Propulsion and Community Activity After Stroke

Kathleen ODonnell

May is Stroke Awareness Month! In recognition of this important topic, this week’s highlighted clip focuses on how therapists can help to maximize patients’ walking recovery and improve community reintegration after a stroke. Hear from Professor Lou Awad, PT, DPT, PhD from Boston University as he discusses the importance of emphasizing paretic propulsion during gait training using training tools like the ReStore Exo-Suit, and the relationships between improvements in propulsion and other gait metrics like the 6-minute walk test and steps in the community.  

The ReStore Exo-Suit enables therapists to specifically target and re-train paretic propulsion during gait training with patients after a stroke. Learn more about this technology here.

This is a highlighted clip from Episode 05 of ReWalk’s Topics in NeuroRehabilitation web series. Check out the full episode here or read the transcript below.

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LA: Now, the reason why energy cost is important, aside from the fact that we’ve been built as a human machine to be economical, is that this is related to how much activity we can do in the real world. What I’m showing you here is the relationship between propulsion – that force generated by the paretic limb to move the body through space – and how far a person can walk in 6 minutes, the 6 minute walk test. And you see that those with low propulsion under 5% body weight, they walk very short distances. So 200 meters. So I tell someone to walk as far as you safely can in 6 minutes. They can only do 200 meters if they have under 5% propulsion. In contrast, those with 20% propulsion from their paretic limb – this is about normal levels. They’re walking 500, 600 meters. And the 6 minute walk test, this metric over here, is – in people post stroke and people with multiple sclerosis, and most neurological diagnostic groups, it’s the single best predictor of community walking activity. So steps per day over here on the Y axis. This is giving people an activity monitor like a Fitbit or something that can monitor how many steps they take in their day to day lives. And we give it to them for 7 days and we take the average of 7 days of walking activity. And you can see there’s a wide range. Some people who are barely walking in the community, close to zero and those who are walking 14,000 steps per day. And the relationship between steps per day and this measure that we take in the clinic, the 6 minute walk test, it’s positively correlated. Those who can walk far up here. They walk more steps in the community. And those who don’t walk very far, they don’t walk many steps in the community. So propulsion is a key determinant of distance, and distance is a key determinant of real life mobility.

KOD: This has been a highlighted clip from ReWalk’s Topics in NeuroRehabilitation web series. To watch the full episode, please go to the ReWalk Robotics YouTube page, or visit the link in the comments below. See you next time!


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