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.