Article

Converging evidence suggests that the amount of stepping practice is
an important training parameter that influences locomotor recovery poststroke.
More recent data suggest that stepping intensity and variability are also
important, although such strategies are often discouraged early poststroke.
OBJECTIVE: The present study examined the efficacy of high-intensity, variable
stepping training on walking and nonwalking outcomes in individuals 1 to 6 months
poststroke as compared with conventional interventions. Methods Individuals with
unilateral stroke (mean duration = 101 days) were randomized to receive </=40,
1-hour experimental or control training sessions over 10 weeks. Experimental
interventions consisted only of stepping practice at high cardiovascular
intensity (70%-80% heart rate reserve) in variable contexts (tasks or
environments). Control interventions were determined by clinical physical
therapists and supplemented using standardized conventional strategies. Blinded
assessments were obtained at baseline, midtraining, and posttraining with a
2-month follow-up. Results A total of 32 individuals (15 experimental) received
different training paradigms that varied in the amount, intensity, and types of
tasks performed. Primary outcomes of walking speed (experimental, 0.27 +/- 0.22
m/s vs control, 0.09 +/- 0.09 m/s) and distances (119 +/- 113 m vs 30 +/- 32 m)
were different between groups, with stepping amount and intensity related to
these differences. Gains in temporal gait symmetry and self-reported
participation scores were greater following experimental training, without
differences in balance or sit-to-stand performance. Conclusion Variable intensive
stepping training resulted in greater improvements in walking ability than
conventional interventions early poststroke. Future studies should evaluate the
relative contributions of these training parameters.
CI - (c) The Author(s) 2015.

Langue : ANGLAIS