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Implementation of Evidenced Based-Interventions during Inpatient Rehabilitation to Improve Mobility, Health and Participation

Posted By Jennifer Moore, PT, NCS, DHS & George Hornby, PT, PhD


Recovery of walking early following stroke, spinal cord injury (SCI) or acquired brain injury (ABI) is a primary goal of patients and their families, although return of independent locomotion depends largely on the magnitude and location of the injury. Most patients with stroke or ABI can recover some gait function (80-95%), but only 25% of those with SCI (50% motor incomplete) walk independently. For those who do recover, most walk at slow speeds and for limited distances. The extent of walking ability is often a primary predictor of discharge destination following rehabilitation, subsequent health status and community participation status. Studies suggest that even small decreases in gait speed from baseline are associated with significant increases in health care utilization.

Converging data over the past 2 decades indicate that substantial amounts of stepping practice can improve walking function in these patient populations. Repeated stepping training is often performed at moderate to high aerobic capacities with data suggesting greater improvements than conventional physical therapy (PT) interventions. However, PT strategies utilized during inpatient rehabilitation unfortunately provided very limited walking practice. Reasons that patients do not achieve greater stepping practice include the magnitude of patient’s impairments, lack of adequate equipment, and therapists’ adherence to traditional interventions. Few studies have attempted to implement focused stepping interventions during inpatient rehabilitation to examine its feasibility and effectiveness on long-term outcomes.

The objective of this project is to evaluate the impact of Focused, Repeated Stepping Training (FIRST) applied during clinical inpatient rehabilitation on short- and long-term mobility outcomes, health, and community participation in adults with acute neurological injury. Our central hypotheses are that the FIRST program provided to patients early following acute-onset neurological injury will augment recovery of short and long-term mobility, health and community participation. Using a two-step implementation process with our partnering rehabilitation hospital (Mary Free Bed Rehabilitation Hospital), we will evaluate the contemporaneous (Years 1-2) and historical (Years 3-5) effectiveness of the FIRST program as compared to conventional strategies. 

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