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Bhavana Raja, PT, PhD; Richard R. Neptune, PhD; Steven A. Kautz, PhD

Quantifiable patterns of limb loading and unloading during hemiparetic gait: Relation to kinetic and kinematic parameters. Bhavana Raja, PT, PhD; Richard R. Neptune, PhD; Steven A. Kautz, PhD. Aim

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Bhavana Raja, PT, PhD; Richard R. Neptune, PhD; Steven A. Kautz, PhD

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  1. Quantifiable patterns of limb loading and unloading during hemiparetic gait: Relation to kinetic and kinematic parameters Bhavana Raja, PT, PhD; Richard R. Neptune, PhD; Steven A. Kautz, PhD

  2. Aim • Determine magnitude and duration of asymmetry in limb loading (LL) and limb unloading (LU) in hemiparesis. • Determine relationship with functional walking status and specific kinematic and kinetic variables during walking. • Relevance • Understanding LL and LU asymmetry will provide insight into changes in poststroke individuals’ locomotion and inspire new walking rehabilitation strategies.

  3. Method • Participants: • 44 people with chronic hemiparesis and 18 nondisabled controls. • Protocol • Participants walked on instrumented split-belt treadmill without assistive device or ankle foot orthosis for 3 walking trials at self-selected speed. • Controls walked at self-selected speed, 0.3 m/s, and 0.6 m/s. • 12-camera motion analysis system collected data as subjects walked. • Variables calculated during double-limb support phases of gait (when LL and LU occur).

  4. Results • LL Magnitude • At self-selected speeds: • Magnitude less in paretic vs nonparetic leg and controls. • At matched speeds: • No significant difference between paretic leg and controls when considering subjects with hemiparesis as single group. • When considered separately, reduced paretic leg LL was related to functional walking status in hemiparesis group. • Slower individuals had significant differences in LL vs controls. • Community ambulators not significantly different.

  5. Results (cont’d.) • LU Magnitude • At self-selected and matched speeds: • For household and limited community ambulators, significantly lower in paretic vs nonparetic leg and controls • No significant difference between community ambulators and nonparetic leg and controls. • LL/LU Timing & Pattern • Household ambulators • LL time of nonparetic leg significantly less than limited community ambulators and community ambulators. • LU time greater than limited community ambulators and community ambulators.

  6. Results (cont’d.) • Mediolateral (M-L) GRF and LL/LU • No significant correlation. • Knee Angle and LL/LU • No significant correlation. • M-L Leg Angle and LL/LU • Subjects with reduced paretic leg LL placed paretic leg further lateral relative to pelvis center of mass. • LL negatively associated with leg angle of paretic side in M-L direction during 1st double-support phase. • Paretic leg M-L angle significantly greater than nonparetic leg and controls at matched speeds.

  7. Conclusion • Paretic LL magnitude was reduced, while duration was increased vs nonparetic leg and controls walking at matched speeds. • 3 LL/LU patterns were identified: concave, convex, and linear. • Results indicate that people with hemiparesis make biomechanical adjustments to maintain a steady walking state. • Characterization of these deviations may inspire new strategies for rehabilitation.

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