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Multivariable passive ankle impedance in stroke patients: A preliminary study.

Rui Moura Coelho1, Stan Durand2, Jorge Martins1

  • 1Institute of Mechanical Engineering (IDMEC), Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001 Lisbon, Portugal.

Journal of Biomechanics
|November 8, 2021
PubMed
Summary

Stroke survivors show altered ankle mechanical impedance, with some exhibiting increased stiffness and damping in the paretic limb, potentially indicating spasticity. Others showed normal impedance, suggesting unaffected intrinsic ankle properties.

Keywords:
2-DOF ankle impedanceDorsi-plantarflexionInversion–eversionStiffnessStroke

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Area of Science:

  • Biomechanics
  • Neurorehabilitation
  • Robotics

Background:

  • Stroke survivors often experience motor impairments, including altered limb mechanics.
  • Ankle mechanical impedance is a key factor in balance and locomotion, but its characteristics post-stroke are not fully understood.
  • Distinguishing between intrinsic changes and spasticity in paretic limbs is crucial for effective rehabilitation.

Purpose of the Study:

  • To quantify multivariable ankle mechanical impedance in stroke survivors.
  • To investigate differences in impedance between paretic and non-paretic limbs during dorsi-plantarflexion and inversion-eversion.
  • To explore the influence of spasticity on ankle impedance.

Main Methods:

  • Utilized an ankle robot to apply external torque perturbations.
  • Employed multi-input, multi-output stochastic system identification to estimate impedance.
  • Fit impedance data to a 2nd order linear model including inertia, viscosity, and stiffness.

Main Results:

  • Increased stiffness and damping in dorsi-plantarflexion were observed in the paretic limb for some subjects.
  • Two subjects showed no significant increase in impedance, suggesting unaffected intrinsic ankle properties.
  • Ankle impedance in the inversion-eversion direction was unaffected by stroke.
  • Botulinum toxin application normalized anisotropy but did not reduce ankle stiffness in volunteers.

Conclusions:

  • Stroke can affect ankle mechanical impedance, with spasticity potentially increasing stiffness and damping in the dorsi-plantarflexion direction.
  • Some stroke survivors may not exhibit spasticity, retaining normal intrinsic ankle properties.
  • Ankle impedance in the inversion-eversion plane appears resilient to stroke.
  • Botulinum toxin may influence ankle impedance anisotropy post-stroke.