MOBILITY FUNCTION FOLLOWING STROKE: THE IMPACT OF MULTIPLE IMPAIRMENTS
Authors: A. C. Novak and B. Brouwer
Abstract: Stroke is a leading cause of adult disability and the number affected is increasing as the population ages and survival rates post-event improve. It is estimated that as many as 60% of stroke survivors live with significant physical deficits including muscle weakness, instability, poor motor coordination and cardiovascular compromise resulting in a loss of independence in performing activities required for daily living. This percentage has remained relatively constant over the past decades, which suggests that interventions to minimize or reverse the effects of stroke are not yet widely available. We propose that while most rehabilitation programs focus on reducing impairment they yield limited effect on mobility function because of inadequacies on two fronts. First, they often deal with impairments as isolated deficiencies and as such fail to consider stroke as a multisystem disorder that demands an integrated treatment approach for optimal restoration of function. Second, the minimum performance requirements of specific aspects of physical function including strength, balance, and aerobic capacity associated with every day activities are unknown. Consequently, clinicians are challenged to identify targets that if attained will translate into enhanced mobility. This chapter reviews the relevant literature and presents research findings to provide insight on these important issues. The approach is to first discuss stroke related physical impairments and their association with mobility deficits. From our own research work and the growing body of literature examining the combined influence of muscle weakness, balance instability, and physiological cost on mobility we explore those factors that are important determinants of mobility function. Going a step further, the impact of reducing impairments on effecting positive change in mobility is discussed. Stroke is a multisystem disorder and mobility is a complex construct dependent upon the integrity of individual physical systems as well as their capacity to work in concert. The research discussed in this chapter provides insight into the unique characteristics of these systems in stroke and their interactions which are fundamental to mobility.