with chronic post-stroke hemiparesis walked at their comfortable and maximal walking speeds on a treadmill. Participants were stratified into 2 groups based on their comfortable walking speeds (≥0.8 m/s or <0.8 m/s). Minimum body center of mass (COM) to center of pressure (COP) distance, weight transfer timing, step width, lateral foot placement relative to the COM, hip moment, peak vertical and anterior ground reaction forces, and changes in walking speed were analyzed. Results showed that slow walkers walked with a delayed and deficient weight transfer to the paretic limb, lower hip abductor moment, and more lateral paretic limb foot placement relative to the COM compared to fast walkers. In addition, propulsive force and walking speed capacity was related to lateral weight transfer ability. These findings demonstrated that deficits in lateral weight transfer and stability could potentially be one of the limiting factors underlying comfortable walking speeds and a determinant of chronic stroke survivors’ ability to increase walking speed.     

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.     

The influence of locomotor training on dynamic balance during steady-state walking post-stroke

Slow walking speed and lack of balance control are common impairments post-stroke. While locomotor training often improves walking speed, its influence on dynamic balance is unclear. The goal of this study was to assess the influence of a locomotor training program on dynamic balance in individuals post-stroke during steady-state walking and determine if improvements in walking speed are associated with improved balance control. Kinematic and kinetic data were collected pre- and post-training from seventeen participants who completed a 12-week locomotor training program. Dynamic balance was quantified biomechanically (peak-to-peak range of frontal plane whole-body angular-momentum) and clinically (Berg-Balance-Scale and Dynamic-Gait-Index). To understand the underlying biomechanical mechanisms associated with changes in angular-momentum, foot placement and ground-reaction-forces were quantified. As a group, biomechanical assessments of dynamic balance did not reveal any improvements after locomotor training. However, improved dynamic balance post-training, observed in a sub-group of 10 participants (i.e., Responders), was associated with a narrowed paretic foot placement and higher paretic leg vertical ground-reaction-force impulse during late stance. Dynamic balance was not improved post-training in the remaining seven participants (i.e., Non-responders), who did not alter their foot placement and had an increased reliance on their nonparetic leg during weight-bearing. As a group, increased walking speed was not correlated with improved dynamic balance. However, a higher pre-training walking speed was associated with higher gains in dynamic balance post-training. These findings highlight the importance of the paretic leg weight bearing and mediolateral foot placement in improving frontal plane dynamic balance post-stroke.     

Effects of passive Bi-axial ankle stretching while walking on uneven terrains in older adults with chronic stroke

Many people with stroke experience foot drop while walking. Further, walking on uneven surfaces is a common fall risk for these people that hinder with their daily life activities. In addition, a few years after a stroke, lower-limb exercises become less focused, especially the ankle joint movement. The objective of this study is to determine the gait performance of older adults with chronic stroke on an uneven surface in relation to ankle mobility after a four-week bi-axial ankle range of motion (ROM) exercise session. Fifteen older adults with chronic post-stroke hemiparesis (N = 15; mean age = 65 years) participated in a total of 12 bi-axial ankle ROM exercises that consisted of three 30-min training sessions per week for four weeks. Basic clinical tests and gait performance in even and uneven surfaces were evaluated before and after training. Participants with chronic post-stroke hemiparesis showed significantly improved ankle functions, decreased ankle stiffness (from 0.140 ± 0.059 to 0.128 ± 0.067 N·m/°; p = 0.025), and increased paretic ankle passive ROMs (dorsiflexion(DF)/plantarflexion(PF): from 27.3 ± 14.7° to 50.6 ± 10.3°, p < 0.001; inversion(INV)/eversion(EV): 21.7 ± 9.7° to 28.6 ± 9.9°; p = 0.033) after training. They exhibited significant improvements in the walking performance over an uneven surface, step kinematics (walking speed 0.257 ± 0.17 to 0.320 ± 0.178 m/s; p = 0.017; step length: 0.214 ± 0.109 to 0.243 ± 0.108 m; p = 0.009), and clinical balance and mobility (Berg balance scale: 47.2 ± 4.7 to 50.1 ± 3.9, p = 0.0001; timed-up and go test: 23.9 ± 10.3 to 20.2 ± 7.0 s, p = 0.0156). This study is the first research to investigate the walking performance on uneven surfaces in the elderly with chronic stroke in relation to the ankle biomechanical property changes.     

Biomechanical impairments and gait adaptations post-stroke: Multi-factorial associations

Understanding the potential causes of both reduced gait speed and compensatory frontal plane kinematics during walking in individuals post-stroke may be useful in developing effective rehabilitation strategies. Multiple linear regression analysis was used to select the combination of paretic limb impairments (frontal and sagittal plane hip strength, sagittal plane knee and ankle strength, and multi-joint knee/hip torque coupling) which best estimate gait speed and compensatory pelvic obliquity velocities at toeoff. Compensatory behaviors were defined as deviations from control subjects’ values. The gait speed model (n=18; p=0.003) revealed that greater hip abduction strength and multi-joint coupling of sagittal plane knee and frontal plane hip torques were associated with decreased velocity; however, gait speed was positively associated with paretic hip extension strength. Multi-joint coupling was the most influential predictor of gait speed. The second model (n=15; p<0.001) revealed that multi-joint coupling was associated with increased compensatory pelvic movement at toeoff; while hip extension and flexion and knee flexion strength were associated with reduced frontal plane pelvic compensations. In this case, hip extension strength had the greatest influence on pelvic behavior. The analyses revealed that different yet overlapping sets of single joint strength and multi-joint coupling measures were associated with gait speed and compensatory pelvic behavior during walking post-stroke. These findings provide insight regarding the potential impact of targeted rehabilitation paradigms on improving speed and compensatory kinematics following stroke.     

Lower limb co-contraction during walking in subjects with stroke: A systematic review

PurposeThe aim of this paper was to identify and synthesise existing evidence on lower limb muscle co-contraction (MCo) during walking in subjects with stroke.MethodsAn electronic literature search on Web of Science, PubMed and B-on was conducted. Studies from 1999 to 2012 which analysed lower limb MCo during walking in subjects with stroke, were included.ResultsEight articles met the inclusion criteria: 3 studied MCo in acute stage of stroke, 3 in the chronic stage and 2 at both stages. Seven were observational and 1 had a pretest–posttest interventional design. The methodological quality was “fair to good” to “high” quality (only 1 study). Different methodologies to assess walking and quantify MCo were used. There is some controversy in MCo results, however subjects with stroke tended towards longer MCo in both lower limbs in both the acute and chronic stages, when compared with healthy controls. A higher level of post-stroke walking ability (speed; level of independence) was correlated with longer thigh MCo in the non-affected limb. One study demonstrated significant improvements in walking ability over time without significant changes in MCo patterns.ConclusionsSubjects with stroke commonly present longer MCo during walking, probably in an attempt to improve walking ability. However, to ensure recommendations for clinical practice, further research with standardized methodologies is needed.     

Segment lengths influence hill walking strategies

Segment lengths are known to influence walking kinematics and muscle activity patterns. During level walking at the same speed, taller individuals take longer, slower strides than shorter individuals. Based on this, we sought to determine if segment lengths also influenced hill walking strategies. We hypothesized that individuals with longer segments would display more joint flexion going uphill and more extension going downhill as well as greater lateral gastrocnemius and vastus lateralis activity in both directions. Twenty young adults of varying heights (below 155 cm to above 188 cm) walked at 1.25 m/s on a level treadmill as well as 6° and 12° up and downhill slopes while we collected kinematic and muscle activity data. Subsequently, we ran linear regressions for each of the variables with height, leg, thigh, and shank length. Despite our population having twice the anthropometric variability, the level and hill walking patterns matched closely with previous studies. While there were significant differences between level and hill walking, there were few hill walking variables that were correlated with segment length. In support of our hypothesis, taller individuals had greater knee and ankle flexion during uphill walking. However, the majority of the correlations were between tibialis anterior and lateral gastrocnemius activities and shank length. Contrary to our hypothesis, relative step length and muscle activity decreased with segment length, specifically shank length. In summary, it appears that individuals with shorter segments require greater propulsion and toe clearance during uphill walking as well as greater braking and stability during downhill walking.     

The cost of walking downhill: Is the preferred gait energetically optimal?

Humans tend to prefer walking patterns that minimize energetic cost, but must also maintain stability to avoid falling over. The relative importance of these two goals in determining the preferred gait pattern is not currently clear. We investigated the relationship between energetic cost and stability during downhill walking, a context in which gravitational energy will assist propulsion but may also reduce stability. We hypothesized that humans will not minimize energetic cost when walking downhill, but will instead prefer a gait pattern that increases stability. Simulations of a dynamic walking model were used to determine whether stable downhill gaits could be achieved using a simple control strategy. Experimentally, twelve healthy subjects walked downhill at 1.25 m/s (0, 0.05, 0.10, and 0.15 gradients). For each slope, subjects performed normal and relaxed trials, in which they were instructed to reduce muscle activity and allow gravity to maximally assist their gait. We quantified energetic cost, stride timing, and leg muscle activity. In our model simulations, increase in slope reduced the required actuation but also decreased stability. Experimental subjects behaved more like the model when using the relaxed rather than the normal walking strategy; the relaxed strategy decreased energetic cost at the steeper slopes but increased stride period variability, an indicator of instability. These results indicate that subjects do not take optimal advantage of the propulsion provided by gravity to decrease energetic cost, but instead prefer a more stable and more costly gait pattern.     

Combining muscle synergies and biomechanical analysis to assess gait in stroke patients

The understanding of biomechanical deficits and impaired neural control of gait after stroke is crucial to prescribe effective customized treatments aimed at improving walking function. Instrumented gait analysis has been increasingly integrated into the clinical practice to enhance precision and inter-rater reliability for the assessment of pathological gait. On the other hand, the analysis of muscle synergies has gained relevance as a novel tool to describe the neural control of walking. Since muscle synergies and gait analysis capture different but equally important aspects of walking, we hypothesized that their combination can improve the current clinical tools for the assessment of walking performance.To test this hypothesis, we performed a complete bilateral, lower limb biomechanical and muscle synergies analysis on nine poststroke hemiparetic patients during overground walking. Using stepwise multiple regression, we identified a number of kinematic, kinetic, spatiotemporal and synergy-related features from the paretic and non-paretic side that, combined together, allow to predict impaired walking function better than the Fugl-Meyer Assessment score. These variables were time of peak knee flexion, VAF_total values, duration of stance phase, peak of paretic propulsion and range of hip flexion. Since these five variables describe important biomechanical and neural control features underlying walking deficits poststroke, they may be feasible to drive customized rehabilitation therapies aimed to improve walking function.This paper demonstrates the feasibility of combining biomechanical and neural-related measures to assess locomotion performance in neurologically injured individuals.     

Changes in lower limb muscle activity after walking on a split-belt treadmill in individuals post-stroke

Background: There is growing evidence that stroke survivors can adapt and improve step length symmetry in the context of split-belt treadmill (SBT) walking. However, less knowledge exists about the strategies involved for such adaptations. This study analyzed lower limb muscle activity in individuals post-stroke related to SBT-induced changes in step length. Methods: Step length and surface EMG activity of six lower limb muscles were evaluated in individuals post-stroke (n = 16) during (adaptation) and after (after-effects) walking at unequal belt speeds. Results: During adaptation, significant increases in EMG activity were mainly found in proximal muscles (p ⩽ 0.023), whereas after-effects were observed particularly in the distal muscles. The plantarflexor EMG increased after walking on the slow belt (p ⩽ 0.023) and the dorsiflexors predominantly after walking on the fast belt (p ⩽ 0.017) for both, non-paretic and paretic-fast conditions. Correlation analysis revealed that after-effects in step length were mainly associated with changes in distal paretic muscle activity (0.522 ⩽ r ⩽ 0.663) but not with functional deficits. Based on our results, SBT walking could be relevant for training individuals post-stroke who present shorter paretic step length combined with dorsiflexor weakness, or individuals with shorter nonparetic step length and plantarflexor weakness.     

Impaired Limb Shortening following Stroke: What’s in a Name?

Background

Difficulty advancing the paretic limb during the swing phase of gait is a prominent manifestation of walking dysfunction following stroke. This clinically observable sign, frequently referred to as ‘foot drop’, ostensibly results from dorsiflexor weakness.

Objective

Here we investigated the extent to which hip, knee, and ankle motions contribute to impaired paretic limb advancement. We hypothesized that neither: 1) minimal toe clearance and maximal limb shortening during swing nor, 2) the pattern of multiple joint contributions to toe clearance and limb shortening would differ between post-stroke and non-disabled control groups.

Methods

We studied 16 individuals post-stroke during overground walking at self-selected speed and nine non-disabled controls who walked at matched speeds using 3D motion analysis.

Results

No differences were detected with respect to the ankle dorsiflexion contribution to toe clearance post-stroke. Rather, hip flexion had a greater relative influence, while the knee flexion influence on producing toe clearance was reduced.

Conclusions

Similarity in the ankle dorsiflexion, but differences in the hip and knee, contributions to toe clearance between groups argues strongly against dorsiflexion dysfunction as the fundamental impairment of limb advancement post-stroke. Marked reversal in the roles of hip and knee flexion indicates disruption of inter-joint coordination, which most likely results from impairment of the dynamic contribution to knee flexion by the gastrocnemius muscle in preparation for swing. These findings suggest the need to reconsider the notion of foot drop in persons post-stroke. Redirecting the focus of rehabilitation and restoration of hemiparetic walking dysfunction appropriately, towards contributory neuromechanical impairments, will improve outcomes and reduce disability.     

Evaluation of lower limb cross planar kinetic connectivity signatures post-stroke

Following stroke, aberrant three dimensional multijoint gait impairments emerge that present in kinematic asymmetries such as circumduction. A precise pattern of cross-planar coordination may underlie abnormal hemiparetic gait as several studies have underscored distinctive neural couplings between medio-lateral control and sagittal plane progression during walking. Here we investigate potential neuromechanical constraints governing abnormal multijoint coordination post-stroke. 15 chronic monohemispheric stroke patients and 10 healthy subjects were recruited. Coupled torque production patterns were assessed using a volitional isometric torque generation task where subjects matched torque targets for a primary joint in 4 directions while receiving visual feedback of the magnitude and direction of the torque. Secondary torques at other lower limb joints were recorded without subject feedback. We find that common features of cross-planar connectivity in stroke subjects include statistically significant frontal to sagittal plane kinetic coupling that overlay a common sagittal plane coupling in healthy subjects. Such coupling is independent of proximal or distal joint control and limb biomechanics. Principal component analysis of the stroke aggregate kinetic signature reveals unique abnormal frontal plane coupling features that explain a larger percentage of the total torque coupling variance. This study supports the idea that coupled cross-planar kinetic outflow between the lower limb joints uniquely emerges during pathological control of frontal plane degrees of freedom resulting in a generalized extension of the limb. It remains to be seen if a pattern of lower limb motor outflow that is centrally mediated contributes to abnormal hemiparetic gait.     

Co-activation of upper limb muscles during reaching in post-stroke subjects: An analysis of the contralesional and ipsilesional limbs

The purpose of this study was to analyze the change in antagonist co-activation ratio of upper-limb muscle pairs, during the reaching movement, of both ipsilesional and contralesional limbs of post-stroke subjects. Nine healthy and nine post-stroke subjects were instructed to reach and grasp a target, placed in the sagittal and scapular planes of movement. Surface EMG was recorded from postural control and movement related muscles. Reaching movement was divided in two sub-phases, according to proximal postural control versus movement control demands, during which antagonist co-activation ratios were calculated for the muscle pairs LD/PM, PD/AD, TRIlat/BB and TRIlat/BR. Post-stroke’s ipsilesional limb presented lower co-activation in muscles with an important role in postural control (LD/PM), comparing to the healthy subjects during the first sub-phase, when the movement was performed in the sagittal plane (p < 0.05). Conversely, the post-stroke’s contralesional limb showed in general an increased co-activation ratio in muscles related to movement control, comparing to the healthy subjects. Our findings demonstrate that, in post-stroke subjects, the reaching movement performed with the ipsilesional upper limb seems to show co-activation impairments in muscle pairs associated to postural control, whereas the contralesional upper limb seems to have signs of impairment of muscle pairs related to movement.     

Joint moment work during the stance-to-swing transition in hemiparetic subjects

Following stroke many individuals are left with neurological and functional deficits, including hemiparesis, which impair their ability to walk. Our previous work reported that propulsion of the paretic leg during pre-swing is impaired and may limit gait speed and knee flexion during swing. To elucidate the mechanism of this impairment, we assessed the mechanical work produced by the hip, knee, and ankle moments during pre-swing of the paretic limb in a group of stroke subjects and compared it with the work produced by non-disabled controls walking at similar speeds. Kinematic and kinetic gait data were collected from 23 hemiparetic and 10 control subjects. The hemiparetic subjects walked at their self-selected speeds. The controls walked at their self-selected and two or three slower speeds. Even when compared to controls walking at slow speeds, ankle plantarflexor work during pre-swing was greatly reduced (-0.136+/-0.062J/kg) in the hemiparetic subjects. Differences in hip (+0.006+/-0.020J/kg) and knee (+0.040+/-0.026J/kg) moment work partially offset the reduction in ankle work, but net joint moment work was still significantly reduced (-0.088+/-0.056J/kg). The reduction in work accounts for the low energy of the paretic limb at the stance-to-swing transition previously reported. Future investigation is needed to determine if targeted training of the plantarflexors in the paretic limb improves swing-phase function and locomotor performance in hemiparetic individuals.