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

I'd have to disagree. I'm sure my walking doesn't meet Paretic Propulsion and Trailing Limb Angle requirements. Long distance walking for me is just pure bullheadedness. I wasn't going to let  my f*cked up walking stop me from walking up to 17 miles a day in Barcelona even with a detached big toenail. No idea what paretic leg proplusion is but I'm sure I don't have it.
http://nnr.sagepub.com/content/29/6/499?etoc

1. Louis N. Awad, DPT1
2. Stuart A. Binder-Macleod, PT, PhD1
3. Ryan T. Pohlig, PhD1
4. Darcy S. Reisman, PT, PhD1

1. ¹University of Delaware, Newark, DE, USA

1. Darcy Reisman, Department of Physical Therapy, University of Delaware, 540 South College Avenue, Newark, DE 19713, USA. Email: dreisman@udel.edu

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, R ² = .655, F(6, 36) = 11.38, P < .001. Interestingly, only ΔProp predicted Δ6MWT; however, pretraining Prop, pretraining TLA, and ΔTLA moderated this relationship (moderation model R ²s = .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.