Anticipatory Postural Adjustments During Gait Initiation in Stroke Patients

Arnaud Delafontaine, Thomas Vialleron, Tarek Hussein, Eric Yiou, Jean-Louis Honeine, Silvia Colnaghi

Research output: Contribution to journalArticle

Abstract

Prior to gait initiation (GI), anticipatory postural adjustments (GI-APA) are activated in order to reorganize posture, favorably for gait. In healthy subjects, the center of pressure (CoP) is displaced backward during GI-APA, bilaterally by reducing soleus activities and activating the tibialis anterior (TA) muscles, and laterally in the direction of the leading leg, by activating hip abductors. In post-stroke hemiparetic patients, TA, soleus and hip abductor activities are impaired on the paretic side. Reduction in non-affected triceps surae activity can also be observed. These may result in a decreased ability to execute GI-APA and to generate propulsion forces during step execution. A systematic review was conducted to provide an overview of the reorganization which occurs in GI-APA following stroke as well as of the most effective strategies for tailoring gait-rehabilitation to these patients. Sixteen articles were included, providing gait data from a total of 220 patients. Stroke patients show a decrease in the TA activity associated with difficulties in silencing soleus muscle activity of the paretic leg, a decreased CoP shift, lower propulsive anterior forces and a longer preparatory phase. Regarding possible gait-rehabilitation strategies, the selected studies show that initiating gait with the paretic leg provides poor balance. The use of the non-paretic as the leading leg can be a useful exercise to stimulate the paretic postural muscles.

Original languageEnglish
Pages (from-to)352
JournalFrontiers in Neurology
Volume10
DOIs
Publication statusPublished - 2019

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Gait
Stroke
Leg
Hip
Rehabilitation
Pressure
Muscles
Posture
Healthy Volunteers
Skeletal Muscle
Exercise

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Anticipatory Postural Adjustments During Gait Initiation in Stroke Patients. / Delafontaine, Arnaud; Vialleron, Thomas; Hussein, Tarek; Yiou, Eric; Honeine, Jean-Louis; Colnaghi, Silvia.

In: Frontiers in Neurology, Vol. 10, 2019, p. 352.

Research output: Contribution to journalArticle

Delafontaine, Arnaud ; Vialleron, Thomas ; Hussein, Tarek ; Yiou, Eric ; Honeine, Jean-Louis ; Colnaghi, Silvia. / Anticipatory Postural Adjustments During Gait Initiation in Stroke Patients. In: Frontiers in Neurology. 2019 ; Vol. 10. pp. 352.
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