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Forced use of paretic leg induced by constraining the non-paretic leg leads to motor learning in individuals post-stroke

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Abstract

The purpose of this study was to determine whether applying repetitive constraint forces to the non-paretic leg during walking would induce motor learning of enhanced use of the paretic leg in individuals post-stroke. Sixteen individuals post chronic (> 6 months) stroke were recruited in this study. Each subject was tested in two conditions, i.e., applying a constraint force to the non-paretic leg during treadmill walking and treadmill walking only. For the constraint condition, subjects walked on a treadmill with no force for 1 min (baseline), with force for 7 min (adaptation), and then without force for 1 min (post-adaptation). For the treadmill only condition, a similar protocol was used but no force was applied. EMGs from muscles of the paretic leg and ankle kinematic data were recorded. Spatial–temporal gait parameters during overground walking pre and post treadmill walking were also collected. Integrated EMGs of ankle plantarflexors and hip extensors during stance phase significantly increased during the early adaptation period, and partially retained (15–21% increase) during the post-adaptation period for the constraint force condition, which were significantly greater than that for the treadmill only (3–5%) condition. The symmetry of step length during overground walking significantly improved (p = 0.04) after treadmill walking with the constraint condition, but had no significant change after treadmill walking only. Repetitively applying constraint force to the non-paretic leg during treadmill walking may lead to a motor learning of enhanced use of the paretic leg in individuals post-stroke, which may transfer to overground walking.

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References

  • Alcantara CC, Charalambous CC, Morton SM, Russo TL, Reisman DS (2018) Different error size during locomotor adaptation affects transfer to overground walking poststroke. Neurorehabil Neural Repair 32:1020–1030

    Article  PubMed  PubMed Central  Google Scholar 

  • Blanchette A, Bouyer LJ (2009) Timing-specific transfer of adapted muscle activity after walking in an elastic force field. J Neurophysiol 102:568–577

    Article  PubMed  Google Scholar 

  • Burridge JH, Wood DE, Taylor PN, McLellan DL (2001) Indices to describe different muscle activation patterns, identified during treadmill walking, in people with spastic drop-foot. Med Eng Phys 23:427–434

    Article  CAS  PubMed  Google Scholar 

  • Centers for Disease Control and Prevention (2012) Prevalence of stroke–United States, 2006–2010. MMWR Morb Mortal Wkly Rep 61:379–382

    Google Scholar 

  • Chen G, Patten C, Kothari DH, Zajac FE (2005) Gait differences between individuals with post-stroke hemiparesis and non-disabled controls at matched speeds. Gait Posture 22:51–56

    Article  PubMed  Google Scholar 

  • Classen J, Liepert J, Wise SP, Hallett M, Cohen LG (1998) Rapid plasticity of human cortical movement representation induced by practice. J Neurophysiol 79:1117–1123

    Article  CAS  PubMed  Google Scholar 

  • Diedrichsen J, White O, Newman D, Lally N (2010) Use-dependent and error-based learning of motor behaviors. J Neurosci 30:5159–5166

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Dietz V, Quintern J, Boos G, Berger W (1986) Obstruction of the swing phase during gait: phase-dependent bilateral leg muscle coordination. Brain Res 384:166–169

    Article  CAS  PubMed  Google Scholar 

  • Duncan PW, Sullivan KJ, Behrman AL, Azen SP, Wu SS, Nadeau SE, Dobkin BH, Rose DK, Tilson JK, Cen S, Hayden SK, Team LI (2011) Body-weight-supported treadmill rehabilitation after stroke. N Engl J Med 364:2026–2036

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Folstein MF, Folstein SE, McHugh PR (1975) Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198

    Article  CAS  PubMed  Google Scholar 

  • Gama GL, Celestino ML, Barela JA, Forrester L, Whitall J, Barela AM (2017) Effects of gait training with body weight support on a treadmill versus overground in individuals with stroke. Arch Phys Med Rehabil 98:738–745

    Article  PubMed  Google Scholar 

  • Hase K, Suzuki E, Matsumoto M, Fujiwara T, Liu M (2011) Effects of therapeutic gait training using a prosthesis and a treadmill for ambulatory patients with hemiparesis. Arch Phys Med Rehabil 92:1961–1966

    Article  PubMed  Google Scholar 

  • Hesse S, Bertelt C, Jahnke MT, Schaffrin A, Baake P, Malezic M, Mauritz KH (1995) Treadmill training with partial body weight support compared with physiotherapy in nonambulatory hemiparetic patients. Stroke 26:976–981

    Article  CAS  PubMed  Google Scholar 

  • Hollman JH, Watkins MK, Imhoff AC, Braun CE, Akervik KA, Ness DK (2016) A comparison of variability in spatiotemporal gait parameters between treadmill and overground walking conditions. Gait Posture 43:204–209

    Article  PubMed  Google Scholar 

  • Hsu CJ, Kim J, Roth EJ, Rymer WZ, Wu M (2017) Forced use of the paretic leg induced by a constraint force applied to the nonparetic leg in individuals poststroke during walking. Neurorehabil Neural Repair 31:1042–1052

    Article  PubMed  PubMed Central  Google Scholar 

  • Jax SA, Rosenbaum DA (2007) Hand path priming in manual obstacle avoidance: evidence that the dorsal stream does not only control visually guided actions in real time. J Exp Psychol Hum Percept Perform 33:425–441

    Article  PubMed  Google Scholar 

  • Jorgensen HS, Nakayama H, Raaschou HO, Olsen TS (1995) Recovery of walking function in stroke patients: the Copenhagen Stroke Study. Arch Phys Med Rehabil 76:27–32

    Article  CAS  PubMed  Google Scholar 

  • Lewek MD, Bradley CE, Wutzke CJ, Zinder SM (2014) The relationship between spatiotemporal gait asymmetry and balance in individuals with chronic stroke. J Appl Biomech 30:31–36

    Article  PubMed  Google Scholar 

  • Macko RF, Ivey FM, Forrester LW, Hanley D, Sorkin JD, Katzel LI, Silver KH, Goldberg AP (2005) Treadmill exercise rehabilitation improves ambulatory function and cardiovascular fitness in patients with chronic stroke: a randomized, controlled trial. Stroke 36:2206–2211

    Article  PubMed  Google Scholar 

  • Moseley AM, Stark A, Cameron ID, Pollock A (2005) Treadmill training and body weight support for walking after stroke. Cochrane Database Syst Rev 4:CD002840

    Google Scholar 

  • Mulroy SJ, Eberly VJ, Gronely JK, Weiss W, Newsam CJ (2010) Effect of AFO design on walking after stroke: impact of ankle plantar flexion contracture. Prosthet Orthot Int 34:277–292

    Article  PubMed  Google Scholar 

  • Nadeau S, Gravel D, Arsenault AB, Bourbonnais D (1999) Plantarflexor weakness as a limiting factor of gait speed in stroke subjects and the compensating role of hip flexors. Clin Biomech (Bristol, Avon) 14:125–135

    Article  CAS  Google Scholar 

  • Olney SJ, Griffin MP, McBride ID (1994) Temporal, kinematic, and kinetic variables related to gait speed in subjects with hemiplegia: a regression approach. Phys Ther 74:872–885

    Article  CAS  PubMed  Google Scholar 

  • Patterson SL, Rodgers MM, Macko RF, Forrester LW (2008) Effect of treadmill exercise training on spatial and temporal gait parameters in subjects with chronic stroke: a preliminary report. J Rehabil Res Dev 45:221–228

    Article  PubMed  PubMed Central  Google Scholar 

  • Patterson KK, Gage WH, Brooks D, Black SE, McIlroy WE (2010) Evaluation of gait symmetry after stroke: a comparison of current methods and recommendations for standardization. Gait Posture 31:241–246

    Article  PubMed  Google Scholar 

  • Perry J, Burnfield JM (2010) Gait analysis. Normal and pathological function. SLACK, Pomona, California

    Google Scholar 

  • Perry J, Garrett M, Gronley JK, Mulroy SJ (1995) Classification of walking handicap in the stroke population. Stroke 26:982–989

    Article  CAS  PubMed  Google Scholar 

  • Pohl M, Mehrholz J, Ritschel C, Ruckriem S (2002) Speed-dependent treadmill training in ambulatory hemiparetic stroke patients: a randomized controlled trial. Stroke 33:553–558

    Article  PubMed  Google Scholar 

  • Raja B, Neptune RR, Kautz SA (2012) Coordination of the non-paretic leg during hemiparetic gait: expected and novel compensatory patterns. Clin Biomech (Bristol, Avon) 27:1023–1030

    Article  PubMed Central  Google Scholar 

  • Reisman DS, Wityk R, Silver K, Bastian AJ (2009) Split-belt treadmill adaptation transfers to overground walking in persons poststroke. Neurorehabil Neural Repair 23:735–744

    Article  PubMed  PubMed Central  Google Scholar 

  • Reisman DS, McLean H, Keller J, Danks KA, Bastian AJ (2013) Repeated split-belt treadmill training improves poststroke step length asymmetry. Neurorehabil Neural Repair 27:460–468

    Article  PubMed  PubMed Central  Google Scholar 

  • Roelker SA, Bowden MG, Kautz SA, Neptune RR (2019) Paretic propulsion as a measure of walking performance and functional motor recovery post-stroke: a review. Gait Posture 68:6–14

    Article  PubMed  Google Scholar 

  • Savin DN, Tseng SC, Morton SM (2010) Bilateral adaptation during locomotion following a unilaterally applied resistance to swing in nondisabled adults. J Neurophysiol 104:3600–3611

    Article  PubMed  PubMed Central  Google Scholar 

  • Savin DN, Morton SM, Whitall J (2014) Generalization of improved step length symmetry from treadmill to overground walking in persons with stroke and hemiparesis. Clin Neurophysiol 125:1012–1020

    Article  PubMed  Google Scholar 

  • Siebers A, Oberg U, Skargren E (2010) The effect of modified constraint-induced movement therapy on spasticity and motor function of the affected arm in patients with chronic stroke. Physiother Can 62:388–396

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Souissi H, Zory R, Boudarham J, Pradon D, Roche N, Gerus P (2019) Muscle force strategies for poststroke hemiparetic patients during gait. Top Stroke Rehabil 26:58–65

    Article  PubMed  Google Scholar 

  • Sullivan KJ, Knowlton BJ, Dobkin BH (2002) Step training with body weight support: effect of treadmill speed and practice paradigms on poststroke locomotor recovery. Arch Phys Med Rehabil 83:683–691

    Article  PubMed  Google Scholar 

  • Taub E, Miller NE, Novack TA, Cook EW 3rd, Fleming WC, Nepomuceno CS, Connell JS, Crago JE (1993) Technique to improve chronic motor deficit after stroke. Arch Phys Med Rehabil 74:347–354

    CAS  PubMed  Google Scholar 

  • Visintin M, Barbeau H, Korner-Bitensky N, Mayo NE (1998) A new approach to retrain gait in stroke patients through body weight support and treadmill stimulation. Stroke 29:1122–1128

    Article  CAS  PubMed  Google Scholar 

  • Wolf SL, Winstein CJ, Miller JP, Taub E, Uswatte G, Morris D, Giuliani C, Light KE, Nichols-Larsen D, Investigators E (2006) Effect of constraint-induced movement therapy on upper extremity function 3–9 months after stroke: the EXCITE randomized clinical trial. JAMA 296:2095–2104

    Article  CAS  PubMed  Google Scholar 

  • Wu M, Hornby TG, Landry JM, Roth H, Schmit BD (2011) A cable-driven locomotor training system for restoration of gait in human SCI. Gait Posture 33:256–260

    Article  PubMed  Google Scholar 

  • Yang JF, Stephens MJ, Vishram R (1998) Transient disturbances to one limb produce coordinated, bilateral responses during infant step**. J Neurophysiol 79:2329–2337

    Article  CAS  PubMed  Google Scholar 

  • Yen SC, Schmit BD, Landry JM, Roth H, Wu M (2012) Locomotor adaptation to resistance during treadmill training transfers to overground walking in human SCI. Exp Brain Res 216:473–482

    Article  PubMed  Google Scholar 

  • Yen SC, Landry JM, Wu M (2013) Size of kinematic error affects retention of locomotor adaptation in human spinal cord injury. J Rehabil Res Dev 50:1187–1200

    Article  PubMed  Google Scholar 

  • Zehr EP, Loadman PM (2012) Persistence of locomotor-related interlimb reflex networks during walking after stroke. Clin Neurophysiol 123:796–807

    Article  PubMed  Google Scholar 

  • Zeni JA Jr, Richards JG, Higginson JS (2008) Two simple methods for determining gait events during treadmill and overground walking using kinematic data. Gait Posture 27:710–714

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This study was supported by NIH/NICHD, R01HD082216. We thank Dr. Rongnian Tang’s assistance for data collection.

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Authors and Affiliations

  1. Legs and Walking Lab, Shirley Ryan AbilityLab, 355 East Erie Street, 23rd Floor, Chicago, IL, 60611, USA

    Ming Wu, Chao-Jung Hsu & Janis Kim

  2. Department of Bioengineering, University of Illinois at Chicago, Chicago, IL, USA

    Ming Wu

  3. Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA

    Ming Wu

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  1. Ming Wu
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  2. Chao-Jung Hsu
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Correspondence to Ming Wu.

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Wu, M., Hsu, CJ. & Kim, J. Forced use of paretic leg induced by constraining the non-paretic leg leads to motor learning in individuals post-stroke. Exp Brain Res 237, 2691–2703 (2019). https://doi.org/10.1007/s00221-019-05624-w

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