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, January 25, 2022

Step Number and Aerobic Minute Exercise Prescription and Progression in Stroke: A Roadmap

Yeah, higher functioning survivors can walk longer and faster. Duh. Measurement does nothing for getting survivors recovered. You need to create a protocol and distribute it to all 10 million yearly stroke survivors.

Step Number and Aerobic Minute Exercise Prescription and Progression in Stroke: A Roadmap

First Published December 23, 2021 Research Article Find in PubMed 

While higher therapeutic intensity improves motor recovery after stroke, translating findings from successful studies is challenging without clear exercise intensity targets. We show in the DOSE trial1 more than double the steps and aerobic minutes within a session can be achieved compared with usual care and translates to improved long-term walking outcomes.

We modeled data from this successful higher intensity multi-site RCT to develop targets for prescribing and progressing exercise for varying levels of walking impairment after stroke.

In twenty-five individuals in inpatient rehabilitation, twenty sessions were monitored for a total of 500 one-hour physical therapy sessions. For the 500 sessions, step number and aerobic minute progression were modeled using linear mixed effects regression. Using formulas from the linear mixed effects regression, targets were calculated.

The model for step number included session number and baseline walking speed, and for aerobic minutes, session number and age. For steps, there was an increase of 73 steps per session. With baseline walking speed, for every 0.1 m/s increase, a corresponding increase of 302 steps was predicted. For aerobic minutes, there was an increase of .56 minutes of aerobic activity (ie, 34 seconds) per session. For every year increase in age, a decrease of .39 minutes (ie, 23 seconds) was predicted.

Using data associated with better walking outcomes, we provide step number and aerobic minute targets that future studies can cross-validate. As walking speed and age are collected at admission, these models allow for uptake of routine measurement of therapeutic intensity.

Registration: www.clinicaltrials.gov; NCT01915368.

Frequency, intensity, time, and type, or the FITT principle, is a way to outline the components of exercise prescription. While interpretation of clinical trials require the components of FITT to be depicted to allow for successful implementation, Billinger et al (2015) report that exercise intensity is only described adequately in 59% of clinical trials.2 Further, no studies outline data-driven prescription and progression of therapeutic exercise intensity after stroke. In the absence of specific exercise prescription guidelines, rehabilitation therapists provide low exercise doses, despite evidence that higher intensity exercise improves neural and functional recovery.1,3

When general targets are given to research therapists, our recent study shows more than double the steps and aerobic minutes can be achieved vs usual care and translates to improved long-term walking outcomes.1 Yet, safety concerns keep some therapists from delivering higher exercise intensity4 since the subacute stroke period is a time of higher risk for cardiac complications.5 A roadmap highlighting key parameters that impact safe prescription and progression targets based on these parameters would be a useful clinical tool. To address this gap, we modeled data from a successful higher intensity multi-site randomized clinical trial to develop formulas for prescribing and progressing exercise for varying walking impairment levels after stroke.1

 

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