Pushing Statistical Roadblocks to Find Rehabilitation Potential: A Case Study
Poster presented at ACRM Annual Fall Conference October 24-30, 2025
A patient participating in post-stroke rehabilitation incorporated ARWell PRO into their intervention and experienced:
improved functional gait
increased enjoyment in rehabilitation sessions
improved movement fluidity
Summary
Research Objective
To investigate the potential for improved functional mobility outcomes in a woman three years post hemorrhagic stroke using body weight supported treadmill training and augmentative reality.
Design
Single-subject pre-post intervention study
Intervention
12 week physical therapy (PT) program with 60-75 minute PT visits 1-2 times per week. PT visits included Body Weight Support Treadmill Training (BWSTT) with forward and backward walking, ARWell PRO augmentative reality program with emphasis on side stepping, kicking, weigh shift, bilateral reaching, balance enhancement, and patient education based on observation and subject query.
Main Outcome Measures
Timed Up and Go test, 6-minute Walk Test, Gait Abnormality Rating Scale, observational gait analysis, Physical Activity Enjoyment Scale (PACES), qualitative questionnaire and diary
Results
The participant was able to demonstrate significant functional gains, including ability to walk without holding onto AD or railing while in harness, improved gait speed and endurance, improved fluidity in game playing with significant enjoyment, hope for making realistic improvements with the assist of novel activity, set up for home program with ARWell Pro, and improved steps without quad cane in home and PT settings.
Conclusions
The secret to success in this study was novelty. Novelty is a critical part of neuroplasticity principles as well as practice, practice, practice, learning and re-learning. While several well-researched colleagues stated hesitancy or skepticism about our BWSTT regimen, based on the evidence, we envisioned outcomes that were not based on guidance of early recovery. Our hope was to apply principles of neuroplasticity toward breaking up habits and opening doors for a participant with nearly 2 year old stroke. Our subject participated in a BWSTT regimen, using forward and backward walking, far past the ideal window for early recovery because she is still driven to improve and her pattern of gait at baseline was far from optimal for someone who desires to be a community ambulator. Because single subjects cannot contribute to statistical curves does not mean that their outcomes do not matter. Well-funded CVA research necessarily follows a hierarchical valuation of research and statistical significance. It seeks the greatest good for the largest numbers. Too often, we put all our eggs in that basket when making common clinical assumptions for a single subject. In the case of our participant, it would have meant we bowed to that necessary bias and chose not to move forward. While participants such our may lack the numbers in the literature, they still have many relevant principles of neuroplasticity that apply. So often, while known to lone clinicians, they are not taken advantage of to further rehabilitation and functional outcomes based on the evidence. Fortunately, the relevant aim of engaging patients in meaningful and enjoyable activity will always be a valid and reliable neuroplastic principle, and thus with that justification alone, we proceeded. Novel activity did break up our participants rut. While walking on the treadmill in the harness, she was able to experience walking with no hands for the first time since her stroke. She has noted that she can now walk backwards over the ground. Her recurvatum has improved. She walks with far less circumduction and extensor synergy. She has retained and improved all gait characteristics while adding new ones. She has had no falls, greater endurance, and longer more enjoyable days. She smiles and laughs during her augmentative reality sessions. She has found a new community of support and envisions, albeit a slow pace, new possibilities, including stair climbing. These are not gains that could have come without the drive of novelty. Our participant will continue the study with future students with a design that will continue to use neurological principles based on her desires and the role of novelty, salience, and practice, practice, practice.