Deans' stroke musings: Anticipatory Postural Adjustments During Gait Initiation in Stroke Patients

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.

Thursday, April 25, 2019

Anticipatory Postural Adjustments During Gait Initiation in Stroke Patients

This is useless, describes a problem, offers NO solution. I still lead with the bad leg from a standing start, even 13 years later. I won't even attempt to change that until research comes up with a defined protocol that addresses the problem. I see no reason to guess my way to a solution that our stroke medical world is responsible for solving.

Anticipatory Postural Adjustments During Gait Initiation in Stroke Patients

Arnaud Delafontaine^1,2^*,

Thomas Vialleron^1,2,

Tarek Hussein³,

Eric Yiou^1,2,

Jean-Louis Honeine⁴ and

Silvia Colnaghi^5,6

¹CIAMS, Université Paris-Sud, Université Paris-Saclay, Orsay, France
²CIAMS, Université d'Orléans, Orléans, France
³ENKRE, Saint-Maurice, France
⁴VEDECOM Institut, Versailles, France
⁵Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
⁶Laboratory of Neuro-otology and Neuro-ophthalmology, IRCCS Mondino Foundation, Pavia, Italy

Prior to gait initiation (GI), anticipatory postural adjustments (GI-APA) are activated in order to reorganize posture, favorably for gait. In healthy subjects, the center of pressure (CoP) is displaced backward during GI-APA, bilaterally by reducing soleus activities and activating the tibialis anterior (TA) muscles, and laterally in the direction of the leading leg, by activating hip abductors. In post-stroke hemiparetic patients, TA, soleus and hip abductor activities are impaired on the paretic side. Reduction in non-affected triceps surae activity can also be observed. These may result in a decreased ability to execute GI-APA and to generate propulsion forces during step execution. A systematic review was conducted to provide an overview of the reorganization which occurs in GI-APA following stroke as well as of the most effective strategies for tailoring gait-rehabilitation to these patients. Sixteen articles were included, providing gait data from a total of 220 patients. Stroke patients show a decrease in the TA activity associated with difficulties in silencing soleus muscle activity of the paretic leg, a decreased CoP shift, lower propulsive anterior forces and a longer preparatory phase. Regarding possible gait-rehabilitation strategies, the selected studies show that initiating gait with the paretic leg provides poor balance. The use of the non-paretic as the leading leg can be a useful exercise to stimulate the paretic postural muscles.