Gordhan B Mahtani1, Catherine R Kinnaird2, Mark Connolly3, Carey L Holleran4, Patrick W Hennessy5, Jane Woodward6, Gabrielle Brazg7, Elliot J Roth8, T George Hornby9. 1. G.B. Mahtani, MS, Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, Illinois. 2. C.R. Kinnaird, MS, Sensory Motor Performance Program, Rehabilitation Institute of Chicago. 3. M. Connolly, BS, Sensory Motor Performance Program, Rehabilitation Institute of Chicago. 4. C.L. Holleran, DHS, Sensory Motor Performance Program, Rehabilitation Institute of Chicago. 5. P.W. Hennessy, PT, MPT, Sensory Motor Performance Program, Rehabilitation Institute of Chicago. 6. J. Woodward, PT, DPT, Sensory Motor Performance Program, Rehabilitation Institute of Chicago. 7. G. Brazg, PT, DPT, Sensory Motor Performance Program, Rehabilitation Institute of Chicago. 8. E.J. Roth, MD, Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. 9. T.G. Hornby, PT, PhD, Sensory Motor Performance Program, Rehabilitation Institute of Chicago; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University; and Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, 355 W 16th St, Indianapolis, IN 46202 (USA).
Abstract
BACKGROUND: Common locomotor deficits observed in people poststroke include decreased speeds and abnormal kinematics, characterized by altered symmetry, reduced sagittal-plane joint excursions, and use of compensatory frontal-plane behaviors during the swing phase of gait. Conventional interventions utilized to mitigate these deficits often incorporate low-intensity, impairment-based or functional exercises focused on normalizing kinematics, although the efficacy of these strategies is unclear. Conversely, higher-intensity training protocols that provide only stepping practice and do not focus on kinematics have demonstrated gains in walking function, although minimal attention toward gait quality may be concerning and has not been assessed. OBJECTIVE: The present study evaluated changes in spatiotemporal and joint kinematics following experimental, high-intensity stepping training compared with conventional interventions. DESIGN: Kinematic data were combined from a randomized controlled trial comparing experimental and conventional training and from a pilot experimental training study. METHODS:Individuals with gait deficits 1 to 6 months poststroke received up to 40 sessions of either high-intensity stepping training in variable contexts or conventional lower-intensity interventions. Analyses focused on kinematic changes during graded treadmill testing before and following training. RESULTS: Significant improvements in speed, symmetry, and selected sagittal-plane kinematics favored experimental training over conventional training, although increases in compensatory strategies also were observed. Changes in many kinematic patterns were correlated with speed changes, and increased compensatory behaviors were associated with both stride length gains and baseline impairments. LIMITATIONS: Limitations include a small sample size and use of multiple statistical comparisons. CONCLUSIONS:Improved speeds and selected kinematics were observed following high-intensity training, although such training also resulted in increased use of compensatory strategies. Future studies should explore the consequences of utilizing these compensatory strategies despite the observed functional gains.
RCT Entities:
BACKGROUND: Common locomotor deficits observed in people poststroke include decreased speeds and abnormal kinematics, characterized by altered symmetry, reduced sagittal-plane joint excursions, and use of compensatory frontal-plane behaviors during the swing phase of gait. Conventional interventions utilized to mitigate these deficits often incorporate low-intensity, impairment-based or functional exercises focused on normalizing kinematics, although the efficacy of these strategies is unclear. Conversely, higher-intensity training protocols that provide only stepping practice and do not focus on kinematics have demonstrated gains in walking function, although minimal attention toward gait quality may be concerning and has not been assessed. OBJECTIVE: The present study evaluated changes in spatiotemporal and joint kinematics following experimental, high-intensity stepping training compared with conventional interventions. DESIGN: Kinematic data were combined from a randomized controlled trial comparing experimental and conventional training and from a pilot experimental training study. METHODS: Individuals with gait deficits 1 to 6 months poststroke received up to 40 sessions of either high-intensity stepping training in variable contexts or conventional lower-intensity interventions. Analyses focused on kinematic changes during graded treadmill testing before and following training. RESULTS: Significant improvements in speed, symmetry, and selected sagittal-plane kinematics favored experimental training over conventional training, although increases in compensatory strategies also were observed. Changes in many kinematic patterns were correlated with speed changes, and increased compensatory behaviors were associated with both stride length gains and baseline impairments. LIMITATIONS: Limitations include a small sample size and use of multiple statistical comparisons. CONCLUSIONS: Improved speeds and selected kinematics were observed following high-intensity training, although such training also resulted in increased use of compensatory strategies. Future studies should explore the consequences of utilizing these compensatory strategies despite the observed functional gains.