this article and any supplementary material should be cited as follows: raja b, neptune rr, kautz...

This article and any supplementary material should be cited as follows: Raja B, Neptune RR, Kautz SA. Quantifiable patterns of limb loading and unloading during hemiparetic gait: Relation to kinetic and kinematic parameters. J Rehabil Res Dev. 2012;49(9):1293–1304. http://dx.doi.org/10.1682/JRRD.2011.02.0018

Slideshow ProjectDOI:10.1682/JRRD.2011.02.0018JSP

Quantifiable patterns of limb loading and unloading during hemiparetic gait: Relation to

kinetic and kinematic parameters

Bhavana Raja, PT, PhD; Richard R. Neptune, PhD;

Steven A. Kautz, PhD



• Aim– Determine magnitude and duration of asymmetry in limb

loading (LL) and limb unloading (LU) in hemiparesis. – Determine relationship with functional walking status and

specific kinematic and kinetic variables during walking.

• Relevance– Understanding LL and LU asymmetry will provide insight

into changes in poststroke individuals’ locomotion and inspire new walking rehabilitation strategies.



Method• Participants: – 44 people with chronic hemiparesis and 18 nondisabled

controls.

• Protocol– Participants walked on instrumented split-belt treadmill

without assistive device or ankle foot orthosis for 3 walking trials at self-selected speed.• Controls walked at self-selected speed, 0.3 m/s, and 0.6 m/s.

– 12-camera motion analysis system collected data as subjects walked.

– Variables calculated during double-limb support phases of gait (when LL and LU occur).



Results• LL Magnitude– At self-selected speeds:• Magnitude less in paretic vs nonparetic leg and controls.

– At matched speeds:• No significant difference between paretic leg and controls

when considering subjects with hemiparesis as single group. • When considered separately, reduced paretic leg LL was

related to functional walking status in hemiparesis group. • Slower individuals had significant differences in LL vs

controls.• Community ambulators not significantly different.



Results (cont’d.)• LU Magnitude– At self-selected and matched speeds:

• For household and limited community ambulators, significantly lower in paretic vs nonparetic leg and controls

• No significant difference between community ambulators and nonparetic leg and controls.

• LL/LU Timing & Pattern– Household ambulators

• LL time of nonparetic leg significantly less than limited community ambulators and community ambulators.

• LU time greater than limited community ambulators and community ambulators.



Results (cont’d.)• Mediolateral (M-L) GRF and LL/LU– No significant correlation.

• Knee Angle and LL/LU– No significant correlation.

• M-L Leg Angle and LL/LU– Subjects with reduced paretic leg LL placed paretic leg further

lateral relative to pelvis center of mass. – LL negatively associated with leg angle of paretic side in M-L

direction during 1st double-support phase. – Paretic leg M-L angle significantly greater than nonparetic leg and

controls at matched speeds.



Conclusion• Paretic LL magnitude was reduced, while duration

was increased vs nonparetic leg and controls walking at matched speeds.

• 3 LL/LU patterns were identified: concave, convex, and linear.

• Results indicate that people with hemiparesis make biomechanical adjustments to maintain a steady walking state. – Characterization of these deviations may inspire new

strategies for rehabilitation.

this article and any supplementary material should be cited as follows: raja b, neptune rr, kautz...

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