Date of Award

6-2026

Degree Name

Doctor of Philosophy

Department

Interdisciplinary Health Sciences

First Advisor

Diane Dirette, Ph.D.

Second Advisor

Rob Lyerla, Ph.D.

Third Advisor

Amy Yorke, Ph.D.

Keywords

Balance, gait training, high intensity, stroke, walking

Abstract

Objective: The purpose of this study is to examine the relationships between personal factors and High-Intensity Gait variables and balance and walking improvement in an outpatient stroke population.

Background: Stroke is a leading cause of long-term disability, with persistent gait and balance impairments commonly limiting independence and participation. High-intensity gait training (HIGT) is an evidence-based rehabilitation approach that improves walking outcomes following stroke; however, guidance on how specific training variables are applied in outpatient physical therapy settings remains broad.

Methods: This retrospective observational study analyzes clinical data from outpatient physical therapy episodes in which HIGT is a primary intervention. Personal factors include age, stroke severity, and stroke chronicity. HIGT variables include visit frequency, total number of visits, duration of gait training per session, type of walking practice, and the proportion of sessions reaching target training intensity. Balance and walking outcomes are assessed using percentage change scores on the Berg Balance Scale, Functional Gait Assessment, Ten Meter Walk Test, and Six Minute Walk Test. Multiple linear regression models are used to examine associations between predictors and outcomes. Exploratory spline models are used to evaluate potential nonlinear relationships.

Results: Results indicate that walking outcomes are most strongly associated with cumulative therapy exposure and training intensity, whereas balance outcomes demonstrate greater variability and possible nonlinear patterns. Age and stroke chronicity do not consistently predict improvement, while stroke severity is associated with proportional gains for walking endurance and speed. The single predictor that was associated with improvements in walking speed and endurance was the number of therapy visits an individual received.

Conclusion: These findings suggest that improvements in balance and walking following outpatient stroke rehabilitation are associated with both personal factors and the specific manner in which HIGT is delivered. Prioritizing higher frequency of visits or number of therapy visits, as well as target intensity during HIGT interventions in outpatient therapy, could optimize balance and walking outcomes following stroke. This study was exploratory in nature, and future studies that include non-linear analysis and variables affecting participation in outpatient therapy are recommended.

Access Setting

Dissertation-Open Access

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