Gait: high-intensity, task-specific, measured

1. Case. A 64-year-old woman, 9 months post-stroke. Comfortable gait speed 0.45 m/s with quad cane. Berg 38/56. She wants to walk her dog in the neighborhood without holding her husband's arm.

2. CPG section. Locomotor CPG (Hornby 2020) strong recommendation: clinicians should use moderate-to-high intensity walking training (60–80% HRR or 70–85% HRmax) to improve walking speed and timed distance in individuals >6 months post-stroke, iSCI, or TBI. Strong recommendation: clinicians should use virtual reality coupled with walking training in stroke specifically. Strong recommendation against: BWSTT, robotic-assisted training, or static sitting/standing balance training (without VR) as primary locomotor interventions in this population.

3. Reasoning walkthrough. Start with the FITT prescription used in Locomotor CPG implementation studies (Holleran 2021): frequency 4x/week, intensity 70–85% HRmax (RPE ≥14/20 if HR unavailable), time 1 hour with ≥40% in target zone, type walking practice across environments — treadmill, overground, stairs, varied terrain. Boyne 2023 reported the 71 m versus 27 m 6MWT gain favoring vigorous over moderate intensity at 12 weeks in chronic stroke. Kinematic perfection is not the target; repetitions at adequate intensity are.

4. Outcome measure. 10MWT comfortable + fast, 6MWT. Stroke 10MWT MCID 0.06/0.13–0.16 m/s (Tilson 2010; Perera 2006). 6MWT MCID 34.4 m (Fulk and He 2018). Cutoffs: 0.8 m/s (Perry 1995); 6MWT ≥288 m (Fulk 2017).