Neuroplasticity (includes neuroscience)
Spinal Cord Injury
This talk will focus on: defining high intensity gait training; providing clinically feasible interventions to achieve it; and discussing potential clinical barriers to high intensity gait training to maximize the knowledge translation of this approach.
Objective: The purpose of this case series was to determine the clinical feasibility of high intensity gait training (HIGT) and promote knowledge translation by assessing clinically effective interventions.
Design: Case Series.
Neurological outpatient physical therapy
Participants (or Animals, Specimens, Cadavers): A convenience sample of three patients were included. All with chronic (>6 months) non-neurodegenerative conditions. Patient A, a 23-year-old male, with a C5 incomplete spinal cord injury. Patient B, a 55-year-old female, suffered a non-traumatic brain injury due to abscess. Patient C, a 21-year-old male, diagnosed with stroke. Acuity ranged 11-42 months. Goal to improve gait.
Interventions: HIGT was the targeted intervention via treadmill or over ground. Sessions lasted 30-60mins. Treadmill interventions included: increasing speed; increasing belt gradient; and ankle weighting or theraband resistance. Over ground interventions involved: fast walking; complex skills (e.g. running, bounding, skipping); ankle weighting; continuous stair training forward/backwards; resisted walking and stair training. HIGT was defined as 60-80% of heart rate reserve as determined by heart rate (HR) tracking every 5 minutes. Each patients’ goal range was calculated using predicted HR maximum (207 – 0.7 x age) and the Karvonen method.
Main Outcome Measure(s): HR, 10MWT, 6MWT, FGA, Mini-BEST Test (MBT), FTSTS.
Results: Results indicate that HIGT appears clinically feasible. Overall HIGT was achieved 85.5% of the time. Treadmill and over ground training HIGT was achieved 84.4% and 85.6%, respectively. All patients exceeded MCD on FGA, MBT, 10MWT, and 6MWT. Each participants’ FTSTS duration also improved but no MCD are available.
Conclusions: These recommendations promote knowledge translation of the locomotor CPG. HIGT is achieved on the treadmill by increasing: speed, gradient, and limb resistance. HIGT is achieved over ground by: fast walking; complex skills; continuous stairs; and resisted walking or stair training.