PT Critically Appraised Topics
 

Document Type

Critically Appraised Topic

Publication Date

2012

Clinical Scenario

The patients that led us to pursue this question included several male patients between the ages of 50 and 70 with a diagnosis of sub-acute cerebral vascular accident that presented with difficulty walking. Medical treatment to date has included occupational therapy, speech therapy, physical therapy in the acute and sub-acute settings, and nursing and physician care. Challenges identified included neglect, difficulty with ambulation, difficulty with transfers, decreased functional mobility and strength, and difficulty communicating. We would like to know if there is an optimal amount of walking training that should be implemented during rehabilitation to maximize walking outcomes.

Clinical Question

Does early intensive gait training with patients after acute or sub-acute stroke improve gait performance as compared to conventional post-stroke rehabilitation?

Clinical Bottom Line

Results from Outermans et al., Peurala et al., and Pohl et al., show that early intensive gait training result in both statistically significant and clinically meaningful improvements in ambulation endurance and velocity in patients with hemiplegic acute or sub-acute stroke. Outermans et al. showed that early intensive over ground gait training, strengthening, and cardiorespiratory training improve ambulation velocity and endurance in high functioning patients significantly more than low intensity physical therapy focused on motor control and balance. Peurala et al.’s results demonstrated that early intensive gait-training either over ground or with a body weight supported gait trainer along with traditional stroke therapy significantly improved ambulation velocity and endurance from baseline, and significantly improved FAC scores and MMA scores over the low intensive control group. The study by Pohl et al. showed that early intensive repetitive locomotor training with an electromechanical gait trainer and additional therapy in non-ambulatory patients significantly improved gait speed, velocity, and independent ambulation abilities more than traditional physical therapy alone. From the three studies, we can generalize these results to acute and sub-acute populations ranging from non-ambulatory to high functioning within the age groups of 18-80 within the inpatient rehabilitation setting. More research in this field is needed with regards to differentiation between acute and sub-acute populations, as well as developing a standard of care within all rehabilitation centers for early intensive gait training.

Components of our clinical question that were not answered include: learning details of therapeutic treatment protocols for over ground gait training, and a lack of discussion of feasibility of treatments within a normal clinic setting, such as cost of equipment, space and equipment required for specific treatments, and applicability to different individuals within the post-stroke category.

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