Abstract
BackgroundAfter stroke, some individuals have latent, propulsive capacity of the paretic leg, that can be elicited during task-specific gait training. The aim of this proof-of-concept study was to investigate the effect of five-week robotic gait training for improving propulsion symmetry by increasing paretic propulsion in chronic stroke survivors.MethodsTwenty-nine individuals with chronic stroke and impaired paretic propulsion (≥ 8% difference in paretic vs. non-paretic propulsive impulse) were enrolled. Participants received ten 60-min sessions of individual robotic gait training targeting paretic propulsion (five weeks, twice a week), complemented with home exercises (15 min/day) focusing on increasing strength and practicing learned strategies in daily life. Propulsion measures, gait kinematics and kinetics, self-selected gait speed, performance of functional gait tasks, and daily-life mobility and physical activity were assessed five weeks (T0) and one week (T1) before the start of intervention, and one week (T2) and five weeks (T3) after the intervention period.ResultsBetween T0 and T1, no significant differences in outcomes were observed, except for a marginal increase in gait speed (+ 2.9%). Following the intervention, propulsion symmetry (+ 7.9%) and paretic propulsive impulse had significantly improved (+ 8.1%), whereas non-paretic propulsive impulse remained unchanged. Larger gains in propulsion symmetry were associated with more asymmetrical propulsion at T0. In addition, following the intervention significantly greater paretic trailing limb angles (+ 6.6%) and ankle plantarflexion moments (+ 7.1%) were observed. Furthermore, gait speed (+ 7.2%), 6-Minute Walk Test (+ 6.4%), Functional Gait Assessment (+ 6.5%), and daily-life walking intensity (+ 6.9%) had increased following the intervention. At five-week follow-up (T3), gains in all outcomes were retained, and gait speed had further increased (+ 3.6%).ConclusionsThe post-intervention gain in paretic propulsion did not only translate into improved propulsion symmetry and gait speed, but also pertained to performance of functional gait tasks and daily-life walking activity levels. These findings suggest that well-selected chronic stroke survivors may benefit from task-specific targeted training to utilize the residual propulsive capacity of the paretic leg. Future research is recommended to establish simple baseline measures for identification of individuals who may benefit from such training and confirm benefits of the used training concepts in a randomized controlled trial.Trial registration: Registry number ClinicalTrials.gov (www.clinicaltrials.gov): NCT04650802, retrospectively registered 3 December 2020.
Highlights
While the majority of stroke survivors regain independent walking [1], gait efficiency and speed are often persistently reduced compared to healthy adults [2]
Post-stroke gait speed is associated with community ambulation, as a minimum speed of 0.4 m/s seems necessary for walking outside the home, and a speed faster than 0.8 m/s seems required for full community ambulation [3, 4]
In order to compensate for the lack of paretic propulsion, stroke survivors tend to rely more on the non-paretic leg’s propulsion generation [19, 27], as well as on paretic hip pull-off to progress the paretic leg during swing [14, 16]
Summary
While the majority of stroke survivors regain independent walking [1], gait efficiency and speed are often persistently reduced compared to healthy adults [2]. Larger trailing limb angles are associated with more anteriorly directed ground reaction forces [11], resulting in a larger contribution of the ankle plantarflexion moment to forward (instead of upward) acceleration of the body. In order to compensate for the lack of paretic propulsion, stroke survivors tend to rely more on the non-paretic leg’s propulsion generation [19, 27], as well as on paretic hip pull-off to progress the paretic leg during swing [14, 16] These compensatory mechanism are, associated with reduced gait efficiency [25, 28]. The aim of this proof-of-concept study was to investigate the effect of five-week robotic gait training for improving propulsion symmetry by increasing paretic propulsion in chronic stroke survivors
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