THE USE OF A LOWER EXTREMITY STEPPING EXERCISE TO IMPROVE FUNCTIONAL GAIT PERFORMANCE IN ADULTS WITH CHRONIC HEMIPLEGIA: A CASE SERIES REPORT. Ralph Garcia*; Zeshaan Qureshi; Raymond Scherer; Joey Weiss Physical Therapy, Touro College, New York, NY UNIQUE: Exercises that incorporate similar lower extremity (LE) movement patterns as gait, should be examined as potential clinical tools that could be used for gait training in persons with neurological dysfunctions, such as a cerebrovascular accident (CVA). The activity of stepping-in place (STIP) incorporates these similar movement patterns. PURPOSE: The purpose of this case report is to describe changes in functional gait performance after a STIP exercise program in adults with chronic hemiplegia. FOUNDATION: The reciprocal, rhythmical flexion and extension of the LEs demonstrated during gait may be driven by spinal stepping generators (central pattern generators) composed of neuronal networks that operate within a certain frequency range and are regulated by supraspinal centers in the brain. Though the supraspinal centers may become impaired after a CVA, central nervous system plasticity and intact descending pathways may allow for improvements in functional activities. DESCRIPTION: Two men and 2 women (mean age was 49 ± 17.6 years old) with chronic hemiplegia secondary to a single CVA (mean time since onset was 9.5 months), who were not currently involved in any form of rehabilitation or exercise program, performed the STIP exercise 2 times per week for 4 weeks. The exercise consisted of reciprocal, rhythmical flexion and extension of the LEs in the standing, sitting, and supine positions. Subjects performed 5 sets of the exercise in 20- second intervals in each position. Functional gait parameters were measured with the GAITRite Portable Walkway System.™ OBSERVATIONS: Improvements were demonstrated in velocity, stride length, and FAP score, a valid and reliable clinical measure of functional gait performance. All 4 subjects demonstrated improvements in velocity. Three subjects demonstrated improvements in right and left stride length. Two subjects demonstrated improvements in the Functional Ambulation Performance (FAP) score. Only 1 subject demonstrated improvements in velocity, right and left stride length, and FAP score. CONCLUSIONS: The outcomes suggest that some aspects of functional gait performance may be improved in adults with chronic hemiplegia after a 4-week STIP exercise program. Future studies can include a larger sample size and compare the effectiveness of the STIP exercise program to other gait training exercises or techniques on functional gait performance in persons with different neurological dysfunctions. FUNDING SOURCE: None. KEYWORDS: Cerebrovascular Accident, Gait, Stepping, Cental Pattern Generator Copyright 2009 by the American Physical Therapy Association. Requests for reprints should be directed to the corresponding author of the article. Educators, students, and other academic customers may receive permission to reprint copyrighted material from Physical Therapy (ISSN 1538-6724) by contacting the Copyright Clearance Center Inc, 222 Rosewood Dr, Danvers, MA 01923. Other types of customers who want permission to reprint should contact the APTA Editorial Office, Attn: Physical Therapy.