Gait training efficacy using a home-based practice model in chronic hemiplegia.

OBJECTIVE: The efficacy of a home practice model for gait training was evaluated in 18 hemiplegic subjects 2.3 years (range, 1 to 5) after stroke. DESIGN: Uncontrolled case series. SETTING: Referral center. SUBJECTS: Patients at least 1 year poststroke referred to an outpatient rehabilitation program. INTERVENTION: Patients were taught home programs in two or more 2- to 5-day blocks averaging 35 physical therapy (PT) contact hours (range, 9.5 to 62.5); training extended over a mean of 22 months (range, 10 to 65). Training emphasized weight bearing, balance, segmental control, stretching, and bracing. MAIN OUTCOME MEASURES: Gait changes were measured using the newly developed Wisconsin Gait Scale (WGS). The patient-rated Falls Efficacy Scale (FES) was administered before and after training to 8 subjects, and the Health Status Questionnaire (HSQ) was retrospectively administered to all subjects to appraise subjective pretraining to posttraining changes and current psychological status. RESULTS: The average WGS score significantly improved (p < .05). Patients perceived that gait training increased the quality of their functional activities (p < .05). In a subset of patients, the FES showed that fear of falling was decreased (p < .05). Perception of well-being was comparable to a normative nonstroke reference population except for physical functioning. Compared to the only other published series (using traditional outpatient programming), the current model was of comparable cost. CONCLUSION: Despite the literature indicating a plateau in mobility function by 6 months after stroke, postacute training of gait in hemiplegic subjects using a home-based training model results in improved gait and the perception of improved function. Additionally, we provide validation for the newly developed Wisconsin Gait Scale, an instrument of gait measurement that may assist in comparing outcomes.

Motor unit firing rates in postpolio and control subjects during submaximal contraction.

Postpolio patients have a deficit in strength recovery after isometric activity. The cause for this is unknown, but may be the result of higher motor unit firing rates during the activity, which leads to excessive fatigue of the motor units. The purpose of this study was to determine whether postpolio subjects recruited motor units at higher firing rates than control subjects. Twelve control and seven postpolio subjects were tested for maximal voluntary contraction of the quadriceps isometrically. Randomly, subjects performed isometric contractions for five 10-s periods freely against gravity (threshold) and at 20% and 40% of maximal voluntary contraction. Decompositional motor unit electromyographic analysis was used to measure motor unit amplitude, motor unit firing rate and counted number of motor units identified. Analysis was by univariate analysis of variance. Motor unit firing rate was not significantly greater (P greater than 0.05) in postpolio subjects than control subjects at all three levels of contraction. Thus, it is unlikely that an increased motor unit firing rate leads to the deficit in recovery of strength in postpolio subjects.