IS A CLINICALLY TRAINED HEMIPARETIC LOWER LIMB READY FOR REAL LIFE ENVIRONMENT BASED CHALLENGES?
After a stroke, majority of stroke individuals regain their ability to walk. However, 70% of these individuals face difficulty in community ambulation even though they achieve relatively good steady-state walking ability. One-third of stroke survivors have reported an inability to walk within their community. Community ambulation is extremely essential as it contributes to health benefits such as an increase in physical activity and it has a tremendous impact on participation in society, reducing the risks for mental illness and hence the quality of life.
Patla and Shumway-cook have proposed a model consisting of eight dimensions which are essential for successful community ambulation.
However, in practice, minimal or no therapy time is spent on training the individual to adapt his/her walking pattern to suit his/her community.
To design an effective rehabilitation intervention that targets community mobility post-stroke, we need to understand how muscle activity alters in individuals with stroke while walking in the community. Despite the availability of few studies that report paretic limb muscle activity during walking at varying speeds, climbing stairs or ramp individually, all these dimensions have not been assessed together. Assessment of these dimensions together becomes important to understand walking adaptability in a community post-stroke.
An observational cross-sectional study with sixteen ambulatory stroke survivors was conducted to assess the influence of real-life environmental dimensions on muscle activity of Rectus Femoris, Biceps Femoris, Tibialis Anterior, and Gastrocnemius Medialis muscles of the paretic lower limb. Delsys, Trigno wireless EMG system (8 channel) AD instruments, USA was used to record muscle activity from four muscles of the paretic lower limb.
Participants walked on the 62 meter-walkway that assessed all the forementioned dimensions.
Our results indicate that walking on challenging real-life environmental dimensions reduced muscle activity in patients with hemiparesis compared to walking on an even surface. The decrease in muscle activity could have been due to an increase in demand to maintain stability while walking on challenging environmental dimensions.
This study provided insight into reduced muscle activity that occurs while walking through environmental dimensions. This suggests that our current methods of assessment and training to provide rehabilitation need to be redesigned so that the clinical rehabilitation that we provide does translate into community re-integration.