Forced Use of the Paretic Leg Induced by a Constraint Force Applied to the Nonparetic Leg in Individuals Poststroke During Walking

Abstract

Background: Individuals with stroke usually show reduced muscle activities of the paretic leg and asymmetrical gait pattern during walking.

Objective: To determine whether applying a resistance force to the nonparetic leg would enhance the muscle activities of the paretic leg and improve the symmetry of spatiotemporal gait parameters in individuals with poststroke hemiparesis.

Methods: Fifteen individuals with chronic poststroke hemiparesis participated in this study. A controlled resistance force was applied to the nonparetic leg using a customized cable-driven robotic system while subjects walked on a treadmill. Subjects completed 2 test sections with the resistance force applied at different phases of gait (ie, early and late swing phases) and different magnitudes (10%, 20%, and 30% of maximum voluntary contraction [MVC] of nonparetic leg hip flexors). Electromyographic (EMG) activity of the muscles of the paretic leg and spatiotemporal gait parameters were collected.

Results: Significant increases in integrated EMG of medial gastrocnemius, medial hamstrings, vastus medialis, and tibialis anterior of the paretic leg were observed when the resistance was applied during the early swing phase of the nonparetic leg, compared with baseline. Additionally, resistance with 30% of MVC induced the greatest level of muscle activity than that with 10% or 20% of MVC. The symmetry index of gait parameters also improved with resistance applied during the early swing phase.

Conclusion: Applying a controlled resistance force to the nonparetic leg during early swing phase may induce forced use on the paretic leg and improve the spatiotemporal symmetry of gait in individuals with poststroke hemiparesis.

Keywords: EMG; constraint force; forced use; locomotion; stroke.

Conflict of interest statement

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.

Mean electromyographic (EMG) data from all subjects for baseline and different phase of resistance force conditions. Data were averaged across 20 consecutive gait cycles and normalized to % gait cycle.

Figure 2.

Average integrated EMG during stance phase in baseline and different phases of resistance force conditions. Error bars, ±1 SE.

Figure 3.

Mean electromyographic (EMG) data from all subjects for baseline and different resistance force intensity conditions. Data were averaged across 20 consecutive gait cycles and normalized to % gait cycle.

Figure 4.

Average integrated EMG during stance phase in baseline and different resistance force magnitude conditions. Error bars, ±1 SE.