Deans' stroke musings: Steps, duration and intensity of usual walking practice during subacute rehabilitation after stroke: an observational study

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Tuesday, June 19, 2018

Steps, duration and intensity of usual walking practice during subacute rehabilitation after stroke: an observational study

But what about accounting for foot drop and spasticity of the leg muscles? Solve those problems and survivors could walk a lot more. They didn't define assistance; cane? walking frame? AFO? gait belt with PT help? parallel bars? BWSTT?
https://www.sciencedirect.com/science/article/pii/S1413355517307104

https://doi.org/10.1016/j.bjpt.2018.06.001

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Highlights

•: Stroke survivors spend approximately 20% of physical therapy time actively walking.
•: Those able to walk without assistance take more steps for longer at a higher intensity.
•: Increased walking practice intensity is needed to drive motor learning.

Abstract

Background

Duration of therapy time is an inadequate indicator of stroke rehabilitation. Steps, duration, and intensity of active therapy time may provide a better indicator of practice.

Objective

This study quantified usual walking practice in terms of steps, duration and intensity of active therapy time, and distance walked during physical therapy sessions in people with sub-acute stroke undertaking inpatient rehabilitation and to examine whether usual walking practice differed depending on walking ability.

Methods

A prospective observational study was conducted across two metropolitan rehabilitation units in Australia. Twenty-four stroke survivors were observed over three physical therapy sessions. Walking ability was categorized as unassisted or assisted based on Item 5 of the Motor Assessment Scale. Walking practice was categorized as basic or advanced. Steps, duration, intensity and distance walked were measured during physical therapy sessions.

Results

Overall, participants took 560 steps (SD 309) over 13 min (SD 6) at an intensity of steps 44 steps/min (SD 17) and walked 222 m (SD 143) in physical therapy. Unassisted walkers (n = 6, 25%) undertook more (or trended towards more) practice of advanced walking than assisted walkers in terms of steps (MD 254 steps, 95% CI 48–462), duration (MD 5 min, 95% CI 0–10), intensity (MD 18 steps/min, 95% CI −8 to 44) and distance (MD 112 m, 95% CI −12 to 236).

Conclusion

Stroke survivors undergoing inpatient rehabilitation spent approximately 20% of physical therapy actively engaged in walking practice. Those able to walk without assistance took more steps for longer, at a higher intensity.