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Coordination of Hemiparetic Locomotion after Stroke Rehabilitation

Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville FL, Department of Physical Therapy, Brooks Center for Rehabilitation Studies, skautz{at}phhp.ufl.edu

Pamela W. Duncan

Rehabilitation Outcomes Research Center, University of Florida, Gainesville, Department of Aging and Geriatric Research, University of Florida, Gainesville

Subashan Perera

Division of Geriatric Medicine, University of Pittsburgh, Pittsburgh, PA

Richard R. Neptune

Department of Mechanical Engineering, University of Texas, Austin

Stephanie A. Studenski

Department of Internal Medicine, University of Pittsburgh, Pittsburgh, PA, Department of Veteran Affairs Medical Center, Pittsburgh, PA

Objectives. Determine whether a rehabilitation program targeting functional motor recovery of persons with poststroke hemiparesis improved motor coordination. Methods. A subgroup of 20 persons with poststroke hemiparesis (n = 11 in intervention and n =9incontrol group) was investigated from within a larger randomized controlled single-blind clinical trial of 100 patients. Motor coordination was measured using a pedaling task, and subjects in the intervention group pedaled during an intensive broad-based home exercise program that targeted flexibility, strength, balance, and endurance. Coordination variables based on paretic leg pedal forces and EMG of 4 thigh muscles were measured while pedaling pre- and postintervention. Results. Despite extensive pedaling practice, up to 30 half-hour sessions that were progressively more intense, there was no effect (P > 0.05) of the intervention on percent of total work done by the paretic leg, quantitative measures of EMG, or pedaling speed. However, walking speed was improved and pedaling and walking faster were associated after the intervention. Conclusions. There is no evidence of improved locomotor coordination postintervention. The increased walking and pedaling speed was likely achieved by a more proficient use of the same impaired pattern without EMG timing changes, likely because of increased strength and endurance postintervention. A more task-specific intervention may be required to improve coordination, consistent with principles of use-dependent plasticity.

Key Words: Stroke • Hemiparesis • Locomotion • Coordination • Rehabilitation

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