The effects of gait retraining on muscle coordination and functional walking ability post-stroke
University of Delaware
The central nervous system (CNS) is believed to use the available flexibility provided by its abundant degrees-of-freedom to co-vary muscles and joint motions involved in stabilizing a variable important for task success, such as the foot position in walking. Appropriate control of the foot during the swing phase is critical to maintain stability and prevent falls. In the first study we investigated the role of flexibility of muscles' activation in stabilizing the foot position during swing in stroke survivors and healthy individuals. Our results suggested that foot position is an important task variable during the swing phase of walking that is controlled by CNS in healthy individuals and stroke survivors. Gait rehabilitation post-stroke is important as it leads to a more efficient walking pattern, improvement in social participation, and independence in the activities of daily living. Body weight supported treadmill training (BWSTT) is widely used method for gait rehabilitation post-stroke. However, this method is labor intensive and requires one or more therapist for manual assistance. To address the limitations of BWSTT, robot-aided gait training (RAGT) has been developed recently. The current RAGT provides continuous assistance that substantially reduces the subjects' effort. Therefore, a novel RAGT using an assist-as-needed paradigm that encourages subjects' active participation was used in the second study for gait rehabilitation post-stroke. Our findings demonstrated improvements in the functional walking ability of stroke survivors that were retained to some extent 6 months post-stroke. In the third study we compared the effects of BWSTT with assist-as-needed RAGT on the improvements of functional walking ability and foot position control post-stroke. Improvements in the walking ability and gait pattern were observed following both the training paradigms, however no difference were seen between the effects of the two training paradigms. Therefore, future studies with larger sample size are needed for better understanding of the effects of gait training on gait parameters and neural control of foot position to optimize gait rehabilitation strategies, improve functional walking ability, and minimize falls.