Energy consumption and cost during walking with different modalities of assistance after stroke: a systematic review and meta-analysis

Purpose: To estimate pooled rates of gross and net energy consumption (ml/kg/min and J/kg/min) and energy cost (ml/kg/m and J/kg/m) during level surface walking with different assistance modalities post-stroke. Materials and Methods: Four databases were searched using keywords related to stroke, walking, and energy requirements. Three independent reviewers screened 3296 records and included 42 studies in quantitative analysis. Results: Pooled rates without significant important heterogeneity were identified for: gross energy consumption during unassisted overground walking at comfortable walking speed (10.55 ml/kg/min; 95% CI [9.93–11.16]), gross energy consumption during treadmill walking with rigid exoskeleton assistance (7.08 ml/kg/min; 95% CI [6.52–7.65]), gross energy cost during unassisted overground walking in patients with chronic stroke (0.24 ml/kg/m; 95% CI [0.28–0.48]), gross energy cost during unassisted treadmill walking in patients with subacute stroke (0.45 ml/kg/m; 95% CI 0.45–0.45]), and net energy cost during overground walking with assistive devices and orthoses in patients with chronic stroke (4.12 J/kg/m, 95% CI [3.55–4.69]). Conclusions: Walking, unassisted and with the use of assistive devices and lower limb orthoses, induces low- to moderate-intensity exercise as recommended by exercise guidelines for stroke survivors. Future studies should explore whether bodyweight-supported or robot-assisted walking can also reach moderate-intensity.Implications for Rehabilitation To induce sufficient cardiorespiratory stress during gait rehabilitation (i.e., moderate-intensity), therapists should train ambulatory patients with stroke without any assistance or if needed with the help of assistive devices or lower limb orthoses. For severely impaired patients who cannot walk independently, therapists could use bodyweight support systems, exoskeletons, or end-effectors to induce low-intensity aerobic exercise.