Speed-Dependent Treadmill Training in Ambulatory Hemiparetic Stroke Patients: A Randomized Controlled Trial Speed-dependent treadmill training is effective to improve gait and balance performance in patients with sub-acute stroke. Long term effects of intensity of upper and lower limb training after stroke: a randomised trial A treadmill and overground walking program improves walking in persons residing in the community after stroke: a placebo-controlled, randomized trial. Treadmill Exercise Activates Subcortical Neural Networks and Improves Walking After Stroke: A Randomized Controlled Trial Effects of a gait training session combined with a mass on the non-paretic lower limb on locomotion of hemiparetic patients: a randomized controlled clinical trial. Locomotor Training Improves Daily Stepping Activity and Gait Efficiency in Individuals Poststroke Who Have Reached a “Plateau” in Recovery Predictors of Response to Treadmill Exercise in Stroke Survivors Gait Training—Induced Change in Corticomotor Excitability in Patients With Chronic Stroke Body-weight-supported treadmill rehabilitation after stroke. Meaningful Gait Speed Improvement During the First 60 Days Poststroke: Minimal Clinically Important Difference Treadmill walking with body weight support in subacute non-ambulatory stroke improves walking capacity more than overground walking: a randomised trial. A Randomized Controlled Trial of Functional Neuromuscular Stimulation in Chronic Stroke Subjects Repetitive locomotor training and physiotherapy improve walking and basic activities of daily living after stroke: a single-blind, randomized multicentre trial (DEutsche GAngtrainerStudie, DEGAS) Treadmill Exercise Rehabilitation Improves Ambulatory Function and Cardiovascular Fitness in Patients With Chronic Stroke: A Randomized, Controlled Trial Effects of Locomotion Training With Assistance of a Robot-Driven Gait Orthosis in Hemiparetic Patients After Stroke: A Randomized Controlled Pilot Study Improved Cerebral Vasomotor Reactivity After Exercise Training in Hemiparetic Stroke Survivors 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 A comparison of regular rehabilitation and regular rehabilitation with supported treadmill ambulation training for acute stroke patients. Improved walking ability and reduced therapeutic stress with an electromechanical gait device. A new approach to retrain gait in stroke patients through body weight support and treadmill stimulation. Impaired Leg Vasodilatory Function After Stroke: Adaptations With Treadmill Exercise Training Randomized Trial of Treadmill Training to Improve Walking in Community-Dwelling People after Stroke: The AMBULATE Trial A task-orientated intervention enhances walking distance and speed in the first year post stroke: a randomized controlled trial Cortical reorganization induced by body weight-supported treadmill training in patients with hemiparesis of different stroke durations. Treadmill Aerobic Training Improves Glucose Tolerance and Indices of Insulin Sensitivity in Disabled Stroke Survivors: A Preliminary Report Effects of intensive therapy using gait trainer or floor walking exercises early after stroke. Treadmill Training With Partial Body Weight Support and an Electromechanical Gait Trainer for Restoration of Gait in Subacute Stroke Patients: A Randomized Crossover Study Feasibility, safety and efficacy of an early aerobic rehabilitation program for patients after minor ischemic stroke: A pilot randomized controlled trial. Evaluation of the impact of exercise of gait on a treadmill on balance of people who suffered from cerebral stroke. An evaluation of two different exercise regimes during the first year following stroke: A randomised controlled trial The Effect of Body Weight Support Treadmill Training on Gait Recovery, Proximal Lower Limb Motor Pattern, and Balance in Patients with Subacute Stroke Pilot study of Lokomat versus manual-assisted treadmill training for locomotor recovery post-stroke Effects of Task-Specific and Impairment-Based Training Compared With Usual Care on Functional Walking Ability After Inpatient Stroke Rehabilitation Conventional physiotherapy and treadmill re-training for higher-level gait disorders in cerebrovascular disease. The effect of a task-oriented walking intervention on improving balance self-efficacy poststroke: a randomized, controlled trial. Varied overground walking-task practice versus body-weight-supported treadmill training in ambulatory adults within one year of stroke: a randomized controlled trial protocol Effect of encouragement on walking test performance. The effect of treadmill training on the ambulation of stroke survivors in the early stages of rehabilitation: a randomized study. Protocol for the Locomotor Experience Applied Post-stroke (LEAPS) trial: a randomized controlled trial 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 Response of sagittal plane gait kinematics to weight-supported treadmill training and functional neuromuscular stimulation following stroke. 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 Additional task-related practice improves mobility and upper limb function early after stroke: a randomised controlled trial. Supported treadmill training to establish walking in non-ambulatory patients early after stroke Improving community ambulation after stroke: the AMBULATE trial Effect of an Overground Training Session Versus a Treadmill Training Session on Timed Up and Go in Hemiparetic Patients Dual Effects of Body-Weight Supported Treadmill Training on Cardiovascular Fitness and Walking Ability Early After Stroke Improving Balance Skills in Patients Who Had Stroke Through Virtual Reality Treadmill Training Circuit class therapy versus individual physiotherapy sessions during inpatient stroke rehabilitation: a controlled trial. The Effects of Body Weight Support Treadmill Training with Power-Assisted Functional Electrical Stimulation on Functional Movement and Gait in Stroke Patients Task-related circuit training improves performance of locomotor tasks in chronic stroke: a randomized, controlled pilot trial. Treadmill training with partial body weight support and physiotherapy in stroke patients: a preliminary comparison. Intensity of leg and arm training after primary middle-cerebral-artery stroke: a randomised trial Comparison of Partial Body Weight-Supported Treadmill Gait Training Versus Aggressive Bracing Assisted Walking Post Stroke Does therapeutic facilitation add to locomotor outcome of body weight--supported treadmill training in nonambulatory patients with stroke? A randomized controlled trial. Effect of partial body weight support treadmill training in chronic stroke patients. The effectiveness of body weight-supported gait training and floor walking in patients with chronic stroke. Speed and Temporal-Distance Adaptations during Treadmill and Overground Walking Following Stroke Bodyweight-supported treadmill training for retraining gait among chronic stroke survivors: A randomized controlled study. The Role of Technology in Task-Oriented Training in Persons with Subacute Stroke: A Randomized Controlled Trial The effectiveness of locomotor therapy using robotic-assisted gait training in subacute stroke patients: a randomized controlled trial. Exercise and health-related quality of life during the first year following acute stroke. A randomized controlled trial Optimal outcomes obtained with body-weight support combined with treadmill training in stroke subjects. Higher-intensity treadmill walking during rehabilitation after stroke in feasible and not detrimental to walking pattern or quality: a pilot randomized trial Aerobic treadmill plus Bobath walking training improves walking in subacute stroke: a randomized controlled trial Treadmill training post stroke: are there any secondary benefits? A pilot study Effects of treadmill training with partial body weight support and the proprioceptive neuromuscular facilitation method on hemiparetic gait: a randomized controlled study. Chronic Stroke Survivors Benefit From High-Intensity Aerobic Treadmill Exercise Intra-limb coordination deficit in stroke survivors and response to treatment. Does a Single Gait Training Session Performed Either Overground or on a Treadmill Induce Specific Short-Term Effects on Gait Parameters in Patients with Hemiparesis? A Randomized Controlled Study Effects of treadmill training with optic flow on balance and gait in individuals following stroke: randomized controlled trials Prospective, Blinded, Randomized Crossover Study of Gait Rehabilitation in Stroke Patients Using the Lokomat Gait Orthosis Step training with body weight support: effect of treadmill speed and practice paradigms on poststroke locomotor recovery. 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 Enhanced life-role participation in response to comprehensive gait training in chronic stroke survivors* Virtual reality-based training improves community ambulation in individuals with stroke: a randomized controlled trial. [Effectiveness of backward walking treadmill training in lower extremity function after stroke]. Varied Overground Walking Training Versus Body-Weight-Supported Treadmill Training in Adults Within 1 Year of Stroke Body Weight–Supported Treadmill Training Is No Better Than Overground Training for Individuals with Chronic Stroke: A Randomized Controlled Trial Feasibility of combining multi-channel functional neuromuscular stimulation with weight-supported treadmill training Enhanced Gait-Related Improvements After Therapist- Versus Robotic-Assisted Locomotor Training in Subjects With Chronic Stroke: A Randomized Controlled Study Exercise training improves walking function in an African group of stroke survivors: a randomized controlled trial Gait outcomes after acute stroke rehabilitation with supported treadmill ambulation training: a randomized controlled pilot study. Stroke patients and long-term training: is it worthwhile? A randomized comparison of two different training strategies after rehabilitation Can we improve gait skills in chronic hemiplegics? A randomised control trial with gait trainer. Bobath or Motor Relearning Programme? A comparison of two different approaches of physiotherapy in stroke rehabilitation: a randomized controlled study Allowing Intralimb Kinematic Variability During Locomotor Training Poststroke Improves Kinematic Consistency: A Subgroup Analysis From a Randomized Clinical Trial Body weight supported treadmill training versus traditional training in patients dependent on walking assistance after stroke: a randomized controlled trial Partial body weight treadmill training in persons with chronic stroke. Does treadmill exercise improve performance of cognitive or upper-extremity tasks in people with chronic stroke? A randomized cross-over trial. Task-specific physical therapy for optimization of gait recovery in acute stroke patients. Effect of duration of upper- and lower-extremity rehabilitation sessions and walking speed on recovery of interlimb coordination in hemiplegic gait. Effects of Task-Specific Locomotor and Strength Training in Adults Who Were Ambulatory After Stroke: Results of the STEPS Randomized Clinical Trial Effectiveness of gait training using an electromechanical gait trainer, with and without functional electric stimulation, in subacute stroke: a randomized controlled trial. Gait Parameters Associated With Responsiveness to Treadmill Training With Body-Weight Support After Stroke: An Exploratory Study Effects of two exercise training techniques on walking function in adult patients with stroke. Body weight-supported treadmill training vs. overground walking training for persons with chronic stroke: a pilot randomized controlled trial Effects of Gait Training With Body Weight Support on a Treadmill Versus Overground in Individuals With Stroke. Exercise on a treadmill or walking outdoors? A randomized controlled trial comparing effectiveness of two walking exercise programmes late after stroke Recovery of Coordinated Gait Effects of Robot-Assisted Gait Training on Cardiopulmonary Fitness in Subacute Stroke Patients
Background and Purpose — A new gait training strategy for patients with stroke seeks to increase walking speed through treadmill training . This study compares the effects of structured speed-dependent treadmill training ( STT ) ( with the use of an interval paradigm to increase the treadmill speed stepwise according to principles of sport physiology ) with limited progressive treadmill training ( LTT ) and conventional gait training ( CGT ) on clinical outcome measures for patients with hemiparesis . Methods — Sixty ambulatory poststroke patients were each r and omly selected to receive 1 of the 3 different gait therapies : 20 subjects were treated with STT , 20 subjects were trained to walk on a treadmill with a 20 % increase of belt speed over the treatment period ( LTT ) , and 20 subjects were treated with CGT . Treatment outcomes were assessed on the basis of overground walking speed , cadence , stride length , and Functional Ambulation Category scores . Results — After a 4-week training period , the STT group scored significantly higher than the LTT and CGT groups for overground walking speed ( STT versus LTT , P < 0.001 ; STT versus CGT , P < 0.001 ) , cadence ( STT versus LTT , P = 0.007 ; STT versus CGT , P < 0.001 ) , stride length ( STT versus LTT , P < 0.001 ; STT versus CGT , P < 0.001 ) , and Functional Ambulation Category scores ( STT versus LTT , P = 0.007 ; STT versus CGT , P < 0.001 ) . Conclusions — Structured STT in poststroke patients result ed in better walking abilities than LTT or CGT . This gait training strategy provides a dynamic and integrative approach for the treatment of gait dysfunction after stroke OBJECTIVE To compare the effects of speed-dependent treadmill training on gait and balance performance in patients with sub-acute stroke . DESIGN Single-blinded r and omized controlled trial . SUBJECTS A total of 26 patients with sub-acute stroke were r and omly assigned to experimental ( n = 13 ) and control ( n = 13 ) groups . METHODS Subjects in the experimental group underwent short interval walking trials with stepwise increases in treadmill speed ( speed-dependent treadmill training ) , following the principles of sprint training . Control subjects received gait training on the treadmill at a steady speed . Gait speed , stride length , cadence , and Berg 's Balance Score were recorded and analysed before and after the 10 training sessions . RESULTS Results of 2-way repeated measures analysis of variance showed significant group × time interactions for gait speed and stride length ( p < 0.05 ) . Within each subject group there were improvements in all gait parameters and Berg ’s Balance Score after the training programme . In addition , the experimental group showed significantly larger increases in gait speed ( mean 0.15 m/s , 95 % confidence interval 0.04–0.26 ) and stride length ( mean 0.16 m , 95 % confidence interval 0.02–0.30 ) than the control subjects . CONCLUSION Speed-dependent treadmill training in patients with sub-acute stroke result ed in larger gains in gait speed and stride length compared with steady speed . The positive findings provide evidence for clinical practice of speed-dependent treadmill training in enhancing gait function after stroke Objective : To assess long term effects at 1 year after stroke in patients who participated in an upper and lower limb intensity training programme in the acute and subacute rehabilitation phases . Design : A three group r and omised controlled trial with repeated measures was used . Method : One hundred and one patients with a primary middle cerebral artery stroke were r and omly allocated to one of three groups for a 20 week rehabilitation programme with an emphasis on ( 1 ) upper limb function , ( 2 ) lower limb function or ( 3 ) immobilisation with an inflatable pressure splint ( control group ) . Follow up assessment s within and between groups were compared at 6 , 9 , and 12 months after stroke . Results : No statistically significant effects were found for treatment assignment from 6 months onwards . At a group level , the significant differences in efficacy demonstrated at 20 weeks after stroke in favour of the lower limb remained . However , no significant differences in functional recovery between groups were found for Barthel index ( BI ) , functional ambulation categories (FAC),action research arm test ( ARAT ) , comfortable and maximal walking speed , Nottingham health profile part 1(NHP-part 1 ) , sickness impact profile-68 ( SIP-68 ) , and Frenchay activities index ( FAI ) from 6 months onwards . At an individual subject level a substantial number of patients showed improvement or deterioration in upper limb function ( n=8 and 5 , respectively ) and lower limb function ( n=19 and 9 , respectively ) . Activities of daily living ( ADL ) scores showed that five patients deteriorated and four improved beyond the error threshold from 6 months onwards . In particular , patients with some but incomplete functional recovery at 6 months are likely to continue to improve or regress from 6 months onwards . Conclusions : On average patients maintained their functional gains for up to 1 year after stroke after receiving a 20 week upper or lower limb function training programme . However , a significant number of patients with incomplete recovery showed improvements or deterioration in dexterity , walking ability , and ADL beyond the error threshold OBJECTIVE To evaluate the effectiveness of a treadmill and overground walking program in reducing the disability and h and icap associated with poor walking performance after stroke . DESIGN R and omized , placebo-controlled clinical trial with a 3-month follow-up . SETTING General community . PARTICIPANTS A volunteer sample of 29 ambulatory individuals ( less 2 dropouts ) who were living in the community after having suffered a stroke more than 6 months previously . INTERVENTIONS The experimental group participated in a 30-minute treadmill and overground walking program , 3 times a week for 4 weeks . The control group received a placebo consisting of a low-intensity , home exercise program and regular telephone contact . MAIN OUTCOME MEASURES Walking speed ( over 10 m ) , walking capacity ( distance over 6 min ) , and h and icap ( stroke-adapted 30-item version of the Sickness Impact Profile ) measured by a blinded assessor . RESULTS The 4-week treadmill and overground walking program significantly increased walking speed ( P=.02 ) and walking capacity ( P<.001 ) , but did not decrease h and icap ( P=.85 ) compared with the placebo program . These gains were largely maintained 3 months after the cessation of training ( P</=.05 ) . CONCLUSIONS The treadmill and overground walking program was effective in improving walking in persons residing in the community after stroke . This suggests that the routine provision of accessible , long-term , community-based walking programs would be beneficial in reducing disability after stroke Background and Purpose — Stroke often impairs gait thereby reducing mobility and fitness and promoting chronic disability . Gait is a complex sensorimotor function controlled by integrated cortical , subcortical , and spinal networks . The mechanisms of gait recovery after stroke are not well understood . This study examines the hypothesis that progressive task-repetitive treadmill exercise ( T-EX ) improves fitness and gait function in subjects with chronic hemiparetic stroke by inducing adaptations in the brain ( plasticity ) . Methods — A r and omized controlled trial determined the effects of 6-month T-EX  ( n=37 ) versus comparable duration stretching ( CON , n=34 ) on walking , aerobic fitness and in a subset ( n=15/17 ) on brain activation measured by functional MRI . Results — T-EX significantly improved treadmill-walking velocity by 51 % and cardiovascular fitness by 18 % ( 11 % and −3 % for CON , respectively ; P<0.05 ) . T-EX but not CON affected brain activation during paretic , but not during nonparetic limb movement , showing 72 % increased activation in posterior cerebellar lobe and 18 % in midbrain ( P<0.005 ) . Exercise-mediated improvements in walking velocity correlated with increased activation in cerebellum and midbrain . Conclusions — T-EX  improves walking , fitness and recruits cerebellum-midbrain circuits , likely reflecting neural network plasticity . This neural recruitment is associated with better walking . These findings demonstrate the effectiveness of T-EX rehabilitation in promoting gait recovery of stroke survivors with long-term mobility impairment and provide evidence of neuroplastic mechanisms that could lead to further refinements in these paradigms to improve functional outcomes BACKGROUND Results of recent studies have suggested that restraint of non-paretic lower limb movement could improve locomotion in hemiplegic patients . The aim of this study was therefore to determine if a mass applied to the non-paretic lower limb during a single gait training session ( GTS ) would specifically improve spatio-temporal , kinematic and kinetic gait parameters ( GP ) of the paretic lower limb . METHODS Sixty chronic hemiplegic subjects were included in this r and omized study . Each participated in one of four GTS conditions : overground or on a treadmill while wearing or not wearing an ankle mass . All subjects were assessed before , immediately after and 20 min after the end of the GTS using 3D gait analysis . RESULTS The results showed that restraining the non-paretic lower limb during a GTS had no specific effect on GP of the paretic limb , whereas it increased braking force of the non-paretic limb . CONCLUSION Restraining the non-paretic lower limb of hemiparetic patients with a mass applied to the ankle does not seem to be an effective approach to improve paretic lower limb parameters during a single GTS 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 . Aerobic treadmill exercise ( T-EX ) therapy has been shown to benefit walking and cardiorespiratory fitness in stroke survivors with chronic gait impairment even long after their stroke . The response , however , varies between individuals . Objective . The purpose of this post hoc analysis of 2 r and omized controlled T-EX trials was to identify predictors for therapy response . Methods . In all , 52 participants received T-EX for 3 ( Germany ) or 6 ( United States ) months . Improvements in overground walking velocity ( 10 m/6-min walk ) and fitness ( peak VO2 ) were indicators of therapy response . Lesion location and volume were measured on T1-weighted magnetic resonance scans . Results . T-EX significantly improved gait and fitness , with gains in 10-m walk tests ranging between + 113 % and −25 % and peak VO2 between −12 % and 88 % . Baseline walking impairments or fitness deficits were not predictive of therapy response ; 10-m walk velocity improved more in those with subcortical rather than cortical lesions and in patients with smaller lesions . Improvements in 6-minute walk velocity were greater in those with more recent strokes and left-sided lesions . No variable other than training intensity , which was different between trials , predicted fitness gains . Conclusions . Despite proving overall effectiveness , the response to T-EX varies markedly between individuals . Whereas intensity of aerobic training seems to be an important predictor of gains in cardiovascular fitness , lesion size and location as well as interval between stroke onset and therapy delivery likely affect therapy response . These findings may be used to guide the timing of training and identify subgroups of patients for whom training modalities could be optimized Background . Numerous studies have reported the effects of gait training on motor performance after stroke . However , there is limited information on treatment-induced changes in corticomotor excitability . Objectives . The purpose of the study was to investigate the effects of additional gait training on motor performance and corticomotor excitability and to demonstrate the relationship between motor improvement and corticomotor excitability change in patients with chronic stroke . Methods . Fourteen patients were r and omly assigned to the experimental or control group . Participants in both groups participated in general physical therapy . Those in the experimental group received additional body weight− supported treadmill training for 4 weeks . All participants received baseline and posttreatment assessment s. The outcome measures included assessment of the Berg Balance Scale ( BBS ) and gait parameters . Focal transcranial magnetic stimulation was used to measure the motor threshold , map size , and location of the amplitude-weighted center of gravity of the motor map for the tibialis anterior ( TA ) and abductor hallucis ( AH ) muscles . Results . After general physical therapy , we noted that the patients showed an improvement only in walking speed and cadence , and there were no significant changes in corticomotor excitability . After additional gait training , participants improved significantly on BBS score , walking speed , and step length . Moreover , the motor threshold for TA decreased significantly in the unaffected hemisphere . The map size for TA was increased in both hemispheres , whereas that for AH was increased only in the affected hemisphere . There were significant differences between the change scores of the groups in terms of walking speed , step length , and motor threshold for TA in the unaffected hemisphere and map size for AH in the affected hemisphere . Additionally , the changes in corticomotor excitability correlated with functional improvement . Conclusions . Additional gait training may improve balance and gait performance and may induce changes in corticomotor excitability BACKGROUND Locomotor training , including the use of body-weight support in treadmill stepping , is a physical therapy intervention used to improve recovery of the ability to walk after stroke . The effectiveness and appropriate timing of this intervention have not been established . METHODS We stratified 408 participants who had had a stroke 2 months earlier according to the extent of walking impairment -- moderate ( able to walk 0.4 to < 0.8 m per second ) or severe ( able to walk < 0.4 m per second)-- and r and omly assigned them to one of three training groups . One group received training on a treadmill with the use of body-weight support 2 months after the stroke had occurred ( early locomotor training ) , the second group received this training 6 months after the stroke had occurred ( late locomotor training ) , and the third group participated in an exercise program at home managed by a physical therapist 2 months after the stroke ( home-exercise program ) . Each intervention included 36 sessions of 90 minutes each for 12 to 16 weeks . The primary outcome was the proportion of participants in each group who had an improvement in functional walking ability 1 year after the stroke . RESULTS At 1 year , 52.0 % of all participants had increased functional walking ability . No significant differences in improvement were found between early locomotor training and home exercise ( adjusted odds ratio for the primary outcome , 0.83 ; 95 % confidence interval [ CI ] , 0.50 to 1.39 ) or between late locomotor training and home exercise ( adjusted odds ratio , 1.19 ; 95 % CI , 0.72 to 1.99 ) . All groups had similar improvements in walking speed , motor recovery , balance , functional status , and quality of life . Neither the delay in initiating the late locomotor training  nor the severity of the initial impairment affected the outcome at 1 year . Ten related serious adverse events were reported ( occurring in 2.2 % of participants undergoing early locomotor training , 3.5 % of those undergoing late locomotor training , and 1.6 % of those engaging in home exercise ) . As compared with the home-exercise group , each of the groups receiving locomotor training had a higher frequency of dizziness or faintness during treatment ( P=0.008 ) . Among patients with severe walking impairment , multiple falls were more common in the group receiving early locomotor training than in the other two groups ( P=0.02 ) . CONCLUSIONS Locomotor training , including the use of body-weight support in stepping on a treadmill , was not shown to be superior to progressive exercise at home managed by a physical therapist . ( Funded by the National Institute of Neurological Disorders and Stroke and the National Center for Medical Rehabilitation Research ; LEAPS Clinical Trials.gov number , NCT00243919 . ) Background When people with stroke recover gait speed , they report improved function and reduced disability . However , the minimal amount of change in gait speed that is clinical ly meaningful and associated with an important difference in function for people poststroke has not been determined . Objective The purpose of this study was to determine the minimal clinical ly important difference ( MCID ) for comfortable gait speed ( CGS ) associated with an improvement in the modified Rankin Scale ( mRS ) score for people between 20 to 60 days poststroke . Design This was a prospect i ve , longitudinal , cohort study . Methods The participants in this study were 283 people with first-time stroke prospect ively enrolled in the ongoing Locomotor Experience Applied Post Stroke ( LEAPS ) multi-site r and omized clinical trial . Comfortable gait speed was measured and mRS scores were obtained at 20 and 60 days poststroke . Improvement of ≥1 on the mRS was used to detect meaningful change in disability level . Results Mean ( SD ) CGS was 0.18 ( 0.16 ) m/s at 20 days and 0.39 ( 0.22 ) m/s at 60 days poststroke . Among all participants , 47.3 % experienced an improvement in disability level ≥1 . The MCID was estimated as an improvement in CGS of 0.16 m/s anchored to the mRS . Limitations Because the mRS is not a gait-specific measure of disability , the estimated MCID for CGS was only 73.9 % sensitive and 57.0 % specific for detecting improvement in mRS scores . Conclusions We estimate that the MCID for gait speed among patients with subacute stroke and severe gait speed impairments is 0.16 m/s . Patients with subacute stroke who increase gait speed ≥0.16 m/s are more likely to experience a meaningful improvement in disability level than those who do not . Clinicians can use this reference value to develop goals and interpret progress in patients with subacute stroke 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 — Conventional therapies fail to restore normal gait to many patients after stroke . The study purpose was to test response to coordination exercise , overground gait training , and weight-supported treadmill training , both with and without functional neuromuscular stimulation ( FNS ) using intramuscular ( IM ) electrodes ( FNS-IM ) . Methods — In a r and omized controlled trial , 32 subjects ( > 1 year after stroke ) were assigned to 1 of 2 groups : FNS-IM or No-FNS .  Inclusion criteria included ability to walk independently but inability to execute a normal swing or stance phase . All subjects were treated 4 times per week for 12 weeks . The primary outcome measure , obtained by a blinded evaluator , was gait component execution , according to the Tinetti gait scale . Secondary measures were coordination , balance , and 6-minute walking distance . Results — Before treatment , there were no significant differences between the 2 groups for age , time since stroke , stroke severity , and each study measure . FNS-IM produced a statistically significant greater gain versus No-FNS for gait component execution ( P=0.003 ; parameter estimate 2.9 ; 95 % CI , 1.2 to 4.6 ) and knee flexion coordination ( P=0.049 ) . Conclusion — FNS-IM can have a significant advantage versus No-FNS in improving gait components and knee flexion coordination 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 and Purpose — Physical inactivity propagates disability after stroke through physical deconditioning and learned nonuse . We investigated whether treadmill aerobic training ( T-AEX ) is more effective than conventional rehabilitation to improve ambulatory function and cardiovascular fitness in patients with chronic stroke . Methods — Sixty-one adults with chronic hemiparetic gait after ischemic stroke ( > 6 months ) were r and omized to 6 months ( 3 × /week ) progressive T-AEX or a reference rehabilitation program of stretching plus low-intensity walking ( R-CONTROL )  . Peak exercise capacity ( Vo2 peak ) , o2 consumption during submaximal effort walking ( economy of gait ) , timed walks , Walking Impairment Question naire ( WIQ ) , and Rivermead Mobility Index ( RMI ) were measured before and after 3 and 6 months of training . Results — Twenty-five patients completed T-AEX and 20 completed R-CONTROL . Only T-AEX  increased cardiovascular fitness ( 17 % versus 3 % , & dgr;% T-AEX versus R-CONTROL , P<0.005 ) . Group-by-time analyses revealed T-AEX  improved ambulatory performance on 6-minute walks ( 30 % versus 11 % , P<0.02 ) and mobility function indexed by WIQ distance scores ( 56 % versus 12 % , P<0.05 ) . In the T-AEX group , increasing training velocity predicted improved Vo2 peak ( r=0.43 , P<0.05 ) , but not walking function . In contrast , increasing training session duration predicted improved 6-minute walk ( r=0.41 , P<0.05 ) , but not fitness gains . Conclusions — T-AEX  improves both functional mobility and cardiovascular fitness in patients with chronic stroke and is more effective than reference rehabilitation common to conventional care . Specific characteristics of training may determine the nature of exercise-mediated adaptations Background and Purpose — The success of gait rehabilitation after stroke depends on active walking exercises . However , the disabling after-effects of stroke often make such exercises impossible at the onset of therapy . To facilitate treadmill training of paraparetic patients , a robot-driven gait orthosis ( Lokomat ) was developed . We investigated the effects of the Lokomat when used with hemiparetic patients . Methods — The authors conducted a r and omized , controlled pilot study of 30 acute stroke survivors . The treatment group received 30 minutes of robotic training daily and the control group 30 minutes of conventional physiotherapy daily in addition to 30 minutes of conventional physiotherapy for each group . Outcome measures were independence of gait , gait speed , gait parameters , and body tissue composition . Results — After 4 weeks of therapy , the walking ability of the Lokomat group and the control group expressed as the functional ambulation classification was significantly improved . The functional ambulation category ( median± interquartile range ) was at baseline 0±0 in control and 0±1 in the therapy group and increased after therapy to 1±3 in both groups significantly ( P=0.01 ) . There was no significant difference in gain of these parameters between the groups . The Lokomat group had a significantly longer single stance phase ( sec ; mean±SEM ) on the paretic leg when walking on the floor . At baseline , it was 0.19±0.17 and after therapy 0.49±0.07 ( P=0.014 ) . The control group had increased their body weight approximately 1.33±1.40 kg ( mean±SEM ; P=0.046 ) , mostly as fat mass , whereas the Lokomat group had lost fat mass approximately −2.9±1.0 kg ( mean±SEM ; P=0.016 ) and increased their muscle mass approximately 3.36±1.4 kg ( mean± SEM ; P=0.031 ) . Conclusions — This pilot study indicates that Lokomat therapy is a promising intervention for gait rehabilitation . Although there was no difference between groups in gain of functional scores , the Lokomat group showed an advantage of robotic training over conventional physiotherapy in improvement of gait abnormality and body tissue composition Background and Purpose — Animal studies provide strong evidence that aerobic exercise training positively influences cerebral blood flow , but no human studies support the use of exercise for improving cerebral hemodynamics . This r and omized study in stroke survivors assessed the effects of treadmill aerobic exercise training ( TM ) on cerebral blood flow parameters compared to a control intervention of nonaerobic stretching . Methods — Thirty-eight participants ( 19 in TM group and 19 in control group ) with remote stroke ( > 6 months ) and mild to moderate gait deficits completed middle cerebral artery blood flow velocity measurements by transcranial Doppler ultrasonography before and after a 6-month intervention period . Middle cerebral artery blood flow velocity was assessed bilaterally during normocapnia and hypercapnia ( 6 % CO2 ) . Cerebral vasomotor reactivity ( cVMR ) was calculated as percent change in middle cerebral artery blood flow velocity from normocapnia to hypercapnia ( cVMR percent ) and as an index correcting percent change for absolute increase in end tidal CO2 ( cVMR index ) . Results — The TM group had significantly larger improvements than did controls for both ipsilesional and contralesional cVMR index ( P⩽0.05 ) and contralesional cVMR percent ( P⩽0.01 ) . Statin users in the TM group ( n=10 ) had higher baseline cVMR and lower training-induced cVMR change , indicating that cVMR change among those not using statins ( n=9 ) primarily accounted for the between-group effects . There was a 19 % increase in VO2 peak for the TM group compared to a 4 % decrease in the control group ( P<0.01 ) , and peak fitness change correlated with cVMR change ( r=0.55 ; P<0.05 ) . Conclusions — Our data provide the first evidence to our knowledge of exercise-induced cVMR improvements in stroke survivors , implying a protective mechanism against recurrent stroke and other brain-related disorders . Statin use appears to regulate cVMR and the cVMR training response 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 ) The purpose of this pilot study was to compare differences in motor recovery between regular rehabilitation ( REG ) , and regular rehabilitation with supported treadmill ambulation training ( STAT ) using the performance on a bicycle exercise test and the locomotor scale of the Functional Independence Measure ( FIM-L ) . Twelve patients with acute strokes were r and omly assigned to either REG or STAT for 2 to 3 weeks . The STAT group received daily gait training utilizing a treadmill with partial support of body weight . After intervention , the STAT group had higher oxygen consumption ( 11.34+/-0.88 vs 8.32+/-0.88 ml/kg/min , p=0.039 ) , total workload ( 58.75+/-7.09 vs 45.42+/-7.09 watts , p = ns ) , and total time pedaling the bike ( 288.91+/-30.61 vs 211.42+/-30.61 s , p = ns ) compared to the REG group . The FIM-L scores were not different for the two groups . This pilot study suggests that the STAT intervention is a promising technique for acute stroke rehabilitation , and that future studies with larger sample sizes are warranted to establish the effectiveness of this intervention OBJECTIVE To evaluate the effectiveness of repetitive locomotor training using a newly developed electromechanical gait device compared with treadmill training/gait training with respect to patient 's ambulatory motor outcome , necessary personnel re sources , and discomfort experienced by therapists and patients . METHODS R and omized , controlled , cross-over trial . Sixteen non-ambulatory patients after stroke , severe brain or spinal cord injury sequentially received 2 kinds of gait training . Study intervention A : 20 treatments of locomotor training with an electromechanical gait device ; control intervention B : 20 treatments of locomotor training with treadmill or task-oriented gait training . The primary variable was walking ability ( Functional Ambulation Category ) . Secondary variables included gait velocity , Motricity-Index , Rivermead-Mobility-Index , number of therapists needed , and discomfort and effort of patients and therapists during training . RESULTS Gait ability and the other motor outcome related parameters improved for all patients , but without significant difference between intervention types . However , during intervention A , significantly fewer therapists were needed , and they reported less discomfort and a lower level of effort during training sessions . CONCLUSION Locomotor training with or without an electromechanical gait trainer leads to improved gait ability ; however , using the electromechanical gait trainer requires less therapeutic assistance , and therapist discomfort is reduced BACKGROUND AND PURPOSE A new gait training strategy for patients with stroke proposes to support a percentage of the patient 's body weight while retraining gait on a treadmill . This research project intended to compare the effects of gait training with body weight support ( BWS ) and with no body weight support ( no-BWS ) on clinical outcome measures for patients with stroke . METHODS One hundred subjects with stroke were r and omized to receive one of two treatments while walking on a treadmill : 50 subjects were trained to walk with up to 40 % of their body weight supported by a BWS system with overhead harness ( BWS group ) , and the other 50 subjects were trained to walk bearing full weight on their lower extremities ( no-BWS group ) . Treatment outcomes were assessed on the basis of functional balance , motor recovery , overground walking speed , and overground walking endurance . RESULTS After a 6-week training period , the BWS group scored significantly higher than the no-BWS group for functional balance ( P = 0.001 ) , motor recovery ( P = 0.001 ) , overground walking speed ( P = 0.029 ) , and overground w alking endurance ( P = 0.018 ) . The follow-up evaluation , 3 months after training , revealed that the BWS group continues to have significantly higher scores for overground walking speed ( P = 0.006 ) and motor recovery ( P = 0.039 ) . CONCLUSIONS Retraining gait in patients with stroke while a percentage of their body weight was supported result ed in better walking abilities than gait training while the patients were bearing their full weight . This novel gait training strategy provides a dynamic and integrative approach for the treatment of gait dysfunction after stroke Background and Purpose — Resting and reactive hyperemic leg blood flows are significantly reduced in the paretic compared with the nonparetic limb after disabling stroke . Our objective was to compare the effects of regular treadmill exercise ( TM ) with an active control regimen of supervised stretching ( CONTROL ) on peripheral hemodynamic function . Methods — This intervention study used a r and omized , controlled design , in which participants were r and omized with stratification according to age and baseline walking capacity to ensure approximate balance between the 2 groups . Fifty-three chronic , ischemic stroke participants ( 29 TM and 24 CONTROL ) with mild to moderate hemiparetic gait completed bilateral measurements of lower leg resting and reactive hyperemic blood flow using venous occlusion strain gauge plethysmography before and after the 6-month intervention period . Participants also underwent testing to track changes in peak aerobic fitness across time . Results — Resting and reactive hyperemic blood flows were significantly reduced in the paretic compared with the nonparetic limb at baseline before any intervention ( −28 % and −34 % , respectively , P<0.01 ) . TM increased both resting and reactive hyperemic blood flow in the paretic limb by 25 % compared with decreases in CONTROL ( P<0.001 , between groups ) . Similarly , nonparetic leg blood flow was significantly improved with TM compared with controls ( P<0.001 ) . Peak aerobic fitness improved by 18 % in TM and decreased by 4 % in CONTROL ( P<0.01 , between groups ) , and there was a significant relationship between blood flow change and peak fitness change for the group as a whole ( r=.30 , P<0.05 ) . Conclusion — Peripheral hemodynamic function improves with regular aerobic exercise training after disabling stroke Background Residual walking deficits are common in community-dwelling people after stroke . Aims The aim of this study was to determine if a four-month treadmill and overground walking program is more effective than a two-month program , compared with control , at improving walking in community-dwelling people with stroke who walk slowly . Method A three-arm r and omized trial with concealed allocation , assessor blinding , and intention-to-treat analysis involving 102 people with stroke living in the community who walked slowly was undertaken . Experimental group 1 undertook 30 min of treadmill and overground walking thrice per week for four-months , experimental group 2 undertook training for two-months , while the control group had no intervention . The primary outcome was walking measured as the distance covered during the six-min walk test . Other outcomes were walking speed , step length and cadence , health status , community participation , self-efficacy and falls . Results By two-months , the experimental groups , who were both undergoing training , had improved their six-min walk distance compared with the control group . The four-month training group continued training beyond two-months and improved further so that by four months they walked 38 m ( 95 % confidence interval 15–60 ) more than the control group and 29 m ( 95 % confidence interval 4–53 ) more than the two-month training group . However , by 12 months , well after the cessation of training , both experimental groups had returned to near baseline levels , and there was no difference between the groups . Conclusion Four months of treadmill training results in better walking . However , these effects disappear once training ceases . Therefore , training should be ongoing Objective : To evaluate the efficacy of a task-orientated intervention in enhancing competence in walking in people with stroke . Design : Two-centre observer-blinded stratified block-r and omized controlled trial . Setting : General community . Subjects : Between May 2000 and February 2003 , 91 individuals with a residual walking deficit within one year of a first or recurrent stroke consented to participate . Interventions : The experimental intervention comprised 10 functional tasks design ed to strengthen the lower extremities and enhance walking balance , speed and distance . The control intervention involved the practice of upper extremity activities . Subjects in both groups attended sessions three times a week for six weeks . Main measures : Six-minute walk test ( SMWT ) , 5-m walk ( comfortable and maximum pace ) , Berg Balance Scale , timed ‘ up and go ’ . Results : At baseline , subjects in the experimental ( n = 44 ) and control ( n = 47 ) groups walked an average distance of 209 m ( SD = 126 ) and 204 m ( SD = 131 ) , respectively , on the SMWT . Mean improvements of 40 m ( SD = 72 ) , and 5 m ( SD = 66 ) were observed following the experimental and control interventions , respectively . The between-group difference was 35 m ( 95 % confidence interval ( CI ) 7 , 64 ) . Significant between-group effects of 0.21 m/s ( 95 % CI 0.12 , 0.30 ) and of 0.11 m/s ( 95 % CI 0.03 , 0.19 ) in maximum and comfortable walking speed , respectively , were observed . People with a mild , moderate or severe walking deficit at baseline improved an average of 36 ( SD = 96 ) , 55 ( SD = 56 ) and 18 m ( SD = 23 ) , respectively , in SMWT performance following the experimental intervention . Conclusions : Study findings support the efficacy of a task-orientated intervention in enhancing walking distance and speed in the first year post stroke , particularly in people with moderate walking deficits OBJECTIVE To investigate corticomotor changes induced by body weight-supported treadmill training ( BWSTT ) in patients with short or long poststroke duration . DESIGN Single-blinded and r and omized controlled trial . SETTING Neurologic physical therapy research laboratory . PARTICIPANTS Hemiparesis patients ( N=18 ) whose motor-evoked potentials could be induced participated in this study . Subjects in each hemiparesis postonset of short ( < 6 mo ) or long ( > 12 mo ) duration group were r and omly assigned to either the control or experimental group . INTERVENTIONS Subjects in the experimental groups participated in BWSTT for 4 weeks . Those in the control groups received the general exercise program . MAIN OUTCOME MEASURES The primary outcomes were motor threshold and map size of the abductor hallucis muscle in the ipsilesional hemisphere . The secondary outcome was Fugl-Meyer Assessment . Outcome measures were blindly assessed before and after completing the 4 weeks of training . RESULTS The 4-week BWSTT result ed in a decrease of motor threshold and an increase of map size in subjects with hemiparesis of short duration , whereas only the expansion of the map size was noted in subjects with hemiparesis of long duration . Improvement of motor control occurred in subjects with hemiparesis of both short and long duration after BWSTT . CONCLUSIONS The BWSTT results in similar improvement in motor control but different patterns of treatment-induced cortical reorganization in subjects with different poststroke duration Background and Purpose — Insulin resistance and glucose intolerance are highly prevalent after stroke , contributing to worsening cardiovascular disease risk and a predisposition to recurrent stroke . Treadmill exercise training ( T-AEX ) increases aerobic capacity ( Vo2 peak ) in chronic stroke patients , suggesting intensity levels that may be adequate to improve glucose metabolism . We compared the effects of a progressive T-AEX intervention to an attention-matched stretching intervention ( CONTROL ) on glucose tolerance and indices of insulin sensitivity in stroke survivors . Methods — Participants had hemiparetic gait after remote ( > 6 months ) ischemic stroke . They were r and omized to 6-month T-AEX or a duration matched reference CONTROL program of supervised stretching exercises . Main outcome measures were glucose and insulin responses during a 3-hour oral glucose tolerance test ( OGTT ) . Results — Forty-six subjects ( T-AEX=26 , CONTROL=20 ) completed OGTT testing before and after the interventions . T-AEX  increased Vo2 peak ( + 15 % versus −3 % & Dgr ; , P<0.01 ) compared with CONTROL . There were significant reductions in fasting insulin ( −23 % versus + 9 % & Dgr ; , P<0.05 ) and the total integrated 3-hour insulin response ( −24 % versus + 3 % & Dgr ; , P<0.01 ) in T-AEX compared with CONTROL . In patients with abnormal glucose tolerance at baseline , T-AEX result ed in a significant 14 % decrease in 3-hour glucose response ( n=12 , P<0.05 ) . Fifty-eight percent of T-AEX participants with abnormal baseline OGTT ( 7 of 12 ) improved glucose tolerance status at 2 hours compared with < 10 % ( 1 of 11 ) of impaired CONTROLS ( P<0.05 ) . Conclusions — These preliminary findings suggest that progressive aerobic exercise can reduce insulin resistance and prevent diabetes in hemiparetic stroke survivors . Larger clinical trials are needed to definitively establish the use of structured exercise training for stimulating metabolic improvement poststroke 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 Background and Purpose — The purpose of this study was to compare treadmill and electromechanical gait trainer therapy in subacute , nonambulatory stroke survivors . The gait trainer was design ed to provide nonambulatory subjects the repetitive practice of a gait-like movement without overexerting therapists . Methods — This was a r and omized , controlled study with a crossover design following an A-B-A versus a B-A-B pattern . A consisted of 2 weeks of gait trainer therapy , and B consisted of 2 weeks of treadmill therapy .  Thirty nonambulatory hemiparetic patients , 4 to 12 weeks after stroke , were r and omly assigned to 1 of the 2 groups receiving locomotor therapy every workday for 15 to 20 minutes for 6 weeks . Weekly gait ability ( functional ambulation category [ FAC ] ) , gait velocity , and the required physical assistance during both kinds of locomotor therapy  were the primary outcome measures , and other motor functions ( Rivermead motor assessment score ) and ankle spasticity ( modified Ashworth score ) were the secondary outcome measures . Follow-up occurred 6 months later . Results — The groups did not differ at study onset with respect to the clinical characteristics and effector variables . During treatment , the FAC , gait velocity , and Rivermead scores improved in both groups , and ankle spasticity did not change . Median FAC level was 4 ( 3 to 4 ) in group A compared with 3 ( 2 to 3 ) in group B at the end of treatment ( P = 0.018 ) , but the difference at 6-month follow up was not significant . The therapeutic effort was less on the gait trainer , with 1 instead of 2 therapists assisting the patient at study onset . All but seven patients preferred the gait trainer . Conclusions — The newly developed gait trainer was at least as effective as treadmill therapy with partial body weight support while requiring less input from the therapist . Further studies are warranted OBJECTIVE To examine the feasibility , safety and effectiveness of an early aerobic rehabilitation program for patients after minor ischemic stroke . DESIGN R and omized control trial . METHODS Twenty-eight patients , 1 - 3 weeks post minor ischemic stroke ( modified Rankin scale ; mRS ≤ 2 ) , were r and omly assigned to intervention or control groups . Measures were taken at weeks 1 and 6 . All participants were instructed in home practice to achieve strength and flexibility , and were asked to continue their normal community routine . Intervention group participants performed a supervised exercise training program twice a week for 6 weeks .  Exercise capacity was evaluated by the 6-minute walk distance test ( 6MWD ) , and the modified Bruce treadmill test . RESULTS Eight subjects out of 14 participated in all 12 training sessions , one at less than 50 % of the sessions , while five reached the highest stage of the program . No adverse events were noted during the intervention period . In the intention to treat analysis a significant improvement over time was seen for the functional parameters only . No interaction ( group*time ) was found . According to the per protocol analysis a significant interaction effect was found ; only the intervention group participants showed a significant clinical change in the 6MWD test ( 412 ± 178 meters to 472 ± 196 meters , vs the control group 459 ± 116 meters to 484 ± 122 meters , p < 0.01 ) . CONCLUSIONS An early supervised aerobic training after minor ischemic stroke is feasible and well tolerated and , in a per- protocol analysis , was associated with improved walking endurance . Further studies with a larger sample size are needed to assess the effect of such a program on functional abilities , prevention of risk factors , and recurrent stroke PURPOSE The aim of the study is to define the impact of exercise on a treadmill on static balance and stability of posture in a group of patients after cerebral stroke rehabilitated in a late period , with an application of a treadmill with the function of visual biofeedback . METHODS The examination was carried out in a group of 46 people in a late period after ischemic cerebral stroke . The patients examined were r and omly put to a group with intervention ( n = 23 ) , in which a rehabilitation programme with an application of a treadmill with the visual feedback function was realized and to a control group ( n = 23 ) . They evaluated balance in st and ing on both feet by means of a force plate , symmetry of load of lower limbs and dynamic balance in Up & Go test . RESULTS A statistically significant change of stabilometric parameters was observed only in the area of postural sways of the centre of pressure ( COP ) . A significant improvement of the symmetry of load of lower limbs in st and ing ( p = 0.0266 ) was diagnosed in the examined group after the end of the programme . After the end of the programme no significant difference between the group with intervention and the control group as for a change of balance of the examined patients was found . CONCLUSIONS In the examined group in the chronic period after cs no significant improvement of stabilometrically evaluated balance was obtained , but improvement of the symmetry of load of lower limbs as well as improvement of dynamic balance were observed The purpose of this r and omised controlled trial was to evaluate the effects of two different exercise approaches during the first 12 months post stroke on Instrumental Activities of Daily Living ( IADL ) , motor function , gait performance , balance , grip strength , and muscle tone . This study is a double-blind longitudinal r and omised trial of first-time-ever stroke patients . Seventy-five patients were included : 35 in an intervention group and 40 in a self-initiated exercise group .  After discharge from acute rehabilitation , patients assigned in the intervention group had physiotherapy for a minimum amount of 80 hours during the first year . Patients in the self-initiated exercise group were not recommended any specific therapy besides treatment when needed . Main outcome measures were Instrumental Activities of Daily Living according to Fillenbaum , Motor Assessment Scale , 6-Minute Walk Test , Berg Balance Scale , Timed Up- and -Go Test , grip strength , Modified Ashworth Scale , and pulse monitoring . The patients were tested on admission , at discharge , and after 3 , 6 , and 12 months post stroke by an experienced investigator , blinded to group assignment . Twelve months post stroke showed higher levels of independence in all items of the Instrumental Activities of Daily Living Test and improvements in the results of Motor Assessment Scale , 6-Minute Walk Test , Berg Balance Scale , Timed Up- and -Go , and grip strength in both groups . Only a few significant differences were seen between groups , and they were in favour of the self-initiated exercise group ( e.g. , ability to use the telephone independently ) . Attending examination sessions following each intervention phase appeared to be strong motivators for training , irrespective of group allocation Objective . Gait performance is an indicator of mobility impairment after stroke . This study evaluated changes in balance , lower extremity motor function , and spatiotemporal gait parameters after receiving body weight supported treadmill training ( BWSTT ) and conventional overground walking training ( CT ) in patients with subacute stroke using 3D motion analysis . Setting . Inpatient department of rehabilitation medicine at a university-affiliated hospital . Participants . 24 subjects with unilateral hemiplegia in the subacute stage were r and omized to the BWSTT ( n = 12 ) and CT ( n = 12 ) groups . Parameters were compared between the two groups . Data from twelve age matched healthy subjects were recorded as reference . Interventions . Patients received gait training with BWSTT or CT for an average of 30 minutes/day , 5 days/week , for 3 weeks . Main Outcome Measures . Balance was measured by the Brunel balance assessment . Lower extremity motor function was evaluated by the Fugl-Meyer assessment scale . Kinematic data were collected and analyzed using a gait capture system before and after the interventions . Results . Both groups improved on balance and lower extremity motor function measures ( P < 0.05 ) , with no significant difference between the two groups after intervention . However , kinematic data were significantly improved ( P < 0.05 ) after BWSTT but not after CT .  Maximum hip extension and flexion angles were significantly improved ( P < 0.05 ) for the BWSTT group during the stance and swing phases compared to baseline . Conclusion . In subacute patients with stroke , BWSTT can lead to improved gait quality when compared with conventional gait training . Both methods can improve balance and motor function Background While manually-assisted body-weight supported treadmill training ( BWSTT ) has revealed improved locomotor function in persons with post-stroke hemiparesis , outcomes are inconsistent and it is very labor intensive . Thus an alternate treatment approach is desirable . Objectives of this pilot study were to : 1 ) compare the efficacy of body-weight supported treadmill training ( BWSTT ) combined with the Lokomat robotic gait orthosis versus manually-assisted BWSTT for locomotor training post-stroke , and 2 ) assess effects of fast versus slow treadmill training speed . Methods Sixteen volunteers with chronic hemiparetic gait ( 0.62 ± 0.30 m/s ) post-stroke were r and omly allocated to Lokomat ( n = 8) or manual-BWSTT ( n = 8) 3 × /wk for 4 weeks . Groups were also stratified by fast ( mean 0.92 ± 0.15 m/s ) or slow ( 0.58 ± 0.12 m/s ) training speeds . The primary outcomes were self-selected overground walking speed and paretic step length ratio . Secondary outcomes included : fast overground walking speed , 6-minute walk test , and a battery of clinical measures . Results No significant differences in primary outcomes were revealed between Lokomat and manual groups as a result of training . However , within the Lokomat group , self-selected walk speed , paretic step length ratio , and four of the six secondary measures improved ( p = 0.04–0.05 , effect sizes = 0.19–0.60 ) . Within the manual group , only balance scores improved ( p = 0.02 , effect size = 0.57 ) . Group differences between fast and slow training groups were not revealed ( p ≥ 0.28 ) . Conclusion Results suggest that Lokomat training may have advantages over manual-BWSTT following a modest intervention dose in chronic hemiparetic persons and further , that our training speeds produce similar gait improvements . Suggestions for a larger r and omized controlled trial with optimal study parameters are provided Background . After inpatient stroke rehabilitation , many people still can not participate in community activities because of limited walking ability . Objective . To compare the effectiveness of 2 conceptually different , early physical therapy ( PT ) interventions to usual care ( UC ) in improving walking 6 months after stroke . Methods . The Locomotor Experience Applied Post-Stroke ( LEAPS ) study was a single-blind , r and omized controlled trial conducted in 408 adults with disabling hemiparetic stroke . Participants were stratified at baseline ( 2 months ) by impairment in walking speed : severe ( < 0.4 m/s ) or moderate ( 0.4 to < 0.8 m/s ) . Between 2 and 6 months , they received either only UC ( n = 143 ) or UC plus 36 therapist-provided sessions of either ( 1 ) walking training on a treadmill using body-weight support and practice overground at clinics ( locomotor training program [ LTP ] , n = 139 ) or ( 2 ) impairment-based strength and balance exercise at home ( home exercise program [ HEP ] , n = 126 ) . Results . LTP participants were 18 % more likely to transition to a higher functional walking level : severe to > 0.4 m/s and moderate to > 0.8 m/s than UC participants ( 95 % confidence interval [ CI ] = 7%-29 % ) , and HEP participants were 17 % more likely to transition ( 95 % CI = 5%-29 % ) . Mean gain in walking speed in LTP participants was 0.13 m/s greater ( 95 % CI = 0.09 - 0.18 ) and in HEP participants , 0.10 m/s greater ( 95 % CI = 0.05 - 0.14 ) than in UC participants . Conclusions . Progressive PT , using either walking training on a treadmill and overground , conducted in a clinic , or strength and balance exercises conducted at home , was superior to UC in improving walking , regardless of severity of initial impairment OBJECTIVES to compare the therapeutic effects of two approaches to gait re-training -- a schedule of conventional physiotherapy and treadmill re-training -- in patients with higher-level gait disorders associated with cerebral multiinfa rct states . DESIGN single-blind crossover study involving a 4-week baseline period , 4 weeks of treadmill re-training and 4 weeks of conventional physiotherapy . SETTING a large teaching hospital . SUBJECTS patients with cerebral multi-infa rct states who met the criteria for higher-level gait disorders . Computed tomographic brain scans showed at least one large vessel infa rct , basal ganglia and white matter lacunes or extensive leukoaraiosis . INTERVENTIONS a schedule of treadmill re-training and a specific schedule of physiotherapy containing 31 interventions in three treatment modules : ( i ) for gait ignition failure and turning ; ( ii ) to improve postural alignment and enhance balance reactions ; and ( iii ) for other components of cerebral multi-infa rct state disordered gait . MAIN OUTCOME MEASURES spatial and temporal gait measures and activity of daily living assessment s. RESULTS we recruited 18 patients , mean ( SD ) age 79.1 ( 6.8 ) years . Patients walked an average of 7.9 ( 5.5 ) km on the treadmill and had an average of 6.7 ( 3.2 ) h of physiotherapy . There were clinical ly moderate but highly statistically significant ( P < 0.001 ) improvements in the following indices : time taken to complete the sit-to-st and test ; time taken to walk 10 m ; number of steps over 10 m ; walking velocity ; right and left step lengths ; and time taken to complete the 'S ' test . There were no differences in the results obtained in each limb of the study . CONCLUSION there is no difference between the effects of conventional physiotherapy and treadmill re-training on the gait of patients with higher-level gait disorders associated with cerebral multi-infa rct states . However , the improvements seen during the treatment period suggest that there is scope to improve the gait of this group of frail , elderly patients OBJECTIVES To evaluate the efficacy of a task-oriented walking intervention in improving balance self-efficacy in persons with stroke and to determine whether effects were task-specific , influenced by baseline level of self-efficacy and associated with changes in walking and balance capacity . DESIGN Secondary analysis of a two-center , observer-blinded , r and omized , controlled trial . SETTING General community . PARTICIPANTS Ninety-one individuals with a residual walking deficit within 1 year of a first or recurrent stroke . INTERVENTION Task-oriented interventions targeting walking or upper extremity ( UE ) function were provided three times a week for 6 weeks . MEASUREMENTS Activities-specific Balance Confidence Scale , Six-Minute Walk Test , 5-m walk , Berg Balance Scale , and Timed " Up and Go " administered at baseline and postintervention . RESULTS The walking intervention was associated with a significantly greater average proportional change in balance self-efficacy than the UE intervention . Treatment effects were largest in persons with low self-efficacy at baseline and for activities relating to tasks practice d. In the walking group , change in balance self-efficacy correlated with change in functional walking capacity ( correlation coefficient=0.45 , 95 % confidence interval=0.16 - 0.68 ) . Results of multivariable modeling suggested effect modification by the baseline level of depressive symptoms and a prognostic influence of age , sex , comorbidity , time poststroke , and functional mobility on change in self-efficacy . CONCLUSION Task-oriented walking retraining enhances balance self-efficacy in community-dwelling individuals with chronic stroke . Benefits may be partially the result of improvement in walking capacity . The influence of baseline level of self-efficacy , depressive symptoms , and prognostic variables on treatment effects are of clinical importance and must be verified in future studies Background Although task-oriented training has been shown to improve walking outcomes after stroke , it is not yet clear whether one task-oriented approach is superior to another . The purpose of this study is to compare the effectiveness of the Motor Learning Walking Program ( MLWP ) , a varied overground walking task program consistent with key motor learning principles , to body-weight-supported treadmill training ( BWSTT ) in community-dwelling , ambulatory , adults within 1 year of stroke . Methods / Design A parallel , r and omized controlled trial with stratification by baseline gait speed will be conducted . Allocation will be controlled by a central r and omization service and participants will be allocated to the two active intervention groups ( 1:1 ) using a permuted block r and omization process . Seventy participants will be assigned to one of two 15-session training programs . In MLWP , one physiotherapist will supervise practice of various overground walking tasks . Instructions , feedback , and guidance will be provided in a manner that facilitates self-evaluation and problem solving . In BWSTT , training will emphasize repetition of the normal gait cycle while supported over a treadmill , assisted by up to three physiotherapists . Outcomes will be assessed by a blinded assessor at baseline , post-intervention and at 2-month follow-up . The primary outcome will be post-intervention comfortable gait speed . Secondary outcomes include fast gait speed , walking endurance , balance self-efficacy , participation in community mobility , health-related quality of life , and goal attainment . Groups will be compared using analysis of covariance with baseline gait speed strata as the single covariate . Intention-to-treat analysis will be used . Discussion In order to direct clinicians , patients , and other health decision-makers , there is a need for a head-to-head comparison of different approaches to active , task-related walking training after stroke . We hypothesize that outcomes will be optimized through the application of a task-related training program that is consistent with key motor learning principles related to practice , guidance and feedback . Trial Registration Clinical Trials.gov # Walking tests , frequently used to document effects of treatment on exercise capacity , have never been st and ardised . We studied the effects of encouragement on walking test performance in a r and omised study that controlled for the nature of the underlying disease , time of day , and order effects . We r and omised 43 patients with chronic airflow limitation or chronic heart failure or both to receive or not receive encouragement as they performed serial two and six minute walks every fortnight for 10 weeks . Simple encouragement improved performance ( p less than 0.02 for the six minute walk ) , and the magnitude of the effect was similar to that reported for patients in studies purporting to show beneficial effects of therapeutic manoeuvres . Age and test repetition also affected performance . These results demonstrate the need for careful st and ardisation of the performance of walking tests , and suggest caution in interpreting studies in which st and ardisation is not a major feature of the study design The objective of this study was to compare the effects of conventional over-ground gait training with treadmill training on the restoration of gait in people with hemiparesis following a stroke . Twenty-five individuals in the early stages of rehabilitation were alternately assigned to one of two treatment groups . In addition to conventional physical therapy , the experimental group participated in 15 treadmill-training sessions in which a h and rail was used for external support . The control group received the same number of equal length sessions of over-ground ambulation . Treatment effects were established by pre- and posttreatment assessment of : 1 ) functional walking ability , 2 ) walking speed , 3 ) stride length , 4 ) temporal characteristics of gait , and 5 ) electromyographic activity of calf muscles . Normal values were obtained from eight healthy individuals of approximately the same age as the stroke survivors . The study demonstrates that individuals following a stroke are well able to tolerate treadmill training in the early stage of their rehabilitation process without the use of a weight support apparatus . Furthermore , the findings suggest that treadmill training may be more effective than conventional gait training for improving some gait parameters such as functional ambulation , stride length , percentage of paretic single stance period , and gastrocnemius muscular activity Background Locomotor training using body weight support and a treadmill as a therapeutic modality for rehabilitation of walking post-stroke  is being rapidly adopted into clinical practice . There is an urgent need for a well- design ed trial to determine the effectiveness of this intervention . The objective of the Locomotor Experience Applied Post-Stroke ( LEAPS ) trial is to determine if there is a difference in the proportion of participants who recover walking ability at one year post-stroke when r and omized to a specialized locomotor training program ( LTP ) , conducted at 2- or 6-months post-stroke , or those r and omized to a home based non-specific , low intensity exercise intervention ( HEP ) provided 2 months post-stroke . We will determine if the timing of LTP delivery affects gait speed at 1 year and whether initial impairment severity interacts with the timing of LTP . The effect of number of treatment sessions will be determined by changes in gait speed taken pre-treatment and post-12 , -24 , and -36 sessions . Methods / Design We will recruit 400 adults with moderate or severe walking limitations within 30 days of stroke onset . At two months post stroke , participants are stratified by locomotor impairment severity as determined by overground walking speed and r and omly assigned to one of three groups : ( a ) LTP-Early ; ( b ) LTP-Late or ( c ) Home Exercise Program -Early . The LTP program includes body weight support on a treadmill and overground training . The LTP and HEP interventions are delivered for 36 sessions over 12 weeks . Primary outcome measure include successful walking recovery defined as the achievement of a 0.4 m/s gait speed or greater by persons with initial severe gait impairment or the achievement of a 0.8 m/s gait speed or greater by persons with initial moderate gait impairment . LEAPS is powered to detect a 20 % difference in the proportion of participants achieving successful locomotor recovery between the LTP groups and the HEP group , and a 0.1 m/s mean difference in gait speed change between the two LTP groups . Discussion The goal of this single-blinded , phase III r and omized clinical trial is to provide evidence to guide post-stroke walking recovery programs . Trial registration NCT00243919 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 After stroke , persistent gait deficits cause debilitating falls and poor functional mobility . Gait restoration can preclude these outcomes . Sixteen subjects ( > 12 months poststroke ) were r and omized to two gait training groups . Group 1 received 12 weeks of treatment , 4 times a week , 90 min per session , including 30 min strengthening and coordination , 30 min over-ground gait training , and 30 min weight-supported treadmill training . Group 2 received the same treatment , but also used functional neuromuscular stimulation ( FNS ) with intramuscular ( IM ) electrodes ( FNS-IM ) for each aspect of treatment . Outcome measures were kinematics of gait swing phase . Both groups showed no significant pre-/posttreatment gains in peak swing hip flexion . Group 1 ( no FNS ) had no significant gains in other gait components at posttreatment or at follow-up . Group 2 ( FNS-IM ) had significant gains in peak swing knee flexion and mid-swing ankle dorsiflexion ( p < 0.05 ) that were maintained for 6 months 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 The purpose of this study was to investigate whether additional practice of either upper limb or mobility tasks improved functional outcome during inpatient stroke rehabilitation . This prospect i ve , r and omised , single blind clinical trial recruited 30 stroke subjects into either an Upper Limb or a Mobility Group . All subjects received their usual rehabilitation and an additional session of task-related practice using a circuit class format . Independent assessors , blinded to group allocation , tested all subjects . Outcome measures used were three items of the Jebsen Taylor H and Function Test ( JTHFT ) , two  arm items  of the Motor Assessment Scale ( MAS ) , and three mobility measures , the Timed Up and Go Test ( TUGT ) , Step Test , and Six Minute Walk Test ( 6MWT ) . Both groups improved significantly between pre- and post-tests on all of the mobility measures , however only the Upper Limb Group made a significant improvement on the JTHFT and MAS upper arm items . Following four weeks training , the Mobility Group had better locomotor ability than the Upper Limb Group ( between-group differences in the 6MWT of 116.4 m , 95 % CI 31.4 to 201.3 m , Step Test 2.6 repetitions , 95 % CI -1.0 to 6.2 repetitions , and TUGT -7.6 sec , 95 % CI -15.5 to 0.2 sec ) . The JTHFT dexterity scores in the Upper Limb Group were 6.5 sec ( 95 % CI -7.4 to 20.4 sec ) faster than the Mobility Group . Our findings support the use of additional task-related practice during inpatient stroke rehabilitation . The circuit class format was a practical and effective means to provide supervised additional practice that led to significant and meaningful functional gains Background It has been reported that only half of the non-ambulatory stroke patients admitted to inpatient rehabilitation in Australia learn to walk again [ 1 ] . Treadmill walking with partial weight support via an overhead harness is a relatively new intervention that is design ed to train walking . The main objective of this r and omised controlled trail is to determine whether treadmill walking with partial weight support via an overhead harness is effective at establishing independent walking ( i ) more often , ( ii ) earlier and ( iii ) with a better quality of walking , than current physiotherapy intervention for non-ambulatory stroke patients . Methods A prospect i ve , r and omised controlled trial of inpatient intervention with a 6 month follow-up with blinded assessment will be conducted . 130 stroke patients who are unable to walk independently early after stroke will be recruited and r and omly allocated to a control group or an experimental group . The control group will undertake 30 min of routine assisted overground walking while the experimental group will undertake 30 min of treadmill walking with partial weight support via an overhead harness per day . The proportion of participants achieving independent walking , the quality of walking , and community participation will be measured . The study has obtained ethical approval from the Human Research Ethics Committees of each of the sites involved in the study . Discussion Given that the Australian population is ageing and people after stroke can expect to live for longer , attainment of safe , independent walking is more likely to be associated with long-term health and well being . In its National Research Priorities , the Government has recognised that it will be important to promote healthy ageing and that this endeavour will be underpinned by research . The results of this study will clearly identify effective intervention to establish early quality walking , thereby promoting an increase in community participation in the longer term . Trial Registration The protocol for this study is registered with US NIH Clinical trials registry ( NCT00167531 Background It has been reported that following rehabilitation , only 7 % of stroke survivors are able to walk at a level commensurate with community participation . Previous research indicates that treadmill and overground walking training can improve walking capacity in people living in the community after stroke . The main objectives of the AMBULATE trial are to determine ( i ) whether a 4-month treadmill walking program is more effective than a 2-month program , compared to control , in improving walking capacity , health and community participation and ( ii ) the " threshold " walking speed that results in sufficient walking capacity that makes walking self-sustaining . Methods / Design A prospect i ve r and omised controlled trial of unsupported treadmill training with a 12 month follow-up with concealed allocation and blinded assessment will be conducted . 210 community-dwelling people after stroke who are able to walk independently but slowly will be recruited and r and omly allocated to either a 4 month training group , 2 month training group or the control ( no intervention ) group . Intervention for the two training groups will occur 3 days per week for 30 minutes each session . Measurements of walking , health and community participation will be taken at baseline , 2 months , 4 months , 6 months and 12 months . This study has obtained ethical approval from the relevant Human Research Ethics Committees . Discussion By improving stroke survivors ' walking ability , it is likely also to improve their general wellbeing by promoting better health and greater community participation . Furthermore , if stroke survivors can reach a point where their walking and community participation is self-sustaining , this will reduce the burden of care on family and friends as well as the economic burden on the health system . Given the major demographic shift in developed nations involving significant growth in the aged population , this research will make an important evidence -based contribution to the promotion of healthy ageing . Trial registration This trial is registered with the Australian New Zeal and Clinical Trials Registry , ( ACTRN012607000227493 Abstract Background : Timed Up and Go ( TUG ) performance is reduced following stroke . Gait training improves gait-related activities in hemiparetic patients . However , no study has compared the impact of a single overground training session with a treadmill training session on gait-related activities ( assessed by TUG ) . Objective : To compare the immediate effect of a single overground training session versus a single treadmill training session on TUG performance in hemiparetic patients . Methods : In this r and omized controlled clinical trial , 56 hemiparetic patients were r and omized to 1 or 2 distinct groups : a single gait training session overground ( O group ) or on a treadmill ( T group ) . Time taken to perform the TUG ( in seconds ) was assessed before and immediately after the completion of each session . Results : Time taken to perform the TUG decreased significantly , and to a similar extent , in both groups following the training session ( O group , 5.9 % ; T group , 5.2 % ) . Conclusions : An overground training session and a treadmill training session were equally effective in improving TUG performance in hemiparetic patients . Hemiparetic patients should be encouraged to walk regularly overground including turns for 20 minutes without stopping . This is an easy and inexpensive self-rehabilitation method to improve functional gait-related activities involved in the TUG test Background . Body-weight-supported treadmill training ( BWSTT ) to train both fitness and ambulation has not been investigated . Objective . To compare the effectiveness of BWSTT to dose-equivalent usual care ( UC ) in improving cardiovascular fitness and walking early after stroke . Methods . Participants were r and omly assigned to 1 of 2 interventions : BWSTT + UC or UC . All individuals participated in 60-minute physiotherapy sessions 5 times weekly as in patients for 6 weeks and 3 times weekly as out patients for another 6 weeks . Baseline , posttraining , 6- , and 12-month follow-up outcome measures were as follows : primary , fitness ( peak oxygen consumption , VO2peak ) and walking ability ( 6-Minute Walk Test [ 6MWT ] and 10-m walk ) ; secondary , Berg Balance Scale ( BBS ) and motor impairment ( Chedoke-McMaster Stages of Recovery [ CMSR ] Leg and Foot ) . Results . In all , 50 individuals ( mean age , 60 ± 14 years ; mean event-to-r and omization , 23 ± 5 days ; 29 men ) participated .  No adverse events occurred . BWSTT improved VO2peak by 30 % , which was significantly greater than the 8 % improvement observed for UC ( P = .004 between groups ) . Similarly , there were significant Time × Group interactions for 6MWT and CMSR Foot , with BWSTT outperforming UC for gains in distance ( P = .15 ; 48 % vs 19 % , respectively ) and stage ( P = .01 ; 1.0 vs 0.3 , respectively ) . No group effect was seen for 10-m walk speed , BBS , or CMSR Leg , with both groups demonstrating significant gains . In general , gains observed were preserved for 12 months . Conclusions . BWSTT elicits greater improvements in cardiovascular fitness and walking endurance than UC in the subacute poststroke period . These gains are largely sustained for 1 year Objective : The aim of this study was to evaluate the effects of virtual reality ( VR ) treadmill training on the balance skills of patients who have had a stroke . Design : A total of 14 patients with strokes were recruited and r and omly assigned to receive VR treadmill or traditional treadmill training . The outcome measures that were included for the study were center of pressure ( COP ) sway excursion , COP maximum sway in anterior-posterior direction , COP maximum sway in medial-lateral direction , COP sway area , bilateral limb-loading symmetric index , the sway excursion values for the paretic foot ( sway excursion/P ) , paretic limb stance time ( stance time/P ) , number of steps of the paretic limb ( number of steps/P ) , and contact area of the paretic foot ( contact A/P ) during quiet stance , sit-to-st and transfer , and level walking . Results : There were no significant improvements in COP-related measures and symmetric index during the quiet stance , either in the VR treadmill or traditional treadmill training group ( P > 0.05 ) . However , the difference between groups after training in COP maximum sway in medial-lateral direction during the quiet stance was significant ( P = 0.038 ) . Traditional treadmill training failed to improve sit-to-st and performance , whereas VR treadmill training improved symmetric index ( P = 0.028 ) and sway excursion ( P = 0.046 ) significantly during sit-to-st and transfer . The changes of symmetric index between groups were markedly different ( P = 0.045 ) . Finally , both groups improved significantly in stance time/P , but only VR treadmill training increased contact A/P ( P = 0.034 ) after training during level walking . The difference between groups during level walking was not significant . Conclusions : Neither traditional treadmill nor VR treadmill training had any effect on balance skill during quiet stance , but VR treadmill training improved balance skill in the medial-lateral direction better than traditional training did . VR treadmill training also improved balance skill during sit-to-st and transfers and the involvement of paretic limb in level walking more than the traditional one did OBJECTIVE To compare the effectiveness of circuit class therapy and individual physiotherapy ( PT ) sessions in improving walking ability and functional balance for people recovering from stroke . DESIGN Nonr and omized , single-blind controlled trial . SETTING Medical rehabilitation ward of a rehabilitation hospital . PARTICIPANTS Sixty-eight persons receiving inpatient rehabilitation after a stroke . INTERVENTIONS Subjects received group circuit class therapy or individual treatment sessions as the sole method of PT service delivery for the duration of their inpatient stay . MAIN OUTCOME MEASURES Five-meter walk test ( 5MWT ) , two-minute walk test ( 2MWT ) , and the Berg Balance Scale ( BBS ) measured 4 weeks after admission . Secondary outcome measures included the Iowa Level of Assistance Scale , Motor Assessment Scale upper-limb items , and patient satisfaction . Measures were taken on admission and 4 weeks later . RESULTS Subjects in both groups showed significant improvements between admission and week 4 in all primary outcome measures . There were no significant between group differences in the primary outcome measures at week 4 ( 5MWT mean difference , .07 m/s ; 2MWT mean difference , 1.8 m ; BBS mean difference , 3.9 points ) . A significantly higher proportion of subjects in the circuit class therapy group were able to walk independently at discharge ( P=.01 ) and were satisfied with the amount of therapy received ( P=.007 ) . CONCLUSIONS Circuit class therapy appeared as effective as individual PT sessions for this sample of subjects receiving inpatient rehabilitation poststroke . Favorable results for circuit classes in terms of increased walking independence and patient satisfaction suggest this model of service delivery warrants further investigation Objective The aim of the current study was to examine the effect of body weight support treadmill training ( BWSTT ) with power-assisted functional electrical stimulation on functional movement and gait in stroke patients . Design Thirty stroke patients were r and omly assigned to either the experimental group ( n = 15 ) or the control group ( n = 15 ) . All subjects participated in the same st and ard rehabilitation program . In addition , the experimental group participated in BWSTT with power-assisted functional electrical stimulation for 30 mins per day , five times a week , for 4 wks , and those in the control group participated in BWSTT for 30 minutes per day , five times a week , for 4 wks . Functional movement was assessed using the Berg Balance Scale , the Timed Up and Go test , and the Stroke Rehabilitation Assessment of Movement . Gait ability was assessed using an electrical walkway system . Results Significant differences in the time factor for functional movement and gait ( P < 0.05 ) were observed in the experimental and control groups . For the group × time interaction , significant improvements were observed in the functional movement ( Berg Balance Scale [ 10.93 vs. 6.00 ] , Timed Up and Go test [ −9.25 vs. −5.25 secs ] , and Stroke Rehabilitation Assessment of Movement scores [ 14.07 vs. 9.80 ] ) and gait ( velocity [ 40.07 vs. 18.64 cm/sec ] , cadence [ 30.57 vs. 17.75 steps per minute ] , paretic side step length [ 19.36 vs. 8.46 cm ] , and stride length [ 30.57 vs. 12.71 cm ] ) ( P < 0.05 ) . Conclusions The findings of the current study demonstrated the efficacy  of BWSTT with power-assisted functional electrical stimulation on the functional movement and gait ability in stroke patients . Therefore , the authors suggest that power-assisted functional electrical stimulation may be an effective method for the improvement of functional movement and gait ability of stroke patients when added to BWSTT OBJECTIVE To evaluate the immediate and retention effects of a 4-week training program on the performance of locomotor-related tasks in chronic stroke . DESIGN R and omized , controlled pilot study with 2-month follow-up . SETTING Rehabilitation center . SUBJECTS A convenience sample consisting of 12 chronic stroke subjects was used . Subjects were r and omly assigned to the experimental or the control group . Three subjects withdrew from the study . INTERVENTION Both experimental and control groups participated in exercise classes three times a week for 4 weeks . The exercise class for the experimental group focused on strengthening the affected lower limb and practicing functional tasks involving the lower limbs , while the control group practice d upper-limb tasks . MAIN OUTCOME MEASURES Lower-limb function was evaluated by measuring walking speed and endurance , peak vertical ground reaction force through the affected foot during sit-to-st and , and the step test . RESULTS The experimental group demonstrated significant immediate and retained ( 2-month follow-up ) improvement ( p < or = .05 ) compared with the control group in walking speed and endurance , force production through the affected leg during sit-to-st and , and the number of repetitions of the step test . CONCLUSION The pilot study provides evidence for the efficacy of a task-related circuit class at improving locomotor function in chronic stroke Treadmill training with partial body weight support can restore the gait ability of chronic non-ambulatory hemiparetic subjects . A combination of physiotherapy and treadmill training may accelerate the rate of recovery . Therefore a r and omized study was planned . Twenty-eight non-ambulatory hemiparetic patients were r and omly assigned to group A or B. A 3-week baseline of conventional therapy was followed by 15 sessions of physiotherapy and treadmill training in patients of group A and by 15 sessions of treadmill training in patients of group B over a period of 3 weeks . Follow-up was 4 months later . The major outcome variables were gait ability and ground level walking velocity . Gait ability and velocity did not change during the baseline . In group B , five patients became independent walkers after the specific intervention , whereas 10 patients of group A regained independent walking ability in the same period ( P < 0.05 ) . Four months later group differences had waned . Three weeks of treadmill training plus physiotherapy accelerated the restoration of gait ability in hemiparetic subjects , however , the double amount of therapy in group A does not exclude a simple dose-response phenomenon BACKGROUND We investigated the effects of different intensities of arm and leg rehabilitation training on the functional recovery of activities of daily living ( ADL ) , walking ability , and dexterity of the paretic arm , in a single-blind r and omised controlled trial . METHODS Within 14 days after stroke onset , 101 severely disabled patients with a primary middle-cerebral-artery stroke were r and omly assigned to : a rehabilitation programme with emphasis on arm training ; a rehabilitation programme with emphasis on leg training ; or a control programme in which the arm and leg were immobilised with an inflatable pressure splint . Each treatment regimen was applied for 30 min , 5 days a week during the first 20 weeks after stroke . In addition , all patients underwent a basic rehabilitation programme . The main outcome measures were ability in ADL ( Barthel index ) , walking ability ( functional ambulation categories ) , and dexterity of the paretic arm ( Action Research arm test ) at 6 , 12 , 20 , and 26 weeks . Analyses were by intention to treat . FINDINGS At week 20 , the leg-training group ( n=31 ) had higher scores than the control group ( n=37 ) for ADL ability ( median 19 [ IQR 16 - 20 ] vs 16 [ 10 - 19 ] , p<0.05 ) , walking ability ( 4 [ 3 - 5 ] vs 3 [ 1 - 4 ] , p<0.05 ) , and dexterity ( 2 [ 0 - 56 ] vs 0 [ 0 - 2 ] , p<0.01 ) . The arm-training group ( n=33 ) differed significantly from the control group only in dexterity ( 9 [ 0 - 39 ] vs 0 [ 0 - 2 ] , p<0.01 ) . There were no significant differences in these endpoints at 20 weeks between the arm-training and leg-training groups . INTERPRETATION Greater intensity of leg rehabilitation improves functional recovery and health-related functional status , whereas greater intensity of arm rehabilitation results in small improvements in dexterity , providing further evidence that exercise therapy primarily induces treatment effects on the abilities at which training is specifically aim ed Purpose : To test the hypothesis that partial body weight-supportcd treadmill training ( PBWSTT ) provides more effective gait training than an equally supportive but less physiologic aggressive bracing assisted walking ( ABAW ) program . Methods : Following informed consent , patients participating in an inpatient re habilitation program with significant leg weakness and need for at least moderate as sistance for walking , without orthostatic hypotension , symptomatic dyspnea , or angina pectoris were r and omized to receive PBWSTT vs. ABAW . PBWSTT was provided by a commercially available , overhead motorized hoist attached to a parachute-type body harness , which provided partial support of the patient 's weight over a treadmill . Ther apists assisted with weight shifting , leg advancement , and foot placement as needed . ABAW included aggressive early therapist-assisted ambulation using knee-ankle com bination bracing and hemi-bar if needed . Treatment sessions of up to 45 minutes per day , five days per week were given as tolerated for the duration of the inpatient stay or until patients could walk over-ground unassisted . All patients had an additional 45- minute session of functionally oriented physical therapy each day with or without brac ing as judged appropriate by the patient 's individual therapist . Results : Fifty-six patients a mean age of 71 ±1 SEM were enrolled 40 ± 3 days post stroke . Although die outcome of the two groups as a whole did not differ , a subgroup with major hemispheric stroke defined by the presence of hemiparesis , hemianopic vi sual deficit , and hemihypesthesia who received more than 12 treatment sessions showed significantly better over-ground endurance ( 90 ± 34 vs. 44 ± 10 meters ) and speed scores ( 12 ± 4 vs. 8 ± 2 meters/minute ) for PBWSTT vs. ABAW , respectively . Conclusions : PBWSTT and ABAW are equally effective gait training techniques except for a subset of patients with major hemispheric stroke who are difficult to mo bilize using ABAW alone OBJECTIVE To assess benefit of the facilitation technique ( FT ) coupled with body weight-supported treadmill training ( BWSTT ) in nonambulatory patients with stroke . DESIGN R and omized controlled trial . SETTING Inpatient rehabilitation hospital . PARTICIPANTS Forty-nine patients with nonambulatory patients with stroke were r and omly allocated to BWSTT coupled with the FT or mechanical assistance ( control ) . INTERVENTIONS Swinging and stance of the paretic leg were assisted using the FT or mechanically ( control ) during BWSTT . MAIN OUTCOME MEASURES The FIM instrument , Fugl-Meyer Assessment , gait speed , and cadence . RESULTS Demographic and clinical features of the  FT ( n=22 ) and control ( n=25 ) groups on admission were comparable after excluding 2 dropouts . There were no differences in the gains of the main outcome measures between the FT and control groups . Patients with severe impairment in the FT group had greater gains in arm function than those in the control group . CONCLUSIONS The FT did not add significantly to locomotor outcome of BWSTT in nonambulatory patients with stroke but it did require more therapists ' assistance OBJECTIVE To compare the effect of Partial Body Weight Support Treadmill Training ( PBWSTT ) technique and floor walking training , on floor walking velocities and functional balance in chronic stroke patients . DESIGN An observer blinded , r and omized controlled trial . MATERIAL AND METHOD Forty-eight chronic stroke patients were r and omized into either the experimental group that received PB WSTT ( n=24 ) or the control group that received floor walking training ( n=24 ) . Both groups received 25 minutes of daily walking training 5 days per weeks , totally 4 weeks . Treatment outcomes were assessed on floor walking velocities and functional balance by Berg Balance Scale RESULTS There was no statistically significant difference between both groups after a 4-week training period with regard to floor walking velocities and functional balance at p < 0.05 . Patients in both groups had statistically significant improvement in these variables after a 4-week training period when compared to before training at p < 0.05 . CONCLUSION The efficacy of PBWSTT in chronic stroke patients was not statistically different to the efficacy of floor walking training in floor walking velocities and functional balance OBJECTIVE To compare body weight-supported exercise on a gait trainer with walking exercise overground . DESIGN R and omized controlled trial . SETTING Rehabilitation hospital . PARTICIPANTS Forty-five ambulatory patients with chronic stroke . INTERVENTIONS Patients were r and omized to 3 groups : ( 1 ) gait trainer exercise with functional electric stimulation ( GTstim ) , ( 2 ) gait trainer exercise without stimulation ( GT ) , and ( 3 ) walking overground ( WALK ) . All patients practice d gait for 15 sessions during 3 weeks ( each session , 20 min ) , and they received additional physiotherapy 55 minutes daily . MAIN OUTCOME MEASURES Ten-meter walk test ( 10MWT ) , six-minute walk test ( 6MWT ) , lower-limb spasticity and muscle force , postural sway tests , Modified Motor Assessment Scale ( MMAS ) , and FIM instrument scores were recorded before , during , and after the rehabilitation and at 6 months follow-up . RESULTS The mean walking distance using the gait trainer was 6900+/-1200 m in the GTstim group and 6500+/-1700 m in GT group . In the WALK group , the distance was 4800+/-2800 m , which was less than the walking distance obtained in the GTstim group ( P=.027 ) . The body-weight support was individually reduced from 30 % to 9 % of the body weight over the course of the program . In the pooled 45 patients , the 10MWT ( P<.001 ) , 6MWT ( P<.001 ) , MMAS ( P<.001 ) , dynamic balance test time ( P<.001 ) , and test trip ( P=.005 ) scores improved ; however , no differences were found between the groups . CONCLUSIONS Both the body weight-supported training and walking exercise training programs result ed in faster gait after the intensive rehabilitation program . Patients ' motor performance remained improved at the follow-up Objective . To compare the maximum gait speed of stroke subjects attained during treadmill and overground in stroke subjects and to identify the temporal-distance determinants of the maximal gait speed . Methods . Ten individuals with hemiparetic gait deficits and whose walking speeds ranged between 0.24 m/s and 0.82 m/s participated . Five healthy age-matched controls were also tested to provide comparative data for the gait speed transfer between the 2 modes of locomotion . Following a brief habituation process to walking on the treadmill , subjects were tested while walking at comfortable and maximal speeds on the treadmill and overground , in a r and om order . Main Outcome Measure . Self-selected comfortable and maximum gait speed and temporal-distance factors were acquired using a 6-camera Vicon ™ motion analysis system and compared between treadmill and overground walking at a similar speed . Results . Overground walking result ed in higher maximal speeds ( P < 0.001 ) , greater stride lengths ( P < 0.001 ) , and a lower cadence ( P < 0.02 ) , as compared to tread-mill . The comfortable gait speed and the maximum stride length proved to be strong determinants for the maximal speed on both modes of locomotion ( P < 0.01 ) , but the maximum cadence was correlated to maximum speed only for overground locomotion ( P < 0.05 ) . Conclusions . Stroke subjects walked slower on the treadmill as compared to overground . They also used a different strategy to increase gait speed , relying mostly on increasing the stride length during treadmill ambulation OBJECTIVE To evaluate the role of bodyweight-supported treadmill training ( BWSTT ) for chronic stroke survivors . DESIGN Prospect i ve , r and omized controlled study . METHODS Patients with a first episode of supratentorial arterial stroke of more than 3months ' duration were r and omly allocated to 3 groups : overground gait training , treadmill training without bodyweight support , and BWSTT ( 20 sessions , 30min/day , 5days/week for 4weeks ) . The primary outcome was overground walking speed and endurance and secondary outcome was improvement by the Sc and inavian Stroke Scale ( SSS ) and locomotion by the Functional Ambulation Category ( FAC ) . We analyzed data within groups ( pre-training vs post-training and pre-training vs 3-month follow-up ) and between groups ( at post-training and 3-month follow-up ) . RESULTS We included 45 patients ( 36 males , mean post-stroke duration 16.51±15.14months ) ; 40 ( 89.9 % ) completed training and 34 ( 75.5 % ) were followed up at 3months . All primary and secondary outcome measures showed significant improvement ( P<0.05 ) in the 3 groups at the end of training , which was sustained at 3-month follow-up ( other than walking endurance in group I ) . Outcomes were better with BWSTT but not significantly ( P>0.05 ) . CONCLUSION BWSTT offers improvement in gait but has no significant advantage over conventional gait-training strategies for chronic stroke survivors This trial compares the effects of task-oriented physical therapy ( PT ) provided with and without the use of rehabilitation technology on locomotor recovery in 63 persons with subacute stroke . Participants in the experimental ( EXP ) group used a treadmill , a Kinetron isokinetic exerciser , and a limb-load monitor , whereas those in the control ( CTL ) group did not while engaging in PT 1 h per day , 5 days per week for 2 months . Locomotor recovery was assessed by clinical ( gait speed , Fugl Meyer motor leg and arm subscores , the Balance Scale , the Timed Up and Go , and the Barthel ambulation subscore ) and laboratory outcomes ( gait kinematics and kinetics ) pre- and posttherapy and 3 months later . Within groups , gait speed ( P < 0.01 ) and all secondary measures improved posttherapy ( P < 0.01 - 0.05 ) , and improvements in clinical measures were maintained at follow-up , but there was no difference between groups ( P > 0.05 ) . When the groups were pooled , the increase in gait speed was associated ( r = 0.52 , P = 0.003 ) with an increase in ankle power generation of the affected leg . The results demonstrate that the efficacy of the task-oriented approach is not dependent on rehabilitation technology 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 Purpose : To evaluate the impact of two different physiotherapy exercise regimes in patients after acute stroke on  health-related quality of life ( HRQoL )  and to investigate how the degree of motor and balance function , gait capacity , activities of daily living and instrumental activities of daily living influenced HRQoL. Methods : A longitudinal r and omized controlled stratified trial of two interventions : the intensive exercise groups with scheduled intensive training during four periods of the first year after stroke and the regular exercise group with self-initiated training . Results : There was a tendency of better HRQoL in the regular exercise group on NHP total score ( p= 0.05 ) . Patients with low scores in activities of daily living , balance and motor function and inability to perform 6-minute walk test on admission , scored lower on self-perceived health than patients with high scores and ability to perform the walking test . At 1 year post-stroke , total scores on NHP were moderately associated with motor function ( r= −0.63 ) , balance ( r= −0.56 ) , gait ( r= −0.57 ) , activities of daily living ( r= −0.57 ) and instrumental activities of daily living ( r= −0.49–0.58 ) . The physical mobility sub-scale of NHP had the strongest association ranging from r= −0.47–0.82 . Conclusion : The regular exercise group with self-initiated training seemed to enhance HRQoL more than the intensive exercise group with scheduled intensive training . The degree of motor function , balance , walking capacity and independence in activities of daily living is of importance for perceived OBJECTIVES To identify stroke patients who are most likely to benefit from locomotor training with body-weight support ( BWS ) , to determine the extent of carryover from treadmill training to overground locomotion , and to determine the variables that are most likely to influence the recovery of locomotion . DESIGN A r and omized clinical trial . SETTING Inpatient rehabilitation hospital . PARTICIPANTS Of 100 stroke subjects , 50 were r and omized to receive locomotor training with BWS ( BWS group ) , and 50 were r and omized to receive locomotor training with full weight bearing ( no-BWS group ) . The subjects were stratified according to their initial overground walking speed and endurance , initial treadmill speed and endurance , functional balance , motor recovery , side of the lesion , and age . INTERVENTION Fifty subjects were trained to walk on a treadmill with up to 40 % of their body weight supported by a BWS system with an overhead harness ( BWS group ) , and 50 subjects were trained to walk while bearing their full weight ( no-BWS group ) . MAIN OUTCOME MEASURES Clinical outcome measures included overground walking speed and endurance , functional balance , and motor recovery . The effect of confounding variables such as age , comorbidity , and depression on locomotor outcome was also investigated . RESULTS After 6 weeks of locomotor training , the BWS group scored significantly higher in all clinical outcomes . When the subjects were stratified according to their initial overground walking speed , endurance , balance , and motor recovery , a significant statistical difference in gait and balance dysfunction of all outcomes occurred in the more severely impaired subjects . An important transfer from treadmill speed to overground walking speed was observed in subjects in the BWS group . Finally , a significantly greater effect was observed in older subjects ( 65 - 85y ) in the BWS group . CONCLUSIONS Retraining gait in severely impaired stroke subjects with a percentage of their body weight supported result ed in better walking and postural abilities than did gait training in patients bearing their full weight . It appears that subjects with greater gait impairments benefited the most from training with BWS , as did the older patients with stroke . There is evidence of transfer from treadmill training to overground locomotion Objective : To determine whether higher-intensity treadmill walking during rehabilitation in those newly able to walk after stroke is feasible , is detrimental to walking or is beneficial . Design : A single-blind , r and omized trial . Setting : Two rehabilitation units . Participants : Thirty people with first stroke . Interventions : Experimental group received 30 minutes of higher-intensity treadmill walking , three times per week for six weeks , in addition to usual physiotherapy . Control group received usual physiotherapy only . Main outcome measures : Feasibility was measured by examining compliance and adverse events . Detriment to walking was measured by examining pattern and quality . Benefit to walking was measured as capacity using six-minute walk test and speed , at baseline ( Week 0 ) , immediately after ( Week 6 ) and at three months ( Week 18 ) . Results : Overall compliance was 89 % , with no adverse events reported . There was no between-group difference in walking pattern and quality . By Week 6 , the experimental group improved walking capacity by 62 m ( 95 % confidence interval ( CI ) 10 to 114 ) , comfortable walking speed by 0.18 m/s ( 95 % CI 0.07 to 0.29 ) and fast walking speed by 0.18 m/s ( 95 % CI 0.03 to 0.35 ) more than the control group . By Week 18 , the experimental group was still walking 0.26 m/s ( 95 % CI 0.12 to 0.41 ) faster than the control group . Conclusions : Higher-intensity treadmill walking during rehabilitation after stroke is feasible and not detrimental to walking pattern and quality in those newly able to walk . 94 participants are required to detect a between-group difference of 75 m on six-minute walk test ( α 0.05 , β 0.90 ) in future trials . Trial registration : Objective : To evaluate the immediate and long-term effects of aerobic treadmill plus Bobath walking training in subacute stroke survivors compared with Bobath walking training alone . Design : R and omized controlled trial . Setting : Rehabilitation unit . Subjects : Fifty patients , first-time supratentorial stroke , stroke interval less than six weeks , Barthel Index ( 0 / 100 ) from 50 to 80 , able to walk a minimum distance of 12 m with either intermittent help or st and -by while walking , cardiovascular stable , minimum 50 W in the bicycle ergometry , r and omly allocated to two groups , A and B. Interventions : Group A 30 min of treadmill training , harness secured and minimally supported according to patients ' needs , and 30 min of physiotherapy , every workday for six weeks , speed and inclination of the treadmill were adjusted to achieve a heart rate of HR : ( Hrmax / HRrest)*0.6 / HRrest ; in group B 60 min of daily physiotherapy for six weeks . Main outcome measures : Primary outcome variables were the absolute improvement of walking velocity ( m/s ) and capacity ( m ) , secondary were gross motor function including walking ability ( score out of 13 ) and walking quality ( score out of 41 ) , blindly assessed before and after the intervention , and at follow-up three months later . Results : Patients tolerated the aerobic training well with no side-effects , significantly greater improvement of walking velocity and capacity both at study end ( p / 0.001 versus p / 0.002 ) and at follow-up ( p < 0.001 versus p<0.001 ) in the experimental group . Between weeks 0 and 6 , the experimental group improved walking speed and capacity by a mean of.31 m/s and 91 m , the control group by a mean of 0.16 m/s and 56 m. Between weeks 0 and 18 , the experimental group improved walking speed and capacity by a mean of 0.36 m/s and 111 m , the control group by a mean of 0.15 m/s and 57 m. Gross motor function and walking quality did not differ at any time . Conclusions : Aerobic treadmill plus Bobath walking training in moderately affected stroke patients was better than Bobath walking training alone with respect to the improvement of walking velocity and capacity . The treatment approach is recommended in patients meeting the inclusion criteria . A multicentre trial should follow to strengthen the evidence Objective : To explore the secondary benefits of treadmill training for people in the chronic stage of recovery from stroke . Design : Modified r and om assignment , matched-pair control group design with repeated measures . Setting : Outpatient stroke centre . Participants : Twenty individuals post first stroke who acknowledged walking slower than pre stroke . Participants matched by side of hemiparesis and motor impairment . Interventions : Twelve 20-minute sessions of walking on a treadmill or weekly phone call . Main outcome measures : Depression ( Beck Depression Index ) , mobility and social participation ( Stroke Impact Scale 3.0 subscales ) were assessed initially , at the end of 12 treatments ( four weeks ) and six weeks later . Results : No significant difference was found between groups for any dependent measure . The ANOVA to investigate main effects in each group found no significant findings in the control group ; however in the treatment group significant improvements over time for depression ( P=0.005 , P<0.001 ) , mobility ( P=0.008 ) and social participation ( P= 0.004 ) were demonstrated . Conclusions : A task-specific intervention design ed to improve gait speed may potentially provide secondary benefits by positively impacting depression , mobility and social participation for people post stroke BACKGROUND Gait disturbance is common after stroke ; however , there is no consensus regarding the optimal therapeutic rehabilitation of hemiparetic gait . AIM To compare the effects of the treadmill training with partial body-weight support ( TPBWS ) and Proprioceptive Neuromuscular Facilitation ( PNF ) method on gait of subjects with chronic stroke . DESIGN R and omized clinical trial , comparing two experimental groups ( comparative study ) . SETTING Laboratory for Human Movement Analysis of UFRN . POPULATION Twenty-three subjects , with a mean age of 56.7±8.0 years and a mean time since the onset of the stroke of 27.7±20.3 months , able to walk with personal assistance or assistive devices . METHODS Two experimental groups underwent gait training based on PNF method ( N.=11 ) or using the TPBWS ( N.=12 ) , for twelve sessions . Evaluation of motor function ( using the STREAM and motor FIM ) , and kinematic gait analysis were carried out before and after the interventions . RESULTS Increases in the STREAM scores ( F=49.189 , P<0.001 ) and in motor FIM scores ( F=7.093 , P=0.016 ) , as well as improvement in symmetry ratio-swing time of the paretic leg/swing time of non-paretic leg--(F=7.729 , P=0.012 ) , were observed for both groups . Speed , stride length and double-support time showed no change after training . Differences between groups were observed only for the maximum ankle dorsiflexion over the swing phase ( F=6.046 , P=0.024 ) , which showed an increase for the PNF group . Other angular parameters remain unchanged . CONCLUSION Improvement in motor function and in gait symmetry was observed for both groups , suggesting similarity of interventions . However , the sample size should be carefully considered in generalizing the results to other population s. CLINICAL REHABILITATION IMPACT The results showed some equivalence between these two approaches with regard to motor recovery , functionality and temporal symmetry of hemiparetic gait , suggesting that the cost-effectiveness of each treatment may have a important role in this choice Background and objective . Ambulatory subjects after stroke may benefit from gait-oriented cardiovascular fitness training , but trials to date have not primarily assessed older persons . Methods . Thirty-eight subjects ( age > 60 years ) with residual hemiparetic gait were enrolled > 6 months after stroke . Participants were r and omized to receive 3 months ( 3 × /week ) progressive grade d , high-intensity aerobic treadmill exercise ( TAEX ) or conventional care physiotherapy . Primary outcome measures were peak exercise capacity ( Vo2peak ) and sustained walking capacity in 6-minute walks ( 6MW ) . Secondary measures were gait velocity in 10-m walks , Berg Balance Scale , functional leg strength ( 5 chair-rise ) , self-rated mobility ( Rivermead Mobility Index ) , and quality of life ( SF-12 ) . Results . Thirty-six participants completed the study ( 18 TAEX , 18 controls ) .  TAEX but not conventional care  improved Vo2peak ( difference 6.4 mL/kg/min , P < .001 ) and 6MW ( 53 m , P < .001 ) . Likewise , maximum walking speed ( 0.13 m/s , P = .01 ) , balance ( P < .05 ) , and the mental subscore of the SF-12 ( P < .01 ) improved more after TAEX . Gains in Vo2peak correlated with the degree at which training intensity could be progressed in the individual participant ( P < .01 ) . Better walking was related to progression in treadmill velocity and training duration ( P < .001 ) . Vo2peak and 6MW performances were still higher 1 year after the end of training when compared with the baseline , although endurance walking ( 6MW ) at 1 year was lower than immediately after training ( P < .01 ) . Conclusion . This trial demonstrates that TAEX effectively improves cardiovascular fitness and gait in persons with chronic stroke PURPOSE Purpose one was to characterize the consistency of intra-limb hip/knee ( H/K ) coordination according to a measure of average coefficient of correspondence ( ACC ) across strides . Purpose two was to investigate H/K ACC validity and ability to discriminate pre-/post-treatment change in stroke survivors . METHODS Five healthy controls and 32 chronic ( > 12 mos ) stroke survivors were enrolled , and H/K ACC was calculated for both groups . Comparison between controls and stroke was made using the Mann-Whitney Test . Convergent validity of H/K ACC was tested using the Pearson Correlation model with gait speed and the 6 min Walk Test ( 6MWT ) . Stroke survivors were r and omized to either : ( 1 ) gait training with functional neuromuscular stimulation ( FNS ) using intramuscular ( IM ) electrodes or ( 2 ) gait training without FNS . Both groups had treatment 1.5 h/day , 5 days/week , for 12 weeks , including .5 h coordination exercise , .5 h body weight supported treadmill training ( BWSTT ) , and .5 h over ground gait training . The FNS-IM group used FNS-IM for all treatment components ; the No-FNS group did not . Pre-/post-treatment comparisons were made using ANOVA . RESULTS H/K ACC detected a significant difference between controls versus stroke involved limb ( p=.0001 ) and controls versus stroke uninvolved limb ( p=.042 ) . The H/K ACC measure was well-correlated with gait speed ( r=.70 ) and 6MWT ( r=.69 ) . H/K ACC showed a significant treatment response to FNS-IM ( p=.003 ) , but not No-FNS ( p=.747 ) . CONCLUSIONS H/K ACC sensitively discriminated between controls versus stroke involved or uninvolved limbs . H/K ACC was valid , with significant correlations with both walking speed and 6MWT .  FNS-IM produced a significant gain in H/K ACC , and No-FNS did not Abstract Background : Gait training for patients with hemiparesis is carried out independently overground or on a treadmill . Several studies have shown differences in hemiparetic gait parameters during overground versus treadmill walking . However , few studies have compared the effects of these 2 gait training conditions on gait parameters , and no study has compared the short-term effects of these techniques on all biomechanical gait parameters . Objective : To determine whether a gait training session performed overground or on a treadmill induces specific short-term effects on biomechanical gait parameters in patients with hemiparesis . Methods : Twenty-six subjects with hemiparesis were r and omly assigned to a single session of either overground or treadmill gait training . The short-term effects on spatiotemporal , kinematic , and kinetic gait parameters were assessed using gait analysis before and immediately after the training and after a 20-minute rest . Results : Speed , cadence , percentage of single support phase , peak knee extension , peak propulsion , and braking on the paretic side were significantly increased after the gait training session . However , there were no specific changes dependent on the type of gait training performed ( overground or on a treadmill ) . Conclusion : A gait training session performed by subjects with hemiparesis overground or on a treadmill did not induce specific short-term effects on biomechanical gait parameters . The increase in gait velocity that followed a gait training session seemed to reflect specific modifications of the paretic lower limb and adaptation of the nonparetic lower limb Objective : This study examined the effects of treadmill training with optic flow on the functional recovery of balance and gait in stroke patients . Design : R and omized controlled experimental study . Participants : Thirty patients following stroke were divided r and omly into the treadmill with optic flow group ( n = 10 ) , treadmill group ( n = 10 ) and control group ( n = 10 ) . Interventions : The subjects in the experimental group wore a head-mounted display to receive speed-modulated optic flow during treadmill training for 30 minutes , while those in the treadmill group and control group received treadmill training and regular therapy for the same time , three times a week for four weeks . Main measures : The data were collected using timed up- and -go test , functional reach test , 10-m walk test , and six-minute walk test before and after treatment . Results : The timed up- and -go test in the treadmill with optic flow group ( 5.55 ± 2.04 ) improved significantly greater than the treadmill ( 1.50 ± 0.93 ) and control ( 0.40 ± 0.84 ) groups . The functional reach test in the treadmill with optic flow group ( 2.78 ± 1.44 ) was significantly higher than the control group ( 0.20 ± 0.16 ) only . The gait velocity in the treadmill with optic flow group ( 0.21 ± 0.06 ) showed a significant decrease compared to the treadmill ( 0.03 ± 0.02 ) and control ( 0.01 ± 0.02 ) groups . Finally , the six-minute walk test in the treadmill with optic flow group ( 24.49 ± 11.00 ) showed significant improvement compared to the treadmill training ( 4.65 ± 3.25 ) and control ( 1.79 ± 3.08 ) groups . Conclusion : Treadmill using optic flow speed modulation improves the balance and gait significantly in patients with stroke who are able to participate in physical gait training Objective . Treadmill training with partial body weight support has been suggested as a useful strategy for gait rehabilitation after stroke . This prospect i ve , blinded , r and omized controlled study of gait retraining tested the feasibility and potential efficacy of using an electromechanical-driven gait orthosis ( Lokomat ) for treadmill training . Methods . Sixteen stroke patients , mostly within 3 months after onset , were r and omized into 2 treatment groups , ABA or BAB ( A = 3 weeks of Lokomat training , B = 3 weeks of conventional physical therapy ) for 9 weeks of treatment . The outcome measures were the EU-Walking Scale , Rivermead Motor Assessment Scale , 10-m timed walking speed , 6-minute timed walking distance , Motricity Index , Medical Research Council Scale of strength , and Ashworth Scale of tone . Results . The EU-Walking Scale , Rivermead Motor Assessment Scale , 6-minute timed walking distance , Medical Research Council Scale , and Ashworth Scale demonstrated significantly more improvement during the Lokomat training phase than during the conventional physical therapy phase within each 3-week interval . Conclusions . Despite the small number of patients , the present data suggest that the Lokomat robotic assistive device provides innovative possibilities for gait training in stroke rehabilitation while eliminating prolonged repetitive movements in a nonergonomic position on the part of the physical therapist OBJECTIVE To investigate the effect of practice paradigms that varied treadmill speed during step training with body weight support in subjects with chronic hemiparesis after stroke . DESIGN R and omized , repeated- measures pilot study with 1- and 3-month follow-ups . SETTING Outpatient locomotor laboratory . PARTICIPANTS Twenty-four individuals with hemiparetic gait deficits whose walking speeds were at least 50 % below normal . INTERVENTION Participants were stratified by locomotor severity based on initial walking velocity and r and omly assigned to treadmill training at slow ( 0.5 mph ) , fast ( 2.0 mph ) , or variable ( 0.5 , 1.0 , 1.5 , 2.0 mph ) speeds . Participants received 20 minutes of training per session for 12 sessions over 4 weeks . MAIN OUTCOME MEASURE Self-selected overground walking velocity ( SSV ) was assessed at the onset , middle , and end of training , and 1 and 3 months later . RESULTS SSV improved in all groups compared with baseline ( P<.001 ) . All groups increased SSV in the 1-month follow-up ( P<.01 ) and maintained these gains at the 3-month follow-up ( P=.77 ) . The greatest improvement in SSV across training occurred with fast training speeds compared with the slow and variable groups combined ( P=.04 ) . Effect size ( ES ) was large between fast compared with slow ( ES=.75 ) and variable groups ( ES=.73 ) . CONCLUSIONS Training at speeds comparable with normal walking velocity was more effective in improving SSV than training at speeds at or below the patient 's typical overground walking velocity 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 Purpose : Intensive gait training can produce improvements in gait and function ( > 6 months after stroke ) ; findings are mixed for enhanced life role participation . Therefore , it is unclear if improved gait and function translate into life role participation gain . Our objective was to evaluate whether intensive gait therapy can produce significant improvements in life role participation for chronic stroke survivors . Methods : In conjunction with a clinical gait training trial , we conducted a secondary analysis for a 44-member cohort with stroke ( > 6 months ) .  Gait training interventions included exercise , body weight supported treadmill training ( BWSTT ) , over-ground gait training , and functional electrical stimulation ( FES ) for 1.5 h/day , 4 days/wk for 12 weeks . Study measures included Tinetti Gait ( TG ) ( gait impairment ) , Functional Independence Measure ( FIM , function ) , Stroke Impact Scale Subscale of Life Role Participation ( SISpart ) , and Craig H and icap Assessment & Reporting Technique ( CHART , life-role participation ) . Analyses included Wilcoxon Signed Rank Test and PLUM Regression Model . Results : Gait interventions produced significant improvement in CHART ( p = 0.020 ) , SISpart ( p = 0.011 ) , FIM ( p < 0.0001 ) , and Tinetti Gait ( p < 0.0001 ) . Age , gender and time since stroke did not predict response to treatment . Conclusions : Intensive , multi-modal , long- duration gait therapy result ed in significant gain in life-role participation , according to a relatively comprehensive , homogeneous measure . Implication s for Rehabilitation It is important to measure life role participation in rehabilitation intervention studies , and using a homogenous measure of life role participation provides clear results . Intensive gait training produced a significant improvement in life role participation in the chronic phase after stroke . Functional electrical stimulation ( FES ) had no significant additive effect on life role participation during the treatment phase , but FES did have an additive effect during the follow-up period , in enhancing life role participation beyond that obtained using an identical comprehensive gait training intervention without FES This is a single blind r and omized controlled trial to examine the effect of virtual reality-based training on the community ambulation in individuals with stroke . Twenty subjects with stroke were assigned r and omly to either the control group ( n=9 ) or the experimental group ( n=11 ) . Subjects in the control group received the treadmill training . Subjects in the experimental group underwent the virtual reality-based treadmill training .  Walking speed , community walking time , walking ability question naire ( WAQ ) , and activities-specific balance confidence ( ABC ) scale were evaluated . Subjects in the experimental group improved significantly in walking speed , community walking time , and WAQ score at posttraining and 1-month follow-up periods . Their ABC score also significantly increased at posttraining but did not maintain at follow-up period . Regarding the between-group comparisons , the experimental group improved significantly more than control group in walking speed ( P=0.03 ) and community walking time ( P=0.04 ) at posttraining period and in WAQ score ( P=0.03 ) at follow-up period . Our results support the perceived benefits of gait training programs that incorporate virtual reality to augment the community ambulation of individuals with stroke OBJECTIVE To examine the effectiveness of backward walking treadmill training for restoration of motor function , balance and walking speed in patients with stroke . METHODS Twenty-six patients with stroke , 17 males and 9 females , aged 36 - 64 , with the lower extremity Brunnstrom motor recovery stage at 3 or 4 , able to walk for 10 m without walking aid or orthosis , were r and omly divided into two equal groups : The patients in the control group were to participate in a 60-minutes conventional training five times a week for three weeks , and the patients in the experimental group received 30-minute conventional training and then 30-minute backward walking training five times a week for three weeks . Before the training and 3 weeks after the training , Fugl-Meyer assessment was used to assess the motor function of the lower extremity ( FMA-L ) , Berg balance scale ( BBS ) was used to assess the balance function , and 10 m maximum walking speed was measured . RESULTS After the three-week training period , the FMA-L score of the experimental group was 28.0 + /- 3.3 , significantly higher than that of the control group ( 25.5 + /- 2.3 , P = 0.033 ) ; the BBS score of the experimental group was 51.4 + /- 1.8 , significantly higher than that of the control group ( 47.3 + /- 3.7 , P = 0.001 , and 10 m MWS of the experimental group was 57 + /- 17 , significantly higher than that of the control group ( 43 + /- 16 , P = 0.034 ) . CONCLUSION A safe and feasible intervention , additional backward walking therapy helps improve the damaged motor function , balance , and walking speed of the patients with stroke Background : Although task-related walking training has been recommended after stroke , the theoretical basis , content , and impact of interventions vary across the literature . There is a need for a comparison of different approaches to task-related walking training after stroke . Objective : To compare the impact of a motor-learning-science – based overground walking training program with body-weight-supported treadmill training ( BWSTT ) in ambulatory , community-dwelling adults within 1 year of stroke onset . Methods : In this rater-blinded , 1:1 parallel , r and omized controlled trial , participants were stratified by baseline gait speed . Participants assigned to the Motor Learning Walking Program ( MLWP ) practice d various overground walking tasks under the supervision of 1 physiotherapist . Cognitive effort was encouraged through r and om practice and limited provision of feedback and guidance . The BWSTT program emphasized repetition of the normal gait cycle while supported on a treadmill and assisted by 1 to 3 therapy staff . The primary outcome was comfortable gait speed at postintervention assessment ( T2 ) . Results : In total , 71 individuals ( mean age = 67.3 ; st and ard deviation = 11.6 years ) with stroke ( mean onset = 20.9 [ 14.1 ] weeks ) were r and omized ( MLWP , n = 35 ; BWSTT , n = 36 ) . There was no significant between-group difference in gait speed at T2 ( 0.002 m/s ; 95 % confidence interval [ CI ] = −0.11 , 0.12 ; P > .05 ) . The MLWP group improved by 0.14 m/s ( 95 % CI = 0.09 , 0.19 ) , and the BWSTT group improved by 0.14 m/s ( 95 % CI = 0.08 , 0.20 ) . Conclusions : In this sample of community-dwelling adults within 1 year of stroke , a 15-session program of varied overground walking-focused training was not superior to a BWSTT program of equal frequency , duration , and in-session step activity Abstract Background : Body weight-supported treadmill training ( BWSTT ) has produced mixed results compared with other therapeutic techniques . Objective : The purpose of this study was to determine whether an intensive intervention ( intensive mobility training ) including BWSTT provides superior gait , balance , and mobility outcomes compared with a similar intervention with overground gait training in place of BWSTT . Methods : Forty-three individuals with chronic stroke ( mean [ SD ] age , 61.5 [ 13.5 ] years ; mean [ SD ] time since stroke , 3.3 [ 3.8 ] years ) , were r and omized to a treatment ( BWSTT , n = 23 ) or control ( overground gait training , n = 20 ) group . Treatment consisted of 1 hour of gait training ; 1 hour of balance activities ; and 1 hour of strength , range of motion , and coordination for 10 consecutive weekdays ( 30 hours ) . Assessment s ( step length differential , self-selected and fast walking speed , 6-minute walk test , Berg Balance Scale [ BBS ] , Dynamic Gait Index [ DGI ] , Activities-specific Balance Confidence [ ABC ] scale , single limb stance , Timed Up and Go [ TUG ] , Fugl-Meyer [ FM ] , and perceived recovery [ PR ] ) were conducted before , immediately after , and 3 months after intervention . Results : No significant differences ( α = 0.05 ) were found between groups after training or at follow-up ; therefore , groups were combined for remaining analyses . Significant differences ( α = 0.05 ) were found pretest to posttest for fast walking speed , BBS , DGI , ABC , TUG , FM , and PR . DGI , ABC , TUG , and PR results remained significant at follow-up . Effect sizes were small to moderate in the direction of improvement . Conclusions : Future studies should investigate the effectiveness of intensive interventions of duration s greater than 10 days for improving gait , balance , and mobility in individuals with chronic stroke More than 3 million stroke survivors live with residual disabilities and mobility deficits even after rehabilitation . Therefore , it is important to develop new , more effective , gait training methods . The purpose of this study was twofold : ( 1 ) testing the feasibility of combining multi-channel functional neuromuscular stimulation ( FNS ) using intramuscular ( IM ) electrodes and body weight supported treadmill training ( BWSTT ) for gait training ; and ( 2 ) documenting the potential gait practice advantages afforded by combining FNS-IM and BWSTT .  Eight subjects with gait deficits in the chronic phase ( > 12 months ) were enrolled . Intramuscular electrodes were placed in the paretic hip abductors , knee flexors and extensors , and ankle dorsiflexors , plantarflexors , and evertors . Subjects were treated with exercise and gait training using the combined technologies 1 1/2 h/week , four times/week , for 12 weeks . Feasibility was tested according to performance of the technologies , clinician skill factors , and subject satisfaction . Impairment , function , and quality of life were measured . Provision of practice for eight gait characteristics was catalogued . We found the following results for the combined technologies : ( 1 ) the combined technologies were safe and feasible ; ( 2 ) clinicians required five training sessions to reach proficiency ; ( 3 ) subjects were satisfied ; ( 4 ) there were significant gains in impairment and functional measures ; ( 5 ) a greater number of gait practice characteristics were provided with the combined technologies than with either alone Background and Purpose — Locomotor training ( LT ) using a treadmill can improve walking ability over conventional rehabilitation in individuals with hemiparesis , although the personnel requirements often necessary to provide LT may limit its application . Robotic devices that provide consistent symmetrical assistance have been developed to facilitate LT , although their effectiveness in improving locomotor ability has not been well established . Methods — Forty-eight ambulatory chronic stroke survivors stratified by severity of locomotor deficits completed a r and omized controlled study on the effects of robotic- versus therapist-assisted LT . Both groups received 12 LT sessions for 30 minutes at similar speeds , with guided symmetrical locomotor assistance using a robotic orthosis versus manual facilitation from a single therapist using an assist-as-needed paradigm . Outcome measures included gait speed and symmetry , and clinical measures of activity and participation . Results — Greater improvements in speed and single limb stance time on the impaired leg were observed in subjects who received therapist-assisted LT , with larger speed improvements in those with less severe gait deficits . Perceived rating of the effects of physical limitations on quality of life improved only in subjects with severe gait deficits who received therapist-assisted LT . Conclusions — Therapist-assisted LT facilitates greater improvements in walking ability in ambulatory stroke survivors as compared to a similar dosage of robotic-assisted LT Objective : To evaluate the effects of treadmill walking and overground walking exercise training on recovery of walking function in an African group of stroke survivors . Design : Prospect i ve , r and omized controlled study . Setting : Outpatient stroke rehabilitation unit in a tertiary hospital . Subjects : Sixty patients with chronic stroke ( ≥3 months ) . Intervention : All subjects received individual outpatient conventional physiotherapy rehabilitation for 12 weeks . In addition , subjects in Group A ( n = 20 ) received treadmill walking exercise training ( TWET ) while those in Group B ( n = 20 ) received overground walking exercise training ( OWET ) . Those in Group C ( control ) ( n = 20 ) received conventional physiotherapy rehabilitation only . Main measures : Outcome measures were ( i ) 10-metre walk time ( 10MWT ) test and ( ii ) six-minute walk distance ( 6MWD ) test . These were evaluated at entry into the study and at the end of every four weeks . Paired t-tests were used to evaluate the significance of the difference between pre-training and post-training scores on the two measures ( P < 0.05 ) . Results : Subjects in the TWET group recorded 22.6 ± 1.5 % decrease in 10MWT and 31.0 ± 4.3 % increase in 6MWD ; those in the OWET group made 26.8 ± 1.3 % and 45.2 ± 4.6 % improvement in 10MWT and 6MWD respectively . Subjects in the control group made 2.2 ± 0.7 % and 2.9 ± 0.8 % improvement in the two functions . These changes were significant for the TWET and OWET groups ( P < 0.05 ) . Conclusion : This study indicated that treadmill and overground walking exercise training programmes , combined with conventional rehabilitation , improved walking function in an African group of adult stroke survivors . Therefore , professionals who conduct stroke rehabilitation programmes should utilize exercise training to optimize patient outcomes OBJECTIVE To investigate gait outcomes with supported treadmill ambulation training ( STAT ) associated with regular rehabilitation in acute stroke survivors . DESIGN R and omized controlled trial , pilot study . SETTING Rehabilitation medicine service at a Veterans Affairs medical center . PARTICIPANTS Seven acute stroke survivors assigned to regular intervention group and 6 patients assigned to STAT intervention .  INTERVENTIONS Regular intervention consisted of 3 hours daily of physical therapy , kinesiotherapy , and occupational therapy . STAT group received regular rehabilitation with STAT substituted for usual gait training . Participants were tested at baseline , treated for an average of 3 weeks , and retested on discharge . The analysis of covariance procedure was used to test for differences between the 2 approaches . MAIN OUTCOME MEASURES Functional Ambulation Category Scale , gait speed , walking distance , gait energy expenditure , and gait energy cost . RESULTS The small sample size did not generate enough power to detect significant differences in any variable . However , medium to large effect sizes of 0.7 and 1.16 st and ard deviation units were observed for gait energy cost and walk distance , respectively . CONCLUSIONS This pilot study indicated that STAT is a safe , feasible , and promising intervention for acute stroke survivors . A larger trial is warranted for statistical relevance Objective : To find out if there were any differences in improvement and maintenance of motor function , activity of daily living and grip strength between patients with first-ever stroke receiving two different strategies of physical exercise during the first year after stroke . Design : A longitudinal r and omized controlled stratified trial . Setting : Rehabilitation institutions , community , patients ' homes and nursing homes . Subjects : Seventy-five male and female first-time-ever stroke patients : 35 in an intensive exercise group and 40 in a regular exercise group . Intervention : The intensive exercise group received physiotherapy with focus on intensive exercises in four periods during the first year after stroke . The regular exercise group patients were followed up according to their subjective needs during the corresponding year . Main outcome measures : Motor Assessment Scale , Barthel Index of Activities of Daily Living , and grip strength . Results : Both groups improved significantly up to six months when function stabilized . The groups did not differ significantly on any test occasions . The difference of improvement from admission to discharge was significant in favour of the intensive exercise group , in the Motor Assessment Scale total score ( intensive exercise group 7.5 ; regular exercise group 1.7 , P = 0.01 ) , and in the Barthel Index of Activities of Daily Living total score ( 17.4 versus 8.9 , P = 0.04 ) . Conclusion : Motor function , activities of daily living functions and grip strength improved initially and were maintained during the first year after stroke in all patients irrespective of exercise regime . This indicates the importance of motivation for regular exercise in the first year following stroke , achieved by regular check-ups AIM Partial body weight support ( PBWS ) is an accepted treatment for hemiplegic patients . The aim of this study is to compare the efficiency of gait trainer with conventional treatment on the gait management after stroke . METHODS Forty chronic post-stroke hemiplegics were part of a prospect i ve research . Inclusion criteria were : first ever stroke in a chronic stage with stabilised motor deficits ; age > 18 and < 80 years ; cognitive and communication skills to underst and the treatment ; absence of cardiac , psychological and orthopedic contraindications . Patients were r and omised into two groups : the control group ( CG ) that used the Bobath method in 40 minutes sessions , 5 times a week , for 5 weeks , and the experimental group ( EG ) that used the gait trainer , for the same period of time and frequency . Assessment tools : Motricity Index ( MI ) ; Toulouse Motor Scale ( TMS ) ; modified Ashworth Spasticity Scale ( mASS ) ; Berg Balance Scale ( BBS ) ; Rivermead Mobility Index ( RMI ) ; Fugl-Meyer Stroke Scale ( F-MSS ) ; Functional Ambulation Category ( FAC ) ; Barthel Index ( BI ) ; 10 meters , time up and go ( TUG ) , 6 minutes , and step tests . EG and CG did the assessment s before treatment ( T(0 ) ) , right after treatment ( T(1 ) ) , and on follow-up , 3 months later ( T(2 ) ) . RESULTS CG and EG were homogenous in all the variables at T(0 ) . CG and EG showed improvement in almost all the assessment scales after treatment , although only some with relevant differences . EG showed statistically relevant improvement on T(1 ) and on T(2 ) in several of the assessment tools , whereas CG only showed statistically significant improvement after T(1 ) and only in some of the assessment tools . CONCLUSIONS Both groups of chronic hemiplegic patients improved after either PBWS with gait trainer or Bobath treatment . Only subjects undergoing PBWS with gait trainer maintained functional gain after 3 months Objective : To examine whether two different physiotherapy regimes caused any differences in outcome in rehabilitation after acute stroke . Design : A double-blind study of patients with acute first-ever stroke . Sixty-one patients were consecutively included , block r and omized into two groups , and stratified according to gender and hemiplegic site . Group 1 ( 33 patients ) and group 2 ( 28 patients ) had physiotherapy according to Motor Relearning Programme ( MRP ) and Bobath , respectively . The supplemental treatment did not differ in the two groups . Main outcome measures : The Motor Assessment Scale ( MAS ) , the Sødring Motor Evaluation Scale ( SMES ) , the Barthel ADL Index and the Nottingham Health Profile ( NHP ) were used . The following parameters were also registered : length of stay in the hospital , use of assistive devices for mobility , and the patient 's accommodation after discharge from the hospital . Results : Patients treated according to MRP stayed fewer days in hospital than those treated according to Bobath ( mean 21 days versus 34 days , p = 0.008 ) . Both groups improved in MAS and SMES , but the improvement in motor function was significantly better in the MRP group . The two groups improved in Barthel ADL Index without significant differences between the groups . However , women treated by MRP improved more in ADL than women treated by Bobath . There were no differences between the groups in the life quality test ( NHP ) , use of assistive devices or accommodation after discharge from the hospital . Conclusion : The present study indicates that physiotherapy treatment using the MRP is preferable to that using the Bobath programme in the acute rehabilitation of stroke patients Background : Locomotor training ( LT ) to improve walking ability in people poststroke can be accomplished with therapist assistance as needed to promote continuous stepping . Various robotic devices also have been developed that can guide the lower limbs through a kinematically consistent gait pattern . It is unclear whether LT with either therapist or robotic assistance could improve kinematic coordination patterns during walking . Objective : The purpose of this study was to determine whether LT with physical assistance as needed was superior to guided , symmetrical , robotic-assisted LT for improving kinematic coordination during walking poststroke . Design : This study was a r and omized clinical trial . Methods : Nineteen people with chronic stroke ( > 6 months ’ duration ) participating in a larger r and omized control trial comparing therapist- versus robotic-assisted LT were recruited . Prior to and following 4 weeks of LT , gait analysis was performed at each participant 's self-selected speed during overground walking . Kinematic coordination was defined as the consistency of intralimb hip and knee angular trajectories over repeated gait cycles and was compared before and after treatment for each group . Results : Locomotor training with therapist assistance result ed in significant improvements in the consistency of intralimb movements of the impaired limb . Providing consistent kinematic assistance during robotic-assisted LT did not result in improvements in intralimb consistency . Only minimal changes in discrete kinematics were observed in either group . Limitations : The limitations included a relatively small sample size and a lack of quantification regarding the extent of movement consistency during training sessions for both groups . Conclusions : Coordination of intralimb kinematics appears to improve in response to LT with therapist assistance as needed . Fixed assistance , as provided by this form of robotic guidance during LT , however , did not alter intralimb coordination Purpose : Treadmill training with body weight support ( TTBWS ) for relearning walking ability after brain damage is an approach under current investigation . Efficiency of this method beyond traditional training is lacking evidence , especially in patients needing walking assistance after stroke . The objective of this study was to investigate change in walking and transfer abilities , comparing TTBWS with traditional walking training . Methods : A single-blinded , r and omized controlled trial was conducted . Sixty patients referred for multi-disciplinary primary rehabilitation were assigned into one of two intervention groups , one received 30 sessions of TTBWS plus traditional training , the other traditional training alone . Daily training was 1 hr . Outcome measures were Functional Ambulation Categories ( FAC ) , Walking , Functional Independence Measure ( FIM ) ; shorter transfer and stairs , 10 m and 6-min walk tests . Results : Substantial improvements in walking and transfer were shown within both groups after 5 and 11 weeks of intervention . Overall no statistical significant differences were found between the groups , but 12 of 17 physical measures tended to show improvements in favour of the treadmill approach . Conclusions : Both training strategies provided significant improvements in the tested activities , suggesting that similar outcomes can be obtained in the two modalities by systematic , intensive and goal directed training . Implication s for Rehabilitation Treadmill training with body weight support ( TTBWS ) and traditional gait training were found to be equally effective in improving walking and transfer in patients dependent on walking assistance after stroke . However , most outcome measures showed a tendency of improvement in favour of the treadmill group . Both training modalities were systematic , goal -directed and intensive , and the time used for training was the same . The choice between the two equally effective training alternatives should be based on the patients ’ preference , and availability of equipment and re sources PURPOSE A series of pilot studies were conducted to examine the effects of partial body weight ( PBW ) ambulation in people with chronic stroke . METHODS First , we compared gait characteristics during 3 modes of walking : level ground ambulation ; level ground ambulation with PBW ; and treadmill ambulation with PBW . Second , we examined the effects of repeated PBW treadmill training during level ground ambulation . RESULTS Improved symmetry in stance/swing times and sEMG activity of pre-tibialis and quadriceps muscle groups during PBW either over level ground or on the treadmill occurred in 10 chronic stroke subjects . Increased single limb support and decreased double limb support improved overall gait symmetry during level ground ambulation in 8 subjects following 6 - -8 weeks repeated PBW treadmill training .  Tinetti Balance score also significantly improved . No changes in sEMG were observed . CONCLUSION These results suggest that PBW treadmill may help normalize gait and improve balance in the person with chronic stroke OBJECTIVE To determine whether acute exercise , using a body-weight-supported treadmill , improves performance on subsequent cognitive tests or an upper-extremity task in people with stroke . DESIGN The study was a within-subject , cross-over design in which 21 subjects received , r and omly , 2 different testing sequences separated by an interval of 7 to 10 days . SETTING Outpatient department of a rehabilitation hospital . PARTICIPANTS Of 72 potential participants in the convenience sample , 21 people with chronic stroke completed the study . They were 0.5 to 5 years after only 1 documented stroke , were able to walk with or without a cane , were able to grasp with the affected h and , and scored more than 24 on the Mini-Mental State Examination . INTERVENTIONS One session of body-weight-supported treadmill walking for 20 minutes at 70 % of estimated heart rate reserve or level 13 on the Borg rating of perceived exertion scale . The control condition consisted of a 20-minute review of a home exercise program with a physiotherapist . MAIN OUTCOME MEASURES Cognitive tests included Trail Making Tests Parts A and B , Symbol Digit Substitution Test , and Paced Auditory Serial Addition Test . The Action Research Arm Test ( ARAT ) measured hemiplegic upper-extremity motor skill . RESULTS Treadmill exercise  improved movement of the hemiplegic upper extremity ( P=.04 ) but not cognitive performance . The improvement in the ARAT occurred without a change in strength ( measured by grip strength ) and was negatively correlated with maximum treadmill speed ( R(2)=.20 ; P=.04 ) . CONCLUSIONS These findings suggest that acute treadmill exercise improves subsequent skilled movement of the hemiplegic upper extremity that seems unrelated to attention , visuomotor processing , or strength . The etiology and duration of this enhancing effect are worth further study . The existence of an exercise-cognition relationship in people with stroke is an intriguing area of future research A r and omized controlled pilot trial was conducted to estimate the effects of early , intensive , gait-focused physical therapy on ambulatory ability in acute , stroke patients . Twenty-seven patients with middle cerebral artery infa rct of thromboembolic origin confirmed by computed axial tomography scan were stratified and r and omly assigned to the experimental group , to a control group that received early , intensive and conventional therapy , or to a group receiving routine conventional therapy that started later and was not intense . Assessment s at entry , six weeks , and three and six months by independent evaluators permitted comparisons with reference to clinical measures of motor performance , balance , and functional capacity , and laboratory measures of gait movements . Group results at six weeks demonstrated that gait velocity was similar in the two conventional groups thereby eliminating the timing of the interventions as an important factor . At that point , gait velocity was faster in the experimental group . The difference translated into a moderate effect size of 0.58 . The time dedicated to gait training but not to total therapy time was correlated ( rs = 0.63 ) to gait velocity . This effect disappeared at three and six months after stroke . These pilot results justify planning a large trial to test the effectiveness of a therapeutic protocol that focuses on early and intense gait therapy in an effort to facilitate early ambulation following stroke BACKGROUND AND PURPOSE The effects of different duration s of rehabilitation sessions for the upper extremities ( UEs ) and lower extremities ( LEs ) on the recovery of interlimb coordination in hemiplegic gait in patients who have had a stroke were investigated . SUBJECTS AND METHODS Fifty-three subjects who had strokes involving their middle cerebral arteries were assigned to rehabilitation programs with ( 1 ) an emphasis on the LEs , ( 2 ) an emphasis on the paretic UE , or ( 3 ) a condition in which the paretic arm ( UE ) and leg ( LE ) were immobilized with an inflatable pressure splint ( control treatment ) . The 3 treatment regimens were applied for 30 minutes , 5 days a week , during the first 20 weeks after onset of stroke . All subjects also participated in a rehabilitation program 5 days a week that consisted of 15 minutes of UE exercises and 15 minutes of LE exercises in addition to a weekly 11/2-hour session of training in activities of daily living . A repeated- measures design was used . Differences among the 3 treatment regimens were evaluated in terms of comfortable and maximal walking speeds . In addition , mean continuous relative phase ( CRP ) between paretic arm and leg ( PAL ) movements and nonparetic arm and leg ( NAL ) movements and st and ard deviations of CRP of both limb pairs as a measurement of stability ( variability ) were evaluated . RESULTS Comfortable walking speed improved in the group that received interventions involving the LEs compared with the group that received interventions involving the UEs and the group that received the control treatment . No differences among the 3 treatment conditions were found for the mean CRP of NAL and PAL as well as the st and ard deviation of CRP of both limb pairs . DISCUSSION AND CONCLUSION With the exception of an improved comfortable walking speed as a result of a longer duration of rehabilitation sessions , no differential effects of duration of rehabilitation sessions for the LEs and UEs on the variable we measured related to hemiplegic gait were found . Increasing walking speed , however , result ed in a larger mean CRP for both limb pairs , with increased stability and asymmetry of walking , indicating that walking speed influences interlimb coordination in hemiplegic gait Background and Purpose : A phase II , single-blinded , r and omized clinical trial was conducted to determine the effects of combined task-specific and lower-extremity ( LE ) strength training to improve walking ability after stroke . Subjects : The participants were 80 adults who were ambulatory 4 months to 5 years after a unilateral stroke . Method : The exercise interventions consisted of body-weight – supported treadmill training ( BWSTT ) , limb-loaded resistive leg cycling ( CYCLE ) , LE muscle-specific progressive-resistive exercise ( LE-EX ) , and upper-extremity ergometry ( UE-EX ) . After baseline assessment s , participants were r and omly assigned to a combined exercise program that included an exercise pair . The exercise pairs were : BWSTT/UE-EX , CYCLE/UE-EX , BWSTT/CYCLE , and BWSTT/LE-EX . Exercise sessions were 4 times per week for 6 weeks ( total of 24 sessions ) , with exercise type completed on alternate days . Outcomes were self-selected walking speed , fast walking speed , and 6-minute walk distance measured before and after intervention and at a 6-month follow-up . Results : The BWSTT/UE-EX group had significantly greater walking speed increases compared with the CYCLE/UE-EX group ; both groups improved in distance walked . All BWSTT groups increased walking speed and distance whether BWSTT was combined with LE strength training or not . Discussion and Conclusion : After chronic stroke , task-specific training during treadmill walking with body-weight support is more effective in improving walking speed and maintaining these gains at 6 months than resisted leg cycling alone . Consistent with the overtraining literature , LE strength training alternated daily with BWSTT walking did not provide an added benefit to walking outcomes 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 Task-specific training programs  after stroke improve walking function , but it is not clear which biomechanical parameters of gait are most associated with improved walking speed . Objective The purpose of this study was to identify gait parameters associated with improved walking speed after a locomotor training program that included body-weight – supported treadmill training ( BWSTT ) . Design A prospect i ve , between-subjects design was used . Methods Fifteen people , ranging from approximately 9 months to 5 years after stroke , completed 1 of 3 different 6-week training regimens . These regimens consisted of 12 sessions of BWSTT alternated with 12 sessions of : lower-extremity resistive cycling ; lower-extremity progressive , resistive strengthening ; or a sham condition of arm ergometry .  Gait analysis was conducted before and after the 6-week intervention program . Kinematics , kinetics , and electromyographic ( EMG ) activity were recorded from the hemiparetic lower extremity while participants walked at a self-selected pace . Changes in gait parameters were compared in participants who showed an increase in self-selected walking speed of greater than 0.08 m/s ( high-response group ) and in those with less improvement ( low-response group ) . Results Compared with participants in the low-response group , those in the high-response group displayed greater increases in terminal stance hip extension angle and hip flexion power ( product of net joint moment and angular velocity ) after the intervention . The intensity of soleus muscle EMG activity during walking also was significantly higher in participants in the high-response group after the intervention . Limitations Only sagittal-plane parameters were assessed , and the sample size was small . Conclusions Task-specific locomotor training alternated with strength training result ed in kinematic , kinetic , and muscle activation adaptations that were strongly associated with improved walking speed . Changes in both hip and ankle biomechanics during late stance were associated with greater increases in gait speed BACKGROUND Patients with stroke usually demonstrate activity limitations manifested by reduced ability to perform daily functions . OBJECTIVE The purpose of this study was to examine the effects of treadmill walking and overground walking exercise training on walking function in adult patients with stroke . METHODS Participants were forty ( 40 ) patients with stroke comprising 22 males and 18 females . Inclusion criteria included absence of any co-morbidity that could affect rehabilitation . They were r and omly assigned to 2 exercise training groups ( 20 in each group ) . All study subjects received conventional physiotherapy rehabilitation for 12 weeks . During the same period , subjects in Group A had treadmill walking exercise training ( TWET ) while those in Group B had overground walking exercise training ( OWET ) in addition to the conventional physiotherapy . Outcomes were measured as ( i ) Ten-metre walk time and ( ii ) Six-minute walk distance . They were evaluated at entry into the study and at the end of every 4 weeks . Results at weeks 0 , 4 , 8 and 12 were used for analysis . For each of the 2 groups , paired t-tests were used to evaluate the significance of the differences between the pre-intervention ( week 0 ) mean scores on both tests and the mean scores at weeks 4 , 8 and 12 . RESULTS With 12 weeks of exercise training , both TWET and OWET produced significant improvement in walking function ( P < 0.05 ) . However , OWET result ed in significantly greater reduction ( 26.8 % ) in mean walking time over 10 metres than TWET ( 22.6 % ) ; and significantly greater increase ( 45.2 % ) in mean walking distance over 6 minutes than TWET ( 31.0 % ) . CONCLUSION Exercise training , especially overground walking , could be integrated into the traditional rehabilitation care given to adult patients with stroke Objective : To compare the effects of body weight-supported treadmill training and overground walking training when matched for task and dose ( duration /frequency/intensity ) on improving walking function , activity , and participation  after stroke . Design : Single-blind , pilot r and omized controlled trial with three-month follow-up . Setting s : University and community setting s. Subjects : A convenience sample of participants ( N = 20 ) at least six months post-stroke and able to walk independently were recruited . Interventions : Thirty-minute walking interventions ( body weight-supported treadmill training or overground walking training ) were administered five times a week for two weeks . Intensity was monitored with the Borg Rating of Perceived Exertion Scale at five-minute increments to maintain a moderate training intensity . Main Measures : Walking speed ( comfortable/fast 10-meter walk ) , walking endurance ( 6-minute walk ) , spatiotemporal symmetry , and the ICF Measure of Participation and ACTivity were assessed before , immediately after , and three months following the intervention . Results : The overground walking training group demonstrated significantly greater improvements in comfortable walking speed compared with the body weight-supported treadmill training group immediately ( change of 0.11 m/s vs. 0.06 m/s , respectively ; p = 0.047 ) and three months ( change of 0.14 m/s vs. 0.08 m/s , respectively ; p = 0.029 ) after training . Only the overground walking training group significantly improved comfortable walking speed ( p = 0.001 ) , aspects of gait symmetry ( p = 0.032 ) , and activity ( p = 0.003 ) immediately after training . Gains were maintained at the three-month follow-up ( p < 0.05 ) for all measures except activity . Improvements in participation were not demonstrated . Conclusion : Overgound walking training was more beneficial than body weight-supported treadmill training at improving self-selected walking speed for the participants in this study OBJECTIVE To investigate the effects of gait training with body weight support ( BWS ) on a treadmill versus overground in individuals with chronic stroke . DESIGN R and omized controlled trial . SETTING University research laboratory . PARTICIPANTS Individuals ( N=28 ) with chronic stroke ( > 6mo from the stroke event ) . INTERVENTIONS Participants were r and omly assigned to receive gait training with BWS on a treadmill ( n=14 ) or overground ( n=14 ) 3 times a week for 6 weeks . MAIN OUTCOME MEASURES Gait speed measured using the 10-meter walk test , endurance measured using the 6-minute walk test , functional independence measured using the motor domain of the FIM , lower limb recovery measured using the lower extremity domain of the Fugl-Meyer assessment , step length , step length symmetry ratio , and single-limb support duration . Measurements were obtained at baseline , immediately after the training session , and 6 weeks after the training session . RESULTS At 1 week after the last training session , both groups improved in all outcome measures except paretic step length and step length symmetry ratio , which were improved only in the overground group ( P=.01 and P=.01 , respectively ) . At 6 weeks after the last training session , all improvements remained and the treadmill group also improved paretic step length ( P<.001 ) but not step length symmetry ratio ( P>.05 ) . CONCLUSIONS Individuals with chronic stroke equally improve gait speed and other gait parameters after 18 sessions of BWS gait training on either a treadmill or overground . Only the overground group improved step length symmetry ratio , suggesting a role of integrating overground walking into BWS interventions poststroke Objective : To evaluate spatial and temporal gait characteristics and endurance late after stroke in people who had received two different walking exercises .  A secondary aim was to compare the outcomes in relation to length of time exercising and number of exercise occasions between the two . Design : A r and omized controlled trial . Setting : A private rehabilitation centre . Subjects : Thirty-nine people with stroke entered the study , and five dropped out . Interventions : Treadmill training versus walking outdoors . Main measures : Six-Minute Walk Test , a 10-metre walk test and pulse rates at rest and in activity . Results : There were significant differences in favour of the treadmill group in Six-Minute Walk Test distance ( P = 0.04 ) , Six-Minute Walk Test speed ( P = 0.03 ) , 10-m walking speed ( P = 0.03 ) , bilateral stride length ( right leg ; P = 0.009 , left leg ; P = 0.003 ) and step width ( P = 0.01 ) , indicating more symmetrical use of the legs in the treadmill group ( 1.02—1.10 m versus 0.97—0.92 m ) . There were no significant differences between groups in cadence ( P = 0.78 ) . All participants complied 100 % with their respective programmes . Exercise frequency did not differ between the groups but significantly less time was spent exercising on the treadmill compared with walking exercise outdoors ( 107 versus 316 minutes , P = 0.002 ) . There were no differences in use of assistive aids between the groups on arrival at the clinic or at departure . Conclusion : The results indicate that treadmill walking improves spatial and temporal gait characteristics more effectively than walking outdoors Background . No single intervention restores the coordinated components of gait after stroke . Objective . The authors tested the multimodal Gait Training Protocol , with or without functional electrical stimulation ( FES ) , to improve volitional walking ( without FES ) in patients with persistent ( > 6 months ) dyscoordinated gait . Methods . A total of 53 subjects were stratified and r and omly allocated to either FES with intramuscular ( IM ) electrodes ( FES-IM ) or No-FES . Both groups received 1.5-hour training sessions 4 times a week for 12 weeks of coordination exercises , body weight – supported treadmill training ( BWSTT ) , and over-ground walking , provided with FES-IM or No-FES . The primary outcome was the Gait Assessment and Intervention Tool ( G.A.I.T. ) of coordinated movement components , with secondary measures , including manual muscle testing , isolated leg movements ( Fugl-Meyer scale ) , 6-Minute Walk Test , and Locomotion/Mobility subscale of the Functional Independence Measure ( FIM ) . Results . No baseline differences in subject characteristics and measures were found . The G.A.I.T. showed an additive advantage with FES-IM versus No-FES ( parameter statistic 1.10 ; P = .045 , 95 % CI = 0.023 - 2.179 ) at the end of training . For both FES-IM and No-FES , a within-group , pre/posttreatment gain was present for all measures ( P < .05 ) , and a continued benefit from mid- to posttreatment ( P < .05 ) was present . For FES-IM , recovered coordinated gait persisted at 6-month follow-up but not for No-FES . Conclusion . Improved gait coordination and function were produced by the multimodal Gait Training Protocol . FES-IM added significant gains that were maintained for 6 months after the completion of training 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 Treadmill training , with or without body weight support using a harness , is used in rehabilitation and might help to improve walking after stroke .
This is an up date of the Cochrane review first published in 2003 and up date d in 2005 and 2014 .
OBJECTIVES To determine if treadmill training and body weight support , individually or in combination , improve walking ability , quality of life , activities of daily living , dependency or death , and institutionalisation or death , compared with other physiotherapy gait-training interventions after stroke .
The secondary objective was to determine the safety and acceptability of this method of gait training .