Locomotor Rehabilitation of Individuals With Chronic Stroke: Difference Between Responders and Nonresponders

Objectives: To identify the clinical measures associated with improved walking speed after locomotor rehabilitation in individuals poststroke and how those who respond with clinically meaningful changes in walking speed differ from those with smaller speed increases. Design: A single group pre-post intervention study. Participants were stratified on the basis of a walking speed change of greater than (responders) or less than (nonresponders) .16m/s. Paired sample t tests were run to assess changes in each group, and correlations were run between the change in each variable and change in walking speed. Setting: Outpatient interdisciplinary rehabilitation research center. Participants: Hemiparetic subjects (N=27) (17 left hemiparesis; 19 men; age: 58.74 +/- 12.97y; 22.70 +/- 16.38mo poststroke). Intervention: A 12-week locomotor intervention incorporating training on a treadmill with body weight support and manual trainers accompanied by training overground walking. Main Outcome Measures: Measures of motor control, balance, functional walking ability, and endurance were collected at pre- and postintervention assessments. Results: Eighteen responders and 9 nonresponders differed by age (responders=63.6y, nonresponders=49.0y, P=.001) and the lower extremity Fugl-Meyer Assessment score (responders=24.7, nonresponders=19.9, P=.003). Responders demonstrated an average improvement of .27m/s in walking speed as well as significant gains in all variables except daily step activity and paretic step ratio. Conversely, nonresponders demonstrated statistically significant improvements only in walking speed and endurance. However, the walking speed increase of .10m/s was not clinically meaningful. Change in walking speed was negatively correlated with changes in motor control in the nonresponder group, implying that walking speed phis may have been accomplished via compensatory mechanisms. Conclusions: This study is a step toward discerning the underlying factors contributing to improved walking performance. Archives of Physical Medicine and Rehabilitation 2013;94:856-62 (C) 2013 by the American Congress of Rehabilitation Medicine