The Variations in Gait Parameters and the Muscle Activities on the Non-Affected Side of the Shoulder Girdle According to Arm Sling Type in Patients with Hemiplegia

팔걸이 형태에 따른 편마비 환자의 보행 변수 및 비마비측 견갑대의 근활성도 변화

  • Lee, Og-Kyung (Dept. of physical Therapy, Good Gangan Hospital) ;
  • An, Duk-Hyun (Dept. of Physical Therapy, College of Biomedical Engineering and Science, Inje University) ;
  • Yoo, Won-Gyu (Dept. of Physical Therapy, College of Biomedical Engineering and Science, Inje University) ;
  • Oh, Jae-Seop (Dept. of Physical Therapy, College of Biomedical Engineering and Science, Inje University) ;
  • Yoon, Ji-Yeon (Dept. of Motion Analysis, Haeundae Paik Hospital)
  • 이옥경 (좋은강안병원 물리치료실) ;
  • 안덕현 (인제대학교 의생명공학대학 물리치료학과) ;
  • 유원규 (인제대학교 의생명공학대학 물리치료학과) ;
  • 오재섭 (인제대학교 의생명공학대학 물리치료학과) ;
  • 윤지연 (해운대백병원 동작분석실)
  • Received : 2010.06.04
  • Accepted : 2010.09.04
  • Published : 2010.09.17

Abstract

The purpose of this study was to investigate the variations in gait parameters in terms of the type of arm sling used in hemiplegic patients. Ten patients with hemiplegia and ten healthy adults participated in this study and walked at self-selected speeds on a GAITRite-instrumented carpet. The activities of the opposite shoulder girdle muscle including the latissimus dorsi, anterior deltoid, and posterior deltoid were simultaneously recorded using surface EMG during gait. They were randomly assigned a condition: without an arm sling, a single strap arm sling, a Harris hemi arm sling, a Rolyan humeral cuff arm sling, and a Bobath roll arm sling. The following gait variables were analyzed: the temporo-spatial parameters of velocity, step length, stride length, swing phase, stance phase, single support, step time and toe in/toe out. The statistical analysis was one-way ANOVA with repeated measures to compare the variation of each variable. In comparison of parameters in each trial in the hemiplegia group, the non-affected side stride length, single support, and toe in/toe out resulted in statistically significantly changes (p<.05). But without an arm sling group did not show any gait parameter differences with arm slings. This study found that several arm slings varied gait patterns in patients with hemiplegia and in healthy adults. In the EMG analysis, the Rolyan humeral cuff arm sling and the Bobath roll arm sling were higher muscle activity for the latissimus dorsi muscle than did the single strap ann sling. Further study should examine the problems that appeared in patients who worn arm slings by focusing on a larger number of subjects and by studying the variety of responses in more detail using an assessment tool that measures variation.

Keywords

References

  1. 한경희, 김경덕, 장기언. 팔걸이의 4가지 유형에 따른 견관절 아탈구 교정효과의 방사선학적 비교. 대한재활의학회지. 1994;18(1):118-124.
  2. Abe H. Michimata A, Sugawara K, et al. Improving gait swbility in stroke hemiplegic patients with a plastic ankle-food orthosis. Tohoku J Exp Med. 2009;218(3):193-199. https://doi.org/10.1620/tjem.218.193
  3. Anders C. Bretschneider S. Bernsdorf A. et al. Activation of shoulder muscles in healthy men and women under isometric conditions. J Electromyogr Kinesiol. 2004:14(6):699-707. https://doi.org/10.1016/j.jelekin.2004.04.003
  4. Akay M, Sekine M, Tamura T, et al. Fractal dynamics of body motion in post-stroke hemiplegic patients during walking. J Neural Eng. 2004;1(2):111-116. https://doi.org/10.1088/1741-2560/1/2/006
  5. Bilney B. Monis M, Webster K. Concurrent related validity of the GAITRite walkway sstem for quantification of the spatial and temporal parameters of gait. Gait Posture. 2003:17(1):68-74. https://doi.org/10.1016/S0966-6362(02)00053-X
  6. Rrooke MM. de Lateur BJ. Diana - Rigby GC, et al. Shoulder subluxation in hemiplegia: Effects of three different supports. Arch Phys Med Rehabil. 1991;72(8):582-586.
  7. Donker SF, Mulder T, Nienhuis B. et al. Adaptations in arm movements for added mass to wrist or ankle during walking. Exp Brain Res. 2002;146(1):26-31. https://doi.org/10.1007/s00221-002-1145-2
  8. Eke-Okoro ST. Gregoric M, Lersson LE. Alterations in gait resulting from deliberate changes of arm-swing amplitude and phase. Clin Biomech(Bristol, Avon). 1997;12(7-8): 516-521. https://doi.org/10.1016/S0268-0033(97)00050-8
  9. Faghri PD, Rodgers MM, Glaser RM, et al. The effects of functional electrical stimulation on shoulder subluxation, arm function recovery, and shoulder pain in hemiplegic stroke patients. Arch Phys Med Rehabil. 1994;75(1):73-79.
  10. Fatone S, Gard SA, Malas BS. Effect of ankle-foot orthosis alignment and foot-plate length on the gait of adults with poststroke hemiplegia. Arch Phys Med Rehabil. 2009;90(5);810-818. https://doi.org/10.1016/j.apmr.2008.11.012
  11. Ferris DP, Huang HJ, Kao PC. Moving the arms to activate the legs. Exerc Sport Sci Rev. 2006;34(3):113-120. https://doi.org/10.1249/00003677-200607000-00005
  12. Ford MP, Wagenaar RC, Newell KM. Phase manipulation and walking in stroke. J Neurol Phys Ther. 2007b;31(2):85-91. https://doi.org/10.1097/NPT.0b013e3180674d18
  13. Hamilton N, Luttgens K. Kinesiology: Scientific basis of human motion. Boston, McGrow-Hill, 1997.
  14. Iwata M, Kondo I, Sato Y, et al. An ankle-foot orthosis with inhibitor bar: Effect on hemiplegic gait. Arch Phys Med Rehabil. 2003;84(6):924-927. https://doi.org/10.1016/S0003-9993(03)00012-1
  15. Kressig RW, Gregor RJ, Oliver A, et al. Temporal and spatial features of gait in older adults transitioning to frailty. Gait Posture. 2004;20(1):30-35. https://doi.org/10.1016/S0966-6362(03)00089-4
  16. Kubo M, Wagenaar RC, Saltzman E, et al. Biomechanical mechcnism for transitions in phase and frequency of arm and leg during walking. Biol Cybern. 2004;91(2):91-98.
  17. LaFiandra M, Wagenaar RC, Holt KG, et al. How do load carriage and walking speed influence trunk coordination and stride parameters? J Biomech. 2003;36(1):87-95. https://doi.org/10.1016/S0021-9290(02)00243-9
  18. McDonough AL, Batavia M, Chen FC, et al. The validity and reliability of the GAITRite system's measurements: Apreliminary evaluation. Arch Phys Med Rehabil. 2001;82(3):419-425. https://doi.org/10.1053/apmr.2001.19778
  19. Menz HB, Latt MD, Tiedemann A, et al. Reliability of the GAITRite walkway system for the quantification of temporo-spatial parameters of gait in young and older people. Gait Posture. 2004;20(1):20-25. https://doi.org/10.1016/S0966-6362(03)00068-7
  20. Ortega JD, Fehlman LA, Farley CT. Effects of aging and arm swing on the metabolic cost of stability in human walking. J Biomech. 2008;41(16):3303-3308. https://doi.org/10.1016/j.jbiomech.2008.06.039
  21. Robinson JL, Smidt GL. Quantitative gait evaluation in the clinic. Phys Ther. 1981;61(3):351-353. https://doi.org/10.1093/ptj/61.3.351
  22. Umberger BR. Effects of suppressing arm swing on kinematics, kinetics, and energetics of human walking. J Biomech. 2008;41(11):2575-2580. https://doi.org/10.1016/j.jbiomech.2008.05.024
  23. Wagenaar RC, Beek WJ. Hemiplegic gait: A kinematic analysis using walking speed as a basis. J Biomech. 1992;25(9):1007-1015. https://doi.org/10.1016/0021-9290(92)90036-Z
  24. Yavuzer G, Ergin S. Effect of an arm sling on gait pattern in patients with hemiplegia. Arch Phys Med Rehabil. 2002;83(7):960-963. https://doi.org/10.1053/apmr.2002.33098
  25. Zehr EP, Haridas C. Modulaton of cutaneous reflexes in arm muscles during walking: Further evidence of similar control mechanisms for rhythmic arm and leg movements. Exp Brain Res. 2003;149(2):260-266. https://doi.org/10.1007/s00221-003-1377-9
  26. Zorowitz RD, Idank D, Ikai T, et al. Shoulder subluxation after stroke: A comparison of four supports. Arch Phys Med Rehabil. 1995;76(8):763-771. https://doi.org/10.1016/S0003-9993(95)80532-X