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Forced use of paretic leg induced by constraining the non-paretic leg leads to motor learning in individuals post-stroke

  • Ming WuEmail author
  • Chao-Jung Hsu
  • Janis Kim
Research Article
  • 34 Downloads

Abstract

The purpose of this study was to determine whether applying repetitive constraint forces to the non-paretic leg during walking would induce motor learning of enhanced use of the paretic leg in individuals post-stroke. Sixteen individuals post chronic (> 6 months) stroke were recruited in this study. Each subject was tested in two conditions, i.e., applying a constraint force to the non-paretic leg during treadmill walking and treadmill walking only. For the constraint condition, subjects walked on a treadmill with no force for 1 min (baseline), with force for 7 min (adaptation), and then without force for 1 min (post-adaptation). For the treadmill only condition, a similar protocol was used but no force was applied. EMGs from muscles of the paretic leg and ankle kinematic data were recorded. Spatial–temporal gait parameters during overground walking pre and post treadmill walking were also collected. Integrated EMGs of ankle plantarflexors and hip extensors during stance phase significantly increased during the early adaptation period, and partially retained (15–21% increase) during the post-adaptation period for the constraint force condition, which were significantly greater than that for the treadmill only (3–5%) condition. The symmetry of step length during overground walking significantly improved (p = 0.04) after treadmill walking with the constraint condition, but had no significant change after treadmill walking only. Repetitively applying constraint force to the non-paretic leg during treadmill walking may lead to a motor learning of enhanced use of the paretic leg in individuals post-stroke, which may transfer to overground walking.

Keywords

EMG Stroke Locomotion Forced use Constraint force 

Notes

Acknowledgements

This study was supported by NIH/NICHD, R01HD082216. We thank Dr. Rongnian Tang’s assistance for data collection.

Compliance with ethical standards

Conflict of interest

None of the authors have potential conflicts of interest to be disclosed.

References

  1. Alcantara CC, Charalambous CC, Morton SM, Russo TL, Reisman DS (2018) Different error size during locomotor adaptation affects transfer to overground walking poststroke. Neurorehabil Neural Repair 32:1020–1030CrossRefGoogle Scholar
  2. Blanchette A, Bouyer LJ (2009) Timing-specific transfer of adapted muscle activity after walking in an elastic force field. J Neurophysiol 102:568–577CrossRefGoogle Scholar
  3. Burridge JH, Wood DE, Taylor PN, McLellan DL (2001) Indices to describe different muscle activation patterns, identified during treadmill walking, in people with spastic drop-foot. Med Eng Phys 23:427–434CrossRefGoogle Scholar
  4. Centers for Disease Control and Prevention (2012) Prevalence of stroke–United States, 2006–2010. MMWR Morb Mortal Wkly Rep 61:379–382Google Scholar
  5. Chen G, Patten C, Kothari DH, Zajac FE (2005) Gait differences between individuals with post-stroke hemiparesis and non-disabled controls at matched speeds. Gait Posture 22:51–56CrossRefGoogle Scholar
  6. Classen J, Liepert J, Wise SP, Hallett M, Cohen LG (1998) Rapid plasticity of human cortical movement representation induced by practice. J Neurophysiol 79:1117–1123CrossRefGoogle Scholar
  7. Diedrichsen J, White O, Newman D, Lally N (2010) Use-dependent and error-based learning of motor behaviors. J Neurosci 30:5159–5166CrossRefGoogle Scholar
  8. Dietz V, Quintern J, Boos G, Berger W (1986) Obstruction of the swing phase during gait: phase-dependent bilateral leg muscle coordination. Brain Res 384:166–169CrossRefGoogle Scholar
  9. Duncan PW, Sullivan KJ, Behrman AL, Azen SP, Wu SS, Nadeau SE, Dobkin BH, Rose DK, Tilson JK, Cen S, Hayden SK, Team LI (2011) Body-weight-supported treadmill rehabilitation after stroke. N Engl J Med 364:2026–2036CrossRefGoogle Scholar
  10. Folstein MF, Folstein SE, McHugh PR (1975) Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198CrossRefGoogle Scholar
  11. Gama GL, Celestino ML, Barela JA, Forrester L, Whitall J, Barela AM (2017) Effects of gait training with body weight support on a treadmill versus overground in individuals with stroke. Arch Phys Med Rehabil 98:738–745CrossRefGoogle Scholar
  12. Hase K, Suzuki E, Matsumoto M, Fujiwara T, Liu M (2011) Effects of therapeutic gait training using a prosthesis and a treadmill for ambulatory patients with hemiparesis. Arch Phys Med Rehabil 92:1961–1966CrossRefGoogle Scholar
  13. Hesse S, Bertelt C, Jahnke MT, Schaffrin A, Baake P, Malezic M, Mauritz KH (1995) Treadmill training with partial body weight support compared with physiotherapy in nonambulatory hemiparetic patients. Stroke 26:976–981CrossRefGoogle Scholar
  14. Hollman JH, Watkins MK, Imhoff AC, Braun CE, Akervik KA, Ness DK (2016) A comparison of variability in spatiotemporal gait parameters between treadmill and overground walking conditions. Gait Posture 43:204–209CrossRefGoogle Scholar
  15. Hsu CJ, Kim J, Roth EJ, Rymer WZ, Wu M (2017) Forced use of the paretic leg induced by a constraint force applied to the nonparetic leg in individuals poststroke during walking. Neurorehabil Neural Repair 31:1042–1052CrossRefGoogle Scholar
  16. Jax SA, Rosenbaum DA (2007) Hand path priming in manual obstacle avoidance: evidence that the dorsal stream does not only control visually guided actions in real time. J Exp Psychol Hum Percept Perform 33:425–441CrossRefGoogle Scholar
  17. Jorgensen HS, Nakayama H, Raaschou HO, Olsen TS (1995) Recovery of walking function in stroke patients: the Copenhagen Stroke Study. Arch Phys Med Rehabil 76:27–32CrossRefGoogle Scholar
  18. Lewek MD, Bradley CE, Wutzke CJ, Zinder SM (2014) The relationship between spatiotemporal gait asymmetry and balance in individuals with chronic stroke. J Appl Biomech 30:31–36CrossRefGoogle Scholar
  19. Macko RF, Ivey FM, Forrester LW, Hanley D, Sorkin JD, Katzel LI, Silver KH, Goldberg AP (2005) Treadmill exercise rehabilitation improves ambulatory function and cardiovascular fitness in patients with chronic stroke: a randomized, controlled trial. Stroke 36:2206–2211CrossRefGoogle Scholar
  20. Moseley AM, Stark A, Cameron ID, Pollock A (2005) Treadmill training and body weight support for walking after stroke. Cochrane Database Syst Rev 4:CD002840Google Scholar
  21. Mulroy SJ, Eberly VJ, Gronely JK, Weiss W, Newsam CJ (2010) Effect of AFO design on walking after stroke: impact of ankle plantar flexion contracture. Prosthet Orthot Int 34:277–292CrossRefGoogle Scholar
  22. Nadeau S, Gravel D, Arsenault AB, Bourbonnais D (1999) Plantarflexor weakness as a limiting factor of gait speed in stroke subjects and the compensating role of hip flexors. Clin Biomech (Bristol, Avon) 14:125–135CrossRefGoogle Scholar
  23. Olney SJ, Griffin MP, McBride ID (1994) Temporal, kinematic, and kinetic variables related to gait speed in subjects with hemiplegia: a regression approach. Phys Ther 74:872–885CrossRefGoogle Scholar
  24. Patterson SL, Rodgers MM, Macko RF, Forrester LW (2008) Effect of treadmill exercise training on spatial and temporal gait parameters in subjects with chronic stroke: a preliminary report. J Rehabil Res Dev 45:221–228CrossRefGoogle Scholar
  25. Patterson KK, Gage WH, Brooks D, Black SE, McIlroy WE (2010) Evaluation of gait symmetry after stroke: a comparison of current methods and recommendations for standardization. Gait Posture 31:241–246CrossRefGoogle Scholar
  26. Perry J, Burnfield JM (2010) Gait analysis. Normal and pathological function. SLACK, Pomona, CaliforniaGoogle Scholar
  27. Perry J, Garrett M, Gronley JK, Mulroy SJ (1995) Classification of walking handicap in the stroke population. Stroke 26:982–989CrossRefGoogle Scholar
  28. Pohl M, Mehrholz J, Ritschel C, Ruckriem S (2002) Speed-dependent treadmill training in ambulatory hemiparetic stroke patients: a randomized controlled trial. Stroke 33:553–558CrossRefGoogle Scholar
  29. Raja B, Neptune RR, Kautz SA (2012) Coordination of the non-paretic leg during hemiparetic gait: expected and novel compensatory patterns. Clin Biomech (Bristol, Avon) 27:1023–1030CrossRefGoogle Scholar
  30. Reisman DS, Wityk R, Silver K, Bastian AJ (2009) Split-belt treadmill adaptation transfers to overground walking in persons poststroke. Neurorehabil Neural Repair 23:735–744CrossRefGoogle Scholar
  31. Reisman DS, McLean H, Keller J, Danks KA, Bastian AJ (2013) Repeated split-belt treadmill training improves poststroke step length asymmetry. Neurorehabil Neural Repair 27:460–468CrossRefGoogle Scholar
  32. Roelker SA, Bowden MG, Kautz SA, Neptune RR (2019) Paretic propulsion as a measure of walking performance and functional motor recovery post-stroke: a review. Gait Posture 68:6–14CrossRefGoogle Scholar
  33. Savin DN, Tseng SC, Morton SM (2010) Bilateral adaptation during locomotion following a unilaterally applied resistance to swing in nondisabled adults. J Neurophysiol 104:3600–3611CrossRefGoogle Scholar
  34. Savin DN, Morton SM, Whitall J (2014) Generalization of improved step length symmetry from treadmill to overground walking in persons with stroke and hemiparesis. Clin Neurophysiol 125:1012–1020CrossRefGoogle Scholar
  35. Siebers A, Oberg U, Skargren E (2010) The effect of modified constraint-induced movement therapy on spasticity and motor function of the affected arm in patients with chronic stroke. Physiother Can 62:388–396CrossRefGoogle Scholar
  36. Souissi H, Zory R, Boudarham J, Pradon D, Roche N, Gerus P (2019) Muscle force strategies for poststroke hemiparetic patients during gait. Top Stroke Rehabil 26:58–65CrossRefGoogle Scholar
  37. Sullivan KJ, Knowlton BJ, Dobkin BH (2002) Step training with body weight support: effect of treadmill speed and practice paradigms on poststroke locomotor recovery. Arch Phys Med Rehabil 83:683–691CrossRefGoogle Scholar
  38. Taub E, Miller NE, Novack TA, Cook EW 3rd, Fleming WC, Nepomuceno CS, Connell JS, Crago JE (1993) Technique to improve chronic motor deficit after stroke. Arch Phys Med Rehabil 74:347–354Google Scholar
  39. Visintin M, Barbeau H, Korner-Bitensky N, Mayo NE (1998) A new approach to retrain gait in stroke patients through body weight support and treadmill stimulation. Stroke 29:1122–1128CrossRefGoogle Scholar
  40. Wolf SL, Winstein CJ, Miller JP, Taub E, Uswatte G, Morris D, Giuliani C, Light KE, Nichols-Larsen D, Investigators E (2006) Effect of constraint-induced movement therapy on upper extremity function 3–9 months after stroke: the EXCITE randomized clinical trial. JAMA 296:2095–2104CrossRefGoogle Scholar
  41. Wu M, Hornby TG, Landry JM, Roth H, Schmit BD (2011) A cable-driven locomotor training system for restoration of gait in human SCI. Gait Posture 33:256–260CrossRefGoogle Scholar
  42. Yang JF, Stephens MJ, Vishram R (1998) Transient disturbances to one limb produce coordinated, bilateral responses during infant stepping. J Neurophysiol 79:2329–2337CrossRefGoogle Scholar
  43. Yen SC, Schmit BD, Landry JM, Roth H, Wu M (2012) Locomotor adaptation to resistance during treadmill training transfers to overground walking in human SCI. Exp Brain Res 216:473–482CrossRefGoogle Scholar
  44. Yen SC, Landry JM, Wu M (2013) Size of kinematic error affects retention of locomotor adaptation in human spinal cord injury. J Rehabil Res Dev 50:1187–1200CrossRefGoogle Scholar
  45. Zehr EP, Loadman PM (2012) Persistence of locomotor-related interlimb reflex networks during walking after stroke. Clin Neurophysiol 123:796–807CrossRefGoogle Scholar
  46. Zeni JA Jr, Richards JG, Higginson JS (2008) Two simple methods for determining gait events during treadmill and overground walking using kinematic data. Gait Posture 27:710–714CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Legs and Walking LabShirley Ryan AbilityLabChicagoUSA
  2. 2.Department of BioengineeringUniversity of Illinois at ChicagoChicagoUSA
  3. 3.Department of Physical Medicine and RehabilitationNorthwestern UniversityChicagoUSA

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