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Understanding the impairments that primarily determine walking ability of individuals with stroke will help with the development of effective gait training strategies. Major determinants of ambulation function in stroke VO 2peak is the criterion measure of cardiovascular fitness and is related to the functional capacity of the heart. Furthermore, self-selected walking speed and walking endurance (6MWT) correlate to the maximal oxygen uptake (VO 2peak) during a treadmill stress test in people with stroke. For example, poorer walking endurance (6MWT) or lower ground reaction forces during walking in people with stroke correlate to lower paretic hip bone density, a condition which contributes to hip fracture risk. In addition, walking ability may also provide some protective effects against secondary complications common after a stroke such as osteoporosis and heart disease.
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Walking endurance as assessed by the 6MWT has been shown to relate to community reintegration in people with a stroke. The inability for independent walking is a predictor for discharge to nursing homes following a stroke and increased probability of death. Similarly, walking is an important predictor in people with stroke. Slow walking speed, the inability to walk a mile (1609 m) or inability to walk up a flight of stairs contribute to the transition to greater frailty or disability states in older adults. found that the ability and time to walk 400 meters was an important predictor for mortality, cardiovascular disease and mobility disability in 3075 community-dwelling older adults. Walking ability has important implications for health in the older adult population. Improved walking ability is one of the most often stated goals by people with stroke undergoing rehabilitation and with those individuals living with stroke in the community. Patients with stroke spend more of their rehabilitation time practicing walking compared to all other activities. Walking endurance, as measured by the distance walked in 6 minutes (Six Minute Walk Test or 6MWT), remains the most striking area of difficulty among individuals with chronic stroke. Īlthough 65% to 85% of stroke survivors learn to walk independently by 6 months post stroke, gait abnormalities persist through the chronic stages of the condition. Community-dwelling individuals with stroke undertake extremely low levels of physical activity. Impairments resulting from stroke, such as muscle weakness, pain, spasticity and poor balance can lead to a reduced tolerance to activity and further sedentary lifestyle. Īlthough some individuals with stroke will have received some rehabilitation during the acute and sub-acute phases, rarely does rehabilitation extend beyond one year post-injury due to the belief that a plateau in functional recovery has been reached by this time and also due to a lack of resources for long term services. Ninety percent of stroke survivors have some functional disability with mobility being a major impairment.
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Of the individuals who survive, approximately 75 to 85% are ultimately discharged home. As a result of an increasing older adult population, coupled with an ever improving acute phase survival rate, the absolute number of persons with stroke is increasing.
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Stroke is a leading cause of long-term disability which results from brain cell damage due to either an interruption of the blood supply to the brain or hemorrhage into the brain tissue.