Comparative Efficacy of Open-Chain Kinematics and Closed-Chain Kinematics on Walking Proficiency and Societal Integration in Post-Stroke Individuals

Abstract

Background: Post-stroke hemiplegic gait is a mixture of deviations and compensatory motion dictated by residual function. To improve stroke survivors' walking ability, it is necessary to evaluate different rehabilitation approaches and identify those that have a greater effect on locomotor recovery of stroke patient. This will improve their general wellbeing by promoting better health and greater community participation, for faster societal integration. Aim: This study compared the effect of open-chain kinematics (bicycle ergometry) and closed-chain kinematics (treadmill) on walking proficiency in post-stroke individuals and their societal integration. Methods: This was a pretest-posttest experimental study involving 35 ambulatory hemiplegic stroke survivors (18 males and 17 females) with a mean age of (53.77 ± 10.95) undergoing rehabilitation at Lagos University Teaching Hospital, Idi Araba and Lagos State University Teaching Hospital, Ikeja. Patients went through 10-week rehabilitation and were randomly assigned to two intervention groups (treadmill and bicycle ergometry groups). Spatio-temporal gait parameters were measured by the six-metre walkway and community integrated questionnaire was used to examine home integration, social integration and productive activities. Data were subjected to inferential and descriptive statistics. Paired t-test was used to analyse the outcomes within the two groups and independent t-test was used to analyse the data between the groups. The level of significance was set at p ≤ 0.05. Results: Results showed significant difference between baseline and post intervention scores for all the gait parameters; stride length (p = 0.001), step length (p = 0.00), natural gait speed (p = 0.00), maximum gait speed (p = 0.01), cadence (p = 0.00) and community integration (p = 0.00) for the participants in the treadmill group; step length (p = 0.001), natural gait speed (p = 0.01), maximum gait (p = 0.02), cadence (p = 0.03) and community integration (p = 0.00) for the participants in the bicycle ergometer group except for stride length which showed no significance difference (p = 0.078). There was also a significant difference in the mean change in cadence between the treadmill and bicycle ergometer group (p = 0.04). Conclusion: Both open-chain and closed-chain kinematics are effective, but closed- chain is most effective in re-educating ambulation and re-gaining spatio-temporal gait parameters after stroke and should be structured into the patients’ treatment regimen to effectively improve functional capability in post-stroke individuals.