The following article has just been accepted for publication in Journal of Neurologic Physical Therapy:
“Motor Learning During Post-Stroke Gait Rehabilitation: A Case Report”
Trisha Kesar, PT, PhD; Michelle J Sauer; Stuart A Binder-Macleod; Darcy S Reisman
INTRODUCTION: Investigation of motor learning time courses underlying improvements in walking function achieved with gait training is critical for the development of more effective gait rehabilitation strategies. The purpose of this case study was to evaluate motor learning through the measurement of within-session and across-session changes in gait biomechanics during the 1st and 6th weeks of a 6-week clinical gait training program.
CASE DESCRIPTION: A 47 year old male with post-stroke left hemiparesis participated in the study (15.5 months post-stroke, lower extremity Fugl-Meyer score of 12).
INTERVENTION: The subject participated in 6-weeks of gait training (3 sessions/week, 36-minutes/session) comprising fast treadmill walking and functional electrical stimulation to paretic plantar- and dorsi-flexors (FastFES). During a training session conducted during the 1st and 6th weeks, paretic propulsive integral and swing phase knee flexion were measured during a pre-test (before training session), post-test (after training session), and retention test (48 hours following the training session).
OUTCOMES: After 6-weeks of training, the subject’s overground gait speed increased from .38 to .57 m/s. Additionally, there was a 55.4% improvement in paretic propulsion and 25% increase in swing phase knee flexion between the 1st and 6th training week. Examination of change scores revealed greater online gains and greater motor learning (retention) during the 1st versus 6th week of gait training for both paretic propulsion and knee flexion.
DISCUSSION: We demonstrate the feasibility and advantage of using within- and across-session changes for evaluating motor learning during clinical gait rehabilitation. An understanding of motor learning time courses underlying gait training can guide the development of novel strategies and dosing regimens to increase the efficacy of each session of gait rehabilitation.
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