Biomechanical gait characteristics of naturally occurring unsuccessful foot clearance during swing in individuals with chronic stroke. Issue 10 (December 2015)

• Record Type: Journal Article
• Authors: Burpee, Jessica L.; Lewek, Michael D.
• Is Part Of: Clinical biomechanics. Volume 30:Issue 10(2015)
• Page Start: 1102
• Page End: 1107
• Publication Date: 2015-12
• Subjects: Stroke -- Gait -- Trip -- Biomechanics; Biomechanics -- Periodicals; Osteopathic medicine -- Periodicals; Biomechanics -- Periodicals; Osteopathic Medicine -- Periodicals; 612.76
• DOI: 10.1016/j.clinbiomech.2015.08.018
• Languages: English
• ISSNs: 0268-0033

Abstract

Abstract: Background: Altered gait mechanics are common following stroke and may increase the risk of falls. Paretic gait impairments have been previously compared to the non-paretic limb or control participants. Unfortunately, the biomechanical parameters underlying instances of naturally occurring unsuccessful foot clearance (trips) have yet to be examined in individuals with chronic stroke. Methods: Gait data from 26 participants with chronic stroke were obtained on a dual-belt instrumented treadmill. Instances of successful and unsuccessful foot swing were identified. Temporal, kinematic, and kinetic measures of the paretic limb occurring during late stance, toe-off, and swing were compared between trip and non-trip steps using paired samples t-tests. An α = 0.004 was used to adjust for multiple comparisons. Findings: In the paretic limb, the ankle angle at toe off ( P = 0.003; d = 0.64), knee flexion velocity at toe off ( P < 0.001; d = 0.73), and peak knee extension moment during terminal stance ( P < 0.001; d = 0.74) were significantly different between trips and non-trip steps. During trip steps, ankle plantarflexion at toe-off was 1.0° greater, knee flexion velocity was reduced by 17.6 °/sec, and peak knee extension moment was increased by 0.011 Nm/kg · m compared to non-trip steps. Interpretation: It appears to take only minor changes in the movement of the paretic limb to result in a trip in individuals with chronic stroke. Although small, the multi-joint biomechanical changes occurring in the paretic limb during unsuccessful foot clearance result in a functionally longer limb. Thus, interventions targeting multiple joints in the paretic limb may be needed to reduce the risk of trips following stroke. Highlights: Small kinematic and kinetic changes from step-to-step can result in a trip. Movement alterations during late stance are responsible for swing phase. An observed change at multiple joints suggests need for a multi-joint intervention. Individuals post-stroke are at risk for a trip from subtle biomechanical changes.