Walking After Stroke: What Does Treadmill Training With Body Weight Support Add to Overground Gait Training in Patients Early After Stroke?

Abstract

on behalf of Gruppo Italiano Studio Allevio Carico Ictus (GISACI)Background and Purpose-This study aimed to assess the effectiveness of gait training using body weight support on a treadmill compared with conventional gait training for people with subacute stroke who were unable to walk. Methods-This was a single-blind, randomized, controlled trial with a 6-month follow-up. Ninety-seven subjects were recruited within 6 weeks of stroke onset and were randomly assigned to conventional rehabilitative treatment plus gait training with body weight support on a treadmill (experimental group; nϭ52) and conventional treatment with overground gait training only (control group; nϭ45). All subjects were treated in 60-minute sessions every weekday for 4 weeks. Outcome measures were Motricity Index, Trunk Control test, Barthel Index, Functional Ambulation Categories, 10-meter and 6-minute Walk Tests, and Walking Handicap Scale. Assessments were made at baseline, after 20 sessions of treatment, 2 weeks after treatment, and 6 months after stroke. Results-After treatment, all patients were able to walk. Both groups showed improvement in all outcome measures (PϽ0.0063) at the end of the treatment and at follow-up. No differences were seen between the 2 groups before, during, and after treatment and at follow-up. Conclusions-In subacute patients with stroke, gait training on a treadmill with body weight support is feasible and as effective as conventional gait training. However, the need for more personnel for treadmill training makes the use of robotically assisted systems more compelling.

Effects of Partial Body Weight Support while Training Acute Stroke Patients to Walk Backwards on a Treadmill -A Controlled Clinical Trial Using Randomized Allocation-

“…For BWS treadmill training, exercise tolerance was set based on several reports 9,10,13,14,[18][19][20] . Because walking backwards is a difficult task, we started with a low load, increasing the speed and time as the experiment progressed.…”

“…However, because walking backwards involves a high risk of falls, only stroke patients in the chronic phase with a quasi-stable gait should undergo this type of training. For walking forwards, partial body weight support (BWS) training has been performed as a therapeutic intervention using a treadmill for patients lacking a fully stable gait in the early stage o f r e h a b i l i t a t i o n , a n d i s p u r p o r t e d l y effectiveness 9,10) ; provided that there are reports to the effect that a training has an effect and those to the effect that any effect can hardly be expected in a systematic review 11,12) . One report showed no significant difference between this training and conventional training, particularly in acute-phase s t r o k e r e h a b i l i t a t i o n 1 3 , 1 4 ) .…”

A Comparison of the Effects of Overground Gait Training and Treadmill Gait Training According to Stroke Patients’ Gait Velocity

“…Gait endurance is the ability to sustain muscle activities related to balance, lower extremity coordination, muscle strength and muscle function weakness, and energy consumption 25) . Son 26) analyzed respiration gas, and observed that more energy was consumed during treadmill gait.…”

Effects of Combined Exercise Training on Balance of Hemiplegic Stroke Patients

“…Task oriented functional training on weight-bearing was especially effective 11,12) . In Frenceshini and colleagues' study 13) , stroke patients' trunk control ability improved after treadmill gait training, which to improved balance ability. When stroke patients performed standing in functional strengthening training, the rate of weight bearing on the affected side increased, improving their balance ability 11) .…”