Asymétrie locomotrice chez le sujet hémiparétique: Pourquoi et comment utiliser le tapis roulant double courroie pour améliorer la performance à la marche
Pr Sylvie M. NADEAUa, Dr Séléna LAUZIÈREb, Mme Carole MIÉVILLEb, Mme Martina BETSCHARTb
a École de réadaptation, Université de Montréal, Pavillon du Parc, b Centre de recherche interdisciplinaire en réadaptation (CRIR), Institut de réadaptation Gingras-Lindsay-de-Montréal
Introduction: The recovery of gait symmetry post-stroke tends to be more challenging compared to other functional deficits when using conventional therapy. However, investigations on walking at unequal speeds on a split-belt treadmill have revealed improvements in symmetry of spatial and temporal gait parameters.
Objective: The main objective of this study was to identify the causes of changes in spatio-temporal parameters by quantifying net joint moments and muscular levels of effort in the lower limbs during different walking conditions on a split-belt treadmill.
Methods: Twenty individuals with chronic stroke and a mean age of 49 (±13) years and 10 age-matched controls walked on an instrumented split-belt treadmill under three gait periods: 1) baseline (tied-belt); 2) adaptation (split-belt); and 3) post-adaptation (tied-belt). Participants post-stroke performed the protocol with the paretic and non-paretic leg on the faster belt when belts were split. Kinematic data were recorded with the Optotrak system and ground reaction forces were collected via the instrumented split-belt treadmill. The dynamic inverse gave the joint moments while levels of effort were assessed with the muscular utilization ratio (ratio of walking moment relative to the muscle’s maximal capability). Repeated measures ANOVA and t-tests were used to compare the variables during the three periods. Pearson correlations were used to assess the relationships between asymmetries in these parameters.
Results: The condition with the shorter step on the fast belt improved the step length symmetry. Placing the paretic limb on the slow belt increased the plantarflexion moment in post-adaptation and that such increase was correlated with the increase in contralateral step length. A more symmetrical gait pattern (temporal or spatial) following walking on the split-belt treadmill required high levels of effort (over 85%) in paretic plantarflexors. Results also revealed that the healthy individuals had a good ability to detect asymmetry. Individuals post stroke perceived temporal asymmetry better than spatial asymmetry.
Discussion/Conclusion: Overall, these results suggest that muscle strength and muscular level of effort, mainly in paretic plantarflexors, need to be considered to use the split-belt treadmill in the adaptation (split-belt) period. The classification of individuals post stroke into subgroups according to their sensorimotor deficits and gait asymmetries might be an important aspect to consider with this type of training.
Mots clés : Locomotion, asymétrie, niveau d'effort, perception, AVC, biomechanique, réadaptation