Article

Gait training at fast speed has been suggested as an
efficient rehabilitation method in hemiparesis. We investigated whether maximal
speed walking might positively impact inter-segmental coordination in hemiparetic
subjects. METHODS: We measured thigh-shank and shank-foot coordination in the
sagittal plane during gait at preferred (P) and maximal (M) speed using the
continuous relative phase (CRP), in 20 healthy and 27 hemiparetic subjects. We
calculated the root-mean square (CRP(RMS)) and its variability (CRP(SD)) over
each phase of the gait cycle.
A small CRP(RMS) indicates in-phasing, i.e. high
level of synchronization between two segments along the gait cycle. A small
CRP(SD) indicates high stability of the inter-segmental coordination across gait
cycles. RESULTS: Increase from preferred to maximal speed was 57% in healthy and
49% in hemiparetic subjects (difference NS). In healthy subjects, the main change
was shank-foot in-phasing at stance (CRP(Shank-Foot/RMS), P, 98+/-10; M, 67+/-12,
p<0.001). In hemiparetic subjects, we also found shank-foot in-phasing at late
stance bilaterally (non-paretic CRP(Shank-Foot/RMS), P, 37+/-9; M, 29+/-8,
p<0.001; paretic CRP(Shank-Foot/RMS), P, 38+/-13; M, 32+/-12, p<0.001), and
thigh-shank in-phasing at mid-stance in the non-paretic limb
(CRP(Thigh-Shank/RMS), P, 57+/-9; M, 49+/-9, p<0.001). CRP(Thigh-Shank)
variability diminished in the paretic limb (CRP(Thigh-Shank/SD), P, 18.3+/-6.3;
M, 16.1+/-5.2, p<0.001). CONCLUSION: During gait velocity increase in
hemiparesis, there is improvement of thigh-shank coordination stability in the
paretic limb and of shank-foot synchronization at late stance bilaterally, which
optimizes the propulsive phase similarly to healthy subjects. These findings may
add incentive for rehabilitation clinicians to explore maximal velocity gait
training in hemiparesis.
CI - Copyright (c) 2012 Elsevier B.V. All rights reserved.

Langue : ANGLAIS