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Use of segmental coordination analysis of nonparetic and paretic limbs during obstacle clearance in community-dwelling persons after stroke.

Research paper by Michael J MJ MacLellan, Carol L CL Richards, Joyce J Fung, Bradford J BJ McFadyen

Indexed on: 20 Feb '13Published on: 20 Feb '13Published in: PM&R



Abstract

To use a segment coordination analysis to identify coordination differences between the paretic and nonparetic limbs for obstacle clearance in community-dwelling persons after stroke.Within-participant design.Gait analysis laboratory.Six community-dwelling persons with a stroke (excluding cerebellar stroke).Participants stepped over obstacles of 2 different heights (7.5% and 15% of leg length), leading alternately with their paretic and nonparetic limbs.Kinematic data were collected, and segment elevation angles (absolute segment angular position with respect to vertical) were calculated for the thigh, shank, and foot segments. Established mathematical techniques related to the planar law of intersegmental coordination (principal component analysis to quantify covariance and temporal phase relationships among elevation angles) were then applied to compare and contrast the coordination of these segment elevation angle trajectories between paretic and nonparetic limbs.Segment covariance in elevation angles followed the planar law of intersegmental coordination during level walking (ie, 3 elevation angles that form a plane and the variance explained by 2 principal components) for both paretic and nonparetic limbs. During obstacle clearance, however, relationships between covariance plane characteristics and phase differences for elevation angles of adjacent segments differed in the nonparetic limb, likely related to a need for greater limb elevation for obstacle clearance during paretic limb support or an altered foot trajectory, which resulted from preobstacle foot placement.The present coordination analysis suggests the preservation of basic control mechanisms in the paretic limb during obstacle clearance after stroke and also reveals its specific motor control compensations. However, a larger study with differing levels of stroke severity must be conducted to understand how the evaluation of intersegmental coordination during walking could guide treatment of specific locomotor control deficits in stroke rehabilitation.