Paretic Propulsion and Trailing Limb Angle Are Key Determinants of Long-Distance Walking Function After Stroke

Useless. No solutions on how to increase propulsion. 

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.

 

I doubt I have any paretic propulsion at all and yet I can walk 30,000 steps in a day, 15 miles. 

Paretic Propulsion and Trailing Limb Angle Are Key Determinants of Long-Distance Walking Function After Stroke

  Louis N. Awad, DPT
1
, Stuart A. Binder-Macleod, PT, PhD
1
, Ryan T. Pohlig, PhD
1
, and Darcy S. Reisman, PT, PhD
1

Abstract

Background
. Elucidation of the relative importance of commonly targeted biomechanical variables to poststroke long-distance walking function would facilitate optimal intervention design.
Objectives
. To determine the relative contribution of variables from 3 biomechanical constructs to poststroke long-distance walking function and identify the biomechanical changes underlying posttraining improvements in long-distance walking function.
 Methods
. Forty-four individuals >6 months after stroke participated in this study. A subset of these subjects (n = 31) underwent 12 weeks of high-intensity locomotor training. Cross-sectional (pretraining) and longitudinal (posttraining change) regression quantified the relationships between poststroke long-distance walking function, as measured via the 6-Minute Walk Test (6MWT), and walking biomechanics. Biomechanical variables were organized into stance phase (paretic propulsion and trailing limb angle), swing phase (paretic ankle dorsiflexion and knee flexion), and symmetry (step length and swing time) constructs.
Results 
Pretraining, all variables correlated with 6MWT distance (rs = .39 to .75,Ps < .05); however, only propulsion (Prop) and trailing limb angle (TLA) independently predicted 6MWT distance,
R2 = .655,F (6, 36) = 11.38,P < .001. Interestingly, only ∆Prop predicted ∆6MWT; however, pretraining Prop, pretraining TLA, and ∆TLA moderated this relationship (moderation model
R2s = .383, .468, .289, respectively).
Conclusions.
The paretic limb’s ability to generate propulsion during walking is a critical determinant of long-distance walking function after stroke. This finding supports the development of poststroke interventions that target deficits in propulsion and trailing limb angle.