http://www.jneuroengrehab.com/content/10/1/12/abstract
Abstract (provisional)
Background
A common goal of persons post-stroke is to regain community ambulation. The plantar
flexor muscles play an important role in propulsion generation and swing initiation
as previous musculoskeletal simulations have shown. The purpose of this study was
to demonstrate that simulation results quantifying changes in plantar flexor activation
and function in individuals post-stroke were consistent with (1) the purpose of an
intervention designed to enhance plantar flexor function and (2) expected muscle function
during gait based on previous literature.
Methods
Three-dimensional, forward dynamic simulations were created to determine the changes
in model activation and function of the paretic ankle plantar flexor muscles for eight
patients post-stroke after a 12-weeks FastFES gait retraining program.
Results
An median increase of 0.07 (Range [-0.01,0.22]) was seen in simulated activation averaged
across all plantar flexors during the double support phase of gait from pre- to post-intervention.
A concurrent increase in walking speed and plantar flexor induced forward center of
mass acceleration by the plantar flexors was seen post-intervention for seven of the
eight subject simulations. Additionally, post-training, the plantar flexors had an
simulated increase in contribution to knee flexion acceleration during double support.
Conclusions
For the first time, muscle-actuated musculoskeletal models were used to simulate the
effect of a gait retraining intervention on post-stroke muscle model predicted activation
and function. The simulations showed a new pattern of simulated activation for the
plantar flexor muscles after training, suggesting that the subjects activated these
muscles with more appropriate timing following the intervention. Functionally, simulations
calculated that the plantar flexors provided greater contribution to knee flexion
acceleration after training, which is important for increasing swing phase knee flexion
and foot clearance.
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