INDIVIDUALS WITH CHRONIC STROKE DEMONSTRATE MUSCLE TORQUE-ANGLE IMPAIRMENT IN THE PARETIC KNEE AND COMPENSATORY STRENGTH GAINS IN THE NONPARETIC KNEE.
Notice bibliographique
Résumé
PURPOSE/HYPOTHESIS: Recent reports suggest that the paretic arm of individuals with stroke produces lower elbow flexion and extension torques (when normalized to peak torque) at short muscle lengths when compared to individuals without stroke. Thus the purpose of this study was to determine whether this phenomenon also exists in the paretic and non-paretic knee when assessed across multiple joint angles. NUMBER OF SUBJECTS: Sixteen subjects with chronic stroke and 14 age-matched control subjects without stroke were voluntarily recruited from the community. MATERIALS/METHODS: Maximal isometric knee extension and flexion joint torques were measured at six different angles (15, 35, 55, 75, 95, and 105 degrees). Due to the high variability of muscle weakness, both between and within subjects, each subject's data points were normalized and expressed as a percentage of their own peak torque. Mean normalized extension and flexion torque-angle curves of the paretic and nonparetic knee were compared with each other and with the nondominant knee of control subjects using a two-factor (subject group, knee joint angle) mixed design analysis of variance (ANOVA). If significant subject group by joint angle interactions were revealed, post-hoc pairwise comparisons with a Bonferonni adjustment were performed to determine relative muscle strength of the paretic, nonparetic, and control conditions at each angle tested. RESULTS: The ANOVA revealed a significant interaction between subject group (paretic, nonparetic, and control) and knee joint angle for the extensors (P = .002), but not the flexors (P = .386). Post-hoc tests for the extensors revealed the paretic knee to be relatively weaker than the control knee at 15 degrees of flexion (i.e. short muscle lengths) (P = .006). In addition, the nonparetic knee was relatively stronger than the control knee at 95 (P = .004) and 105 (P = .007) degrees of flexion (i.e. long muscle lengths). CONCLUSIONS: The results of this work suggest that the paretic knee extensors are selectively weak when required to contract at short muscle lengths. This agrees with the clinical observation that the quadriceps is more severely impaired as the knee joint approaches terminal extension, particularly during gait. In addition, the nonparetic quadriceps is selectively stronger than the control quadriceps when required to contract at long muscle lengths; suggesting individuals with stroke compensate through overuse of the nonparetic side during functional activities such as sit-to-stand and stair climbing. This learned nonuse of the paretic leg leads to a task specific increase in quadriceps strength of the nonparetic knee at long muscle lengths. CLINICAL RELEVANCE: Rehabilitation interventions should emphasize paretic knee strengthening near terminal extension and encourage symmetrical use of the paretic and nonparetic legs to enhance recovery of strength throughout functional range of motion.
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Comment cette classification a été obtenuedéplier
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Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».