Effects of handrail hold and light touch on energetics, step parameters, and neuromuscular activity during walking after stroke

In the next month your stroke department should have incorporated this into updating the walking protocols. If that doesn't occur call the stroke hospital president and demand the stroke department head be fired for incompetence. Not keeping up with the latest research is grounds. YOU need to demand the best and if this isn't occurring you have a slacker on your hands that needs to be removed.
http://www.jneuroengrehab.com/content/12/1/70

T. IJmker^12*, C. J. Lamoth³, H. Houdijk¹², M. Tolsma², L. H. V. van der Woude³, A. Daffertshofer¹ and P. J. Beek¹

• * Corresponding author: T. IJmker t.ijmker@vu.nl

Author Affiliations

¹ MOVE Research Institute Amsterdam, Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, VU University Amsterdam, van der Boechorststraat 9, Amsterdam, 1081 BT, The Netherlands
² Heliomare Rehabilitation, Research and Development, Relweg 51, Wijk aan Zee, 1949 EC, The Netherlands
³ University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Center for Rehabilitation, Antonius Deusinglaan 1, Groningen, 9713AV, The Netherlands

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Journal of NeuroEngineering and Rehabilitation 2015, 12:70  doi:10.1186/s12984-015-0051-3
The electronic version of this article is the complete one and can be found online at: http://www.jneuroengrehab.com/content/12/1/70

Received:	5 February 2015
Accepted:	26 June 2015
Published:	23 August 2015

© 2015 IJmker et al.

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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Abstract

Background

Holding a handrail or using a cane may decrease the energy cost of walking in stroke survivors. However, the factors underlying this decrease have not yet been previously identified. The purpose of the current study was to fill this void by investigating the effect of physical support (through handrail hold) and/or somatosensory input (through light touch contact with a handrail) on energy cost and accompanying changes in both step parameters and neuromuscular activity. Elucidating these aspects may provide useful insights into gait recovery post stroke.

Methods

Fifteen stroke survivors participated in this study. Participants walked on a treadmill under three conditions: no handrail contact, light touch of the handrail, and firm handrail hold. During the trials we recorded oxygen consumption, center of pressure profiles, and bilateral activation of eight lower limb muscles. Effects of the three conditions on energy cost, step parameters and neuromuscular activation were compared statistically using conventional ANOVAs with repeated measures. In order to examine to which extent energy cost and step parameters/muscle activity are associated, we further employed a partial least squares regression analysis.

Results

Handrail hold resulted in a significant reduction in energy cost, whereas light touch contact did not. With handrail hold subjects took longer steps with smaller step width and improved step length symmetry, whereas light touch contact only resulted in a small but significant decrease in step width. The EMG analysis indicated a global drop in muscle activity, accompanied by an increased constancy in the timing of this activity, and a decreased co-activation with handrail hold, but not with light touch. The regression analysis revealed that increased stride time and length, improved step length symmetry, and decreased muscle activity were closely associated with the decreased energy cost during handrail hold.

Conclusion

Handrail hold, but not light touch, altered step parameters and was accompanied by a global reduction in muscle activity, with improved timing constancy. This suggests that the use of a handrail allows for a more economic step pattern that requires less muscular activation without resulting in substantial neuromuscular re-organization. Handrail use may thus have beneficial effects on gait economy after stroke, which cannot be accomplished through enhanced somatosensory input alone.