Enhancing Physical Therapy Best Practice for Improving Walking After Stroke

This multi-site study will have each site start in usual care with participants consented to collecting outcome measures. The twelve inpatient stroke units include: Kelowna General Hospital, Nanaimo Regional General Hospital, Glenrose Rehabilitation Hospital, Saskatoon City Hospital, Wascana Rehabilitation Centre, Joseph Brant Hospital, Bruyère Hospital, Freeport Grand River Hospital, CIUSSS-de-l'Estrie-CHUS Centre de réadaptation de l'Estrie, Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Dr. Everett Chalmers Regional Hospital, and Queen Elizabeth Hospital. Each site will randomly switch over to Enhanced Usual Care (best practice implementation) where all physical therapists at the site will be educated on delivery of best practice for locomotor retraining. The specific therapy activities are at the discretion of the physical therapist; however, physical therapists must work towards thirty minutes of weight-bearing/stepping activity at greater than forty percent heart rate reserve. Participants will continue to be consented to collecting outcome measures. Additionally, participants will be given and trained to use activity watches to monitor their own progress.

Inclusion criteria

• Admitted by inpatient or day stroke rehabilitation
• Improved walking is a rehabilitation goal
• Within 12 weeks post hemorrhagic or ischemic CVA with hemiparesis (confirmed by medical chart or motor assessment)
• Able to ambulate at least 5 steps. May use assistive and/or orthotic device and maximum one person assist
• Overground walking speed slower than normal
• Able to understand and follow directions
• Greater than or equal to 19 years of age
• Medically stable

Exclusion criteria

• Pre-stroke health included a serious gait disorder or disease that affected ambulation (musculoskeletal conditions, amputation, surgery/arthroplasty in the last 6 months, etc.)
• Pre-stroke health included a neurological condition (such as Parkinson's disease or Multiple Sclerosis) or other serious medical condition (active cancer, uncontrolled diabetes)
• Excessive pain in the body/joint preventing participation in an exercise intervention
• Participating in an experimental drug field study
• Participating in another formal exercise rehabilitation clinical trial
• Expected to receive <2 weeks daily in-/out- patient rehabilitation