These legs were made for propulsion: advancing the diagnosis and treatment of post-stroke propulsion deficits

• Type of Material: Article
• Authors: Louis N. Awad, Boston University; Michael D. Lewek, University of North Carolina; Trisha Kesar, Emory University; Jason R. Franz, University of North Carolina; Mark G. Bowden, Medical University of South Carolina
• Language: English
• Date: 2020-10-21
• Publisher: BMC
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2020
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s12984-020-00747-6
• Title of Journal or Parent Work: JOURNAL OF NEUROENGINEERING AND REHABILITATION
• Volume: 17
• Issue: 1
• Start Page: 139
• End Page: 139
• Grant/Funding Information: The authors acknowledge funding support from the NIH (R01AG067394, R01HD095975, and K01HD079584) and AHA (18TPA34170171 and 18IPA34170487).
• Keywords: Life Sciences & Biomedicine; ANKLE-FOOT ORTHOSIS; Locomotion; PARETIC PROPULSION; Intervention; Neurosciences & Neurology; Diagnosis; Engineering, Biomedical; GROUND REACTION FORCES; Engineering; Propulsion; Walking; Neurosciences; TRANSCRANIAL MAGNETIC STIMULATION; MOTOR CORTEX; BODY-WEIGHT SUPPORT; Technology; Science & Technology; CHRONIC STROKE; TRAILING LIMB ANGLE; Rehabilitation; COMMUNITY WALKING ACTIVITY; FUNCTIONAL ELECTRICAL-STIMULATION; Robotics; Sensors
• Research Categories: Engineering, Biomedical; Health Sciences, Rehabilitation and Therapy; Biology, Neuroscience

Abstract

Advances in medical diagnosis and treatment have facilitated the emergence of precision medicine. In contrast, locomotor rehabilitation for individuals with acquired neuromotor injuries remains limited by the dearth of (i) diagnostic approaches that can identify the specific neuromuscular, biomechanical, and clinical deficits underlying impaired locomotion and (ii) evidence-based, targeted treatments. In particular, impaired propulsion by the paretic limb is a major contributor to walking-related disability after stroke; however, few interventions have been able to target deficits in propulsion effectively and in a manner that reduces walking disability. Indeed, the weakness and impaired control that is characteristic of post-stroke hemiparesis leads to heterogeneous deficits that impair paretic propulsion and contribute to a slow, metabolically-expensive, and unstable gait. Current rehabilitation paradigms emphasize the rapid attainment of walking independence, not the restoration of normal propulsion function. Although walking independence is an important goal for stroke survivors, independence achieved via compensatory strategies may prevent the recovery of propulsion needed for the fast, economical, and stable gait that is characteristic of healthy bipedal locomotion. We posit that post-stroke rehabilitation should aim to promote independent walking, in part, through the acquisition of enhanced propulsion. In this expert review, we present the biomechanical and functional consequences of post-stroke propulsion deficits, review advances in our understanding of the nature of post-stroke propulsion impairment, and discuss emerging diagnostic and treatment approaches that have the potential to facilitate new rehabilitation paradigms targeting propulsion restoration.