Understanding gait control in post-stroke: Implications for management

Survivors don't give a shit about 'management'. They want EXACT STROKE PROTOCOLS that deliver 100% recovery. WHEN THE HELL will you get there? Useless generalities. 

Understanding gait control in post-stroke: Implications for management

 Rajesh  Verma, DM (Neurology), DNB (Neurology), Professor, Kamal Narayan Arya, MOT, PhD (Scholar), Sr. Occupational Therapist*,Pawan Sharma, MD (Medicine), Sr. Resident, DM (Neurology)-III,R.K. Garg, DM (Neurology), Professor & HOD
Department of Neurology, CSM Medical University (KGMU), Lucknow 226003, UP, India
Received 7 September 2010; received in revised form 2 December 2010; accepted 3 December 2010
KEYWORDS
Gait; Locomotion; Stroke; Hemiparesis; Rehabilitation
Summary
 The role of the brain in post-stroke gait is not understood properly, although the ability to walk becomes impaired in more than 80% of post-stroke patients. Most, however, re-gain some ability to walk with either limited mobility or inefficient, asymmetrical or unsafe gait. Conventional intervention focuses on support of weak muscles or body part by use of foot orthosis and walking aids. This review provides an overview of available evidence of neuro-kinesiology & neurophysiology of normal and post-stroke gait. The role of the spinal cord has been explored, more in animals than humans. Mammalian locomotion is based on a rhythmic, “
 pacemaker
” activity of the spinal stepping generators. Bipedal human locomotion is different from quadripedal animal locomotion. However, knowledge derived from the spinal cord investigation of animals, is being applied for management of human gait dysfunction. The potential role of the brain is now recognized in the independent activation of muscles during walking. The brain modifies the gait pattern during the complex demands of daily activities. Though the exact role of the motor cortex in control of gait is unclear, available evidence may be applied to gait rehabilitation of post-stroke patients.
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 2010 Elsevier Ltd. All rights reserved.
Introduction
Stroke is the second leading cause of death and one of theleading causes of adult disability in the world today(Gresham et al., 1997). Ability to walk gets impaired inmore than 80% of post-stroke patients (Duncan et al., 2005;
* Corresponding author. Pt. Deendayal Upadhyaya Institute for the Physically Handicapped, University of Delhi, Ministry of SocialJustice & Empowerment, Govt. of India, New Delhi 110002, India.
E-mail address:
 kamalnarya@yahoo.com (K.N. Arya).
available at www.sciencedirect.comjournal homepage: www.elsevier.com/jbmt
Journal of Bodywork & Movement Therapies (2012)
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211360-8592/$ - see front matter
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 2010 Elsevier Ltd. All rights reserved.doi:10.1016/j.jbmt.2010.12.005