Effects of Dynamic Stepping Training on Nonlocomotor Tasks in Individuals Poststroke

Abstract

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.

Feasibility of Focused Stepping Practice During Inpatient Rehabilitation Poststroke and Potential Contributions to Mobility Outcomes

“…14,38 Such improvements may have resulted from the substantial amounts of stepping practice provided, where performance of unpracticed mobility tasks may improve with practice of higher-level skills, as suggested previously. 39,40 The primary limitations of this investigation include the lack of a control group and long-term follow-up to evaluate the comparative efficacy following discharge. Given these limitations, the primary objective of the present study was to apply training strategies established in previous trials on patients early poststroke within the constraints of inpatient rehabilitation and without stringent inclusion criteria.…”

Alterations in Aerobic Exercise Performance and Gait Economy Following High-Intensity Dynamic Stepping Training in Persons With Subacute Stroke

“…Changes in locomotor and metabolic function in individuals 1–6 months post stroke were assessed following an 8–10 week, experimental, high-intensity stepping training paradigm 30,31 or conventional interventions. 32,33 Data from both an assessor-blinded RCT comparing the two interventions, 29 and a non-blinded, pilot experimental study 30 that used nearly identical inclusion criteria are incorporated in this analysis.…”

“…The present investigation represents a secondary analysis from two separate studies 29–31 detailing the effects of a 10-week (≤ 40 sessions) high-intensity stepping training protocol on metabolic measures in individuals with subacute stroke. The published experimental interventions focused on providing practice of variable stepping tasks at high aerobic intensities (70–80% HR reserve).…”

“…Gains in locomotor and non-locomotor measures have been described previously from both a randomized controlled trial (RCT) comparing this training strategy with conventional therapy, 29 and in a pilot experimental study that served as the basis for the RCT. 30,31 In the present analysis, we were specifically interested in changes in aerobic performance during graded treadmill testing and overground walking in individuals with subacute stroke at baseline (BSL), following training (POST) and at a 2–3 month follow-up (F/U) assessment. We hypothesized that variable stepping training performed at high aerobic intensities would lead to substantial gains in peak metabolic capacity and economy during stepping that would be associated with walking performance.…”

Effects of Training Intensity on Locomotor Performance in Individuals With Chronic Spinal Cord Injury: A Randomized Crossover Study

“…In patients with other acute-onset neurological injuries (i.e., patients post-stroke) , LT performed at moderate to high intensities (i.e., up to 85% of maximum HR) has been shown to improve walking function as compared to lower-intensity interventions, 32,33 even when the amount of practice is controlled 17,18 . While gains in cardiopulmonary capacity have been observed with such training 26 , improvements in neuromuscular impairments 34 and walking function 35,36 have also been demonstrated.…”