Stroke constitutes a major cause of functional disability and mortality, with increasing prevalence. Thus, the timely and accurate prognosis of stroke outcomes based on clinical or radiological markers is vital for both physicians and stroke survivors. Among radiological markers, cerebral microbleeds (CMBs) constitute markers of blood leakage from pathologically fragile small vessels. In the present review, we evaluated whether CMBs affect ischemic and hemorrhagic stroke outcomes and explored the fundamental question of whether CMBs may shift the risk–benefit balance away from reperfusion therapy or antithrombotic use in acute ischemic stroke patients. A literature review of two databases (MEDLINE and Scopus) was conducted to identify all the relevant studies published between 1 January 2012 and 9 November 2022. Only full-text articles published in the English language were included. Forty-one articles were traced and included in the present review. Our findings highlight the utility of CMB assessments, not only in the prognostication of hemorrhagic complications of reperfusion therapy, but also in forecasting hemorrhagic and ischemic stroke patients’ functional outcomes, thus indicating that a biomarker-based approach may aid in the provision of counseling for patients and families, improve the selection of more appropriate medical therapies, and contribute to a more accurate choice of patients for reperfusion therapy.

Background/Objectives: Chronic stroke survivors often regain walking speed but continue to exhibit heightened gait variability, increasing fall risk. This study investigated the effects of a 12-week moderate-to-high intensity muscle strengthening program on gait parameters and their variability in stroke survivors, without incorporating gait-specific training. Methods: Stroke survivors participated in a twice-weekly, 45–60 min strengthening program using Pilates equipment. Spatiotemporal gait parameters were measured before and after the intervention using 3D motion capture. Walking speed, cadence, step/stride length, step width, and various temporal parameters were analyzed for both paretic and non-paretic limbs, along with their coefficients of variation (CV). Correlation analyses were performed to understand the relationships between parameter changes. Results: Eleven patients (age 61 ± 7.4 years, 9 males) participated in the study. Significant improvements were observed in walking speed for both paretic (0.61 to 0.69 m/s, p = 0.032) and non-paretic limbs (0.62 to 0.69 m/s, p = 0.024). Step length significantly increased in the paretic limb (0.36 to 0.41 m, p = 0.042) with a substantial reduction in variability (CV: 19.91% to 14.99%). Cadence increased significantly in the non-paretic limb (89.24 to 92.01 steps/min, p = 0.024). Correlation analysis revealed distinct adaptation patterns between limbs, with speed improvements strongly associated with stride length in both limbs, but with step length only in the non-paretic limb. Conclusions: A moderate-to-high intensity strengthening program, even without direct gait training, can improve walking speed and reduce movement variability in chronic stroke survivors. The intervention predominantly influenced the spatial parameters, with modest changes in the temporal aspects, suggesting that enhanced force production and control primarily affect step execution while preserving temporal gait patterns.

Background/Objectives: While strength training interventions improve walking performance in stroke survivors, the underlying neuromuscular mechanisms remain poorly understood. This study investigated muscle-level adaptations following a 12-week moderate-to-high-intensity strength training program in ten chronic stroke survivors using comprehensive musculoskeletal modeling analysis. Methods: Three-dimensional gait analysis was performed pre- and post-intervention, with subject-specific OpenSim models estimating individual muscle forces, powers, and work capacities throughout stance phase. Results: Non-paretic hip flexor negative work capacity increased significantly (0.033 to 0.042 J/kg, p = 0.033, Cohen’s d = 0.47), driven by enhanced rectus femoris power absorption during late stance that mechanistically facilitated trunk acceleration through leg deceleration. Knee extensor force generation showed increasing trends during loading response in both limbs. During push-off, ankle plantar flexor force generation showed trends toward bilateral improvements, primarily through paretic soleus and gastrocnemius contributions, though power output remained unchanged, indicating persistent velocity-dependent muscular deficits. Conclusions: Improved gait performance in both limbs demonstrates that strength training produces functionally beneficial bilateral muscle-level reorganization. The absence of a control group limits causal inference, though the observed biomechanical adaptations align with functional improvements, supporting the integration of strength training into comprehensive stroke rehabilitation protocols targeting locomotor recovery.

While strength training interventions improve walking performance in stroke survivors, the underlying neuromuscular mechanisms remain poorly understood. This study investigated muscle-level adaptations following a 12-week moderate-to-high intensity strength training program in ten chronic stroke survivors using comprehensive musculoskeletal modeling analysis. Three-dimensional gait analysis was performed pre- and post-intervention, with subject-specific OpenSim models estimating individual muscle forces, powers, and work capacities throughout stance phase. Knee extensor force generation increased during loading response in both limbs. During push-off, ankle plantarflexor force generation improved bilaterally, primarily through paretic soleus and gastrocnemius contributions, though power output remained unchanged, indicating persistent velocity-dependent muscular deficits. Non-paretic hip flexor negative work capacity increased significantly (0.280 to 0.335 J/kg, p=0.033), driven by enhanced rectus femoris power absorption during late stance that mechanistically facilitated trunk acceleration through leg deceleration. Improved gait performance in both sides demonstrates that strength training produces functionally beneficial bilateral muscle-level reorganization, supporting its integration into comprehensive stroke rehabilitation protocols targeting locomotor recovery.