Interventions for coordination of walking following stroke: Systematic review

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Interventions for coordination of walking following stroke: Systematic review

 KristenL.Hollands
a,
*,TrudyA.

Pelton
b
,SarahF.Tyson
a
,MarkA. Hollands
c
,PauletteM. vanVliet
d
a
School of Health,

Sport  and Rehabilitation Sciences,

University of Salford,

Frederick Rd.

Campus,

Salford

M66PU,

UK
b
.School of Psychology,

College of Life and Environmental Sciences,

University of Birmingham,

UK
c
.School of Sport and Exercise Sciences,

College of Life and Environmental Sciences,

University of Birmingham,

UK
d
.School of Health Sciences,

University of Newcastle,

 Australia
1.


 Article history:
Received

5May

2011
Receivedinrevisedform20July2011
Accepted

22

October

2011
Keywords:
StrokeGaitCoordinationRehabilitation

ABSTRACT

Impairments in gait coordination may be a factor in falls and mobility limitations after stroke.

Therefore, rehabilitation targeting gait coordination may be an effective way to improve walking poststroke. This review sought to examine current treatments that target impairments of gait coordination, the theoretical basis on which they are derived and the effects of such interventions. Few high quality RCTs with a low risk of bias specifically targeting and measuring restoration of coordinated gait were found. Consequently, we took a pragmatic approach to describing and quantifying the available evidence and included non-randomised study designs and limited the influence of heterogeneity in experimental design and control comparators by restricting meta-analyses to pre- and post-test comparisons of experimental interventions only. Results show that

physiotherapy interventions significantly improved gait function and coordination. Interventions involving repetitive task specific practice and/or auditory cueing appeared to be the most promising approaches to restore gait coordination. The fact that overall improvements in gait coordination coincided with increased walking speed lends support to the hypothesis is that targeting gait coordination gait may be a way of improving overall walking ability post-stroke. However,

establishing the mechanism for improved locomotor control requires a better understanding of the nature of both neuroplasticity and coordination deficits in functional tasks after stroke.

Future research requires the measurement of  impairment, activity and cortical activation in an effort to establish the mechanism by which functional gains are achieved.
@ 2011ElsevierB.V.All rights reserved.