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Doctor of Physical Therapy student Rachel Scherbenske (left) checks in with community study participant Kim Ford several times weekly. Ford (right) has a current goal of walking 4,000 steps a day.
Doctor of Physical Therapy student Rachel Scherbenske (left) checks in with community study participant Kim Ford several times weekly. Ford (right) has a current goal of walking 4,000 steps a day.

Bridging the gap

Photos by Evan Krape and Ashley Barnas Larrimore

UD physical therapy stroke study aims to improve health one step at a time

It was a hot summer day on June 6, 2019, when Kim Ford felt so incredibly hot that she couldn’t keep her clothes on. She was working from home in customer care when she tripped and couldn’t get up. Before she knew it, she was in an ambulance, heading to Christiana Hospital, where EMTs pointed to her husband’s wrist and asked her what was on it. She couldn’t answer them. 

Ford, who was 50 years old at the time, had what doctors described as a one-in-a-million stroke. Covering the entire left side of her brain, Ford suffered cognitive deficits that affected her memory. That’s how she linked up with the University of Delaware College of Health Sciences, where she’s participated in several studies for stroke survivors, including the five-year PROWALKS clinical trial led by Darcy Reisman, professor and chair of the Department of Physical Therapy. The PROWALKS study emphasized daily walking activity in the community through step monitoring, goal setting, and coaching. These efforts resulted in significant improvements in gait, walking speed, and endurance. Interestingly, only participants with FitBits who received a behavioral intervention improved their daily step count. That finding spawned the subsequent community-based study, in which Reisman seeks to bridge the gap between clinic research and community implementation. 

The 12-week community study optimized walking capacity in stroke survivors like Ford. It’s similar to PROWALKS but substitutes licensed physical therapists with non-licensed doctor of physical therapy (DPT) students to test feasibility and determine whether the intervention can be implemented in community settings like senior centers. 

“High-intensity walking is good at improving a person’s capacity for doing something, but it doesn’t change actual behavior,” explained Reisman. “If we want to improve what people do in their real life outside the clinic, we need a behavioral intervention that can be delivered potentially by non-licensed people. With PROWALKS, this is where we saw bang for our buck in improving actual performance.”

Reisman’s community study is funded through a generous grant from WeRunWithYou, a nonprofit co-founded by marathon runner and brain aneurysm survivor Kathy Nguyen of Newark, a former patient at UD’s Physical Therapy Clinic. WeRunWithYou helps survivors overcome perceived limitations and return to doing what they love while raising funds for brain aneurysm research. 

“We are excited to support UDPT and fund this multi-year research project for advancing post-stroke and brain aneurysm rehabilitation technologies and techniques,” Nguyen said. “We hope it will make a difference in the lives of many stroke and brain injury survivors for years to come.” 

WeRunWithYou is also raising money through the Run4Rehab campaign, associated with the Philadelphia Marathon, in partnership with UDPT students and stroke survivors participating in the study and the marathon. Nguyen praised UDPT students for choosing a path of service. 

“Their participation in this study will provide them with valuable experience and an opportunity to make a difference in the community,” said Nguyen. 

UD’s Department of Physical Therapy was awarded a grant from the local non-profit organization WeRunWithYou to fund research in stroke survivors. WeRunWithYou cofounder Kathy Nguyen (second from left, front), a former UDPT Clinic patient, survived a brain aneurysm in 2015 and was present with her husband and co-founder Rob Alvarez (L front) for the check presentation on STAR Campus.
UD’s Department of Physical Therapy was awarded a grant from the local non-profit organization WeRunWithYou to fund research in stroke survivors. WeRunWithYou cofounder Kathy Nguyen (second from left, front), a former UDPT Clinic patient, survived a brain aneurysm in 2015 and was present with her husband and co-founder Rob Alvarez (L front) for the check presentation on STAR Campus.

Improving health through experiential learning

UD’s community study has empowered Ford, who also has diabetes, to take control of her health. Before the study, she was only taking 400 steps per day.

“Now, I’m averaging 4,000 steps daily, and my blood sugar is also down,” said Ford.  

She meets weekly with her accountability partner, DPT student Rachel Scherbenske, who’s running the Philadelphia Half Marathon in November to help raise money for stroke and brain aneurysm research. 

“She said she was a homebody, so I encouraged her to check the mail or take out the trash to get extra steps,” said Scherbenske. “Finding little ways to help increase step count through basic day-to-day activities was key.” 

Ford’s long-term goal is to take 10,000 steps per day. 

“We have eight more weeks to reach that goal!” She smiled, “I think I can do it.” 

Scherbenske was one of several DPT students who jumped at the chance to volunteer for this study.

“I’ve learned about the power of a simple conversation,” Scherbenske said. “It’s exciting to help Kim improve her overall health and well-being. That’s why I went into the PT profession.”

Jackie Linton of New Castle was driving to work in March 2020 when COVID hit, and she lost use of her right arm. She had a hemorrhagic stroke. 

“I’m a couch potato, but I knew I needed to walk more,” said Linton. “Now, I’m hitting my 8,000-step goal daily—unless it’s raining. I feel more energized.” 

Her accountability partner, DPT student Jenna Mlecko, who also plans to run the Philly Half Marathon, keeps her motivated. 

“I appreciate the opportunity to have more contact with patients and follow them on this 12-week journey,” said Mlecko. “I’ve learned a lot about changing someone’s life in their environment with their own resources.” 

Doctor of Physical Therapy student Jenna Mlecko (right) is an accountability partner for Jackie Linton (left). Linton, who had a stroke in 2020, now aims to walk 8,000 steps per day.
Doctor of Physical Therapy student Jenna Mlecko (right) is an accountability partner for Jackie Linton (left). Linton, who had a stroke in 2020, now aims to walk 8,000 steps per day.

Carolyn Hepler-Smith, a DPT student, works with Ellen Pollack, who had a brain aneurysm in 2018 and walks with a walker. She, too, found conversation to be a key element of a successful rehabilitation. 

“It’s important to know everything going on in a person’s life outside of rehab because it affects rehab,” said Hepler-Smith. “People are busy, and even something like construction in town and weather can affect how many steps Ellen takes.”  

Reisman called these experiential learning experiences paramount. 

“We want our DPT students to hone their communication skills and feel more confident in delivering a community-based program like this wherever they land,” said Reisman. 

The feasibility data collected from this study will help inform future interventions. Next, researchers will test participation in the program in person versus via Zoom to determine the best form of delivery before piloting the intervention at a senior center. 

“We want to see whether people show up for sessions, whether they make fewer gains than they did in the clinical trial, so we can understand barriers and challenges and bridge the gap between the clinic and delivering this intervention in the real world,” said Reisman.

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