Project 458500

One in 5 adults over age 55 suffers a stroke, the leading neurological impairment that leads to walking disability in older adults. Post-stroke, the most commonly reported goal is to return to independent walking; accordingly, this goal accounts for the most time and effort during a patient's time spent in rehabilitation. Despite this investment, health outcomes associated with walking function remain poor. Commonly, after a stroke, people struggle with anxiety, activity avoidance, and sedentary lifestyles. These outcomes are strongly associated with decreased balance confidence, regardless of walking ability. Decreased balance confidence has been shown to be a stronger predictor of falls than balance ability or leg strength after stroke. Despite these critical findings, integrating measurement of the individual's perception of, and confidence in their abilities post-stroke has received very little attention. Canadian Stroke Best Practices guidelines urge the use of motor tasks that progressively increase challenge during rehabilitation to optimize outcomes. However, there are currently no established measures to guide clinical decisions around treatment dose and intensity as it pertains to either the perceptual or actual difficulty of walking tasks. This is in sharp contrast to the training of endurance for which there are established measures such as heart rate to provide a metric for progressive approaches to training. Considering the well-established principle that too much or too little challenge can result in poor levels of motor skill mastery, it is surprising that rehab does not integrate this aspect of measurement for each patient. We will establish psychophysiological and perceptual measurement and progression guidelines for the intensity of rehab of mobility post-stroke. Individualization of rehab of mobility post-stroke could significantly improve activity levels, community reintegration and decrease falls after stroke.