Importance of Specificity, Amount, and Intensity of Locomotor Training to Improve Ambulatory Function in Patients Poststroke

Abstract

The majority of individuals poststroke recover the ability to walk overground, although residual impairments contribute to reduced walking speed, spatiotemporal asymmetries, inefficient gait, and limited walking activity in the home and community. A substantial number of studies have investigated the effects of various interventions on locomotor function in individuals poststroke; these studies vary widely in types of tasks practiced, the amount of practiced activities, and the intensity or workload during the intervention. In contrast, basic and applied studies have identified specific parameters of training that could be applied towards treatment of patients poststroke. More directly, the specificity, amount, and intensity of walking practice are thought to be critical variables of rehabilitation interventions that can facilitate plasticity of neuromuscular and cardiopulmonary systems and result in improved locomotor function. In the present commentary, we delineate the evidence and physiological rationale for providing large amounts of high-intensity locomotor training to improve ambulatory function in individuals poststroke. Additional evidence is presented to indicate that improvements in non-walking tasks, such as static balance and performance of transfers, may also occur following locomotor training. We further evaluate previous and more recent studies in the context of these parameters and provide suggestions for providing locomotor training for patients with stroke in the clinical setting.

Reliability and validity of the inertial sensor-based Timed “Up and Go” test in individuals affected by stroke

“…Moreover, an increase in stance phase duration and left-right asymmetry seems to be a characteristic feature of the gait of patients with stroke [1][2][3]9]. Accordingly, in this study those five iTUG metrics were highlighted by a separate reliability analysis for which the stroke group was separated from the nondisabled elderly controls ( Table 4).…”

“…Several studies described the typical "hemiplegic gait" poststroke with a decreased walking velocity, cadence, and stride length [1][2][3]5,8]. Moreover, an increase in stance phase duration and left-right asymmetry seems to be a characteristic feature of the gait of patients with stroke [1][2][3]9].…”

“…After a stroke, many individuals experience hemiparesis, which often leads to an impaired walking pattern with altered gait characteristics [1][2][3][4][5][6][7]. Specifically, hemiplegic gait is typically associated with a reduced gait speed [1][2][3]5,8], cadence [2,5,8], and stride length [2,8] and an increased left-right asymmetry during walking [1,3,9] when compared with nondisabled, age-matched controls.…”

“…Specifically, hemiplegic gait is typically associated with a reduced gait speed [1][2][3]5,8], cadence [2,5,8], and stride length [2,8] and an increased left-right asymmetry during walking [1,3,9] when compared with nondisabled, age-matched controls. Furthermore, it is often characterized by an increased stance phase duration [2].…”

How to determine the initial treadmill speed for the aerobic training of chronic hemiparetics?

“…After completing their rehabilitation, 14% of individuals manage a full recovery of physical function, 60-70% are able to walk independently, 25-50% of them need some help with their activities of daily living, and only 7% are able to walk around in the community. [4][5][6][7] Hemiparetics present an independent gait after completing their rehabilitation, however this gait has defects such as reduced speed, reduced distance, asymmetrical movements, and postural instability, [6][7][8] so in this context their need to continue participation in motor training is evident in order to maintain or improve their physical conditioning and functioning and reduce sedentarism and its consequences.…”