Article

Hemiparetic gait following stroke requires substantial energy
consumption, which would promote deconditioning and disability. Optimal
modalities for decreasing this energy cost remain challenging. Excessive energy
consumption, however, seems to be mainly due to extra positive muscle work to
substantially lift the body's center of mass (CM) against gravity during the
paretic limb swing. OBJECTIVE: The authors tested a new rehabilitation strategy
in a pilot study to specifically reduce the energy cost in hemiparetic gait.
METHODS: Six chronic hemiparetic patients underwent a 6-week gait training
program on a treadmill with real-time feedback of their CM and were asked to
reduce its increased vertical displacement. The authors assessed the walking
energy cost, vertical CM displacement, kinematics, and electromyogram activity
without feedback before and after treatment. RESULTS: After treatment, the
vertical CM displacement decreased by 10% (P = .005), particularly when the CM
vaulted over the nonparetic limb in stance, and the energy cost decreased
markedly by 30% (P = .009). The paretic knee flexion in swing increased
concomitantly by 45% and muscle co-contraction decreased significantly in both
thigh muscles by 15%. CONCLUSIONS: The rehabilitation approach followed in this
study seems remarkably effective in decreasing the walking energy cost. By
treating the compensatory strategy (ie, the increased CM displacement), we also
appear to treat primary deviations such as poststroke knee impairments, which is
novel and complementary to current concepts in rehabilitation. This new approach
is promising and merits further investigation.

Langue : ANGLAIS