These legs were made for propulsion: advancing the diagnosis and treatment of post-stroke propulsion deficits.
Louis N Awad, Michael D Lewek, Trisha M Kesar and 2 others
PMID 33087137WHAT IT FOUND
Post-stroke walking deficits stem from poor propulsion, not just weakness.
Current rigid braces can block push-off. Emerging therapies like functional electrical stimulation and soft exosuits aim to restore true propulsion, but these remain experimental and require rigorous testing before clinical adoption.
Key findings
01Rigid ankle-foot orthoses can limit propulsion by preventing plantarflexion during push-off, potentially encouraging compensatory hip strategies rather than restoring normal gait.
02In a randomized trial, FastFES (functional electrical stimulation to plantarflexors) improved paretic plantarflexor moments and reduced energy cost, whereas control groups improved speed via trailing limb angle changes without restoring plantarflexor moment.
03Propulsion deficits are heterogeneous, arising from varying combinations of limb positioning issues, muscle strength deficits, or reduced neural drive, requiring individualized assessment to match treatment effectively.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
This is a narrative review, not a systematic review or meta-analysis, so the selection of studies may be biased toward the authors' prior work and interests. Many of the interventions discussed (exosuits, point-of-care sensors) are still in early-stage research or pilot phases and are not widely available in clinical practice. The review highlights a gap in diagnostic tools: current clinical settings lack accessible ways to measure propulsion, making the recommended individualized assessments difficult to implement immediately. The cited RCT on FastFES showed no between-group difference in 6-minute walk test distance, suggesting that improved propulsion metrics do not always translate to immediate functional gains in endurance.
Declared interests
The authors declare no competing interests. The work was supported by NIH and other non-US government grants.
The easy way to misread this
Do not interpret the promising results of FastFES or exosuits as evidence that these technologies are ready for routine clinical use or that they universally improve functional walking speed. The review notes that improved propulsion metrics (like energy cost) did not always lead to better performance on standard functional tests like the 6-minute walk test, and many devices are still in safety/feasibility trials.