Stepping before standing: hip muscle function in stepping and standing balance after stroke

• Published in: Journal of neurology, neurosurgery and psychiatry Vol. 68; no. 4; pp. 458 - 464
• Main Authors: Kirker, S G B, Simpson, D S, Jenner, J R, Wing, A M
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd 01-04-2000; BMJ; BMJ Publishing Group LTD; BMJ Group
• Subjects: balance; Biological and medical sciences; Electromyography; Female; Fitness equipment; gait; hemiparesis; Hip - physiopathology; Humans; Male; Medical sciences; Middle Aged; Muscles - physiopathology; Neurology; Patients; Pelvic Bones - physiopathology; Postural Balance - physiology; Posture; Posture - physiology; Spinal cord; Stroke; Stroke - physiopathology; Vascular diseases and vascular malformations of the nervous system; Walking; Human; Hemiparesis; Nervous system diseases; Stroke; Motor system disorder; Cardiovascular disease; Exploration; Striated muscle; Cerebral disorder; Vascular disease; Electrodiagnosis; Walking; Central nervous system disease; Electromyography; Orthostatism; Neurological disorder; Cerebrovascular disease; Orthostatic equilibrium; Pelvic girdle
• ISSN: 0022-3050; 1468-330X
• DOI: 10.1136/jnnp.68.4.458

OBJECTIVE To compare the pattern of pelvic girdle muscle activation in normal subjects and hemiparetic patients while stepping and maintaining standing balance. DESIGN Group comparison. METHOD Seventeen patients who had regained the ability to walk after a single hemiparetic stroke were studied together with 16 normal controls. Median interval between stroke and testing was 17 months. Amplitude and onset latency of surface EMG activity in hip abductors and adductors were recorded in response to sideways pushes in either direction while standing. Similar recordings were made in the same subjects during gait initiation and a single stride. RESULTS In the standing balance task, normal subjects resisted a sideways push to the left with the left gluteus medius (74 ms) and with the right adductor (111 ms), and vice versa. In hemiparetic patients, the amplitude of activity was reduced in the hemiparetic muscles, the onset latencies of which were delayed (gluteus medius 96 ms, adductor 144 ms). Contralateral, non-paretic, adductor activity was increased after a push towards the hemiparetic side of patients with stroke and the latency was normal (110 ms). During self initiated sideways weight shifts at gait initiation, hemiplegic muscle activation was impaired. By contrast, the pattern and peak amplitude of hip muscle activation in stepping was normal in both hemiparetic and non-hemiparetic muscles of the subjects with stroke. CONCLUSIONS In ambulant patients with stroke, a normal pattern of activation of hemiparetic muscles is seen in stepping whereas the response of these muscles to a perturbation while standing remains grossly impaired and is compensated by increased activity of the contralateral muscles. This suggests that hemiparetic patients should be able to step before regaining standing balance.