You are probably like most people who have achieved some level of mobility following stroke but are still extremely limited. Walking can be limited by speed, safety, endurance, environment and the high energy consumption that a hemiparetic gait is often characterised by.
As therapists, we have known for a long time that specificity and intensity are very important paramaters in re-training someone to walk. The question has always been how much is enough to make significant changes?
A recent analysis of the literature provided by Hornby and his colleagues in the USA has demonstrated that in order to make changes in your walking following a stroke, the training needs to be delivered intensively, specifically and in large amounts….much larger than is commonly delivered in a rehab setting.
There are many ways that we as therapists can enhance your walking ability in the clinical setting. Apart from strength and coordination training, getting people to practice walking is often one of the most effective methods. Over the past twenty years, treadmill training with body weight support has been researched a lot in both laboratory and clinical environments. One of the rationales behind using body weight support harnessing on a treadmill is that is can provide a safe environment during gait training. This is especially true for individuals who may only be able to take a few steps out of a wheelchair.
Using body weight support harnessing also means that the therapist can be down working on getting your legs to step through rather than focusing on keeping you upright and standing. For this reason, people can often walk further on a treadmill with a harness, which means they get larger amounts and a higher dose of training. It would be reasonable to think that the more walking you do the better you get at it!
Most therapy sessions evaluated in a recent trial of rehabilitation settings showed that ‘average total amount of stepping dosage was between 300 to 900 steps per session’. The same group of people were then trained up to 4000 steps per session. They showed a 25% increase in total daily stepping in the home and community after 4 weeks of training. This is very impressive in a group of people who were considered to have plateaued in their walking.
Other studies have looked at how training higher treadmill velocities and ‘sprint’ training appears to enhance improvements in walking speed and independence. Again, does this mean that walking faster gives you more steps over a fixed time or does the intensity of effort have an impact?
It is an exciting time for rehabilitation following stroke and if you are interested in improving your walking please contact us at the clinic for more information on our Stroke Mobility Program.