Influence of Lower Extremity Sensory Function on Threshold of Inter-Limb Gait Asymmetry Perception in People Post Stroke Public Deposited

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  • March 19, 2019
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  • Wutzke, Clinton
    • Affiliation: School of Medicine, Department of Allied Health Sciences, Curriculum in Human Movement Science
Abstract
  • People with chronic hemiparesis often walk with spatiotemporal asymmetry despite rehabilitation programs targeted to improve walking function. The persistence of walking asymmetry may be due, in part, to the perception of established walking patterns post stroke as `normal.' As a result of perceiving this movement pattern as normal, people with chronic hemiparesis may therefore be unable to identify walking patterns that are more symmetrical. Also potentially contributing to this inability to perceive walking asymmetry are lower extremity sensory impairments. Although accurate afferent feedback is delivered to the central nervous system, inappropriate motor responses are produced leading to spatiotemporal asymmetry. The purpose of this study was to identify sensory impairments in the lower extremity of people with chronic hemiparesis and to determine associations between lower extremity sensation and perception of walking asymmetry in people with chronic hemiparesis. Thirty people post stroke completed an assessment of lower extremity sensation including cutaneous, vibratory, and proprioceptive sensation of the paretic and non paretic limbs as well as walking on a split-belt treadmill under varying conditions of differences in speed between treadmill belts. Subjects responded when differences in speed between treadmill belts were perceived. Logistic regression models were used to determine thresholds of conscious perception and the spatiotemporal asymmetry ratios at the threshold of perception. Subconscious detection was determined as changes from baseline treadmill walking and walking with the belts moving at different speeds. Associations between the thresholds of conscious (awareness) and subconscious (detection) perception, spatiotemporal gait asymmetry (step length, stance time) ratios at thresholds of perception, and measures of lower extremity sensation were determined. It was found that cutaneous, vibratory, and proprioceptive differences in sensation exist between the paretic and non paretic lower limbs in people with chronic hemiparesis. Additionally, it was determined that magnitude of spatiotemporal asymmetry necessary for perception is greater than the gait asymmetry people post stroke typically walk with. Interestingly, individuals with overground step length or stance time asymmetry identify differences in speed between treadmill belts using step length or stance time respectively. However, sensation in the lower extremity of people post stroke did not appear to be associated with perception of walking asymmetry. Instead, perception of asymmetry was correlated with motor coordination of the lower extremity in people with chronic hemiparesis due to stroke. These results suggest that individuals in the chronic stage following stroke have impairments in sensation in the lower extremity but these impairments are not associated with perception of walking asymmetry on a split-belt treadmill. Future studies should identify the components of motor coordination that contribute to the perception of walking asymmetry.
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  • In Copyright
Advisor
  • Segal, Richard L.
  • Mercer, Vicki S.
  • Reisman, Darcy
  • Faldowski, Richard
  • Blackburn, J. Troy
  • Lewek, Michael
Degree
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2014
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  • Chapel Hill, NC
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