Background Previous data suggest the amount and aerobic intensity of stepping training may improve walking post-stroke. Recent animal and human studies suggest training in challenging and variable contexts can also improve locomotor function. Such practice may elicit substantial stepping errors, although alterations in locomotor strategies to correct these errors could lead to improved walking ability. Objective This un-blinded, pretest-posttest pilot study was designed to evaluate the feasibility and preliminary efficacy of providing stepping practice in variable, challenging contexts (tasks and environments) at high aerobic intensities in participants with chronic (< 6 months) and subacute (1–6 months) stroke. Methods Twenty-five participants with stroke (gait speeds < 0.9 m/s with no more than moderate assistance) participated in ≤ 40 1-hr training sessions within 10 weeks. Stepping training in variable, challenging contexts was performed at 70–80% heart rate reserve, with feasibility measures of total steps/session, ability to achieve targeted intensities, patient tolerance, dropouts, and adverse events. Measures of daily stepping, gait speed, symmetry, and 6-min walk were performed every 4–5 weeks or 20 sessions with a 3 month follow-up. Results Twenty-two participants completed ≥ 4 weeks of training, averaging 2887±780 steps/session over 36±5.8 sessions. Self-selected and fastest speed, paretic single limb stance, and 6-min walk improved significantly at post-training and follow-up. Conclusions This preliminary study suggests stepping training at high aerobic intensity in variable contexts was tolerated by participants post-stroke, with significant locomotor improvements. Future trials should delineate the relative contributions of amount, intensity and variability of stepping training to maximize outcomes.

Background A comprehensive, reliable, and valid measurement system is needed to monitor changes in children with neurological conditions who experience lifelong functional limitations. Objective This article describes the development and psychometric properties of the pediatric version of the Quality of Life in Neurological Disorders (Neuro-QOL) measurement system. Methods The pediatric Neuro-QOL consists of generic and targeted measures. Literature review, focus groups, individual interviews, cognitive interviews of children and consensus meetings were used to identify and finalize relevant domains and item content. Testing was conducted on 1018 children aged 10 to 17 years drawn from the US general population for generic measures and 171 similarly aged children with muscular dystrophy or epilepsy for targeted measures. Dimensionality was evaluated using factor analytic methods. For unidimensional domains, item parameters were estimated using item response theory models. Measures with acceptable fit indices were calibrated as item banks; those without acceptable fit indices were treated as summary scales. Results Ten measures were developed: 8 generic or targeted banks (anxiety, depression, anger, interaction with peers, fatigue, pain, applied cognition, and stigma) and 2 generic scales (upper and lower extremity function). The banks reliably (r > 0.90) measured 63.2% to 100% of the children tested. Conclusions The pediatric Neuro-QOL is a comprehensive measurement system with acceptable psychometric properties that could be used in computerized adaptive testing. The next step is to validate these measures in various clinical populations.

The present data suggest that significant gains in selected nonlocomotor tasks can be achieved with high-intensity, variable stepping training. Improvements in nonpracticed tasks may minimize the need to practice multiple tasks within and across treatment sessions.

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