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Mobility Function and Recovery After Stroke

Preliminary Insights From Sympathetic Nervous System Activity

Chatterjee, Sudeshna A. PhD; Daly, Janis J. PhD; Porges, Eric C. PhD; Fox, Emily J. PhD; Rose, Dorian K. PhD; McGuirk, Theresa E. MS; Otzel, Dana M. PhD; Butera, Katie A. DPT; Clark, David J. ScD

Journal of Neurologic Physical Therapy: October 2018 - Volume 42 - Issue 4 - p 224–232
doi: 10.1097/NPT.0000000000000238
Research Articles

Background and Purpose: Poststroke hemiparesis increases the perceived challenge of walking. Perceived challenge is commonly measured by self-report, which is susceptible to measurement bias. A promising approach to objectively assess perceived challenge is measuring sympathetic nervous system (SNS) activity with skin conductance to detect the physiological stress response. We investigated the feasibility of using skin conductance measurements to detect task-related differences in the challenge posed by complex walking tasks in adults poststroke.

Methods: Adults poststroke (n = 31) and healthy young adults (n = 8) performed walking tasks including typical walking, walking in dim lighting, walking over obstacles, and dual-task walking. Measures of skin conductance and spatiotemporal gait parameters were recorded. Continuous decomposition analysis was conducted to assess changes in skin conductance level (ΔSCL) and skin conductance response (ΔSCR). A subset of participants poststroke also underwent a 12-week rehabilitation intervention.

Results: SNS activity measured by skin conductance (both ΔSCL and ΔSCR) was significantly greater for the obstacles task and dual-task walking than for typical walking in the stroke group. Participants also exhibited “cautious” gait behaviors of slower speed, shorter step length, and wider step width during the challenging tasks. Following the rehabilitation intervention, SNS activity decreased significantly for the obstacles task and dual-task walking.

Discussion and Conclusions: SNS activity measured by skin conductance is a feasible approach for quantifying task-related differences in the perceived challenge of walking tasks in people poststroke. Furthermore, reduced SNS activity during walking following a rehabilitation intervention suggests a beneficial reduction in the physiological stress response evoked by complex walking tasks.

Video Abstract available for more insights from the authors (See Video, Supplemental Digital Content 1,

Brain Rehabilitation Research Center (S.A.C., J.J.D., D.K.R., T.E.M., K.A.B., D.J.C.) and VA Geriatric Research, Education and Clinical Center (D.M.O.), North Florida/South Georgia Veterans Health System, Gainesville, Florida; Departments of Physical Therapy (S.A.C., E.J.F., D.K.R., K.A.B.), Neurology (J.J.D.), Clinical and Health Psychology (E.C.P.), and Aging and Geriatric Research (D.J.C.), University of Florida, Gainesville; and Brooks Rehabilitation, Jacksonville, Florida (E.J.F.).

Correspondence: David J. Clark, ScD, Brain Rehabilitation Research Center (151A), Malcom Randall VA Medical Center, 1601 SW Archer Rd, Gainesville, FL 32608 (

This article reflects work presented at APTA Combined Sections Meeting: Chatterjee S, Rose D, Porges E, et al. Quantifying the perceived challenge of walking after stroke by measuring sympathetic activation: a pilot study. Paper presented at: APTA Combined Sections Meeting; February 17, 2017; San Antonio, TX.

Conflicts of interest: none

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (

Clinical trial registration numbers: NCT02132650 (Dr David Clark); NCT02362282 (Dr Janis Daly)

© 2018 Academy of Neurologic Physical Therapy, APTA