Abstract
Objectives
To
identify the clinical measures associated with improved walking speed
after locomotor rehabilitation in individuals poststroke and how those
who respond with clinically meaningful changes in walking speed differ
from those with smaller speed increases.
Design
A
single group pre-post intervention study. Participants were stratified
on the basis of a walking speed change of greater than (responders) or
less than (nonresponders) .16m/s. Paired sample t tests were
run to assess changes in each group, and correlations were run between
the change in each variable and change in walking speed.
Setting
Outpatient interdisciplinary rehabilitation research center.
Participants
Hemiparetic subjects (N=27) (17 left hemiparesis; 19 men; age: 58.74±12.97y; 22.70±16.38mo poststroke).
Intervention
A
12-week locomotor intervention incorporating training on a treadmill
with body weight support and manual trainers accompanied by training
overground walking.
Main Outcome Measures
Measures
of motor control, balance, functional walking ability, and endurance
were collected at pre- and postintervention assessments.
Results
Eighteen responders and 9 nonresponders differed by age (responders=63.6y, nonresponders=49.0y, P=.001) and the lower extremity Fugl-Meyer Assessment score (responders=24.7, nonresponders=19.9, P=.003).
Responders demonstrated an average improvement of .27m/s in walking
speed as well as significant gains in all variables except daily step
activity and paretic step ratio. Conversely, nonresponders demonstrated
statistically significant improvements only in walking speed and
endurance. However, the walking speed increase of .10m/s was not
clinically meaningful. Change in walking speed was negatively correlated
with changes in motor control in the nonresponder group, implying that
walking speed gains may have been accomplished via compensatory
mechanisms.
Conclusions
This study is a step toward discerning the underlying factors contributing to improved walking performance. Did you look at the damage location at all? Or are you that stupid? And these people have PhDs?
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