Gait training strategies to optimize walking ability in people with stroke: a synthesis of the evidence

Abstract

Stroke is a leading cause of long-term disability. Impairments resulting from stroke lead to persistent difficulties with walking and, subsequently, improved walking ability is one of the highest priorities for people living with a stroke. In addition, walking ability has important health implications in providing protective effects against secondary complications common after a stroke such as heart disease or osteoporosis. This paper systematically reviews common gait training strategies (neurodevelopmental techniques, muscle strengthening, treadmill training and intensive mobility exercises) to improve walking ability. The results (descriptive summaries as well as pooled effect sizes) from randomized controlled trials are presented and implications for optimal gait training strategies are discussed. Novel and emerging gait training strategies are highlighted and research directions proposed to enable the optimal recovery and maintenance of walking ability.

Figure 1

Use of the International Classification of Functioning (ICF) Model to guide the identification of primary factors resulting in particular gait problem, the selection of appropriate walking ability-related outcome measures that are reliable, valid and sensitive to changes, and the identification of potential environmental or personal factors that facilitate or impede an individual’s goal to improve walking ability.