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J Biomech. 2016 Feb 8;49(3):388-95. doi: 10.1016/j.jbiomech.2015.12.040. Epub 2015 Dec 31.

Mechanisms used to increase peak propulsive force following 12-weeks of gait training in individuals poststroke.

Author information

1
Biomechanics and Movement Science Program, University of Delaware, United States. Electronic address: haoyuan@udel.edu.
2
Delaware Rehabilitation Institute, University of Delaware, United States. Electronic address: bknarr@udel.edu.
3
Biostatistics Core Facility, University of Delaware, United States. Electronic address: rpohlig@udel.edu.
4
Department of Mechanical Engineering, University of Delaware, United States. Electronic address: higginso@udel.edu.
5
Department of Physical Therapy, University of Delaware, United States. Electronic address: sbinder@udel.edu.

Abstract

Current rehabilitation efforts for individuals poststroke focus on increasing walking speed because it is a predictor of community ambulation and participation. Greater propulsive force is required to increase walking speed. Previous studies have identified that trailing limb angle (TLA) and ankle moment are key factors to increases in propulsive force during gait. However, no studies have determined the relative contribution of these two factors to increase propulsive force following intervention. The purpose of this study was to quantify the relative contribution of ankle moment and TLA to increases in propulsive force following 12-weeks of gait training for individuals poststroke. Forty-five participants were assigned to 1 of 3 training groups: training at self-selected speeds (SS), at fastest comfortable speeds (Fast), and Fast with functional electrical stimulation (FastFES). For participants who gained paretic propulsive force following training, a biomechanical-based model previously developed for individuals poststroke was used to calculate the relative contributions of ankle moment and TLA. A two-way, mixed-model design, analysis of covariance adjusted for baseline walking speed was performed to analyze changes in TLA and ankle moment across groups. The model showed that TLA was the major contributor to increases in propulsive force following training. Although the paretic TLA increased from pre-training to post-training, no differences were observed between groups. In contrast, increases in paretic ankle moment were observed only in the FastFES group. Our findings suggested that specific targeting may be needed to increase ankle moment.

KEYWORDS:

Extension; Functional electrical stimulation; Gait; Moment; Propulsion; Stroke; Trailing limb

PMID:
26776931
PMCID:
PMC4761516
DOI:
10.1016/j.jbiomech.2015.12.040
[Indexed for MEDLINE]
Free PMC Article

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