Browsing by Author "Roth, Elliot J."

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    Altered Sagittal- and Frontal-Plane Kinematics Following High-Intensity Stepping Training Versus Conventional Interventions in Subacute Stroke
    (Oxford, 2016) Mahtani, Gordhan B.; Kinnaird, Catherine R.; Connolly, Mark; Holleran, Carey L.; Hennessy, Patrick W.; Woodward, Jane; Brazg, Gabrielle; Roth, Elliot J.; Hornby, T. George; Physical Medicine and Rehabilitation, School of Medicine
    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.
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    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 Medicine
    Background 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.
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    Influence of skill and exercise training parameters on locomotor recovery during stroke rehabilitation
    (Wolters Kluwer, 2016-12) Hornby, T. George; Moore, Jennifer L.; Lovell, Linda; Roth, Elliot J.; Physical Medicine and Rehabilitation, School of Medicine
    Purpose of review: Research findings from the fields of motor learning and exercise physiology suggest specific training parameters that can be manipulated during physical rehabilitation profoundly influence skilled task performance. This review details the rationale for some of these training variables and their application in selected intervention studies focused on improving walking function in patients poststroke. Recent findings: Basic and applied studies have shown that the amount, intensity, and variability of specific task practice applied during rehabilitation interventions can affect recovery of walking poststroke. Many studies detailing the effects of conventional, therapist, and mechanically assisted interventions may incorporate some of these training parameters but minimize others, and their relative contributions may influence walking outcomes. Specific patient factors, such as the stroke acuity and degree of impairments, appear to influence the relative contributions of these training variables, and different patient subgroups may benefit from greater emphasis on specific parameters. Summary: The present findings suggest these training parameters should be considered when evaluating or implementing physical interventions directed toward improving locomotor function poststroke. More work is needed to understand their optimal combinations to maximize walking outcomes in patients with different levels of impairment poststroke.
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    Stepwise Regression and Latent Profile Analyses of Locomotor Outcomes Poststroke
    (American Heart Association, 2020-10) Hornby, T. George; Henderson, Christopher E.; Holleran, Carey L.; Lovell, Linda; Roth, Elliot J.; Jang, Jeong Hoon; Physical Medicine and Rehabilitation, School of Medicine
    Background and purpose: Previous data suggest patient demographics and clinical presentation are primary predictors of motor recovery poststroke, with minimal contributions of physical interventions. Other studies indicate consistent associations between the amount and intensity of stepping practice with locomotor outcomes. The goal of this study was to determine the relative contributions of these combined variables to locomotor outcomes poststroke across a range of patient demographics and baseline function. Methods: Data were pooled from 3 separate trials evaluating the efficacy of high-intensity training, low-intensity training, and conventional interventions. Demographics, clinical characteristics, and training activities from 144 participants >1-month poststroke were included in stepwise regression analyses to determine their relative contributions to locomotor outcomes. Subsequent latent profile analyses evaluated differences in classes of participants based on their responses to interventions. Results: Stepwise regressions indicate primary contributions of stepping activity on locomotor outcomes, with additional influences of age, duration poststroke, and baseline function. Latent profile analyses revealed 2 main classes of outcomes, with the largest gains in those who received high-intensity training and achieved the greatest amounts of stepping practice. Regression and latent profile analyses of only high-intensity training participants indicated age, baseline function, and training activities were primary determinants of locomotor gains. Participants with the smallest gains were older (≈60 years), presented with slower gait speeds (<0.40 m/s), and performed 600 to 1000 less steps/session. Conclusions: Regression and cluster analyses reveal primary contributions of training interventions on mobility outcomes in patients >1-month poststroke. Age, duration poststroke, and baseline impairments were secondary predictors.
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    The Value of Rehabilitation Interventions --Integrating Evidence, Clinical Expertise, Critical Assessment, and Patient Needs: A Conference Report
    (Elsevier, 2021) Roth, Elliot J.; Hornby, T. George; Physical Medicine and Rehabilitation, School of Medicine
    In order to understand issues related to value, outcomes, and cost-effectiveness of rehabilitation interventions, and to explore how scientific evidence, clinical expertise, and patient needs can be integrated, the Rehabilitation Research and Training Center on Developing Optimal Strategies in Exercise and Survival Skills to Increase Health and Function held a State of the Science (SOS) Symposium on “ The Value of Rehabilitation Interventions” at Shirley Ryan AbilityLab in Chicago in 2017. In this conference, the perspectives of 35 invited experts, including people with disabilities, professionals, and consumers, explored the topic of “value” of rehabilitation interventions and discussed their perspectives on the means to integrate best scientific evidence with clinical expertise and patient preferences. This Symposium also resulted in the production of several multifaceted manuscripts providing perspectives on the topic of value and how to use evidence to best determine and demonstrate it. These papers comprise this Supplement. The present paper introduces the key concepts of value, evidence, and knowledge translation, in an effort to provide a context for the papers of the Supplement.