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Rehabilitation with accurate adaptability walking tasks or steady state walking: A randomized clinical trial in adults post-stroke.

Clinical rehabilitation
August 1, 2021
David J Clark et al. (12 authors)
Journal ArticleRandomized Controlled TrialHuman StudyClinical
Study Details

Study Goal

To compare the effects of two post-stroke walking rehabilitation interventions (ACC and SS) on walking function and prefrontal cortical activity.

Results Summary

Both ACC and SS interventions improved preferred walking speed similarly, with no significant difference between groups. fNIRS data suggested ACC training may reduce prefrontal executive demands during walking.

Population

Adults with chronic post-stroke hemiparesis and walking deficits.

Effective Dosage

36 sessions led by a physical therapist.

Duration

3 months (post-intervention assessment), with follow-up at 6 months.

Interactions

None mentioned

Extracted Claims (5)
InterventionDirectionEndpointPopulationDosageImpactClaim #
accurate adaptability (ACC) walking intervention
increase
preferred walking speed
Adults with chronic post-stroke hemiparesis and walking deficits
0.13 ± 0.11 m/s
increased
#1
steady state (SS) walking intervention
increase
preferred walking speed
Adults with chronic post-stroke hemiparesis and walking deficits
0.14 ± 0.13 m/s
increased
#2
accurate adaptability (ACC) walking intervention
decrease
prefrontal (executive) resources during walking
Adults with chronic post-stroke hemiparesis and walking deficits
-
suggested a potential benefit for reducing demand
#3
accurate adaptability (ACC) walking intervention
increase
corticospinal tract activation
-
-
recruit cortical regions that increase
#4
steady state (SS) walking intervention
decrease
corticospinal tract activation
-
-
activates the corticospinal tract less intensely
#5
Abstract

OBJECTIVE: To assess changes in walking function and walking-related prefrontal cortical activity following two post-stroke rehabilitation interventions: an accurate adaptability (ACC) walking intervention and a steady state (SS) walking intervention. DESIGN: Randomized, single blind, parallel group clinical trial. SETTING: Hospital research setting. SUBJECTS: Adults with chronic post-stroke hemiparesis and walking deficits. INTERVENTIONS: ACC emphasized stepping accuracy and walking adaptability, while SS emphasized steady state, symmetrical stepping. Both included 36 sessions led by a licensed physical therapist. ACC walking tasks recruit cortical regions that increase corticospinal tract activation, while SS walking activates the corticospinal tract less intensely. MAIN MEASURES: The primary functional outcome measure was preferred steady state walking speed. Prefrontal brain activity during walking was measured with functional near infrared spectroscopy to assess executive control demands. Assessments were conducted at baseline, post-intervention (three months), and follow-up (six months). RESULTS: Thirty-eight participants were randomized to the study interventions (mean age 59.6 ± 9.1 years; mean months post-stroke 18.0 ± 10.5). Preferred walking speed increased from baseline to post-intervention by 0.13 ± 0.11 m/s in the ACC group and by 0.14 ± 0.13 m/s in the SS group. The Time × Group interaction was not statistically significant ( CONCLUSIONS: The ACC and SS interventions produced similar changes in walking function. fNIRS suggested a potential benefit of ACC training for reducing demand on prefrontal (executive) resources during walking.

Medical Subject Headings (MeSH)
AdultAgedExecutive FunctionExercise TherapyHumansMaleMiddle AgedParesisSingle-Blind MethodStrokeStroke RehabilitationWalking
Study Links
Quality Scores
SafetyNot Assessed
Efficacy75/10
Quality85/10
Citation Metrics
Total Citations7
Citations/Year1.8
Relative Citation Ratio0.92
NIH Percentile47%
Research Impact Scores
APT Score0.75
Weight Score2.50
Normalized Score0.67
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