Studies on energy expenditure in walking after stroke

Sammanfattning: After stroke, altered movement pattern involves low walking speed and increased energy cost as compared to normal. Cardiovascular disease is common in the stroke population. Knowledge about the physiological demands of various training interventions is important for the planning of exercise. Gait training on a treadmill with body weight support is a new training strategy in stroke rehabilitation. Ankle-foot orthoses are often used to improve gait after stroke. The overall aim with the present studies was to measure the energy expenditure of two gait interventions after stroke; body weight support and ankle foot orthosis. Methods: The main measurement method was breath-by-breath analysis of oxygen and carbon dioxide exchange and electrocardiography. Perceived exertion was rated on a Borg scale. The energy expenditure of walking on a treadmill with 30% BWS was compared to walking with full weight bearing. Tests were carried out at the individual self-selected and maximum speed. Nine persons with stroke and nine healthy persons participated. Oxygen consumption, energy cost and walking speeds were compared during treadmill walking with and without an AFO, in ten participants with stroke. Results: The results showed lower energy expenditure with BWS both for stroke and healthy persons, both at self-selected and maximum speed. Heart rate was lower with BWS in the stroke but not in the healthy group. Perceived exertion was slightly lower with BWS in the stroke group. Lower energy cost, although not clinically relevant, and significantly higher self-selected walking speed, were effects of the AFO. Wearing an AFO did not affect heart rate. Conclusions: Walking with 30% BWS on a treadmill was less energy demanding than full weight bearing, in stroke and healthy participants. Wearing an AFO might reduce energy cost and increase walking speed after stroke.