Treadmill walking with body weight support in subacute non-ambulatory stroke improves walking capacity more than overground walking: a randomised trial. Supported treadmill training to establish walking in non-ambulatory patients early after stroke Varied overground walking-task practice versus body-weight-supported treadmill training in ambulatory adults within one year of stroke: a randomized controlled trial protocol Varied Overground Walking Training Versus Body-Weight-Supported Treadmill Training in Adults Within 1 Year of Stroke Effects of Task-Specific Locomotor and Strength Training in Adults Who Were Ambulatory After Stroke: Results of the STEPS Randomized Clinical Trial Higher-intensity treadmill walking during rehabilitation after stroke in feasible and not detrimental to walking pattern or quality: a pilot randomized trial Body weight-supported treadmill training vs. overground walking training for persons with chronic stroke: a pilot randomized controlled trial Protocol for the Locomotor Experience Applied Post-stroke (LEAPS) trial: a randomized controlled trial Gait recovery is not associated with changes in the temporal patterning of muscle activity during treadmill walking in patients with post-stroke hemiparesis Comparison of Partial Body Weight-Supported Treadmill Gait Training Versus Aggressive Bracing Assisted Walking Post Stroke A new approach to retrain gait in stroke patients through body weight support and treadmill stimulation. Pilot study of Lokomat versus manual-assisted treadmill training for locomotor recovery post-stroke Whole-Body Vibration Combined with Treadmill Training Improves Walking Performance in Post-Stroke Patients: A Randomized Controlled Trial Combined use of body weight support, functional electric stimulation, and treadmill training to improve walking ability in individuals with chronic incomplete spinal cord injury. A treadmill and overground walking program improves walking in persons residing in the community after stroke: a placebo-controlled, randomized trial. Treadmill training with partial body weight support and physiotherapy in stroke patients: a preliminary comparison. Body weight supported treadmill training versus traditional training in patients dependent on walking assistance after stroke: a randomized controlled trial Optimal outcomes obtained with body-weight support combined with treadmill training in stroke subjects. The effectiveness of locomotor therapy using robotic-assisted gait training in subacute stroke patients: a randomized controlled trial.
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 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 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 # 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 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 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 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 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 OBJECTIVE To establish whether functional recovery of gait in patients with post-stroke hemiparesis coincides with changes in the temporal patterning of lower extremity muscle activity and coactivity during treadmill walking . METHODS  Electromyographic ( EMG ) data from both legs , maximum walking speed , the amount of swing phase asymmetry and clinical measures were obtained from a group of post-acute patients with hemiparesis , as early as possible after admission in a rehabilitation centre ( mean time post-stroke 35 days ) and 1 , 3 , 6 , and 10 weeks later , while all patients participated in a regular rehabilitation program .  EMG data from the first assessment were compared to those obtained from a group of healthy controls to identify abnormalities in the temporal patterning of muscle activity . Within subject comparisons of patient data were made over time to investigate whether functional gait recovery was accompanied by changes in the temporal patterns muscle (co-)activity . RESULTS EMG patterns during the first assessment showed a number of abnormalities on the paretic side , namely abnormally long duration s of activity in biceps femoris ( BF ) during the single support ( SS ) phase and in gastrocnemius medialis ( GM ) during the first double support phase ( DS1 ) . Furthermore , in both legs a prolongation of the activity was seen in the rectus femoris ( RF ) during the SS phase . In addition , the duration of BF-RF coactivation was longer on the paretic side than it was in controls . Over time , the level of ambulatory independence , body mobility , and maximum walking speed increased significantly , indicating that substantial improvements in gait ability occurred . Despite these improvements , duration s of muscle ( co- ) activity and the level of swing phase asymmetry did not change during rehabilitation . More specifically , timing abnormalities in muscle (co-)activity that were found during the first assessment did not change significantly , indicating that these aberrations were not an impediment for functional gait improvements . CONCLUSIONS Normalization of the temporal patterning of gait related muscle activity in the lower extremities is not a prerequisite for functional recovery of gait in patients with post-stroke hemiparesis . Apparently , physiological processes other than improved temporal muscular coordination must be important determinants of the restoration of ambulatory capacity after stroke . SIGNIFICANCE Recovery of walking ability in post-stroke hemiparesis is not necessarily associated with , or dependent on , reorganization in the temporal control of gait related muscle activity . Normalization of the temporal coordination of muscle activity during gait may not be an important clinical goal during post-acute rehabilitation 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 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 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 Stroke is characterized by an asymmetrical gait pattern that causes poor stability and reduces overall activity levels . The aim of this study was to investigate the effect of whole-body vibration combined with treadmill training ( WBV-TT ) on walking performance in patients with chronic stroke . Material / Methods Thirty ambulatory chronic stroke patients were r and omly allocated to the WBV-TT group or the treadmill training ( TT ) group . The participants in the WBV-TT group performed 6 types of exercises on a vibrating platform for 4.5 minutes and then walked on the treadmill for 20 minutes . The participants in the TT group conducted the same exercise on a platform without vibration and then walked on the treadmill in the same manner . The vibration lasted for 45 seconds in each exercise , and the intervention was performed 3 times weekly for 6 weeks . The treadmill walking speed was gradually increased by 5 % in both groups . The outcome measures included the temporospatial parameter of gait ( GAITRite ® ) and 6-minute walk test . Results The WBV-TT group showed significant improvements in walking performance with respect to walking speed , cadence , step length , stride length , single-limb support , double-limb support , and 6-minute walk test compared with baseline ( p<0.05 ) . Significant improvements were also seen in walking speed , step length , stride length , and double-limb support compared with the TT group ( p<0.05 ) . Conclusions These findings indicate that WBV-TT is more effective than TT for improving walking performance of patients with chronic stroke OBJECTIVE To assess the effect of an intervention combining body weight support ( BWS ) , functional electric stimulation ( FES ) , and treadmill training on overground walking speed ( OGWS ) , treadmill walking speed , speed and distance , and lower extremity motor scores ( LEMS ) . DESIGN Before and after comparison . SETTING Miami Project to Cure Paralysis . PARTICIPANTS Nineteen subjects with American Spinal Injury Association class C injury who were at least 1 year postinjury and had asymmetrical lower extremity function . INTERVENTION Subjects trained 1.5 hours per day , 3 days per week , for 3 months . The training consisted of body weight-supported treadmill walking assisted by electric stimulation . Stimulation was applied to common peroneal nerve of the weaker lower extremity ( LE ) and timed to assist with the swing phase of the step cycle . MAIN OUTCOME MEASURES OGWS in the absence of both BWS and FES ; LEMS , and treadmill training parameters of speed and distance . RESULTS Over the course of training , there was a significant increase in OGWS ( from.12 + /- 0.8 m/s to .21 + /- .15 m/s , p = .0008 ) , treadmill walking speed ( from .23 + /- .12 m/s to.49 + /- .20 m/s , p = .00003 ) , and treadmill walking distance ( from 93 + /- 84 m to 243 + /- 139 m , p = .000001 ) . The median LEMS increased significantly for both the stimulated and nonstimulated leg ( from 8 to 11 in the FES-assisted leg , from 15 to 18 in the nonassisted leg , p < .005 for each ) . CONCLUSIONS All subjects showed improvement in OGWS and overall LE strength . Further research is required to delineate the essential elements of these particular training strategies 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 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 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 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 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
Mechanically assisted walking with body weight support is more effective than overground walking at increasing independent walking in non-ambulatory patients early after stroke .
QUESTION Does mechanically assisted walking with body weight support result in more independent walking and is it detrimental to walking speed or capacity in non-ambulatory patients early after stroke ?