Browsing by Author "Binder-Macleod,Stuart A."
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Item Baseline predictors of treatment gains in peak propulsive force in individuals poststroke(Biomed Central Ltd, 1/15/16) Hsiao,HaoYuan; Higginson,Jill S.; Binder-Macleod,Stuart A.; HaoYuan Hsiao, Jill S. Higginson, Stuart A. Binder-Macleod; Higginson, Jill Startzell; Binder-Macleod, StuartBackground: Current rehabilitation for individuals poststroke focuses on increasing walking speed because it is an indicator of community walking ability and quality of life. Propulsive force generated from the paretic limb is critical to walking speed and may reflect actual neural recovery that restores the affected neural systems. A wide variation across individuals in the improvements in paretic propulsive force was observed following an intervention that targeted paretic propulsive force. This study aimed to determine if specific baseline characteristics can be used to predict patients who would respond to the intervention. Methods: Participants (N = 19) with chronic poststroke hemiparesis walked at their self-selected and maximal walking speeds on a treadmill before and after a 12-week gait training program. Propulsive forces from the paretic limb were analyzed. Pearson correlation coefficient was used to determine the relationships between (1) treatment gains in walking speed and propulsive force following intervention, and (2) treatment gains in propulsive force and baseline propulsive forces. Results: Treatment gains in self-selected walking speed were correlated to treatment gains in paretic propulsive force following intervention. In addition, changes in paretic propulsive force between self-selected and maximal walking speeds at baseline were strongly correlated to treatment gains in paretic propulsive force. Conclusions: The capacity to modulate paretic propulsive force, rather than the absolute propulsive force during self-selected or maximal walking speed, predicted treatment gains in propulsive force following the intervention. Findings from this research could help to inform clinicians and researchers to target the appropriate patient population for rehabilitation interventions.Item Identifying candidates for targeted gait rehabilitation after stroke: better prediction through biomechanics-informed characterization(Biomed Central Ltd, 9/23/16) Awad,Louis N.; Reisman,Darcy S.; Pohlig,Ryan T.; Binder-Macleod,Stuart A.; Darcy S. Reisman PT, PhD, Ryan T. Pohlig PhD and Stuart A. Binder-MacleodPT, PhD; Reisman, Darcy S;Pohlig, Ryan Todd;Binder-Macleod, StuartBackground: Walking speed has been used to predict the efficacy of gait training; however, poststroke motor impairments are heterogeneous and different biomechanical strategies may underlie the same walking speed. Identifying which individuals will respond best to a particular gait rehabilitation program using walking speed alone may thus be limited. The objective of this study was to determine if, beyond walking speed, participants' baseline ability to generate propulsive force from their paretic limbs (paretic propulsion) influences the improvements in walking speed resulting from a paretic propulsion-targeting gait intervention. Methods: Twenty seven participants > 6 months poststroke underwent a 12-week locomotor training program designed to target deficits in paretic propulsion through the combination of fast walking with functional electrical stimulation to the paretic ankle musculature (FastFES). The relationship between participants' baseline usual walking speed (UWSbaseline), maximum walking speed (MWSbaseline), and paretic propulsion (prop(baseline)) versus improvements in usual walking speed (Delta UWS) and maximum walking speed (Delta MWS) were evaluated in moderated regression models. Results: UWSbaseline and MWSbaseline were, respectively, poor predictors of Delta UWS (R-2 = 0.24) and Delta MWS (R-2 = 0.01). Paretic propulsion x walking speed interactions (UWSbaseline x propbaseline and MWSbaseline x propbaseline) were observed in each regression model (R(2)s = 0.61 and 0.49 for Delta UWS and Delta MWS, respectively), revealing that slower individuals with higher utilization of the paretic limb for forward propulsion responded best to FastFES training and were the most likely to achieve clinically important differences. Conclusions: Characterizing participants based on both their walking speed and ability to generate paretic propulsion is a markedly better approach to predicting walking recovery following targeted gait rehabilitation than using walking speed alone.