Faster treadmill walking facilitates a more normal walking pattern after stroke, without concomitant increases in common gait compensations, such as circumduction. The improvements in gait deviations were observed with small increases in walking speed.

The specific descriptors of walking activity presented provide insight into walking deficits after stroke that cannot be ascertained by looking at steps per day alone. The deficits that were revealed could be addressed through appropriate exercise prescription, underscoring the need to analyze the structure of walking activity.

Background and Purpose In rehabilitation, examining how variables change over time can help to define the minimal number of training sessions required to produce a desired change. The purpose of this study was to identify the time course of changes in gait biomechanics and walking function in persons with chronic stroke. Methods Thirteen persons > 6 months post-stroke participated in 12 weeks of fast treadmill training combined with plantar- and dorsi-flexor muscle functional electrical stimulation (FastFES). All participants completed testing before the start of intervention, after 4, 8 and 12 weeks of FastFES locomotor training. Results Peak limb paretic propulsion, paretic limb propulsive integral, peak paretic limb knee flexion, (p<0.05 for all) and peak paretic trailing limb angle (p<0.01) improved from pre-training to 4 weeks but not between 4 and 12 weeks. Self-selected walking speed and 6-minute walk test distance improved from pre-training to 4 weeks and from 4 to 12 weeks (p<0.01 and p<0.05, respectively for both). Timed Up & Go test time did not improve between pre-training and 4 weeks, but improved by 12 weeks (p=0.24 and p<0.01, respectively). Discussion and Conclusions The results demonstrate that walking function improves with a different time course compared to gait biomechanics in response to a locomotor training intervention in persons with chronic stroke. Thirty-six training sessions were necessary to achieve an increase in walking speed that exceeded the MCID. These finding should be considered when designing locomotor training interventions after stroke. Video Abstract available (see Video, Supplemental Digital Content 1) for more insights from the authors.