Variable Intensive Early Walking Poststroke (VIEWS)

Once again proving that every stroke survivor is a guinea pig in your doctors and therapists single case research study. But these research studies are never written up and consolidated for other stroke providers or survivors.  We still have NO stroke protocol for walking, probably the most requested recovery item as well as the most dangerous to your life.
For people 65 years old and older falls are the number one cause of death from an injury, according to the Centers for Disease Control and Prevention (CDC). 
http://nnr.sagepub.com/content/30/5/440?etoc

1. T. George Hornby, PhD1,2,3⇑
2. Carey L. Holleran, DHS2
3. Patrick W. Hennessy, MPT2
4. Abigail L. Leddy, DPT2
5. Mark Connolly2
6. Jaclyn Camardo2
7. Jane Woodward, DPT2
8. Gordhan Mahtani, MS2
9. Linda Lovell2
10. Elliot J. Roth, MD2,3

1. ¹University of Illinois at Chicago, Chicago, IL, USA
2. ²Rehabilitation Institute of Chicago, Chicago, IL, USA
3. ³Northwestern University, Chicago, IL, USA

1. T. George Hornby, PhD, Department of Physical Therapy, University of Illinois, 1919 W Taylor, Chicago, IL 60611, USA. Email: tgh@uic.edu

Abstract

Background. Converging evidence suggests that the amount of stepping practice is an important training parameter that influences locomotor recovery poststroke. More recent data suggest that stepping intensity and variability are also important, although such strategies are often discouraged early poststroke.  

Objective. The present study examined the efficacy of high-intensity, variable stepping training on walking and nonwalking outcomes in individuals 1 to 6 months poststroke as compared with conventional interventions.  

Methods. Individuals with unilateral stroke (mean duration = 101 days) were randomized to receive ≤40, 1-hour experimental or control training sessions over 10 weeks. Experimental interventions consisted only of stepping practice at high cardiovascular intensity (70%-80% heart rate reserve) in variable contexts (tasks or environments). Control interventions were determined by clinical physical therapists and supplemented using standardized conventional strategies. Blinded assessments were obtained at baseline, midtraining, and posttraining with a 2-month follow-up.  

Results. A total of 32 individuals (15 experimental) received different training paradigms that varied in the amount, intensity, and types of tasks performed. Primary outcomes of walking speed (experimental, 0.27 ± 0.22 m/s vs control, 0.09 ± 0.09 m/s) and distances (119 ± 113 m vs 30 ± 32 m) were different between groups, with stepping amount and intensity related to these differences. Gains in temporal gait symmetry and self-reported participation scores were greater following experimental training, without differences in balance or sit-to-stand performance. 

Conclusion. Variable intensive stepping training resulted in greater improvements in walking ability than conventional interventions early poststroke. Future studies should evaluate the relative contributions of these training parameters.