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Open Access Research

Changes in the activation and function of the ankle plantar flexor muscles due to gait retraining in chronic stroke survivors

Brian A Knarr15*, Trisha M Kesar4, Darcy S Reisman12, Stuart A Binder-Macleod12 and Jill S Higginson13

Author Affiliations

1 Biomechanics and Movement Science, University of Delaware, Newark, DE, USA

2 Department of Physical Therapy, University of Delaware, Newark, DE, USA

3 Department of Mechanical Engineering, University of Delaware, Newark, DE, USA

4 Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University, Atlanta, GA, USA

5 University of Delaware, 126 Spencer Lab, Newark, DE 19716, USA

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Journal of NeuroEngineering and Rehabilitation 2013, 10:12  doi:10.1186/1743-0003-10-12

Published: 31 January 2013

Abstract

Background

A common goal of persons post-stroke is to regain community ambulation. The plantar flexor muscles play an important role in propulsion generation and swing initiation as previous musculoskeletal simulations have shown. The purpose of this study was to demonstrate that simulation results quantifying changes in plantar flexor activation and function in individuals post-stroke were consistent with (1) the purpose of an intervention designed to enhance plantar flexor function and (2) expected muscle function during gait based on previous literature.

Methods

Three-dimensional, forward dynamic simulations were created to determine the changes in model activation and function of the paretic ankle plantar flexor muscles for eight patients post-stroke after a 12-weeks FastFES gait retraining program.

Results

An median increase of 0.07 (Range [−0.01,0.22]) was seen in simulated activation averaged across all plantar flexors during the double support phase of gait from pre- to post-intervention. A concurrent increase in walking speed and plantar flexor induced forward center of mass acceleration by the plantar flexors was seen post-intervention for seven of the eight subject simulations. Additionally, post-training, the plantar flexors had an simulated increase in contribution to knee flexion acceleration during double support.

Conclusions

For the first time, muscle-actuated musculoskeletal models were used to simulate the effect of a gait retraining intervention on post-stroke muscle model predicted activation and function. The simulations showed a new pattern of simulated activation for the plantar flexor muscles after training, suggesting that the subjects activated these muscles with more appropriate timing following the intervention. Functionally, simulations calculated that the plantar flexors provided greater contribution to knee flexion acceleration after training, which is important for increasing swing phase knee flexion and foot clearance.

Keywords:
Gait; Stroke; Musculoskeletal simulation; Plantar flexors; Muscle function