Maybe there is something in these 8 pages but that is your doctor's responsibility to know and apply. Only 13 years to accomplish that, how is the competence of your doctor and stroke hospital appearing in light of what should have been done 13 years ago? CREATING PROTOCOLS FOR REHAB BASED ON RESEARCH!
Physiological evaluation of gait disturbances post stroke
Anouk Lamontagne
*
, Jennifer L. Stephenson, Joyce Fung
School of Physical and Occupational Therapy, McGill University, Montreal, CanadaJewish Rehabilitation Hospital Research Site of the Montreal Centre for Interdisciplinary Research in Rehabilitation (CRIR),3205 Place Alton-Goldbloom, Laval (Quebec), Canada H7V 1R2
Accepted 26 December 2006Available online 16 February 2007
*
, Jennifer L. Stephenson, Joyce Fung
School of Physical and Occupational Therapy, McGill University, Montreal, CanadaJewish Rehabilitation Hospital Research Site of the Montreal Centre for Interdisciplinary Research in Rehabilitation (CRIR),3205 Place Alton-Goldbloom, Laval (Quebec), Canada H7V 1R2
Accepted 26 December 2006Available online 16 February 2007
Abstract
A large proportion of stroke survivors have to deal with problems in mobility. Proper evaluations must be undertaken to understand the sensorimotor impairments underlying locomotor disorders post stroke, so that evidence-based interventions can be developed. The current electrophysiological, biomechanical, and imagery evaluations that provide insight into locomotor dysfunction post stroke, as well as their advantages and limitations, are reviewed in this paper. In particular, electrophysiological evaluations focus on the contrast of electromyographic patterns and integrity of spinal reflex pathways during perturbed and unperturbed locomotion between persons with stroke and healthy individuals. At a behavioral level, biomechanical evaluations that include temporal distance factors, kinematic and kinetic analyses, as well as the mechanical energy and metabolic cost, are useful when combined with electrophysiological measures for the interpretation of gait disturbances that are related to the control of the central nervous system or secondary to biomechanical constraints. Finally, current methods in imaging and transcranial magnetic stimulation can provide further insight into cortical control of locomotion and the integrity of the corticospinal pathways.
2007 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.
Keywords:
Cerebrovascular accident; Cerebrovascular disease; Locomotion; Electromyography; Kinematics; Kinetics; Electrophysiology; Reflex;Functional imagery
1. Introduction
Gait disorders affect a large proportion of stroke survi-vors and limit their ability to ambulate in the community(Keenan et al., 1984). Walking after stroke is characterizedby slow gait speed (von Schroeder et al., 1995), poor endurance (Dean et al., 2001) and a reduced ability to adapt tothe task and the environmental constraints (Lamontagne et al., 2003; Said et al., 1999). Motor impairments arebelieved to be the primary cause of this poor walking ability, as suggested by the association between muscle weakness of specific muscle groups, such as the plantarflexorson the paretic side, and slow gait speed (Nadeau et al.,1999; Olney et al., 1994). Sensory perception (Lamontagne et al., 2005b) and cognitive factors (Bowen et al., 2001;Haggard et al., 2000; Regnaux et al., 2005), however, alsoinfluence mobility in stroke and are now gaining increased attention. Many electrophysiological, biomechanical and imagery measures have been developed to quantify gait dis-turbances post stroke. This paper aims to review some of the outcomes provided by such measures, emphasizing how the proper evaluation of locomotor disorders will lead to a better understanding of the underlying pathophysiology and hence more effective interventions can be developed.
2007 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.
Keywords:
Cerebrovascular accident; Cerebrovascular disease; Locomotion; Electromyography; Kinematics; Kinetics; Electrophysiology; Reflex;Functional imagery
1. Introduction
Gait disorders affect a large proportion of stroke survi-vors and limit their ability to ambulate in the community(Keenan et al., 1984). Walking after stroke is characterizedby slow gait speed (von Schroeder et al., 1995), poor endurance (Dean et al., 2001) and a reduced ability to adapt tothe task and the environmental constraints (Lamontagne et al., 2003; Said et al., 1999). Motor impairments arebelieved to be the primary cause of this poor walking ability, as suggested by the association between muscle weakness of specific muscle groups, such as the plantarflexorson the paretic side, and slow gait speed (Nadeau et al.,1999; Olney et al., 1994). Sensory perception (Lamontagne et al., 2005b) and cognitive factors (Bowen et al., 2001;Haggard et al., 2000; Regnaux et al., 2005), however, alsoinfluence mobility in stroke and are now gaining increased attention. Many electrophysiological, biomechanical and imagery measures have been developed to quantify gait dis-turbances post stroke. This paper aims to review some of the outcomes provided by such measures, emphasizing how the proper evaluation of locomotor disorders will lead to a better understanding of the underlying pathophysiology and hence more effective interventions can be developed.
5. Conclusions
Gait disturbances post stroke are multi-faceted and hence must be studied from multiple perspectives. Biomechanical measurements such as temporal distance parameters, kinematics, kinetics, mechanical energy and energy costs as well as electromyography can evaluate the behavioral profile of gait and reflect central nervous system adaptation with respect to internal and external demands.Electrophysiological measurements such as stretch reflex,H-reflex and cutaneous reflexes can evaluate the integrity of spinal cord functions during gait and indirectly assess the integrity of the descending control system. Further-more, transcranial magnetic stimulation and advances inimaging techniques have provided new opportunities to examine supraspinal mechanisms and cortical activationsduring gait.
Gait disturbances post stroke are multi-faceted and hence must be studied from multiple perspectives. Biomechanical measurements such as temporal distance parameters, kinematics, kinetics, mechanical energy and energy costs as well as electromyography can evaluate the behavioral profile of gait and reflect central nervous system adaptation with respect to internal and external demands.Electrophysiological measurements such as stretch reflex,H-reflex and cutaneous reflexes can evaluate the integrity of spinal cord functions during gait and indirectly assess the integrity of the descending control system. Further-more, transcranial magnetic stimulation and advances inimaging techniques have provided new opportunities to examine supraspinal mechanisms and cortical activationsduring gait.
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