Propulsive force generation is critical to walking speed. Trialing limb angle and ankle moment are major contributors to increases in propulsive force during gait. For able-bodied individuals, trailing limb angle contributes twice as much as ankle moment to increases in propulsive force during speed modulation. The aim of this study was to quantify the relative contribution of ankle moment and trailing limb angle to increases in propulsive force for individuals poststroke. A biomechanical-based model previously developed for able-bodied individuals was evaluated and enhanced for individuals poststroke. Gait analysis was performed as subjects (N = 24) with chronic poststroke hemiparesis walked at their self-selected and fast walking speeds on a treadmill. Both trailing limb angle and ankle moment increased during speed modulation. In the paretic limb, the contribution from trailing limb angle versus ankle moment to increases in propulsive force is 74% and 17%. In the non-paretic limb, the contribution from trailing limb angle versus ankle moment to increases in propulsive force is 67% and 22%. Individuals poststroke increase propulsive force mainly by changing trailing limb angle in both the paretic and non-paretic limbs. This strategy may contribute to the inefficiency in poststroke walking patterns. Future work is needed to examine whether these characteristics can be modified via intervention.
10 July 2016 in Neurorehabilitation and Neural Repair
Background. Recent rehabilitation efforts after stroke often focus on increasing walking speed because it is associated with quality of life. For individuals poststroke, propulsive force generated from the paretic limb has been shown to be correlated to walking speed. However, little is known about the relative contribution of the paretic versus the nonparetic propulsive forces to changes in walking speed. Objective. The primary purpose of this study was to determine the contribution of propulsive force generated from each limb to changes in walking speed during speed modulation within a session and as a result of a 12-week training program. Methods. Gait analysis was performed as participants (N = 38) with chronic poststroke hemiparesis walked at their self-selected and faster walking speeds on a treadmill before and after a 12-week gait retraining program. Results. Prior to training, stroke survivors increased nonparetic propulsive forces as the primary mechanism to change walking speed during speed modulation within a session. Following gait training, the paretic limb played a larger role during speed modulation within a session. In addition, the increases in paretic propulsive forces observed following gait training contributed to the increases in the self-selected walking speeds seen following training. Conclusions. Gait retraining in the chronic phase of stroke recovery facilitates paretic limb neuromotor recovery and reduces the reliance on the nonparetic limb’s generation of propulsive force to increase walking speed. These findings support gait rehabilitation efforts directed toward improving the paretic limb’s ability to generate propulsive force.