Interlimb Coordination During the Stance Phase of Gait in Subjects With Stroke

Abstract

Objective: To analyse the relation between contralesional and ipsilesional limbs in subjects with stroke during step-to-step transition of walking.Design: Observational, transversal, analytical study with a convenience sample. Setting:Patients from a physical medicine and rehabilitation clinic in Portugal (Braga). Participants:Sixteen subjects with post-stroke hemiparesis with the ability to walk independently and twenty-two healthy controls.Interventions: Not applicable. Conclusions:The findings obtained suggest that the lower performance of the contralesional limb in forward propulsion during gait is not only related to contralateral supraspinal damage but also to a dysfunctional influence of the ipsilesional limb.

Ankle antagonist coactivation in the double-support phase of walking: Stroke vs. healthy subjects

“…Based on neurophysiology, it would be expected that when assuming LEAD position, the CONTRA limb would present ankle antagonist coactivation dysfunction as a result of a higher impairment in TA recruitment (agonist role) subsequent from the corticospinal lesion. However, the possible dysfunction of postural control system, also described in stroke subjects in this limb, can lead to a decreased activity of the antagonist activity (SOL and GM) (Sousa et al 2013). This can explain the lack of differences observed in ankle coactivation comparing to CONTROL, when assuming the LEAD position.…”

“…The double support phase was assessed through ground reaction forces. The beginning of double support during stance phase was defined as the interval where Fz of LEAD presents a value equal or higher than 7% of body weight, till the initiation of TRAIL swing phase Sousa et al 2013). The EMG activity of each muscle was assessed during double support in two conditions: (a) when the IPSI limb was the TRAIL and the CONTRA was the LEAD, and (b) when the CONTRA was the TRAIL and the IPSI limb was the LEAD.…”

“…In fact in a study developed by Sousa et. al., 2013, a negative influence of IPSI SOL during loading response, as leading limb (LEAD), over forward propulsive, as trailing limb (TRAIL), muscles of CONTRA was found (Sousa et al 2013). …”

The role of the ipsilesional side in the rehabilitation of post-stroke subjects

“…The leading limb's ankle dorsiflexors attenuate the initial contact, being important in weight acceptance (Winter, 1983). In fact, the hypothesis that the neuronal injury is the cause for the ipsilesional limb's atypical behaviour instead of a compensatory mechanism is supported both by the fact that the performance of ipsilesional plantar flexors, in stroke subjects, changes according to the limb's position (Silva et al, 2015) and by the fact that, during step-to-step transition, the contralesional limb is influenced by the ipsilesional limb and not the opposite (Sousa et al, 2013a). This also reinforces the evidence that the muscles associated with the ventral-medial systems' activity may present a more pronounced atypical behaviour while assuming an agonist role.…”

“…Moreover, the study of these tasks must focus the subphases with higher postural control demand, i.e. the initial phase of sit-to-stand and standto-sit (Silva et al, 2012b;Silva et al, 2012c), middle stance (Silva et al, 2012d;, double support (Silva et al, 2015;Sousa et al, 2013a;Sousa et al, 2013b) and gait initiation (Sousa et al, 2015a(Sousa et al, , 2015b.…”