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mariaminipt
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Posted: Tue Jul 27th, 2010 08:48 pm |
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I would agree that a therapist facilitation of DF would interfere w/ emg activation. A better way to measure would be if the therapist used FES on AT for DF control.
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jkelly
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Posted: Tue Feb 3rd, 2009 05:33 pm |
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I noticed this article from the upcoming APTA CSM meeting in Las Vegas. As most of us know intuitively, this article lends support to increasing your patient's speed while walking on the treadmill in order to improve outcomes. Although this article did not document improvement in functional outcomes per se, the EMG changes in Hamstrings, Gastroc, and Quads with faster speeds are impressive. A little puzzling is the lack of changes in Anterior Tibialis EMG. The authors theorize this was due to the therapist's facilitation technique. Any thoughts?
Here is the abstract:
INFLUENCE OF PARTIAL BODY WEIGHT SUPPORT TREADMILL TRAINING WALKING
SPEED ON MUSCLE ACTIVATION AND STRIDE CHARACTERISTICS IN ADULTS WITH
ACUTE UNILATERAL STROKE
Judith M. Burnfield1, Laura M. Corbridge1, Amy J. Goldman1, Michelle E. Rey2, Aaron J. Ankeny1, Thad W. Buster1
1. Movement and Neurosciences Center, Madonna Rehabilitation Hospital, Lincoln, NE, USA.
2. Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA.
Purpose/Hypothesis : Despite expanded use of partial body weight support treadmill
training (PBWSTT) in acute stroke inpatient rehabilitation programs, only limited research guides selection of training speeds to optimize muscle demand and stride characteristics. In the current study, we hypothesized that stride length, cadence and involved limb muscle activation would increase with faster walking velocities. Number of Subjects : Ten adults with hemiparesis secondary to acute unilateral cerebral vascular accident (onset < 1 month prior) were recruited from an inpatient rehabilitation program. Materials/Methods : Each participant engaged in 3 PBWSTT sessions (30% weight support, _ 3 clinicians facilitated movement) over a one week period prior to data collection. During session four, stride characteristics (footswitches) and involved limb vastus lateralis (VL), medial hamstrings (MH), medial gastrocnemius (MG) and tibialis anterior (TA) muscle activation patterns (surface EMG) were recorded simultaneously as subjects walked two minutes at each of four randomly imposed speeds (0.5, 1.0, 1.5, and 2.0 mph). Maximum voluntary contractions (MVC) were elicited and provided a basis for subsequent normalization of EMG data. For each subject, 10 representative strides from the final 30 seconds of each trial were analyzed. All EMG data were filtered, rectified, and integrated. Peak and mean EMG activity were normalized to MVCs. EMG duration was expressed as a percentage of the gait cycle. Separate one-way analyses of variance with repeated measures (4x1 ANOVAs) identified significant differences across the four walking speeds in select EMG variables (peak and mean amplitude, duration) and stride characteristics (stride length, cadence). Results : Faster walking speeds were achieved by significantly increasing both stride length (2.0>1.5>1.0>0.5 mph; p<0.001) and cadence (2.0>1.5>1.0>0.5 mph; p<0.001), with each augmented approximately two-fold from the slowest to fastest condition. More rapid speeds resulted in greater EMG activity in the MG with respect to the peak (2.0>1.5>1.0 and 0.5 mph; p<0.001), mean (2.0>1.5>1.0 and 0.5 mph; p<0.001), and duration (2.0>1.5>1.0 and 0.5 mph; p<0.001). Similarly, at faster speeds, higher MH peak (1.5>1.0 and 0.5 mph; p=0.011) and mean activity (2.0 and 1.5>0.5 mph, 1.5>1.0 mph; p=0.014) were documented. VL demonstrated a trend for greater peak (p=0.16) and mean (p=0.17) EMG activity at faster speeds. In contrast, TA EMG activity did not vary significantly across speeds. Conclusions : Faster walking velocities, which were achieved in part through longer stride lengths, necessitated greater activation of key muscles required for stance stability and controlled forward progression. Lack of significant changes in TA activity across speeds may have been influenced by facilitation techniques for the involved leg. Clinical Relevance : This study's findings indicate that if increased muscle effort is one goal of PBWSTT during acute stroke rehabilitation then use of faster speeds should be considered.
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