title: Time course of functional and biomechanical improvements during a gait training intervention in persons with chronic stroke.
abstract: OBJECTIVE
  In rehabilitation, examining how variables change over time can help define the minimal number of training sessions required to produce a desired change. The purpose of this study was to identify the time course of changes in gait biomechanics and walking function in persons with chronic stroke.
  
  
  METHODS
  Thirteen persons who were more than 6 months poststroke participated in 12 weeks of fast treadmill training combined with plantar- and dorsiflexor muscle functional electrical stimulation (FastFES). All participants completed testing before the start of intervention, after 4, 8, and 12 weeks of FastFES locomotor training.
  
  
  RESULTS
  Peak limb paretic propulsion, paretic limb propulsive integral, peak paretic limb knee flexion (P < 0.05 for all), and peak paretic trailing limb angle (P < 0.01) improved from pretraining to 4 weeks but not between 4 and 12 weeks. Self-selected walking speed and 6-minute walk test distance improved from pretraining to 4 weeks and from 4 to 12 weeks (P < 0.01 and P < 0.05, respectively for both). Timed Up & Go test time did not improve between pretraining and 4 weeks, but improved by 12 weeks (P = 0.24 and P < 0.01, respectively).
  
  
  CONCLUSIONS
  The results demonstrate that walking function improves with a different time course compared with gait biomechanics in response to a locomotor training intervention in persons with chronic stroke. Thirty-six training sessions were necessary to achieve an increase in walking speed that exceeded the minimally clinically important difference. These findings should be considered when designing locomotor training interventions after stroke.Video Abstract available (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A63) for more insights from the authors.
authors.affiliation: Biomechanics and Movement Science Program, (D.S.R., M.A.R., K.S.R., J.H., E.H., S.B.M.), Department of Physical Therapy, (D.S.R., R.P., M.A.R., K.S.R., S.B.M.), Department of Mechanical Engineering (J.H.), University of Delaware, Newark, Delaware; and Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University, Atlanta, Georgia (T.M.K.).
authors.forename: Darcy
authors.initials: D
authors.lastname: Reisman
authors.forename: Trisha
authors.initials: T
authors.lastname: Kesar
authors.forename: Ramu
authors.initials: R
authors.lastname: Perumal
authors.forename: Margaret
authors.initials: M
authors.lastname: Roos
authors.forename: Katherine
authors.initials: K
authors.lastname: Rudolph
authors.forename: Jill
authors.initials: J
authors.lastname: Higginson
authors.forename: Erin
authors.initials: E
authors.lastname: Helm
authors.forename: Stuart
authors.initials: S
authors.lastname: Binder-Macleod
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena / Q000502:physiology; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005684:Gait / Q000502:physiology*; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function / Q000502:physiology*; D020521:Stroke / Q000150:complications / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D013997:Time Factors; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology*