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Optimizing stroke rehabilitation : determining the therapeutic dose and intensity to maximize walking and functional recovery early after stroke Klassen, Tara D.

Abstract

Background: Stroke is a serious health concern and a leading cause of disability worldwide. Up to two-thirds of stroke survivors will experience physical and/or cognitive deficits thus requiring ongoing rehabilitation. Determining the appropriate exercise intensity and dose to optimize recovery is one of the top priorities in stroke rehabilitation research. Purpose: To determine the feasibility and efficacy of higher exercise intensity and dose on walking and functional recovery, cognition, and quality of life in the early phase after stroke. Methods: Multiple studies were conducted to examine how exercise intensity and dose may influence recovery early after stroke. Two studies were completed to identify and assess the precision of a readily available monitoring device to accurately record step count, a measure of walking dose. The results of these studies contributed to the design and implementation of an ongoing national, multi-site, randomized clinical trial occurring during inpatient stroke rehabilitation, to investigate how higher exercise intensity and dose impact walking and functional recovery, cognition, and quality of life. Results: From the two studies examining measurement of walking dose, The Fitbit One was identified as a monitoring device that could accurately assess step count (< 10% error), when positioned at the ankle, with individuals post-stroke that had a walking speed greater than 0.4m/s. Preliminary data from the ongoing multi-site randomized clinical trial revealed that individuals who received a higher exercise intensity and dose within their inpatient stroke rehabilitation were able to walk a clinically meaningful longer distance on the six-minute walk test and had a higher perception of their health status compared to those individuals that received usual care physical therapy. Conclusions: Higher exercise intensity and dose can be accurately measured and safely delivered during inpatient stroke rehabilitation. Furthermore, although preliminary results suggest that higher exercise intensity and dose may be effective at improving walking recovery and quality of life in the early phase after stroke, further analysis will need to be conducted when the complete study population is recruited to verify these findings.

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