Effects of a short burst of gait training with body weight-supported treadmill training for a person with chronic stroke: a single-subject study.

The purpose of this study was to investigate the effects of a short-burst dose of intense gait training with body weight-supported treadmill training (BWSTT) on walking speed, endurance, and quality of life of a participant with chronic stroke. A single-subject experimental (A-B-A-A) design with immediate and 3-month retention phases was used. The participant was a 66-year-old woman, 1 year after left cerebrovascular accident. Repeated baseline walking performance was established during 2 weeks of testing using the comfortable 10-meter walk test (CWT) and the 6-minute walk test (6MWT). The Stroke Impact Scale (SIS) was measured one time during baseline. Baseline testing was followed by ten 30-minute sessions of BWSTT over a 2-week duration. Retention testing was conducted immediately and 3 months following the intervention. Statistically significant improvements from baseline with the CWT and the 6MWT were achieved and maintained by the participant across all subsequent measurement phases. Improvements considered to be clinically meaningful changes in the SIS domains of strength and mobility achieved immediately after the intervention were not maintained at 3-month retention testing. For the participant in this study, the short-burst dosage of BWSTT provided a feasible and effective means for improving goal-oriented functional walking ability.

Motor and functional outcomes of a patient post-stroke following combined activity and impairment level training.

The purpose of this single-subject report was to determine the effect of a targeted training regimen aimed at improving motor and functional outcomes for a patient with chronic deficits after stroke. A 51-year-old woman with hemiparesis, 6 months post-stroke, participated in this prospective study. During the baseline, intervention, and immediate retention phases, performance was established by using repeated measures of four dependent variables: Fugl-Meyer assessment, Berg Balance Scale, 10-meter walk, and 6-minute walk. Two standard deviation band analyses were conducted on the four dependent variables with repeated measures. The Frenchay Activities Index and step length/single-limb support time measured at baseline and immediate retention were compared. During intervention, the participant was involved in a combined treatment protocol including body weight supported (BWS) treadmill training and strengthening exercises. Results indicated significant improvements in motor activity, balance, gait speed, and endurance. Progression was found in self-perceived participation. Although an improvement in step length symmetry occurred following training, a decrease in single-limb support time symmetry was found. BWS treadmill training, combined with strength training, significantly improved motor and functional performance in this participant with chronic deficits after stroke.

Effects of age, task complexity, and exercise on reaction time of women during ambulation tasks.

PURPOSE: Reaction time (RT) is defined as the time lapse between the onset of a stimulus and the initiation of a response. The purpose of Study 1 was to compare RTs of young and elderly women during ambulation. The purpose of Study 2 was to investigate the effects of regular exercise on RTs of elderly women during ambulation tasks. METHODS: Reaction times were measured using a portable computer, 2 transistor radios, and a radio interface box. The computer generated an auditory signal to which participants reacted by pushing a hand-held switch. Reaction times were compared in Study 1 between 17 healthy elderly women and 13 university students and in Study 2 between 15 exercising and 16 non-exercising elderly women. Testing of each participant occurred during sitting, walking on tile, and walking on foam padded carpet. RESULTS: The results of Study 1 revealed differences in RT between the 2 groups and between the sitting and the 2 walking conditions, but no interaction between group and task complexity. The results of Study 2 revealed differences among all conditions, but not between groups. CONCLUSIONS: The surprising result of Study 1 was that the elderly were not compromised to a greater extent than the young by increased task complexity. This suggests less age related RT decline during familiar activities. Results of Study 2 showed that level of exercise did not differentiate elderly participants' performance on RT. This may be because the active lifestyle of both groups of participants was more important in maintaining RT than a formal exercise program.

Geriatric referral patterns for physical therapy: a descriptive analysis.

PURPOSE: The purposes of this study were to: (1) describe older adults being seen for physical therapy, (2) identify the most prevalent physician orders and physical therapy interventions, and (3) compare these results across US regions. METHODS: A written questionnaire was mailed to a random sample of 1600 therapists. Therapists completed information for up to 10 patients including classification of diagnosis according to the Guide to Physical Therapist Practice. ANALYSIS: Descriptive analyses were performed. RESULTS: 118 therapists provided information on 839 patients. More of the patients were women (65%) than men (35%); their average age was 76.4 years. Most patients were seen in the outpatient setting (56%) and over 70% were classified into one of the musculoskeletal diagnostic categories. "Evaluate and treat" was present in 66.2% of the physician orders. The 6 most frequently performed interventions were in the therapeutic exercise category. CONCLUSION: Many physical therapists, even those who may not consider themselves geriatric physical therapists, are seeing older adults in a variety of settings. Knowledge about the diverse needs of older adults, therefore, is important for clinicians and students to meet the rising demand for quality physical therapy for this population.

Body weight support treadmill and overground ambulation training for two patients with chronic disability secondary to stroke.

BACKGROUND AND PURPOSE: Body weight support (BWS) treadmill training has recently been shown to be effective for gait training following stroke, but few researchers have measured the usefulness of this intervention in enhancing function, and there are no reports in which BWS overground ambulation was studied. The purposes of this case report were (1) to report the feasibility and patient tolerance for using a BWS system for overground ambulation, (2) to measure the function of patients with chronic stroke (2 years post-stroke) prior to and following BWS treadmill and overground ambulation training, and (3) to describe a protocol used for patient treatment progression using BWS treadmill training. CASE DESCRIPTIONS: The participants were 2 women, aged 87 and 93 years, who had strokes more than 2 years before data collection. A 10-m timed walk test, the Berg Balance Scale, the gait portion of the Tinetti Gait and Balance Assessment, and a measure of step length were administered. Intervention consisted of BWS ambulation training 3 times a week for 6 to 7 weeks. Each day there was BWS treadmill and overground training. OUTCOMES: Participant A improved most in 10-m walking time and Berg Balance Scale score. Participant B exhibited improvements in step length and 10-m walking time. DISCUSSION: The outcomes suggest that very old patients with chronic functional deficits secondary to cerebrovascular accident tolerated BWS treadmill and overground ambulation training and made improvements following this intervention.