Approximately 70% of patients post-stroke experience persistent lower extremity deficits in strength and coordination; these impairments contribute to limitations in the ability to perform many functional activities in the home and community, including walking, rising from a chair, and maintaining balance. These activity limitations severely restrict mobility in the home and community, which in turn leads to secondary health complications and decreased participation. Over the past 2 decades, converging data from animal models and individuals with neurological injury suggests that the amount and specificity of motor practice are important training parameters that facilitate improvements in walking performance. Providing substantial stepping practice on a treadmill or overground can improve gait speed and endurance as compared to traditional approaches. Such training appears to strengthen synaptic circuits underlying the practiced behaviors, with more recent data suggesting that the amount of stepping practice is associated with improved locomotor performance.
The overall goal of this project is to evaluate the individual and paired contributions of intensity and variability of stepping training on lower extremity function, health and community participation in patients with chronic hemiparesis post-stroke. We will use a randomized controlled clinical trial design to investigate the independent and combined (paired) contributions of intensity and variability of stepping training on locomotor function, with secondary measures of health and community mobility.
We also will evaluate the independent and combined effects of intensity and variability of stepping training on non-walking lower extremity tasks and we will evaluate the cost effectiveness of providing these interventions. Our central hypothesis is that results of this study will provide a theoretical foundation for implementation of physical therapy interventions which can facilitate short-term gains in locomotor function, and contribute to long-term improvements in health, function and participation through increased community mobility.
This research is supported under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research, NIDILRR: [Project Number: 90RT5027 (formerly H133B140012)]