Characteristics of uneven surface walking in stroke patients: Modification in biomechanical parameters and muscle activity

Yasuhiro Inui; Naomichi Mizuta; Kazuki Hayashida; Yuki Nishi; Yuki Yamaguchi; Shu Morioka

doi:10.1016/j.gaitpost.2023.05.022

Characteristics of uneven surface walking in stroke patients: Modification in biomechanical parameters and muscle activity

Gait Posture. 2023 Jun:103:203-209. doi: 10.1016/j.gaitpost.2023.05.022. Epub 2023 May 23.

Authors

Yasuhiro Inui¹, Naomichi Mizuta², Kazuki Hayashida³, Yuki Nishi⁴, Yuki Yamaguchi⁵, Shu Morioka⁶

Affiliations

¹ Department of Neurorehabilitation, Kio University, Nara, Japan; Department of Rehabilitation, Nara Prefecture General Rehabilitation Center, Nara, Japan. Electronic address: y.inui.pt@gmail.com.
² Department of Physical Therapy, School of Health Science, Nihon Fukushi University, Japan; Neurorehabilitation Research Center, Kio University, Nara, Japan.
³ Department of Rehabilitation, Wakayama Faculty of Health Care Sciences, Takarazuka University of Medical and Health Care, Wakayama, Japan; Neurorehabilitation Research Center, Kio University, Nara, Japan.
⁴ Institute of Biomedical Sciences (Health Sciences), Nagasaki University, Nagasaki, Japan; Neurorehabilitation Research Center, Kio University, Nara, Japan.
⁵ Department of Neurorehabilitation, Kio University, Nara, Japan; Department of Rehabilitation, Nara Prefecture General Rehabilitation Center, Nara, Japan.
⁶ Department of Neurorehabilitation, Kio University, Nara, Japan; Neurorehabilitation Research Center, Kio University, Nara, Japan.

PMID: 37245334
DOI: 10.1016/j.gaitpost.2023.05.022

Abstract

Background: Stroke patients have difficulty walking in outdoor environments, including uneven surfaces, reducing their opportunities for social participation. Changes in stroke patients' gait while walking on even surfaces have been reported; however, gait alterations on uneven surfaces remain unclear.

Research question: To what extent do biomechanical parameters and muscle activity during even and uneven surface walking differ between stroke patients and healthy people?

Methods: Twenty stroke patients and 20 age-matched healthy people walked on a 6 m even and uneven surfaces. Data on gait speed, root mean square (RMS) of trunk acceleration as a measure of gait stability, maximum joint angle, average muscle activity, and muscle activity time were quantified using accelerometers attached to the trunk, video camera images, and electromyography of lower extremities. A two-factor mixed-model analysis of variance was used to test the effects of group, surface, and group × surface interactions.

Results: Gait speed decreased (p < 0.001) on the uneven surface in stroke patients and healthy people. RMS showed an interaction (p < 0.001), and the post-hoc test revealed an increase in stroke patients in the mediolateral direction during the swing phase on the uneven surface. The hip extension angle during the stance phase showed an interaction (p = 0.023), and the post-hoc test revealed a decrease in stroke patients on the uneven surface. The soleus muscle activity time showed an interaction during the swing phase (p = 0.041), and the post-hoc test revealed an increase in stroke patients compared to healthy people only on the uneven surface.

Significance: While walking on an uneven surface, stroke patients showed decreased gait stability, decreased hip extension angle during stance phase, and increased ankle plantar flexor activity time during swing phase. These changes may result from impaired motor control and compensatory strategies used by stroke patients on uneven surfaces.

Keywords: Biomechanics; EMG; GAIT; Stroke; Uneven surface.

MeSH terms

Biomechanical Phenomena / physiology
Electromyography
Gait / physiology
Humans
Muscle, Skeletal / physiology
Stroke* / complications
Walking* / physiology