Intensive Goal-Directed Treatments in Enriched Environments Augments Patient Outcomes Post-Stroke

Objective: Previous research indicates that patients post-stroke, average 400-800 steps within physical therapy sessions and demonstrate heart rate values of 24-35% of HR Max. This dosage and intensity is inadequate to promote neuroplastic changes and maximize recovery. The goal of this study was to quantify and examine the amount of high-intensity stepping practice that was delivered within an Acute Inpatient Rehabilitation (AIR) setting for individuals with sub-acute stroke. Methods: 14 patients with a diagnosis of sub-acute stroke were admitted to AIR. Standardized outcomes included the 6-Minute Walk Test (6MWT), 10-Meter Walk Test (10MWT), the Berg Balance Scale (BBS) and the Postural Assessment Scale for Stroke Patients (PASS). A step activity monitor with an internal accelerometer was applied on the non-paretic extremity from the hours of 7 am to 5 pm. During therapy sessions, subjects were exposed to a plan of care that involved high-intensity, high-frequency stepping practice through Body Weight Supported Treadmill Training (BWSTT), over-ground stepping, stair climbing, obstacle navigation, dynamic standing balance activities and error augmentation tasks. All individuals were continuously monitored with heart rate monitors, and perceived intensity was recorded within 5-minute intervals and after modification of activity with the Borg Rate of Perceived Exertion (RPE) Scale. Target intensity was defined with heart rate values of 70-85% of HR Max and RPE values of 14-20 (hard to maximal exertion). Time spent in target intensity ranges was collected. Each subject was scheduled for 1-2 hours of physical therapy per day. Results: During the 2-month collection period, subjects demonstrated ability to tolerate a high-intensity, high-frequency stepping gait training program within the intensities defined. Stepping data indicated that subjects received an average daily stepping dosage of 2000-8000 steps per day, well above previously reported values. Conclusion: It is possible to implement a high-intensity, high-frequency stepping gait training program within an acute inpatient rehabilitation setting for the stroke population. However, future research concerning therapy intensity and frequency of stepping should be designed with a larger sample size