High-Intensity Gait Training in a Post-COVID, Chronic Stroke Patient: A Case Report

Background: Current standards of stroke rehabilitation emphasize lower-intensity aerobic exercise and involve limited stepping practice, which are often inadequate to address the long-term deconditioning and mobility impairments following a stroke. A newer approach, high-intensity gait training, may meet the intensity thresholds required to address the effects of deconditioning and promote motor recovery, reducing the risk for recurrent stroke. Little is known, however, about the effectiveness of high-intensity gait training in maximal-assist stroke patients or those with significant cardiorespiratory comorbidities. The purpose of this case report is to highlight the implementation and use of high-intensity gait training in a post-COVID, chronic stroke patient with high-level gait impairments. Case Description: Seven months after hospitalization for a severe COVID-19 infection and a subsequent stroke, a 64-year-old male presented to outpatient physical therapy with significant mobility deficits and no independent ambulation ability. Intervention: Thirteen high-intensity gait training sessions, each lasting approximately 1 hour, were performed over a period of 8 weeks. Target intensity ranged from 70-80% of age-predicted heart rate max for 30-50% or more of each session and various equipment strategies were utilized to provide bodyweight support and facilitate successful stepping. Outcome Measures: Primary outcome measures utilized were the SwePASS, Functional Reach Test, and 6-minute walk test, in addition to qualitative analysis of gait, amount of successful stepping, and level of assistance required to ambulate. Discussion: This case report demonstrates the successful implementation of high-intensity gait training in a chronic, maximal-assist stroke patient with a comorbidity of severe COVID-19 infection at the time of stroke.