Locomotor Rehabilitation of Individuals With Chronic Stroke: Difference Between Responders and Nonresponders

Abstract

ObjectivesTo identify the clinical measures associated with improved walking speed after locomotor rehabilitation in individuals poststroke and how those who respond with clinically meaningful changes in walking speed differ from those with smaller speed increases. DesignA single group pre-post intervention study. Participants were stratified on the basis of a walking speed change of greater than (responders) or less than (nonresponders) .16m/s. Paired sample t tests were run to assess changes in each group, and correlations were run between the change in each variable and change in walking speed. SettingOutpatient interdisciplinary rehabilitation research center. ParticipantsHemiparetic subjects (N=27) (17 left hemiparesis; 19 men; age: 58.74±12.97y; 22.70±16.38mo poststroke). InterventionA 12-week locomotor intervention incorporating training on a treadmill with body weight support and manual trainers accompanied by training overground walking. Main Outcome MeasuresMeasures of motor control, balance, functional walking ability, and endurance were collected at pre- and postintervention assessments. ResultsEighteen responders and 9 nonresponders differed by age (responders=63.6y, nonresponders=49.0y, P=.001) and the lower extremity Fugl-Meyer Assessment score (responders=24.7, nonresponders=19.9, P=.003). Responders demonstrated an average improvement of .27m/s in walking speed as well as significant gains in all variables except daily step activity and paretic step ratio. Conversely, nonresponders demonstrated statistically significant improvements only in walking speed and endurance. However, the walking speed increase of .10m/s was not clinically meaningful. Change in walking speed was negatively correlated with changes in motor control in the nonresponder group, implying that walking speed gains may have been accomplished via compensatory mechanisms. ConclusionsThis study is a step toward discerning the underlying factors contributing to improved walking performance.