Guest Editorial: Gait coordination protocol for recovery of coordinated gait, function, and quality of life following stroke

SNS activity measured by skin conductance is a feasible approach for quantifying task-related differences in the perceived challenge of walking tasks in people poststroke. Furthermore, reduced SNS activity during walking following a rehabilitation intervention suggests a beneficial reduction in the physiological stress response evoked by complex walking tasks.Video Abstract available for more insights from the authors (See Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A234).

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“…The intervention protocol used in this study has been successfully implemented in prior studies. 28–30…”

Section: Study Assessmentsmentioning

confidence: 99%

Mobility Function and Recovery After Stroke: Preliminary Insights From Sympathetic Nervous System Activity

Chatterjee

Daly

Porges

et al. 2018

Journal of Neurologic Physical Therapy

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“…The methods for coordination training and gait coordination training and neurorehabilitation treatment progression were conducted according to prior published work [ 10 , 19 , 20 ], and based on the phenomenon of brain plasticity and motor learning principles, including the following: motor task-specific practice (practice as close-to-normal movement as possible [ 23 , 24 , 25 , 26 ] with continual progression toward normal); high repetition of the desired movement pattern [ 27 , 28 , 29 ]; focused attention [ 30 ], training specificity [ 28 , 31 , 32 , 33 ], and awareness and feedback [ 34 ].…”

Section: Methodsmentioning

confidence: 99%

“… Number of repetitions of the motor task that could be performed with only a “beat” between repetitions before the motor task was performed in an abnormal fashion. ([ 20 ], page xix). …”

Section: Methodsmentioning

confidence: 99%

Innovative Long-Dose Neurorehabilitation for Balance and Mobility in Chronic Stroke: A Preliminary Case Series

et al. 2020

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(1) Objective: The objective was two-fold: (a) test a protocol of combined interventions; (b) administer this combined protocol within the framework of a six-month, intensive, long-duration program. The array of interventions was designed to target the treatment-resistant impairments underlying persistent mobility dysfunction: weakness, balance deficit, limb movement dyscoordination, and gait dyscoordination. (2) Methods: A convenience sample of eight chronic stroke survivors (>4 months post stroke) was enrolled. Treatment was 5 days/week, 1–2.5 h/day for 6 months, as follows: strengthening exercise, balance training, limb/gait coordination training, and aerobic exercise. Outcome measures: Berg Balance Scale (BBS), Fugl-Meyer Lower Limb Coordination (FM), gait speed, 6 Minute Walk Test (6MWT), Timed up and Go (TUG), Functional Independence Measure (FIM), Craig Handicap Assessment Rating Tool (CHART), and personal milestones. Pre-/post-treatment comparisons were conducted using the Permutation Test, suitable for ordinal measures and small sample size. (3) Results: For the group, there was a statistically (p ≤ 0.04) significant improvement in balance, limb movement coordination (FM), gait speed, functional mobility (TUG), and functional activities (FIM). There were measurable differences (minimum detectible change: MDC) in BBS, FM, gait speed, 6MWT, and TUG. There were clinically significant milestones achieved for selected subjects according to clinical benchmarks for the BBS, 6MWT, gait speed, and TUG, as well as achievement of personal milestones of life role participation. Effect sizes (Cohen’s D) ranged from 0.5 to 1.0 (with the exception of the (6MWT)). After six months of treatment, the above array of gains were beyond that reported by other published studies of chronic stroke survivor interventions. Personal milestones included: walking to mailbox, gardening/yardwork, walking a distance to neighbors, return to driving, membership at a fitness center, vacation trip to the beach, swimming at local pool, returning to work, housework, cooking meals. (4) Conclusions: Stroke survivors with mobility dysfunction were able to participate in the long-duration, intensive program, with the intervention array targeted to address impairments underlying mobility dysfunction. There were either clinically or statistically significant improvements in an array of measures of impairment, functional mobility, and personal milestone achievements.

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“…Her neurorehabilitation program included a comprehensive mobility and fitness training program, during which she received 1.5 -2 hours of physical therapy per day in an outpatient clinic, 5 days/ week for 6 months, followed by an additional 4 months of treatment 3 days/week. The neurorehabilitation program included the following: moderate intensity aerobic training on a recumbent cycle for 45 min twice weekly, using methods established by Quaney, et al [2]; strength and gait coordination training 3-5 days/week per established protocols [3,4]. Strength training included 1-3 days/week at 50-80% 1RM, 6-12 reps per set, 1-4 sets per muscle group.…”

Section: Methodsmentioning

confidence: 99%

“…Strength training included 1-3 days/week at 50-80% 1RM, 6-12 reps per set, 1-4 sets per muscle group. Balance training was 2-3 days/ week, including a combination of Yang-style Tai Chi movements and conventional static and dynamic balance training on varying surfaces; and voluntary muscle activation re-training was integrated with coordination exercises and surface functional electrical stimulation [4].…”

Section: Methodsmentioning

confidence: 99%

Feasibility and benefit of long-dose stroke neurorehabilitation which produced and maintained balance and mobility gains throughout cancer surgery and radiation treatment

Boissoneault¹,

Khanna²,

Daly³

2018

Vascul Dis Ther

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Purpose: This case study provides quantitative evidence of the feasibility and benefit of a long-dose, 10-month neurorehabilitation program for a chronic stroke survivor who, in the midst of the neurorehabilitation program, underwent surgery and radiation treatment for breast cancer. Methods:The patient was age 60 years, and 6 years post-stroke (left middle cerebral artery stroke), exhibiting impairments in balance, strength, and gait coordination, as well as deficits in functional mobility, and compromised quality of life. Her comprehensive mobility/fitness neurorehabilitation program included aerobics, strength and coordination training, and balance and gait coordination training. Treatment was 1.5 -2 hours per day, 5 days/week for 6 months, followed by an additional 4 months of treatment 3 days/week. Outcome measures were acquired at entry into the neurorehabilitation program, and at months 2, 4, 6, 8 and 10. Measures included the following: modified Ashworth (mASH, spasticity); Fugl-Meyer (FM; isolated limb joint coordination); 6-minute walk test (6MWT; walking endurance); gait speed; Berg Balance Scale (BBS; static and dynamic balance); Timed Up and Go (TUG; mobility); 10 Meter Walk Test (10MWT; short distance, self-selected and fast walking speed); Functional Gait Assessment (FGA; dynamic balance and postural stability during gait); Functional Independence Measure (FIM; assessment of functional status and disability); Craig Handicap Assessment and Reporting Technique (CHART; quality of life assessment of how patients with disabilities function in the community and at home); 36-Item Short Form Survey (SF36; quality of life measure); and the Stroke Impact Scale (SIS; stroke-specific quality of life measure). Fatigue level was queried during and following radiation therapy.Results: From baseline through month 4, the patient demonstrated improvements in most outcome measures. For example, she improved from 3 minutes of cycling endurance to 45 minutes, and balance improvement reached the threshold for functional independence. At month 5, she was diagnosed with breast cancer and underwent a partial mastectomy. She underwent radiation treatment, which concluded in month 7. Prior, during, and after the cancer treatment, she continued participation in the neurorehabilitation program.Following the partial mastectomy, she exhibited continued improvement in BBS, 10MWT-normal speed, FGA, CHART, SF-36, and SIS. Notably, the TUG continued to improve significantly by 4.73sec. She showed some decline in values for the 6MWT, gait speed, and 10MWT-fast walking speed.Four weeks following the end of the course of radiation therapy, most measures showed a small decline. But in contrast, by 12 weeks after the end of radiation (which coincided with 10 months of participation in the neurorehabilitation program), the following measures showed a revival in improvement: Fugl-Myer (limb coordination); 6MWT (walking endurance); gait speed; BBS (balance); FIM (functional tasks); subdomains of the CHART quality of life measure (p...

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Guest Editorial: Gait coordination protocol for recovery of coordinated gait, function, and quality of life following stroke

Abstract: The Gait Coordination Protocol (GCP) was successful in producing clinically and statistically significant gains in impairment, function, and life-role participation for those in the chronic phase after stroke who had exhibited persistent moderate to severe gait deficits

Cited by 10 publications

References 24 publications

Mobility Function and Recovery After Stroke: Preliminary Insights From Sympathetic Nervous System Activity

Mobility Function and Recovery After Stroke: Preliminary Insights From Sympathetic Nervous System Activity

Innovative Long-Dose Neurorehabilitation for Balance and Mobility in Chronic Stroke: A Preliminary Case Series

Feasibility and benefit of long-dose stroke neurorehabilitation which produced and maintained balance and mobility gains throughout cancer surgery and radiation treatment

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