Transient Ischemic Attack (TIA)

One Patients Story to Treatment and Recovery

““The AlterG is a great way to maximize brain plasticity; my patients can’t say enough about how good (it) feels to run again. I love this machine!”-”

Nancy Byl, PhD, PT, Physical Therapy and Rehabilitation Science, UCSF

One Patients Transient Ischemic Attack Treatment with AlterG

Karen Shuler, PT, DPT


The patient is a 93 y.o. male who experienced a Transient Ischemic Attack 2 weeks ago. He presents with moderate balance deficits, difficulty with ambulation on even and uneven terrain, gait deviations, difficulty negotiating stairs, and he is unable to drive. He is an extremely active 93 year old and prior to his TIA he was driving, taking care of his 2 story condo, stretching daily, and walking outside for 30 minutes which included 2 hills. He has a history of claudication which limited his walking to 30 minutes daily. He was independent with walking in the home, the community, negotiating stairs, and he had no balance deficits prior to his TIATest. 

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In 4 weeks:

  • Pt. to increase dynamic gait index to 10/24

In 8 weeks:

  • Negotiate over various terrain for 1500 ft. with minimal calf cramping and no LOB in 8 weeks
  • Negotiate 10 steps with independence without falling in 8 weeks
  • Report 1/10 pain after 20 minutes in calves and thighs in 8 weeks
  • Increase BERG balance score to 41/56 in 8 weeks
  • Reduce his TUG to the left to 13 seconds in 8 weeks
  • Increase dynamic gait index to 18/24 to reduce risk of falling in the home

History / Progression

Pt. exhibits:

  • Increased base of support with decreased stride length.
  • Dizziness when standing.
  • Decreased muscular endurance with walking; quick to fatigue.
  • Calf cramping with walking throughout the day.
  • Pt. reports 3 incidents of near falling after returning home from hospital
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Pt. has the following co-morbidities: Transient Ischemic Attack (TIA), Peripheral Artery Disease (PAD), High Blood Pressure, Macular Degeneration in R eye, Vascular Claudication.


After physical therapy exercises on the AlterG:

  • Patient stated that leg pain was relieved for the remainder of the day
  • Patient able to demonstrate a reciprocal gait pattern without loss of balance on level and uneven terrain
  • Patient able to turn his head, step over objects, and change his speed without loss of balance
  • Patient able to ambulate safely without an assistive device with increased muscular and cardiovascular endurance and decreased symptoms
  • Timed Up and Go scores improved
  • At initial evaluation: 14.5 seconds turning to the left, 11.91 seconds turning to the right)
  • At discharge: 8.88 seconds turning to the left, 8.81 seconds turning to the right)
  • Berg balance score improved from 38/56 to 50/56
  • Dynamic Gait Index score improved from 6/24 to 23/24

Patient progressed at a good pace throughout his physical therapy. At discharge, he presented with independence with household and community mobility. Vascular claudication was a limiting factor throughout the rehab process however improvements were noted following physical therapy. The

AlterG allowed the patient to train for longer periods without calf pain. Training on a regular treadmill and overground were limited due to reports of calf pain within 5 minutes of gait training. The patient was also able to work on his dynamic balance within the AlterG feeling safe and having confidence with direct carryover to overground walking.

The rehabilitation program incorporating the AlterG enabled this 93 year old patient to return to an independent active lifestyle in his home and community.