Mechanical energy of walking of stroke patients.

The mechanical energy costs of walking have been studied in ten stroke patients with hemiplegia. A two-dimensional sagittal plane cinematographic analysis of two strides of the subjects' normal walking was undertaken, yielding continuous information about the mechanical energy costs of the whole body and each of its parts, about the energy types involved, and the amounts of energy conservation. The large head, arms, and trunk (HAT) were found to dominate the total pattern. Three major disturbances were seen. In contrast to normal subjects who show energy-conserving negatively correlated potential and kinetic energy curves for the HAT, the subjects who demonstrated the first disturbance showed gross irregularity of the curves, with almost no opportunity for exchange between energy types. In a second disturbance the curves of the HAT showed some energy-conserving portions, but levels of kinetic energy curves were low, resulting in little energy exchange. In the third disturbance, some exchange was evident, but the pattern was dominated by potential energy changes in the form of a single large rise and fall, coinciding with swing phase of the affected leg. Each of these disturbances would require a different approach to treatment. Although mechanical energy analyses do not reflect certain energy costs, such as the effort required to hold the body up against the pull of gravity and that used in contracting antagonist muscles, they could be of considerable assistance in pinpointing costly variations in energy patterns during walking and in determining appropriate treatment procedures.