Gait patterns in ischemic and hemorrhagic post-stroke patients with delayed access to physiotherapy.

OBJECTIVES: (1) To assess the effects of a conventional, delayed physiotherapy protocol used by Ischemic Stroke (IS) and Hemorrhagic Stroke (HS) post-stroke patients, in their electromyographic activation patterns during hemiparetic gait; and (2) to study whether this protocol may improve the functional abilities in this population. METHODS: This is an observational, descriptive, and analytical quasi-experimental trial. Forty patients with unilateral IS ( n = 25 ) and HS ( n = 15 ) stroke were recruited; the stroke involved the motor cortex or sub-cortical areas, and the patients were able to walk independently. Interventions with standard protocols of physiotherapy were carried out. Evaluations (clinical and gait assessment) were performed at the time of admission and at the end of the protocol. Outcome measures include Stroke Impact Scale, Timed Up and Go Test, and gait electromyographic evaluation. RESULTS: Only IS patients (with an average of 124 . 4 ± 45 . 4 months delayed access to physiotherapy rehabilitation) had improvements in Timed Up and Go Test (change in speed =- 8 . 0 seg p < 0 . 05 ) and presented an anticipation of the onset in Upper leg muscles after the intervention. BF ( p = 0 . 05 ), ST ( p = 0 . 001 ), and RF ( p = 0 . 024 ), started their recruitment (onset) earlier at the swing phase of the gait cycle, which is more similar to the normal pattern (grey shadow). IS and HS ( 120 . 4 ± 28 . 4 months since last stroke) patients presented higher electromyographic activation, after physiotherapy, of the posterior leg muscles (gastrocnemius, semitendinosus and biceps femoris) during stance phase ( p < 0 . 05 ). CONCLUSION: IS patients had improvements after delayed conventional physiotherapy. For HS limited response to intervention was observed.

Changes in plantar load distribution in legally blind subjects.

We investigated the impact of visual impairment on balance control. We measured the center of pressure (COP) between the two feet and plantar surface pressures on each foot in 18 normal-sighted participants and compared their data with measures from 18 legally blind participants, either acquired or congenital. Pressures were measured in open- and closed-eye conditions using a baropodometric resistive plate. In the eyes-open condition, there were no differences between the sighted and legally blind groups in COP displacement. However, participants with visual loss had significantly increased pressures in two metatarsal regions (M1 and M2 zones) of the plantar surface in both viewing conditions (p < 0.05). The differences in pressure measures between the normally sighted and legally blind groups could be attributed mainly to the subgroup of subjects with acquired impairment. Our findings suggest that subjects with visual impairment present increased metatarsal pressures (i.e. forefoot), not yet associated to anterior displacement of COP or impaired balance control.