Stroke is the leading cause of chronic disability in the United States. In Northern Manhattan, forty-one percent of individuals six months post ischemic stroke residing at home are not independent in walking. Those who reach independence may continue to be disabled because of their limited community ambulation ability. Many intervention strategies have been advocated to promote recovery of gait function in individuals after stroke, yet little is known about the effects of an obstacle ambulation training program. A stratified randomized control pilot study will evaluate and compare the effectiveness of two outpatient training programs. Twenty patients with chronic sequelae from stroke will be stratified according to ambulation performance and then randomly assigned to an obstacle ambulation or an overground ambulation training group. Each group will meet twice a week for four weeks. Baseline, post-intervention and retention assessments include: temporal-spatial and kinematic variables of the subject's overground ambulation, the walking section of the Motor Assessment Scale, a standardized quality of life survey (SF-36) and a 6 minute walk. The expected results will show the obstacle ambulation training group improves significantly more than the overground ambulation training group and retains that improvement on all 4 assessments. These results should confirm that obstacle ambulation training is a more effective way to diminish disability in individuals after stroke than practice of the ambulation task itself.
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