Citation

Pollock CL, Boyd LA, Hunt MA, Garland SJ. Phys. Ther. 2014; 94(4): 562-570.

Affiliation

C.L. Pollock, School of Rehabilitation Sciences, University of British Columbia, Vancouver, British Columbia, Canada.

Copyright

(Copyright © 2014, American Physical Therapy Association)

DOI

10.2522/ptj.20130046

PMID

24363337

Abstract

BACKGROUND AND PURPOSE: Stepping reactions are important for walking balance and community-level mobility. Stepping reactions of people with stroke are characterized by slow reaction times, poor coordination of motor responses and low amplitude of movements, which may contribute to their decreased ability to recover their balance when challenged. An important aspect of rehabilitation of mobility following stroke is optimizing the motor learning associated with retraining effective stepping reactions. The Challenge Point Framework (CPF) optimizes motor learning by manipulating conditions of practice to modify task difficulty, i.e. the interaction of the skill of the learner and the difficulty of the 'to-belearned' task. This case series illustrates how the retraining of multi-directional stepping reactions may be informed by the CPF to improve balance function in people with stroke. CASE DESCRIPTION: Four people (53-68 years of age) with chronic stroke (> 1year) with mild to moderate motor recovery, participated in four weeks of multi-directional stepping reaction retraining. Important tenets of motor learning were optimized for each individual during retraining in accordance with the CPF. OUTCOMES: Participants demonstrated improved community-level walking balance on the Community Balance and Mobility Scale. These improvements were evident one year later. Aspects of balance related self-efficacy and movement kinematics also demonstrated improvement over the intervention. DISCUSSION: The application of CPF motor learning principles appears promising in retraining of stepping reactions to improve community-level walking balance in people with chronic stroke. The CPF provides a plausible theoretical framework in neurorehabilitation for the progression of functional task training and would benefit from further investigation.

Language: en