The goal of this project is to develop rehabilitation guidelines for restoration of ambulation in patients following a stroke. Specifically the aims are to identify patterns of gait deviations in both the sound and paretic sides among patients with hemiplegia, form classifications of motor control strategies used during walking and relate these findings to the patient's potential for recovery of ambulation and response to intensive rehabilitation. Three gait training strategies will be compared: i) supported treadmill gait training, 2) intensified-use of the paretic leg and 3) functional independence and endurance training using motor learning principles. Variables that predict improvement in walking ability after rehabilitation will be identified. Three clinical tests (Functional Independence Measure, Fugl-meyer and Upright Motor Control) will be used to identify predictor-criteria. Testing will be done within one week of admission to rehabilitation and at the 6 month-post-stroke anniversary. Gait analysis will be performed to define outcome measures (level and community velocities) and associated gait impairment variables (muscle and motion patterns). The comprehensive baseline gait evaluation will be conducted within the first week the patient is able to walk six meters with assistance. Follow-up testing will be conducted at discharge from inpatient rehabilitation and at 6 months and i year post-stroke. Function of lower gluteus maximus, gluteus medius, long head of biceps femoris, semimembranosus, rectus femoris, adductor longus, vastus intermedius, soleus, anterior tibialis and peroneus brevis muscles will be recorded with dynamic EMG using intramuscular fine wire electrodes. Motion of the trunk, pelvis, hip, thigh, knee and ankle will be recorded for both the sound and paretic limbs with the Vicon Motion Analysis system. Stride characteristics and foot-floor contact patterns will be recorded with Stride Analyzer footswitch system. Subjects will ambulate on level surfaces and over a curb both in bare feet and in shoes with their customary orthoses. Patterned muscle strength will be documented with the Upright Motor Control test and selective strength of both lower extremities will be recorded with the LIDO isokinetic dynamometer (knee and ankle) and a strain gauge tensiometer (hip). Walking endurance will be measured in a fifteen minute test on an outdoor track. Clinical factors and gait impairment variables that best predict level and community walking velocities will be identified. Patterns of gait errors and substitutions will be formulated. Patients will be classified by their gait motor control strategy with a data analysis/expert system. Effectiveness of the three treatment programs will be discerned by comparing functional outcome measures (gait velocities) and gait impairment variables (EMG and motion). Patients in the three treatment groups will be subdivided based on initial motor control strategy to determine if initial severity affects the response to the rehabilitation strategies.
| Mulroy, Sara; Gronley, JoAnne; Weiss, Walt et al. (2003) Use of cluster analysis for gait pattern classification of patients in the early and late recovery phases following stroke. Gait Posture 18:114-25 |
