Improved walking function in laboratory does not guarantee increased community walking in stroke survivors: Potential role of gait biomechanics

Ardestani, Marzieh M.; Henderson, Christopher E.; Hornby, T. George

doi:10.1016/j.jbiomech.2019.05.011

Cited by 17 publications

(15 citation statements)

References 34 publications

(47 reference statements)

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“…Improvement in walking speed does not differentiate post-stroke recovery from compensation (Bowden et al, 2012 ; Combs et al, 2012 ). Thus, it is necessary to examine the biomechanical changes that accompany walking speed changes to substantiate the nature of motor recovery (Bowden et al, 2012 ; Reinkensmeyer et al, 2016 ; Ardestani et al, 2019a , b ; Roelker et al, 2019 ).…”

Section: Discussionmentioning

confidence: 99%

Targeting Paretic Propulsion and Walking Speed With a Soft Robotic Exosuit: A Consideration-of-Concept Trial

et al. 2021

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Background: Soft robotic exosuits can facilitate immediate increases in short- and long-distance walking speeds in people with post-stroke hemiparesis. We sought to assess the feasibility and rehabilitative potential of applying propulsion-augmenting exosuits as part of an individualized and progressive training program to retrain faster walking and the underlying propulsive strategy.Methods: A 54-yr old male with chronic hemiparesis completed five daily sessions of Robotic Exosuit Augmented Locomotion (REAL) gait training. REAL training consists of high-intensity, task-specific, and progressively challenging walking practice augmented by a soft robotic exosuit and is designed to facilitate faster walking by way of increased paretic propulsion. Repeated baseline assessments of comfortable walking speed over a 2-year period provided a stable baseline from which the effects of REAL training could be elucidated. Additional outcomes included paretic propulsion, maximum walking speed, and 6-minute walk test distance.Results: Comfortable walking speed was stable at 0.96 m/s prior to training and increased by 0.30 m/s after training. Clinically meaningful increases in maximum walking speed (Δ: 0.30 m/s) and 6-minute walk test distance (Δ: 59 m) were similarly observed. Improvements in paretic peak propulsion (Δ: 2.80 %BW), propulsive power (Δ: 0.41 W/kg), and trailing limb angle (Δ: 6.2 degrees) were observed at comfortable walking speed (p's < 0.05). Likewise, improvements in paretic peak propulsion (Δ: 4.63 %BW) and trailing limb angle (Δ: 4.30 degrees) were observed at maximum walking speed (p's < 0.05).Conclusions: The REAL training program is feasible to implement after stroke and capable of facilitating rapid and meaningful improvements in paretic propulsion, walking speed, and walking distance.

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Section: Discussionmentioning

confidence: 99%

Targeting Paretic Propulsion and Walking Speed With a Soft Robotic Exosuit: A Consideration-of-Concept Trial

et al. 2021

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“…The second clinical assumption is that a change in an individual’s capacity is equivalent to a change in that individual performance in daily life. Over the past few years, multiple reports have now demonstrated discrepant outcomes in capacity and performance over the course of research and clinical interventions [ 21 , 22 , 23 , 24 ]. Each of these aforementioned belief barriers will require educational strategies tailored towards rehabilitation professionals to improve adoption of performance tracking with wearable device systems within clinical populations.…”

Section: The Current Situation In Clinical Carementioning

confidence: 99%

Implementation of Wearable Sensing Technology for Movement: Pushing Forward into the Routine Physical Rehabilitation Care Field

Lang

Barth

Holleran

et al. 2020

Sensors

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While the promise of wearable sensor technology to transform physical rehabilitation has been around for a number of years, the reality is that wearable sensor technology for the measurement of human movement has remained largely confined to rehabilitation research labs with limited ventures into clinical practice. The purposes of this paper are to: (1) discuss the major barriers in clinical practice and available wearable sensing technology; (2) propose benchmarks for wearable device systems that would make it feasible to implement them in clinical practice across the world and (3) evaluate a current wearable device system against the benchmarks as an example. If we can overcome the barriers and achieve the benchmarks collectively, the field of rehabilitation will move forward towards better movement interventions that produce improved function not just in the clinic or lab, but out in peoples’ homes and communities.

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“…Future work is required to determine how improved propulsion control and a reduced energy cost of walking can be leveraged to reduce post-stroke walking disability. Indeed, while the FastFES body of evidence supports the importance of more normal propulsion function to an energetically economical gait [6], walking improvements made and measured in a motion analysis laboratory may not translate to improved walking in unconstrained, real world settings [139]. Overground adaptations of the FastFES training approach have the potential to increase ecological validity but require the development of new plantarflexor FES control approaches suitable for overground walking and the identification of methods to facilitate the necessary paretic trailing limb angle during training without the assistance of a fast treadmill belt.…”

Section: The Fastfes Interventionmentioning

confidence: 99%

These legs were made for propulsion: advancing the diagnosis and treatment of post-stroke propulsion deficits

Awad

Lewek

Kesar

et al. 2020

J NeuroEngineering Rehabil

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Advances in medical diagnosis and treatment have facilitated the emergence of precision medicine. In contrast, locomotor rehabilitation for individuals with acquired neuromotor injuries remains limited by the dearth of (i) diagnostic approaches that can identify the specific neuromuscular, biomechanical, and clinical deficits underlying impaired locomotion and (ii) evidence-based, targeted treatments. In particular, impaired propulsion by the paretic limb is a major contributor to walking-related disability after stroke; however, few interventions have been able to target deficits in propulsion effectively and in a manner that reduces walking disability. Indeed, the weakness and impaired control that is characteristic of post-stroke hemiparesis leads to heterogeneous deficits that impair paretic propulsion and contribute to a slow, metabolically-expensive, and unstable gait. Current rehabilitation paradigms emphasize the rapid attainment of walking independence, not the restoration of normal propulsion function. Although walking independence is an important goal for stroke survivors, independence achieved via compensatory strategies may prevent the recovery of propulsion needed for the fast, economical, and stable gait that is characteristic of healthy bipedal locomotion. We posit that post-stroke rehabilitation should aim to promote independent walking, in part, through the acquisition of enhanced propulsion. In this expert review, we present the biomechanical and functional consequences of post-stroke propulsion deficits, review advances in our understanding of the nature of post-stroke propulsion impairment, and discuss emerging diagnostic and treatment approaches that have the potential to facilitate new rehabilitation paradigms targeting propulsion restoration.

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Improved walking function in laboratory does not guarantee increased community walking in stroke survivors: Potential role of gait biomechanics

Cited by 17 publications

References 34 publications

Targeting Paretic Propulsion and Walking Speed With a Soft Robotic Exosuit: A Consideration-of-Concept Trial

Targeting Paretic Propulsion and Walking Speed With a Soft Robotic Exosuit: A Consideration-of-Concept Trial

Implementation of Wearable Sensing Technology for Movement: Pushing Forward into the Routine Physical Rehabilitation Care Field

These legs were made for propulsion: advancing the diagnosis and treatment of post-stroke propulsion deficits

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