Motor learning during poststroke gait rehabilitation: a case study.

Abstract

To develop more effective gait rehabilitation strategies, it is important to understand the time course of motor learning that underlies improvements achieved with gait training. The purpose of this case study was to evaluate motor learning through the measurement of within-session and across-session changes in gait biomechanics during the first and sixth weeks of a 6-week clinical gait training program. A 47-year-old man with poststroke left hemiparesis participated in the study (15.5 months poststroke, lower extremity Fugl-Meyer score of 12). The subject participated in 6 weeks of training with 3 sessions per week, comprising fast treadmill walking and functional electrical stimulation to plantar and dorsiflexors. In one training session during the first and sixth weeks, paretic propulsion and swing phase knee flexion were measured during a pretest (before the training session), posttest (after the training session), and retention test (48 hours after training). After 6 week of training, the subject's gait speed increased from 0.38 to 0.57 m/s; there was a 55.4% improvement in paretic propulsion and 25% increase in swing phase knee flexion. Examination of change scores revealed greater within-session gains and greater retention during the first versus sixth weeks of gait training for both paretic propulsion and knee flexion. We demonstrate the feasibility and advantage of using within- and across-session changes for evaluating motor learning during clinical gait rehabilitation. An understanding of the time course of motor learning that underlies gait training can guide the development of novel strategies and dosing regimens to increase the efficacy of each session of gait rehabilitation. (See Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A72, for more insights from the authors.).