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Gait velocity and joint power generation after stroke

contribution of strength and balance

Mentiplay, Benjamin F., PhD1,2,3; Williams, Gavin, PhD3,4; Tan, Dawn, ClinDoc(Physio)5; Adair, Brooke, PhD6; Pua, Yong-Hao, PhD5; Bok, Chek Wai, MD7; Bower, Kelly J., PhD8; Cole, Michael H., PhD9; Ng, Yee Sien, MD7; Lim, Lek Syn, DipEng10; Clark, Ross A., PhD8

American Journal of Physical Medicine & Rehabilitation: December 28, 2018 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/PHM.0000000000001122
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Objective To assess the degree to which isometric strength of multiple lower limb muscle groups and balance is associated with gait velocity and joint power generation during gait after stroke.

Design Sixty-three participants in a multi-site, multi-national cross-sectional, observational study underwent assessment of gait velocity (10m walk test), standing balance (computerised posturography), and isometric strength (hand-held dynamometry). Twenty-seven participants had joint power generation assessed (three-dimensional gait analysis). Bivariate associations were examined using Spearman’s correlations. Regression models with partial F-tests were used to compare the contribution to gait between measures.

Results While all muscle groups demonstrated significant associations with gait velocity (rho = 0.40-0.72), partial F-tests identified that ankle plantarflexor and hip flexor strength made the largest contribution to gait velocity. Ankle plantarflexor strength also had strong associations with habitual and fast paced ankle power generation (rho = 0.65 and 0.75). Balance had significant associations with habitual and fast gait velocity (rho = -0.57 and -0.53), with partial F-tests showing the contribution was independent of strength.

Conclusion Ankle plantarflexor and hip flexor strength had the largest contribution to gait velocity. Future research may wish to refocus strength assessment and treatment to target the ankle plantarflexors and hip flexors.

1La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia

2Victorian Infant Brain Studies, Murdoch Children’s Research Institute, Melbourne, Australia

3Physiotherapy Department, Epworth HealthCare, Melbourne, Australia

4Physiotherapy Department, University of Melbourne, Melbourne, Australia

5Physiotherapy Department, Singapore General Hospital, Singapore

6Centre for Disability and Development Research, Australian Catholic University, Melbourne, Australia

7Department of Rehabilitation Medicine, Singapore General Hospital, Singapore

8Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Sunshine Coast, Australia

9Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia

10Movement Science Laboratory, Singapore General Hospital, Singapore

Conflict of interest: The authors declare no conflict of interest.

Acknowledgements: The authors wish to thank Laura Di Nicolantonio for her generous assistance in participant recruitment. Author BFM was funded by an Endeavour Research Fellowship from the Australian Government, Department of Education and Training; author GW was funded by a National Health and Medical Research Council Translating Research into Practice Fellowship; and author RAC was funded by a National Health and Medical Research Council Career Development Fellowship. The funding bodies had no involvement in the study.

Corresponding Author: Benjamin F Mentiplay, La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora VIC 3086 AUSTRALIA, Phone: +61 400 801 627; Email: b.mentiplay@latrobe.edu.au

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