Walking fast after stroke improves rehabilitation

Oct 8 2004

Stroke survivors who walked fast in a rehabilitation program improved their overall walking ability, according to a small study reported in Stroke: Journal of the American Heart Association.

A more intense physical rehabilitation program may also enhance stroke survivors’ cardiovascular fitness, muscle power, motor coordination, posture, balance and range of motion, researchers said.

“This could make a difference in a stroke patient’s ability to walk fast enough to cross the street on time or go shopping,” said lead author Anouk Lamontagne, Ph.D., P.T., assistant professor, School of Physical and Occupational Therapy, McGill University, Montreal, Canada. “Before rehabilitation, most of our discharged patients stayed indoors and only walked a few steps at a time.”

Lamontagne and co-author Joyce Fung, Ph.D., P.T., investigated whether an intensive walking program could increase walking speed in stroke survivors.

“This study shows that stroke survivors can increase their over-ground walking speed two to three times beyond comfortable levels, given proper instructions and a safe environment,” Lamontagne said. “Slow walking after stroke may be a behavioral adaptation to poor endurance, poor balance and the individual’s perceived limits of stability.”

After stroke, walking is often characterized by a slowed gait and changes in quality and adaptability of walking patterns. Conventional rehabilitation programs focus on treadmill training at “preferred” speeds – which are generally slow. Gains in walking speed achieved on the treadmill are not completely transferred to over-ground movement.

“Fast walking promotes large muscle activation and strengthens both the paralyzed and non-paralyzed sides after stroke,” she said. “Intensity is the key, like athletes training for a sport. That’s not something we have done before in these patients.”

Rather than using treadmills, the survivors walked on the ground, supported in a harness suspended from a railing with a pressurized weight support system. The system can provide constant body weight support throughout the gait cycle or be used only as a safety measure without weight support.

The study included 12 patients (average age 70) who had suffered a first stroke during the past year, affecting one side of their body. All survivors wore a harness and were evaluated while walking on the ground bearing their full weight and with partial body weight support. The participants were classified as high functioning – able to walk more than 45 centimeters (1.5 feet) per second (cm/s), or low functioning – walking less than 45 cm/s. The survivors were analyzed through a multi-camera motion-analysis system as they walked 10-meters, (33 feet) at their preferred speed and then at a fast speed.

“During the fast walking, patients were told to walk like they were about to miss the bus, or they were chasing their dog,” she said. “Researchers cheered them on, calling for them to walk faster and faster.”

Survivors who walked at a fast speed bearing their full weight increased their gait speed by an average 165 percent. Fast walking combined with body weight support also improved the walking pattern in all patients.

When patients used the harness for partial weight bearing and walked at preferred speeds, only the low-functioning subjects increased their speeds (69 percent). The high-functioning individuals did not increase their speed. When patients used the combination of body weight support and fast walking, they gained the greatest increments in speed. Low-functioning patients with support increased their speed by 258 percent, while high-functioning patients increased their speed by 95 percent.

If proven effective in larger trials, the rehabilitation treatment could benefit many post-stroke patients, possibly reducing rehabilitation time, as well as improving quality of life, Lamontagne said.

Researchers cautioned that fast walking may not be recommended for survivors with other co-existing diseases such as heart disease or exercise-exacerbated muscle or joint pain.

The use of body weight support during over-ground fast walking should be recommended as a useful intervention strategy in early rehabilitation with severely disabled subjects, the researchers said. However, they warned this is not a technique to recommend for patients outside the rehabilitation facility, or those with unstable cardiac problems, or severe pain.

“Faster walking does improve the pattern of walking instead of making it worse,” the researcher said.