Advertisement

Ankle stiffness modulation during different gait speeds in individuals post-stroke

      Highlights

      • Speed is positively related to ankle quasi-stiffness across individuals post-stroke.
      • Propulsion is positively related to ankle quasi-stiffness among persons post-stroke.
      • Ankle quasi-stiffness change isn't predicted by walking speed change after stroke.
      • Paretic ankle quasi-stiffness is less than nonparetic ankle quasi-stiffness.

      Abstract

      Background

      Neurotypical individuals alter their ankle joint quasi-stiffness in response to changing walking speed; however, for individuals post-stroke, the ability to alter their ankle quasi-stiffness is unknown. Individuals post-stroke commonly have weak plantarflexor muscles, which may limit their ability to alter ankle quasi-stiffness. The objective was to investigate the relationship between ankle quasi-stiffness and propulsion, at two walking speeds. We hypothesized that in individuals post-stroke, there would be no difference in their paretic ankle quasi-stiffness between walking at a self-selected versus a fast speed. However, we hypothesized that ankle quasi-stiffness would correlate with gait speed and propulsion across individuals.

      Methods

      Twenty-eight participants with chronic stroke walked on an instrumented treadmill at their self-selected and fast-walking speeds. Multilevel models were used to determine the relationships between ankle quasi-stiffness, speed, and propulsion.

      Findings

      Overall, ankle quasi-stiffness did not increase within individuals from a self-selected to a fast gait speed (p = 0.69). A 1 m/s increase in speed across participants predicted an increase in overall ankle quasi-stiffness of 0.02 Nm/deg./kg (p = 0.03) and a 1 N/BW change in overall propulsion across participants predicted a 0.265 Nm/deg./kg increase in overall ankle quasi-stiffness (p < 0.0001).

      Interpretation

      Individuals post-stroke did not modulate their ankle quasi-stiffness with increased speed, but across individuals there was a positive relationship between ankle quasi-stiffness and both speed and peak propulsion. Walking speed and propulsion are limited in individuals post-stroke, therefore, improving either could lead to a higher functional status. Understanding post-stroke ankle stiffness may be important in the design of therapeutic interventions and exoskeletons, where these devices augment the biological ankle quasi-stiffness to improve walking performance.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Clinical Biomechanics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Bowden M.G.
        • Balasubramanian C.K.
        • Neptune R.R.
        • Kautz S.A.
        Anterior-posterior ground reaction forces as a measure of paretic leg contribution in Hemiparetic walking.
        Stroke. 2006; 37: 872-876https://doi.org/10.1161/01.STR.0000204063.75779.8d
      1. Cohen Jacob Cohen Patricia West Stephen G. Aiken L.S. Applied Multiple Regression/Correlation Analysis for the Behavioral Sciences. 3rd ed. Routledge, 2002https://doi.org/10.4324/9780203774441
        • Davis R.B.
        • DeLuca P.A.
        Gait characterization via dynamic joint stiffness.
        Gait Posture. 1996; https://doi.org/10.1016/0966-6362(95)01045-9
        • Duncan P.W.
        • Zorowitz R.
        • Bates B.
        • Choi J.Y.
        • Glasberg J.J.
        • Graham G.D.
        • Katz R.C.
        • Lamberty K.
        • Reker D.
        Management of Adult Stroke Rehabilitation Care a Clinical Practice Guideline.
        Stroke. 2005; 36: e100-e143https://doi.org/10.1161/01.STR.0000180861.54180.FF
        • Farris D.J.
        • Hampton A.
        • Lewek M.D.
        • Sawicki G.S.
        Revisiting the mechanics and energetics of walking in individuals with chronic hemiparesis following stroke: from individual limbs to lower limb joints.
        J Neuroeng Rehabil. 2015; 12https://doi.org/10.1186/s12984-015-0012-x
        • Fey N.P.
        • Klute G.K.
        • Neptune R.R.
        The influence of energy storage and return foot stiffness on walking mechanics and muscle activity in below-knee amputees.
        Clin. Biomech. 2011; 26: 1025-1032https://doi.org/10.1016/j.clinbiomech.2011.06.007
        • Genthe K.
        • Schenck C.
        • Eicholtz S.
        • Zajac-cox L.
        • Wolf S.
        • Kesar T.M.
        Effects of real-time gait biofeedback on paretic propulsion and gait biomechanics in individuals post-stroke.
        Top. Stroke Rehabil. 2018; 25: 186-193https://doi.org/10.1080/10749357.2018.1436384
        • Go A.S.
        • Mozaffarian D.
        • Roger V.L.
        • Benjamin E.J.
        • Berry J.D.
        • Blaha M.J.
        • Dai S.
        • Ford E.S.
        • Gillespie C.
        • Hailpern S.M.
        • Heit J.A.
        • Virginia J.
        • Kittner S.J.
        • Lackland D.T.
        • Magid D.J.
        • Marcus G.M.
        • Marelli A.
        Heart disease and stroke statistics 2014 update.
        Circulation. 2014; 129: e28-e292https://doi.org/10.1161/01.cir.0000441139.02102.80.Heart
        • Hansen A.H.
        • Childress D.S.
        • Miff S.C.
        • Gard S.A.
        • Mesplay K.P.
        The human ankle during walking: implications for design of biomimetic ankle prostheses.
        J. Biomech. 2004; 37: 1467-1474https://doi.org/10.1016/j.jbiomech.2004.01.017
        • Hedrick E.A.
        • Malcolm P.
        • Wilken J.M.
        • Takahashi K.Z.
        The effects of ankle stiffness on mechanics and energetics of walking with added loads : a prosthetic emulator study.
        J. Neuroeng Rehabil. 2019; 16: 1-15
        • Hedrick E.A.
        • Parker S.M.
        • Hsiao H.
        • Knarr B.A.
        Mechanisms used to increase propulsive forces on a treadmill in older adults.
        J. Biomech. 2021; : 115
        • Hsiao H.
        • Knarr B.A.
        • Higginson J.S.
        • Binder-Macleod S.A.
        Mechanisms to increase propulsive force for individuals poststroke.
        J. Neuroeng Rehabil. 2015; 12: 1-8https://doi.org/10.1186/s12984-015-0030-8
        • Hsiao H.
        • Knarr B.A.
        • Pohlig R.T.
        • Higginson J.S.
        • Binder-Macleod S.A.
        Mechanisms used to increase peak propulsive force following 12-weeks of gait training in individuals poststroke.
        J. Biomech. 2016; 49: 388-395https://doi.org/10.1016/j.jbiomech.2015.12.040
        • Jin L.
        • Hahn M.E.
        Modulation of lower extremity joint stiffness, work and power at different walking and running speeds.
        Hum. Mov. Sci. 2018; 58: 1-9https://doi.org/10.1016/j.humov.2018.01.004
        • Kern A.M.
        • Papachatzis N.
        • Patterson J.M.
        • Bruening D.A.
        • Takahashi K.Z.
        Ankle and midtarsal joint quasi-stiffness during walking with added mass.
        PeerJ. 2019; 7e7487https://doi.org/10.7717/peerj.7487
        • Kim C.M.
        • Eng J.J.
        The relationship of lower-extremity muscle torque to locomotor performance in people with stroke.
        Phys. Ther. 2003; 83: 49-57https://doi.org/10.1093/ptj/83.1.49
        • Lamontagne A.
        • Malouin F.
        • Richards C.L.
        Contribution of passive stiffness to ankle plantarflexor moment during gait after stroke.
        Arch. Phys. Med. Rehabil. 2000; 81: 351-358https://doi.org/10.1053/apmr.2000.0810351
        • Lewek M.D.
        • Raiti C.
        • Doty A.
        The presence of a paretic propulsion reserve during gait in individuals following stroke.
        Neurorehabil. Neural Repair. 2018; 32: 1011-1019https://doi.org/10.1177/1545968318809920
        • Li S.
        • Francisco G.E.
        • Zhou P.
        Post-stroke hemiplegic gait: new perspective and insights.
        Front. Physiol. 2018; 9: 1-8https://doi.org/10.3389/fphys.2018.01021
        • Mager F.
        • Richards J.
        • Hennies M.
        • Dotzel E.
        • Chohan A.
        • Mbuli A.
        • Capanni F.
        Determination of ankle and metatarsophalangeal stiffness during walking and jogging.
        J. Appl. Biomech. 2018; 34: 448-453https://doi.org/10.1123/jab.2017-0265
        • McNeish D.M.
        • Stapleton L.M.
        The effect of small sample size on two-level model estimates: a review and illustration.
        Educ. Psychol. Rev. 2016; https://doi.org/10.1007/s10648-014-9287-x
        • Middleton A.
        • Fritz S.L.
        • Lusardi M.
        Walking speed: the functional vital sign.
        J. Aging Phys. Act. 2015; 23: 314-322https://doi.org/10.1123/japa.2013-0236
        • Olney S.J.
        • Richards C.
        Hemiparetic gait following stroke.
        Part I : Charact. Gait Posture. 1996; 4: 136-148
        • Raudenbush A.S.
        • Bryk S.W.
        Hierarchical Linear Models: Appplications and Data Analysis.
        2nd ed. Sage Publications Inc., Thousand Oaks, California2002
        • Safaeepour Z.
        • Esteki A.
        • Ghomshe F.T.
        • Abu Osman N.A.
        Quantitative analysis of human ankle characteristics at different gait phases and speeds for utilizing in ankle-foot prosthetic design.
        Biomed. Eng. Online. 2014; 13: 1-8https://doi.org/10.1186/1475-925X-13-19
        • Sekiguchi Y.
        • Muraki T.
        • Kuramatsu Y.
        • Furusawa Y.
        • Izumi S.I.
        The contribution of quasi-joint stiffness of the ankle joint to gait in patients with hemiparesis.
        Clin. Biomech. 2012; 27: 495-499https://doi.org/10.1016/j.clinbiomech.2011.12.005
        • Sekiguchi Y.
        • Muraki T.
        • Tanaka N.
        • Izumi S.I.
        Relationship between activation of ankle muscles and quasi-joint stiffness in early and middle stances during gait in patients with hemiparesis.
        Gait Posture. 2015; 42: 348-353https://doi.org/10.1016/j.gaitpost.2015.04.020
        • Sekiguchi Y.
        • Muraki T.
        • Owaki D.
        • Honda K.
        • Izumi S.I.
        Regulation of quasi-joint stiffness by combination of activation of ankle muscles in midstances during gait in patients with hemiparesis.
        Gait Posture. 2018; 62: 378-383https://doi.org/10.1016/j.gaitpost.2018.03.042
        • Shamaei K.
        • Cenciarini M.
        • Dollar A.M.
        On the mechanics of the ankle in the stance phase of the gait, in.
        in: 33rd Annual International Conference of the IEEE EMBS. 2011: 8135-8140https://doi.org/10.1109/ICORR.2011.5975478
        • Shamaei K.
        • Sawicki G.S.
        • Dollar A.M.
        Estimation of quasi-stiffness and propulsive work of the human ankle in the stance phase of walking.
        PLoS One. 2013; 8https://doi.org/10.1371/journal.pone.0059935