These legs were made for propulsion: advancing the diagnosis and treatment of post-stroke propulsion deficits

Abstract

Advances in medical diagnosis and treatment have facilitated the emergence of precision medicine. In contrast, locomotor rehabilitation for individuals with acquired neuromotor injuries remains limited by the dearth of (i) diagnostic approaches that can identify the specific neuromuscular, biomechanical, and clinical deficits underlying impaired locomotion and (ii) evidence-based, targeted treatments. In particular, impaired propulsion by the paretic limb is a major contributor to walking-related disability after stroke; however, few interventions have been able to target deficits in propulsion effectively and in a manner that reduces walking disability. Indeed, the weakness and impaired control that is characteristic of post-stroke hemiparesis leads to heterogeneous deficits that impair paretic propulsion and contribute to a slow, metabolically-expensive, and unstable gait. Current rehabilitation paradigms emphasize the rapid attainment of walking independence, not the restoration of normal propulsion function. Although walking independence is an important goal for stroke survivors, independence achieved via compensatory strategies may prevent the recovery of propulsion needed for the fast, economical, and stable gait that is characteristic of healthy bipedal locomotion. We posit that post-stroke rehabilitation should aim to promote independent walking, in part, through the acquisition of enhanced propulsion. In this expert review, we present the biomechanical and functional consequences of post-stroke propulsion deficits, review advances in our understanding of the nature of post-stroke propulsion impairment, and discuss emerging diagnostic and treatment approaches that have the potential to facilitate new rehabilitation paradigms targeting propulsion restoration.

Pelvis-Toe Distance: 3-Dimensional Gait Characteristics of Functional Limb Shortening in Hemiparetic Stroke

“…However, gait speed has been pointed out to be insufficient to detect qualitative changes in stroke population [ 12 , 33 ]. Various outcomes of kinematics and kinetics to capture gait quality have been presented by researchers, as follows: muscle synergies [ 33 ], paretic propulsion [ 34 , 35 ], gait asymmetry [ 33 , 36 ], intralimb/interlimb coordination [ 37 , 38 ], gait deviation index [ 39 , 40 ], and gait variability index [ 39 , 41 ]. Nonetheless, no recommended outcomes have been determined at this time [ 12 ].…”

Clarify Sit-to-Stand Muscle Synergy and Tension Changes in Subacute Stroke Rehabilitation by Musculoskeletal Modeling

“…For medical diagnosis and treatment, the most applicable and clinically relevant information is about the longitudinal outcome investigated serially by kinematic and kinetic measurements in conjunction with clinical assessments (Kwakkel et al, 2017 ; Vigotsky et al, 2018 ; Awad et al, 2020 ). EMG-informed conclusions made by researchers can easily become unsubstantiated due to the complexity of EMG data itself and insufficient longitudinal investigations (Vigotsky et al, 2018 ).…”

Lost in Translation: Simple Steps in Experimental Design of Neurorehabilitation-Based Research Interventions to Promote Motor Recovery Post-Stroke

“…For locomotion, compensatory behaviors are characterized by maladaptive use of both lower extremities. An example is over-reliance on the less affected lower extremity for weight bearing (Olney and Richards, 1996) and forward propulsion (Roelker et al, 2019;Awad et al, 2020), leading to decreased used of the paretic extremity and associated reductions in bone mineral density (Worthen et al, 2005). Therefore, given the clear adverse long-term effects of these kinds of compensatory behaviors, targeted evidence-based interventions are needed to reverse or adapt maladaptive movement patterns in the chronic stages of recovery Wolpaw, 2014, 2019).…”