Effect of a walking training with a mass around the paretic ankle in chronic hemiparetic
Dr Wafa ELLEUCHa, Mrs Mouna GHEDIRAb, Dr Inke Marie ALBERTSENb, Prof Jean-Michel GRACIESb, Dr Emilie HUTINb
a Service de médecine physique, rééducation et réadaptation fonctionnelle, CHU Habib Bourguiba, Sfax, Tunisie Unité de recherche de l’évaluation des pathologies de l’appareil locomoteur UR12ES18, université de Sfax, route de l’Aéroport 0,5 km, BP 1169, b Laboratoire Analyse et Restauration du Mouvement (ARM), EA BIOTN, Hôpitaux Universitaires Henri Mondor, Assistance Publique - Hôpitaux de Paris, Université Paris-Est Créteil
The rehabilitation intensity in spastic paresis is an important factor of recovery. We investigated the effect of daily walking training at fast speed with adding resistance around the paretic shank on gait performance.
To compare the acute effect of two 30-minute walking training at fast speed, without and with a mass around the paretic ankle on spatiotemporal and kinematic parameters in chronic hemiparetic gait.
Prospective, controlled, randomized, single-blind study. Six subjects with chronic hemiparesis (1 F, 41±11y, time from CNS lesion: 7±8y) performed gait training during 30min at fast speed twice one week apart: without (M0), or with mass as 2% of the body weight fixed around the paretic ankle (M1). All participants were assessed before and immediately after the training. The principal evaluation criterion was the maximal walking speed measured barefoot in the laboratory. Three kinematic parameters were quantified based on videographic analysis: maximal active hip flexion, maximal passive knee flexion and maximal active ankle dorsiflexion during swing phase.
The maximal walking speed increased in both training sessions, with superior improvement with adding mass (N=5; M0, 5.6%, p=0.043; M1, 9.9%, p=0.043; M0 vs M1, p=0.043). No modification in flexion of hip, knee and ankle was measured during swing phase.
A mass added on the paretic shank leads to improve short term benefits of 30-minute walking training at fast speed. It would be interesting to test long term effect of this training method over several weeks.
Blanchette A, Lambert S, Richards C, Bouyer L. Walking while resisting a perturbation: Effects on ankle dorsiflexor activation during swing and potential for rehabilitation. Gait Posture. 2011;34:358-63.
Keywords : chronic hemiparetic, gait, maximal walking speed, resistance, kinematic parameters