Article

With the advances in stroke care, the number of high-functioning patients after
stroke is increasing. However, existing clinical tools may not be sensitive
enough to identify the residual deficits in these patients. The current study
aimed to investigate the control of the pelvis, and the joints and end-point of
the lower limbs in high-functioning older patients post-stroke during
obstacle-crossing using motion analysis techniques. Twenty-four high-functioning
older patients following unilateral stroke and fifteen healthy controls walked
and crossed obstacles of three different heights. End-point variables (leading
toe-clearance and trailing toe-obstacle distance) and crossing pelvic and joint
angles were obtained for both limbs during leading limb crossing. Whether leading
with the contralesional or ipsilesional limb, the stroke group exhibited
significantly different joint kinematics from the controls mainly in the frontal
and transverse planes, with greater leading toe-clearance, trailing toe-obstacle
distance, and posterior pelvic tilt. None of the end-point and joint variables
were significantly different between limbs. High-functioning patients post-stroke
appeared to have acquired a specific symmetric kinematic strategy with increased
leading toe-clearance during obstacle-crossing, most likely in order to prevent
tripping. This symmetric strategy, possibly a consequence of brain
reorganization, may help in performing functional activities during which
symmetric performance between the contralesional and ipsilesional sides is
required. Obstacle-crossing training with both limbs leading alternately may be
helpful for the development of this symmetric strategy. It is suggested that
computerized motion analysis of obstacle-crossing can be a sensitive assessment
tool for distinguishing the motor performance between normal and high-functioning
patients post-stroke.
CI - Copyright 2010 Elsevier B.V. All rights reserved.

Langue : ANGLAIS