Article

OBJECTIVE: To use a segment coordination analysis to identify coordination
differences between the paretic and nonparetic limbs for obstacle clearance in
community-dwelling persons after stroke. DESIGN: Within-participant design.
SETTING: Gait analysis laboratory. PARTICIPANTS: Six community-dwelling persons
with a stroke (excluding cerebellar stroke). METHODS: Participants stepped over
obstacles of 2 different heights (7.5% and 15% of leg length), leading
alternately with their paretic and nonparetic limbs. MAIN OUTCOME MEASUREMENTS:
Kinematic data were collected, and segment elevation angles (absolute segment
angular position with respect to vertical) were calculated for the thigh, shank,
and foot segments. Established mathematical techniques related to the planar law
of intersegmental coordination (principal component analysis to quantify
covariance and temporal phase relationships among elevation angles) were then
applied to compare and contrast the coordination of these segment elevation angle
trajectories between paretic and nonparetic limbs. RESULTS: Segment covariance in
elevation angles followed the planar law of intersegmental coordination during
level walking (ie, 3 elevation angles that form a plane and the variance
explained by 2 principal components) for both paretic and nonparetic limbs.
During obstacle clearance, however, relationships between covariance plane
characteristics and phase differences for elevation angles of adjacent segments
differed in the nonparetic limb, likely related to a need for greater limb
elevation for obstacle clearance during paretic limb support or an altered foot
trajectory, which resulted from preobstacle foot placement. CONCLUSIONS: The
present coordination analysis suggests the preservation of basic control
mechanisms in the paretic limb during obstacle clearance after stroke and also
reveals its specific motor control compensations. However, a larger study with
differing levels of stroke severity must be conducted to understand how the
evaluation of intersegmental coordination during walking could guide treatment of
specific locomotor control deficits in stroke rehabilitation.
CI - Copyright (c) 2013 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS