Investigation of Factors Causing Knee Hyperextension During Walking in Chronic Stroke Patients

Study Overview
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Brief Summary
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In this study, it is aimed to examine the factors that cause knee hyperextension in chronic stroke patients. Although the presence of weakness or spasticity in the quadriceps muscle, weakness or spasticity in the plantar flexors, and weakness of the dorsiflexors, hamstrings and gastrocnemius muscle are shown in the literature as the cause of hyperextension of the affected knee in hemiplegic patients, there is a comprehensive study that shows the effect of both muscle strength and spasticity in the lower extremity muscles. there are no studies. The hypotheses of the study are: Hypothesis 1: H0: There is no relationship between knee hyperextension in the stance phase of gait and lower extremity muscle strength in stroke patients. H1: There is a relationship between knee hyperextension in the stance phase of gait and lower extremity muscle strength in stroke patients. Hypothesis 2; H0: There is no relationship between knee hyperextension in the stance phase of gait and lower extremity spasticity in stroke patients. H1: There is a relationship between knee hyperextension in the stance phase of gait and lower extremity spasticity in stroke patients. Hypothesis 3; H0: There is no relationship between knee hyperextension and electromyographic muscle activations in chronic stroke patients. H1: There is a relationship between knee hyperextension and electromyographic muscle activations in chronic stroke patients.

Official Title
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Investigation of Factors Causing Knee Hyperextension During Walking in Chronic Stroke Patients by Electromyographic Method

Conditions
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Stroke

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Being between the ages of 40-65 At least 6 months have passed since the stroke Ambulation with or without a walking aid (walker, cane, or tripod) Being between 0-3 points according to the Modified Rankin Score Getting a score of 24 or higher on the Mini Mental Test Presence of hyperextension in the stance phase of gait Volunteering to participate in the study Exclusion Criteria: Having a history of more than one stroke Known presence of dementia Having a known orthopedic, psychiatric or other neurological disease Having a situation that prevents communication Having a history of surgery involving lower extremities and gait

Ages Eligible for Study
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Minimum Age: 40 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Chronic stroke patients with knee hyperextension<br> | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Movement Analysis | Reflective signs will be placed at certain anatomical points of the participants. Participants will be asked to walk a distance of 5 meters. The three-dimensional positions of these reflective marks will be recorded with the 8-camera Vicon motion capture system. Then it will be examined in computer environment using Blade software. | Baseline | 
| Electromyographic Measurements | Electromyography (EMG) is frequently used in the literature for motion analysis evaluations. It shows the amplitude of the electrical activity of the muscles. In this study, 8-channel Delsys Bagnoli desktop cable electromyography system (Delsys (Delsys Inc., USA)) will be used. EMG; It shows whether the muscles are active during movement, when they are active and how active they are. In this study, the muscles to be measured by EMG: tibialis anterior, medial gastrocnemius, medial hamstrings, rectus femoris, gluteus medius and the lower part of the latismus dorsi are planned. | Baseline | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Muscle Strength Evaluation | Manual muscle testing will be performed on patients' hip flexors, hip extensors, hip abductors, hip adductors, knee flexors, knee extensors, dorsiflexors, and plantar flexors. A score between 0 and 5 will be given according to the manual muscle test, the ability of the muscles to move against gravity in certain positions, and the resistance of the movement against gravity. | Baseline | 
| Spasticity Evaluation | The spasticity of the lower extremity muscles (quadriceps, hip extensors, hip adductors, hip internal retractors and plantar flexors) will be evaluated according to the Modified Ashworth Scale. The spasticity assessment will be scored between 0 and 4 according to the resistance of the muscles to passive movement. | Baseline | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Gait Analysis, Stroke, Knee Hyperextension, Electromyography