Brian Wadsworth is a Physical Therapist at Rusk Rehabilitation at NYU Langone Health in New York City. He completed his Residency in Neurologic PT at NYU Rusk in 2017-2018 after graduating from Sacred Heart University with his DPT in July 2017.
Gait difficulties are a common complaint of individuals who suffer a stroke, spinal cord injury or traumatic brain injury. The locomotors clinical practice guidelines promoted high intensity gait training (HIGT) as a vital strategy to improve walking within these populationsi. Research based HIGT protocols are often unrealistic for the clinical settingii,iii,iv,v. The purpose of this case series was to provide examples of clinically feasible HIGT interventions to promote knowledge translation and close the gap between research and rehabilitation. A convenience sample was taken of patients (n = 3) with one of each of the following diagnoses: stroke, acquired brain injury, and incomplete spinal cord injury. Interventions included over ground and treadmill based locomotors training with the goal of achieving HIGT during 30-60 minute sessions for 10 sessions. Successful HIGT was determined by measuring heart rate every five minutes. Results indicated that HIGT was clinically feasible. Overall, HIGT was achieved 85.5% of the time with combined modes of intervention. Isolated treadmill training and over ground training achieved HIGT 84.4% and 85.6% of the time, respectively. In a 30 minute span, on average, 24.3mins were spent actively targeting HIGT and of that 19.3mins were spent achieving it. The most consistently effective treadmill interventions included: increasing speed; weighting impaired limb; and changing surface gradient. Effective over ground interventions included: running; jumping activities; stairs; and resisted walking. This case series showed that HIGT can be clinically feasible and provided examples of exercises that promote the knowledge translation of this approach.