![]() Other studies that applied a similar method to the lower limb suggested that the primary contributor to lower-limb motor deficits was the weakness of voluntary torque rather than the value of abnormal synergy. Patients after stroke could not generate voluntary torque selectively without generating torque in other joints. They found that patients after stroke had significantly decreased maximum voluntary torque compared with the control subjects, and that the patients exhibited reductions in maximum torques when required to control the secondary torque. ![]() measured the joint torque that the subjects were attempting to maximize as the primary torque and the torques at other directions as secondary torques, along with electromyographic (EMG) measurements during voluntary isometric muscle contractions. In a study quantifying the upper-limb abnormal synergy in patients after stroke, Dewald et al. By quantitatively assessing the abnormal synergy in the lower limb by measuring the torque exerted as abnormal synergy, and then investigating its relation with gait ability, we may be able to gain insight into the relation between abnormal synergy and gait ability. The ability to exert lower-limb muscle torque is important for gait. It was also found that attempts to make gait patterns resemble those of neurologically healthy adults by using Lokomat or a robotic knee orthosis did not result in the extinction of abnormal synergy. A previous study showed that the Fugl-Meyer synergy score was significantly correlated with gait speed. Many patients recover gait activity with compensatory adaptation. Difference in kinematics is also seen in stroke subjects. Studies measuring the relative phase in stroke patients have shown that patients after stroke differ from normal subjects in intra- and inter-limb coordination of the lower limb. Abnormal synergy has been recognized as a factor limiting the motor rehabilitation of patients after stroke. For the lower limb, abnormal synergy is grouped into extension synergy (internal rotation, adduction, and extension of the hip extension of the knee and extension and inversion of the ankle) and flexion synergy (external rotation, abduction, and flexion of the hip flexion of the knee and flexion and eversion of the ankle). ![]() These coupled movements are known as abnormal synergy. Some patients lose independent control of selected muscle groups, resulting in coupled joint movements that are often inappropriate for the desired task. Therefore, it is important to understand the relation between impairment and gait deficit in patients after stroke.Ībnormal synergy is a motor impairment in patients after stroke. The ability to perform activities of daily living depends on gait ability. Secondarily generated torque was found to be a factor that affects TUG speed, and the ability to generate torque even through abnormal synergy may help for gait ability in subjects after stroke.Īfter stroke, many patients experience motor impairments that cause gait deficits. Pearson product–moment correlation coefficient analysis revealed that TUG speed is related to secondarily generated torque accompanying maximal hip extension but not with selectively generated torque. In subjects after stroke, there was no difference between the amount of plantar flexion torque generated secondarily and the selectively generated torque, whereas the selective torque was significantly greater in control subjects. The relation of torque generation with the gait speed and timed-up-and go test (TUG) was also analyzed. In subjects after stroke, secondary torque generation while controlling hip extension torque as 25%, 50%, and 75% of the maximal hip extension was also measured. Selectively generated plantar flexion torque in the ankle and plantar flexion torque secondarily generated accompanying maximal hip extension (i.e., torque generated with abnormal synergy) were measured in subjects after stroke and control subjects. We attempted to quantify the torque generation in the lower limb, selectively and as an abnormal synergy, and its relation with gait. Therefore, the ability to generate torque may be important either as a primary movement or as an abnormal synergy. However, in the lower extremity, antigravity torque generation rather than precise movement is needed for functions such as sit-to-stand movement and gait. The abnormal synergy seen in patients after stroke is considered to limit the ability of these patients. ![]()
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