Article

Feedback about performance may optimize motor relearning after
stroke. OBJECTIVES: Develop an international collaboration to rapidly test the
potential efficacy of daily verbal feedback about walking speed during inpatient
rehabilitation after stroke, using a protocol that requires no research funds.
METHODS: This phase 2, single-blinded, multicenter trial randomized inpatients to
either feedback about self-selected fast walking speed (daily reinforcement of
speed, DRS) immediately after a single, daily 10-m walk or to no reinforcement of
speed (NRS) after the walk, performed within the context of routine physical
therapy. The primary outcome was velocity for a 15.2-m (50-foot) timed walk at
discharge. Secondary outcomes were walking distance in 3 minutes, length of stay
(LOS), and level of independence (Functional Ambulation Classification, FAC).
RESULTS: Within 18 months, 179 participants were randomized. The groups were
balanced for age, gender, time from onset of stroke to entry, initial velocity,
and level of walking-related disability. The walking speed at discharge for DRS
(0.91 m/s) was greater (P = .01) than that for NRS (0.72 m/s). No difference was
found for LOS. LOS for both DRS and NRS was significantly shorter, however, for
those who had mean walking speeds >0.4 m/s at entry. The DRS group did not have a
higher proportion of FAC independent walkers (P = .1) and did not walk longer
distances ( P = .09). CONCLUSIONS: An Internet-based collaboration of 18 centers
found that feedback about performance once a day produced gains in walking speed
large enough to permit unlimited, slow community ambulation at discharge from
inpatient rehabilitation.

Langue : ANGLAIS