Using muscle strength as a predictor for walking ability after stroke

After a stroke, reduced muscle strength is a main cause of reduced ability to walk. In this observational study, we'll examine the relationship between muscle strength and walking ability, and using muscle strength to predict walking speed at 6 months. Muscle strength will be measured using manual muscle test (MMT) and for muscles scoring at 0 or 1 on the MMT, a surface electromyography (EMG) reading will be recorded to ascertain the actual amount of muscle activity. We'll measure the muscle strength for all eligible stroke survivors who were initially non-ambulant post stroke onset. Walking speed will be measured when the stroke survivor is able to walk independently. The follow up period will be at 1, 2,3,4,8,12, 26 and 52 weeks following stroke onset. Muscle strength testing procedures: - 4 trials will be performed to ascertain muscle strength for hip and knee extensors, as well as ankle dorsiflexor and plantar flexors - the participants will lie in supine with their particle limb positioned at 90 degrees of hip and knee flexion on a stool as standardised positions for testing of muscle strength - if the participant scores 0 or 1 on manual muscle test, we will perform EMG for relevant muscle groups only - EMG electrodes will be positioned longitudinally over the innervation zone and distal tendon to ascertain muscle activity, and a third electrode as reference on a boney prominence - the actual reading from EMG machine will be recorded for all 4 attempts - the testing will be performed by either the site physiotherapist or the researcher - the approximate testing procedure will take 10-15minutes, and we will assess muscle strength at all timepoints in this study up to 26 weeks. At 52 weeks (12 months), we will follow up with phone call to participants who were not able to walk at 6 months to ascertain walking ability at 12 months.