An intensive intervention for improving gait, balance, and mobility in individuals with chronic incomplete spinal cord injury: a pilot study of activity tolerance and benefits.

OBJECTIVE: To determine the tolerance to and benefits of an intensive mobility training (IMT) approach for individuals with incomplete spinal cord injury (ISCI). DESIGN: Prospective pretest-posttest study with 6-month follow-up. SETTING: University research laboratory. PARTICIPANTS: A volunteer sample of individuals with ISCI (N=15; >6 mo postinjury and able to walk at least 3.05 m with or without assistance). Follow-up data were collected for 10 of the participants. INTERVENTIONS: Participants received IMT for 3h/d for 10 weekdays, participating in activities that encouraged repetitive, task-specific training of their lower extremities in a massed practice schedule. MAIN OUTCOME MEASURES: Amount of time spent in therapeutic activities and rest was used to assess participants' tolerance to the intervention. Treatment outcomes were assessed pretest, posttest, and 6 months after the intervention and included the Berg Balance Scale (BBS), Dynamic Gait Index (DGI), 6-minute walk test, gait speed, and Spinal Cord Injury Functional Ambulation Inventory. RESULTS: Individuals in the higher functioning ISCI group (BBS score ≥45 and gait speed ≥0.6 m/s) spent more time in the intensive therapy on average than individuals in the lower functioning ISCI group. Effect sizes were comparable for changes in balance and mobility assessments between the lower and higher functioning groups, with the largest effect sizes observed for the DGI. CONCLUSIONS: This dosage of IMT may be a more appropriate treatment approach for higher functioning ISCI individuals, as they were better able to tolerate the length of the session and demonstrated higher effect sizes postintervention.

An intense intervention for improving gait, balance, and mobility for individuals with chronic stroke: a pilot study.

PURPOSE: Stroke is the leading cause of disability in the United States. At present, there is a paucity of experimental evidence available to indicate what physical therapy techniques are effective for improving mobility in an individual with chronic stroke. The purpose of this study was to determine the feasibility and effect size of an intensive mobility training program for people with chronic stroke. METHOD: A convenience sample of eight individuals with chronic stroke received an intensive mobility intervention for 3 hours per day for 10 consecutive weekdays. Treatment outcomes were assessed using standardized outcomes of gait, balance, and mobility including the GAITRite to collect spatial and temporal parameters of gait, the Falls Efficacy Scale, Berg Balance Scale, Dynamic Gait Index, and Timed Up and Go. Data were collected at four different time points: baseline, pre-test, post-test, and 3 months after intervention. RESULTS: The overall effect size of the intervention was 0.72, with changes in balance having much greater effects than changes in gait or mobility. The group demonstrated an average improvement from pre- to post-tests of 12 points on the Berg Balance Scale where a change of 6 is considered a minimal detectable change. CONCLUSIONS: This intense mobility training was a feasible intervention for this sample and demonstrated large effect sizes for balance outcome measures. Future studies incorporating more participants, a standard control, and more emphasis on gait would provide insight into the effectiveness and clinical relevance of this intervention.