Improving Outcomes After Stroke By LEAPS (Locomotor Experience Applied Post-Stroke) and Bounds

Abstract

Stroke is a chronic, lasting condition. Over 795 000 persons have a new stroke each year.1 The vast majority survive, with those in the seventh decade living an average of 7 years thereafter,1 most with some form of loss of function and limitation of activity.2 Increasing evidence suggests that these deficits are not fixed, but instead that the brain is plastic, that a number of different therapies have the potential to improve brain structure and function once the acute stroke period passes and stroke injury is fixed, and that this plasticity can reduce poststroke disability. Brain plasticity is facilitated by repeated practice. This is true during development, during learning, in times of health, and after brain injury such as stroke. This principle is the foundation of poststroke treatments applied across behavioral modalities such as neglect, aphasia, or weakness. Evidence suggests that the responsiveness of the brain to such intervention declines with time poststroke.3 However, many patients long past stroke can nonetheless benefit from repeated practice such as with an activity-based regimen that is initiated even months after stroke onset. For example, the Extremity Constraint Induced Therapy Evaluation (EXCITE) trial was a landmark study that found that constraint-induced therapy improved upper extremity motor function when initiated 3 to 9 months after stroke onset.4 It is in this context that the Locomotor Experience Applied Post-Stroke (LEAPS) trial was initiated. The LEAPS trial focused on improving gait after stroke by comparing 2 different activity-based therapies and 2 different time points. Gait is a priority because it is commonly affected by stroke, gait improvements after stroke are linked to better quality of life,5 and hemiplegic patients rank recovery of gait as their top priority.6 Importantly, gait velocity is linked to level of social participation.7 A typical …