Background and Purpose- Therapeutic strategies that capitalize on the intrinsic capacity for neurological recovery early poststroke to improve locomotion are uncertain. Emerging data suggest that task-specific stepping practice provided at higher cardiovascular intensities may be critical dosage parameters that could maximize locomotor recovery. The purpose of this investigation was to determine the comparative effectiveness of providing high-intensity training on locomotor capacity early poststroke as compared with usual care. Methods- A quasi-experimental design was used to compare changes in stepping activity (StepWatch), walking, and balance outcomes during usual care (n=56) versus high-intensity stepping intervention (n=54) in inpatient stroke patients. Primary outcomes assessed weekly included self-selected and fastest gait speed, 6-minute walk test, and the Berg Balance Scale, with secondary outcomes of Swedish Postural Assessment Scale for Stroke-Norwegian version, Functional Ambulation Category, 30-s sit-to-stand, strength (average manual muscle testing), and Barthel Index. Regression analyses identified relationships between demographics, baseline function, and training activities (steps per day; duration achieved, 70%-85% maximum heart rates) and primary outcomes at discharge. Results- Following implementation of high-intensity stepping, average steps per day (5777±2784) were significantly greater than during usual care (3917±2656; P<0.001). Statistically different and clinically meaningful changes in self-selected speed (0.39±0.28 versus 0.16±0.26 m/s) and fastest gait speed (0.47±0.41 versus 0.17±0.38 m/s; both P<0.001) were observed following high-intensity interventions versus usual care and at every assessment throughout the length of stay. Changes in Berg Balance Scale and 6-minute walk test were also statistically and clinically different between groups, while secondary measures of Functional Ambulation Category and strength were also different at discharge. Primary predictors of improved walking capacity were steps per day, baseline impairments, and age. Conclusions- Provision of high-intensity stepping training applied during inpatient rehabilitation resulted in significantly greater walking and balance outcomes. This training paradigm should be further tested in other contexts to determine the generalizability to real-world and community settings.

中文翻译：

---

在住院卒中康复期间实施高强度踏步训练可改善功能结果。

背景和目的-利用脑卒中后早期神经功能恢复的内在能力来改善运动的治疗策略尚不确定。新兴数据表明，在较高的心血管强度下提供的针对特定任务的分步练习可能是关键剂量参数，可以使运动恢复最大化。这项研究的目的是确定与常规护理相比，对中风后早期运动能力进行高强度训练的相对有效性。方法-准实验设计用于比较住院卒中患者常规照护（n = 56）与高强度踩踏干预（n = 54）时踩踏活动（StepWatch），步行和平衡结局的变化。每周评估的主要结局包括自我选择的步态和最快的步态，6分钟步行测试，以及Berg平衡量表，其中包括瑞典-挪威版本的姿势评估量表，功能性行走类别，坐姿-站立30秒钟，力量（平均手动肌肉测试）和Barthel指数的次要结果。回归分析确定了人口统计学，基线功能和训练活动（每天的步数；达到的持续时间，最大心率的70％-85％）与出院时的主要结局之间的关系。结果-实施高强度踏步后，每天的平均步数（5777±2784）显着大于常规护理期间的平均步数（3917±2656; P <0.001）。自选速度（0.39±0.28 vs.0.16±0.26 m / s）和最快步态速度（0.47±0.41 vs 0.17±0.38 m / s）的统计学差异和临床意义的变化；均P <0。在进行高强度干预与常规护理后以及在整个住院期间的每次评估中均观察到001）。两组之间Berg平衡量表和6分钟步行测试的变化在统计学和临床​​上也不同，而功能性活动类别和强度的辅助测量在出院时也不同。步行能力提高的主要预测指标是每天步数，基线障碍和年龄。结论-在住院病人康复期间提供高强度的踏步训练可显着提高步行和平衡结局。应该在其他情况下进一步测试此培训范例，以确定对现实世界和社区设置的普遍性。两组之间Berg平衡量表和6分钟步行测试的变化在统计学和临床​​上也不同，而功能性活动类别和强度的辅助测量在出院时也不同。步行能力提高的主要预测指标是每天步数，基线障碍和年龄。结论-在住院病人康复期间提供高强度的踏步训练可显着提高步行和平衡结局。应该在其他情况下进一步测试此培训范例，以确定对现实世界和社区设置的普遍性。两组之间Berg平衡量表和6分钟步行测试的变化在统计学和临床​​上也不同，而功能性活动类别和强度的辅助测量在出院时也不同。步行能力提高的主要预测指标是每天步数，基线障碍和年龄。结论-在住院病人康复期间提供高强度的踏步训练可显着提高步行和平衡结局。应该在其他情况下进一步测试此培训范例，以确定对现实世界和社区设置的普遍性。步行能力提高的主要预测指标是每天步数，基线障碍和年龄。结论-在住院病人康复期间提供高强度的踏步训练可显着提高步行和平衡结局。应该在其他情况下进一步测试此培训范例，以确定对现实世界和社区设置的普遍性。步行能力提高的主要预测指标是每天步数，基线障碍和年龄。结论-在住院病人康复期间提供高强度的踏步训练可显着提高步行和平衡结局。应该在其他情况下进一步测试此培训范例，以确定对现实世界和社区设置的普遍性。