A Stability-Based Approach to Post-Stroke Gait Training


Humans have a remarkable ability to create stable walking patterns that can resist and recover from perturbations. Unfortunately, this ability is substantially impaired after a stroke, limiting mobility and contributing to a high fall rate. To facilitate gait training during post-stroke rehabilitation, clinicians often incorporate body-weight support (BWS) systems that apply vertical forces to the pelvis and trunk to assist with upright walking. However, these BWS forces change the patients walking dynamics and balance control, potentially limiting the patient’s ability to relearn walking balance. My thesis proposes a new stability-based framework for post- stroke gait rehabilitation, which considers how rehabilitation devices interact with the control of gait stability. To do this, I first explore how a BWS system affects gait stability and stepping coordination in healthy adults. I demonstrate that walking with high levels of BWS reduces active modulation of foot placement to control walking balance and encourages a compensatory stepping strategy that poorly translates to the dynamics of real-world walking. Next, I explore how a new type of rehabilitation device, which applies lateral assistive forces to the body, affects the control of gait stability in adults with and without stroke. I find that individuals with stroke use a stepping strategy that relies on wide steps that are less coordinated to the body state during walking. In addition, I find that walking with lateral assistance does not interfere with the control of stability and tends to improve stepping coordination for individuals with stroke, warranting further investigation. Together, these results; 1) advance our understanding of how common assistive tools may interfere with learning walking balance and, 2) present an alternative method of gait training for adults with stroke. Further, this thesis provides a framework and a path forward for modifying current rehabilitation techniques to better target gait stability.

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