BIOMECHANICAL DETERMINANTS AND PREDICTORS OF WALKING SPEED IN THE GAIT TRAINING OF HEMIPARETIC STROKE PATIENTS
Kenji Suzuki (Tohoku University, Sendai, Japan)
Abstract: Twenty-five hemiparetic stroke patients, within 3 months since the onset, were examined to investigate the biomechanical determinants and predictors of walking speed in computer-assisted gait training (CAGT) for more than 8 weeks. Maximum walking speed for 10 m, maximal isokinetic muscle strength for extension of both knees and postural stability and control on station were measured quantitatively at the start of CAGT, 4 and 8 weeks later, as biomechanical variables. Stepwise regression analyses revealed that the determinant was a postural control in shifting the body weight left and right for first 4 weeks and muscle strength of the affected side after 4 weeks, respectively. The maximum walking speeds at the times of 4 and 8 weeks later could be predicted significantly by the initial maximum walking speed and the muscle strength for knee extension of the affected side at the start of CAGT.
SHOULDER SUBLUXATION IN HEMIPLEGIC PATIENTS
Tetsuo IKAI, Kenshaku TEl (Tokyo Metropolitan Rehabilitation Hospital, Tokyo, Japan) Satoshi MIYANO, Kyozo YONEMOTO (Dep. of Rehabilitation Medicine, Jikei University School of Medicine, Tokyo, Japan)
[Objective] Shoulder subluxation in hemiplegic patients has been recognized as a difficult problem to manage. This study was designed to evaluate shoulder subluxation, to clarify if shoulder subluxation causes pain and to discuss the treatment of shoulder subluxation.
[Method] 60 hemiplegic patients with shoulder subluxation were included in this study. Each patient was inquired about the degree of shoulder pain, and also was evaluated motor recovery of the upper extremity and shoulder rang of motion. Radiographs of both shoulders were taken in the sitting position. Vertical disparity, horizontal disparity and the descendant ratio of humeral head were measured. Arthrograms of the affected shoulder joint were taken in 22 patients.
[Results] Most of the patients were classified into Bruunstrom stage I and II. Vertical disparity was strongly correlated with the descendant ratio of humeral head. Sever inferior subluxation had a tendency to show medial displacement of the humeral head. There were correlations between shoulder pain and shoulder rang of motion, especially external rotation. Adhesive changes on arthrogram were seen in most of the patients.
[Discussion] These results do not support a relation between shoulder subluxation and pain, and indicate that adhesive capsulitis is a main cause of shoulder pain. Correct positioning and shoulder rang of motion exercise are necessary for shoulder subluxation.