A systematic review of mechanisms of gait speed change post-stroke. Part 2: exercise capacity, muscle activation, kinetics, and kinematics

Abstract

Background: Regaining locomotor ability is a primary goal in stroke rehabilitation and is most commonly measured using changes in self-selected walking speed. However, walking speed cannot identify the mechanisms by which an individual recovers. Laboratory-based mechanistic measures such as exercise capacity, muscle activation, force production, and movement analysis variables may better explain neurologic recovery.

Objectives: The objectives of this systematic review are to examine changes in mechanistic gait outcomes and describe motor recovery as quantified by changes in laboratory-based mechanistic variables in rehabilitation trials.

Methods: Following a systematic literature search (in PubMed, Ovid, and CINAHL), we included rehabilitation trials with a statistically significant change in self-selected walking speed post-intervention that concurrently collected mechanistic variables. Methodological quality was assessed using Cochrane Collaboration’s tool. Walking speed changes, mechanistic variables, and intervention data were extracted.

Results: Twenty-five studies met the inclusion criteria and examined: cardiorespiratory function (n = 5), muscle activation (n = 5), force production (n = 11), and movement analysis (n = 10). Interventions included: aerobic training, functional electrical stimulation, multidimensional rehabilitation, robotics, sensory stimulation training, strength/resistance training, task-specific locomotor rehabilitation, and visually-guided training.

Conclusions: Following this review, no set of outcome measures to mechanistically explain changes observed in walking speed were identified. Nor is there a theoretical basis to drive the complicated selection of outcome measures, as many of these outcomes are not independent of walking speed. Since rehabilitation literature is yet to support a causal, mechanistic link for functional gains post-stroke, a systematic, multimodal approach to stroke rehabilitation will be necessary in doing so.

Keywords:

• Stroke
• walking speed
• rehabilitation
• recovery of function
• exercise capacity
• electromyography
• kinetics
• kinematics

Abbreviations:

• SSWS, self-selected walking speed
• EMG, electromyography
• ROM, range of motion
• FES, functional electrical stimulation
• BWSTT, body weight support treadmill training
• VO_2peak, peak oxygen uptake
• BWS, body weight support

Acknowledgments

The authors would like to thank Heather Shaw Bonilha, PhD, CCC-SLP for her guidance in the early stages of this manuscript idea. The contents do not represent the views of the Department of Veterans Affairs or the United States Government. We certify that no party having a direct interest in the results of the research supporting this article has or will confer a benefit on us or on any organization with which we are associated and, if applicable, we certify that all financial and material support for this research and work are clearly identified in the title page of the manuscript.