Faster is better: implications for speed-intensive gait training after stroke.

Abstract

The instantaneous adaptations to speed and load changes during overground locomotion have major implications for mobility after stroke. We examined the extent to which stroke subjects could increase their overground walking speed with respect to speed and unloading changes. Twelve subjects with a unilateral stroke were evaluated while walking overground full weight bearing (FWB) or with body weight support (BWS) at preferred or fast speed. On the basis of their preferred walking speed, subjects were classified as high (> or =45 cm/s) or low functioning (<45 cm/s). Gait speed, temporal distance factors (TDFs), as well as movements and muscle activation of the lower limbs were measured and compared across the conditions. FWB-Fast condition induced marked (165%) increment in gait speed in all subjects. BWS at preferred speed induced faster speeds in low- but not the high-functioning subjects, whereas combined BWS and fast walking yielded further speed increments in the high-functioning subjects. Fast walking was associated with bilateral increases in joint excursion and muscle activation, as well as improved symmetry in some TDFs. BWS favored a hip flexion strategy in early swing while decreasing limb circumduction. This study shows that stroke subjects can increase substantially their walking speed without deleterious effects. Fast walking induces marked speed-related improvements in body and limb kinematics and muscle activation patterns. BWS during overground walking also increases gait speed, but to a lesser extent and only in low-functioning subjects. The combination of BWS with fast speed produces the greatest increments in walking speed in all subjects.