Sarah M. Schwab

Background: People with stroke have historically had limited involvement in physical and occupational therapy research studies. Scientists and funders, rather than those most affected by the outcomes of research, largely make decisions about what studies should focus on. When research is not informed by the lived experiences of people with disability, researchers may ask the wrong questions or make incorrect assumptions about disability. Objective: The purpose of this study was to identify desired features and characteristics for physical and occupational therapy research studies, from the perspective of people with chronic stroke. Methods: We completed four iterative focus group discussions with a small group of adults with chronic stroke. The group was purposively sampled to ensure a range of prior stroke research experiences and stroke‐related impairments. Thematic analysis was conducted on discussion content to identify desired study features. Results: Four major desired study features were constructed: (1) Desire for relationships; (2) Understand the purpose; (3) Capability‐oriented; and (4) Focused on individual participation needs. Participants expressed a desire for physical and occupational therapy studies to focus on what they can do (rather than what they cannot do) while also embracing the heterogeneity of stroke presentation. Studies involving elements of stroke community support and an understanding of potential benefits or information about stroke are also desired. Conclusion: Collaborative research design can contribute to future research that is authentic and valuable to people with lived experience while concurrently lessening harmful disability narratives that are often unintentionally maintained by non‐disabled researchers. By working with a group of adults with chronic stroke, we were able to identify valued study features that can be incorporated into future stroke research studies. Lived Experience or Public Contribution: Individuals with lived experience of stroke engaged in the discussions presented in this paper to collaboratively identify desired stroke study features. People with stroke were also involved in the developing interpretation of the presented data and reviewed the final version of the manuscript.

Background: Moderate- to high-intensity walking training (M-HIT) is an established intervention for improving walking capacity in chronic stroke. Musculoskeletal (MSK) adverse events commonly occur during M-HIT, yet tools to identify individuals at higher risk are limited. Baseline clinical characteristics may provide insight into susceptibility to training-related MSK adverse events during M-HIT. Thus, this study aimed to develop and internally validate a model for predicting MSK adverse events during a 12-week M-HIT program in chronic stroke using baseline clinical characteristics. Methods: Participants (n=100) from HIT-Stroke Trials 1 and 2 were included. Baseline clinical characteristics included measures of orthopedic history, pre-existing pain, motor function, recent exercise history, demographics and health characteristics, stroke chronicity, and psychological health. Logistic regression models evaluated all possible combinations of baseline characteristics with up to three predictors. Leave-one-out cross-validation was used for internal validation to mitigate overfitting. Predictive performance was quantified using the C-statistic, and the candidate model with the highest cross-validated C-statistic was selected as the final model. Results: MSK adverse events occurred in 32.0% of participants. The optimal three-variable model included prior orthopedic condition (Odds ratio [OR] 3.02 [95% CI 1.14-8.64]), Fugl-Meyer lower extremity motor score (OR 1.14 [95% CI 1.02-1.28]), and self-reported participation in regular walking exercise (OR 0.17 [95% CI 0.05-0.49]) at baseline. This model demonstrated moderate discrimination (cross-validated C-statistic = 0.74; apparent C-statistic = 0.78). Conclusions: Participants reporting at least one pre-existing lower extremity or lumbar spine orthopedic condition and those with better lower-extremity motor function exhibited greater odds of experiencing MSK adverse events during M-HIT, while participants reporting participation in regular walking exercise had lower odds. These findings suggest that baseline clinical characteristics may help identify individuals at elevated risk for MSK adverse events during M-HIT who may warrant closer monitoring or risk-reduction strategies. Future studies are needed for external validation. Clinical Trial Registration: https://ClinicalTrials.gov ; Unique identifiers: NCT03760016 , NCT06268041

Individuals in the Hispanic and Latino community have the lowest levels of post-stroke function compared to other races and ethnicities and are poorly represented in stroke rehabilitation research studies. To understand the Hispanic and Latino perspective on stroke and rehabilitation research in the midwestern United States. An academic-community partnership was formed between stroke rehabilitation researchers and community experts. Over a 9-month period, we developed and administered a survey and conducted focus group discussions aimed at understanding Hispanic and Latino perspectives on stroke and rehabilitation research. Themes from focus group discussions were abstracted using inductive thematic analysis. The survey identified that there are concerns which may limit research participation in general and that family comfort with the research team is valued. Three themes emerged from focus group discussions: (1) Research Engagement and Information; (2) Stroke Knowledge; and (3) Community Contextualization and Cultural Congruence. While generally interested in research and motivated to attain additional information, participants were widely unaware of stroke and rehabilitation research opportunities and reported limited stroke knowledge. Participants noted language differences as a critical concern, and there was a strong desire to understand the community impact of research. Limited information exchange and limited understanding of stroke are concerns among the Hispanic and Latino community in the midwestern United States. It is necessary for stroke and rehabilitation research teams to engage in productive information sharing and enhance relationships with community partners.

People with stroke (PwS) often exhibit altered postural control, and concomitant stroke-related communication disorders (e.g., aphasia, dysarthria) may be an underrecognized risk factor for post-stroke falls. This heightened fall risk may be related to alterations in postural control that emerge during different speaking and listening conditions. This study evaluated how variations in the relative articulatory demands during speech production-termed "oral-motor complexity"-affect postural center of pressure (COP) patterns among PwS, both with communication disorders (PwS-CDis) and without (PwS). Three groups of adults (PwS, PwS-CDis, and a nondisabled Control group) stood on a force platform while completing four 30-second quiet stance trials, followed by twelve 30-second trials randomized across three experimental conditions of varying oral-motor complexities ("ba", "puh tuh kuh", "rah shah lah nah"). COP variability (SD) was significantly higher during experimental conditions compared to quiet stance, regardless of group and movement plane. Differences in nonlinear time-dependent metrics were found across oral-motor task conditions, particularly among PwS-CDis, suggesting oral-motor complexity may influence underlying postural-motor organization. Distinct temporal-dynamical patterns observed in PwS-CDis indicate a possible link between pathology, postural control, and speech motor tasks, which is relevant when evaluating postural control in individuals with stroke-related communication disorders.

Individuals post-stroke commonly demonstrate alterations in motor behavior with regard to both task performance and the motor strategies used in pursuit of task goals. We evaluated whether constraining postural sway (motor strategy) during practice would affect upper-limb precision aiming performance (task performance) and postural control adaptations. Adults with stroke stood on a force plate while immersed in a virtual scene displaying an anterior target. Participants aimed to position a virtual laser pointer (via handheld device) in the target. Participants then completed practice trials involving aiming at a lateral target. For this practice session, participants were randomized to either (a) a "constraint" group wherein they received physical constraint to limit postural sway, or (b) a "no-constraint" group. Task performance and postural control were assessed before and after practice, and transfer to another upper-limb task was evaluated. After practice, both groups improved paretic upper-limb performance. For the target task, the no-constraint group showed task-sensitive changes in postural control. The constraint group showed no changes in postural control. At transfer, the constraint group increased postural sway. Constraining postural sway after stroke should be carefully considered with the recognition that postural sway arises from exploratory movements involved in the discovery of adaptable motor solutions.

People with stroke (PwS) often exhibit altered postural control, and concomitant stroke-related communication disorders (e.g., aphasia, dysarthria) may be an underrecognized risk factor for post-stroke falls. This heightened fall risk may be related to alterations in postural control that emerge during different speaking and listening conditions. This study evaluated how variations in the relative articulatory demands during speech production—termed “oral-motor complexity”—affect postural center of pressure (COP) patterns among PwS, both with communication disorders (PwS-CDis) and without (PwS). Three groups of adults (PwS, PwS-CDis, and a nondisabled Control group) stood on a force platform while completing four 30-second quiet stance trials, followed by twelve 30-second trials randomized across three experimental conditions of varying oral-motor complexities (“ba”, “puh tuh kuh”, “rah shah lah nah”). COP variability (SD) was significantly higher during experimental conditions compared to quiet stance, regardless of group and movement plane. Differences in nonlinear time-dependent metrics were found across oral-motor task conditions, particularly among PwS-CDis, suggesting oral-motor complexity may influence underlying postural-motor organization. Distinct temporal-dynamical patterns observed in PwS-CDis indicate a possible link between pathology, postural control, and speech motor tasks, which is relevant when evaluating postural control in individuals with stroke-related communication disorders.

Objective To investigate longitudinal changes in spatiotemporal gait parameters after maximal versus moderate speed locomotor training in chronic stroke, by comparing short-burst high-intensity interval training (HIIT) versus moderate-intensity aerobic training (MAT). Compared to MAT, short-burst HIIT was hypothesized to exhibit greater improvement in non-paretic step length. Design Secondary analysis from the HIT-Stroke randomized controlled trial Setting Three rehabilitation research centers Participants Individuals with chronic stroke and residual walking limitations (N=55) Interventions Participants were randomized to short-burst HIIT (N=27) or MAT (N=28) for 45 minutes of walking practice, 3 times weekly, over 12 weeks. HIIT involved 30-second bursts of maximum walking speed, targeting >60% heart rate reserve (HRR). MAT involved continuous walking, targeting 40%-60% HRR. Main Outcome Measure(s) Mean spatiotemporal gait parameter changes between groups, averaging the 4-week, 8-week, and 12-week estimates minus baseline. The primary measure of interest was non-paretic step length, an indicator of paretic propulsion and biomechanical efficiency. Results Non-paretic step length increased significantly more in the HIIT group (+4.4 cm [95% CI, 1.9, 6.9]) compared to the MAT group (+0.1 [-2.5, 2.7]; HIIT vs. MAT p = .01). Both groups demonstrated significant increases in cadence, paretic step length, and bilateral single support time, and significant decreases in the coefficient of variation (CV) for stride velocity, stride time, and stride length. Symmetry measures did not significantly change in either group. Conclusions Greater increases in non-paretic step length with short-burst HIIT suggest that maximal speed training may yield greater increases in paretic propulsion, a marker of biomechanical efficiency. Both moderate and maximal speed training (MAT and HIIT) appear to reduce spatiotemporal variability, possibly indicating improved gait stability.

In this chapter, we describe how the concept of affordance has impacted the field of disability studies and how it can guide a necessary paradigm shift in physical therapy practice, centered on the experiences of people with disability. In particular, we review the work of disability scholars and activists who describe the daily challenges experienced by people with disability as a result of living in a world that does not readily complement their bodily capabilities and skills. People with disability respond by using their bodily performances to create previously unimagined affordances through deliberate and effortful action termed activist affordances. We demonstrate how the concept of activist affordances invites an understanding of disability that is both embedded and embodied. The chapter concludes with our proposition of a new vision for physical therapy practice inspired by this understanding of disability and a description of pathways for future affordance research that is needed to support the desired shift in physical therapy practice.

Interprofessional collaboration among speech-language pathology, physical therapy, and occupational therapy is considered to promote best practice in rehabilitation as it can enhance efficiency, patient outcomes, and clinician and patient satisfaction. Although clinician experiences with interprofessional collaboration have been studied in each of the rehabilitation professions separately, limited research has been conducted on the shared attitudes or experiences across speech-language pathology, physical therapy, and occupational therapy. The purpose of this study was to understand speech-language pathologist, physical therapist, and occupational therapist experiences of interprofessional collaborations. We conducted an exploratory cross-sectional online survey study. The survey included Likert-scale questions and open-ended questions that probed clinicians' general experiences with interprofessional practice and views and beliefs regarding barriers and facilitators to interprofessional collaboration. Responses from 213 clinician respondents were analyzed using descriptive quantitative methods and a qualitative content analysis. The results revealed overlap in attitudes and experiences across speech-language pathology, physical therapy, and occupational therapy about barriers and benefits to interprofessional collaboration. Perceived respect differed among the professions, with speech-language pathologists more frequently reporting that their role is often misunderstood or undervalued by other rehabilitation professionals. These results may guide future research focused upon the predictors of successful interprofessional collaborations and interactions.