Objective: To describe the recovery of neurophysiological responses to perturbation of standing balance after stroke.
Methods: Surface electromyography (EMG) from hip abductors and adductors and ground reaction forces (GRF) were measured in response to 20 sideways pushes applied to the pelvis by a linear motor. Each subject's data from pushes in each direction were averaged and the presence of a muscle EMG response was assessed visually.
Subjects: Thirteen acute hemiplegic patients were tested as soon as they could stand after stroke (median six weeks) and serially during recovery.
Results: Four patterns of hip muscle activity were seen: (1) no response at all, (2) no response in hemiparetic muscles but compensation by contralateral muscles, (3) an appropriate, if delayed, response in the hemiparetic abductor but not adductor muscles, and (4) a relatively normal pattern in both hemiparetic muscles. Nine of 13 patients showed a change in pattern of hip muscle activity during recovery. All patients who initially resisted the sideways pushes solely with muscles of the unaffected leg later regained use of the hemiparetic hip abductors
Conclusions: The pattern of hip muscle activation changed towards normal during recovery from stroke in most patients. Use of compensatory strategies early after stroke in these subjects did not prevent return of normal patterns of muscle activation later.
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References
1.
Twitchell TE. The restoration of motor function following hemiplegia in man. Brain1951; 74: 443–480.
2.
Wade DT, Wood VA, Heller A et al. Walking after stroke. Measurement and recovery over the first 3 months. Scand J Rehabil Med1987; 19: 25–30.
3.
Wade DT, Langton Hewer R, Wood VA et al. The hemiplegic arm after stroke: measurement and recovery. J Neurol Neurosurg Psychiatry1983; 46: 521–524.
4.
Wade DT, Langton Hewer R. Functional abilities after stroke: measurement, natural history and prognosis. J Neurol Neurosurg Psychiatry1987; 50: 177–182
5.
Heller A, Wade DT, Wood VA, Sunderland A, Langton Hewer R, Ward E. Arm function after stroke: measurement and recovery over the first three months. J Neurol Neurosurg Psychiatry1987; 50: 714–719.
6.
Friedman PJ. Gait recovery after hemiplegic stroke. Int Disabil Stud1990; 12: 119–122.
7.
Heald A, Bates D, Cartlidge NEF, French JM, Miller S. Longitudinal study of central motor conduction time following stroke: 1 – Natural history of central motor conduction. Brain1993; 116: 1355–1370.
8.
Turton A, Wroe S, Trepte N, Fraser C, Lemon RN. Contralateral and ipsilateral EMG responses to transcranial magnetic stimulation during recovery of arm and hand function after stroke. Electroencephalogr Clin Neurophysiol1996; 101: 316–328.
9.
Horak FB, Nashner LM. Central programming of postural movements: adaptation to altered support-surface configurations. J Neurophys1986; 55: 1369–1381.
10.
Diener HC, Bacher M, Guschlbauer B, Thomas C, Dichgans J. The co-ordination of posture and voluntary movement in patients with hemiparesis. J Neurol1993; 240: 161–167.
11.
Gilles M, Wing AM, Kirker SG. Lateral balance organisation in human stance in response to a random or predictable perturbation. Exp Brain Res1999; 124: 137–144
12.
Kirker SGB, Simpson DS, Jenner JR, Wing AM. Stepping before standing: hip muscle function in posture and gait after stroke. J Neurol Neurosurg Psychiatry2000; 68: 458–464.
13.
Holt R, Simpson DS, Wing AM, Kirker SGB, Jenner JR. Ground reaction force after a sideways push as a measure of balance in recovery from stroke. Clin Rehabil2000; 14: 88–95.
14.
Collen FM, Wade DT, Robb GF, Bradshaw CM. The Rivermead Mobility Index: a further development of the Rivermead Motor Assessment. Int Disabil Stud1991; 13, 50–54.
15.
Demeurisse G, Demol O, Robaye E. Motor evaluation in vascular hemiplegia. Eur Neurol1980, 19: 382–389.
16.
Warlow CP. Disorders of the cerebral circulation. In: Walton J ed. Brain's diseases of the nervous system. Oxford: Oxford University Press, 1993: 197–269.
17.
Wade DT, Collen FM, Robb GF, Warlow CP. Physiotherapy intervention late after stroke and mobility. BMJ1992; 304: 609–613.
18.
Badke MB, Duncan PW. Patterns of rapid motor responses during postural adjustments when standing in healthy subjects and hemiplegic patients. Phys Ther1983; 63: 13–20.
19.
Di Fabio RP, Badke MB. Reliability of postural response as a function of muscular synergisms: effect of supraspinal lesions. Hum Movement Sci1989; 8: 447–464.
20.
Dickstein R, Hocherman S, Dannenbaum E, Pilar T. Responses of ankle musculature of healthy subjects and hemiplegic patients to sinusoidal anterior-posterior movements of the base of support. J Motor Behav1989; 21: 99–112.
21.
Diener HC, Ackermann H, Dichgans J, Guschlbauer B. Medium- and long-latency responses to displacements of the ankle joint in patients with spinal and central lesions. Electroencephalogr Clin Neurophysiol1985; 60: 407–416.
22.
Jenner J R, Stephens JA. Cutaneous reflex responses and their central nervous pathways studied in man. J Physiol1982, 333: 405–419.
23.
Marsden CD, Merton PA, Morton HB, Adam J. The effect of lesions of the central nervous system on long latency stretch reflexes in the human thumb. In: Desmedt JE ed. Progress in clinical neurophysiology, Volume 4. Cerebral motor control in man: long loop mechanisms. Basel: Karger, 1978: 334–341.
24.
Wade DT. Measurement in neurological rehabilitation. Oxford: Oxford University Press, 1992: 452-452.
25.
Blower PW, Carter L, Sulch DA. Relationship between wheelchair propulsion and independent walking in hemiplegic stroke. Stroke1995; 26: 606–668.
