Partial body weight support treadmill training speed influences paretic and non-paretic leg muscle activation, stride characteristics, and ratings of perceived exertion during acute stroke rehabilitation

Are our doctors and therapists EVER going to write up a stroke walking protocol? EVER?
With no protocol we can never make appropriate improvements to get this better for every survivor.
You'll hear the fuckingly stupid excuse of: 'All strokes are different, all stroke recoveries are different'.
It's time to start screaming at your 'stroke medical professionals'. With no protocols you are essentially dealing with amateurs. OOPS, not the way to; 'How To Win Friends and Influence People'.
http://www.sciencedirect.com/science/article/pii/S0167945716300124

• Judith M. Burnfield^{a, ,} ,
• Thad W. Buster^a,
• Amy J. Goldman^a,
• Laura M. Corbridge^a,
• Kellee Harper-Hanigan^b

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doi:10.1016/j.humov.2016.01.012

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Abstract

Background

Intensive task-specific training is promoted as one approach for facilitating neural plastic brain changes and associated motor behavior gains following neurologic injury. Partial body weight support treadmill training (PBWSTT), is one task-specific approach frequently used to improve walking during the acute period of stroke recovery (<1 month post infarct). However, only limited data have been published regarding the relationship between training parameters and physiologic demands during this early recovery phase.

Objective

To examine the impact of four walking speeds on stride characteristics, lower extremity muscle demands (both paretic and non-paretic), Borg ratings of perceived exertion (RPE), and blood pressure.

Design

A prospective, repeated measures design was used.

Methods

Ten inpatients post unilateral stroke participated. Following three familiarization sessions, participants engaged in PBWSTT at four predetermined speeds (0.5, 1.0, 1.5 and 2.0 mph) while bilateral electromyographic and stride characteristic data were recorded. RPE was evaluated immediately following each trial.

Results

Stride length, cadence, and paretic single limb support increased with faster walking speeds (p ⩽ 0.001), while non-paretic single limb support remained nearly constant. Faster walking resulted in greater peak and mean muscle activation in the paretic medial hamstrings, vastus lateralis and medial gastrocnemius, and non-paretic medial gastrocnemius (p ⩽ 0.001). RPE also was greatest at the fastest compared to two slowest speeds (p < 0.05).

Conclusions

During the acute phase of stroke recovery, PBWSTT at the fastest speed (2.0 mph) promoted practice of a more optimal gait pattern with greater intensity of effort as evidenced by the longer stride length, increased between-limb symmetry, greater muscle activation, and higher RPE compared to training at the slowest speeds.

Corresponding author at: Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospital, 5401 South Street, Lincoln, NE 68506, United States.