Contributions of Stepping Intensity and Variability to Mobility in Individuals Poststroke

dc.contributor.authorHornby, T. George
dc.contributor.authorHenderson, Christopher E.
dc.contributor.authorPlawecki, Abbey
dc.contributor.authorLucas, Emily
dc.contributor.authorLotter, Jennifer
dc.contributor.authorHolthus, Molly
dc.contributor.authorBrazg, Gabrielle
dc.contributor.authorFahey, Meghan
dc.contributor.authorWoodward, Jane
dc.contributor.authorArdestani, Marzieh
dc.contributor.authorRoth, Elliot J.
dc.contributor.departmentPhysical Medicine and Rehabilitation, School of Medicineen_US
dc.date.accessioned2021-05-28T15:52:33Z
dc.date.available2021-05-28T15:52:33Z
dc.date.issued2019-08-22
dc.description.abstractBackground 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.en_US
dc.eprint.versionAuthor's manuscripten_US
dc.identifier.citationHornby, T. G., Henderson, C. E., Plawecki, A., Lucas, E., Lotter, J., Holthus, M., Brazg, G., Fahey, M., Woodward, J., Ardestani, M., & Roth, E. J. (2019). Contributions of Stepping Intensity and Variability to Mobility in Individuals Poststroke. Stroke, 50(9), 2492–2499. https://doi.org/10.1161/STROKEAHA.119.026254en_US
dc.identifier.urihttps://hdl.handle.net/1805/26044
dc.language.isoen_USen_US
dc.publisherAmerican Heart Associationen_US
dc.relation.isversionof10.1161/STROKEAHA.119.026254en_US
dc.relation.journalStrokeen_US
dc.sourcePMCen_US
dc.subjectlocomotionen_US
dc.subjectrehabilitationen_US
dc.subjectexerciseen_US
dc.titleContributions of Stepping Intensity and Variability to Mobility in Individuals Poststrokeen_US
dc.typeArticleen_US
Files
Original bundle
Now showing 1 - 1 of 1
Loading...
Thumbnail Image
Name:
nihms-1534948.pdf
Size:
562.19 KB
Format:
Adobe Portable Document Format
Description:
Author's manuscript
License bundle
Now showing 1 - 1 of 1
No Thumbnail Available
Name:
license.txt
Size:
1.99 KB
Format:
Item-specific license agreed upon to submission
Description: