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Background: Improving hand and arm function is an important goal for individuals with cervical spinal cord injury (cSCI). Activity Based Therapy (ABT) is a neurorestorative approach that incorporates a high intensity, long duration and effortful engagement to garner sensory-motor improvements. Spinal cord stimulation is a neuromodulation modality that can restore sensory-motor function. Spinal cord stimulation can elevate the excitability of the spinal neural network and potentially enhance the neurorestorative benefits of ABT. However, there is scarce evidence on the combined effects of ABT and spinal cord stimulation on UL recovery after cSCI., Objective: This report aims to describe how theory informed the design and development of a Phase 1 study on a new UL intervention combining ABT and transcutaneous cervical spinal cord stimulation (tCSCS) (short form:ABT-tCSCS) delivered simultaneously for individuals with cSCI., Method: The design of the ABT-tCSCS was guided by theory-based frameworks such as the Rehabilitation treatment specification system and the Template for Intervention Description and Replication guide. The ABT-TCSCS aimed to improve somatosensory-motor deficits and function in the UL after cSCI. The ABT-tCSCS intervention was developed through the following stages: (a) Description of the active ingredients, mechanism of action, and targets of the ABT-tCSCS; (b) Tailoring of ABT-tCSCS; and (c) Development of treatment regimen guidelines for the delivery of the ABT-tCSCS., Results: ABT constitutes 4 types of exercises, including cardio-fitness, resistance, postural/weightbearing, and functional exercises, for activation of the neuromuscular system below the level of lesion to target somatosensory-motor impairments. In tCSCS, electrical stimulation is delivered at a frequency of 30-50 Hz at 500-1000 μs between C3-C7. The spinal neural networks of the cervical region are stimulated to neuromodulate the descending motor commands which control the muscles. ABT-tCSCS will be delivered simultaneously over 28 sessions (1 h/session, 3x/week over 9-10 weeks)., Conclusions: Combined ABT-tCSCS is a new intervention for neurorestoration of the upper limbs after cSCI., Trail Registration: ClinicalTrials.gov ID: NCT06472986., (© 2025 John Wiley & Sons Ltd.)

Background and Purpose: We investigated the effect of higher therapeutic exercise doses on walking during inpatient rehabilitation, typically commencing 1 to 4 weeks poststroke., Methods: This phase II, blinded-assessor, randomized controlled trial recruited from 6 Canadian inpatient rehabilitation units, between 2014 and 2018. Subjects (n=75; 25/group) were randomized into: control (usual care) physical therapy: typically, 1 hour, 5 days/week; Determining Optimal Post-Stroke Exercise (DOSE1): 1 hour, 5 days/week, more than double the intensity of Control (based on aerobic minutes and walking steps); and DOSE2: 2 hours, 5 days/week, more than quadruple the intensity of Control, each for 4 weeks duration. The primary outcome, walking endurance at completion of the 4-week intervention (post-evaluation), was compared across these groups using linear regression. Secondary outcomes at post-evaluation, and longitudinal outcomes at 6 and 12-month evaluations, were also analyzed., Results: Both DOSE1 (mean change 61 m [95% CI, 9-113], P =0.02) and DOSE2 (mean change 58 m, 6-110, P =0.03) demonstrated greater walking endurance compared with Control at the post-evaluation. Significant improvements were also observed with DOSE2 in gait speed (5-m walk), and both DOSE groups in quality of life (EQ-5D-5 L) compared with Control. Longitudinal analyses revealed that improvements in walking endurance from the DOSE intervention were retained during the 1-year follow-up period over usual care., Conclusions: This study provides the first preliminary evidence that patients with stroke can improve their walking recovery and quality of life with higher doses of aerobic and stepping activity within a critical time period for neurological recovery. Furthermore, walking endurance benefits achieved from a 4-week intervention are retained over the first-year poststroke. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01915368.

Rationale: A top priority in stroke rehabilitation research is determining the appropriate exercise dose to optimize recovery. Although more intensive rehabilitation very early after stroke may be deleterious to recovery, inpatient rehabilitation, occurring after acute care, may be a more appropriate setting to assess therapeutic dose on neurological recovery., Hypothesis: Individuals receiving higher intensity and dose exercise programs will yield greater improvements in walking ability over usual inpatient physical therapy care., Methods and Design: Seventy-five individuals across seven inpatient rehabilitation sites in Canada will be randomized into one of three treatment programs, each 5 days/week, for four weeks and monitored for exertion (heart rate) and repetitions (step count)., Study Outcomes: The primary outcome measure is the 6 min walk and secondary outcomes include functional independence, cognitive, and quality-of-life measures. Outcome data will be assessed at four time points., Summary: This trial will contribute to our knowledge of the therapeutic intensity and dose necessary to maximize functional recovery at a very important stage of rehabilitation and neural recovery poststroke.

Background: The Stroke Canada Optimization of Rehabilitation by Evidence-Implementation Trial (SCORE-IT) showed that a facilitated knowledge translation (KT) approach to implementing a stroke rehabilitation guideline was more likely than passive strategies to improve functional walking capacity, but not gross manual dexterity, among patients in rehabilitation hospitals. This paper presents the results of a planned process evaluation designed to assess whether the type and number of recommended treatments implemented by stroke teams in each group would help to explain the results related to patient outcomes., Methods: As part of a cluster randomized trial, 20 rehabilitation units were stratified by language and allocated to a facilitated or passive KT intervention group. Sites in the facilitated group received the guideline with treatment protocols and funding for a part-time nurse and therapist facilitator who attended a 2-day training workshop and promoted guideline implementation for 16 months. Sites in the passive group received the guideline excluding treatment protocols. As part of a process evaluation, nurses, and occupational and physical therapists, blinded to study hypotheses, were asked to record their implementation of 18 recommended treatments targeting motor function, postural control and mobility using individualized patient checklists after treatment sessions for 2 weeks pre- and post-intervention. The percentage of patients receiving each treatment pre- and post-intervention and between groups was compared after adjusting for clustering and covariates in a random-effects logistic regression analysis., Results: Data on treatment implementation from nine and eight sites in the facilitated and passive KT group, respectively, were available for analysis. The facilitated KT intervention was associated with improved implementation of sit-to-stand (p = 0.028) and walking (p = 0.043) training while the passive KT intervention was associated with improved implementation of standing balance training (p = 0.037), after adjusting for clustering at patient and provider levels and covariates., Conclusions: Despite multiple strategies and resources, the facilitated KT intervention was unsuccessful in improving integration of 18 treatments concurrently. The facilitated approach may not have adequately addressed barriers to integrating numerous treatments simultaneously and complex treatments that were unfamiliar to providers., Trial Registration: Unique identifier- NCT00359593.

Background: and objective. In spite of the challenges, engaging in exercise programs very early after stroke may positively influence aerobic capacity and stroke-related outcomes, including walking ability. The objective of this study was to evaluate the feasibility of adding aerobic cycle ergometer training to conventional rehabilitation early after stroke and to determine effects on aerobic capacity, walking ability, and health-related quality of life., Methods: A prospective matched control design was used. All participants performed a graded maximal exercise test on a semi-recumbent cycle ergometer, spatiotemporal gait assessments, 6-Minute Walk Test, and Stroke Impact Scale. The Exercise group added 30 minutes of aerobic cycle ergometry to conventional inpatient rehabilitation 3 days/week until discharge; the Control group received conventional rehabilitation only., Results: All Exercise participants (n = 23) completed the training without adverse effects. In the 18 matched pairs, both groups demonstrated improvements over time with a trend toward greater aerobic benefit in the Exercise group with 13% and 23% increases in peak VO(2) and work rate respectively, compared to 8% and 16% in the Control group (group-time interaction P = .71 and .62). A similar trend toward improved 6-Minute Walk Test distance (Exercise 53% vs Controls 23%, P = .23) was observed., Conclusion: Early aerobic training can be safely implemented without deleterious effects on stroke rehabilitation. A trend toward greater improvement in aerobic capacity and walking capacity suggests that such training may have an early beneficial effect and should be considered for inclusion in rehabilitation programs.