Space-time assessment and mechanical energy transfer during gait in a patient with a CVA
A pilot study
Abstract
Introduction: individuals who suffered a CVA present an asymmetrical gait. It is important to learn about the angles in the hip, knee and ankle during different events in order to contribute to their recovery, although this does not allow the calculation of the degree of fulfillment in stepping with minimum energy output.
The study of the center of mass mechanics during gait may contribute in the latter. This contribution, once discussed and assessed, together with the angle values would enable a better understanding of the complexities of gait following a CVA.
Objective: to apply a tool to assess the best use of mechanical energy in the gait of CVA patients, and to discuss results considering angle values observed in lower limbs.
Method: we conducted a three-dimensional reconstruction study of movement with a Vicon Motion Systems equipment in a CVA patient and a healthy individual. Angles in the hip, knee and ankle were assessed in the sagittal plane during different gait events, and the energy exchange was estimates by means of Energy recovery (R) calculation.
Results: The CVA patient presented a gait pattern where flexion of both lower limbs prevails during the contact phase and R was significantly lower (33%) than that of the control individual (56%). These results suggest there is an association between angle values and energy in the calculation of R. The approach has potential for clinical usefulness in the analysis of gait in individuals following a CVA.
References
(1) American Stroke Association. Impact of Stroke (Stroke statistics) Disponible en: Disponible en: http://www.strokeassociation.org/STROKEORG/AboutStroke/Impact-of-Stroke-Stroke-statistics_UCM_310728_Article.jsp#.VzofCTXhCUk Consulta: 2 mayo 2016.
(2) Frontera W, DeLisa JA, eds. Physical Medicine & Rehabilitation. 5th ed. Philadelphia: Lippincott Williams & Wilkins, 2010.
(3) Shumway-Cook A, Woollacott M. Motor control: translating research into clinical practice. 4th ed. Philadelphia: Lippincott Williams & Wilkins , 2012.
(4) Allen JL, Kautz SA, Neptune RR. Step length asymmetry is representative of compensatory mechanisms used in post-stroke hemiparetic walking. Gait Posture 2011; 34(4):538-43. Disponible en: Disponible en: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3085662/ Consulta: 27 jun 2016.
(5) Willems P-A, Schepens B, Detrembleur C. Marcha normal. EMC-Kinesiterapia-Med Física 2012; 33(2):1-29. Disponible en: Disponible en: http://dx.doi.org/10.1016/S1293-2965(12)61944-6 Consulta: 12 mayo 2016.
(6) Saibene F, Minetti AE. Biomechanical and physiological aspects of legged locomotion in humans. Eur J Appl Physiol 2003; 88(4-5):297-316. Disponible en: Disponible en: http://link.springer.com/10.1007/s00421-002-0654-9 Consulta: 27 jun 2016.
(7) Perry J. Análise de marcha: marcha normal. São Pablo: Prima, 2005.
(8) Cavagna GA, Heglund NC, Taylor CR. Mechanical work in terrestrial locomotion: two basic mechanisms for minimizing energy expenditure. Am J Physiol 1977; 233(5):R243-61. Disponible en: Disponible en: http://ajpregu.physiology.org/content/233/5/R243.abstract Consulta: 4 octubre 2015.
(9) Willems PA, Cavagna GA, Heglund NC. External, internal and total work in human locomotion. J Exp Biol 1995; 198(Pt 2):379-93.
(10) Kuo AD, Donelan JM. Dynamic principles of gait and their clinical implications. Phys Ther 2010; 90(2):157-74. Disponible en: Disponible en: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2816028/#!po=2.77778 Consulta: 10 abril 2016.
(11) Awad LN, Palmer JA, Pohlig RT, Binder-Macleod SA, Reisman DS. Walking speed and step length asymmetry modify the energy cost of walking after stroke. Neurorehabil Neural Repair 2015; 29(5):416-23.
(12) Farris DJ, Hampton A, Lewek MD, Sawicki GS. Revisiting the mechanics and energetics of walking in individuals with chronic hemiparesis following stroke: from individual limbs to lower limb joints. J Neuroeng Rehabil 2015; 12:24. Disponible en: Disponible en: http://www.jneuroengrehab.com/content/12/1/24 Consulta: 22 marzo 2015.
(13) Detrembleur C, van den Hecke A, Dierick F. Motion of the body centre of gravity as a summary indicator of the mechanics of human pathological gait. Gait Posture 2000; 12:243-50.
(14) Peterson CL, Kautz SA, Neptune RR. Muscle work is increased in pre-swing during hemiparetic walking. Clin Biomech (Bristol, Avon) 2012; 26(8):859-66. Disponible en: Disponible en: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3159858/pdf/nihms294269.pdf Consulta: 10 marzo 2015.
(15) Ansari NN, Naghdi S, Arab TK, Jalaie S. The interrater and intrarater reliability of the Modified Ashworth Scale in the assessment of muscle spasticity: limb and muscle group effect. NeuroRehabilitation 2008; 23(3):231-7.
(16) Gambelli CN, Theisen D, Willems PA, Schepens B. Motor Control of Landing from a Jump in Simulated Hypergravity. PLoS One 2015; 10(10):e0141574. Disponible en: Disponible en: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=4624769&tool=pmcentrez&rendertype=abstract Consulta: 4 febrero 2016.
(17) Yamasaki M, Sasaki T, Tsuzki S, Torii M. Stereotyped pattern of lower limb movement during level and grade walking on treadmill. Ann Physiol Anthropol 1984; 3(4):291-6.
(18) Olney SJ, Monga TN, Costigan PA. Mechanical energy of walking of stroke patients. Arch Phys Med Rehabil 1986; 67:92-8.
(19) Olney SJ, Jackson VG, George SR. Gait re-education guidelines for stroke patients with hemiplegia using mechanical energy and power analyses. Physiother Canada 1988; 40:242-8.
(20) Olney SJ, Grondin RC, McBride ID. Energy and power considerations in slow walking. J Biomech 1989; 22(10):1066.
(21) Olney SJ, Richards C. Hemiparetic gait following stroke. Part I: Characteristics. Gait Posture 1996; 4:136-48.