Validating stroke-induced bilateral ankle coordination deficits using bilateral ankle measure relationship with motor functions in lower limbs

Jia-Lan Chang; Hung-Ju Chen; Po-Yin Chen; Li-Wei Chou; Chien-Hung Lai; Yueh-Hsun Lu; Shang-Lin Chiang; Chia-Huei Lin; Xin-Miao Wang; Chueh-Ho Lin

doi:10.1186/s12984-023-01157-0

Validating stroke-induced bilateral ankle coordination deficits using bilateral ankle measure relationship with motor functions in lower limbs

J Neuroeng Rehabil. 2023 Mar 17;20(1):32. doi: 10.1186/s12984-023-01157-0.

Authors

Jia-Lan Chang^#^{1

2}, Hung-Ju Chen³, Po-Yin Chen^#², Li-Wei Chou⁴, Chien-Hung Lai^{5

6}, Yueh-Hsun Lu^{7

8}, Shang-Lin Chiang⁹, Chia-Huei Lin¹⁰, Xin-Miao Wang¹¹, Chueh-Ho Lin^{12

13

14}

Affiliations

¹ Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, No. 291, Jhongjheng Rd., Jhonghe, New Taipei, 23561, Taiwan.
² Master Program in Long-Term Care, College of Nursing, Taipei Medical University, No. 250 Wu-Xing Street, Taipei, 110, Taiwan (R.O.C.).
³ National Center for Geriatrics and Welfare Research, National Health Research Institutes, 35 Keyan Rd., Zhunan Town, Miaoli County, 350, Taiwan (R.O.C.).
⁴ Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong Street, Taipei, 112, Taiwan (R.O.C.).
⁵ Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, No. 250 Wu-Xing Street, Taipei, 110, Taiwan (R.O.C.).
⁶ Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, No. 252 Wu-Xing Street, Taipei, 110, Taiwan (R.O.C.).
⁷ Department of Radiology, Shuang-Ho Hospital, Taipei Medical University, No. 291, Zhongzheng Rd., New Taipei City, 235, Taiwan (R.O.C.).
⁸ Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, No. 250 Wu-Xing Street, Taipei, 110, Taiwan (R.O.C.).
⁹ Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, No. 325, Sec. 2, Chenggong Rd., Taipei, 114, Taiwan (R.O.C.).
¹⁰ Department of Nursing, Tri-Service General Hospital; School of Nursing, National Defense Medical Center, No. 325, Sec. 2, Chenggong Rd., Taipei, 114, Taiwan (R.O.C.).
¹¹ Faculty of Humanities, Zhejiang Dong Fang Polytechnic College, 47Th Floor, China Resources Building B 1366 Qianjiang Road, Hangzhou, China.
¹² Master Program in Long-Term Care, College of Nursing, Taipei Medical University, No. 250 Wu-Xing Street, Taipei, 110, Taiwan (R.O.C.). chueh.ho@tmu.edu.tw.
¹³ Research Center in Nursing Clinical Practice, Wan Fang Hospital, Taipei Medical University, No. 111, Sec. 3, Xinglong Rd., Taipei, 116, Taiwan (R.O.C.). chueh.ho@tmu.edu.tw.
¹⁴ International Ph.D. Program in Gerontology and Long-Term Care, Taipei Medical University, No. 250 Wu-Xing Street, Taipei, 110, Taiwan (R.O.C.). chueh.ho@tmu.edu.tw.

^# Contributed equally.

Abstract

Background: Coordinated control between the bilateral ankle joints plays an important role in performing daily life functions, such as walking and running. However, few studies have explored the impact of stroke on movement disorders that decrease the coordination control of the bilateral extremities and may decrease daily activities that require coordination control of the bilateral ankles. This study aimed to investigate the coordination control of the bilateral ankles using a novel bilateral ankle measurement system and evaluate the relationship of bilateral movement coordination control deficits with motor and functional performances of the lower extremities in patients with stroke.

Methods: Twenty-one healthy adults (36.5 ± 13.2 y/o) and 19 patients with chronic stroke (58.7 ± 10.5 y/o) were enrolled. A novel measurement device with embedded rotary potentiometers was used to evaluate bilateral ankle coordination control. Participants were asked to move their dominant (non-paretic) foot from dorsiflexion to plantarflexion position and non-dominant (paretic) foot from dorsiflexion to plantarflexion position (condition 1) simultaneously, and vice versa (condition 2). Alternating time and angle for coordination control with movements of both ankles were calculated for each condition. Motor and functional performance measurements of the lower extremities included the lower-extremity portion of the Fugl-Meyer assessment (FMA-LE), Berg Balance Test (BBS), Timed Up and Go Test (TUG), and Barthel Index (BI).

Results: Compared with the healthy group, alternating time was shorter in the stroke group by 8.3% (p = 0.015), and the alternating angles of conditions 1 and 2 were significantly higher than those of the healthy group by 1.4° (p = 0.001) and 2.5° (p = 0.013), respectively. The alternating angle in condition 2 showed moderate correlations with TUG (r = 0.512; p = 0.025), 10-m walk (r = 0.747; p < 0.001), gait speed (r = - 0.497 to - 0.491; p < 0.05), length (r = - 0.518 to - 0.551; p < 0.05), and BI (r = - 0.457; p = 0.049).

Conclusion: Stroke decreases alternating time, increases alternating angle, and shows bilateral ankle coordination control deficits temporally and spatially. A higher alternating angle is moderately to highly associated with motor function and lower limb function in patients with stroke.

Keywords: Ankles; Coordination control; Movement disorder; Stroke.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Ankle
Ankle Joint
Humans
Lower Extremity
Postural Balance
Stroke Rehabilitation*
Stroke* / complications
Time and Motion Studies
Walking