Deans' stroke musings: Revisiting the mechanics and energetics of walking in individuals with chronic hemiparesis following stroke: from individual limbs to lower limb joints

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.

Thursday, April 9, 2015

Revisiting the mechanics and energetics of walking in individuals with chronic hemiparesis following stroke: from individual limbs to lower limb joints

I'm sure your doctor and therapists can use this to explain and correct the fatigue you have just from walking. I don't think I have any push-off at all.
http://www.jneuroengrehab.com/content/12/1/24/abstract

Dominic James Farris¹², Austin Hampton¹, Michael D Lewek³⁴ and Gregory S Sawicki¹^*

* Corresponding author: Gregory S Sawicki greg_sawicki@ncsu.edu

Author Affiliations

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Journal of NeuroEngineering and Rehabilitation 2015, 12:24 doi:10.1186/s12984-015-0012-x
Published: 27 February 2015

Abstract

Background

Previous reports of the mechanics and energetics of post-stroke hemiparetic walking have either not combined estimates of mechanical and metabolic energy or computed external mechanical work based on the limited combined limbs method. Here we present a comparison of the mechanics and energetics of hemiparetic and unimpaired walking at a matched speed.

Methods

Mechanical work done on the body centre of mass (COM) was computed by the individual limbs method and work done at individual leg joints was computed with an inverse dynamics analysis. Both estimates were converted to average powers and related to simultaneous estimates of net metabolic power, determined via indirect calorimetry. Efficiency of positive work was calculated as the ratio of average positive mechanical power

to net metabolic power.

Results

Total

was 20% greater for the hemiparetic group (H) than for the unimpaired control group (C) (0.49 vs. 0.41 W · kg⁻¹). The greater

was partly attributed to the paretic limb of hemiparetic walkers not providing appropriately timed push-off

in the step-to-step transition. This led to compensatory non-paretic limb hip and knee

which resulted in greater total mechanical work. Efficiency of positive work was not different between H and C.

Conclusions

Increased work, not decreased efficiency, explains the greater metabolic cost of hemiparetic walking post-stroke. Our results highlighted the need to target improving paretic ankle push-off via therapy or assistive technology in order to reduce the metabolic cost of hemiparetic walking.