Effect of Gait Training With Non-paretic Knee Immobilization on Lower Limb and Trunk Acceleration in a Post-stroke Hemiparetic Patient: A Case Report

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Effect of Gait Training With Non-paretic Knee Immobilization on Lower Limb and Trunk Acceleration in a Post-stroke Hemiparetic Patient: A Case Report

Ryosuke Todaka • Tetsu Kajiyama • Naoya Kariu • Masaya Anan

Published: July 09, 2024

DOI: 10.7759/cureus.64193

Peer-Reviewed

Cite this article as: Todaka R, Kajiyama T, Kariu N, et al. (July 09, 2024) Effect of Gait Training With Non-paretic Knee Immobilization on Lower Limb and Trunk Acceleration in a Post-stroke Hemiparetic Patient: A Case Report. Cureus 16(7): e64193. doi:10.7759/cureus.64193

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Abstract

This case report describes a woman in her fifties who experienced a left-sided atherothrombotic cerebral infarction with lesions in the left corona radiata. The patient exhibited motor paralysis of the right upper and lower limbs. After a 10-day acute hospital stay, she was admitted to a rehabilitation facility for an intensive program of physical, occupational, and speech therapy. By day 17 of the onset, she had achieved independence by walking with a cane.

This case was documented to study the effects of gait training with non-paretic knee immobilization on muscle activity and trunk kinematics in post-stroke hemiplegia. Traditional physical therapy was used initially, followed by an intervention phase in which gait training was performed with the non-paretic knee immobilized. This approach was hypothesized to induce beneficial kinematic and muscle activity changes in the paretic limb. The results showed increased muscle activity in the paretic lateral gastrocnemius without compromising trunk stability, suggesting that this method may improve rehabilitation outcomes in similar cases.

Introduction

After stroke, many patients present with motor paralysis, which is characterized by decreased muscle strength in the paretic lower limb [1], gait asymmetry, and decreased gait speed [2]. Motor function, such as muscle strength and the severity of motor paralysis in the paretic lower limb, is thought to be associated with performance measures such as walking speed [3]. Therefore, efforts to improve the functionality of the paretic lower limb are clinically imperative.

In the quest to improve the functionality of the paretic limb, the importance of use-dependent plasticity is emphasized [4]. In the field of upper limb rehabilitation, the effectiveness of constraint-induced movement therapy has been widely documented [5]. Similar to the upper limb, the efficacy of constraint-induced movement therapy as a proactive strategy for using the paretic limb has been reported in the lower limb [6]. Specific methods include exercises such as gait training, sit-to-stand, and stepping under the constraint of the non-paretic lower limb [7-9]. These methods have been reported to increase the anterior-posterior ground reaction force during forward propulsion of the paretic limb and to increase the single-support time of the paretic lower limb during gait [8]. The change in parameters of the paretic lower limb in the stance phase is attributed to the fact that the knee joint of the non-paretic lower limb is immobilized and the knee joint of the non-paretic lower limb does not bend during the swing phase of the non-paretic lower limb. Lateral flexion of the trunk or extension of the knee joint of the paretic lower limb is required to compensate for the lack of flexion of the knee joint of the non-paretic lower limb during the swing phase [9]. The lateral flexion of the trunk to the paretic side and the increased knee extension angle on the paretic side result in a greater load on the paretic lower limb during the stance phase, which could serve as training to strengthen the paretic lower limb. Increased loading during the stance phase on the paretic side may increase the activity of the ankle plantarflexors, which are antigravity muscles.

However, few studies have demonstrated changes in muscle activity with non-paretic knee immobilization. Gait speed in post-stroke patients is related to the severity of motor paralysis in the paretic lower limb, muscle strength [10], muscle strength in the non-paretic lower limb [11], and trunk stability [10]. In particular, because lower limb strength training combined with gait training after stroke is effective in improving gait speed [12], it is clinically relevant for monitoring changes in muscle activity. In addition, trunk kinematics and concurrent contractions during gait compensate for stability, which merits investigation because of their potential impact on gait stability and joint stiffness [10]. Because gait training with non-paretic knee immobilization often results in compensatory movements such as lateral trunk flexion [9], this lateral trunk flexion may cause excessive trunk instability during gait and lead to co-contraction of the ankle plantar and dorsiflexors to compensate for trunk stability [10]. We hypothesized that gait training with immobilization of the non-paretic knee joint would induce kinematic changes in the stance phase of the paretic lower limb as well as changes in muscle activity and trunk kinematics in the background. This case report examined the effects of gait training with non-paretic knee immobilization on trunk and lower limb kinematic parameters in a post-stroke hemiplegic patient.

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