MOTOR
Gait coordination protocol for recovery of coordinated gait, function, and quality of life following stroke
Journal of Rehabilitation Research & Development 2012 JJ Daly, JP. McCabe, J Gansen, JRogers, K Butler, I Brenner, R Burdsall, J Nethery
The Gait Coordination Protocol (GCP) was successful in producing clinically and statistically significant gains in impairment, function, and life-role participation for those in the chronic phase after stroke who had exhibited persistent moderate to severe gait deficits [1–3]. The GCP was initially developed to test response to functional electrical stimulation (FES); notably, the GCP produced enhanced coordinated gait regardless of whether FES was used [1]. (The Video shows gait recovery in response to the GCP for a participant from the –No-FES group.–) In response to national and state presentations, there was a strong call for description of the details of the GCP and its clinical implementation. Therefore, the purpose here is to detail the implementation of this treatment protocol. https://www.rehab.research.va.gov/jour/2012/498/pagexix.html
Revisiting the mechanics and energetics of walking in individuals with chronic hemiparesis following stroke: from individual limbs to lower limb joints.
Journal of NeuroEngineering and Rehabilitation 2015 DJ Farris, A Hampton, MD Lewek and GS Sawicki
Abstract
Background: Previous reports of the mechanics and energetics of post-stroke hemiparetic walking have either not combined estimates of mechanical and metabolic energy or computed external mechanical work based on the limited combined limbs method. Here we present a comparison of the mechanics and energetics of hemiparetic and unimpaired walking at a matched speed. Methods: Mechanical work done on the body centre of mass (COM) was computed by the individual limbs method and work done at individual leg joints was computed with an inverse dynamics analysis. Both estimates were converted to average powers and related to simultaneous estimates of net metabolic power, determined via indirect calorimetry. Efficiency of positive work was calculated as the ratio of average positive mechanical power P þ to net metabolic power. Results: Total P þ was 20% greater for the hemiparetic group (H) than for the unimpaired control group (C) (0.49 vs. 0.41 W · kg−1). The greater P þ was partly attributed to the paretic limb of hemiparetic walkers not providing appropriately timed push-off P þ in the step-to-step transition. This led to compensatory non-paretic limb hip and kneeP þ which resulted in greater total mechanical work. Efficiency of positive work was not different between H and C. Conclusions: Increased work, not decreased efficiency, explains the greater metabolic cost of hemiparetic walking post-stroke. Our results highlighted the need to target improving paretic ankle push-off via therapy or assistive technology in order to reduce the metabolic cost of hemiparetic walking. https://jneuroengrehab.biomedcentral.com/track/pdf/10.1186/s12984-015-0012-x?site=jneuroengrehab.biomedcentral.com