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Advancing Measurement of Locomotor Rehabilitation Outcomes to Optimize Interventions and Differentiate Between Recovery Versus Compensation

Bowden, Mark G. PT, PhD; Behrman, Andrea L. PT, PhD; Woodbury, Michelle PhD, OTR/L; Gregory, Chris M. PT, PhD; Velozo, Craig A. PhD, OTR/L; Kautz, Steven A. PhD

Journal of Neurologic Physical Therapy: March 2012 - Volume 36 - Issue 1 - p 38–44
doi: 10.1097/NPT.0b013e3182472cf6
Research Articles: Special Interest

Progress in locomotor rehabilitation has created an increasing need to understand the factors that contribute to motor behavior, to determine whether these factors are modifiable, and if so, to determine how best to modify them in a way that promotes improved function. Currently available clinical measures do not have the capacity to distinguish between neuromotor recovery and compensation for impaired underlying body structure/functions. This Special Interest article examines the state of outcomes measurement in physical therapy in regard to locomotor rehabilitation, and suggests approaches that may improve assessment of recovery and clinical decision-making capabilities. We examine historical approaches to measurement of locomotor rehabilitation outcomes, including rating scales, timed movement tasks, and laboratory-based outcome measures, and we discuss the emerging use of portable technology to assess walking in a free-living environment. The ability to accurately measure outcomes of rehabilitation, both in and away from the clinical/laboratory setting, allows assessment of skill acquisition, retention, and long-term carryover in a variety of environments. Accurate measurement allows behavioral changes to be observed, and assessments to be made, regarding an individual's ability to adapt during interventions and to incorporate new skills into real-world behaviors. The result of such an approach to assessment may be that interventions truly translate from clinical/laboratory to real-world environments. Future locomotor measurement tools must be based on a theoretical framework that can guide their use to accurately quantify treatment effects and provide a basis upon which to develop and refine therapeutic interventions.

Ralph H. Johnson VA Medical Center, Charleston, South Carolina, and Department of Health Sciences and Research, Medical University of South Carolina, Charleston (M.G.B., M.W., C.M.G., S.A.K.); and Departments of Physical Therapy (A.L.B.) and Occupational Therapy (C.A.V.), University of Florida, Gainesville, and NF/SG Veterans Health System, Gainesville.

Correspondence: Mark G. Bowden, PT, PhD, 77 President St, MSC 700, Charleston, SC 29425 (bowdenm@musc.edu).

This material is the result of work supported with resources and the use of facilities at the Ralph H. Johnson VA Medical Center in Charleston, South Carolina, and the NF/SG Veterans Health System in Gainesville, Florida. The contents do not represent the views of the Department of Veterans Affairs or the US government.

Funding: VA Career Development Award (Phase I): B7177; K12 HD055929 National Institutes of Health – National Center for Medical and Rehabilitation Research (NICHD) and National Institute for Neurological Disorders & Stroke; VA Merit Review grant B3983-R; and VA Center of Excellence grant # F2182C (Brain Rehabilitation Research Center).

The authors declare no conflict of interest

© 2012 Neurology Section, APTA