Background and Purpose.
Previous studies suggest that individuals poststroke can achieve
substantial gains in walking function following high-intensity locomotor
training (LT). Recent findings also indicate practice of variable
stepping tasks targeting locomotor deficits can mitigate selected
impairments underlying reduced walking speeds. The goal of this study
was to investigate alterations in locomotor biomechanics following 3
different LT paradigms.
Methods.
This secondary analysis of a
randomized trial recruited individuals 18 to 85 years old and >6
months poststroke. We compared changes in spatiotemporal, joint
kinematics, and kinetics following up to 30 sessions of high-intensity
(>70% heart rate reserve [HRR]) LT of variable tasks targeting
paretic limb and balance impairments (high-variable, HV), high-intensity
LT focused only on forward walking (high-forward, HF), or low-intensity
LT (<40% HRR) of variable tasks (low-variable, LV). Sagittal
spatiotemporal and joint kinematics, and concentric joint powers were
compared between groups. Regressions and principal component analyses
were conducted to evaluate relative contributions or importance of
biomechanical changes to between and within groups.
Results.
Biomechanical data were available on 50 participants who could walk ≥0.1
m/s on a motorized treadmill. Significant differences in spatiotemporal
parameters, kinematic consistency, and kinetics were observed between
HV and HF versus LV. Resultant principal component analyses were
characterized by paretic powers and kinematic consistency following HV,
while HF and LV were characterized by nonparetic powers.
Conclusion.
High-intensity LT results in greater changes in kinematics and kinetics
as compared with lower-intensity interventions. The results may suggest
greater paretic-limb contributions with high-intensity variable
stepping training that targets specific biomechanical deficits.
Clinical Trial Registration.
https://clinicaltrials.gov/ Unique Identifier: NCT02507466
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