Deans' stroke musings: Walking velocity and lower limb coordination in hemiparesis

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Friday, May 4, 2012

Walking velocity and lower limb coordination in hemiparesis

Lots of big words /acronyms here. Bottom line, therapists maybe should be working you at maximal speed.
http://www.sciencedirect.com/science/article/pii/S0966636212000677

Abstract

Background/objective

Gait training at fast speed has been suggested as an efficient rehabilitation method in hemiparesis. We investigated whether maximal speed walking might positively impact inter-segmental coordination in hemiparetic subjects.

Methods

We measured thigh–shank and shank–foot coordination in the sagittal plane during gait at preferred (P) and maximal (M) speed using the continuous relative phase (CRP), in 20 healthy and 27 hemiparetic subjects. We calculated the root-mean square (CRP_RMS) and its variability (CRP_SD) over each phase of the gait cycle. A small CRP_RMS indicates in-phasing, i.e. high level of synchronization between two segments along the gait cycle. A small CRP_SD indicates high stability of the inter-segmental coordination across gait cycles.

Results

Increase from preferred to maximal speed was 57% in healthy and 49% in hemiparetic subjects (difference NS). In healthy subjects, the main change was shank–foot in-phasing at stance (CRP_{Shank–Foot/RMS}, P, 98 ± 10; M, 67 ± 12, p < 0.001). In hemiparetic subjects, we also found shank–foot in-phasing at late stance bilaterally (non-paretic CRP_{Shank–Foot/RMS}, P, 37 ± 9; M, 29 ± 8, p < 0.001; paretic CRP_{Shank–Foot/RMS}, P, 38 ± 13; M, 32 ± 12, p < 0.001), and thigh–shank in-phasing at mid-stance in the non-paretic limb (CRP_{Thigh–Shank/RMS}, P, 57 ± 9; M, 49 ± 9, p < 0.001). CRP_{Thigh–Shank} variability diminished in the paretic limb (CRP_{Thigh–Shank/SD}, P, 18.3 ± 6.3; M, 16.1 ± 5.2, p < 0.001).

Conclusion

During gait velocity increase in hemiparesis, there is improvement of thigh–shank coordination stability in the paretic limb and of shank–foot synchronization at late stance bilaterally, which optimizes the propulsive phase similarly to healthy subjects. These findings may add incentive for rehabilitation clinicians to explore maximal velocity gait training in hemiparesis.