Physical activity early after stroke and its association to functional outcome 3 months later. Locomotor Training Improves Daily Stepping Activity and Gait Efficiency in Individuals Poststroke Who Have Reached a “Plateau” in Recovery Inactive and Alone: Physical Activity Within the First 14 Days of Acute Stroke Unit Care Treadmill walking with body weight support in subacute non-ambulatory stroke improves walking capacity more than overground walking: a randomised trial. Impact of Time on Improvement of Outcome After Stroke Predicting Improvement in Gait After Stroke: A Longitudinal Prospective Study Repetitive locomotor training and physiotherapy improve walking and basic activities of daily living after stroke: a single-blind, randomized multicentre trial (DEutsche GAngtrainerStudie, DEGAS) Gait training in subacute non-ambulatory stroke patients using a full weight-bearing gait-assistance robot: A prospective, randomized, open, blinded-endpoint trial Multicenter Randomized Clinical Trial Evaluating the Effectiveness of the Lokomat in Subacute Stroke Randomized Trial of Treadmill Walking With Body Weight Support to Establish Walking in Subacute Stroke: The MOBILISE Trial Who May Have Durable Benefit From Robotic Gait Training?: A 2-Year Follow-Up Randomized Controlled Trial in Patients With Subacute Stroke A longitudinal, prospective study of industrial back injury reporting. Effects of intensive therapy using gait trainer or floor walking exercises early after stroke. Meaningful change and responsiveness in common physical performance measures in older adults. A Pilot Study of Randomized Clinical Controlled Trial of Gait Training in Subacute Stroke Patients With Partial Body-Weight Support Electromechanical Gait Trainer and Functional Electrical Stimulation: Six-Month Follow-Up Gait recovery is not associated with changes in the temporal patterning of muscle activity during treadmill walking in patients with post-stroke hemiparesis Observation of amounts of movement practice provided during stroke rehabilitation. Walking After Stroke: What Does Treadmill Training With Body Weight Support Add to Overground Gait Training in Patients Early After Stroke?: A Single-Blind, Randomized, Controlled Trial The relation between impairments and functional outcomes poststroke. The effectiveness of locomotor therapy using robotic-assisted gait training in subacute stroke patients: a randomized controlled trial. Stroke rehabilitation patients, practice, and outcomes: is earlier and more aggressive therapy better? Disentangling the contribution of the paretic and non-paretic ankle to balance control in stroke patients Risk factors for falls in stroke patients during inpatient rehabilitation Walking training of patients with hemiparesis at an early stage after stroke: a comparison of walking training on a treadmill with body weight support and walking training on the ground Who May Benefit From Robotic-Assisted Gait Training? A Very Early Rehabilitation Trial after stroke (AVERT): a Phase III, multicentre, randomised controlled trial. A new system for grading recommendations in evidence based guidelines Efficacy of an Electromechanical Gait Trainer Poststroke in Singapore: A Randomized Controlled Trial. Is the proportional recovery rule applicable to the lower limb after a first-ever ischemic stroke? Recovery of Gait After Stroke: What Changes? Effectiveness of gait training using an electromechanical gait trainer, with and without functional electric stimulation, in subacute stroke: a randomized controlled trial. Effects of Robot-Assisted Gait Training on Cardiopulmonary Fitness in Subacute Stroke Patients
BACKGROUND Early rehabilitation that includes early mobilization and increased amount of motor activity is hypothesized to be one of the most important factors contributing to the beneficial effect of comprehensive stroke unit treatment , whereas too much bed rest is hypothesized to be harmful . The purpose of the present study was to assess the association between early activity/bed rest and functional outcome 3 months later . METHODS This was a prospect i ve cohort study including patients with the diagnosis of stroke admitted to Trondheim University Hospital , Norway . Patients were eligible if they were less than 14 days poststroke and did not receive palliative care . Motor activity/bed rest  was recorded in the acute phase using a st and ard method of observation , and the outcome was assessed by the modified Rankin Scale ( mRS ) score 3 months later . A proportional odds model was used to analyze the association between motor activity/bed rest and outcome . All analyses were adjusted for age , gender , stroke severity , time from stroke to observation , and prestroke function . RESULTS A total of 106 patients ( mean age 79.0 years , 56.6 % men ) were included . The odds ratio for a higher mRS score ( poor outcome ) was 1.04 ( 95 % confidence interval [ CI ] 1.02 - 1.07 , P = .001 ) as time in bed increased and .97 ( 95 % CI .93 - 1.02 , P = .283 ) as time in motor activity increased . CONCLUSIONS This study confirms that time in bed in the early phase is associated with poor functional outcome 3 months later , indicating that too much bed rest should be avoided in the early phase after stroke Background and Purpose — Individuals with chronic stroke often demonstrate a “ plateau , ” or deceleration of motor recovery , which may lead to discharge from physical therapy ( PT ) . However , numerous studies report improvements in motor function when individuals are provided intensive practice of motor tasks . We suggest that reduced task-specific walking practice during clinical PT contributes to limited gains in ambulatory function in those with a perceived plateau poststroke , and suggest that further gains can be realized if intensive stepping , or locomotor training ( LT ) is provided after discharge . Methods — Twenty subjects with chronic stroke completed a repeated baseline measures , r and omized crossover trial in which walking performance was assessed during the last 4 weeks of clinical PT before discharge secondary to reaching a plateau , followed by 4 weeks of intensive LT and 4 weeks of no intervention . Outcome measures included clinical and physiological ( metabolic ) measures of walking overground and on a treadmill , and measures of daily stepping activity in the home and community , including during clinical PT and subsequent LT sessions . Results — Stepping practice was more than 4-fold higher during LT versus clinical PT sessions , with significant improvements in daily stepping and gait efficiency only after LT . Changes in daily stepping after clinical PT and intensive LT were correlated ( P<0.001 ) with the amount of stepping practice received during these interventions . Conclusions — Intensive LT results in improved daily stepping in individuals poststroke who have been discharged from PT because of a perceived plateau in motor function . These improvements may be related to the amount and intensity of stepping practice Background and Purpose — One way that stroke units may improve outcome is by reducing complications of immobility through early mobilization ; however , this intervention needs testing . The purpose of this study was to determine the physical activity patterns of stroke patients managed within acute stroke units as a first step in developing an early mobilization protocol . Methods — We recruited 64 patients within 14 days after stroke from 5 metropolitan stroke units and observed them for 2 consecutive days at 10-minute intervals between the hours of 8 am and 5 pm . At each observation , we ascertained physical activity , location , and other person(s ) present . Therapists recorded therapy details . Results — The 58 patients who completed the study had a mean age of 71.3 years . Stroke severity ranged from mild ( National Institutes of Health Stroke Scale score , 1 ) to severe ( score , 27 ) , and mean time after stroke at observation was 5.6 days ( range , 0 to 13 days ) . Only 9 patients were restricted to bed . During the therapeutic day , patients spent > 50 % resting in bed , 28 % sitting out of bed , and only 13 % engaged in activities with the potential to prevent complications and improve recovery of mobility . Patients were alone > 60 % of the time . Conclusions — This is the first multicenter study of physical activity early after stroke . We believe the next step is to conduct a r and omized controlled trial to evaluate the effect of increased levels of  physical activity  early after stroke compared with current st and ards of care QUESTIONS Is treadmill walking with body weight support during inpatient rehabilitation detrimental to walking quality compared with assisted overground walking ? Does it result in better walking capacity , perception of walking or community participation ? DESIGN Analysis of secondary outcomes of a r and omised trial with concealed allocation , assessor blinding and intention-to-treat analysis . PARTICIPANTS 126 patients unable to walk within 4 weeks of a stroke who were undergoing inpatient rehabilitation . INTERVENTION The experimental group undertook up to 30 minutes of treadmill walking with body weight support via an overhead harness per day while the control group undertook up to 30 minutes of overground walking . OUTCOME MEASURES The secondary outcomes were walking quality and capacity , walking perception , community participation and falls . RESULTS Six months after entering the study , there was no difference between the groups of independent walkers in terms of speed ( MD 0.10 m/s , 95 % CI -0.06 to 0.26 ) or stride ( MD 6 cm , 95 % CI -7 to 19 ) . The independent walkers in the experimental group walked 57 m further ( 95 % CI 1 to 113 ) in the 6 min walk than those in the control group . The experimental group ( walkers and non-walkers ) rated their walking 1 point out of 10 ( 95 % CI 0.1 to 1.9 ) higher than the control group . There was no difference between the groups in community participation or number of falls . CONCLUSION Treadmill training with body weight support results in better walking capacity and perception of walking compared to overground walking without deleterious effects on walking quality Background and Purpose — Longitudinal conducted studies show that neurologic and functional recovery show faster recovery in the first weeks poststroke . The aim of the present study was to study the effects of progress of time on observed improvements in motor strength , synergisms , and activities during the first 16 weeks poststroke . Methods — Based on data from a previous study , 101 patients with first-ever ischemic middle cerebral artery strokes were prospect ively investigated during the first 16 weeks after stroke . Progress of time was categorized into 8 biweekly time intervals and was used as the independent covariate in a first-order longitudinal regression model . The biweekly time change ( progress of time ) was related to improvement in upper and lower limb motor recovery assessed with Fugl-Meyer score and Motricity Index , reduction in visuospatial inattention based on the letter cancellation task , and improvement in walking ability , dexterity , and activities of daily living measured with the Functional Ambulation Categories , Action Research Arm test , and Barthel Index . Results — Time explained a significant change of 8.4 ( 42 % ) measurement units on the Barthel Index for the first 10 weeks poststroke , 1.1 ( 22 % ) measurement units on Functional Ambulation Categories , and 19 % on the Action Research Arm test for the first 6 and 8 weeks poststroke . Approximately 25 % ( for Fugl-Meyer – arm ) to 26 % ( for Motricity Index – arm ) of the significant change in measurements units was explained by time alone for the upper limb compared with 33 % for Fugl-Meyer – leg and 39 % for Motricity Index – leg of the lower limb . Time accounted for a reduction of 16 % in the letter cancellation task . Observed associations did not change after controlling for covariates such as age , gender , hemisphere of stroke , type of stroke , or intervention . Conclusion — Progress of time is an independent covariate that reflects spontaneous recovery of body functions and activities explaining ≈16 % to 42 % of the observed improvements in the first 6 to 10 weeks after stroke onset Background and Purpose — To study the longitudinal relationship of functional change in walking ability and change in time-dependent covariates and to develop a multivariate regression model to predict longitudinal change of walking ability . Methods — A total of 101 acute stroke patients with first-ever ischemic middle cerebral artery strokes was used as the population . Prospect i ve cohort study based on 18 repeated measurements over time during the first poststroke year . Baseline characteristics as well as longitudinal information from functional ambulation categories ( FAC ) , Fugl – Meyer leg score ( FM-leg ) , Motricity index leg score ( MI-leg ) , letter cancellation task ( LCT ) , Fugl-Meyer balance ( FM-balance ) , and timed balance test ( TBT ) were obtained . Intervention consisted of a basic rehabilitation program with additional arm , leg , or air splint therapy . Main outcome measure constituted change scores on FAC over time . Results — In total , 1532 of the 1717 change scores were available for regression analysis . The regression model showed that TBT change scores were the most important factor in predicting improvement on FAC ( & bgr;=0.094 ; P<0.001 ) followed by changes scores on FM-leg ( & bgr;=0.014 ; P<0.001 ) and reduction in LCT omissions ( & bgr;=−0.010 ; P<0.001 ) and MI leg test ( & bgr;=0.001 ; P<0.001 ) . In addition , time itself was significantly negatively associated with improvement ( & bgr;=−0.002 ; P<0.001 ) . Conclusion — Improvement in st and ing balance control is more important than improvement in leg strength or synergism to achieve improvement in walking ability , whereas reduction in visuospatial inattention is independently related to improvement of gait . Finally , time itself is an independent covariate that is negatively associated with change on FAC , suggesting that most pronounced improvements occur earlier after stroke Objective : To evaluate the effect of repetitive locomotor training on an electromechanical gait trainer plus physiotherapy in subacute stroke patients . Design : R and omized controlled trial . Setting : Four German neurological rehabilitation centres . Subjects : One hundred and fifty-five non-ambulatory patients ( first-time stroke < 60 days ) . Intervention : Group A received 20 min locomotor training and 25 min physiotherapy ; group B had 45 min physiotherapy every week day for four weeks . Main outcome measures : Primary variables were gait ability ( Functional Ambulation Category , 0 - 5 ) and the Barthel Index ( 0 - 100 ) , blindly assessed at study onset , end , and six months later for follow-up . Responders to the therapy had to become ambulatory ( Functional Ambulation Category 4 or 5 ) or reach a Barthel Index of ≥ 75 . Secondary variables were walking velocity , endurance , mobility and leg power . Results : The intention-to-treat analysis revealed that significantly greater number of patients in group A could walk independently : 41 of 77 versus 17 of 78 in group B ( P B < 0.0001 ) at treatment end . Also , significantly more group A patients had reached a Barthel Index ≥ 75 : 44 of 77 versus 21 of 78 ( P B < 0.0001 ) . At six-month follow-up , the superior gait ability in group A persisted ( 54 of 77 versus 28 of 78 , P B < 0.0001 ) , while the Barthel Index responder rate did not differ . For all secondary variables , group A patients had improved significantly more ( P B < 0.0001 ) during the treatment period , but not during follow-up . Conclusions : Intensive locomotor training plus physiotherapy result ed in a significantly better gait ability and daily living competence in subacute stroke patients  compared with physiotherapy alone BACKGROUND This study was a prospect i ve , r and omized , open , blinded-endpoint trial with the aim of examining whether gait training with a gait-assistance robot ( GAR ) improves gait disturbances in subacute non-ambulatory hemiplegic stroke patients more than overground conventional gait training . The GAR adopts a robot arm control system with full weight bearing and foot pressure visual biofeedback . METHODS Twenty-six hemiplegic patients were r and omly assigned to either the  GAR-assisted gait training ( GAGT ) group or the  overground conventional gait training ( OCGT ) group . Both groups underwent 60 min of st and ard physical therapy and 20 min of GAGT or OCGT 5 days a week for 4 weeks . The primary outcome measure was the Functional Ambulation Classification ( FAC ) . The secondary outcome measures were the peak torque of the extensor muscles in the lower extremities and a 10-m walking test . The lower extremity function was evaluated using the Fugl-Meyer Assessment , and activities of daily living were assessed using the Functional Independence Measure . RESULTS The GAGT group demonstrated significantly greater improvements in FAC and peak torque on the unaffected side ( p=0.02 ) than the OCGT group . Additionally , gait speed tended to be faster ( p=0.07 ) in the GAGT group . CONCLUSIONS GAGT combined with st and ard physical therapy in subacute non-ambulatory hemiplegic patients led to significant improvements in gait and peak torque on the unaffected side compared to OCGT Objective . To compare the efficacy of robotic-assisted gait training with the Lokomat to conventional gait training in individuals with subacute stroke . Methods . A total of 63 participants < 6 months poststroke with an initial walking speed between 0.1 to 0.6 m/s completed the multicenter , r and omized clinical trial . All participants received twenty-four 1-hour sessions of either Lokomat or conventional gait training . Outcome measures were evaluated prior to training , after 12 and 24 sessions , and at a 3-month follow-up exam . Self-selected overground walking speed and distance walked in 6 minutes were the primary outcome measures , whereas secondary outcome measures included balance , mobility and function , cadence and symmetry , level of disability , and quality of life measures . Results . Participants who received conventional gait training experienced significantly greater gains in walking speed ( P = .002 ) and distance ( P = .03 ) than those trained on the Lokomat . These differences were maintained at the 3-month follow-up evaluation . Secondary measures were not different between the 2 groups , although a 2-fold greater improvement in cadence was observed in the conventional versus Lokomat group . Conclusions . For subacute stroke participants with moderate to severe gait impairments , the diversity of conventional gait training interventions appears to be more effective than robotic-assisted gait training for facilitating returns in walking ability Background and Purpose — The main objective of this r and omized trial was to determine whether treadmill walking with body weight support was effective at establishing independent walking more often and earlier than current physiotherapy intervention for nonambulatory stroke patients . Methods — A r and omized trial with concealed allocation , blinded assessment , and intention-to-treat analysis was conducted . One hundred twenty-six stroke patients who were unable to walk were recruited and r and omly allocated to an experimental or a control group within 4 weeks of stroke . The experimental group undertook up to 30 minutes per day of treadmill walking with body weight support via an overhead harness whereas the control group undertook up to 30 minutes of overground walking . The primary outcome was the proportion of participants achieving independent walking within 6 months . Results — Kaplan – Meier estimates of the proportion of experimental participants who achieved independent walking were 37 % compared with 26 % of the control group at 1 month , 66 % compared with 55 % at 2 months , and 71 % compared with 60 % at 6 months ( P=0.13 ) . The experimental group walked 2 weeks earlier , with a median time to independent walking of 5 weeks compared to 7 weeks for the control group . In addition , 14 % ( 95 % CI , −1–28 ) more of the experimental group were discharged home . Conclusions — Treadmill walking with body weight support is feasible , safe , and tends to result in more people walking independently and earlier after stroke . Trial Registration — NN Clinical Trial.gov ( NCT00167531 ) Background and Purpose — Robotic-assisted walking training after stroke aims to enhance the odd of regaining independent gait . Recent studies have suggested that this approach is more effective than conventional therapy alone only in severely affected patients . We determined whether these results persist at long-term follow-up . Methods — Forty-eight nonambulant participants after subacute stroke were stratified by motricity index into high ( < 29 ) and low ( ≥29 ) motor impairment groups . Each arm was r and omized to a robotic or control group at a mean of 20 days after stroke . All patients underwent 2 therapy sessions per day , 5 days per week , for 3 months . Robotic group subjects underwent 20 sessions of robotic-assisted gait training in the first 4 weeks of inpatient therapy and abbreviated conventional therapy , whereas control group patients received only conventional gait training . The primary outcome was Functional Ambulation Category , and secondary measures were the Rivermead Mobility Index and Barthel Index scores . The scales were administered before and after the inpatient stay and 2 years after discharge . Results — At follow-up , as at discharge , the low motricity robotic group improved more than the control group counterpart with regard to functional ambulation category ( 4.7±0.5 versus 3.1±1.5 , P=0.002 ) , Barthel Index ( 76.9±11.5 versus 64.7±14.0 , P=0.024 ) , and Rivermead Mobility Index ( 11.8±3.5 versus 7.0±3.6 , P=0.010 ) , whereas conventional and robotic therapies were equally effective in the high motricity groups . Conclusions — The higher efficacy of the combination of robotic therapy and conventional therapy versus conventional therapy alone that was observed at discharge only in patients with greater motor impairments was sustained after 2 years The authors prospect ively evaluated 3020 volunteers of the Boeing-Everett plant to assess risk factors that predispose workers to file industrial back injury cl aims . During four years of follow-up observation , more than 279 subjects reported acute back problems .  The effect of the only predictive physical variable was explainable by a history of medical treatment . The most predictive individual factors were ( 1 ) job task dissatisfaction and ( 2 ) distress as reported on Scale 3 of the Minnesota Multiphasic Personality Inventory ( MMPI ) . This data perhaps explains why the focus on purely physical and injury-related factors has met with little success in dealing with what has become the most expensive orthopedic problem . Clinical ly , nonphysical factors that significantly impact the reporting of back injuries may also affect patients ' responses to medical treatment OBJECTIVE To analyse the effects of gait therapy for patients after acute stroke in a r and omized controlled trial . METHODS Fifty-six patients with a mean of 8 days post-stroke participated in : ( i ) gait trainer exercise ; ( ii ) walking training over ground ; or ( iii ) conventional treatment . Patients in the gait trainer exercise and walking groups practice d gait for 15 sessions over 3 weeks and received additional physiotherapy .  Functional Ambulatory Category and several secondary outcome measures assessing gait and mobility were administered before and after rehabilitation and at 6-month follow-up . Patients also evaluated their own effort . RESULTS Walking ability improved more with intensive walk training compared with conventional treatment ; median Functional Ambulatory Category was zero in all patients at the start of the study , but it was 3 in both walk-training groups and 0.5 in the conventional treatment group at the end of the therapy . Median Functional Ambulatory Category was 4 in both walk-training groups and 2.5 in conventional treatment group at 6-month follow-up . Mean accomplished walking distance was not different between the gait trainer exercise and over ground walking groups . Borg scale indicated more effort in over ground walking . Secondary outcomes also indicated improvements . CONCLUSION Exercise therapy with walking training improved gait function irrespective of the method used , but the time and effort required to achieve the results favour the gait trainer exercise . Early intensive gait training result ed in better walking ability than did conventional treatment OBJECTIVES To estimate the magnitude of small meaningful and substantial individual change in physical performance measures and evaluate their responsiveness . DESIGN Secondary data analyses using distribution- and anchor-based methods to determine meaningful change . SETTING Secondary analysis of data from an observational study and clinical trials of community-dwelling older people and subacute stroke survivors . PARTICIPANTS Older adults with mobility disabilities in a strength training trial ( n=100 ) , subacute stroke survivors in an intervention trial ( n=100 ) , and a prospect i ve cohort of community-dwelling older people ( n=492 ) . MEASUREMENTS  Gait speed , Short Physical Performance Battery ( SPPB ) , 6-minute-walk distance ( 6MWD ) , and self-reported mobility . RESULTS Most small meaningful change estimates ranged from 0.04 to 0.06 m/s for gait speed , 0.27 to 0.55 points for SPPB , and 19 to 22 m for 6MWD . Most substantial change estimates ranged from 0.08 to 0.14 m/s for gait speed , 0.99 to 1.34 points for SPPB , and 47 to 49 m for 6MWD . Based on responsiveness indices , per-group sample sizes for clinical trials ranged from 13 to 42 for substantial change and 71 to 161 for small meaningful change . CONCLUSION Best initial estimates of small meaningful change are near 0.05 m/s for gait speed , 0.5 points for SPPB , and 20 m for 6MWD and of substantial change are near 0.10 m/s for gait speed , 1.0 point for SPPB , and 50 m for 6MWD . For clinical use , substantial change in these measures and small change in gait speed and 6MWD , but not SPPB , are detectable . For research use , these measures yield feasible sample sizes for detecting meaningful change Background and Purpose — This study aim ed to assess the effectiveness of gait training using an electromechanical gait trainer with or without functional electrical stimulation for people with subacute stroke . Methods — This was a nonblinded r and omized controlled trial with a 6-month follow-up . Fifty-four subjects were recruited within 6 weeks after stroke onset and were r and omly assigned to 1 of 3 gait intervention groups : conventional overground gait training treatment ( CT , n=21 ) , electromechanical gait trainer ( GT , n=17 ) and , electromechanical gait trainer with functional electrical stimulation ( GT-FES , n=16 ) . All subjects were to undergo an assigned intervention program comprising a 20-minute session every weekday for 4 weeks . The outcome measures were Functional Independence Measure , Barthel Index , Motricity Index leg subscale , Elderly Mobility Scale ( EMS ) , Berg Balance Scale , Functional Ambulatory Category ( FAC ) , and 5-meter walking speed test . Assessment s were made at baseline , at the end of the 4-week intervention program , and 6 months after the program ended . Results — By intention-to-treat and multivariate analysis , statistically significant differences showed up in EMS ( Wilks ' & lgr;=0.743 , P=0.005 ) , FAC ( Wilks ' & lgr;=0.744 , P=0.005 ) and gait speed ( Wilks ' & lgr;=0.658 , P<0.0001 ) . Post hoc analysis ( univariate 2-way ANCOVA ) revealed that the GT and GT-FES groups showed significantly better improvement in comparison with the CT group at the end of the 4 weeks of training and in the 6-month follow-up . Conclusions — For the early stage after stroke , this study indicated a higher effectiveness in poststroke gait training that used an electromechanical gait trainer compared with conventional overground gait training . The training effect was sustained through to the 6-month follow-up after the intervention OBJECTIVE To establish whether functional recovery of gait in patients with post-stroke hemiparesis coincides with changes in the temporal patterning of lower extremity muscle activity and coactivity during treadmill walking . METHODS  Electromyographic ( EMG ) data from both legs , maximum walking speed , the amount of swing phase asymmetry and clinical measures were obtained from a group of post-acute patients with hemiparesis , as early as possible after admission in a rehabilitation centre ( mean time post-stroke 35 days ) and 1 , 3 , 6 , and 10 weeks later , while all patients participated in a regular rehabilitation program .  EMG data from the first assessment were compared to those obtained from a group of healthy controls to identify abnormalities in the temporal patterning of muscle activity . Within subject comparisons of patient data were made over time to investigate whether functional gait recovery was accompanied by changes in the temporal patterns muscle (co-)activity . RESULTS EMG patterns during the first assessment showed a number of abnormalities on the paretic side , namely abnormally long duration s of activity in biceps femoris ( BF ) during the single support ( SS ) phase and in gastrocnemius medialis ( GM ) during the first double support phase ( DS1 ) . Furthermore , in both legs a prolongation of the activity was seen in the rectus femoris ( RF ) during the SS phase . In addition , the duration of BF-RF coactivation was longer on the paretic side than it was in controls . Over time , the level of ambulatory independence , body mobility , and maximum walking speed increased significantly , indicating that substantial improvements in gait ability occurred . Despite these improvements , duration s of muscle ( co- ) activity and the level of swing phase asymmetry did not change during rehabilitation . More specifically , timing abnormalities in muscle (co-)activity that were found during the first assessment did not change significantly , indicating that these aberrations were not an impediment for functional gait improvements . CONCLUSIONS Normalization of the temporal patterning of gait related muscle activity in the lower extremities is not a prerequisite for functional recovery of gait in patients with post-stroke hemiparesis . Apparently , physiological processes other than improved temporal muscular coordination must be important determinants of the restoration of ambulatory capacity after stroke . SIGNIFICANCE Recovery of walking ability in post-stroke hemiparesis is not necessarily associated with , or dependent on , reorganization in the temporal control of gait related muscle activity . Normalization of the temporal coordination of muscle activity during gait may not be an important clinical goal during post-acute rehabilitation UNLABELLED Lang CE , MacDonald JR , Reisman DS , Boyd L , Jacobson Kimberley T , Schindler-Ivens SM , Hornby TG , Ross SA , Scheets PL . Observation of amounts of movement practice  provided during stroke rehabilitation . OBJECTIVE To investigate how much movement practice  occurred during stroke rehabilitation , and what factors might influence doses of practice provided . DESIGN Observational survey of stroke therapy sessions . SETTING Seven inpatient and outpatient rehabilitation sites . PARTICIPANTS We observed a convenience sample of 312 physical and occupational therapy sessions for people with stroke . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES We recorded numbers of repetitions in specific movement categories and data on potential modifying factors ( patient age , side affected , time since stroke , FIM item scores , years of therapist experience ) . Descriptive statistics were used to characterize amounts of practice . Correlation and regression analyses were used to determine whether potential factors were related to the amount of practice in the 2 important categories of upper extremity functional movements and gait steps . RESULTS Practice of task-specific , functional upper extremity movements occurred in 51 % of the sessions that addressed upper limb rehabilitation , and the average number of repetitions/session was 32 ( 95 % confidence interval [CI]=20 - 44 ) .  Practice of gait occurred in 84 % of sessions that addressed lower limb rehabilitation and the average number of gait steps/session was 357 ( 95 % CI=296 - 418 ) . None of the potential factors listed accounted for significant variance in the amount of practice in either of these 2 categories . CONCLUSIONS The amount of practice provided during poststroke rehabilitation is small compared with animal models . It is possible that current doses of task-specific practice during rehabilitation are not adequate to drive the neural reorganization needed to promote function poststroke optimally Background and Purpose — This study aim ed to assess the effectiveness of gait training using body weight support on a treadmill compared with conventional gait training for people with subacute stroke who were unable to walk . Methods — This was a single-blind , r and omized , controlled trial with a 6-month follow-up . Ninety-seven subjects were recruited within 6 weeks of stroke onset and were r and omly assigned to conventional rehabilitative treatment plus gait training with body weight support on a treadmill ( experimental group ; n=52 ) and conventional treatment with overground gait training only ( control group ; n=45 ) . All subjects were treated in 60-minute sessions every weekday for 4 weeks . Outcome measures were Motricity Index , Trunk Control test , Barthel Index , Functional Ambulation Categories , 10-meter and 6-minute Walk Tests , and Walking H and icap Scale . Assessment s were made at baseline , after 20 sessions of treatment , 2 weeks after treatment , and 6 months after stroke . Results — After treatment , all patients were able to walk . Both groups showed improvement in all outcome measures ( P<0.0063 ) at the end of the treatment and at follow-up . No differences were seen between the 2 groups before , during , and after treatment and at follow-up . Conclusions — In subacute patients with stroke , gait training on a treadmill with body weight support is feasible and as effective as conventional gait training . However , the need for more personnel for treadmill training makes the use of robotically assisted systems more compelling OBJECTIVE To assess the influence of initial stroke impairments on the severity of basic and higher level functional deficits over time and to determine the cumulative impact on functional deficits beyond severity of motor deficits alone . DESIGN Observational study . SETTING Twelve participating hospitals in the Greater Kansas City area , as part of the Kansas City Stroke Study ( October 1995-March 1998 ) . PARTICIPANTS Individuals ( n = 459 ) who sustained an eligible stroke were evaluated prospect ively using st and ardized assessment s at enrollment ( within 14 days of stroke onset , 8.8 + /- 3.5 days ) . MAIN OUTCOME MEASURES Mobility and activities of daily living ( ADLs ) were assessed at 1 , 3 , and 6 months poststroke using the Functional Independence Measure , Barthel index , Lawton Instrumental Activities of Daily Living ( IADL ) , and the Medical Outcomes Study Short-Form Health Survey instruments . RESULTS The cumulative probability of achieving independence with walking , a Barthel index of 60 or greater or 90 or greater , and independence in 3 or more IADL was significantly different for the following 4 impairment groups in descending order : motor ; motor and somatosensory ; motor and hemianopia ; and motor , sensory , and hemianopia . Although motor severity was a strong predictor of outcome ( p < .0001 ) , the additional somatosensory and hemianopia deficits significantly ( p < .05 ) affected time and likelihood of achieving these levels of function . CONCLUSION Cumulative deficits poststroke affect patients ' functional outcome in the first 6 months poststroke beyond the effect of motor severity alone OBJECTIVE To evaluate the effectiveness of early and prolonged locomotor treatment with the use of a robotic-assisted gait training ( RAGT ) device ( Lokomat ; Hocoma Inc. , Zurich , Switzerl and ) on the functional outcomes of patients after subacute stroke . DESIGN A nonblinded prospect i ve , r and omized , controlled study . SETTING Rehabilitation department in tertiary university medical center . PATIENTS Sixty-seven patients in the first 3 months after subacute stroke were r and omized into 2 groups as follows . Thirty-seven patients were treated with RAGT , and 30 were treated with regular physiotherapy . Inclusion criteria were first stroke , independent ambulation before the stroke , and neurological severity between 6 and 20 according to the National Institutes of Health Stroke Scale ( NIHSS ) . INTERVENTION RAGT treatment was administered 3 times a week for 30 minutes , combined with regular physiotherapy for 6 weeks . Control patients received the equivalent additional time of regular physiotherapy . MAIN OUTCOME MEASUREMENTS The primary outcome was the ability to walk independently , as assessed by use of the functional ambulatory capacity scale . The secondary outcomes included the neurological status according to the NIHSS ; functional motor assessment ( determined by use of the stroke activity scale ) ; and gait parameters , including gait velocity , endurance , and number of climbed stairs . RESULTS In the intention-to-treat analysis , subjects in the RAGT group exhibited greater gains than the control group in their ability to walk independently , as expressed by a greater functional ambulatory capacity score ( P < .01 ) , and in their neurological status according to NIHSS ( P < .01 ) . Among those who achieved independent walking , nonsignificant differences between groups were noted according to secondary outcome measures of gait parameters except from step climbing . CONCLUSION This controlled study showed , at the end of a 6-week trial , that locomotor therapy with the use of RAGT combined with regular physiotherapy produced promising effects on functional and motor outcomes in patients after subacute stroke as compared with regular physiotherapy alone UNLABELLED Horn SD , DeJong G , Smout RJ , Gassaway J , James R , Conroy B. Stroke rehabilitation patients , practice , and outcomes : is earlier and more aggressive therapy better ? OBJECTIVE To examine associations of patient characteristics , rehabilitation therapies , neurotropic medications , nutritional support , and timing of initiation of rehabilitation with functional outcomes and discharge destination for inpatient stroke rehabilitation patients . DESIGN Prospect i ve observational cohort study . SETTING Five U.S. inpatient rehabilitation facilities . PARTICIPANTS Post-stroke rehabilitation patients ( N=830 ; age , > 18 y ) with moderate or severe strokes , from the Post-Stroke Rehabilitation Outcomes Project data base . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Discharge total , motor , and cognitive FIM scores and discharge destination . RESULTS Controlling for patient differences , various activities and interventions were associated with better outcomes including earlier initiation of rehabilitation , more time spent per day in higher-level rehabilitation activities such as gait , upper-extremity control , and problem solving , use of newer psychiatric medications , and enteral feeding . Several findings part with conventional practice , such as starting gait training in the first 3 hours of physical therapy , even for low-level patients , was associated with better outcomes . CONCLUSIONS Specific therapy activities and interventions are associated with better outcomes . Earlier rehabilitation admission , higher-level activities early in the rehabilitation process , tube feeding , and newer medications are associated with better stroke rehabilitation outcomes During stroke recovery , restoration of the paretic ankle and compensation in the non-paretic ankle may contribute to improved balance maintenance . We examine a new approach to disentangle these recovery mechanisms by objective ly quantifying the contribution of each ankle to balance maintenance .  Eight chronic hemiparetic patients were included .  Balance responses were elicited by continuous r and om platform movements . We measured body sway and ground reaction forces below each foot to calculate corrective ankle torques in each leg . These measurements yielded the Frequency Response Function ( FRF ) of the stabilizing mechanisms , which expresses the amount and timing of the generated corrective torque in response to sway at the specified frequencies . The FRFs were used to calculate the relative contribution of the paretic and non-paretic ankle to the total amount of generated corrective torque to correct sway . All patients showed a clear asymmetry in the balance contribution in favor of the non-paretic ankle . Paretic balance contribution was significantly smaller than the contribution of the paretic leg to weight bearing , and did not show a clear relation with the contribution to weight bearing . In contrast , a group of healthy subjects instructed to distribute their weight asymmetrically showed a one-on-one relation between the contribution to weight bearing and to balance . We conclude that the presented approach objective ly quantifies the contribution of each ankle to balance maintenance . Application of this method in longitudinal surveys of balance rehabilitation makes it possible to disentangle the different recovery mechanisms . Such insights will be critical for the development and evaluation of rehabilitation strategies Objectives : To assess the incidence and circumstances of falls among stroke patients in a rehabilitation ward , the frequency of fall-related fractures , the relationship between falls and rehabilitation outcomes , and risk factors for falls . Design : Prospect i ve observational study . Setting : Neurological rehabilitation ward . Patients : In total 1155 patients ( 56 % men ; mean age 61.5 ± 14.3 years ) admitted to the neurological rehabilitation ward after a stroke .  Median ( interquartile range ) time since stroke onset was 36.5 ( 68 ) days . Main measures : Patients ' falls were registered during hospitalization ( 1—74 days ) and variables relating to the type and symptoms of stroke , current medications , neurological deficit ( Sc and inavian Stroke Scale ) and disability ( Barthel Index ) were collected from medical records . Results : A total of 252 falls were recorded for 189 ( 16.3 % ) patients and 45 patients experienced 108 repeated falls . The incidence rate for falls was 7.6/1000 patient-days ( 95 % confidence interval ( CI ) 6.6—8.5 ) . Most patients fell while being transferred ( 33.9 % ) and while seated ( 21.5 % ) , and 1.2 % of falls result ed in fractures ( n = 3 ) . Increased risk of both first and multiple falls was strongly associated with initial Barthel score below 15 ( hazard ratio ( HR ) 5.2 and 4.5 , respectively ) and time since stroke onset ≥12 weeks ( HR 2.3 and 2.3 , respectively ) . First falls were significantly associated with visuo-spatial neglect ( HR 1.5 ) . Repeated falls were related to age greater than 65 years ( HR 1.4 ) . Conclusions : Patients with severe stroke-related disability in the early period after stroke are prone to falls during rehabilitation . Multiple falls are most frequent in patients over 65 years of age Objective : To compare the effect of walking training on a treadmill with body weight support ( BWS ) and walking training on the ground at an early stage of rehabilitation in patients with hemiparesis after stroke . Design : R and omized controlled experimental study . Setting : Multicentre design ; three departments of rehabilitation medicine . Subjects : Seventy-three consecutive first stroke patients admitted to a rehabilitation clinic were r and omized into a treatment group and a control group . Interventions : The treatment group received walking training on a treadmill with BWS for 30 minutes , 5 days a week . The control group received walking training according to the Motor Relearning Programme ( MRP ) on the ground for 30 minutes 5 days a week , not including treadmill training . During the time in the rehabilitation department ( about two months ) , all patients in the study also received professional stroke rehabilitation besides the walking training in the two groups . Main outcome measures : Functional Independence Measure ( FIM ) , walking velocity for 10 m , Functional Ambulation Classification ( FAC ) , Fugl-Meyer Stroke Assessment and Berg 's Balance Scale . The assessment s were performed at admission , at discharge and at 10-month follow-up . Results : There were no statistically significant differences between the groups at discharge or at the 10-month follow-up with regard to FIM , walking velocity , FAC , Fugl-Meyer Stroke Assessment , and Berg 's Balance Scale . Patients in both groups improved in these variables from admission to the 10-month follow-up . Conclusions : Treadmill training with BWS at an early stage of rehabilitation after stroke is a comparable choice to walking training on the ground Background . Robotic-assisted walking training after stroke aims to enable highly impaired patients to walk independently , but results have been mixed . Objective . The authors aim ed to identify the characteristics of patients who may be most likely to benefit . Methods . A total of 48 participants with motor and gait dysfunction following subacute stroke were stratified by the motricity index into high ( < 29 ) and low ( ≥29 ) motor impairment groups . Each arm was r and omized to a robotic or control group ( RG or CG ) at a mean of 20 days after stroke . All patients underwent 2 therapy sessions per day , 5 days per week for 3 months . Those in the RG underwent 20 sessions of robotic-assisted gait training in the first 4 weeks of inpatient therapy using controlled endpoint trajectories and abbreviated conventional therapy , whereas the CG received only conventional gait training . The primary outcome was the functional ambulation category ( FAC ) , and secondary measures were the Rivermead mobility index ( RMI ) and 6-minute walking distance , all evaluated at hospital admission and at discharge . Results . The lower motricity group assigned to an electromechanical device significantly improved in the FAC ( P < .001 ) , RMI ( P = .001 ) , and walking distance ( P = .029 ) . Conventional and robotic therapies were equivalent in the higher motricity arm . Conclusion . Robotic therapy combined with conventional therapy may be more effective than conventional therapy alone in patients with greater motor impairment during inpatient stroke rehabilitation BACKGROUND Mobilising patients early after stroke [  early mobilisation ( EM ) ] is thought to contribute to the beneficial effects of stroke unit care but it is poorly defined and lacks direct evidence of benefit . OBJECTIVES We assessed the effectiveness of frequent higher dose very early mobilisation ( VEM ) after stroke . DESIGN We conducted a parallel-group , single-blind , prospect i ve r and omised controlled trial with blinded end-point assessment using a web-based computer-generated stratified r and omisation . SETTING The trial took place in 56 acute stroke units in five countries . PARTICIPANTS We included adult patients with a first or recurrent stroke who met physiological inclusion criteria . INTERVENTIONS Patients received either usual stroke unit care ( UC ) or UC plus VEM commencing within 24 hours of stroke . MAIN OUTCOME MEASURES The primary outcome was good recovery [ modified Rankin scale ( mRS ) score of 0 - 2 ] 3 months after stroke . Secondary outcomes at 3 months were the mRS , time to achieve walking 50 m , serious adverse events , quality of life ( QoL ) and costs at 12 months . Tertiary outcomes included a dose-response analysis . DATA SOURCES Patients , outcome assessors and investigators involved in the trial were blinded to treatment allocation . RESULTS We recruited 2104 ( UK , n = 610 ; Australasia , n = 1494 ) patients : 1054 allocated to VEM and 1050 to UC . Intervention protocol targets were achieved . Compared with UC , VEM patients mobilised 4.8 hours [ 95 % confidence interval ( CI ) 4.1 to 5.7 hours ; p < 0.0001 ] earlier , with an additional three ( 95 % CI 3.0 to 3.5 ; p < 0.0001 ) mobilisation sessions per day . Fewer patients in the VEM group ( n = 480 , 46 % ) had a favourable outcome than in the UC group ( n = 525 , 50 % ) ( adjusted odds ratio 0.73 , 95 % CI 0.59 to 0.90 ; p = 0.004 ) . Results were consistent between Australasian and UK setting s. There were no statistically significant differences in secondary outcomes at 3 months and QoL at 12 months . Dose-response analysis found a consistent pattern of an improved odds of efficacy and safety outcomes in association with increased daily frequency of out-of-bed sessions but a reduced odds with an increased amount of mobilisation ( minutes per day ) . LIMITATIONS UC clinicians started mobilisation earlier each year altering the context of the trial . Other potential confounding factors included staff patient interaction . CONCLUSIONS Patients in the VEM group were mobilised earlier and with a higher dose of therapy than those in the UC group , which was already early . This VEM protocol was associated with reduced odds of favourable outcome at 3 months caution ing against very early high-dose mobilisation . At 12 months , health-related QoL was similar regardless of group . Shorter , more frequent mobilisation early after stroke may be associated with a more favourable outcome . FUTURE WORK These results informed a new trial proposal [ A Very Early Rehabilitation Trial - DOSE ( AVERT-DOSE ) ] aim ing to determine the optimal frequency and dose of EM . TRIAL REGISTRATION The trial is registered with the Australian New Zeal and Clinical Trials Registry number ACTRN12606000185561 , Current Controlled Trials IS RCT N98129255 and IS RCT N98129255 . FUNDING This project was funded by the National Institute for Health Research ( NIHR ) Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol . 21 , No. 54 . See the NIHR Journals Library website for further project information . Funding was also received from the National Health and Medical Research Council Australia , Singapore Health , Chest Heart and Stroke Scotl and , Northern Irel and Chest Heart and Stroke , and the Stroke Association . In addition , National Health and Medical Research Council fellowship funding was provided to Julie Bernhardt ( 1058635 ) , who also received fellowship funding from the Australia Research Council ( 0991086 ) and the National Heart Foundation ( G04M1571 ) . The Florey Institute of Neuroscience and Mental Health , which hosted the trial , acknowledges the support received from the Victorian Government via the Operational Infrastructure Support Scheme The Scottish Intercollegiate Guidelines Network ( SIGN ) develops evidence based clinical guidelines for the NHS in Scotl and . The key elements of the methodology are ( a ) that guidelines are developed by multidisciplinary groups ; ( b ) they are based on a systematic review of the scientific evidence ; and ( c ) recommendations are explicitly linked to the supporting evidence and grade d according to the strength of that evidence . Until recently , the system for grading guideline recommendations was based on the work of the US Agency for Healthcare Research and Quality ( formerly the Agency for Health Care Policy and Research ) . 1 2 However , experience over more than five years of guideline development led to a growing awareness of this system 's weaknesses . Firstly , the grading system was design ed largely for application to questions of effectiveness , where r and omised controlled trials are accepted as the most robust study design with the least risk of bias in the results . However , in many areas of medical practice r and omised trials may not be practical or ethical to undertake ; and for many questions other types of study design may provide the best evidence . Secondly , guideline development groups often fail to take adequate account of the method ological quality of individual studies and the overall picture presented by a body of evidence rather than individual studies or they fail to apply sufficient judgment to the overall strength of the evidence base and its applicability to the target population of the guideline . Thirdly , guideline users are often not clear about the implication s of the grading system . They misinterpret the grade of recommendation as relating to its importance , rather than to the strength of the supporting evidence , and may therefore fail to give due weight to low grade recommendations . # # # # Summary points A revised system of determining levels of evidence and grade s OBJECTIVE To evaluate the longer-term effects of electromechanical gait trainers ( GTs ) combined with conventional physiotherapy on health status , function , and ambulation in people with subacute stroke in comparison with conventional physiotherapy given alone . DESIGN R and omized controlled trial with intention-to-treat analysis . SETTING Community hospital in Singapore . PARTICIPANTS Nonambulant individuals ( N=106 ) recruited approximately 1 month poststroke . INTERVENTIONS Both groups received 45 minutes of physiotherapy 6 times per week for 8 weeks as follows : the GT group received 20 minutes of GT training and 5 minutes of stance/gait training in contrast with 25 minutes of stance/gait training for the control group . Both groups completed 10 minutes of st and ing and 10 minutes of cycling . MAIN OUTCOME MEASURES The primary outcome was the Functional Ambulation Category ( FAC ) . Secondary outcomes were the Barthel Index ( BI ) , gait speed and endurance , and Stroke Impact Scale ( SIS ) . Measures were taken at baseline and 4 , 8 , 12 , 24 , and 48 weeks . RESULTS Generalized linear model analysis showed significant improvement over time ( independent of group ) for the FAC , BI , and SIS physical and participation subscales . However , no significant group × time or group differences were observed for any of the outcome variables after generalized linear model analysis . CONCLUSIONS The use of GTs combined with conventional physiotherapy can be as effective as conventional physiotherapy applied alone for people with subacute stroke Objective To investigate ( a ) the applicability of the proportional recovery rule of spontaneous neurobiological recovery to motor function of the paretic lower extremity ( LE ) ; and ( b ) the presence of fitters and non-fitters of this prognostic rule poststroke . When present , the clinical threshold for fitting nor non-fitting would be determined , as well as within-subject generalizability to the paretic upper extremity ( UE ) . Methods Prospect i ve cohort study in which the  Fugl-Meyer Assessment (FMA)-LE and FMA-UE  were measured < 72 hours and 6 months poststroke . Predicted maximum potential recovery was defined as [ FMA-LEmax−FMA-LEinitial = 34 –FMA-LEinitial ] . Hierarchical clustering in 202 first-ever ischemic stroke patients distinguished between fitting and not fitting the rule . Descriptive statistics determined whether fitters and non-fitters for LE were the same persons as for UE . Results 175 ( 87 % ) patients fitted the FMA-LE recovery rule . The observed average improvement of the fitters was ~64 % of the predicted maximum potential recovery . In the non-fitter group , the maximum initial FMA-LE score was 13 points . Fifty-one out of 78 patients ( ~65 % ) who scored below the identified 14-point threshold at baseline fitted the FMA-LE rule . Non-fitters were more severely affected than fitters . All non-fitters of the FMA-LE rule did also not fit the proportional recovery rule for FMA-UE . Conclusions Proportional recovery seems to be consistent within subjects across LE and UE motor impairment at the hemiplegic side in first-ever ischemic hemispheric stroke subjects . Future studies should investigate prospect ively distinguishing between fitters and not-fitters within the subgroup of patients who have initial low FMA-LE scores . Subsequently , patients could be stratified based on fitting or not fitting the recovery rule as this would impact rehabilitation management and trial design Background . Little is known about whether changes in coordination patterns of muscle activation after stroke are related to functional recovery of walking . Objective . The present study investigated the longitudinal relationship between changes in neuromuscular activation patterns of paretic muscles in hemiplegic gait and improvement in walking ability after stroke . Methods . Thirteen patients diagnosed with a first unilateral ischemic stroke had their recovery of walking measured by the Rivermead Mobility Index , Functional Ambulation Categories , Barthel Index , Trunk Control Test , Motricity Index , and comfortable walking speed . Surface electromyography ( SEMG )  of the erector spinae , gluteus maximus , gluteus medius , rectus femoris , vastus lateralis , semitendinosus , gastrocnemius , and tibialis anterior muscles of both legs was used to quantify coordination patterns in comfortable walking mode . All clinical and electromyography-related measurements were taken at 3 , 6 , 9 , 12 , and 24 weeks poststroke . Timing parameters of the SEMG patterns were calculated , using an objective burst detection algorithm , and analyzed with the measures of functional recovery . Results . All functional measures , except Trunk Control Test , showed statistically significant improvement over time , whereas SEMG patterns did not change significantly over time . Conclusion . The lack of significant change in SEMG patterns over time suggests that functional gait improvements may be more related to compensatory strategies in muscle activation of the unaffected leg and biomechanical changes than by restitution of muscle coordination patterns in the affected leg OBJECTIVE To compare the therapeutic effects of conventional gait training ( CGT ) , gait training using an electromechanical gait trainer ( EGT ) , and gait training using an electromechanical gait trainer with functional electric stimulation ( EGT-FES ) in people with subacute stroke . DESIGN Nonblinded r and omized controlled trial . SETTING Rehabilitation hospital for adults . PARTICIPANTS Fifty patients were recruited within 6 weeks after stroke onset ; 46 of these completed the 4-week training period . INTERVENTION Participants were r and omly assigned to 1 of 3 gait intervention groups : CGT , EGT , or EGT-FES . The experimental intervention was a 20-minute session per day , 5 days a week ( weekdays ) for 4 weeks . In addition , all participants received their 40-minute sessions of regular physical therapy every weekday as part of their treatment by the hospital . MAIN OUTCOME MEASURES Five-meter walking speed test , Elderly Mobility Scale ( EMS ) , Berg Balance Scale , Functional Ambulatory Category ( FAC ) , Motricity Index leg subscale , FIM instrument score , and Barthel Index . RESULTS The EGT and EGT-FES groups had statistically significantly more improvement than the CGT group in the 5-m walking speed test ( CGT vs EGT , P=.011 ; CGT vs EGT-FES , P=.001 ) , Motricity Index ( CGT vs EGT-FES , P=.011 ) , EMS ( CGT vs EGT , P=.006 ; CGT vs EGT-FES , P=.009 ) , and FAC ( CGT vs EGT , P=.005 ; CGT vs EGT-FES , P=.002 ) after the 4 weeks of training . No statistically significant differences were found between the EGT and EGT-FES groups in all outcome measures . CONCLUSIONS In this sample with subacute stroke , participants who trained on the electromechanical gait trainer with body-weight support , with or without FES , had a faster gait , better mobility , and improvement in functional ambulation than participants who underwent conventional gait training . Future studies with assessor blinding and larger sample sizes are warranted Background . Robot-assisted gait training has the potential to improve cardiopulmonary fitness after stroke , even for patients who are in the early stages of recovery and not independent ambulators . The authors compared the effects of robot-assisted gait training and conventional physical therapy on cardiopulmonary fitness . Methods . A prospect i ve single-blinded , r and omized controlled study of 37 patients receiving inpatient rehabilitation was performed within 1 month after stroke onset . The robot-assisted gait training group ( n = 20 ) received 40 minutes of gait training with Lokomat and 60 minutes of conventional physical therapy each day , whereas the control group ( n = 17 ) received 100 minutes of conventional physical therapy daily . Using a semirecumbent cycle ergometer , changes in cardiopulmonary fitness were investigated using incremental exercise testing . Motor and gait functional recovery was measured according to changes in the lower-extremity score of the Fugl-Meyer Assessment Scale ( FMA-L ) , leg score of the Motricity Index ( MI-L ) , and the Functional Ambulation Category ( FAC ) . Results . Compared with the control group , the robot group showed 12.8 % improvement in peak VO2 after training ( P < .05 ) . Compared with the control group , the robot group also improved in FMA-L score ( P < .05 ) . Conclusion . Patients can be trained to increase their VO2 and lower-extremity strength using a robotic device for stepping during inpatient rehabilitation . This training has the potential to improve cardiopulmonary fitness in patients who are not yet independent ambulators , but that may require more than 2 weeks of continued , progressive training
BACKGROUND Pre- clinical evidence suggests a period early after stroke during which the brain is most receptive to rehabilitation , if it is provided as high-dose motor training .
OBJECTIVE To evaluate the feasibility of repetitive gait training within the first 3 months post-stroke and the effects on gait-specific outcomes .