Recovery of gait after stroke: what changes?

Background. Little is known about whether changes in coordination patterns of muscle activation after stroke are related to functional recovery of walking. Objective. The present study investigated the longitudinal relationship between changes in neuromuscular activation patterns of paretic muscles in hemiplegic gait and improvement in walking ability after stroke. Methods. Thirteen patients diagnosed with a first unilateral ischemic stroke had their recovery of walking measured by the Rivermead Mobility Index, Functional Ambulation Categories, Barthel Index, Trunk Control Test, Motricity Index, and comfortable walking speed. Surface electromyography (SEMG) of the erector spinae, gluteus maximus, gluteus medius, rectus femoris, vastus lateralis, semitendinosus, gastrocnemius, and tibialis anterior muscles of both legs was used to quantify coordination patterns in comfortable walking mode. All clinical and electromyography-related measurements were taken at 3, 6, 9, 12, and 24 weeks poststroke. Timing parameters of the SEMG patterns were calculated, using an objective burst detection algorithm, and analyzed with the measures of functional recovery. Results. All functional measures, except Trunk Control Test, showed statistically significant improvement over time, whereas SEMG patterns did not change significantly over time. Conclusion. The lack of significant change in SEMG patterns over time suggests that functional gait improvements may be more related to compensatory strategies in muscle activation of the unaffected leg and biomechanical changes than by restitution of muscle coordination patterns in the affected leg. Copyright © 2008 The American Society of Neurorehabilitation.