Targeting Paretic Propulsion to Improve Poststroke Walking Function: A Preliminary Study

Do we need better propulsion to improve our walking? WHOM do we go to to ask that extremely simple question? I want specific names so we can determine competence in following up stroke survivor question/needs. 

Your doctor is responsible to explain and provide protocols for all your paretic propulsion needs. At least if competent. You may have to call the hospital president if there is nothing for paretic propulsion.

• Paretic Propulsion (7 posts to June 2015)

 

Targeting Paretic Propulsion to Improve Poststroke Walking Function: A Preliminary Study

 Louis N. Awad, PT, DPT,
a,b
Darcy S. Reisman, PT, PhD,
a,b
Trisha M. Kesar, PT, PhD,
c,d
Stuart A. Binder-Macleod, PT, PhD
a,b
From the
 a
Biomechanics and Movement Science Program, University of Delaware, Newark, DE;
 b
Department of Physical Therapy, University of Delaware, Newark, DE;
 c
Division of Physical Therapy, Emory University, Atlanta, GA; and
 d
Department of Rehabilitation Medicine, Emory University, Atlanta, GA.

Abstract

Objectives:
 To determine the feasibility and safety of implementing a 12-week locomotor intervention targeting paretic propulsion deficits during walking through the joining of 2 independent interventions, walking at maximal speed on a treadmill and functional electrical stimulation of the paretic ankle musculature (FastFES); to determine the effects of FastFES training on individual subjects; and to determine the influence of baseline impairment severity on treatment outcomes.
Design:
 Single group pre-post preliminary study investigating a novel locomotor intervention.
Setting:
 Research laboratory.
Participants:
 Individuals (N=13) with locomotor deficits after stroke.
Intervention:
 FastFES training was provided for 12 weeks at a frequency of 3 sessions per week and 30 minutes per session.
Main Outcome Measures:
 Measures of gait mechanics, functional balance, short- and long-distance walking function, and self-perceived participation were collected at baseline, post training, and 3-month follow-up evaluations. Changes after treatment were assessed using pairwise comparisons and compared with known minimal clinically important differences or minimal detectable changes. Correlation analyses were run to determine the correlation between baseline clinical and biomechanical performance versus improvements in walking speed.
Results:
 Twelve of the 13 subjects that were recruited completed the training. Improvements in paretic propulsion were accompanied by improvements in functional balance, walking function, and self-perceived participation (each
 P&lt.02)---All of which were maintained at 3-monthfollow-up. Eleven of the 12 subjects achieved meaningful functional improvements. Baseline impairment was predictive of absolute, but notrelative, functional change after training.
Conclusions:
 This report demonstrates the safety and feasibility of the FastFES intervention and supports further study of this promising locomotor intervention for persons post stroke.