The Implementation of an Advanced Technology Clinical Practice Guideline to Achieve Walking Recovery for Acute Stroke Survivors Stratified by Prognostic Categories: A Case Series

Abstract

<h3>Research Objectives</h3> To observe how the implementation of a clinical practice guideline (CPG) for use of advanced rehabilitation technology affects walking recovery in acute stroke survivors stratified by the time to walking independently after stroke (TWIST) algorithm. <h3>Design</h3> Prospective Case Series. <h3>Setting</h3> Inpatient Rehabilitation. <h3>Participants</h3> 14 persons with acute stroke stratified by the TWIST algorithm into either a "good walking prognosis" (GWP) group (n=10) or a "poor walking prognosis" (PWP) group (n=4). <h3>Interventions</h3> The CPG for advanced rehabilitation technology was standard of care at our facility. <h3>Main Outcome Measures</h3> Functional Ambulation Category (FAC) and 10 Meter Walk Test (10 MWT) at initial evaluation, discharge, and at 3 months. Session steps were measured via accelerometers and technology use was tracked for each patient. <h3>Results</h3> At 3 month follow-up, 50% of the GWP group had achieved independent walking (FAC=4 and 10 MWT > .8 m/s) compared to 0% in the PWP group. However, 50% of patients in the PWP group did achieve FAC=3 at 3 months or greater after initial stroke. Average step counts between both groups were similar: GWP group=1469 steps, PWP group=1296. Advanced rehabilitation technology was utilized 92% of the time in the PWP group compared to 52% for the GWP group. Most notably, the PWP group utilized robotic exoskeletons 26.8% of therapy sessions compared to 2.9% in the GWP group. <h3>Conclusions</h3> Standardized use of advanced rehabilitation technology allowed for similar stepping repetitions between groups, although not equal walking outcomes. Interestingly, 50% of the PWP group ambulated without physical assistance, although this was not achieved until at least 3 months after stroke. A sparing of the motor pattern early in stroke recovery may have downstream affects for gait function. <h3>Author(s) Disclosures</h3> None.