R2. Improving Delivery of Intensive Gait Training in the Clinical setting to Augment Community Ambulation

Contact Information:

George Hornby, Ph.D, P.T.

g-hornby@northwestern.edu

Abstract

Up to 80% of individuals who suffer a stroke recover the ability to ambulate following discharge from inpatient rehabilitation, although a large proportion of these patients walk at slower speeds and continue to have difficulty walking in the community. Limited community ambulation reduces the probability of successful return to gainful employment and is associated with decreased participation in community activities. Accordingly, independent community ambulation is a primary goal for patients post-stroke, although current data indicate that stepping practice delivered in the outpatient rehabilitation setting is extremely limited. Physical rehabilitation interventions such as task-specific gait training (i.e., locomotor training [LT]) performed on a treadmill have consistently demonstrated improvements in walking ability in individuals post-stroke in large part because of the substantial amount of stepping practice. Unfortunately, clinical implementation of LT remains limited secondary to the physical demands required of therapists. Further, recently developed robotic locomotor devices are costly and may be less effective than therapist-assisted training. A solution to providing an economical and effective means to facilitate LT in the clinical setting to increase stepping practice has yet to be achieved.

The primary objective of this project is to increase the dosage of intensive stepping practice in the rehabilitation setting by using simple, cost-effective devices. We have constructed and tested a spring-loaded (passive) device, developed previously to assess the metabolic and muscular costs of walking in intact human subjects, to facilitate treadmill stepping in individuals with gait dysfunction following stroke (See Figure Below). By providing passive, mechanical assistance for limb swing and propulsion, our preliminary data suggest improvements in the ability of subjects with hemiparesis post-stroke to increase peak treadmill walking speed without therapist assistance. Use of these devices in the clinical setting may facilitate the application of task-specific LT, thereby increasing the dosage of step training, and ultimately enhance walking-related outcomes in individuals post-stroke. The selection of the appropriate amount and location of forces to optimally facilitate stepping using passive assistance is still uncertain, however. Further, whether providing such training results in outcomes superior to those achieved during conventional rehabilitation is unclear.

Geppetto Gait Device