Deans' stroke musings: Documenting abnormal anticipatory control prior to gait initiation in sub-acute stroke

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Wednesday, January 25, 2012

Documenting abnormal anticipatory control prior to gait initiation in sub-acute stroke

Get your PT excited and ask them about this paper and anticipatory movements.
From the 2011 Canadian Stroke Congress.
page 125 here:
http://www.strokecongress.org/2011/wp-content/uploads/2011/12/CSC_Abstracts.pdf
Background: Anticipatory postural adjustments (APAs) are medio-lateral centre of pressure (ML COP) shifts towards the swing limb to preserve lateral stability prior to gait initiation. Previous research demonstrated that APAs are reduced in magnitude or delayed among individuals with stroke compared to healthy controls.
Clinically, we have observed multiple APAs prior to gait initiation in individuals post-stroke, which has not been reported in the literature. The purpose of this study was to document the prevalence of abnormal APA patterns and to examine the differences in APA timing and magnitude in a sub-acute stroke population prior to gait initiation. Methods: Sixty-six independently ambulatory stroke inpatients stood on two force plates and were instructed to initiate gait at a self-selected speed. Six trials were completed, three leading with each limb. MLCOP was obtained from the force plates. An APA was defined as a shift in ML COP >10mm from baseline. An
abnormal APA pattern could involve either no APA or multiple APAs (mAPA). Results: Fifty-six percent of patients (37/66) exhibited trials with both one and multiple APAs. Foot-off time was significantly faster for trials with
mAPAs than those with one APA (p=0.0029). Unloading time for trials with mAPAs was also faster than those with one APA (p=0.014). Forty-eight percent of patients (32/66) demonstrated trials with both normal APAs and no
APA activity. When comparing trials with one APA to those with no APA, there were no significant differences in timing. Conclusions: This study reports a high prevalence of abnormal anticipatory control prior to gait initiation
in individuals with stroke. Significant temporal differences associated with multiple APAs exist, which alter the normal gait initiation sequence. The clinical significance of these abnormal APA patterns in individuals with stroke prior to voluntary gait initiation warrants further investigation.