Research Report
Population: Adult
Amber Maureen Devers, PT, DPT, NCS, Physical Therapist, Sheltering Arms Physical Rehabilitation Centers amdevers@shelteringarms.com
Pete Pidcoe, PT, DPT, PhD, ASSOCIATE PROFESSOR AND ASSISTANT CHAIR DIRECTOR OF THE ENGINEERING AND BIOMECHANICS LAB, Virginia Commonwealth University pepidcoe@vcu.edu
Anne Chan, PT, DPT, NCS, MBA, Physical Therapist, Director, Business Development, Sheltering Arms Physical Rehabilitation Centers achan@shelteringarms.com
Matt Wilks, PT, NCS, Physical Therapist, Associate Vice President, Rehabilitation and Fitness, Sheltering Arms Physical Rehabilitation Centers mwilks@shelteringarms.com
Katherine Schendt, PT, DPT, Physical Therapist, Sheltering Arms Physical Rehabilitation Centers kschendt@shelteringarms.com
Keywords: Plasticity, stroke rehabilitation, gait rehabilitation, repetition
Purpose/Hypothesis : Emphasis has been placed on repetition of task-specific activities to optimize neuroplasticity in stroke recovery. Additionally, the changing healthcare landscape requires innovative use of resources to improve patient participation in care and functional outcomes. The purpose of the present study was to compare amount of steps per day and functional outcomes during inpatient rehabilitation after stroke when some patients are given opportunities for extra walking practice. Two hypotheses were examined: 1) Patients who receive additional walking opportunities in an inpatient rehabilitation facility will achieve greater steps per day, as measured by a step activity monitor (SAM); and 2) Patients who receive additional walking opportunities will show greater functional outcome changes.
Subjects: Participants were chosen based on criteria as follows: primary diagnosis of stroke, a goal to improve walking, and current walking speed of less than 0.4 m/s. Data from six participants were initially used.
Materials/Methods: Steps per day were measured on all patients meeting inclusion criteria using a step activity monitor (SAM); the StepWatch. Patients in the experimental group were given a maximum of two opportunities for 30 minutes of extra walking practice at least 5 days per week. The extra practice consisted of use of walking aids the therapist deemed safe to use during extra practice. A rehabilitation technician and nursing staff were trained on walking with each patient specifically and provided the opportunity for extra practice.
Results: The experimental group did achieve more than twice the number of steps per day on average compared to the control patients; however, the difference was not statistically significant. With regard to functional outcomes, results of the 6-minute walk test, Dynamic Gait Index and 10-meter walk test all showed significant change from admission to discharge (p=0.05) in favor of the experimental group. All other outcome measures were not significant secondary to a high standard deviation in the data.
Conclusions: Extra practice resulted in more walking repetition in the inpatient rehabilitation setting, as expected, and was safe. Steps per day in the experimental group were achieved at much higher levels than reported in previous literature. The group receiving extra practice demonstrated more improvement in functional walking outcomes in terms of endurance, dynamic balance, and self-selected gait speed.
Clinical relevance: Repetition has been reported to be one important component of effective gait rehabilitation after stroke; however, there are barriers in a traditional rehabilitation environment to providing sufficient repetition. This pilot study presents a safe and feasible method to incorporating additional walking practice that may lead to improved functional outcomes in stroke survivors.
Citation:
Devers, Amber Maureen, PT, DPT, NCS; Pidcoe, Pete , PT, DPT, PhD; Chan, Anne , PT, DPT, NCS, MBA; Wilks, Matt , PT, NCS; Schendt, Katherine , PT, DPT. Translating Knowledge to Action: Improved patient outcomes with extra walking practice in inpatient rehabilitation. Poster Presentation. IV STEP Conference, American Physical Therapy Association, Columbus, OH, July 17, 2016. Online. https://u.osu.edu/ivstep/poster/abstracts/034_devers-et-al/