Article

Weakness in patients with hemiparesis.

Occupational Therapy, Ecole de Réadaptation, Université de Montréal, Canada.
The American journal of occupational therapy.: official publication of the American Occupational Therapy Association (Impact Factor: 1.7). 06/1989; 43(5):313-9. DOI: 10.5014/ajot.43.5.313
Source: PubMed

ABSTRACT Clinical and experimental results are reviewed concerning muscle weakness in patients with hemiparesis after a stroke. The discussion includes the important role that alterations in the physiology of motor units, notably changes in firing rates and muscle fiber atrophy, play in the manifestation of muscle weakness. This role is compared with the lesser role that spasticity (defined as hyperactive stretch reflexes) of the antagonist muscle group appears to play in determining the weakness of agonist muscles. The contribution of other factors that result in mechanical restraint of the agonist by the antagonist (e.g., passive mechanical properties and inappropriate cocontraction) is discussed relative to muscle weakness in patients with hemiparesis.

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    ABSTRACT: The foot and ankle forms the interface between the body and ground hence stroke related changes impact on mobility but there is little research has considered the foot and ankle post-stroke. This thesis bridges these knowledge gaps to enable clinical trials to be carried out. Methods The initial chapters (1-3) review the knowledge about stroke-related problems in the foot and ankle and their association with mobility limitations. The following chapters (4-5) evaluate interventions targeting motor and sensory foot and ankle problems with a systematic review and clinical trial. The final chapter draws overall conclusions integrating the motor and sensory components. Results There is relatively little literature concerning the foot and ankle after stroke and that available focuses on activity without examining the underlying mechanisms. Pooled analysis of data from 251 stroke patients showed that foot sensory problems are common (37%) and significantly contribute to balance (p<0.03), mobility (p<0.01) and independence in ADLs (p<0.001) along with muscle weakness, time since stroke, neglect and age. In all models the independent variables explained about a half of the variance in mobility measures (p<0.001). To investigate the treatment of motor impairments, a systematic review of the effect of an ankle foot orthosis (AFO) on the biomechanics of walking was undertaken. It showed that an AFO improved dorsiflexion at initial contact (PO.00001) and weight transfer over the affected foot (PO.001). To investigate the treatment of sensory impairments, 29 stroke survivors participated in a randomised controlled crossover trial of supplementary sensory stimulation to the foot. This stimulation improved ankle strength (P<0.03) and sensation (P<0.025), and functional balance (P<0.003). Conclusion To date research about the foot-ankle complex post-stroke has emphasised the motor aspects. This work shows that sensory problems are also common and stroke survivors may be responsive to a sensory enhancing intervention. - See more at: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.548515#sthash.y2MF1inS.dpuf
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