Rehabilitating Walking Speed Poststroke With Treadmill-Based Interventions

Charalambous, Charalambos C.; Bonilha, Heather Shaw; Kautz, Steven A.; Gregory, Chris; Bowden, Mark G.

doi:10.1177/1545968313491005

Cited by 23 publications

(17 citation statements)

References 32 publications

(151 reference statements)

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“…On the other hand, it may accelerate the development of independent walking in children with Down syndrome (Damiano and DeJong, 2009 ; Valentin-Gudiol et al, 2013 ). Stroke patients who are able to walk, but not those unable to walk, benefit from the intervention by increasing walking speed and endurance (Mehrholz et al, 2014 ), although the superiority of the intervention relative to other control therapies has failed to be established (Charalambous et al, 2013 ). In SCI patients, locomotor training may induce the reappearance of kinematic regularities (Grasso et al, 2004a ), EMG temporal components shared by multiple muscles (Ivanenko et al, 2003 ), and flexor reflexes (Smith et al, 2014 ).…”

Section: Clinical Applications Of Simulated Hypogravitymentioning

confidence: 99%

Human Locomotion in Hypogravity: From Basic Research to Clinical Applications

et al. 2017

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We have considerable knowledge about the mechanisms underlying compensation of Earth gravity during locomotion, a knowledge obtained from physiological, biomechanical, modeling, developmental, comparative, and paleoanthropological studies. By contrast, we know much less about locomotion and movement in general under sustained hypogravity. This lack of information poses a serious problem for human space exploration. In a near future humans will walk again on the Moon and for the first time on Mars. It would be important to predict how they will move around, since we know that locomotion and mobility in general may be jeopardized in hypogravity, especially when landing after a prolonged weightlessness of the space flight. The combination of muscle weakness, of wearing a cumbersome spacesuit, and of maladaptive patterns of locomotion in hypogravity significantly increase the risk of falls and injuries. Much of what we currently know about locomotion in hypogravity derives from the video archives of the Apollo missions on the Moon, the experiments performed with parabolic flight or with body weight support on Earth, and the theoretical models. These are the topics of our review, along with the issue of the application of simulated hypogravity in rehabilitation to help patients with deambulation problems. We consider several issues that are common to the field of space science and clinical rehabilitation: the general principles governing locomotion in hypogravity, the methods used to reduce gravity effects on locomotion, the extent to which the resulting behavior is comparable across different methods, the important non-linearities of several locomotor parameters as a function of the gravity reduction, the need to use multiple methods to obtain reliable results, and the need to tailor the methods individually based on the physiology and medical history of each person.

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Section: Clinical Applications Of Simulated Hypogravitymentioning

confidence: 99%

Human Locomotion in Hypogravity: From Basic Research to Clinical Applications

et al. 2017

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“…To collectively address these factors and to promote greater opportunity for motor learning during gait rehabilitation, several studies recommend treadmill-based gait training paradigms [ 15 ], including the recent American Heart Association (AHA) scientific report for exercise training in stroke survivors [ 16 ]. However, most treadmill paradigms, especially those that integrate limb unweighting via body weight support (BWS), have had varying degrees of success over the past few decades, with some studies reporting no significant outcome differences compared with over-ground training approaches [ 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

A Challenge-Based Approach to Body Weight–Supported Treadmill Training Poststroke: Protocol for a Randomized Controlled Trial

2018

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BackgroundBody weight support treadmill training protocols in conjunction with other modalities are commonly used to improve poststroke balance and walking function. However, typical body weight support paradigms tend to use consistently stable balance conditions, often with handrail support and or manual assistance.ObjectiveIn this paper, we describe our study protocol, which involved 2 unique body weight support treadmill training paradigms of similar training intensity that integrated dynamic balance challenges to help improve ambulatory function post stroke. The first paradigm emphasized walking without any handrails or manual assistance, that is, hands-free walking, and served as the control group, whereas the second paradigm incorporated practicing 9 essential challenging mobility skills, akin to environmental barriers encountered during community ambulation along with hands-free walking (ie hands-free + challenge walking).MethodsWe recruited individuals with chronic poststroke hemiparesis and randomized them to either group. Participants trained for 6 weeks on a self-driven, robotic treadmill interface that provided body weight support and a safe gait-training environment. We assessed participants at pre-, mid- and post 6 weeks of intervention-training, with a 6-month follow-up. We hypothesized greater walking improvements in the hands-free + challenge walking group following training because of increased practice opportunity of essential mobility skills along with hands-free walking.ResultsWe assessed 77 individuals with chronic hemiparesis, and enrolled and randomized 30 individuals poststroke for our study (hands-free group=19 and hands-free + challenge walking group=20) from June 2012 to January 2015. Data collection along with 6-month follow-up continued until January 2016. Our primary outcome measure is change in comfortable walking speed from pre to post intervention for each group. We will also assess feasibility, adherence, postintervention efficacy, and changes in various exploratory secondary outcome measures. Additionally, we will also assess participant responses to a study survey, conducted at the end of training week, to gauge each group's training experiences.ConclusionsOur treadmill training paradigms, and study protocol represent advances in standardized approaches to selecting body weight support levels without the necessity for using handrails or manual assistance, while progressively providing dynamic challenges for improving poststroke ambulatory function during rehabilitation.Trial RegistrationClinicalTrials.gov NCT02787759; https://clinicaltrials.gov/ct2/show/NCT02787759 (Archived by Webcite at http://www.webcitation.org/6yJZCrIea)

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“…9 BWSTT has been shown to have superior outcomes regarding gait speed compared to cycle ergometry with or without concomitant strength training in stroke patients. 10 Charalambos et al, 11 concluded that there was no significant difference between BWSTT and other interventions. 11 Veerbeek et al showed significant effect size for use of body weight support treadmill training for improving gait speed.There are several rationales for the use of BWSTT for improving gait function in stroke patients.…”

Section: Introductionmentioning

confidence: 99%

“…10 Charalambos et al, 11 concluded that there was no significant difference between BWSTT and other interventions. 11 Veerbeek et al showed significant effect size for use of body weight support treadmill training for improving gait speed.There are several rationales for the use of BWSTT for improving gait function in stroke patients. One rationale is the concept of mass practice, where multiple repetitions of a movement drive changes in corticomotor stimulation.…”

Section: Introductionmentioning

confidence: 99%

The effects on gait speed and activity level of a novel body weight supported treadmill training program on a 39-year-old patient with right hemiparesis

Concors¹,

Stagliano²

2018

IPMRJ

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Background and Purpose: Stroke is a disease that can cause neurological impairments that can affect a patient's ability to ambulate. Research suggests that body weight supported treadmill training (BWSTT) may improve gait speed and reduce the risk of falls for those with difficulty ambulating. The purpose of this case report is to describe the effects of a novel BWSTT device on the gait speed and fall risk on a 39-year-old patient who had suffered a stroke. Case description: The patient was a 39-year-old female who had suffered a stroke resulting in right side hemiplegia. Over a 4-week period, the patient completed seven sessions of BWSTT with the GlideTrak. The duration of each session and the intervals within the session were performed at the patient's tolerance for treadmill speed and duration of the interval. Outcomes: Improvement of 35% on the Activities-specific Balance Confidence (ABC) Scale and 25% on the Timed Up and Go (TUG) indicate that the intervention may have lowered the risk for falls but a 14% increase in the 10 Meter Walk Test time indicated that the intervention didn't improve the patient's gait speed as predicted. Discussion: This case report indicates that one month of body weight supported treadmill training using the GlideTrak does not improve gait speed in a patient with hemiplegia, but is shown to have a positive effect on patient's balance. This intervention may have a role in maintaining a patient's cardiovascular and overall fitness, but should not be the sole intervention to improve gait speed.

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Rehabilitating Walking Speed Poststroke With Treadmill-Based Interventions

Cited by 23 publications

References 32 publications

Human Locomotion in Hypogravity: From Basic Research to Clinical Applications

Human Locomotion in Hypogravity: From Basic Research to Clinical Applications

A Challenge-Based Approach to Body Weight–Supported Treadmill Training Poststroke: Protocol for a Randomized Controlled Trial

The effects on gait speed and activity level of a novel body weight supported treadmill training program on a 39-year-old patient with right hemiparesis

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