Deans' stroke musings: Impairment from key lower limb antagonists vs. ambulation speed in chronic hemiparesis

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.

Monday, October 2, 2017

Impairment from key lower limb antagonists vs. ambulation speed in chronic hemiparesis

My conclusion on this is that it is totally fucking useless, no way to get a stroke protocol out of this without objectively describing three motor mechanisms and how to get there from stroke survivor impairments.
http://www.sciencedirect.com/science/article/pii/S1877065717301409

ValentinaMardale¹ Catherine-MarieLoche¹ CarolineColas¹ CatherineHennegrave² Jean-MichelGracies¹ EmilieHutin¹

https://doi.org/10.1016/j.rehab.2017.07.019 Get rights and content

Objective

In hemiparesis, three main motor mechanisms in lower limb produce ambulation impairment: paresis in agonists and contracture and overactivity in antagonists. The present study explores correlations between ambulation speed and indices of contracture, spasticity, and cocontraction in key ankle, knee and hip muscles in chronic hemiparesis.

Material/patients and methods

This retrospective study has included 132 subjects with chronic hemiparesis (mean ± SD, 50 ± 15 years, time since stroke, 8 ± 10 years). Inclusion criteria were: time since stroke > 6 months; completion, at the same visit, of the 10-meter ambulation test (AT10), barefoot without assistance at comfortable speed (CS) and fast speed (FS) and of the Five-Step Assessment (FSA), in three key muscles: triceps surae (TS), quadriceps (QD) and gluteus maximus (GM); no botulinum toxin injections in the 3 months prior to the visit. FSA was carried out on ankle dorsiflexion knee extended (against TS resistance), knee flexion hip extended (against QD resistance) and hip flexion knee flexed (against GM resistance) and measured passive range of motion at slow stretch (XV1), angle of catch at fast stretch (XV3) and active range of motion (XA). A multivariable regression analysis was performed with XV1, XV3, XA against each muscle as predictors and ambulation speeds (CS, FS) as dependent variables.

Results

Mean ambulation speeds were CS = 0.63 ± 0.28 m/s and FS = 0.84 ± 0.39 m/s. Both speeds were positively correlated with XA against TS (vs. CS, r = 0.50, P = 0.005; FS, r = 0.50, P = 0.006), QD (vs. CS, r = 0.62, P = 0.0001; FS, r = 0.56, P = 0.001) and GM (vs. CS, r = 0.68, P = 0.002; FS, r = 0.64, P = 0.013). XV1 and XV3 were not correlated with ambulation speeds.

Discussion – conclusion

After stroke, ambulation speed is correlated with active range of motion against triceps surae, quadriceps and gluteus maximus rather than corresponding passive ranges of motion or spasticity levels. These results may encourage therapists to primarily aim for improvement of individual active ranges of motion against key lower limb antagonists to enhance ambulation in chronic hemiparesis.