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Researcher: Doctors should pick up the pace when improving walking skills in stroke survivors

Hornby Aha Release

T. George Hornby, PhD, left, and Flora Hammond, MD, center, work with a patient at the Rehabilitation Hospital of Indiana.

A new study led by an Indiana University School of Medicine researcher is encouraging physicians and therapists to increase the intensity when helping patients recovering from stroke find their footing.

Published in the American Stroke Association’s “Stroke Journal Report,” the study was authored by T. George Hornby, PhD—a professor with the Department of Physical Medicine and Rehabilitation at IU School of Medicine.

According to Hornby, his research suggests that to help patients recovering from a stroke improve their walking ability, high-intensity step training that mimics real-world conditions may better improve walking ability in stroke survivors, compared to traditional low-impact training.

By raising their expectations of what they think their patients are capable of, Hornby said health care professionals can put their patients on a stronger path to success.

Can you describe some of the common difficulties, or problems, people who have suffered a stroke have with walking and balance?

Most post-stroke patients have residual deficits in strength, postural stability and coordination, which results in impairments in walking function and balance in standing or during walking. Those deficits can be readily assessed during laboratory or clinical measures of walking ability, such as speed or distance, and are related to quality of life, participating and return to previous societal roles.

These deficits often vary substantially between patients, as some individuals have difficulty crossing a street before the light turns red or walking long distances. Some other patients may not be able to safely get up from a chair and go to the kitchen or bathroom, much less walk outside, and they may be dependent on someone else for help.

Watch video from Hornby’s Locomotor Recovery Lab

Prior to this study, what did traditional rehabilitation look like for those patients?

Traditional rehabilitation tends to focus on mitigating the impairments underlying walking function—such as loss of strength, balance and coordination—but also focuses on tasks a patient wants to improve, such as walking.

However, when practicing walking or other tasks, attention is given to performing the correct movement and making sure patients don’t demonstrate abnormal walking patterns, so oftentimes the patient is not exerting substantial effort or achieving high intensities, as that impairs coordination.

How do the findings of this study differ from the traditional model? What made you want to pursue looking into this difference?

In combination with previous studies from our lab, the present study suggests that focusing not only on walking, but also performing very difficult tasks and at higher cardiovascular intensities to normalize movement doesn’t appear to be as helpful for patients post stroke.

What will this study mean for people recovering from strokes?

This study will hopefully be another piece of evidence that patterns of physical practice should change to challenge our patients, so that we can optimize their function. More directly, that therapists may not have to treat their patients with kid-gloves, as the patients can tolerate not only high intensity and challenging exercise regiments, but they also demonstrate greater benefits by doing so.

It also means that the high-tech equipment that are now becoming popular may not be needed, as all of the strategies described here didn’t use them to achieve the walking outcomes.

What are the next steps in getting this new way of thinking about stroke rehabilitation into widespread use?

The next steps are focused around implementing these strategies in the clinical setting. However, that requires a large-scale, multidimensional reassessment of not only how we train our patients, but also how we train our therapists doing their initial education during graduate school and throughout their careers.

We likely need to remove the kid-gloves from ourselves and reconsider the traditional theories that we are often attached to. Rather, we believe we need to think more about better utilizing and incorporating evidence and science into our clinical practice.

Read more about Hornby’s recent study in the IU School of Medicine Newsroom. 

The views expressed in this content represent the perspective and opinions of the author and may or may not represent the position of Indiana University School of Medicine.
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Katie Duffey

Katie Duffey joined the Indiana University School of Medicine Office of Strategic Communications as assistant director in 2018 after a 14-year career in newspaper journalism. Contact Katie at