Interventions for coordination of walking following stroke: Systematic review

Abstract

Impairments in gait coordination may be a factor in falls and mobility limitations after stroke. Therefore, rehabilitation targeting gait coordination may be an effective way to improve walking post-stroke. This review sought to examine current treatments that target impairments of gait coordination, the theoretical basis on which they are derived and the effects of such interventions. Few high quality RCTs with a low risk of bias specifically targeting and measuring restoration of coordinated gait were found. Consequently, we took a pragmatic approach to describing and quantifying the available evidence and included non-randomised study designs and limited the influence of heterogeneity in experimental design and control comparators by restricting meta-analyses to pre- and post-test comparisons of experimental interventions only. Results show that physiotherapy interventions significantly improved gait function and coordination. Interventions involving repetitive task-specific practice and/or auditory cueing appeared to be the most promising approaches to restore gait coordination. The fact that overall improvements in gait coordination coincided with increased walking speed lends support to the hypothesis that targeting gait coordination gait may be a way of improving overall walking ability post-stroke. However, establishing the mechanism for improved locomotor control requires a better understanding of the nature of both neuroplasticity and coordination deficits in functional tasks after stroke. Future research requires the measurement of impairment, activity and cortical activation in an effort to establish the mechanism by which functional gains are achieved.

A robotic exoskeleton for overground gait rehabilitation

“…When the lower limbs are affected, a rehabilitation treatment is required to restore gait function and regain the capacity to walk independently. A number of individual rehabilitation treatment approaches have been proposed to improve overall walking ability [2].…”

Rehabilitation of Walking After Stroke

“…Recent reviews have demonstrated improvements in symmetry utilizing a wide range of parameters from 2 sessions/day, 5 days/week× 6 weeks to 3 minute walking trials for a total of 3 sessions spread out over 5 weeks. Gait speed and coordination improve [41] as well as balance and stability measures [42] but information on long-term follow-up is limited.…”

Correlation between mobility assessed by the Modified Rivermead Mobility Index and physical function in stroke patients

“…Mobility limitations after stroke include decreased strength8 ) and range of motion9 ) , in addition to spasticity10 ) , impaired sensory function11 ) , and impaired coordination12 ) . However, the physical function variables that have the most influence on mobility after stroke have not been clarified.…”