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Clinical Practice Guideline to Improve Locomotor Function Following Chronic Stroke, Incomplete Spinal Cord Injury,
T George Hornby1, Darcy S Reisman, Irene G Ward
1Department of Physical Medicine and Rehabilitation, Indiana University, Indianapolis (T.G.H., C.E.H.); Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois (T.G.H.); Department of Physical Therapy, University of Delaware, Newark (D.S.R., A.M.); Kessler Institute for Rehabilitation, West Orange, New Jersey (I.G.W., A.M., D.H.); Rutgers, New Jersey Medical School, Newark (I.G.W.); Infinity Rehab, Wilsonville, Oregon (P.L.S.); Department of Physical Therapy, University of Florida, Gainesville and Brooks Rehabilitation Center, Jacksonville, Florida (E.J.F., K.A.H.); Department of Physical Therapy, Wayne State University, Detroit, Michigan (N.E.F.); Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, Massachusetts (K.L.H.); Program in Physical Therapy, Washington University in St Louis, St Louis, Missouri (C.L.H.); Department of Physical Therapy, A.T. Still University, Mesa, Arizona (J.V.L.); and Sheltering Arms Hospital, Mechanicsville, Virginia (A.W.).
Task-specific walking training at moderate to high intensities or with virtual reality is recommended for improving walking speed and distance after central nervous system (CNS) injury. Avoid body weight-supported treadmill, robotic, or non-virtual reality balance training.
Area of Science:
- Neurorehabilitation
- Clinical Practice Guidelines
- Locomotion Recovery
Background:
- Central nervous system (CNS) injuries like stroke, spinal cord injury, and traumatic brain injury often cause persistent gait deficits.
- Quantifiable measures include reduced walking speed and timed distance over a set duration.
- This guideline focuses on improving walking function in ambulatory individuals over 6 months post-injury.
Purpose of the Study:
- To evaluate the effectiveness of various interventions for enhancing walking speed and timed distance.
- To provide evidence-based recommendations for clinicians managing patients with CNS injuries.
- To guide rehabilitation strategies for individuals with chronic locomotor deficits.
Main Methods:
- Systematic review of randomized controlled trials (RCTs) from 1995-2016.
- Included studies focused on ambulatory individuals at least 6 months post-CNS injury.
- Analyzed intervention parameters (frequency, intensity, time, type) and evidence strength.
Main Results:
- Strong evidence supports moderate-to-high intensity walking training or virtual reality (VR) training.
- Weak evidence suggests potential benefits from strength, circuit, cycling, or VR-based balance training.
- Strong evidence advises against body weight-supported treadmill, robotic, or non-VR balance training.
Conclusions:
- Task-specific (locomotor) practice is crucial for gait improvement, particularly at higher intensities or with augmented feedback.
- Lower-intensity or impairment-based training shows limited efficacy.
- Recommendations aim to optimize rehabilitation for stroke, spinal cord, and traumatic brain injury survivors.
