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Time Course of Functional and Biomechanical Improvements During a Gait Training Intervention in Persons With Chronic Stroke

Reisman, Darcy PT, PhD; Kesar, Trisha PT, PhD; Perumal, Ramu PhD; Roos, Margaret DPT, PhD; Rudolph, Katherine PT, PhD; Higginson, Jill PhD; Helm, Erin BS; Binder-Macleod, Stuart PT, PhD

Journal of Neurologic Physical Therapy: December 2013 - Volume 37 - Issue 4 - p 159–165
doi: 10.1097/NPT.0000000000000020
Research Articles
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Background and Purpose: In rehabilitation, examining how variables change over time can help define the minimal number of training sessions required to produce a desired change. The purpose of this study was to identify the time course of changes in gait biomechanics and walking function in persons with chronic stroke.

Methods: Thirteen persons who were more than 6 months poststroke participated in 12 weeks of fast treadmill training combined with plantar- and dorsiflexor muscle functional electrical stimulation (FastFES). All participants completed testing before the start of intervention, after 4, 8, and 12 weeks of FastFES locomotor training.

Results: Peak limb paretic propulsion, paretic limb propulsive integral, peak paretic limb knee flexion (P < 0.05 for all), and peak paretic trailing limb angle (P < 0.01) improved from pretraining to 4 weeks but not between 4 and 12 weeks. Self-selected walking speed and 6-minute walk test distance improved from pretraining to 4 weeks and from 4 to 12 weeks (P < 0.01 and P < 0.05, respectively for both). Timed Up & Go test time did not improve between pretraining and 4 weeks, but improved by 12 weeks (P = 0.24 and P < 0.01, respectively).

Discussion and Conclusions: The results demonstrate that walking function improves with a different time course compared with gait biomechanics in response to a locomotor training intervention in persons with chronic stroke. Thirty-six training sessions were necessary to achieve an increase in walking speed that exceeded the minimally clinically important difference. These findings should be considered when designing locomotor training interventions after stroke.

Video Abstract available (see Video, Supplemental Digital Content 1, for more insights from the authors.

Supplemental Digital Content is Available in the Text.

Biomechanics and Movement Science Program, (D.S.R., M.A.R., K.S.R., J.H., E.H., S.B.M.), Department of Physical Therapy, (D.S.R., R.P., M.A.R., K.S.R., S.B.M.), Department of Mechanical Engineering (J.H.), University of Delaware, Newark, Delaware; and Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University, Atlanta, Georgia (T.M.K.).

Correspondence: Darcy Reisman, PT, PhD, University of Delaware, 301 McKinly Laboratory, Newark, DE 19716 (

This study was supported by the National Institute of Nursing Research grant R01NR010786; the National Institute of Health Shared Instrumentation grant S10RR022396; and the National Institute of Child Health and Human Development grant K01HD050582.

Results were presented in part at the Combined Sections Meeting of the American Physical Therapy Association in February 2011.

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (

© 2013 Neurology Section, APTA