Cost-effectiveness of a structured progressive task-oriented circuit class training programme to enhance walking competency after stroke: The protocol of the FIT-Stroke trial Effects of individualized versus group task-oriented circuit training on balance ability and gait endurance in chronic stroke inpatients Task-Oriented Circuit Class Training Program with Motor Imagery for Gait Rehabilitation in Poststroke Patients: A Randomized Controlled Trial Clinical application of circuit training for subacute stroke patients: a preliminary study Effects of circuit training as alternative to usual physiotherapy after stroke: randomised controlled trial Feasibility and Effectiveness of Circuit Training in Acute Stroke Rehabilitation Circuit-based rehabilitation improves gait endurance but not usual walking activity in chronic stroke: a randomized controlled trial. Effect of the a circuit training program using obstacles on the walking and balance abilities of stroke patients rTMS Combined With Task-Oriented Training to Improve Symmetry of Interhemispheric Corticomotor Excitability and Gait Performance After Stroke A task-oriented circuit training in multiple sclerosis: a feasibility study People with stroke spend more time in active task practice, but similar time in walking practice, when physiotherapy rehabilitation is provided in circuit classes compared to individual therapy sessions: an observational study. Task-related circuit training improves performance of locomotor tasks in chronic stroke: a randomized, controlled pilot trial. Motor Imagery Training on Muscle Strength and Gait Performance in Ambulant Stroke Subjects-A Randomized Clinical 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 Training dual-task walking in community-dwelling adults within 1 year of stroke: a protocol for a single-blind randomized controlled trial Effectiveness of a structured circuit class therapy model in stroke rehabilitation: a protocol for a randomised controlled trial Treadmill Exercise Activates Subcortical Neural Networks and Improves Walking After Stroke: A Randomized Controlled Trial Task-Oriented Biofeedback to Improve Gait in Individuals With Chronic Stroke: Motor Learning Approach Effects of a high-intensity task-oriented training on gait performance early after stroke: a pilot study Circuit Class Therapy or Seven-Day Week Therapy for Increasing Rehabilitation Intensity of Therapy after Stroke (CIRCIT): A Randomized Controlled Trial Effect of Task Specific Exercises, Gait Training, and Visual Biofeedback on Equinovarus Gait among Individuals with Stroke: Randomized Controlled Study Additional task-related practice improves mobility and upper limb function early after stroke: a randomised controlled trial. Improvements in Speed-Based Gait Classifications Are Meaningful Circuit Class Therapy and 7-Day-Week Therapy Increase Physiotherapy Time, But Not Patient Activity: Early Results From the CIRCIT Trial The Role of Technology in Task-Oriented Training in Persons with Subacute Stroke: A Randomized Controlled Trial Physiotherapists systematically overestimate the amount of time stroke survivors spend engaged in active therapy rehabilitation: an observational study. Gait Parameters Associated With Responsiveness to Treadmill Training With Body-Weight Support After Stroke: An Exploratory Study Dual-task exercise improves walking ability in chronic stroke: a randomized controlled trial. Effect of Strengthening Exercise in Addition to Task-Specific Gait Training after Stroke: a Randomised Trial
Background Most patients who suffer a stroke experience reduced walking competency and health-related quality of life ( HRQoL ) . A key factor in effective stroke rehabilitation is intensive , task-specific training . Recent studies suggest that intensive , patient-tailored training can be organized as a circuit with a series of task-oriented workstations . Primary aim of the FIT-Stroke trial is to evaluate the effects and cost-effectiveness of a structured , progressive task-oriented circuit class training ( CCT ) programme , compared to usual physiotherapeutic care during outpatient rehabilitation in a rehabilitation centre . The task-oriented CCT will be applied in groups of 4 to 6 patients . Outcome will be defined in terms of gait and gait-related ADLs after stroke . The trial will also investigate the generalizability of treatment effects of task-oriented CCT in terms of perceived fatigue , anxiety , depression and perceived HRQoL. Methods / design The multicentre single-blinded r and omized trial will include 220 stroke patients discharged to the community from inpatient rehabilitation , who are able to communicate and walk at least 10 m without physical , h and s-on assistance . After discharge from inpatient rehabilitation , patients in the experimental group will receive task-oriented CCT two times a week for 12 weeks at the physiotherapy department of the rehabilitation centre . Control group patients will receive usual individual , face-to-face , physiotherapy . Costs will be evaluated by having each patient keep a cost diary for the first 24 weeks after r and omisation . Primary outcomes are the mobility part of the Stroke Impact Scale ( SIS-3.0 ) and the EuroQol . Secondary outcomes are the other domains of SIS-3.0 , lower limb muscle strength , walking endurance , gait speed , balance , confidence not to fall , instrumental ADL , fatigue , anxiety , depression and HRQoL. Discussion Based on assumptions about the effect of intensity of practice and specificity of treatment effects , FIT-Stroke will address two key aims . The first aim is to investigate the effects of task-oriented CCT on walking competency and HRQoL compared to usual face-to-face physiotherapy . The second aim is to reveal the cost-effectiveness of task-oriented CCT in the first 6 months post stroke . Both aims were recently recommended as priorities by the American Hearth Association and Stroke Council . Trial registration This study is registered in the Dutch Trial Register as NTR1534 [ Purpose ] The purpose of this study was to analyze the effects of task-oriented circuit training on the balance ability and gait endurance of chronic stroke in patients . [ Subjects and Methods ] The participants were 30 patients who had stroke > 6 months previously , result ing in a disability such as hemiparesis . The participants were r and omly divided into the group task-oriented circuit training group and the individual task-oriented circuit-training group . They performed eight types of modified task-oriented training .  Balance ability and gait endurance were measured by using the Berg balance scale question naire and the 6-min walk test , respectively , before and after the experiment . [ Results ] Significant differences were observed between before and after the intervention in all variables . There was a significant difference between groups in Berg balance scale scores ; however , no significant differences were seen in the timed up and go test and the 6-min walk test . [ Conclusion ] The results of this study indicated that group exercise can better improve the balance ability of chronic stroke in patients after stroke than can individualized exercise intervention Abstract Background and Objective : The ability to walk is impaired in more than 80 % of poststroke patients . The objective of the present study was to evaluate the effectiveness of the task-oriented circuit class training ( TOCCT ) with motor imagery ( MI ) on the gait during the subacute phase after a stroke . Method : This was a r and omized , controlled , assessor-blinded trial in a neurology department of a university hospital . A convenience sample of 30 people , 4 to 12 weeks ( mean , 6.3 weeks ) after the stroke was r and omized into 2 groups ( the TOCCT with MI and st and ard training group ) of 15 people each . Twenty-nine participants completed the 6-week follow-up . Participants were assigned to receive either the TOCCT with MI or dose-matched st and ard training program based on the Bobath ’s neurodevelopmental technique , 7 days a week for 2 weeks , as out patients or in patients . Outcome measures were the Functional Ambulation Classification ( FAC ) , the Rivermead Visual Gait Assessment ( RVGA ) , step length asymmetry , walking speed , and 6-minute walk test ( 6MWT ) . Results : The TOCCT with MI group showed a positive improvement in the mean/median scores on most of the outcome measures at post and follow-up assessment s in comparison to the control group . However , statistically significant differences were observed in changes between the groups at post and follow-up assessment for FAC , RVGA , walking speed , and 6MWT ( ANOVA , P = .001 to .049 ; Mann-Whitney U test , P = .001 ) . Conclusion : Among the patients who had a stroke within the previous 4 to 12 weeks , the TOCCT with MI produced statistically significant and clinical ly relevant improvements in the gait and the gait-related activities [ Purpose ] To investigate how task-oriented circuit training for the recovery motor control of the lower-extremity , balance and walking endurance could be clinical ly applied to subacute stroke inpatient group therapy . [ Subjects and Methods ] Twenty subacute stroke patients were r and omly assigned to the intervention group ( n=10 ) or the control group ( n=10 ) . The intervention consisted of a structured , progressive , inpatient circuit training program focused on mobility and gait training as well as physical fitness training that was performed for 90 minutes , 5 days a week for 4 weeks . The control group received individual physiotherapy of neurodevelopmental treatment for 60 minutes , 5 days a week for 4 weeks . Outcome measures were lower-extremity motor control , balance , gait endurance and activities of daily living before and after 4 weeks . [ Results ] There were no significant differences at baseline between the two groups . After 4 weeks , both groups showed significant improvements in all outcome measures , but there were no significant differences between the two groups during the invention period . [ Conclusion ] In spite of the small sample size , these findings suggest that task-oriented circuit training might be used as a cost-effective and alternative method of individual physiotherapy for the motor recovery of lower-extremity , balance and walking endurance of subacute stroke patients Objective To analyse the effect of task oriented circuit training compared with usual physiotherapy in terms of self reported walking competency for patients with stroke discharged from a rehabilitation centre to their own home . Design R and omised controlled trial with follow-up to 24 weeks . Setting Multicentre trial in nine outpatient rehabilitation centres in the Netherl and s Participants Patients with stroke who were able to walk a minimum of 10 m without physical assistance and were discharged from inpatient rehabilitation to an outpatient rehabilitation clinic . Patients were r and omly allocated to circuit training or usual physiotherapy , after stratification by rehabilitation centre , with an online r and omisation procedure . Intervention Patients in the intervention group received circuit training in 90 minute sessions twice a week for 12 weeks . The training included eight different workstations in a gym and was intended to improve performance in tasks relating to walking competency . The control group received usual outpatient physiotherapy . Main outcome measures The primary outcome was the mobility domain of the stroke impact scale ( SIS , version 3.0 ) . Secondary outcomes were st and ing balance , self reported abilities , gait speed , walking distance , stair climbing , instrumental activities of daily living , fatigue , anxiety , and depression . Differences between groups were analysed according to the intention to treat principle . All outcomes were assessed by blinded observers in a repeated measurement design lasting 24 weeks . Results 126 patients were included in the circuit training group and 124 in the usual care group ( control ) , with data from 125 and 117 , respectively , available for analysis . One patient from the circuit training  group and seven from the control group dropped out . Circuit training was a safe intervention , and no serious adverse events were reported . There were no significant differences between groups for the stroke impact scale mobility domain ( β=0.05 ( SE 0.68 ) , P=0.943 ) at 12 weeks . Circuit training was associated with significantly higher scores in terms of gait speed ( 0.09 m/s ( SE 0.02 ) , P<0.001 ) , walking distance ( 20.0 m ( SE 7.4 ) , P=0.007 ) , and modified stairs test ( −1.6 s ( SE 0.7 ) , P=0.015 ) . There were no significant differences between groups for the other secondary outcomes , except for the leisure domain of the Nottingham extended activities of daily living and the memory and thinking domain of the stroke impact scale . With the exception of gait speed ( −0.04 m/s ( SE 0.02 ) , P=0.040 ) , there were no significant differences between groups at follow-up . Conclusion Task oriented circuit training can safely replace usual physiotherapy for patients with stroke who are discharged from inpatient rehabilitation to the community and need further training in gait and gait related activities as an outpatient . Trial registration Dutch Trial Register ( NTR1534 ) Background : Task-specificity , repetition and progression are key variables in the acquisition of motor skill however they have not been consistently implemented in post-stroke rehabilitation . Objective : To evaluate the effectiveness of a stroke rehabilitation plan of care that incorporated task-specific practice , repetition and progression to facilitate functional gain compared to st and ard physical therapy for individuals admitted to an inpatient stroke unit . Methods : Individuals participated in either a circuit training ( CTPT ) model ( n = 72 ) or a st and ard ( SPT ) model ( n = 108 ) of physical therapy , 5 days/week . Each 60 minute circuit training session , delivered according to severity level , consisted of four functional mobility tasks . Daily exercise logs documented both task repetition and progression . Results : The CTPT model was successfully implemented in an acute rehabilitation setting . The CTPT group showed a significantly greater improved change in gait speed from hospital admission to discharge than the SPT group ( 0.21± 0.25 m/sec vs. 0.13± 0.22 m/sec ; p = 0.03 ) . The difference between groups occurred primarily among those who were ambulatory upon admission . There were no significant differences between the two cohorts at 90 days post-stroke as measured by the FONE-FIM , SF-36 and living location . Conclusions : Therapy focused on systematic ally progressed functional tasks can be successfully implemented in an inpatient rehabilitation stroke program . This circuit-training model result ed in greater gains in gait velocity over the course of inpatient rehabilitation compared to the st and ard model of care . Community-based services following hospital discharge to maintain these gains should be included in the continuum of post-stroke care UNLABELLED Mudge S , Barber PA , Stott NS . Circuit-based rehabilitation improves gait endurance but not usual walking activity in chronic stroke : a r and omized controlled trial . OBJECTIVE To determine whether circuit-based rehabilitation would increase the amount and rate that individuals with stroke walk in their usual environments . DESIGN Single-blind r and omized controlled trial . SETTING Rehabilitation clinic . PARTICIPANTS Sixty participants with a residual gait deficit at least 6 months after stroke originally enrolled in the study . Two withdrew in the initial phase , leaving 58 participants ( median age , 71.5y ; range , 39.0 - 89.0y ) who were r and omized to the 2 intervention groups . INTERVENTIONS The exercise group had 12 sessions of clinic-based rehabilitation delivered in a circuit class design ed to improve walking . The control group received a comparable duration of group social and educational classes . MAIN OUTCOME MEASURES Usual walking performance was assessed using the StepWatch Activity Monitor . Clinical tests were gait speed ( timed 10-meter walk ) and endurance ( six-minute walk test [ 6MWT ] ) , confidence ( Activities-Based Confidence Scale ) , self-reported mobility ( Rivermead Mobility Index [ RMI ] ) , and self-reported physical activity ( Physical Activity and Disability Scale ) . RESULTS Intention-to-treat analysis revealed that the exercise group showed a significantly greater distance for the 6MWT than the control group immediately after the intervention ( P=.030 ) but that this effect was not retained 3 months later . There were no changes in the StepWatch measures of usual walking performance for either group . The exercise and control groups had significantly different gait speed ( P=.038 ) and scores on the RMI ( P=.025 ) at the 3-month follow-up . These differences represented a greater decline in the control group compared with the exercise group for both outcome measures . CONCLUSIONS Circuit-based rehabilitation leads to improvements in gait endurance but does not change the amount or rate of walking performance in usual environments . Clinical gains made by the exercise group were lost 3 months later . Future studies should consider whether rehabilitation needs to occur in usual environments to improve walking performance [ Purpose ] The aim of this study was to investigate the impact of a circuit training program on the walking and balance abilities of stroke patients using an up-to- date walking analysis device . [ Subjects and Methods ] The subjects of this study were 12 adults who were diagnosed with stroke . Evaluation was conducted using the Smart Step test for walking ability ; ( BBS ) for balance ability ; and the Timed Up and Go test ( TUG ) for functional mobility and movement ability . The 12 stroke patients were r and omly recruited and divided into two groups ; an experimental group which performed circuit training with obstacles , and a control group which performed flat gait training ) . [ Results ] Between-group comparison of the change in the 10-m walking speed found a statistically significant difference between the two groups . Between-group comparison of the changes in BBS and TUG found statistically significant differences between the two groups . [ Conclusion ] The circuit training program using obstacles had a positive effect on the gait and balance abilities of the stroke patients Background . The model of interhemispheric competition after stroke has been established for the upper but not for the lower extremity . Repetitive transcranial magnetic stimulation ( rTMS ) of the brain has been shown to modulate cortical excitability . Objective . The purpose of this study was to investigate the effects of rTMS followed by task-oriented training on cortical excitability and walking performance in individuals with chronic stroke . Methods . A total of 24 patients with average Fugl-Meyer lower limb scores of 17.88 ± 5.27 and average walking speeds of 63.81 ± 18.25 cm/s were r and omized into an experimental group and a control group . Participants received rTMS ( experimental group ) or sham rTMS ( control group ) followed by task-oriented training ( 30 minutes ) for 10 sessions over 2 weeks . Repetitive TMS was applied at a 1-Hz frequency over the leg area of the motor cortex of the unaffected hemisphere for 10 minutes . Outcomes , including motor-evoked potential ( MEP ) , lower-extremity Fugl-Meyer score , and gait performance , were measured before and after training . Results . Decreased interhemispheric asymmetry of the amplitude of the MEP was noted after rTMS and task-oriented training . Improvement in spatial asymmetry of gait was comparable with increased symmetry in interhemispheric excitability . Motor control and walking ability were also significantly improved after rTMS and task-oriented training . Conclusions . rTMS enhances the effect of task-oriented training in those with chronic stroke , especially by increasing gait spatial symmetry and corticomotor excitability symmetry Background The aim of this study was to evaluate the safety , feasibility and preliminary effects of a high-intensity rehabilitative task-oriented circuit training ( TOCT ) in a sample of multiple sclerosis ( MS ) subjects on walking competency , mobility , fatigue and health-related quality of life ( HRQoL ) . Methods 24 MS subjects ( EDSS 4.89 ± 0.54 , 17 female and 7 male , 52.58 ± 11.21 years , MS duration 15.21 ± 8.68 years ) have been enrolled and r and omly assigned to 2 treatment groups : ( i ) experimental group received 10 TOCT sessions over 2 weeks ( 2 hours/each session ) followed by a 3 months home exercise program , whereas control group did not receive any specific rehabilitation intervention . A feasibility patient-reported question naire was administered after TOCT . Functional outcome measures were : walking endurance ( Six Minute Walk Test ) , gait speed ( 10 Meter Walk Test ) , mobility ( Timed Up and Go test ) and balance ( Dynamic Gait Index ) . Furthermore , self-reported question naire of motor fatigue ( Fatigue Severity Scale ) , walking ability ( Multiple Sclerosis Walking Scale – 12 ) and health-related quality of life ( Multiple Sclerosis Impact Scale – 29 ) were included . Subjects ’ assessment s were delivered at baseline ( T0 ) , after TOCT ( T1 ) and 3 months of home-based exercise program ( T2 ) . Results After TOCT subjects reported a positive global rating on the received treatment . At 3 months , we found a 58.33 % of adherence to the home-exercise program . After TOCT , walking ability and health-related quality of life were improved ( p < 0.05 ) with minor retention after 3 months . The control group showed no significant changes in any variables . Conclusions This two weeks high-intensity task-oriented circuit class training followed by a three months home-based exercise program seems feasible and safe in MS people with moderate mobility impairments ; moreover it might improve walking abilities . Trial registration QUESTION Do people with stroke spend more time in active task practice during circuit class therapy sessions versus individual physiotherapy sessions ? Do people with stroke practise different tasks during circuit class therapy sessions versus individual physiotherapy sessions ? DESIGN Prospect i ve , observational study . PARTICIPANTS Twenty-nine people with stroke in inpatient rehabilitation setting s. INTERVENTIONS Individual therapy sessions and circuit class therapy sessions provided within a larger r and omised controlled trial . OUTCOME MEASURES Seventy-nine therapy sessions were video-recorded and the footage was analysed for time spent engaged in various categories of activity . In a sub sample of 28 videos , the number of steps taken by people with stroke per therapy session was counted . RESULTS Circuit class therapy sessions were of a longer duration ( mean difference 38.0minutes , 95 % CI 29.9 to 46.1 ) , and participants spent more time engaged in active task practice ( mean difference 23.8minutes , 95 % CI 16.1 to 31.4 ) compared with individual sessions . A greater percentage of time in circuit class therapy sessions was spent practising tasks in sitting ( mean difference 5.3 % , 95 % CI 2.4 to 8.2 ) and in sit-to-st and practice ( mean difference 2.7 % , 95 % CI 1.4 to 4.1 ) , and a lower percentage of time in walking practice ( mean difference 19.1 % , 95 % CI 10.0 to 28.1 ) compared with individual sessions . PARTICIPANTS took an average of 371 steps ( SD 418 ) during therapy sessions and this did not differ significantly between group and individual sessions . CONCLUSION People with stroke spent more time in active task practice , but a similar amount of time in walking practice when physiotherapy was offered in circuit class therapy sessions versus individual therapy sessions . There is a need for effective strategies to increase the amount of walking practice during physiotherapy sessions for people after stroke 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 INTRODUCTION The ultimate goal of physiotherapy in stroke rehabilitation is focused towards physical independence and to restore their functional ability during activities of daily living ( ADLs ) . Motor imagery ( MI ) is an active process during which a specific action is reproduced within working memory without any actual movements . MI training enhances motor learning , neural reorganization and cortical activation in stroke . The efficacy of MI training involving lower extremity mobility tasks need to be assessed . AIM To evaluate the effects of combining motor imagery with physical practice in paretic Lower Extremity Muscles Strength and Gait Performance in Ambulant Stroke subjects . MATERIAL S AND METHODS A R and omized Clinical Trial was conducted in Department of Physical Therapy , Tertiary Care Hospitals , Mangalore , India which includes 40 hemi paretic subjects ( > 3 months post-stroke ) who were ambulant with good imagery ability in both KVIQ-20 ≥ 60 and Time dependent MI screening test were recruited and r and omly allocated into task-oriented training group ( n=20 ) and task-oriented training group plus MI group ( n=20 ) . Subjects in both groups underwent task orientated training for lower extremity 45 - 60 minutes , 4 days per week for 3 weeks . In addition , the experimental group received 30 minutes of audio-based lower extremity mobility tasks for MI practice  . Isometric muscle strength of Hip , Knee and Ankle using a h and -held dynamometer and self-selected 10 m gait speed were assessed before and after 3 weeks of intervention . RESULTS Both the groups had found a significant change for all the outcome measures following 3 weeks of interventions with p < .05 . The experimental group had shown a significant improvement in paretic hip muscles ( both flexors and extensors ) , knee extensors and ankle dorsiflexors and gait speed compare to control group with p < .05 between group analyses . CONCLUSION Additional task specific MI training improves paretic muscle strength and gait performance in ambulant stroke patients 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 Community ambulation is a highly complex skill requiring the ability to adapt to increased environmental complexity and perform multiple tasks simultaneously . After stroke , individuals demonstrate a diminished ability to perform dual-tasks . Current evidence suggests that conventional rehabilitation does not adequately address gait-related dual-task impairments after stroke , which may be contributing to low levels of participation and physical inactivity in community-dwelling stroke survivors . The objective of this study is to investigate the efficacy of dual-task gait training in community-dwelling adults within 1 year of stroke . Specifically , we will compare the effects of dual-task gait training and single-task gait training on cognitive-motor interference during walking at preferred speed and at fastest comfortable speed ( Aim 1 ) , locomotor control during obstacle negotiation ( Aim 2 ) , and spontaneous physical activity ( Aim 3 ) . Methods / Design This single-blind r and omized controlled trial will involve 44 individuals within 12 months of stroke . Following baseline evaluation , participants will be r and omly allocated to single- or dual-task gait training . Both groups will receive 12 , 30-minute sessions provided one-on-one over 4–6 weeks in an outpatient therapy setting . Single-task gait training involves practice of gait activities incorporating motor relearning principles . Dual-task gait training involves an identical gait training protocol ; the critical difference being that the dual-task gait training group will practice the gait activities while simultaneously performing a cognitive task for 75 % of the repetitions . Blinded assessors will measure outcomes at baseline , post-intervention , and 6 months after completion of the intervention . The primary outcome measure will be dual-task effects on gait speed and cognition during unobstructed walking . Secondary outcomes include spatiotemporal and kinetic gait parameters during unobstructed single- and dual-task walking at preferred and fastest comfortable walking speeds , gait parameters during high and low obstacle crossing , spontaneous physical activity , executive function , lower extremity motor function , Timed Up and Go , balance self-efficacy , number of falls , and stroke-related disability . Hypotheses for each aim will be tested using an intention-to-treat analysis with repeated measures ANOVA design . Discussion This trial will provide evidence to help clinicians make decisions about the types of activities to include in rehabilitation to improve dual-task walking after stroke . Trial registration Clinical Trials.gov Background Currently , the key advocacy in neuroscientific studies for stroke rehabilitation is that therapy should be directed towards task specificity performed with multiple repetitions . Circuit Class Therapy ( CCT ) is well suited to accomplish multiple task-specific activities . However , while repetitive task practice is achievable with circuit class therapy , in stroke survivors repetitive activities may be affected by poor neurologic inputs to motor units , result ing in decreases in discharging rates which consequently may reduce the efficiency of muscular contraction . To accomplish multiple repetitions , stroke survivors may require augmented duration of practice . To date , no study has examined the effect of augmented duration of CCT in stroke rehabilitation , and specifically what duration of CCT is more effective in influencing functional capacity among stroke survivors . Methods / design Using a r and omised controlled trial with blinded outcome assessment , this study is aim ed at determining the effectiveness of structured augmented CCT in stroke rehabilitation . Sixty-eight stroke survivors ( to be recruited from a tertiary health institution in Kano , Northwest , Nigeria ) will be r and omised into one of four groups : three intervention groups of differing CCT duration s namely : 60 min , 90 min , and 120minuntes respectively , and a control group . Participants will take part in an 8-week structured intensive CCT intervention . Participants will be assessed at baseline , post-intervention , and six-month follow-up for the effectiveness of the varied duration s of therapy , using st and ardised tools . Based on the WHO-ICF model , the outcomes are body structure/function , activity limitation , and participation restriction measures . Discussion It is expected that the outcome of this study will clarify whether increasing CCT duration leads to better recovery of motor function in stroke survivors . Trial registration Pan African Clinical Trial Registry ( PACTR ) : 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 . Electromyographic biofeedback ( EMG-BFB ) has shown equivocal benefits on gait retraining after stroke . Objective . The authors evaluated the efficacy of EMG-BFB applied in a task-oriented approach based on principles of motor learning to increase peak ankle power of the affected leg and gait velocity in patients with chronic mild to moderate hemiparesis . Methods . They assigned 20 participants r and omly to the EMG-BFB group or a control group that received conventional therapy for the same duration . Quantitative gait analysis was performed before and after treatment . The EMG-BFB involved the triceps surae during functional gait activities . Treatment was administered with a fading frequency of BFB application and an increasing variability in gait activities . Both groups had 20 treatment sessions of 45 minutes each , including at least 15 minutes of walking-related therapy for the control group . Follow-up ( FU ) gait analysis was obtained 6 weeks after training . Results . BFB treatment led to significant increases ( P < .01 ) in peak ankle power at push-off ( from 0.63 W/kg to 1.04 W/kg ) in conjunction with significant increases in velocity ( from 28.3 % h/s — normalized to percentage height per second — to 39.6 % h/s ) and stride length ( from 44.5 % h — normalized to percentage height — to 57.6 % h ) . Increases remained significant at FU . There were no changes in any gait variable in the control group . Conclusion . A task-oriented BFB treatment was effective in increasing peak ankle power , gait velocity , and stride length in a population with hemiparesis . Further studies should compare the combination intervention with either of its components in more impaired patients Objective : To investigate the feasibility and the effects on gait of a high intensity task-oriented training , incorporating a high cardiovascular workload and large number of repetitions , in patients with subacute stroke , when compared to a low intensity physiotherapy-programme . Design and subjects : R and omized controlled clinical trial : Forty-four patients with stroke were recruited at 2 to 8 weeks after stroke onset . Measures : Maximal gait speed assessed with the 10-metre timed walking test ( 10MTWT ) , walking capacity assessed with the six-minute walk test ( 6MWT ) . Control of st and ing balance assessed with the Berg Balance Scale and the Functional Reach test . Group differences were analysed using a Mann — Whitney U-test . Results : Between-group analysis showed a statistically significant difference in favour of the high intensity task-oriented training in performance on the 10MTWT ( Z = -2.13 , P = 0.03 ) and the 6MWT ( Z = -2.26 , P = 0.02 ) . No between-group difference were found for the Berg Balance Scale ( Z = —0.07 , P = 0.45 ) and the Functional Reach test ( Z = —0.21 , P = 0.84 ) . Conclusion : A high-intensity task-oriented training programme design ed to improve hemiplegic gait and physical fitness was feasible in the present study and the effectiveness exceeds a low intensity physiotherapy-programme in terms of gait speed and walking capacity in patients with subacute stroke . In a future study , it seems appropriate to additionally use measures to evaluate physical fitness and energy expenditure while walking Background Increased therapy has been linked to improvements in functional ability of people with stroke . Aim To determine the effectiveness of two alternative models of increased physiotherapy service delivery ( seven-day week therapy or group circuit class therapy five days a week ) to usual care . Method Three-armed r and omized controlled trial with blinded assessment of outcome . People admitted with a diagnosis of stroke , previously independently ambulant and with a moderate level of disability were recruited .  ‘ Usual care ’ was individual physiotherapy provided five-days a week . Seven-day week therapy was usual care physiotherapy provided seven-days a week . Participants in the circuit class therapy arm of the trial received physiotherapy in group circuit classes in two 90-min sessions , five-days a week . Primary outcome was distance walked on the six-minute walk test at four-weeks post-r and omization . Results Two hundred eighty-three participants were r and omized ; primary outcome data were available for 259 ( 92 % ) . In the seven-day arm participants received an additional three hours of physiotherapy and thosein the circuit class armanadditional 22 h. There were no significant between-group differences at four-weeks in walking distance ( P = 0·72 ) . Length of stay was shorter for seven-day ( mean difference −2·9 days , 95 % confidence interval −17·9 to 12·0 ) and circuit class participants ( mean difference −9·2 days , 95 % confidence interval −24·2 to 5·8 ) compared to usual care , but this was not significant . Conclusions Both seven-day therapy and group circuit class therapy increased physiotherapy time , but walking outcomes were equivalent to usual care Background and Purpose . Equinovarus foot is a common sign after stroke . The aim of this study is to investigate the effect of task specific exercises , gait training , and visual biofeedback on correcting equinovarus gait among individuals with stroke . Subjects and Methods . Sixteen subjects with ischemic stroke were r and omly assigned to two equal groups ( G1 and G2 ) . All the patients were at stage 4 of motor recovery of foot according to Chedoke-McMaster Stroke Assessment without any cognitive dysfunction . E-med pedography was used to measure contact time , as well as force underneath hind and forefoot during walking . Outcome measures were collected before r and omization , one week after the last session , and four weeks later . Participants in G1 received task specific exercises , gait training , and visual biofeedback and a traditional physical therapy program was applied for participants in G2 for 8 weeks . Results . Significant improvement was observed among G1 patients ( P ≤ 0.05 ) which lasts one month after therapy termination . On the other h and , there were no significant differences between measurements of the participants in G2 . Between groups comparison also revealed a significant improvement in G1 with long lasting effect . Conclusion . The results of this study showed a positive long lasting effect of the task specific exercises , gait training , and visual biofeedback on equinovarus gait pattern among individuals with stroke 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 and Purpose — Gait velocity is a powerful indicator of function and prognosis after stroke . Gait velocity can be stratified into clinical ly meaningful functional ambulation classes , such as household ambulation ( < 0.4 m/s ) , limited community ambulation ( 0.4 to 0.8 m/s ) , and full community ambulation ( > 0.8 m/s ) . The purpose of the current study was to determine whether changes in velocity-based community ambulation classification were related to clinical ly meaningful changes in stroke-related function and quality of life . Methods — In subacute stroke survivors with mild to moderate deficits who participated in a r and omized clinical trial of stroke rehabilitation and had a baseline gait velocity of 0.8 m/s or less , we assessed the effect of success versus failure to achieve a transition to the next class on function and quality of life according to domains of the Stroke Impact Scale ( SIS ) . Results — Of 64 eligible participants , 19 were initially household ambulators , and 12 of them ( 68 % ) transitioned to limited community ambulation , whereas of 45 initially limited community ambulators , 17 ( 38 % ) became full community ambulators . Function and quality -of-life SIS scores after treatment were significantly higher among survivors who achieved a favorable transition compared with those who did not . Among household ambulators , those who transitioned to limited or full community ambulation had significantly better SIS scores in mobility ( P=0.0299 ) and participation ( P=0.0277 ) . Among limited community ambulators , those who achieved the transition to full community ambulatory status had significantly better scores in SIS participation ( P=0.0085 ) . Conclusions — A gait velocity gain that results in a transition to a higher class of ambulation results in better function and quality of life , especially for household ambulators . Household ambulators possibly had more severe stroke deficits , reducing the risk of “ ceiling ” effects in SIS-measured activities of daily living and instrumental activities of daily living . Outcome assessment based on transitions within a mobility classification scheme that is rooted in gait velocity yields potentially meaningful indicators of clinical benefit . Outcomes should be selected that are clinical ly meaningful for all levels of severity Background and Purpose — The optimum model of physiotherapy service delivery for maximizing active task practice during rehabilitation after stroke is unknown . The purpose of the study was to examine the relative effectiveness of 2 alternative models of physiotherapy service delivery against a usual care control with regard to increasing patient activity . Methods — Sub study within a large 3-armed r and omized controlled trial , which compared 3 different models of physiotherapy service delivery , was provided for 4 weeks during subacute , inpatient rehabilitation ( n=283 ) . The duration of all physiotherapy sessions was recorded . In addition , 32 participants were observed at 10-minute intervals for 1 weekday and 1 weekend day between 8:00 AM and 4:30 PM . At each observation , we recorded physical activity , location , and people present . Results — Participants receiving 7-day-week and circuit class therapy received an additional 3 hours and 22 hours of physiotherapy time , respectively , when compared with usual care . Participants were  st and ing or walking  for a median of 8.2 % of observations . On weekdays , circuit class therapy participants spent more time in therapy-related activity ( 10.2 % of observations ) when compared with usual care participants ( 6.1 % of observations ) . On weekends , 7-day therapy participants spent more time in therapy-related activity ( 4.2 % of observations ) when compared with both usual care and circuit class therapy participants ( 0 % of observations for both groups ) . Activity levels outside of therapy sessions did not differ between groups . Conclusions — A greater dosage of physiotherapy time did not translate into meaningful increases in physical activity across the day . Clinical Trial Registration — URL : http://www.anzctr.org.au/. Unique identifier : ACTRN12610000096055 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 QUESTIONS How accurately do physiotherapists estimate how long stroke survivors spend in  physiotherapy sessions and the amount of time stroke survivors are engaged in physical activity during physiotherapy sessions ? Does the mode of therapy ( individual sessions or group circuit classes ) affect the accuracy of therapists ' estimates ? DESIGN Observational study embedded within a r and omised trial . PARTICIPANTS People who participated in the CIRCIT trial after having a stroke . INTERVENTION  47 therapy sessions scheduled and supervised by physiotherapists  ( n = 8) and physiotherapy assistants ( n = 4 ) for trial participants were video-recorded . OUTCOME MEASURES Therapists ' estimations of therapy time were compared to the video-recorded times . RESULTS The agreement between therapist-estimated and video-recorded data for total therapy time and active time was excellent , with intraclass correlation coefficients ( ICC ) of 0.90 ( 95 % CI 0.83 to 0.95 ) and 0.83 ( 95 % CI 0.73 to 0.93 ) respectively . Agreement between therapist-estimated and video-recorded data for inactive time was good ( ICC score 0.62 , 95 % CI 0.40 to 0.77 ) . The mean ( SD ) difference between therapist-estimated and video-recorded total therapy time , active time , and inactive time for all sessions was 7.7 ( 10.5 ) , 14.1 ( 10.3 ) and -6.9 ( 9.5 ) minutes respectively . Bl and -Altman analyses revealed a systematic bias of overestimation of total therapy time and total active time , and underestimation of inactive time by therapists . Compared to individual therapy sessions , therapists estimated total circuit class therapy duration more accurately , but estimated active time within circuit classes less accurately . CONCLUSION Therapists are inaccurate in their estimation of the amount of time stroke survivors are active during therapy sessions . When accurate therapy data are required , use of objective measures is recommended 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 OBJECTIVE To examine the effectiveness of a dual-task-based exercise program on walking ability in subjects with chronic stroke . DESIGN Single-blind r and omized controlled trial . SETTING General community . PARTICIPANTS Twenty-five subjects with chronic stroke who were at least limited community ambulatory subjects ( a minimum gait velocity , 58cm/s ) . INTERVENTIONS Participants were r and omized into a  control group ( n=12 ) or experimental group ( n=13 ) . Subjects in the control group did not receive any rehabilitation training . Subjects in the experimental group underwent a 4-week ball exercise program . MAIN OUTCOME MEASURES Gait performance was measured under single task ( preferred walking ) and tray-carrying task . Gait parameters of interest were walking speed , cadence , stride time , stride length , and temporal symmetry index . RESULTS The experimental group showed significant improvement in all selected gait measures except for temporal symmetry index under both task conditions . In the control group , there were no significant changes over the 4-week period for all selected measures . There was a significant difference between groups for all selected gait variables except for temporal symmetry index under both task conditions . CONCLUSIONS The dual-task-based exercise program is feasible and beneficial for improving walking ability in subjects with chronic stroke Rationale Gait deficits contribute considerably to functional disability after stroke , and the regaining of walking ability is a major goal in most stroke rehabilitation programmes . Evidence suggests that muscular strengthening exercises after stroke can improve strength and activity . Additionally , task-related practice performed at high intensities may enhance walking competency in people with stroke . However , there is insufficient evidence to conclude which approach is most effective . Aim This study will test the hypothesis that task-specific walking training plus targeted strength training is superior to task-specific walking training alone in improving strength , motor co-ordination , quality of independent walking , and participation in acute stroke patients . Design This trial is a prospect i ve , r and omised clinical trial . People after stroke who are living at home and attending outpatient clinics will be r and omly allocated into either an experimental or a control group . The experimental group will undertake task-specific walking training , plus targeted strength training three times per week over 10 weeks , while the control group will only undertake task-specific walking training . At baseline , after 10 weeks of intervention and 4 weeks after the cessation of the interventions , allocation-blinded research ers will collect outcome measures . Study outcomes Primary outcomes will be measured for levels of impairment ( strength and co-ordination ) , activity ( quality of walking ) , and participation ( quality of life ) . Secondary outcomes will be the minimal clinical ly important differences of lower limb strength , motor co-ordination , and gait speed
Nonsignificant summary effect sizes in favor of task-oriented circuit class training were found for the step test and balance control .
This meta- analysis supports the use of task-oriented circuit class training to improve gait and gait-related activities in patients with chronic stroke .
BACKGROUND AND PURPOSE There is increasing interest in the potential benefits of circuit class training after stroke , but its effectiveness is uncertain .
Our aim was to systematic ally review r and omized , controlled trials of task-oriented circuit class training on gait and gait-related activities in patients with stroke .