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Title: Relationship of hemiparetic gait patterns to underlying neurological impairment and its relevance to physiotherapeutic intervention
Author: Cooper, Allison
ISNI:       0000 0004 2747 5866
Awarding Body: Cardiff University
Current Institution: Cardiff University
Date of Award: 2005
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Many stroke patients who regain the ability to walk do so with abnormal gait patterns. To improve abnormal gait patterns physiotherapists must determine the underlying causes in order to provide effective treatment. Therefore, this study aimed to determine the neurological impairments of hemiparetic stroke patients, explore their relationship to gait deviations and test whether observation of an individual patient's gait pattern helps determine their underlying impairments and therefore guide rehabilitation. A cross-sectional study design was used and included 31 hemiparetic stroke patients and 20 healthy controls. Gait deviations and neurological impairments were identified from a clinical examination, observational gait analysis, and measurement of EMG responses to quick and slow stretch, isometric force-EMG relationships and muscle activation during gait. Patients were classified into different gait patterns based on their gait deviations. The relationships of impairments to gait deviations and gait patterns were explored. Data analysis used a range of non-parametric and parametric procedures. The paretic limbs of patients produced larger and longer sustained stretch responses compared with controls (p = 0.003 and p<0.0005, respectively). Stretch responses and Modified Ashworth Scale (MAS) scores were greater in the presence of contracture (p = 0.008 and p<0.0005, respectively). The MAS correlated with the magnitude of both quick and slow stretch response activity (rs = 0.204, p = 0.024 and rs = 0.221, p = 0.014, respectively) and with the duration of sustained responses (p<0.0005). The paretic limbs of patients were also considerably weaker overall (p<0.0005) and different causes of weakness were identified direct changes of the agonist were more common than antagonist restraint and contracture. Little out-of-phase EMG activity was found during gait. Individual gait deviations were related to particular underlying impairments such as spasticity, weakness and contracture, whereas the overall gait patterns were not. In conclusion, it is suggested that: physiotherapists consider the possibility of biomechanical changes when providing interventions to reduce spasticity the MAS is a valid clinical measure of spasticity if biomechanical changes are acknowledged physiotherapists should consider all the possible causes of weakness in order to provide appropriate treatment for individual patients some gait deviations are linked to underlying impairments and some to possible compensatory strategies and this may help to guide treatment and gait classification may have little benefit in guiding treatment.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available