Muscle work is increased in pre-swing during hemiparetic walking.

BACKGROUND: Muscle mechanical work is likely affected by gait abnormalities in hemiparetic walking during the paretic pre-swing phase (i.e., double support phase preceding paretic toe-off). Previous experimental studies suggest that muscle work may be decreased in the paretic leg, but paretic work may have been underestimated since experimental approaches based on net joint moments do not account for co-contraction of antagonist muscles. Also, whether the non-paretic leg does more work compared to control subjects at matched speeds and how work generation may differ between hemiparetic subjects walking with different self-selected speeds remains unknown.

METHODS: Three-dimensional forward dynamics simulations of two representative hemiparetic subjects walking with different self-selected speeds (i.e., limited community=0.45 m/s and community walkers=0.9 m/s) and a speed and age-matched control subject were generated to quantify musculotendon (fiber and in-series tendon) work during paretic pre-swing.

FINDINGS: Total paretic and non-paretic fiber work were increased in both the limited community and community hemiparetic walkers compared to the control. Increased fiber work in the limited community walker was primarily related to decreased fiber and tendon work by the paretic plantar flexors requiring compensatory work by other muscles. Increased fiber work in the community walker was primarily related to increased work by the hip abductors and adductors.

INTERPRETATION: The hemiparetic walkers would expend more metabolic energy during pre-swing if the hemiparetic and control subjects were to perform work with the same mechanical efficiency. These results may partly explain the increased metabolic cost of hemiparetic walkers compared to nondisabled walkers at matched speeds.