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Options examined for stroke survivors
A physical therapy program that included task-specific walking training using a body-weight supported treadmill and over-ground practice was not shown to be superior in improving walking ability among stroke survivors compared to a home physical therapy program focused on structured, progressive strength and balance exercises and general encouragement to walk. This late-breaking science was presented at the American Stroke Association's International Stroke Conference 2011.
The primary analysis at one year after stroke demonstrated that 52% of participants had improved functional walking ability after participating in either of the two structured programs.
"All groups achieved similar important gains in walking speed, motor recovery, balance, functional status and quality of life" said Pamela W. Duncan, PT, PhD, principal investigator and professor at Duke University School of Medicine in Durham, NC. "However, the home program seems to be more practical with fewer risks."
Although comparable in outcomes, the task-specific walking program was associated with a small increased risk of adverse events such as dizziness or feeling faint while exercising. Individuals in the task-specific walking program, especially those with more severe walking limitations, were at increased risk for multiple falls over the one-year study.
This randomized trial, called "Locomotor Experience Applied Post-stroke" (LEAPS), included 408 recent stroke survivors (average age 62, 55% male, 58% Caucasian, 22% African American, 13% Asian), assigned to either:
All participants were assigned 36 sessions of 75-90 minutes for 12-16 weeks. They were recruited from six U.S. stroke rehabilitation centers between April 2006 and June 2009.
At study entry, participants were considered severely limited in walking if their walking speed was less than 0.4 meters per second; for them functional walking was considered improved if they reached a speed needed for mobility in the home (more than 0.4 meters per second). Walkers were considered moderately limited if their initial walking speed was more than 0.4 but less than 0.8 meters per second; they were considered improved if they reached a speed needed for independent mobility outside the home (more than 0.8 meters per second).
Individuals demonstrated similar improvements in walking whether the task-specific walking training was provided at two or six months post-stroke, and both severely and moderately limited walkers improved with all programs.
In a secondary finding at six months post-stroke, a group who had not yet received any therapy beyond usual care showed improved walking speed, but only about half as much as the participants who received one of the two therapy programs at two months. The six-month findings suggest that both programs are effective forms of physical therapy, and both are superior to usual care provided according to current standards.
In the United States, nearly 800,000 people suffer a stroke each year and 2/3 of survivors have limited walking ability after three months, according to Duncan. This study gives stroke survivors the hope that walking can continue to improve over time, and recovery might be enhanced by well-designed physical therapy programs, she said.
Home-based therapy programs with structured, progressive strength and balance training are more accessible and feasible in current practice than the task specific walking program tested in this trial.