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Feasibility of Intensive Mobility Training to Improve Gait, Balance, and Mobility in Persons With Chronic Neurological Conditions: A Case Series

Fritz, Stacy MSPT, PhD; Merlo-Rains, Angela DPT, MS; Rivers, Erin DPT; Brandenburg, Barbara DPT; Sweet, Janea DPT; Donley, Jonathan PT, DPT, MEd, ATC; Mathews, Harvey PT, DPT; deBode, Stella PhD; McClenaghan, Bruce A. PT, PED

Journal of Neurologic Physical Therapy: September 2011 - Volume 35 - Issue 3 - p 141–147
doi: 10.1097/NPT.0b013e31822a2a09
Case Studies

Background and Purpose: Intensive mobility training (IMT) is a rehabilitative approach aimed at improving gait, balance, and mobility through the incorporation of task-specific, massed practice. The purpose of this case series was to examine the feasibility and benefits of the IMT protocol across a sample of 4 individuals with diverse chronic neurological diagnoses, including incomplete spinal cord injury, Parkinson's disease, stroke, and cerebral hemispherectomy.

Methods: The 4 participants enrolled in the IMT protocol and followed an intensive treatment schedule of 3 h/d sessions for 10 consecutive weekdays totaling 30 hours. Each session allocated 1 hour each to (1) body weight–supported treadmill-based locomotor training, (2) balance interventions, and (3) activities to improve coordination, strength, and range of motion. Interventions emphasized repetitive, task-specific training of lower-extremity movements in a massed practice schedule. Pain, fatigue, and time in activity were used to assess feasibility of the treatment. Temporal-spatial gait parameters, Berg Balance Scale, Dynamic Gait Index, Timed Up and Go test, and 6-Minute Walk test were used to assess changes in performance.

Results: Participants were able to complete an average of 144 of 180 minutes of activity per day for 10 days. Participants demonstrated modest improvements after the intervention on at least one outcome measure for each target area of gait, mobility, and balance. Some improvements were maintained for 1 to 6 months after participation.

Discussion: Despite differences in diagnosis among these participants with chronic neurological disorders, on average they were able to complete 80% of an intensive treatment schedule of 3 hours/day for 10 days with no adverse effects. It appears that some gains made during participation are maintained for a period of time after the end of training. IMT is a feasible intervention incorporating an intensive training approach to improve gait, balance, and mobility; however, a randomized trial is needed to further investigate the effects of the intervention.

Exercise Science (S.F., A.M-R., E.R., B.B., J.S., H.M., B.A.M.), Physical Therapy Program, University of South Carolina, Columbia, South Carolina; Palmetto Health (J.D.), Geriatric Specialty Clinics, South Carolina; and University Medical Center (S.deB.), Utrecht, Children Neuropsychology, Utrecht, the Netherlands.

Correspondence: Stacy Fritz, MSPT, PhD, University of South Carolina, Columbia, SC (

Funded by the South Carolina Spinal Cord Injury Research Fund, the American Heart Association (Scientist Development Grant), and the National Institutes of Health (grant 5R21HD050707).

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© 2011 Neurology Section, APTA