Contribution of muscle activity at different gait phases for improving walking performance in chronic stroke patients with hemiparesis.
Kazuki Fujita, Hideaki Hori, Yasutaka Kobayashi
PMID 30464370WHAT IT FOUND
In 40 chronic stroke walkers, more paretic-leg biceps femoris activity during swing was associated with faster walking, while more tibialis anterior activity was associated with slower walking.
It does not show training these muscles changes speed.
Key findings
01During swing phase, greater normalized paretic biceps femoris activity was associated with faster walking (r=0.47), while greater paretic tibialis anterior activity was associated with slower walking (r=-0.44).
02In multiple regression, swing-phase biceps femoris activity (β=0.45, p=0.003) and swing-phase tibialis anterior activity (β=-0.35, p=0.035) were significant determinants of gait velocity.
03Swing-phase biceps femoris activity was a significant determinant of the swing duration asymmetry index (β=-0.41, p=0.008), but no significant factors were found for the step length asymmetry index.
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What it does not show
This was a cross-sectional observational study, so it cannot show that changing muscle activity causes changes in walking speed. It included only 40 chronic stroke survivors who could walk unassisted or with a T-handled cane at 0.1 to 1 m/s, so findings may not apply to non-ambulatory patients, those needing other devices, or very fast walkers. The paper tested many muscle-phase-outcome relationships at a 5% significance level and does not state that the analyses were adjusted for multiple comparisons. Muscle activity was recorded on the paretic side only and normalized within the gait cycle, so absolute activity level and non-paretic contribution were not examined. No intervention was given, so no dose, timing, or training method can be recommended.
Declared interests
The authors declared no conflict of interest.
The easy way to misread this
Do not conclude that strengthening or activating the paretic biceps femoris during swing will improve walking speed. This was an observational study of walking patterns, not a training trial, so it cannot show that changing muscle activity caused faster walking.