Validating stroke-induced bilateral ankle coordination deficits using bilateral ankle measure relationship with motor functions in lower limbs

Measurements and evaluation DO ABSOLUTELY NOTHING TO GET SURVIVORS RECOVERED!  I'd have you all fired. The goal of stroke research is to get survivors recovered. Hope you're OK with not recovering when you are the 1 in 4 per WHO that has a stroke

Validating stroke-induced bilateral ankle coordination deficits using bilateral ankle measure relationship with motor functions in lower limbs

• Jia-Lan Chang,
• Hung-Ju Chen,
• Po-Yin Chen,
• Li-Wei Chou,
• Chien-Hung Lai,
• Yueh-Hsun Lu,
• Shang-Lin Chiang,
• Chia-Huei Lin,
• Xin-Miao Wang &
• Chueh-Ho Lin 

Journal of NeuroEngineering and Rehabilitation volume 20, Article number: 32 (2023) Cite this article

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Abstract

Background

Coordinated control between the bilateral ankle joints plays an important role in performing daily life functions, such as walking and running. However, few studies have explored the impact of stroke on movement disorders that decrease the coordination control of the bilateral extremities and may decrease daily activities that require coordination control of the bilateral ankles. This study aimed to investigate the coordination control of the bilateral ankles using a novel bilateral ankle measurement system and evaluate the relationship of bilateral movement coordination control deficits with motor and functional performances of the lower extremities in patients with stroke.

Methods

Twenty-one healthy adults (36.5 ± 13.2 y/o) and 19 patients with chronic stroke (58.7 ± 10.5 y/o) were enrolled. A novel measurement device with embedded rotary potentiometers was used to evaluate bilateral ankle coordination control. Participants were asked to move their dominant (non-paretic) foot from dorsiflexion to plantarflexion position and non-dominant (paretic) foot from dorsiflexion to plantarflexion position (condition 1) simultaneously, and vice versa (condition 2). Alternating time and angle for coordination control with movements of both ankles were calculated for each condition. Motor and functional performance measurements of the lower extremities included the lower-extremity portion of the Fugl-Meyer assessment (FMA-LE), Berg Balance Test (BBS), Timed Up and Go Test (TUG), and Barthel Index (BI).

Results

Compared with the healthy group, alternating time was shorter in the stroke group by 8.3% (p = 0.015), and the alternating angles of conditions 1 and 2 were significantly higher than those of the healthy group by 1.4° (p = 0.001) and 2.5° (p = 0.013), respectively. The alternating angle in condition 2 showed moderate correlations with TUG (r = 0.512; p = 0.025), 10-m walk (r = 0.747; p < 0.001), gait speed (r =  − 0.497 to − 0.491; p < 0.05), length (r =  − 0.518 to − 0.551; p < 0.05), and BI (r =  − 0.457; p = 0.049).

Conclusion

Stroke decreases alternating time, increases alternating angle, and shows bilateral ankle coordination control deficits temporally and spatially. A higher alternating angle is moderately to highly associated with motor function and lower limb function in patients with stroke.

Background

Coordination control and performance in bilateral ankles play important roles in daily activities, such as walking and balance, requiring reciprocal dorsiflexion and plantarflexion movements (ankle rocks) of the bilateral ankles [1,2,3]. However, stroke leads to muscle weakness, poorer perception, and spasticity of the paretic lower limbs [4,5,6,7,8], which can result in motor and functional deficits and abnormal compensation during walking after stroke [9, 10]. In addition, recent studies reported that the function of unaffected limbs could also be impacted in patients with stroke [11, 12], which may affect the coordination-related functions of both paretic and non-paretic limbs. Meanwhile, many studies have also shown that functional deficits of paretic ankle joints in the lower limbs worsen with increasing time after stroke [13, 14]. This can cause more deterioration impacts on motor and coordination performances between bilateral lower limbs and may increase the dependence on daily care for 1/4–3/4 stroke patients [15]. A recent study also reported that coordination control of ankles could be related to walking performance of patients with stroke [16]. Therefore, appropriate evaluation tools for the direct measurement of coordination control deficits of the movements in both ankles are important in the clinic. These tools could allow assessment of the functional status of bilateral ankle cooperation control and enable the development of appropriate interventions to improve coordination deficits in both ankles and relevant functions in the lower limbs of stroke patients.

The performance of bilateral lower limb coordination is strongly related to the locomotion of patients with neurological deficits, but the current assessments do not seem to completely meet the demand for evaluating bilateral coordination control. For example, the heel to shin coordination test of the Fugl-Meyer Assessment (FMA) was developed and has been commonly applied to quantitatively evaluate the coordination control of bilateral lower limbs of patients with dysmetria and tremors, as well as stroke patients with inaccurate coordination of the lower limbs [17, 18]. The Lower Extremity Motor Coordination Test (LEMOCOT) is also an effective measurement tool with excellent validity and reliability [19], which can be applied to evaluate coordination deficits in the lower limbs [20], detect changes in motor coordination [21] and predict the prognosis of functional recovery [22] in patients with stroke. These tests measure coordination control of the ankle and lower limbs by calculating the repetitions required to complete tasks using the ankle and lower limbs simultaneously, which may indicate the dexterity of paretic lower limbs rather than directly reflect the performance of reciprocal coordination of ankle or lower limbs. Therefore, these assessment tools could not directly determine changes in the movements in coordination control between two ankles while simultaneously executing tasks with both ankles.

Combined biosensors and computer programs have been developed in recent years which can be used to quantify coordination control among the limbs. For example, recent studies employed an evaluation system with two dynamometers to identify that the coordination controls in grip strength between the hands were associated with motor and functional performances in the upper limbs of stroke patients [23, 24]. In contrast, spatial and temporal changes in the movement performance of both ankles during coordination control tasks have rarely been discussed or demonstrated in patients with stroke due to the lack of appropriate assessment tools for both ankles. Furthermore, few studies have investigated the relationship between the time and movement performance of both ankles during coordination control, and the motor and functional performance of the paretic lower limb. Therefore, the aim of this study was to investigate stroke-related changes in coordination control of movements using a bilateral ankle measurement system and to evaluate the relationship between coordination control of the ankles, and the relationship with motor and functional performances of the paretic lower extremity in patients with stroke.

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