Characterizing stroke-induced changes in the variability of lower limb kinematics using multifractal detrended fluctuation analysis

Movement variability reflects the adaptation of the neuromuscular control system to internal or external perturbations, but its relationship to stroke-induced injury is still unclear. In this study, the multifractal detrended fluctuation analysis was used to explore the stroke-induced changes in movement variability by analyzing the joint angles in a treadmill-walking task. Eight healthy subjects and ten patients after stroke participated in the experiment, performing a treadmill-walking task at a comfortable speed. The kinematics data of the lower limbs were collected by the motion-capture system, and two indicators, the degree of multifractality (α) and degree of correlation [h(2)], were used to investigate the mechanisms underlying neuromuscular control. The results showed that the knee and ankle joint angles were multifractal and persistent at various scales, and there was a significant difference in the degree of multifractality and the degree of correlation at the knee and ankle joint angles among the three groups, with the values being ranked in the following order: healthy subjects < non-paretic limb < paretic limb. These observations highlighted increased movement variability and multifractal strength in patients after stroke due to neuromotor defects. This study provided evidence that multifractal detrended analysis of the angles of the knee and ankle joints is useful to investigate the changes in movement variability and multifractal after stroke. Further research is needed to verify and promote the clinical applications.