Measurements of the centre of pressure of individual legs reveal new characteristics of reduced anticipatory postural adjustments during gait initiation in patients with post-stroke hemiplegia

Authors

  • Ryo Onuma
  • Tadashi Masuda
  • Fumihiko Hoshi
  • Tadamitsu Matsuda
  • Tomoko Sakai
  • Atsushi Okawa
  • Tetsuya Jinno Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center

DOI:

https://doi.org/10.2340/16501977-2856

Keywords:

postural control, balance, posture, kinematics, gait

Abstract

Objectives: To determine whether individual measurements of the centre of pressure for the stance and stepping legs can reveal new characteristics of reduced anticipatory postural adjustments during gait initiation in post-stroke hemiplegic patients.

Methods: Subjects included 30 stroke patients and 10 healthy age-matched controls. The acceleration of the trunk, and the centre of pressure of each leg, were measured during gait initiation, 3 times each with the paretic and non-paretic legs leading. Anticipatory postural adjustments were characterized using trunk acceleration and centre of pressure displacement data.

Results: Latency of the posterior displacement peak of the paretic leg centre of pressure with either the paretic or non-paretic leg leading was significantly longer in stroke patients compared with controls, and was also longer than that of the non-paretic leg. The magnitude of the posterior displacement peak of the paretic leg centre of pressure was smaller than that of the non-paretic leg. Peak latency of the paretic stepping leg centre of pressure correlated with the clinical measures of motor dysfunction, postural balance, and gait ability.

Conclusion: Measurements of the latency and magnitude of centre of pressure displacement peak individually for the paretic and non-paretic legs can help elucidate the mechanism behind reduced anticipatory postural adjustments. This information will be useful in designing new treatment strategies for stroke patients.

 

Lay Abstract

Measuring the centre of pressure individually for the stance and stepping legs can reveal what happens during initiation of gait in stroke patients. The latency and magnitude of the centre of pressure displacement peak showed characteristic differences between stroke patients and control subjects, and between paretic and non-paretic legs. The peak latency of the paretic stepping leg centre of pressure correlated significantly with clinical measures of motor dysfunction, postural balance, and gait ability. These findings may contribute to the development of effective rehabilitation exercises for stroke patients.

Downloads

Download data is not yet available.

References

Delafontaine A, Gagey O, Colnaghi S, Do MC, Honeine JL. Rigid ankle foot orthosis deteriorates mediolateral balance control and vertical braking during gait initiation. Front Hum Neurosci 2017; 11: 214. https://doi.org/10.3389/fnhum.2017.00214

Yiou E, Caderby T, Delafontaine A, Fourcade P, Honeine JL. Balance control during gait initiation: state-of-the-art and research perspectives. World J Orthop 2017; 8: 815-828. https://doi.org/10.5312/wjo.v8.i11.815

Delafontaine A, Vialleron T, Hussein T, Yiou E, Honeine JL, Colnaghi S. Anticipatory postural adjustments during gait initiation in stroke patients. Front Neurol 2019; 10: 352. https://doi.org/10.3389/fneur.2019.00352

Brunt D, Vander Linden DW, Behrman AL. The relation between leg loading and control parameters of gait initiation in persons with stroke. Arch Phys Med Rehabil 1995; 76: 627-634. https://doi.org/10.1016/S0003-9993(95)80631-8

Bensoussan L, Mesure S, Viton JM, Curvale G, Delarque A. Asymétries chronométriques, cinétiques et cinématiques de l’initiation de la marche chez un sujet hémiplégique. Ann Readapt Med Phys 2004; 47: 611-620. https://doi.org/10.1016/S0168-6054(04)00177-1

Bensoussan L, Mesure S, Viton JM, Delarque A. Kinematic and kinetic asymmetries in hemiplegic patients’ gait initiation patterns. J Rehabil Med 2006; 38: 287-294. https://doi.org/10.1080/16501970600694859

Lin S, Sun Q, Wang H, Xie G. Influence of transcutaneous electrical nerve stimulation on spasticity, balance, and walking speed in stroke patients: a systematic review and meta-analysis. J Rehabil Med 2018; 50: 3-7. https://doi.org/10.2340/16501977-2266

Sousa AS, Silva A, Santos R. Ankle anticipatory postural adjustments during gait initiation in healthy and post-stroke subjects. Clin Biomech 2015; 30: 960-965. https://doi.org/10.1016/j.clinbiomech.2015.07.002

Hess S, Reiter F, Jahnke M, Dawson M, Sarkodie Gyan T, Mauritz KH. Asymmetry of gait initiation in hemiparetic stroke subjects. Arch Phys Med Rehabil 1997; 78: 719-724. https://doi.org/10.1016/S0003-9993(97)90079-4

Rajachandrakumar R, Fraser JE, Schinkel-Ivy A, Inness EL, Biasin L, Brunton K, et al. Atypical anticipatory postural adjustments during gait initiation among individuals with sub-acute stroke. Gait Posture 2017; 52: 325-331. https://doi.org/10.1016/j.gaitpost.2016.12.020

Belenkii VE, Gurfinkel VS, Paltsev EI. Control elements of voluntary movements. Biofizika 1967; 12: 135-141.

Elble RJ, Moody C, Leffler K, Sinha R. The initiation of normal walking. Mov Disord 1994; 9: 139-146. https://doi.org/10.1002/mds.870090203

Breniere Y, Cuong DM, Bouisset S. Are dynamic phenomena prior to stepping essential to walking? J Mot Behav 1987; 19: 62-76. https://doi.org/10.1080/00222895.1987.10735400

Crenna P, Frigo C. A motor programme for the initiation of forward-oriented movements in humans. J Physiol 1991; 437: 635-653.https://doi.org/10.1113/jphysiol.1991.sp018616

Winter DA. Human balance and posture control during standing and walking. Gait Posture 1995; 3: 193-214. https://doi.org/10.1016/0966-6362(96)82849-9

Sun R, Guerra R, Shea JB. The posterior shift anticipatory postural adjustment in choice reaction step initiation. Gait Posture 2015; 41: 894-898. https://doi.org/10.1016/j.gaitpost.2015.03.010

Chang WH, Tang PF, Wang YH, Lin KH, Chiu MJ, Hsing S. Role of the premotor cortex in leg selection and anticipatory postural adjustments associated with a rapid stepping task in patients with stroke. Gait Posture 2010; 32: 487-493. https://doi.org/10.1016/j.gaitpost.2010.07.007

Dessery Y, Barbier F, Gillet C, Corbeil P. Does lower leg preference influence gait initiation? Gait Posture 2011; 33: 550-555. https://doi.org/10.1016/j.gaitpost.2011.01.008

Chang H, Krebs DE. Dynamic balance control in elders: gait initiation assessment as a screening tool. Arch Phys Med Rehabil 1999; 80: 490-494. https://doi.org/10.1016/S0003-9993(99)90187-9

Schlenstedt C, Mancini M, Nutt J, Hiller AP, Maetzler W, Deuschl G, et al. Are hypometric anticipatory postural adjustments contributing to freezing of gait in Parkinson’s disease? Front Aging Neurosci 2018; 10: 36. https://doi.org/10.3389/fnagi.2018.00036

Mancini M, Zampieri C, Carlson-Kuhta P, Chiari L, Horak FB. Anticipatory postural adjustments prior to step initiation are hypometric in untreated Parkinson’s disease: an accelerometer-based approach. Eur J Neurol 2009; 16: 1028-1034. https://doi.org/10.1111/j.1468-1331.2009.02641.x

Agrell B, Dehlin O. Mini mental state examination in geriatric stroke patients. Validity, differences between subgroups of patients, and relationships to somatic and mental variables. Aging 2000; 12: 439-444. https://doi.org/10.1007/BF03339874

Tombaugh TN, McIntyre NJ. The mini-mental state examination: a comprehensive review. J Am Geriatr Soc 1992; 40: 922-935. https://doi.org/10.1111/j.1532-5415.1992.tb01992.x

Brunt D, Liu SM, Trimble M, Bauer J, Short M. Principles underlying the organization of movement initiation from quiet stance. Gait Posture 1999; 10: 121-128. https://doi.org/10.1016/S0966-6362(99)00020-X

Kasukawa Y, Miyakoshi N, Hongo M, Ishikawa Y, Noguchi H, Kamo K, et al. Relationships between falls, spinal curvature, spinal mobility and back extensor strength in elderly people. J Bone Miner Metab 2010; 28: 82-87. https://doi.org/10.1007/s00774-009-0107-1

Ishikawa Y, Miyakoshi N, Kasukawa Y, Hongo M, Shimada Y. Spinal curvature and postural balance in patients with osteoporosis. Osteoporos Int 2009; 20: 2049-2053. https://doi.org/10.1007/s00198-009-0919-9

Wade DT, Wood VA, Heller A, Maggs J, Langton HR. Walking after stroke. Measurement and recovery over the first 3 months. Scand J Rehabil Med 1987; 19: 25-30.

Winairuk T, Pang MYC, Saengsirisuwan V, Horak FB, Boonsinsukh R. Comparison of measurement properties of three shortened versions of the balance evaluation system test (BESTest) in people with subacute stroke. J Rehabil Med 2019; 51: 683-691. https://doi.org/10.2340/16501977-2589

Dennis RL, Janice JE. Berg Balance Scale score at admission can predict walking suitable for community ambulation at discharge from inpatient stroke rehabilitation. J Rehabil Med 2018; 50: 37-44. https://doi.org/10.2340/16501977-2280

Kirker SGB, Simpson DS, Jenner JR, Miles Wing A. Stepping before standing: hip muscle function in stepping and standing balance after stroke. J Neurol Neurosurg Psychiatry 2000; 68: 458-464. https://doi.org/10.1136/jnnp.68.4.458

Yiou E, Artico R, Teyssedre CA, Labaune O, Fourcade P. Anticipatory postural control of stability during gait initiation over obstacles of different height and distance made under reaction-time and self-initiated instructions. Front Hum Neurosci 2016; 10: 449. https://doi.org/10.3389/fnhum.2016.00449

Honeine JL, Schieppati M, Crisafulli O, Do MC. The neuro-mechanical processes that underlie goal-directed medio-lateral APA during gait initiation. Front Hum Neurosci 2016; 10: 445. https://doi.org/10.3389/fnhum.2016.00445

Gama GL, Celestino ML, Barela JA, Barela AMF. Gait initiation and partial body weight unloading for functional improvement in post-stroke individuals. Gait Posture 2019; 68: 305-310. https://doi.org/10.1016/j.gaitpost.2018.12.008

Tokuno CD, Eng JJ. Gait initiation is dependent on the function of the paretic trailing leg in individuals with stroke. Gait Posture 2006; 24: 424-428. https://doi.org/10.1016/j.gaitpost.2005.09.012

Cook T, Cozzens B. Human solutions for locomotion: the initiation of gait. Neural control of locomotion. New York: Plenum Press; 1976, 65-76. https://doi.org/10.1007/978-1-4757-0964-3_4

Artico R, Fourcade P, Teyssèdre C, Caderby T, Delafontaine A, Yiou E. Influence of swing-foot strike pattern on balance control mechanisms during gait initiation over an obstacle to be cleared. Appl Sci 2020; 10: 244. https://doi.org/10.3390/app10010244

Downloads

Published

2021-07-02

How to Cite

Onuma, R., Masuda, T., Hoshi, F., Matsuda, T., Sakai, T., Okawa, A., & Jinno, T. (2021). Measurements of the centre of pressure of individual legs reveal new characteristics of reduced anticipatory postural adjustments during gait initiation in patients with post-stroke hemiplegia. Journal of Rehabilitation Medicine, 53(7), jrm00211. https://doi.org/10.2340/16501977-2856

Issue

Section

Original Report

Categories