Article

Task-specific training programs after stroke improve walking
function, but it is not clear which biomechanical parameters of gait are most
associated with improved walking speed.
The purpose of this study was
to identify gait parameters associated with improved walking speed after a
locomotor training program that included body-weight-supported treadmill training
(BWSTT). DESIGN: A prospective, between-subjects design was used. METHODS:
Fifteen people, ranging from approximately 9 months to 5 years after stroke,
completed 1 of 3 different 6-week training regimens. These regimens consisted of
12 sessions of BWSTT alternated with 12 sessions of: lower-extremity resistive
cycling; lower-extremity progressive, resistive strengthening; or a sham
condition of arm ergometry. Gait analysis was conducted before and after the
6-week intervention program. Kinematics, kinetics, and electromyographic (EMG)
activity were recorded from the hemiparetic lower extremity while participants
walked at a self-selected pace. Changes in gait parameters were compared in
participants who showed an increase in self-selected walking speed of greater
than 0.08 m/s (high-response group) and in those with less improvement
(low-response group). RESULTS: Compared with participants in the low-response
group, those in the high-response group displayed greater increases in terminal
stance hip extension angle and hip flexion power (product of net joint moment and
angular velocity) after the intervention. The intensity of soleus muscle EMG
activity during walking also was significantly higher in participants in the
high-response group after the intervention. LIMITATIONS: Only sagittal-plane
parameters were assessed, and the sample size was small. CONCLUSIONS:
Task-specific locomotor training alternated with strength training resulted in
kinematic, kinetic, and muscle activation adaptations that were strongly
associated with improved walking speed. Changes in both hip and ankle
biomechanics during late stance were associated with greater increases in gait
speed.

Langue : ANGLAIS