Targeting Paretic Propulsion to Improve Poststroke Walking Function: A Preliminary Study

• Authors: Louis N. Awad, University of Delaware; Darcy S. Reisman, University of Delaware; Trisha M. Kesar, Emory University; Stuart A. Binder-Macleod, University of Delaware
• Journal Title: Archives of Physical Medicine and Rehabilitation
• Volume: Volume 95, Number 5
• Publisher: Elsevier: 12 months | 2014-05-01, Pages 840-848
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.apmr.2013.12.012
• Subjects: Biology, Neuroscience; Health Sciences, Rehabilitation and Therapy
• Keywords: Science & Technology; Life Sciences & Biomedicine; Rehabilitation; Sport Sciences; Paresis; Stroke; Walking; BODY-WEIGHT SUPPORT; GAIT SPEED; CHRONIC STROKE; LOCOMOTOR REHABILITATION; HEMIPARETIC WALKING; KINETIC VARIABLES; PERFORMANCE; TREADMILL; INDIVIDUALS; RECOVERY

Abstract

Objectives: To determine the feasibility and safety of implementing a 12-week locomotor intervention targeting paretic propulsion deficits during walking through the joining of 2 independent interventions, walking at maximal speed on a treadmill and functional electrical stimulation of the paretic ankle musculature (FastFES); to determine the effects of FastFES training on individual subjects; and to determine the influence of baseline impairment severity on treatment outcomes. Design: Single group pre-post preliminary study investigating a novel locomotor intervention. Setting: Research laboratory. Participants: Individuals (N=13) with locomotor deficits after stroke. Intervention: FastFES training was provided for 12 weeks at a frequency of 3 sessions per week and 30 minutes per session. Main Outcome Measures: Measures of gait mechanics, functional balance, short- and long-distance walking function, and self-perceived participation were collected at baseline, posttraining, and 3-month follow-up evaluations. Changes after treatment were assessed using pairwise comparisons and compared with known minimal clinically important differences or minimal detectable changes. Correlation analyses were run to determine the correlation between baseline clinical and biomechanical performance versus improvements in walking speed. Results: Twelve of the 13 subjects that were recruited completed the training. Improvements in paretic propulsion were accompanied by improvements in functional balance, walking function, and self-perceived participation (each P<.02) - all of which were maintained at 3-month follow-up. Eleven of the 12 subjects achieved meaningful functional improvements. Baseline impairment was predictive of absolute, but not relative, functional change after training. Conclusions: This report demonstrates the safety and feasibility of the FastFES intervention and supports further study of this promising locomotor intervention for persons poststroke.