A systematic review of mechanisms of gait speed change post-stroke. Part 2: exercise capacity, muscle activation, kinetics, and kinematics

Elizabeth C Wonsetler, Mark G Bowden, Elizabeth C Wonsetler, Mark G Bowden

Abstract

Background: Regaining locomotor ability is a primary goal in stroke rehabilitation and is most commonly measured using changes in self-selected walking speed. However, walking speed cannot identify the mechanisms by which an individual recovers. Laboratory-based mechanistic measures such as exercise capacity, muscle activation, force production, and movement analysis variables may better explain neurologic recovery.

Objectives: The objectives of this systematic review are to examine changes in mechanistic gait outcomes and describe motor recovery as quantified by changes in laboratory-based mechanistic variables in rehabilitation trials.

Methods: Following a systematic literature search (in PubMed, Ovid, and CINAHL), we included rehabilitation trials with a statistically significant change in self-selected walking speed post-intervention that concurrently collected mechanistic variables. Methodological quality was assessed using Cochrane Collaboration's tool. Walking speed changes, mechanistic variables, and intervention data were extracted.

Results: Twenty-five studies met the inclusion criteria and examined: cardiorespiratory function (n = 5), muscle activation (n = 5), force production (n = 11), and movement analysis (n = 10). Interventions included: aerobic training, functional electrical stimulation, multidimensional rehabilitation, robotics, sensory stimulation training, strength/resistance training, task-specific locomotor rehabilitation, and visually-guided training.

Conclusions: Following this review, no set of outcome measures to mechanistically explain changes observed in walking speed were identified. Nor is there a theoretical basis to drive the complicated selection of outcome measures, as many of these outcomes are not independent of walking speed. Since rehabilitation literature is yet to support a causal, mechanistic link for functional gains post-stroke, a systematic, multimodal approach to stroke rehabilitation will be necessary in doing so.

Keywords: BWS, body weight support; BWSTT, body weight support treadmill training; EMG, electromyography; FES, functional electrical stimulation; ROM, range of motion; SSWS, self-selected walking speed; Stroke; VO2peak, peak oxygen uptake; electromyography; exercise capacity; kinematics; kinetics; recovery of function; rehabilitation; walking speed.

Figures

Figure 1
Figure 1
Flow of studies through the review.
Figure 2
Figure 2
Growth of literature including both functional and mechanistic measures.

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Source: PubMed

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