Speed gait training improves stroke rehab

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When it comes to walking as part of stroke rehabilitation, faster is better, according to results of a small study.

Stroke survivors participating in a supervised rehab program who were helped to walk faster than is typically the case had a substantial improvement in their overall walking ability, investigators from McGill University in Montreal report.

In addition to improving mobility, they point out, more intensive physical rehabilitation should also improve cardiovascular fitness, muscle strength, and range of motion.

“Walking after stroke is characterized by slow gait speed, poor endurance, and changes in the quality and adaptability of walking pattern,” Drs. Anouk Lamontagne and Joyce Fung note in their report in the American Heart Association’s journal Stroke.

Most rehabilitation programs focus on treadmill walking at “preferred” speeds, which are generally slow, and gains in walking speed on the treadmill are not readily transferable to over-ground movement, they explain.

The Canadian duo investigated what effect walking at either the preferred rate or at faster speeds had on the walking pattern of 12 patients (average age 70 years) who had a first stroke within the previous year.

During training, all of patients wore a safety harness and walked either with their body weight supported or while bearing their full weight.

Fast walking with body weight support produced the greatest improvements in walking speed in all subjects, the team reports. Participants with greater functioning at the outset increased their speed by 258 percent while those who were more impaired to begin with had a 95 percent increase in speed.

In comparison, walking at the slower “preferred” speed with body weight support increased gait speed by 69 percent in the lower-functioning individuals and not at all in high-functioning subjects.

“Fast walking promotes large muscle activation and strengthens both the paralyzed and non-paralyzed sides after stroke,” Lamontagne said in a statement. “Intensity is the key, like athletes training for a sport. That’s not something we have done before in these patients.”

SOURCE: Stroke, November 2004.

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