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Effects of Dynamic Stepping Training on Nonlocomotor Tasks in Individuals Poststroke

Don D. Straube, Carey L. Holleran, Catherine R. Kinnaird, Abigail L. Leddy, Patrick W. Hennessy, T. George Hornby
DOI: 10.2522/ptj.20130544 Published 1 July 2014
Don D. Straube
D.D. Straube, PT, PhD, NCS, Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, Illinois.
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Carey L. Holleran
C.L. Holleran, PT, MPT, NCS, Sensory Motor Performance Program, Rehabilitation Institute of Chicago.
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Catherine R. Kinnaird
C.R. Kinnaird, MS, Sensory Motor Performance Program, Rehabilitation Institute of Chicago.
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Abigail L. Leddy
A.L. Leddy, PT, DPT, MSCI, Sensory Motor Performance Program, Rehabilitation Institute of Chicago.
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Patrick W. Hennessy
P.W. Hennessy, PT, DPT, NCS, Sensory Motor Performance Program, Rehabilitation Institute of Chicago.
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T. George Hornby
T.G. Hornby, PT, PhD, Sensory Motor Performance Program, Rehabilitation Institute of Chicago; Department of Physical Therapy and Kinesiology & Nutrition, University of Illinois at Chicago; and Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. Mailing address: Department of Physical Therapy, University of Illinois, 1919 W Taylor St, Chicago, IL 60612 (USA).
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Abstract

Background During the physical rehabilitation of individuals poststroke, therapists are challenged to provide sufficient amounts of task-specific practice in order to maximize outcomes of multiple functional skills within limited visits. Basic and applied studies have suggested that training of one motor task may affect performance of biomechanically separate tasks that utilize overlapping neural circuits. However, few studies have explicitly investigated the impact of training one functional task on separate, nonpracticed tasks.

Objective The purpose of this preliminary study was to investigate the potential gains in specific nonlocomotor assessments in individuals poststroke following only stepping training of variable, challenging tasks at high aerobic intensities.

Methods Individuals with locomotor deficits following subacute and chronic stroke (n=22) completed a locomotor training paradigm using a repeated-measures design. Practice of multiple stepping tasks was provided in variable environments or contexts at high aerobic intensities for ≥40 sessions over 10 weeks. The primary outcome was timed Five-Times Sit-to-Stand Test (5XSTS) performance, with secondary measures of sit-to-stand kinematics and kinetics, clinical assessment of balance, and isometric lower limb strength.

Results Participants improved their timed 5XSTS performance following stepping training, with changes in selected biomechanical measures. Statistical and clinically meaningful improvements in balance were observed, with more modest changes in paretic leg strength.

Conclusions The present data suggest that significant gains in selected nonlocomotor tasks can be achieved with high-intensity, variable stepping training. Improvements in nonpracticed tasks may minimize the need to practice multiple tasks within and across treatment sessions.

Footnotes

  • Dr Straube, Ms Kinnaird, and Dr Hornby provided concept/idea/research design. Dr Straube, Ms Holleran, Dr Leddy, Dr Hennessy, and Dr Hornby provided writing. Dr Straube, Ms Holleran, Ms Kinnaird, Dr Leddy, and Dr Hornby provided data collection and analysis. Ms Kinnaird and Dr Hornby provided project management. Dr Hornby provided fund procurement, facilities/equipment, and institutional liaisons. Dr Leddy and Dr Hornby provided study participants. Ms Kinnaird provided clerical support. Dr Straube, Ms Kinnaird, and Dr Hennessy provided consultation (including review of manuscript before submission).

  • The project was approved by the Northwestern University Institutional Review Board.

  • Portions of this research were presented at the Combined Sections Meeting of the American Physical Therapy Association; February 8–11, 2012; Chicago, Illinois.

  • Funding for the study was provided by National Institute on Disability and Rehabilitation Research grant H133B031127.

  • Received November 12, 2013.
  • Accepted March 7, 2014.
  • © 2014 American Physical Therapy Association
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Vol 94 Issue 7 Table of Contents
Physical Therapy: 94 (7)

Issue highlights

  • Dosing in Children With Brain Injury or Cerebral Palsy
  • Effects of Stepping Training on Nonlocomotor Skills
  • Physical Therapists' Clinical Knowledge of Multidisciplinary Low Back Pain Treatment Guidelines
  • Lower Extremity Muscle Strength and All-Cause Mortality in Japanese Patients Undergoing Dialysis
  • Muscle Weakness Poststroke
  • Clinical Identifiers for Early-Stage Primary/Idiopathic Adhesive Capsulitis
  • Hierarchical Properties of the Fugl-Meyer Assessment Scale in Acute and Chronic Stroke
  • Lower-Extremity Range-of-Motion Measurements in Children With Cerebral Palsy
  • Modified Dynamic Gait Index
  • A Simple Discharge Planning Tool Following Hospital Admission for an Isolated Lower Limb Fracture
  • Application of LSVT BIG Intervention in Parkinson Disease
  • Unilateral Vestibular Damage and the Musculoskeletal System
  • Human Movement System
  • Continuum of Care
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Effects of Dynamic Stepping Training on Nonlocomotor Tasks in Individuals Poststroke
Don D. Straube, Carey L. Holleran, Catherine R. Kinnaird, Abigail L. Leddy, Patrick W. Hennessy, T. George Hornby
Physical Therapy Jul 2014, 94 (7) 921-933; DOI: 10.2522/ptj.20130544

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Effects of Dynamic Stepping Training on Nonlocomotor Tasks in Individuals Poststroke
Don D. Straube, Carey L. Holleran, Catherine R. Kinnaird, Abigail L. Leddy, Patrick W. Hennessy, T. George Hornby
Physical Therapy Jul 2014, 94 (7) 921-933; DOI: 10.2522/ptj.20130544
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