Identifying candidates for targeted gait rehabilitation after stroke: better prediction through biomechanics-informed characterization.
Louis N Awad, Darcy S Reisman, Ryan T Pohlig and 1 others
PMID 27663199WHAT IT FOUND
Adding paretic propulsion to baseline walking speed better predicted who improved after FastFES gait training.
The best outcomes were seen in slower walkers who still had some ability to push off with the affected leg, rather than those with the lowest propulsion.
Key findings
01A model combining baseline walking speed and paretic propulsion explained more variance in usual walking speed improvement than walking speed alone.
02Participants with high baseline propulsion and slow walking speed showed the largest gains in usual walking speed, exceeding the minimal clinically important difference.
03FastFES training was not more effective in those with the lowest baseline propulsion, contrary to the hypothesis that it would benefit those with the greatest deficit.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
This is a secondary analysis with a small sample size (n=27 recruited, n=25 analysed), limiting generalizability. Paretic propulsion was measured using an instrumented split-belt treadmill, which is not available in most clinical settings, making direct application of the finding difficult without surrogate measures. The study did not include a control group in this analysis, so it cannot confirm that the observed changes were solely due to the intervention rather than natural recovery or other factors. Two participants were excluded from the main analysis due to technical issues with data collection.
Declared interests
Funded by the National Institutes of Health and the American Heart Association. No conflicts of interest declared by the authors.
The easy way to misread this
Do not conclude that patients with the lowest paretic propulsion are the best candidates for propulsion-based gait training. The data showed that those with higher baseline propulsion, even if they were slow walkers, achieved the greatest improvements.