A systematic review of mechanisms of gait speed change post-stroke. Part 2: exercise capacity, muscle activation, kinetics, and kinematics

Abstract

Background Regaining locomotor ability is a primary goal in stroke rehabilitation and is most commonly measured using changes in self-selected walking speed. However, walking speed cannot identify the mechanisms by which an individual recovers. Laboratory-based mechanistic measures such as exercise capacity, muscle activation, force production, and movement analysis variables may better explain neurologic recovery. Objectives The objectives of this systematic review are to examine changes in mechanistic gait outcomes and describe motor recovery as quantified by changes in laboratory-based mechanistic variables in rehabilitation trials. Methods Following a systematic literature search (in PubMed, Ovid, and CINAHL), we included rehabilitation trials with a statistically significant change in self-selected walking speed post-intervention that concurrently collected mechanistic variables. Methodological quality was assessed using the Cochrane Collaboration's tool. Walking speed changes, mechanistic variables, and intervention data were extracted. Results 25 studies met the inclusion criteria and examined: cardiorespiratory function (n=5), muscle activation (n=5), force production (n=11), and movement analysis (n=10). Interventions included: aerobic training, functional electrical stimulation, multidimensional rehabilitation, robotics, sensory stimulation training, strength/resistance training, task-specific locomotor rehabilitation, and visually-guided training. Conclusions Following this review, no set of outcome measures to mechanistically explain changes observed in walking speed was identified. Nor is there a theoretical basis to drive the complicated selection of outcome measures, as many of these outcomes are not independent of walking speed. Since rehabilitation literature has yet to support a causal, mechanistic link for functional gains post stroke, a systematic, multi-modal approach to stroke rehabilitation will be necessary in doing so.

Effect of robotic-assisted gait training on objective biomechanical measures of gait in persons post-stroke: a systematic review and meta-analysis

“…Step length and stride length are considered closely connected to gait speed [74]. However, even though a difference between groups was not detectable with regards to gait speed, our analyses showed that step length (Fig.…”

Association between in-hospital frailty and health-related quality of life after stroke: the Nor-COAST study

“…As robust individuals are known to have better HRQoL than frail individuals, the results in the present study therefore likely overestimate EQ-5 L-5D scores and underestimate the decrease in HRQoL from 3 to 18 months. Of the Fried criteria applied in this study, weight loss, self-reported exhaustion, and low physical activity refer to the participants' pre-stroke states, while slow gait speed and low grip strength had to be assessed poststroke and may have been influenced by the stroke incident [55,56]. We have adjusted for stroke severity, but this may still comprise a methodical challenge in our study.…”

Functional Electrical Stimulation for Foot Drop in Post-Stroke People: Quantitative Effects on Step-to-Step Symmetry of Gait Using a Wearable Inertial Sensor

“…Foot drop interferes with ankle dorsiflexion during the swing phase of gait and contributes to the disruption in weight acceptance and weight transfer in the initial foot contact and stance phases [ 7 ]. The most evident alterations in gait, besides a marked asymmetry, include walking speed reduction, longer durations of double-stance and paretic swing phases, reduced paretic single-stance phase duration, cadence, and stride length [ 3 , 8 ], asymmetric postural behavior during walking and standing [ 9 ], altered kinematics, and reduced ankle push-off ability in terminal stance [ 10 , 11 ]. In this context, gait impairments cause difficulties with performing the activities of daily living and mobility, thus reducing independence and quality of life [ 12 ].…”