Mechanical abnormalities of the spastic ankle in chronic stroke subjects

We examined the intrinsic and reflex contributions to ankle stiffness in people with chronic stroke and healthy subjects using the parallel system identification technique. Modulation of intrinsic and reflex stiffness was characterized by applying pseudorandom binary sequence (PRBS) perturbations to the ankle at different initial ankle joint over the entire range of motion (ROM). The experiments were performed for both paretic (stroke) and contralateral (control) side. Healthy (normal) subjects were used a secondary control. Reflex stiffness gain significantly increased in stroke than in control side at most positions. Intrinsic stiffness gain also increased significantly at dorsiflexing positions. These changes were position dependent. Thus, the abnormalities in intrinsic stiffness gain increased continuously from middle plantarflexion to full dorsiflexion while the major increase in reflex stiffness happened at the middle ROM. No significant changes were found in other intrinsic and reflex stiffness parameters. As compared to the normal ankle, the reflex stiffness gain of the control side was significantly larger, indicating that the control side is not normal. These findings demonstrate that both intrinsic and reflex stiffness contribute significantly to the mechanical abnormality associated with spastic ankle in hemiplegic stroke subjects. The results also suggest that the contralateral limb may not be used as a suitable control.