Effects of Treadmill Inclination on Hemiparetic Gait

Gama, Gabriela Lopes; Trigueiro, Larissa Coutinho de Lucena; Simão, Camila Rocha; Sousa, Angélica Vieira Cavalcanti de; Silva, Emília Márcia Gomes de Souza e; Galvão, Élida Rayanne Viana Pinheiro; Lindquist, Ana Raquel Rodrigues

doi:10.1097/phm.0000000000000240

Cited by 26 publications

(28 citation statements)

References 29 publications

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“…Our results suggest that HISTT does not improve or worsen spatiotemporal symmetry and that walking speed can improve and be retained regardless of changes in symmetry. These findings do not appear to be related to the high-intensities involved in HISTT because other studies using a variety of moderate-intensity training interventions have also found improvements in walking speed with no change in symmetry (although direct relations were not tested) (36)(37)(38)(39)(40). Only a couple studies have reported the direct relation between change in walking speed and spatiotemporal symmetry; one found that increased propulsive asymmetry was associated with greater improvements in walking speed (39), while another (41) found no relation between changes in walking speed and changes in spatiotemporal symmetry.…”

Section: Discussionmentioning

confidence: 76%

Changes in Walking Speed After High-Intensity Treadmill Training Are Independent of Changes in Spatiotemporal Symmetry After Stroke

Cleland

Madhavan

2021

Front. Neurol.

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Objectives: Decreased walking speeds and spatiotemporal asymmetry both occur after stroke, but it is unclear whether and how they are related. It is also unclear whether rehabilitation-induced improvements in walking speed are associated with improvements in symmetry or greater asymmetry. High-intensity speed-based treadmill training (HISTT) is a recent rehabilitative strategy whose effects on symmetry are unclear. The purpose of this study was to: (1) assess whether walking speed is cross-sectionally associated with spatiotemporal symmetry in chronic stroke, (2) determine whether HISTT leads to changes in the spatiotemporal symmetry of walking, and (3) evaluate whether HISTT-induced changes in walking speed are associated with changes in spatiotemporal symmetry.Methods: Eighty-one participants with chronic stroke performed 4 weeks of HISTT. At pre, post, and 3-month follow-up assessments, comfortable and maximal walking speed were measured with the 10-meter walk test, and spatiotemporal characteristics of walking were measured with the GAITRite mat. Step length and swing time were expressed as symmetry ratios (paretic/non-paretic). Changes in walking speed and symmetry were calculated and the association was determined.Results: At pre-assessment, step length and swing time asymmetries were present (p < 0.001). Greater temporal symmetry was associated with faster walking speeds (p ≤ 0.001). After HISTT, walking speeds increased from pre-assessment to post-assessment and follow-up (p ≤ 0.002). There were no changes in spatiotemporal symmetry (p ≥ 0.10). Change in walking speed was not associated with change in spatial or temporal symmetry from pre- to post-assessment or from post-assessment to follow-up (R2 ≤ 0.01, p ≥ 0.37).Conclusions: HISTT improves walking speed but does not systematically improve or worsen spatiotemporal symmetry. Clinicians may need to pair walking interventions like HISTT with another intervention designed to improve walking symmetry simultaneously. The cross-sectional relation between temporal symmetry and walking speed may be mediated by other factors, and not be causative.

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Section: Discussionmentioning

confidence: 76%

Changes in Walking Speed After High-Intensity Treadmill Training Are Independent of Changes in Spatiotemporal Symmetry After Stroke

Cleland

Madhavan

2021

Front. Neurol.

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“…We excluded studies that assessed only gait parameters, based on our selection criteria ( Figure 1 ). Four studies reported significantly improved lower limb recovery and balance following four weeks of 20–30-minute cycling or body weight supported treadmill training [ 42 , 43 , 45 , 46 ]. Likewise, eight weeks of moderate AE improved functional lower limb mobility after training while balance was significantly improved at follow-up 8 weeks later [ 41 ].…”

Section: Resultsmentioning

confidence: 99%

Defining Optimal Aerobic Exercise Parameters to Affect Complex Motor and Cognitive Outcomes after Stroke: A Systematic Review and Synthesis

et al. 2016

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Although poststroke aerobic exercise (AE) increases markers of neuroplasticity and protects perilesional tissue, the degree to which it enhances complex motor or cognitive outcomes is unknown. Previous research suggests that timing and dosage of exercise may be important. We synthesized data from clinical and animal studies in order to determine optimal AE training parameters and recovery outcomes for future research. Using predefined criteria, we included clinical trials of stroke of any type or duration and animal studies employing any established models of stroke. Of the 5,259 titles returned, 52 articles met our criteria, measuring the effects of AE on balance, lower extremity coordination, upper limb motor skills, learning, processing speed, memory, and executive function. We found that early-initiated low-to-moderate intensity AE improved locomotor coordination in rodents. In clinical trials, AE improved balance and lower limb coordination irrespective of intervention modality or parameter. In contrast, fine upper limb recovery was relatively resistant to AE. In terms of cognitive outcomes, poststroke AE in animals improved memory and learning, except when training was too intense. However, in clinical trials, combined training protocols more consistently improved cognition. We noted a paucity of studies examining the benefits of AE on recovery beyond cessation of the intervention.

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“…Sample size was calculated by using an online calculator [31], and the variable gait speed (in meters per second) was adopted as the primary outcome measure. According to a previous study involving individuals with post-stroke hemiparesis who performed treadmill training with partial weight support and anterior inclination of 10° (experimental) and no inclination (control) [26], standard deviations observed in the experimental and control groups were 0.1 and 0.2, respectively. The sample size was calculated from these data to detect a difference in gait speed between the groups of 0.18 m/s (α = 5% and power = 80%) since the minimum detectable difference in the gait speed for patients with chronic stroke was 0.18 m/s [32].…”

Section: Methodsmentioning

confidence: 99%

“…Treadmill training can be carried out according to several protocols and also associated with difficult factors such as anterior or posterior inclination of the treadmill, direction changes in movement (backward), and an increase in load in order to increase weight [23–25]. Specifically, regarding the treadmill anterior inclination, some studies have been carried out in patients with stroke [20, 23, 26–28] given that walking on inclined surfaces is an activity commonly faced by community-dwelling people with locomotor impairments [26]. All of these studies observed improvement in gait variables—such as increased walking speed and range of motion of lower limbs, longer paretic step length, and improved gait balance and symmetry—during or after training on an inclined treadmill.…”

Section: Introductionmentioning

confidence: 99%

“…All of these studies observed improvement in gait variables—such as increased walking speed and range of motion of lower limbs, longer paretic step length, and improved gait balance and symmetry—during or after training on an inclined treadmill. Authors point out that slope seems to promote beneficial changes in hemiparetic gait pattern, which can lead to a better adaptation of ambulant stroke subjects to real environments [26, 27]. In addition to gait parameters, Globas et al [20] investigated cardiovascular parameters after a fitness training (3 months), verifying better cardiovascular fitness with training on inclined treadmill compared with conventional physiotherapy.…”

Section: Introductionmentioning

confidence: 99%

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Effects of inclined treadmill training on functional and cardiovascular parameters of stroke patients: study protocol for a randomized controlled trial

Silva

Souza

et al. 2019

Trials

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Background Treadmill training has been widely used for gait recovery after stroke. Gait re-establishment is one of the main objectives of rehabilitation programs after stroke, aiming to acquire more functional patterns and increase walking speed, along with improvement in cardiovascular function. The aim of this study is to evaluate the effects of a treadmill gait training protocol on functional and cardiovascular variables in patients with chronic stroke. Methods A single-blind randomized clinical trial will be conducted. The sample will consist of 36 patients, who will be allocated in three groups: control group (n = 12), experimental group 1 (n = 12), and experimental group 2 (n = 12). The intervention will occur for 6 consecutive weeks, three times a week, 30 min each session, in all groups. The control group will perform a treadmill gait training without inclination, experimental group 1 will perform a treadmill gait training with anterior inclination of 5%, and experimental group 2 will perform a treadmill gait training with anterior inclination of 10%. All participants will be assessed for sample characterization measures, gait speed, functional capacity, systemic arterial blood pressure, heart rate, peripheral oxygen saturation, exercise capacity, neuromuscular torque, and quality of life. Evaluations of outcome measures will occur at the end of the interventions (post-training) and after 1 month and 1 year after the end of the interventions (short- and long-term follow-up). Statistical analysis will be performed descriptively and inferentially. Alpha equals 5% will be considered for inferential analysis. Mixed analysis of variance with repeated measures will be used to compare outcome measures between groups and between baseline, post-training, and follow-up. Normality test (Shapiro–Wilk) and subsequently t test (or Mann–Whitney) will be used to compare groups during the same training session. Discussion It is believed that treadmill training, especially treadmill training with anterior inclination, may result in improved exercise capacity in patients with stroke, reduced blood pressure and heart rate values, and an improvement in functional parameters with increased gait speed, functional capacity, quadriceps muscle torque, and quality of life. Trial registration Registration in Brazilian Registry of Clinical Trials (ReBEC) identifier RBR-5ffbxz , date of registration October 25 2017. Electronic supplementary material The online version of this article (10.1186/s13063-019-3298-3) contains supplementary material, which is available to authorized users.

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Effects of Treadmill Inclination on Hemiparetic Gait

Abstract: In subjects with hemiparesis, the addition of inclination is a stimulus capable of enhancing the effects of partial body weight-support treadmill gait training.

Cited by 26 publications

References 29 publications

Changes in Walking Speed After High-Intensity Treadmill Training Are Independent of Changes in Spatiotemporal Symmetry After Stroke

Changes in Walking Speed After High-Intensity Treadmill Training Are Independent of Changes in Spatiotemporal Symmetry After Stroke

Defining Optimal Aerobic Exercise Parameters to Affect Complex Motor and Cognitive Outcomes after Stroke: A Systematic Review and Synthesis

Effects of inclined treadmill training on functional and cardiovascular parameters of stroke patients: study protocol for a randomized controlled trial

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