Citation

Burpee JL, Lewek MD. Clin. Biomech. 2015; 30(10): 1102-1107.

Affiliation

Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA. Electronic address: mlewek@med.unc.edu.

Copyright

(Copyright © 2015, Elsevier Publishing)

DOI

10.1016/j.clinbiomech.2015.08.018

PMID

26371855

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 0.011Nm/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.

Language: en