Hornby T George, Holleran Carey L, Hennessy Patrick W, Leddy Abigail L, Connolly Mark, Camardo Jaclyn, Woodward Jane, Mahtani Gordhan, Lovell Linda, Roth Elliot J
University of Illinois at Chicago, Chicago, IL, USA Rehabilitation Institute of Chicago, Chicago, IL, USA Northwestern University, Chicago, IL, USA
Rehabilitation Institute of Chicago, Chicago, IL, USA.
Neurorehabil Neural Repair. 2016 Jun;30(5):440-50. doi: 10.1177/1545968315604396. Epub 2015 Sep 3.
Converging evidence suggests that the amount of stepping practice is an important training parameter that influences locomotor recovery poststroke. More recent data suggest that stepping intensity and variability are also important, although such strategies are often discouraged early poststroke.
The present study examined the efficacy of high-intensity, variable stepping training on walking and nonwalking outcomes in individuals 1 to 6 months poststroke as compared with conventional interventions. Methods Individuals with unilateral stroke (mean duration = 101 days) were randomized to receive ≤40, 1-hour experimental or control training sessions over 10 weeks. Experimental interventions consisted only of stepping practice at high cardiovascular intensity (70%-80% heart rate reserve) in variable contexts (tasks or environments). Control interventions were determined by clinical physical therapists and supplemented using standardized conventional strategies. Blinded assessments were obtained at baseline, midtraining, and posttraining with a 2-month follow-up. Results A total of 32 individuals (15 experimental) received different training paradigms that varied in the amount, intensity, and types of tasks performed. Primary outcomes of walking speed (experimental, 0.27 ± 0.22 m/s vs control, 0.09 ± 0.09 m/s) and distances (119 ± 113 m vs 30 ± 32 m) were different between groups, with stepping amount and intensity related to these differences. Gains in temporal gait symmetry and self-reported participation scores were greater following experimental training, without differences in balance or sit-to-stand performance. Conclusion Variable intensive stepping training resulted in greater improvements in walking ability than conventional interventions early poststroke. Future studies should evaluate the relative contributions of these training parameters.
越来越多的证据表明，步行练习的量是影响中风后运动恢复的一个重要训练参数。最新数据表明，步行强度和变异性也很重要，尽管在中风后早期通常不鼓励采用此类策略。
本研究旨在探讨与传统干预措施相比，高强度、可变步幅训练对中风后1至6个月个体的步行和非步行结果的疗效。
将单侧中风患者（平均病程 = 101天）随机分为两组，在10周内接受≤40次、每次1小时的实验性或对照性训练。实验性干预仅包括在不同情境（任务或环境）下以高心血管强度（心率储备的70%-80%）进行步行练习。对照性干预由临床物理治疗师确定，并采用标准化的传统策略进行补充。在基线、训练中期和训练后进行盲法评估，并进行2个月的随访。
共有32名个体（15名实验组）接受了不同的训练模式，这些模式在执行的任务量、强度和类型上有所不同。两组之间的主要步行速度结果（实验组为0.27±0.22米/秒，对照组为0.09±0.09米/秒）和步行距离结果（119±113米对30±32米）存在差异，步幅量和强度与这些差异有关。实验性训练后，步态时间对称性和自我报告的参与度得分的改善更大，平衡或从坐到站的表现没有差异。
与中风后早期的传统干预措施相比，可变强度步幅训练能使步行能力得到更大改善。未来的研究应评估这些训练参数的相对贡献。
