Background/Purpose: Studies on the implementation of high-intensity gait training (HIT) post-stroke have been conducted in inpatient rehabilitation facilities (IRF). However, implementation of HIT in acute care has not been reported. Research indicates that early mobility 48 hours after stroke onset is safe, but the ability to achieve higher targeted intensities remains undefined. This case series examined HIT implementation and outcomes in the acute care setting. Case Description: Five individuals with acute stroke (four ischemic, one hemorrhagic) initiated HIT > 48 hours after stroke onset. Four licensed physical therapists (PTs) delivered HIT 4-5 days/week, for 30 minutes/session while targeting 70-85% age-predicted heart rate maximum (HR max ) or the rating of perceived exertion (RPE) scale of 15-17. Barriers to delivering HIT were documented. Clinical measures of walking and balance function were assessed at baseline and discharge. Outcomes: Participants completed 4-10 sessions with a median session time of 43 minutes. Session characteristics included a peak RPE of 11-17, and peak HR max of 65%-88%. Greater than 70% HRmax was achieved in 52% of sessions. Changes in Berg Balance Scale were greater than published MCIDs, with the range of improvements from 8 to 31 points (median 24.5 points). Gait speed gains ranged from 0.0 m/s to 0.82 m/s (median .19 m/s). Barriers included the patients’ functional dependency, lack of dedicated training space, and unexpected session interruptions. Discussion/Conclusion: This case series details potential benefits and barriers to HIT implementation in the acute care setting. The data illustrated that initiation of HIT in acute care is feasible. Future research should confirm safety in larger cohorts, establish efficacy through controlled trials, define optimal training parameters, and explore strategies to overcome implementation barriers.
Mulvaney et al. (Wed,) studied this question.