Influence of systematic increases in treadmill walking speed on gait kinematics after stroke.
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TL;DR: Faster treadmill walking facilitates a more normal walking pattern after stroke, without concomitant increases in common gait compensations, such as circumduction.
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Abstract: Background Fast treadmill training improves walking speed to a greater extent than training at a self-selected speed after stroke. It is unclear whether fast treadmill walking facilitates a more normal gait pattern after stroke, as has been suggested for treadmill training at self-selected speeds. Given the massed stepping practice that occurs during treadmill training, it is important for therapists to understand how the treadmill speed selected influences the gait pattern that is practiced on the treadmill.
Objective The purpose of this study was to characterize the effect of systematic increases in treadmill speed on common gait deviations observed after stroke.
Design A repeated-measures design was used.
Methods Twenty patients with stroke walked on a treadmill at their self-selected walking speed, their fastest speed, and 2 speeds in between. Using a motion capture system, spatiotemporal gait parameters and kinematic gait compensations were measured.
Results Significant improvements in paretic- and nonparetic-limb step length and in single- and double-limb support were found. Asymmetry of these measures improved only for step length. Significant improvements in paretic hip extension, trailing limb position, and knee flexion during swing also were found as speed increased. No increases in circumduction or hip hiking were found with increasing speed.
Limitations Caution should be used when generalizing these results to survivors of a stroke with a self-selected walking speed of less than 0.4 m/s. This study did not address changes with speed during overground walking.
Conclusions Faster treadmill walking facilitates a more normal walking pattern after stroke, without concomitant increases in common gait compensations, such as circumduction. The improvements in gait deviations were observed with small increases in walking speed.
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Citations
Repeated Split-Belt Treadmill Training Improves Poststroke Step Length Asymmetry
TL;DR: It is demonstrated that short-term adaptations can be capitalized on through repetitive practice and can lead to longer-term improvements in gait deficits poststroke and the error augmentation strategy appears to be critical for obtaining the improvements observed.
292
Walking adaptability after a stroke and its assessment in clinical settings
TL;DR: Nine domains of walking adaptability were created from dimensions of community mobility to address the conceptual challenges in measurement and performance-based clinical assessments of walking were reviewed to determine if the assessments measure Walking adaptability in these domains.
Paretic propulsion as a measure of walking performance and functional motor recovery post-stroke: A review.
TL;DR: Factors associated with the ability to generate Pp are assessed and rehabilitation targets aimed at improving Pp and paretic limb function are identified and should be a primary target of post-stroke gait rehabilitation.
132
The relative contribution of ankle moment and trailing limb angle to propulsive force during gait
TL;DR: The main findings were that ankle moment and trailing limb angle each contributes linearly to propulsive force, and that the change in trailing limb angles contributes almost as twice as much as thechange in ankle moment to the increase in propulsiveforce during speed modulation for able-bodied individuals.
131
Dynamic balance and instrumented gait variables are independent predictors of falls following stroke
Kelly J Bower,Shamala Thilarajah,Shamala Thilarajah,Yong-Hao Pua,Gavin Williams,Dawn Tan,Benjamin F. Mentiplay,Linda Denehy,Ross A. Clark +8 more
TL;DR: Reduced displacement of the pelvis in the mediolateral direction during walking was the strongest predictor of post-stroke falls compared with other gait variables, and dynamic balance measures, such as the TUG and step test, may better predict falls than gait speed or static balance measures.
References
Improved Gait Symmetry in Hemiparetic Stroke Patients Induced During Body Weight-Supported Treadmill Stepping:
TL;DR: In this article, body weight-supported treadmill training was used as an adjunct to conventional gait training for the treatment of hemiparetic stroke patients, and the potential effica...
Relationships between muscle activity and anteroposterior ground reaction forces in hemiparetic walking.
TL;DR: The results suggest that exaggerated flexor muscle activity may counteract the effects of the plantarflexors by offloading the leg and interfering with the limb's ability to generate appropriate AP ground reaction forces.
An Overview of Treadmill Locomotor Training with Partial Body Weight Support: A Neurophysiologically Sound Approach Whose Time Has Come for Randomized Clinical Trials:
TL;DR: Therapists will have to learn how to employ body weight-supported treadmill training (BWSTT) so that they optimize the segmental sensory inputs that best facilitate spinal and supraspinal locomotor networks.
Prolonged Quadriceps Activity Following Imposed Hip Extension: A Neurophysiological Mechanism for Stiff-Knee Gait?
Michael D. Lewek,Michael D. Lewek,T. George Hornby,Yasin Y. Dhaher,Yasin Y. Dhaher,Brian D. Schmit,Brian D. Schmit +6 more
TL;DR: Hyperexcitable heteronymous connections from hip flexors to knee extensors appear to elicit prolonged quadriceps activity and may contribute to altered swing-phase knee kinematics following stroke.
Influence of speed on walking economy poststroke.
TL;DR: For those poststroke whose fastest walking speed after stroke is below 1.2 m/s, walking economy improves when speed is increased above the self-selected walking speed, and for people with chronic stroke if faster walking speeds can be attained through intervention.