Maximum walking speeds obtained using treadmill and overground robot system in persons with post-stroke hemiplegia

Abstract

BackgroundPrevious studies demonstrated that stroke survivors have a limited capacity to increase their walking speeds beyond their self-selected maximum walking speed (SMWS). The purpose of this study was to determine the capacity of stroke survivors to reach faster speeds than their SMWS while walking on a treadmill belt or while being pushed by a robotic system (i.e. “push mode”).MethodsEighteen chronic stroke survivors with hemiplegia were involved in the study. We calculated their self-selected comfortable walking speed (SCWS) and SMWS overground using a 5-meter walk test (5-MWT). Then, they were exposed to walking at increased speeds, on a treadmill and while in “push mode” in an overground robotic device, the KineAssist, until they were tested at a speed that they could not sustain without losing balance. We recorded the time and number of steps during each trial and calculated gait speed, average cadence and average step length.ResultsMaximum walking speed in the “push mode” was 13% higher than the maximum walking speed on the treadmill and both were higher (“push mode”: 61%; treadmill: 40%) than the maximum walking speed overground. Subjects achieved these faster speeds by initially increasing both step length and cadence and, once individuals stopped increasing their step length, by only increasing cadence.ConclusionsWith post-stroke hemiplegia, individuals are able to walk at faster speeds than their SMWS overground, when provided with a safe environment that provides external forces that requires them to attempt dynamic stability maintenance at higher gait speeds. Therefore, this study suggests the possibility that, given the appropriate conditions, people post-stroke can be trained at higher speeds than previously attempted.

Knee posture during gait and global functioning post-stroke: a theoretical ICF framework using current measures in stroke rehabilitation

“…The following clinical measures, which are commonly used to assess patients and/or predict stroke recovery [20][21][22][23][24][25][26][27][28][29] were employed to describe and compare global functioning in participants with NKP and AKP: Isometric muscle strength (knee extensors, knee flexors) [20], Modified Ashworth Scale [21], Leg sub-score of Fugl-Meyer [22], structure of brain affected, 5-m Walk at self-selected speed, 5-m Walk at fast speed, Timed Up and Go test [23], Functional Ambulatory Category [24], Falls Efficacy Scale [25], Use of walking aid [27] and World Health Organization Disability Assessment Schedule [28] and Body Mass Index (BMI) [29]. Each clinical measure was then linked to the relevant ICF categories (body functions and structures and activities and participation using corresponding ICF codes published by Ustun et al [29] and Mudge et al [13]).…”

“…Self-selected and fast walking speed were assessed using the 5-meter walk test (5mWT) [42] performed following standard procedures [23]. Patients walked three trials at their comfortable speed, with a 5-m interval between each trial and then repeated the same procedures at their fastest speed.…”

Fast gait speed and self-perceived balance as valid predictors and discriminators of independent community walking at 6 months post-stroke – a preliminary study

“…Walking speed was assessed with the 5-m walk test (5mWT), a shortened variation of the 10-m walk test [17] widely used in acute stroke patients to minimize participant fatigue [19]. Tape was placed on the floor, following the standard procedures [19]. Subjects performed three trials at their comfortable speed, with a 5-min interval between each trial and then repeated the same procedures at their fastest speed.…”

“…Subjects with a significant difference between comfortable and fast speeds have greater potential to adapt to different modes of locomotion and, consequently, are more likely to be able to walk in the community. Walking speed was assessed with the 5-m walk test (5mWT), a shortened variation of the 10-m walk test [17] widely used in acute stroke patients to minimize participant fatigue [19]. Tape was placed on the floor, following the standard procedures [19].…”

Visuotemporal cues clinically improved walking ability of ambulatory patients with spinal cord injury within 5 days

“…27,28 Repetitive practice in a fastest walking manner imposed a high demand on many body systems involved in the task, specifically the muscular and cardiopulmonary systems, which subsequently improved the functional ability of the participants. 29,30 While both groups demonstrated improvements, the significantly greater improvement seen in the participants in the experimental group may reflect the importance of the external information provided (P < 0.05, Table 3). Injury to the spinal cord distorted both the motor and the sensory functions of the participants (Table 2), preventing them from fully utilizing their internal reference of movement correction.…”