title: Effects of dynamic stepping training on nonlocomotor tasks in individuals poststroke.
abstract: BACKGROUND
  During the physical rehabilitation of individuals poststroke, therapists are challenged to provide sufficient amounts of task-specific practice in order to maximize outcomes of multiple functional skills within limited visits. Basic and applied studies have suggested that training of one motor task may affect performance of biomechanically separate tasks that utilize overlapping neural circuits. However, few studies have explicitly investigated the impact of training one functional task on separate, nonpracticed tasks.
  
  
  OBJECTIVE
  The purpose of this preliminary study was to investigate the potential gains in specific nonlocomotor assessments in individuals poststroke following only stepping training of variable, challenging tasks at high aerobic intensities.
  
  
  METHODS
  Individuals with locomotor deficits following subacute and chronic stroke (n=22) completed a locomotor training paradigm using a repeated-measures design. Practice of multiple stepping tasks was provided in variable environments or contexts at high aerobic intensities for ≥40 sessions over 10 weeks. The primary outcome was timed Five-Times Sit-to-Stand Test (5XSTS) performance, with secondary measures of sit-to-stand kinematics and kinetics, clinical assessment of balance, and isometric lower limb strength.
  
  
  RESULTS
  Participants improved their timed 5XSTS performance following stepping training, with changes in selected biomechanical measures. Statistical and clinically meaningful improvements in balance were observed, with more modest changes in paretic leg strength.
  
  
  CONCLUSIONS
  The present data suggest that significant gains in selected nonlocomotor tasks can be achieved with high-intensity, variable stepping training. Improvements in nonpracticed tasks may minimize the need to practice multiple tasks within and across treatment sessions.
authors.affiliation: D.D. Straube, PT, PhD, NCS, Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, Illinois.
authors.forename: Don D
authors.initials: DD
authors.lastname: Straube
authors.affiliation: C.L. Holleran, PT, MPT, NCS, Sensory Motor Performance Program, Rehabilitation Institute of Chicago.
authors.forename: Carey L
authors.initials: CL
authors.lastname: Holleran
authors.affiliation: C.R. Kinnaird, MS, Sensory Motor Performance Program, Rehabilitation Institute of Chicago.
authors.forename: Catherine R
authors.initials: CR
authors.lastname: Kinnaird
authors.affiliation: A.L. Leddy, PT, DPT, MSCI, Sensory Motor Performance Program, Rehabilitation Institute of Chicago.
authors.forename: Abigail L
authors.initials: AL
authors.lastname: Leddy
authors.affiliation: P.W. Hennessy, PT, DPT, NCS, Sensory Motor Performance Program, Rehabilitation Institute of Chicago.
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Hennessy
authors.affiliation: T.G. Hornby, PT, PhD, Sensory Motor Performance Program, Rehabilitation Institute of Chicago; Department of Physical Therapy and Kinesiology & Nutrition, University of Illinois at Chicago; and Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. Mailing address: Department of Physical Therapy, University of Illinois, 1919 W Taylor St, Chicago, IL 60612 (USA). tgh@uic.edu.
authors.forename: T George
authors.initials: TG
authors.lastname: Hornby
mesh_terms: D000368:Aged; D001696:Biomechanical Phenomena; D005080:Exercise Test; D005260:Female; D006801:Humans; D035002:Lower Extremity / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D009068:Movement / Q000502:physiology*; D053580:Muscle Strength; D018482:Muscle, Skeletal / Q000503:physiopathology; D026741:Physical Therapy Modalities; D004856:Postural Balance; D011214:Practice, Psychological; D020521:Stroke / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D013647:Task Performance and Analysis