Faculty Advisor(s)

Maureen Pascal



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Background/Purpose: Neuromuscular dysfunction encompasses a wide variety of conditions that impact proper muscle functioning. One common condition resulting in neuromuscular dysfunction is a cerebrovascular accident (CVA) which can disrupt sensory, motor, visual and language systems. The resulting combination of impairments can cause limitations in activity performance and restrict participation across domains. In addition, muscle weakness is widely recognized as a major contributing factor to decline in function. Literature is showing that rehabilitation programs focusing on development of core strength with emphasis on repetition, intensity and novelty are critical for recovery of motor function. The purpose of this research was to develop a modified quadruped-based exercise program appropriate for an individual with chronic stroke that utilizes the principles of repetition, intensity and novelty. The goal of intervention was to improve core muscle strength and function across gait, endurance, and subjective assessment of quality of life.

Case Description: Patient is a 57 year old Caucasian male with an 11 year history of left middle cerebral artery CVA. Prior to initiation of the study, the patient presented with impaired endurance, abnormalities of gait and posture secondary to muscle weakness in right lower extremity, impaired right upper extremity function secondary to presence of synergy pattern. The patient has received treatment at this clinic since 2014 with interventions focused on gait and strength training as well as improving upper extremity function.

Methods: Hour-long intervention sessions were conducted twice per week for eight weeks. Sessions consisted of a warm-up, wrist mobility exercises, core and shoulder muscle activations, quadruped-based stretches and traveling movements. As the individual progressed through the program, movements began to be connected into flows, and circuit training was introduced.

Results: Data was analyzed through calculation of percent change from pre-intervention to post-intervention. Notable improvements were seen in timed crawl forwards (+41.8%), timed crawl backwards (+24.82%), left grip strength (+19.5%), 6 Minute Walk Test (+3.35%), and posture (53.9% decrease in effective head weight). Improvements were also seen throughout various parameters of gait specifically pertaining to improved weight bearing through the affected side (gait velocity, step length ratio, percent single limb support ratio, integrated pressure ratio).

Conclusion: A modified quadruped-based exercise program was an effective intervention for individuals following a CVA. Therefore, the intervention provided would be advantageous to incorporate into physical therapy practice.

Clinical Relevance: Quadruped based movement would be a beneficial intervention for a variety of diagnoses. Patient modifications, to accommodate patient impairments and limitations, should be utilized to ensure safety and ability to participate in intervention.

Publication Date


Document Type



Physical Therapy


stroke, rehabilitation, quadruped, function


Physical Therapy | Physiotherapy | Rehabilitation and Therapy

Effects of Quadruped Movement in an Individual with Chronic Stroke: A Case Study