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Abstract

Current rehabilitation methods for individuals poststroke often focus on increasing walking speed because it is associated with community participation and quality of life. A previous study has shown that walking speed is correlated to propulsive force generated from the paretic limb in individuals poststroke. The primary purpose of this dissertation was to study the mechanism to increase propulsive force during gait. Improving the propulsive force in the paretic limb should increase walking speed and ultimately lead to better life quality for persons with stroke. Previous work has shown that ankle moment and trailing limb angle (TLA) were the two factors most highly correlated to propulsive force in healthy and stroke populations. However, the relative contribution of the ankle moment versus TLA to increases in propulsive force has not yet been studied. In Aim 1, a biomechanical-based model was developed. Using this model, we found that the relative contribution of changes in TLA versus ankle moment to increases in forward propulsive force was approximately 2:1 in able-bodied individuals. In Aim 2, the model was enhanced for individuals poststroke and we showed that the relative contribution of changes in TLA versus ankle moment to increases in forward propulsive force was approximately 4:1 in the paretic limb and 3:1 in the non-paretic limb. Thus, compared to able-bodied individuals, individuals poststroke relied more on changing TLA to increase propulsive force during speed modulation.

In Aim 3, we studied the therapeutic effects of a 12-week gait training program. We found that TLA was the major contributor to increases in propulsive force following training. In addition, our results suggest that TLA may be a more modifiable variable for poststroke gait training and that specific targeting may be needed to increase ankle moment. Moreover, we showed that those individuals who demonstrated the greatest ability to increase their propulsive forces at baseline were most likely to benefit from the intervention. In summary, this work determined the underlying mechanism that increases propulsive force during gait and attempted to advance the design of more effective rehabilitation strategies to improve paretic propulsion for persons with stroke.

Details

Title
Mechanisms for increasing propulsive force during walking in individuals poststroke
Author
Hsiao, HaoYuan
Year
2015
Publisher
ProQuest Dissertations & Theses
ISBN
978-1-339-48751-9
Source type
Dissertation or Thesis
Language of publication
English
ProQuest document ID
1767224376
Copyright
Database copyright ProQuest LLC; ProQuest does not claim copyright in the individual underlying works.