Advancing individualized, evidence-based rehabilitation after stroke

Awad, Louis N.
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University of Delaware
The restoration of walking ability is the most commonly voiced goal of rehabilitation by stroke survivors. However, despite an emphasis on walking retraining during rehabilitation, limitations in walking ability persist. Current walking therapies have been reported to produce comparable gains in walking function regardless of the mode or sophistication of the training used, with all therapies failing to improve the majority of subjects' capacity for community walking. Rehabilitation efforts have been limited by a poor understanding of the clinical and biomechanical mechanisms underlying intervention-induced functional recovery, as well as a poor understanding of how the heterogeneous nature of poststroke motor impairment confounds optimal treatment. Through cross-sectional (ie, pretraining) and longitudinal (ie, posttraining changes) analyses, this dissertation identified changes in poststroke maximum walking speed (aim 1) and the function of the paretic limb during its late stance phase (aim 2) as key determinants of functional recovery after stroke. In aim 3 of this dissertation, the efficacy of a novel, hypothesis-driven locomotor intervention (FastFES) designed to improve the walking ability of persons poststroke through specific effects on these key clinical and biomechanical variables was demonstrated. Moreover, the hypothesized effects of the FastFES intervention were validated and the best candidates for FastFES training were explored. Ultimately, this dissertation attempts to advance individualized, evidence-based neurorehabilitation after stroke.