Exploring approaches to implement high intensity gait training for people with stroke during inpatient rehabilitation.

Thursday, November 2, 2023

9:50 AM – 9:56 AM

Location: Station 6

Presenting Author(s)

Radha T. Morar, PT, DPT (she/her/hers)

Physical Therapist
Baylor Scott and White Institute for Rehabilitation
Dallas, Texas, United States
Maddie Melton, PT, DPT

Physical Therapist
Baylor Scott & White Institute for Rehabilitation, United States

Non-presenting Author(s)

Lauren Gibson, PT, DPT (she/her/hers)

Physical Therapist
Baylor Scott & White Institute for Rehabilitation
Dallas, Texas, United States
AO

Amanda Ogletree, PT, DPT, NCS, CKTP (she/her/hers)

Physical Therapist
Baylor Scott and White, United States
Hayden M. Fowler, PT, DPT, NCS (she/her/hers)

Physical Therapist
Baylor Scott and White Institute for Rehabilitation
Dallas, Texas, United States
Molly Trammell, PT

Physical therapy supervisor
Baylor Scott and White Institute for rehabilitation, Texas, United States
Chad Swank, PT, PhD

Research Investigator
Baylor Research Institute
Dallas, Texas, United States
Christa Ochoa, MPH

Research Analyst
Baylor Scott & White Institute for Rehabilitation
dallas, Texas, United States
Jaime Gillespie, DPT (she/her/hers)

Research Physical Therapist
Baylor Scott & White Institute for Rehabilitation, Texas, United States

Research Objectives: High intensity gait training (HIGT) is established as best practice for patients following stroke. The optimal mode to implement HIGT is unknown. This study compares the use of usual care approaches and overground robotic exoskeletons (ORE) to achieve HIGT in people with stroke during inpatient rehabilitation.

Design: Prospective Observational Study.

Setting: Large urban inpatient rehabilitation facility (IRF).

Participants: Patients admitted to IRF within 6 months post-stroke with an appropriate walking goal.

Interventions: Patients received physical therapy (45-90 minutes) 5 days per week focused on HIGT including: conventional overground gait training, body weight supported treadmill training (BWSTT), LiteGait, and ORE. Heart rate (HR) was measured using the Polar A370 Fitness Watch. ORE was provided using Ekso Bionics exoskeleton.

Main Outcome Measures: Intensity achieved during HIGT sessions was assessed by HR, time spent walking per session, and number of steps.

Results: Patients (n=46; age 64 ± 13 years; 52% female) were admitted for inpatient rehabilitation at 16.55 ± 22.22 days since onset of stroke for an average length of stay of 22.72 ± 12.19 days. Conventional overground gait training (51%) was the most common mode of all HIGT sessions, followed by BSWTT (28%), and ORE (11%). ORE sessions (63%) attained the greatest amount of time in moderate-to-vigorous intensity, followed by BSWTT (46%), Litegait (36%), conventional overground (30%). Time spent walking across sessions was greatest during ORE (24.6±-7.1 minutes), followed by conventional overground gait training (19.3±10.5), BSWTT (20.9±6.4), and Litegait (19.6±6.0). The average number of steps during ORE sessions was 505.59±208.10.

Conclusions: No mode of gait training attained HIGT cardiovascular intensity recommendations for patients with stroke. However, ORE elicited the greatest cardiovascular intensity and amount of time spent walking during IRF physical therapy sessions.

Author(s) Disclosures: The authors do not have any conflicts of interest.

Learning Objectives:

Describe the efficacy of using an overground robotic exoskeleton in implementation of high intensity gait training.
Discuss possible cardiovascular intensity that can be achieved during overground robotic exoskeleton gait training in comparison to conventional gait training modalities during implementation of high intensity gait training.
Discuss percentage of time spent walking during overground robotic exoskeleton gait training in comparison to conventional gait training modalities during implementation of high intensity gait training.