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Browsing by Author "Fahey, Meghan"
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Item Contributions of Stepping Intensity and Variability to Mobility in Individuals Poststroke(American Heart Association, 2019-08-22) Hornby, T. George; Henderson, Christopher E.; Plawecki, Abbey; Lucas, Emily; Lotter, Jennifer; Holthus, Molly; Brazg, Gabrielle; Fahey, Meghan; Woodward, Jane; Ardestani, Marzieh; Roth, Elliot J.; Physical Medicine and Rehabilitation, School of MedicineBackground and Purpose: The amount of task-specific stepping practice provided during rehabilitation post-stroke can influence locomotor recovery, and reflects one aspect of exercise “dose” that can affect the efficacy of specific interventions. Emerging data suggest that markedly increasing the intensity and variability of stepping practice may also be critical, although such strategies are discouraged during traditional rehabilitation. The goal of this study was to determine the individual and combined contributions of intensity and variability of stepping practice to improving walking speed and distance in individuals post-stroke. Methods: This Phase 2, randomized, blinded assessor clinical trial was performed between May 2015-November 2018. Individuals between 18-85 years old with hemiparesis post-stroke of >6 months duration were recruited. Of the 152 individuals screened, 97 were randomly assigned to 1 of 3 training groups, with 90 completing >10 sessions. Interventions consisted of either high intensity stepping (70-80% heart rate [HR] reserve) of variable, difficult stepping tasks (high-variable), high intensity stepping performing only forward walking (high-forward), and low intensity stepping in variable contexts at 30-40% HR reserve (low-variable). Participants received up to 30 sessions over 2 months, with testing at baseline, post-training and a 3-month follow-up. Primary outcomes included walking speeds and timed distance, with secondary measures of dynamic balance, transfers, spatiotemporal kinematics and metabolic measures. Results: All walking gains were significantly greater following either high-intensity group vs low-variable training (all p<0.001) with significant correlations with stepping amount and rate (r=0.48-60; p<0.01). Additional gains in spatiotemporal symmetry were observed with high-intensity training, and balance confidence increased only following high-variable training in individuals with severe impairments. Conclusion: High intensity stepping training resulted in greater improvements in walking ability and gait symmetry than low-intensity training in individuals with chronic stroke, with potential greater improvements in balance confidence.Item The Value of High Intensity Locomotor Training Applied to Patients With Acute-Onset Neurologic Injury(Elsevier, 2022) Fahey, Meghan; Brazg, Gabrielle; Henderson, Christopher E.; Plawecki, Abbey; Lucas, Emily; Reisman, Darcy S.; Schmit, Brian D.; Hornby, T. George; Physical Medicine and Rehabilitation, School of MedicineLong-standing research in animal models and humans with stroke or incomplete spinal cord injury (iSCI) indicate that specific physical training variables, such as the specificity and amount of practice, may influence neurologic recovery and locomotor function. More recent data highlight the contributions of exercise intensity, as estimated indirectly by cardiovascular exertion, as potentially more important than previously considered. The effects of exercise intensity are well described in neurologically intact individuals, although confusion regarding the definitions of intensity and safety concerns have limited its implementation during physical rehabilitation of patients with neurologic injury. The purpose of this review is to delineate some of the evidence regarding the effects of exercise intensity during locomotor training in patients with stroke and iSCI. We provide specific definitions of exercise intensity used within the literature, describe methods used to ensure appropriate levels of exertion, and discuss potential adverse events and safety concerns during its application. Further details on the effects of locomotor training intensity on clinical outcomes, and on neuromuscular and cardiovascular function will be addressed as available. Existing literature across multiple studies and meta-analyses reveals that exercise training intensity is likely a major factor that can influence locomotor function after neurologic injury. To extend these findings, we describe previous attempts to implement moderate to high intensity interventions during physical rehabilitation of patients with neurologic injury, including the utility of specific strategies to facilitate implementation, and to navigate potential barriers that may arise during implementation efforts.