![]() The guideline suggests that task-specific walking training should be performed to improve walking speed and distance in those with acute-onset CNS injury although only at higher intensities or with augmented feedback. This guideline may not apply to patients with limited ambulatory function, where provision of walking training may require substantial physical assistance. Limitations:Īs walking speed and distance were primary outcomes, the research participants included in the studies walked without substantial physical assistance. Lower-intensity walking interventions or impairment-based training strategies demonstrated equivocal or limited efficacy. The collective findings suggest that large amounts of task-specific (ie, locomotor) practice may be critical for improvements in walking function, although only at higher cardiovascular intensities or with augmented feedback to increase patient's engagement. Finally, strong evidence suggests that body weight–supported treadmill training, robotic-assisted training, or sitting/standing balance training without virtual reality should not be performed to improve walking speed or distance in ambulatory individuals greater than 6 months following acute-onset CNS injury to improve walking speed or distance. In contrast, weak evidence suggests that strength training, circuit (ie, combined) training or cycling training at moderate to high intensities, and virtual reality–based balance training may improve walking speed and distance in these patient groups. Strong evidence indicates that clinicians should offer walking training at moderate to high intensities or virtual reality–based training to ambulatory individuals greater than 6 months following acute-onset CNS injury to improve walking speed or distance. Recommendations were determined on the basis of the strength of the evidence and the potential harm, risks, or costs of providing a specific training paradigm, particularly when another intervention may be available and can provide greater benefit. For all studies, specific parameters of training interventions including frequency, intensity, time, and type were detailed as possible. Methods:Ī systematic review of the literature published between 19 was performed in 4 databases for randomized controlled clinical trials focused on these specific patient populations, at least 6 months postinjury and with specific outcomes of walking speed and timed distance. The goal of the present clinical practice guideline was to delineate the relative efficacy of various interventions to improve walking speed and timed distance in ambulatory individuals greater than 6 months following these specific diagnoses. Individuals with acute-onset central nervous system (CNS) injury, including stroke, motor incomplete spinal cord injury, or traumatic brain injury, often experience lasting locomotor deficits, as quantified by decreases in gait speed and distance walked over a specific duration (timed distance). ![]() The work cannot be changed in any way or used commercially without permission from the journal. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The authors indicate no potential conflicts of interest. George Hornby, PT, PhD, Locomotor Recovery Laboratory, Rehabilitation Hospital of Indiana, 4141 Shore Dr, Indianapolis, IN 46254 ( ).Īll members of the workgroup submitted written conflict-of-interest forms and CVs, which were evaluated the Practice Committee of the ANPT and found to be free of financial and intellectual conflict of interest.The Academy of Neurologic Physical Therapy (ANPT) welcomes comments on this guideline. Still University, Mesa, Arizona (J.V.L.) and Sheltering Arms Hospital, Mechanicsville, Virginia (A.W.).Ĭorrespondence: T. Department of Physical Medicine and Rehabilitation, Indiana University, Indianapolis (T.G.H., C.E.H.) Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois (T.G.H.) Department of Physical Therapy, University of Delaware, Newark (D.S.R., A.M.) Kessler Institute for Rehabilitation, West Orange, New Jersey (I.G.W., A.M., D.H.) Rutgers, New Jersey Medical School, Newark (I.G.W.) Infinity Rehab, Wilsonville, Oregon (P.L.S.) Department of Physical Therapy, University of Florida, Gainesville and Brooks Rehabilitation Center, Jacksonville, Florida (E.J.F., K.A.H.) Department of Physical Therapy, Wayne State University, Detroit, Michigan (N.E.F.) Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, Massachusetts (K.L.H.) Program in Physical Therapy, Washington University in St Louis, St Louis, Missouri (C.L.H.) Department of Physical Therapy, A.T.
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