People who’ve had a stroke often need physical therapy as part of their recovery. Though most are age 65 or older, high-intensity gait training can be the fastest way for these patients to regain their ability to walk.
UAB Spain Rehabilitation Center is implementing a new program that focuses on high-intensity gait training (HIGT) as the preferred approach for helping patients walk again after a stroke. Spain Rehab patient Marvin Windham is happy to be among the first to benefit from this program, which is helping him get his life back.
Windham, 71, had a stroke in June 2024 that caused slurred speech and loss of control on the right side of his body. It was a hemorrhagic stroke, which is the less common type but more dangerous, as the burst blood vessel in the brain can quickly kill or damage brain cells. Windham didn’t hesitate to go to the UAB Medicine Emergency Department, and fortunately he did not need a procedure to stop the bleeding.
“I wasn’t shocked that I could have a stroke at 71, but I was at least surprised, because I have a high level of cardio fitness,” said Windham, an avid golfer. “I’m retired, and I walked and played the entire Inverness Country Club course three times a week prior to this. That’s a course known for being hilly and tiring – it’s about six miles long.”
HIGT highlights
After a stay in UAB Hospital, Windham was moved to UAB Spain Rehabilitation Center to undergo inpatient physical rehabilitation. Spain Rehab’s physical therapists specialize in stroke recovery for a wide range of patients facing various levels of physical and cognitive challenges.
The Spain Rehab team told Windham that he likely could regain most of his lost mobility over the following six months, but the first several weeks would be important. They asked Windham if he wanted to participate in a pilot program of HIGT, a research-backed approach in which patients do plenty of walking with assistance, which elevates their heart rates and helps them make progress more quickly.
“There’s been a lot of research over the last 10-15 years that has changed our thought process on how we need to address deficits after a stroke,” said Katie Blackburn, the physical therapist who worked with Windham. “If we want to help patients recover the ability to walk, we need to get them walking as much as possible. And the research has shown that it’s important for them to elevate their heart rate to a high level for a specific amount of time.”
A person’s gait is his or her normal walking pattern. With HIGT, the goal is for patients’ heart rate to reach 70-85% of their maximum in each session.
“HIGT improves multiple impairments at the same time,” Blackburn said. “For example, patients may get better at rolling out of bed as well as going to the bathroom on their own, without training on those specific moves. It’s a more efficient way to make big improvements, and it’s one that many patients can do.”
HIGT at Spain Rehab
HIGT is a well-established method, but therapists needed to problem-solve the best way to implement this program on the stroke unit at Spain Rehab. “We needed to work out how it could be standardized,” Blackburn said. “This meant accounting for patient volume, specialized equipment to help them move – such as harnesses and overhead tracks – the personnel needed, and measures of success.”
Beyond the equipment needed and the ability of each patient, attitude also matters. “Patients really do need to be agreeable to pushing themselves a bit, because they’re going to feel the exertion more than with some other types of therapy,” Blackburn added.
That wasn’t a problem for Windham. “I had shifted my thinking to getting past this, and I was ready to work hard for it,” he said. “I was excited when I heard about the potential for this to truly change my life.”
Rapid improvement
“It took a team of three people to get me up on the treadmill my first day at Spain Rehab,” Windham recalled. “It took work from me, but it was harder on Katie those first few days, to be honest.”
Windham saw improvement within three days of his 24-day inpatient stay, and his team gradually let him do more of the work. “Within the first week, I started to see dramatic results,” he said. “I was able to stand up, with some supervision, and transfer from the wheelchair to the bed and to the bathroom.”
“Research indicates that if we can get patients to the point of being able to walk with minimal manual assistance, we know that they’ll be much more independent back home and more successful with ongoing therapy,” Blackburn said.
Within just a few weeks, Windham was able to walk 150 feet and climb a full flight of stairs with minimal assistance. He continues to undergo physical therapy, including at home. “I ordered a recumbent (stationary) bike, so I can start training every day safely at the house,” he said, adding that he’s optimistic about playing golf again using a cart. “HIGT was a great jumpstart to recovery, but I have to keep working.”
Blackburn says the results from HIGT are inspiring – so much so that she has to remind patients to take precautions at home. “We can do a lot in mere weeks to start that process,” she said. “But stroke recovery is ongoing, and many people are going to need their family to help keep them safe and maintain their progress.”
Click here to learn more about UAB Spain Rehabilitation Center.