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

Multivariable ankle mechanical impedance was estimated in four stroke survivors, in coupled dorsi- plantarflexion and inversion-eversion. We applied external torque perturbation with an ankle robot and used multi-input, multi-output stochastic system identification methods to estimate impedance, in both paretic and nonparetic limbs. Subjects were instructed to remain at rest throughout the four trials performed on each leg. Impedance projected onto the directions of maximum and minimum stiffness was fit to a 2nd order linear model, including inertia, viscosity and stiffness. For most trials, stiffness and damping in dorsi-plantarflexion are increased on the paretic side. However, for two subjects, overall impedance is not increased in the absence of sustained involuntary tonic contraction, registering values comparable to the non-paretic side. Thus, we speculate that the intrinsic properties of the paretic ankle remained unaffected at the evaluated pose. Spasticity (hyperflexive stretch reflex) would have systematically increased stiffness and damping, even in the absence of involuntary contraction. Hence, we speculate that these two subjects did not exhibit spasticity, while the remaining two subjects did, since impedance was increased, with no involuntary tonic muscle contraction. Regarding inversion-eversion, impedance in this direction remained unaffected by stroke. We evaluated two volunteers before and after the application of botulinum toxin. Surprisingly, ankle stiffness was not reduced, but anisotropy was normalized.