title: Interventions for coordination of walking following stroke: systematic review.
abstract: Impairments in gait coordination may be a factor in falls and mobility limitations after stroke. Therefore, rehabilitation targeting gait coordination may be an effective way to improve walking post-stroke. This review sought to examine current treatments that target impairments of gait coordination, the theoretical basis on which they are derived and the effects of such interventions. Few high quality RCTs with a low risk of bias specifically targeting and measuring restoration of coordinated gait were found. Consequently, we took a pragmatic approach to describing and quantifying the available evidence and included non-randomised study designs and limited the influence of heterogeneity in experimental design and control comparators by restricting meta-analyses to pre- and post-test comparisons of experimental interventions only. Results show that physiotherapy interventions significantly improved gait function and coordination. Interventions involving repetitive task-specific practice and/or auditory cueing appeared to be the most promising approaches to restore gait coordination. The fact that overall improvements in gait coordination coincided with increased walking speed lends support to the hypothesis that targeting gait coordination gait may be a way of improving overall walking ability post-stroke. However, establishing the mechanism for improved locomotor control requires a better understanding of the nature of both neuroplasticity and coordination deficits in functional tasks after stroke. Future research requires the measurement of impairment, activity and cortical activation in an effort to establish the mechanism by which functional gains are achieved.
authors.affiliation: School of Health, Sport and Rehabilitation Sciences, University of Salford, Frederick Rd. Campus, Salford M6 6PU, UK. k.hollands@salford.ac.uk
authors.forename: Kristen L
authors.initials: KL
authors.lastname: Hollands
authors.forename: Trudy A
authors.initials: TA
authors.lastname: Pelton
authors.forename: Sarah F
authors.initials: SF
authors.lastname: Tyson
authors.forename: Mark A
authors.initials: MA
authors.lastname: Hollands
authors.forename: Paulette M
authors.initials: PM
authors.lastname: van Vliet
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D051346:Mobility Limitation; D026741:Physical Therapy Modalities; D004856:Postural Balance / Q000502:physiology; D011379:Prognosis; D011597:Psychomotor Performance / Q000502:physiology*; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function; D020521:Stroke / Q000150:complications / Q000175:diagnosis; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology*