These legs were made for propulsion: advancing the diagnosis and treatment of post-stroke propulsion deficits
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(2020) 17:139
REVIEW
Open Access
These legs were made for propulsion: advancing the diagnosis and treatment of post-stroke propulsion deficits Louis N. Awad1*
, Michael D. Lewek2 , Trisha M. Kesar3 , Jason R. Franz4 and Mark G. Bowden5
Abstract Advances in medical diagnosis and treatment have facilitated the emergence of precision medicine. In contrast, locomotor rehabilitation for individuals with acquired neuromotor injuries remains limited by the dearth of (i) diagnostic approaches that can identify the specific neuromuscular, biomechanical, and clinical deficits underlying impaired locomotion and (ii) evidence-based, targeted treatments. In particular, impaired propulsion by the paretic limb is a major contributor to walking-related disability after stroke; however, few interventions have been able to target deficits in propulsion effectively and in a manner that reduces walking disability. Indeed, the weakness and impaired control that is characteristic of post-stroke hemiparesis leads to heterogeneous deficits that impair paretic propulsion and contribute to a slow, metabolically-expensive, and unstable gait. Current rehabilitation paradigms emphasize the rapid attainment of walking independence, not the restoration of normal propulsion function. Although walking independence is an important goal for stroke survivors, independence achieved via compensatory strategies may prevent the recovery of propulsion needed for the fast, economical, and stable gait that is characteristic of healthy bipedal locomotion. We posit that post-stroke rehabilitation should aim to promote independent walking, in part, through the acquisition of enhanced propulsion. In this expert review, we present the biomechanical and functional consequences of post-stroke propulsion deficits, review advances in our understanding of the nature of post-stroke propulsion impairment, and discuss emerging diagnostic and treatment approaches that have the potential to facilitate new rehabilitation paradigms targeting propulsion restoration. Keywords: Propulsion, Locomotion, Walking, Rehabilitation, Diagnosis, Intervention, Sensors, Robotics
Introduction THE fast, economical, and stable gait that is characteristic of healthy bipedal locomotion [1–6] requires the coordination of three locomotor subtasks—propulsion, limb advancement, and bodyweight support. During the propulsion locomotor subtask, positive work by the trailing limb accelerates the body into the next gait cycle [7]. To walk faster, people with intact neural control symmetrically increase the positive work performed by each *Correspondence: [email protected] College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston MA, USA Full list of author information is available at the end of the article 1
limb [8–10]. The coordinated modulation of the work performed by each limb leverages the natural oscillatory dynamics that arise from repeating foot-ground interactions to optimize stability and economy of effort while regulating walking speed [6, 10]. In contra
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