Kinematic analysis of gait in individuals with spastic hemiparesis secondary to stroke
DOI:
https://doi.org/10.15448/1980-6108.2016.2.22776Keywords:
stroke, kinematics, biomechanical phenomena, gait.Abstract
Aims: To evaluate linear and angular kinematics of gait in patients with spastic hemiparesis secondary to stroke considering reference values and the unaffected limb.
Methods: Cross-sectional study of adult patients with spastic hemiparesis secondary to stroke selected from the Physical Therapy Clinic of Universidade de Caxias do Sul (UCS). The kinematic gait analysis was performed at the Human Motion Biomechanical Analysis Laboratory at UCS according to Larouche’s protocol. Descriptive statistics, one-sample t test, and paired t test were used for the data analysis. Statistical significance was set as p<0.05.
Results: Eight adult male and female individuals aged 43 to 59 years were assessed. All variables indicated a significant difference in the linear kinematics of the gait of the affected limb. By comparing the lower limbs, stride length and rate were significantly higher in the affected hemibody. Angular kinematics was significantly different from reference values, except for hip flexion. There was a lower angular variation (flexion/extension) in the knee of the affected limb in comparison to the healthy one.
Conclusions: This study showed changes in the gait kinematics of the affected limb in hemiparetic patients after a stroke in comparison to normal patterns and to the contralateral limb, which indicates an unusual flexor pattern. These changes may be related to poor balance and motor control, muscle weakness, proprioceptive deficit, increased muscle tone, contractures, and deformities.
Downloads
References
Neumann D. Cinesiologia do aparelho musculoesquelético, fundamentos para a reabilitação. 2ª ed. Rio de Janeiro: Elsevier; 2011.
Iwabe C, Diz M, Barudy DP. Análise cinemática da marcha em indivíduos com Acidente Vascular Encefálico. Rev Neurocienc. 2008;16(4):292-6.
Lianza S. Medicina de reabilitação. Rio de Janeiro: Guanabara Koogan; 2007.
Stokes M. Neurologia para fisioterapeutas. São Paulo: Premier; 2000.
Rosa MC, Marques A, Demain S, Metcalf CD. Lower limb co-contraction during walking in subjects with stroke: A systematic review. J Electromyogr Kinesiol. 2014 Feb;24(1):1-10. http://dx.doi.org/10.1016/j.jelekin.2013.10.016
Perry J, Schoneberger B. Análise de marcha: marcha patológica. São Paulo: Manole; 2005.
Sousa AS, Tavares JM.Interlimb coordination during step-to-step transition and gait performance. J Mot Behav. 2015;47(6):563-74. http://dx.doi.org/10.1080/00222895.2015.1023391
Morioka S, Miyaoto S, Abe M. Relatioship between the center of gravity point in spontaneous standing and the middle point calculated from the center of gravity shifting distance to the non-paralytic and paralytic sides in hemiplegics after stroke. J Phys Ther Sci. 2003;15(2):99-103. http://dx.doi.org/10.1589/jpts.15.99
Rose J, Gamble JG. Marcha humana. 2ª ed. São Paulo: Premier; 2007.
Ottoboni C, Fontes SV, Fukujima MM. Estudo comparativo entre a marcha normal e a de pacientes hemiparéticos por acidente vascular encefálico: aspectos biomecânicos. Rev Neurocienc. 2002;10(1):5-9.
Araújo AGN, Andrade LM, Barros RML. Sistema para analise cinemática da marcha humana baseado em videogrametria. Fisioter Pesqui. 2004;1(1):3-10.
Laroche D, Duval A, Morisset C, Beis JN, D'athis P, Maillefert JF, Ornetti P. Test-retest reliability of 3D kinematic gait variables in hip osteoarthritis patients. Osteoarthritis Cartilage. 2011 Feb;19(2):194-9. http://dx.doi.org/10.1016/j.joca.2010.10.024
Callegari-Jacques SM. Bioestatística: princípios e aplicações. Porto Alegre: Artmed; 2003.
Wist S, Clivaz J, Sattelmayer M. Muscle strengthening for hemiparesis after stroke: A meta-analysis. Ann Phys Rehabil Med. 2016 Apr;59(2):114-24. http://dx.doi.org/10.1016/j.rehab.2016.02.001.
Polese JC, Nascimento LR, Faria CDCM, Laurentino GEC, Rodrigues de Paula F, Ada L, Teixeira SLF. Percepção de hemiplégicos crônicos sobre o uso de dispositivos auxiliares na marcha. Rev Panam Salud Publica. 2011;30(3):204-8. http://dx.doi.org/10.1590/S1020-49892011000900003
Stowe S, Hopesb J, Mulley G. Gerotechnology series: 2. Walking aids. Eur Geriatr Med. 2010;1(2):122-7. http://dx.doi.org/10.1016/j.eurger.2010.02.003
Kerrigan DC, Karvosky ME, Riley PO. Spastic paretic stiff-legged gait: joint kinetics. Am J Phys Med Rehabil. 2001 Apr;80(4):244-9. http://dx.doi.org/10.1097/00002060-200104000-00002
Burnfield JM, Buster TW, Goldman AJ, Corbridge LM, Harper-Hanigan K. Partial body weight support treadmill training speed influences paretic and non-paretic leg muscle activation, stride characteristics, and ratings of perceived exertion during acute stroke rehabilitation. Hum Mov Sci. 2016 Feb 1;47:16-28. http://dx.doi.org/10.1016/j.humov.2016.01.012
Corrêa FI, Soares F, Andrade DV, Gondo RM, Reres JÁ, Fernandes AO. Atividade muscular durante a marcha após acidente vascular encefálico. Arq Neuropsiquiatr. 2005;63(3b):847-51. http://dx.doi.org/10.1590/S0004-282X2005000500024
Silva A, Sousa AS, Silva C, Tavares JM, Santos R, Sousa F. Ankle antagonist coactivation in the double-support phase of walking: Stroke vs. healthy subjects. Somatosens Mot Res. 2015;32(3):153-7. http://dx.doi.org/10.3109/08990220.2015.1012492
Romero VM, Carvalho PTC, Laraia SEM, Soares NC. Análise das variáveis de distância da marcha de pacientes com acidente vascular encefálico. Conscientiae Saúde. 2008;7(3):329-34.
Barela J, Whitall J, Black P, Clark J. An examination of constraints affecting the intralimb coordination of hemiparetic gait. Hum Mov Sci. 2000 Jul;19(2):251-73. http://dx.doi.org/10.1016/S0167-9457(00)00014-2
Silva LLM, Moura CEM, Godoy JRP. A marcha no paciente hemiparético. Universitas. 2005;3(2):261-73.
Martins FLM, Guimarães LHCT, Vitorino DFM, Souza LCF. Eficácia da eletroestimulação funcional na amplitude de movimento de dorsiflexão de hemiparéticos. Rev Neurocienc. 2004;12(2):103-9.
Buurke JH, Hermens HJ, Erren-Wolters CV, Nene AV. The effect of walking aids on muscle activation patterns during walking in stroke patients. Gait Posture. 2005 Oct;22(2):164-70. http://dx.doi.org/10.1016/j.gaitpost.2004.09.003
Hesse S, Werner C, Paul T, Bardeleben A, Chaler J. Influence of walking speed on lower limb muscle activity and energy consumption during treadmill walking of hemiparetic patients. Arch Phys Med Rehabil. 2001 Nov;82(11):1547-50. http://dx.doi.org/10.1053/apmr.2001.26607
O'Sullivan, SB, Schimitz TJ. Fisioterapia: avaliação e tratamento. 4ª ed. São Paulo: Manole; 2004.
Downloads
Published
How to Cite
Issue
Section
License
Copyright
The submission of originals to Scientia Medica implies the transfer by the authors of the right for publication. Authors retain copyright and grant the journal right of first publication. If the authors wish to include the same data into another publication, they must cite Scientia Medica as the site of original publication.
Creative Commons License
Except where otherwise specified, material published in this journal is licensed under a Creative Commons Attribution 4.0 International license, which allows unrestricted use, distribution and reproduction in any medium, provided the original publication is correctly cited.
