Effects of task-specific paretic ankle plantar flexor training on walking in a stroke patient: a single-case study.
Shingo Miyata, Shigeru Terada, Nobumasa Matsui and 1 others
PMID 29581668WHAT IT FOUND
A stroke patient added task-specific heel-raise training to outpatient range-of-motion, standing practice, and daily home walking.
Paretic plantar flexor strength, walking speed, step length, and trailing limb angle improved; a single case cannot prove the exercise works.
Key findings
01The authors judged improvement when repeated measurements exceeded the baseline variability band; paretic plantar flexor strength, maximum walking speed, step length, and trailing limb angle were judged improved during training, and walking speed, step length, and trailing limb angle remained improved after training.
02Task-specific heel-raise training was added to ongoing outpatient range-of-motion and standing practice and daily home walking, so the contribution of the heel-raise training alone cannot be separated.
03Gait video showed increased hip extension angle and heel lift distance at paretic terminal stance during training, but no changes in ankle plantar flexion angle or knee flexion angle in paretic pre-swing.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
This is a single-subject study, so the result describes one patient and does not show that the exercise works for others. The task-specific heel-raise training was added to ongoing outpatient range-of-motion and standing practice and daily home walking, so the contribution of the heel-raise training alone cannot be separated. The patient was Brunnstrom recovery stage V and outdoor-independent, so the result is from a patient who could already walk outdoors. No rapid ankle plantar flexion or knee flexion was seen in paretic pre-swing after training, so the exercise did not reproduce all walking demands.
Declared interests
The paper reports no conflicts of interest.
The easy way to misread this
Do not conclude that task-specific heel-raise training caused the improvements. This was a single-subject study, and the training was added to existing outpatient range-of-motion, standing practice, and daily home walking, so the contribution of any single component cannot be separated.