Article

Elucidation of the relative importance of commonly targeted
biomechanical variables to poststroke long-distance walking function would
facilitate optimal intervention design. OBJECTIVES: To determine the relative
contribution of variables from 3 biomechanical constructs to poststroke
long-distance walking function and identify the biomechanical changes underlying
posttraining improvements in long-distance walking function. METHODS: Forty-four
individuals >6 months after stroke participated in this study.
A subset of these
subjects (n = 31) underwent 12 weeks of high-intensity locomotor training.
Cross-sectional (pretraining) and longitudinal (posttraining change) regression
quantified the relationships between poststroke long-distance walking function,
as measured via the 6-Minute Walk Test (6MWT), and walking biomechanics.
Biomechanical variables were organized into stance phase (paretic propulsion and
trailing limb angle), swing phase (paretic ankle dorsiflexion and knee flexion),
and symmetry (step length and swing time) constructs. RESULTS: Pretraining, all
variables correlated with 6MWT distance (rs = .39 to .75, Ps < .05); however,
only propulsion (Prop) and trailing limb angle (TLA) independently predicted 6MWT
distance, R(2) = .655, F(6, 36) = 11.38, P < .001. Interestingly, only DeltaProp
predicted Delta6MWT; however, pretraining Prop, pretraining TLA, and DeltaTLA
moderated this relationship (moderation model R(2)s = .383, .468, .289,
respectively). CONCLUSIONS: The paretic limb's ability to generate propulsion
during walking is a critical determinant of long-distance walking function after
stroke. This finding supports the development of poststroke interventions that
target deficits in propulsion and trailing limb angle.
CI - (c) The Author(s) 2014.

Langue : ANGLAIS