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, May 28, 2015

Walking Speed and Step Length Asymmetry Modify the Energy Cost of Walking After Stroke

Well, do I have enough energy to walk and talk at the same time? Inquiring minds want to know.
From this your PT should be figuring out a way to get your walking more symmetric.
http://nnr.sagepub.com/content/29/5/416?etoc
  1. Louis N. Awad, DPT1,2
  2. Jacqueline A. Palmer, DPT1,2
  3. Ryan T. Pohlig, PhD1,3
  4. Stuart A. Binder-Macleod, PhD1,2,3
  5. Darcy S. Reisman, PhD1,2
  1. 1Department of Physical Therapy, University of Delaware, Newark, DE, USA
  2. 2Graduate Program in Biomechanics and Movement Science, University of Delaware, Newark, DE, USA
  3. 3Delaware Clinical and Translational Research Accel Program, University of Delware, Newark, DE, USA
  1. Darcy Reisman, PhD, University of Delaware, 540 South College Avenue, Newark, DE 19713, USA. Email: dreisman@udel.edu

Abstract

Background. A higher energy cost of walking poststroke has been linked to reduced walking performance and reduced participation in the community.  
Objective. To determine the contribution of postintervention improvements in walking speed and spatiotemporal gait asymmetry to the reduction in the energy cost of walking after stroke. Methods. In all, 42 individuals with chronic hemiparesis (>6 months poststroke) were recruited to participate in 12 weeks of walking rehabilitation. The energy cost of walking, walking speed, and step length, swing time, and stance time asymmetries were calculated pretraining and posttraining. Sequential regression analyses tested the cross-sectional (ie, pretraining) and longitudinal (ie, posttraining changes) relationships between the energy cost of walking versus speed and each measure of asymmetry.  
Results. Pretraining walking speed (β = −.506) and swing time asymmetry (β = .403) predicted pretraining energy costs: adj R 2 = 0.713; F(3, 37) = 34.05; P < .001. In contrast, change in walking speed (β = .340) and change in step length asymmetry (β = .934) predicted change in energy costs with a significant interaction between these independent predictors: adj R 2 = 0.699; F(4, 31) = 21.326; P < .001. Moderation by the direction or the magnitude of pretraining asymmetry was not found. 
Conclusions. For persons in the chronic phase of stroke recovery, faster and more symmetric walking after intervention appears to be more energetically advantageous than merely walking faster or more symmetrically. This finding has important functional implications, given the relationship between the energy cost of walking and community walking participation.

2 comments:

  1. How's your walking gait, Dean? A gait is a pendulum in motion. Each stroke victim has to be evaluated for muscle participation. EMG studies, and a whole list of other data points to find out whats working and whats not. Then, short and long term plans and goals needs to be put in place for recovery. Diet, real world workouts, rest, evaluations, emotional support and etc. Insurance coverage? Not!
    My brother (severe left CVA) and me are walking up the sides of hills in Minot, with the help of climbing poles. The hills are grassy and uneven with varying slope. Tough stuff for a guy that wasn't suppose to walk again. (This was one neurologist prognosis during the acute phase). Anyways, If the brain is challenged in ways beyond the therapist's box of orthodoxy, maybe we can make progress toward your goals of a better protocol and 100% recovery.

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  2. My walking gait sucks, my knee barely bends, dorsiflexion is pretty good, spasticity causes the left foot to angle to the left about 20 degrees. It doesn't make a damn bit of difference, I've walked up to 17 miles a day. Did 77 miles on a vacation cruise. That is the problem, with motion capture systems someone could pinpoint exactly where my muscles are going wrong, and based on that give me a stroke protocol to correct it. But that won't occur under current stroke leadership.

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