Article

The task of stepping over obstacles is known to be particularly risky for persons
post stroke. A kinetic analysis informing on the movement strategies used to
ensure clearance of the leading limb over an obstacle is, however, lacking. We examined obstacle avoidance strategies in six community dwelling stroke survivors
comparing the use of paretic and non-paretic limb as the leading limb for
clearance over obstacles measuring 7.5% and 15% of their total leg length.
Subjects were able to increase foot clearance height in both limbs in order to
avoid the two obstacles. Obstacle clearance with the non-paretic limb leading was
associated with positive knee flexor work that increased when stepping over each
obstacle, thus showing a normal knee strategy that flexes both the knee and the
hip for foot clearance. There was also slightly increased hip flexor contribution
for non-paretic obstacle clearance that was the same for both obstacle heights.
When the paretic limb led during obstacle clearance, there was also evidence of
an increased knee flexor moment, suggesting a residual knee strategy, but it was
less pronounced than for the non-paretic limb and was assisted by greater
vertical hip elevation and additional positive hip flexor work that both gained
greater importance with increased obstacle height.
These findings suggest that
rehabilitation should explore the ability to improve the residual, but less
powerful, knee flexor strategy in the paretic limb in specific patients, with
further promotion of a hip flexor and limb elevation strategy depending on
patient deficits and obstacle height.
CI - Copyright (c) 2015 Elsevier B.V. All rights reserved.

Langue : ANGLAIS