Ep 121 - High Intensity Gait Training with Meghan Larson

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High Intensity Gait Training is a new research-based approach to Physical Therapy. Rather than focusing on the details of walking, it focuses more on the volume of steps — even if they’re not the cleanest steps.  It’s not just the steps, though. It’s also about getting the heart rate up safely. This therapy drives heart rates up to 65-85% of the max.

And you know what? It works.

Patients who go through this therapy walk faster. They walk further. Their sit-to-stand performance is better.

It turns out the intensity primes the brain for the neuroplastic changes that work with the repetitions we need to do to acquire or re-acquire skills like walking.

You can read one of the studies here.

This week we learn about High Intensity Gait Training from Dr. Meghan Larson, PT, DPT, NCS. Not only is Meghan specially trained in this therapy, she is also the woman who taught me to walk at age 46. She was my inpatient PT back in 2017. And she continues to be an utter delight.


Dr. Meghan Larson, PT, DPT, NCS stands in front of a wall and looks directly at the camera.

Dr. Meghan Larson, PT, DPT, NCS is a board certified Neurological Clinical Specialist Physical Therapist who completed her doctoral work at Columbia University and undergraduate degree at Gonzaga University. Currently, Meghan is a staff Physical Therapist at Swedish Medical Center Cherry Hill Campus in the Acute Rehabilitation Unit. She has previous experience in Neuro ICU, Neuro Telemetry, Long Term Acute Care and outpatient orthopedics therapy. Currently areas of interest and specialty are Stoke Rehabilitation, Vestibular Rehab, gait training and balance re-training. Meghan lives with her husband, two kids and dog in Seattle, WA. She enjoys cooking, running, hiking, traveling and spending time with her growing family.

  • Doctorate Degree- Columbia University
  • Undergraduate Degree- Gonzaga University
  • Board Certification- Neurological Clinical Specialist
Work Experience
  • Current- Staff Physical Therapist at Swedish Medical Center- Cherry Hill Campus in the Acute Rehabilitation
  • Past- Highline Medical Center- Regional Hospital Lead Therapist and Physiotherapy Associates Staff Physical Therapist

Two Things Successful Patients Do

Meghan works with a lot of patients. Some are more successful than others. What drives that difference? Meghan sees two things that the successful patients do

First, they trust the process and the therapists. The therapists spend years studying this stuff. They push us. And sometimes we develop an intense dislike of them because they are pushing us so hard.

But the thing I, most of them know what they are doing. They’re pushing us because pushing us works.

So trust the therapists and the work they are making us do.

The second thing successful folks do is they are kind to themselves.

That doesn’t mean treating therapy as a vacation or not trying hard. It means trying and working and when failing, not beating themselves up. This stuff is hard. We are going to fail. That’s how we know we are trying.

But thinking of ourselves as failures or getting angry with ourselves or engaging in negative self talk doesn’t help.

We have to forgive ourselves for the things we can’t do — yet.

Would you talk to another survivor the way you talk to yourself? Would you call someone the names that you call yourself? If not, then don’t treat yourself that badly either. Be kind to yourself.


Caffeinated Comics

A couple weeks ago, I joined visited the Caffeinated Comics. We talked about the insurrection at the US Capitol and a lot about Star Trek. We also talked about Voice Over Artist Tom Kane who recently survived a stroke and now lives with aphasia.

You can learn more about and listen to the episode here.


Hack of the Week

If there is something you want to do after stroke, let your therapist know.

If something gave you joy before your stroke, talk about it and dive into the resources available to help with it. Whether it’s a hobby, skill, or other passion, ask your therapists about it. They can help tune your therapy in that direction.

They also just know stuff. They may be familiar with gear or techniques that can help.

If you’re no longer in therapy, they may still be able to help. So shoot them a quick email. There’s help out there. Sometimes you just need to ask. Give it a shot.

And here’s the thing — they want to hear from you even after you’ve finished therapy with them. Especially when they worked with you in the early days after your stroke. They saw you at the very early stages, and they are thrilled to see the progress you’ve made after a month, 6 months, a year, or more.



eghan (Fuchs) Larson, PT, DPT, NCS

Academy of Neurological Physical Therapy

Intensity Matters Campaign

BORG Scale

Shirley Ryan Ability Lab

High Intensity Interval Training in Chronic Stroke (HIT)

Variable Intensive Early Walking Poststroke (VIEWS): A Randomized Controlled Trial

Importance of specificity, amount, and intensity of locomotor training to improve ambulatory function in patients poststroke

Clinical Practice Guideline to Improve Locomotor Function Following Chronic Stroke, Incomplete Spinal Cord Injury, and Brain Injury

Emilee Mason on Strokecast

Other Swedish team members on Strokecast

Bill on Caffeinated Comics


Where do we go from here?

  • To learn more about, or connect with Meghan, find her on LinkedIn here.
  • Do you know a PT, physiatrist, or survivor who you think would be interested in High Intensity Gait Training? Share this episode with them by giving them the link http://Strokecast.com/HIT.
  • Let your therapists know how you’re doing.
  • Don’t get best…get better.

Strokecast is the stroke podcast where a Gen X stroke survivor explores rehab, recovery, the frontiers of neuroscience and one-handed banana peeling by helping stroke survivors, caregivers, medical providers and stroke industry affiliates connect and share their stories.



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