The impact of modified standardized task-specific training (MSTT) on gait outcomes in persons with subacute stroke: A case report

Figures & data

Table 1. Inclusion/exclusion criteria

Inclusion	Exclusion
Confirmed diagnosis of CVA (less than 6 weeks post at time of admission to inpatient rehab)	Bilateral stroke
First time stroke OR complete gait recovery from prior stroke	Presence of severe cardiac problems (heart failure [New York Heart Association > Class 2], unstable or exercise-induced angina)
Sufficient support at home to participate in home-based fitness training program	Co-morbidities that could affect gait training (i.e. amputation, spinal cord injury, traumatic brain injury)
Able to follow one-part commands	Non-ambulatory before onset of stroke
BMI < 40	Severe lower extremity joint disease/pathology that would interfere with gait training
Age 18–80	Significant cognitive impairment (<2 on FIM cognitive subscale)

Table 2. Zeno Walkway temporal/spatial computerized gait analysis

Parameters	Initial	10 weeks	6 months	10 months	Norms
	Condition 1	Condition 2	Condition 3	Condition 3
Participant 1
Velocity (cm/sec)	7.8	26.1	31.3	43.6	120–150
Cadence (steps/minute)	28.3	50	48.2	59.2	90–120
Step length: L =	12.1	31.3	32.6	39.6	58–85
R =	20.4	31.8	46.0	45.5
Step length differential (cm)	8.3	0.5	13.4	5.9	–
Double limb support average (% gait cycle)	72.1	62.5	55.5	48.5	16–24
Single limb support (% gait cycle): L =	22.3	22.7	25.6	30.6	38–42
R =	5.5	15.0	18.5	20.8
Toe in/out (degrees L/R)	1/17.5	11.8/5.5	19.2/9.7	20.3/7.4	5–10
Base of support average [not including the cane] (cm)	17.6	13.3	7.4	6.0	8–12
Participant 2
Velocity (cm/sec)	N/A	31.6	65.2	58.8	120–150
Cadence (steps/minute)	N/A	52.8	92.1	93.8	90–120
Step length: L =	N/A	25.7	28.4	23.3	58–85
R =		35.3	57.1	52.1
Step length differential (cm)	N/A	9.6	28.7	28.8	–
Double limb support average (% gait cycle)	N/A	49.9	36.1	34.3	16–24
Single limb support (% gait cycle): L =	N/A	34.5	43.2	45.6	38–42
R =		22.9	20.9	20.4
Toe in/out (degrees L/R)	N/A	6.6/20.7	2.8/13.5	3.3/22.6	5–10
Base of support average [not including the cane] (cm)	N/A	14.5	19.4	22.7	8–12

Notes: Participant 1: Condition 1: DAJ AFO right, small based quad cane left; Condition 2: DAJ AFO right, forearm crutch left; Condition 3: DAJ AFO right, single tip cane left.

Participant 2: Condition 1: left forearm crutch, right DAJ AFO, right Swedish knee cage; Condition 2: left single tip cane, right DAJ AFO; Condition 3: right DAJ AFO.

Abbreviations: cm/sec = centimeters per second; L = left; R = right; DAJ AFO = double action joint ankle foot orthosis.

Table 3. Walking endurance, velocity, STREAM scores, FIM scores, Stroke Impact Scale scores, sensation

Measure		Initial				10 weeks			6 months (end of MSTT)					10 months
Participant 1
6MWT		41 feet, left SBQC, DAJ AFO, walked 3 min 25 s total, min-mod assistance for balance				302 feet, left forearm crutch, DAJ AFO, CGA for balance, completed 6 min			365 feet, left single tip cane, DAJ AFO, independent, completed 6 min					391 feet, left single tip cane, DAJ AFO, independent, completed 6 min
Velocity (6MWT)		0.06 m/s				0.26 m/s			0.31 m/s					0.33 m/s
STREAM: Upper extremity		5/100				5/100			20/100					20/100
Lower extremity		10/100				30/100			35/100					30/100
Mobility		33/100				40/100			37/100					40/100
Total		16/100				25/100			31/100					30/100
FIM (locomotion/stairs)		1/1				4/3			6/5					6/6
Stroke Impact Scale:
Mobility subscale		47				Not collected per protocol			69					78
Participation subscale		25							69					72
Likert scale of recovery		40							70					70
Sensation: Light touch		Intact				Intact			Intact					Intact
Vibration		Intact				Intact			Intact					Intact
Spasticity: Modified Ashworth Spasticity Scale*	Muscle	Right		Left		Right		Left	Right		Left			Right		Left
	Hip add	0		0		1		1	1		0			1		0
	Knee flex	0		0		0		0	0		0			0		0
	Knee ext	1+		0		1+		0	1+		0			1+		0
	Ankle PF	1		1		2		0	2		0			2		0
Participant 2
6MWT		Unable			428 feet with 2 brief standing rests, 6 losses of balance requiring assist for recovery, left forearm crutch, right DAJ AFO, right Swedish knee cage					882 feet, left single tip cane, right DAJ AFO, contact guard assist for safety			969 feet, right DAJ AFO, right Swedish knee cage, no assistive device, independent
Velocity (6MWT)		N/A			0.36 m/s					0.75 m/s			0.82 m/s
STREAM: Upper extremity		0/100			0/100					25/100			20/100
Lower extremity		0/100			30/100					35/100			25/100
Mobility		33/100			33/100					33/100			33/100
Total		11/100			21/100					31/100			26/100
FIM (locomotion/stairs)		1/1			4/2					4/4			6/6
Stroke Impact Scale
Mobility subscale		Not collected secondary to degree of aphasia			Not collected per protocol					75			72
Participation subscale										22			53
Likert scale of recovery										50			70
Sensation: Light touch		Absent			Impaired					Impaired			Intact
Vibration		Absent			Impaired					Impaired			Intact
Spasticity: Modified Ashworth Spasticity Scale*	Muscle	Right	Left		Right		Left			Right		Left	Right		Left
	Hip add	1+	0		1+		0			1		0	0		0
	Knee flex	0	0		1		0			0		0	0		0
	Knee ext	0	0		0		0			0		0	0		0
	Ankle PF	1+	0		0		0			0		0	0		0

Notes: Abbreviations: FIM = Functional Independence Measure; 6MWT = 6 Minute Walk Test; SBQC = small based quad cane; DAJ AFO = double action joint ankle foot orthosis; min = minimum; mod = moderate; m/s = meters per second; CGA = contact guard assistance; MSTT = Modified Standardized Task-specific Training; hip add = hip adductors; knee flex = knee flexors; knee ext = knee extensors; ankle PF = ankle plantarflexors; STREAM = Stroke Rehabilitation Assessment of Movement.

* Modified Ashworth Spasticity Scale: 0 = no increase in muscle tone; 1 = slight increase in muscle tone, manifested by a catch and release or by minimal resistance at the end range of motion when the affected part is moved in flexion or extension; 1+= slight increase in muscle tone, manifested by a catch, followed by minimal resistance throughout the remainder (less than half) of the range of motion; 2 = more marked increase in muscle tone through most of the range of motion, but the affected part is easily moved; 3 = considerable increase in muscle tone, passive movement is difficult; 4 = affected part is rigid in flexion or extension.