A quantitative and qualitative exploration of changes in walking post-stroke and the impact of functional electrical stimulation for correction of dropped foot

Abstract

The research presented in this thesis explores changes in walking following a stroke, empirically at a group level and from the perspective of the individual. Walking does not appear to have been previously been systematically explored from the perspective of the individual stroke survivor.

In the first phase of this research, quantitative methods were used to investigate existing gait rehabilitation interventions applied in a novel population. Problems with ‘dropped foot’ post-stroke are common and can result in trips, falls and restricted mobility. Electrical stimulation of the common peroneal nerve produces dorsiflexion and eversion to correct dropped foot and is associated with improved motor control and walking post-stroke, however most research studies have recruited people with chronic stroke to reduce sample variability. People who are less than six months post-stroke may gain added benefit from electrical stimulation as poor walking patterns may not yet have become habitual and the potential for motor recovery due to cortical reorganisation is greatest. A pilot parallel group partially single blinded randomised controlled clinical trial (n=20) identified statistically significant within group differences in mobility after the intervention period in both groups (maintained during follow-up). No statistically significant between group differences were observed apart from gait quality, which was slightly better in the intervention group. Participants in the intervention group also walked faster when stimulation was used than without it. The protocol was feasible and 144 participants per group would produce an adequately powered definitive study.

Participants in the pilot clinical trial spoke about valued personal aspects of walking but these were not fully captured by the outcome measures and are not reflected in the published literature. To systematically explore changes in walking post-stroke in depth interviews with a subgroup of the original participants were undertaken using an interpretative phenomenological approach (n=4). The participants gave examples of post-stroke walking related changes in their self-perception, roles and their embodied experience of walking that are rarely mentioned in the rehabilitation literature, apart from in personal accounts written by people living with chronic illness. They spoke about walking within the context of activities that they identified as personally important. These participants valued being able to walk distances at a reasonable speed, being independent, safe and confident. They said that they missed their pre-stroke spontaneity, freedom, agility and their lost automatic body movement, which are not usually assessed in stroke rehabilitation research or reflected in published research. Areas for further work have been identified.

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ORCID for Jane Burridge: orcid.org/0000-0003-3497-6725

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