Combined effects of backward treadmill training and botulinum toxin type A therapy on gait and balance in patients with chronic stroke: A pilot, single-blind, randomized controlled trial

Abstract

BACKGROUND: Backward walking is recommended to improve the components of physiological gait in neurological disease. Botulinum toxin type A is an effective safe first line-treatment for post-stroke spasticity. OBJECTIVE: To compare the effects of backward treadmill training (BTT) versus standard forward treadmill training (FTT) on motor impairment in patients with chronic stroke receiving botulinum toxin type A therapy. METHODS: Eighteen chronic stroke patients were randomly assigned to receive BTT (n = 7) or FTT (n = 11) as adjunct to botulinum toxin type A therapy. A total of twelve 40-minute sessions (3 sessions/week for 4 weeks) of either BTT or FTT were conducted. A blinded assessor evaluated the patients before and after treatment. The primary outcome was the 10-meter Walking Test (10 MWT). Secondary outcomes were the modified Ashworth Scale, gait analysis, and stabilometric assessment. RESULTS: Between-group comparison showed a significant change on the 10 MWT (P = 0.008) and on stabilometric assessment [length of centre of pressure CoP (P = 0.001) and sway area (P = 0.002) eyes open and length of CoP (P = 0.021) and sway area (P = 0.008) eyes closed] after treatment. CONCLUSIONS: Greater improvement in gait and balance was noted after BTT than after FTT as an adjunct to botulinum toxin therapy in patients with chronic stroke.

Backward Walking Training Impacts Positive Effect on Improving Walking Capacity after Stroke: A Meta-Analysis

“…Similarly, no significant heterogeneity was observed between studies focusing on BBS comparison (I 2 = 0%, p > 0.05) [ 19 , 20 , 21 , 22 ], paretic step length (I 2 = 0%, p > 0.05) [ 12 , 18 , 20 , 23 ]. The combined results based on the fixed effect models showed significant improvement on BBS (WMD (95% CI) = 4.38 (2.60, 6.15), p < 0.01, Figure 3 C) and paretic step length (WMD (95% CI) = 5.32 (1.97, 8.67) cm, p < 0.01, Figure 3 D) after BWT.…”

“…Manual searches failed to obtain studies that could be included in the analysis. Finally, nine articles were included in this meta-analysis [ 11 , 12 , 14 , 18 , 19 , 20 , 21 , 22 , 23 ].…”

“…Therefore, conventional walking training was used as the control in six studies, and forward walking training was used as the control in four studies ( Table 1 ). Except for the study conducted by Munari et al [ 23 ], where the BWT training time was 40 min, the training time of BWT in other studies was all 30 min, but several studies combined conventional exercise intervention and BWT. Conventional walking training included standing balance training, overground walk training, strengthening, function and mobility activities, gait training, and so on.…”

“…In total, five studies reported the evaluation of cadence [ 11 , 12 , 14 , 20 , 23 ]. Figure 3 B showed that no significant heterogeneity was observed (I 2 = 0%, p = 0.70), and significant improvement of BWT was found on cadence based on the fixed effect model (WMD (95% CI) = 4.00 (0.99, 7.02) step/minute, p < 0.01).…”

Outcome Using Either Intradermal Botox Injection or Endoscopic Thoracic Sympathectomy for Patients with Primary Palmar Hyperhidrosis: A Comparative Study

“…Botulinum neurotoxin (BoNT), produced by Clostridium botulinum, is the most potent toxin; [5] it is a zinc protease that acts through the cleavage of neuronal vesicle-associated proteins responsible for the release of acetylcholine into the neuromuscular junction [6]. While there are seven biological serotypes of BoNT, only two are used in clinical practice [7]: BoNT serotypes A and B are used for a variety of medical indications, including facial wrinkles, dystonia, spasticity, migraines, multiple sclerosis, post-stroke gait disorders, and cerebral palsy deformities [8][9][10][11].…”