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Rapid and Long-term Adaptations in Gait Symmetry Following Unilateral Step Training in People With Hemiparesis

JH Kahn, PT, DPT, NCS, is Research Physical Therapist, Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, Illinois.
TG Hornby, PT, PhD, is Assistant Professor, Department of Physical Therapy, University of Illinois at Chicago, 1919 W Taylor St, Chicago, IL 60612 (USA), and Research Scientist, Sensory Motor Performance Program, Rehabilitation Institute of Chicago.

tgh{at}uic.edu

Background and Objective: Evidence for specific physical interventions that improve walking symmetry in individuals with hemiparesis poststroke is limited. The aim of this study was to investigate the rapid and prolonged effects of unilateral step training (UST) on step length asymmetry (SLA) in people with hemiparesis.

Subjects and Design: Eighteen individuals with chronic hemiparesis and substantial SLA during overground walking participated in a single-group, pretest-posttest study. The study consisted of 2 phases, with 10 subjects participating in each phase; 2 subjects participated in both phases.

Interventions and Measurements: To investigate rapid effects of UST, the participants completed a 20-minute session of UST on a treadmill with their unimpaired limb, with the impaired limb held stationary off the treadmill. Data for spatiotemporal gait parameters during overground walking at self-selected and fastest speeds were collected prior to and following UST, with follow-up measurements at 1 day and 1 week. To investigate the prolonged effects, the participants completed ten 20-minute sessions of UST. Data for spatiotemporal gait parameters were collected prior to training as well as after every third session, with follow-up measurements at 1 and 2 weeks.

Results: Immediately following UST, SLA tested during fast-paced overground walking improved by up to 13% (49% reduced to a 36% SLA), with changes retained for up to 24 hours. Following 10 sessions of UST, SLA improved significantly, with changes retained for up to 2 weeks.

Limitations: Despite repeated baseline measurements, the absence of a control group was a limitation. Furthermore, stepping characteristics during UST were not quantified.

Conclusion: Unilateral step training may improve spatiotemporal patterns in people with substantial gait asymmetry poststroke. Repeated training may be necessary for maintenance of adaptations.

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