Enhanced Life-Role Participation in Response to Comprehensive Gait Training in Chronic-Stroke Survivors

Svetlana Pundik, Case Western Reserve University
John Peter Holcomb, Cleveland State University
Jessica McCabe, Cleveland VA Medical Center
Janis J. Daly, University of Florida College of Medicine


Purpose: Intensive gait training can produce improvements in gait and function (>6 months after stroke); however, findings are mixed for enhanced life-role participation. Therefore, it is unclear if improved gait and function translate into life-role participation gain. Our objective was to evaluate whether intensive gait therapy can produce improvements in life-role participation for chronic-stroke survivors, according to a comprehensive measure dedicated to life-role participation. Methods: In conjunction with a clinical gait-training trial, we conducted a secondary analysis for a 44-member cohort with stroke (>6 months). Gait-training interventions included functional neuromuscular stimulation, body-weight supported treadmill training, over-ground gait training and exercise for 1.5 hours/day, 4 days/week for 12 weeks. Study measures included Tinetti Gait (gait impairment), Functional Independence Measure (FIM, function), Stroke Impact Scale subscale of life-role participation (SIS part) and Craig Handicap Assessment and Reporting Technique (CHART, life-role participation). Analysis included Wilcoxon signed rank test and polytomous universal regression model. Results: Gait interventions produced significant improvement in CHART (p = 0.020), SIS part (p = 0.011), FIM (p < 0.0001), and Tinetti Gait (p < 0.0001). Age, gender and time since stroke did not predict response to treatment. Conclusions: Intensive gait therapy resulted in significant gain in life-role participation, according to a comprehensive measure, so dedicated. Implications for Rehabilitation: (1) It is important to measure life-role participation in rehabilitation intervention studies, and using a homogeneous measure of life-role participation provides clear results. (2) Intensive gait training produced a significant improvement in life-role participation in the chronic phase after stroke. (3) Functional electrical stimulation (FES) had no significant additive effect on life-role participation during the treatment phase, but FES did have an additive effect during the follow-up period in enhancing life-role participation beyond that obtained using an identical comprehensive gait-training intervention without FES.