Effect of blocked vision treadmill training on knee joint proprioception of patients with chronic stroke

[Purpose] The purpose of this study was to compare the effect of treadmill training with the eyes closed and eyes open on the joint position sense of chronic stroke patients. [Subjects and Methods] Thirty patients with chronic stroke participated in this study. Patients performed the timed up and go test and were assigned to one of two treadmill training groups with and without visual deprivation. The treadmill gait training for each group lasted 40 minutes, and sessions were held 3 times a week for 4 weeks. The knee joint proprioception was measured using the Biodex System Pro 3 before and after the intervention. [Results] The knee joint proprioception of the treadmill training with blocked vision group showed more significant improvement after the treadmill training sessions than that of the eyes open group. [Conclusion] This study demonstrated that treadmill training with blocked vision may be useful for the proprioceptive sensory rehabilitation of patients with chronic stroke.Key words: Chronic stroke, Knee joint proprioception, Visual deprivation     

Treadmill Sideways Gait Training with Visual Blocking for Patients with Brain Lesions

[Purpose] The aim of this study was to verify the effect of sideways treadmill training with and without visual blocking on the balance and gait function of patients with brain lesions. [Subjects] Twenty-four stroke and traumatic brain injury subjects participated in this study. They were divided into two groups: an experimental group (12 subjects) and a control group (12 subjects). [Methods] Each group executed a treadmill training session for 20 minutes, three times a week, for 6 weeks. The sideways gait training on the treadmill was performed with visual blocking by the experimental group and with normal vision by the control group. A Biodex Gait Trainer 2 was used to assess the gait function. It was used to measure walking speed, walking distance, step length, and stance time on each foot. The Five-Times-Sit-To-Stand test (FTSST) and Timed Up and Go test (TUG) were used as balance measures. [Results] The sideways gait training with visual blocking group showed significantly improved walking speed, walking distance, step length, and stance time on each foot after training; FTSST and TUG times also significantly improved after training in the experimental group. Compared to the control group, the experimental group showed significant increases in stance time on each foot. [Conclusion] Sideways gait training on a treadmill with visual blocking performed by patients with brain lesions significantly improved their balance and gait function.Key words: Brain lesions, Treadmill training, Visual block     

Effects of stationary cycling exercise on the balance and gait abilities of chronic stroke patients

[Purpose] The objective of this study was to investigate the effects of stationary cycling exercise on the balance and gait abilities of chronic stroke patients. [Subjects] Thirty-two chronic stroke patients were randomly assigned to an experimental group (n=16) or a control group (n=16). [Methods] All of the subjects received the standard rehabilitation program for 30 minutes, while the experimental group additionally participated in a daily session of stationary cycling exercise for 30 minutes, 5 times per week for 6 weeks. To assess balance function, the Berg Balance Scale and timed up-and-go test were used. The 10-m walking test was conducted to assess gait function. [Results] Both groups showed significant improvements in balance and gait abilities. The improvements in the Berg Balance Scale and timed up-and-go test scores (balance), and 10-m walking test score (gait) in the stationary cycling exercise group were significantly greater than those in the control group. [Conclusion] This study demonstrated that stationary cycling exercise training is an effective intervention for increasing the balance and gait abilities of chronic stroke patients. Therefore, we suggest that stationary cycling training is suitable for stroke rehabilitation and may be used in clinical practice.Key words: Gait, Balance, Stationary cycling     

Effects of gait training with horizontal impeding force on gait and balance of stroke patients

[Purpose] The purpose of this study was to investigate the effects of treadmill training with a horizontal impeding force applied to the center of upper body mass on the gait and balance of post-stroke patients. [Subjects and Methods] Twenty-four subjects with hemiplegia less than 3 months after stroke onset were randomly assigned to 2 groups: an applied horizontal impeding force on treadmill training (experimental) group (n = 12), and a control group (n = 12). Both groups walked on a treadmill at a comfortable or moderate speed for 20 minutes per day, 3 sessions per week for 8 weeks after a pre-test. The experimental group also had a horizontal impeding force applied to the center of their upper body mass. [Results] All groups demonstrated significant improvement after 8 weeks compared to baseline measurements. In intra-group comparisons, the subjects’ gait ability (CGS, MGS, cadence, and step length) and balance ability (TUG, BBS, and FRT) significantly improved. In inter-group comparisons, the experimental group’s improvement was significantly better in CGS MGS, cadence, step length, TUG, and BBS, but not in FRT. [Conclusion] Treadmill training was identified as an effective training method that improved gait and balance ability. A horizontal impeding force applied during treadmill training was more effective than treadmill walking training alone at improving the gait and dynamic balance of patients with stroke.Key words: Treadmill gait, Horizontal impeding force, Upper body     

The Effect of Various Dual Task Training Methods with Gait on the Balance and Gait of Patients with Chronic Stroke

[Purpose] This study examined the effects of various dual task gait training methods (motor dual task gait training, cognitive dual task gait training, and motor and cognitive dual task gait training) on the balance and gait abilities of chronic stroke patients. [Subjects and Methods] Thirty-three outpatients performed dual task gait training for 30 minutes per day, three times a week, for eight weeks from June to August, 2012. Balance ability was measured pre-and posttest using the stability test index, the weight distribution index, the functional reach test, the timed up and go test, and the four square step test. Gait ability was measured by the 10 m walk test and a 6 min walk test before and after the training. The paired t-test was used to compare measurements before and after training within each group, and ANOVA was used to compare measurements before and after training among the groups. [Results] Comparisons within each group indicated significant differences in all variables between before and after the training in all three groups. Comparison between the groups showed that the greatest improvements were seen in all tests, except for the timed up and go test, following motor and cognitive dual task gait training. [Conclusion] In a real walking environment, the motor and cognitive dual task gait training was more effective at improving the balance and gait abilities of chronic stroke patients than either the motor dual task gait training or the cognitive dual task gait training alone.Key words: Stroke, Dual task, Balancing     

Effects of a multifactorial fall prevention program on balance,gait, and fear of falling in post-stroke inpatients

[Purpose] This study investigated the effects of a multifactorial fall prevention program on balance, gait, and fear of falling in stroke patients. [Subjects] Twenty-five stroke patients were divided randomly into multifactorial fall prevention program group (n=15) and control treadmill group (n=10). [Methods] All interventions were applied for 30 min, five times per week, for five weeks. The fall prevention program included interventions based on the “Step Up to Stop Falls” initiative and educational interventions based on the Department of Health guidelines. For those in the treadmill group, the speed was increased gradually. The Korean falls efficacy scale and Korean activities-specific balance confidence scale were used to assess fear of falling. To assess balance and walking ability, the Korean performance-oriented mobility assessment scale and the 10-m and 6-minute walk tests were used. [Results] The fall prevention program interventions were found to be very effective at improving gait, balance, and fear of falling compared with the treadmill intervention and therefore seem appropriate for stroke patients. [Conclusion] A multifactorial fall prevention program is effective at improving balance, gait ability, and fear of falling. It is a more specific and broad intervention for reducing falls among inpatients in facilities and hospitals.Key words: Multifactorial fall prevention, Balance, Gait ability     

Effect of handrail use while performing treadmill walking on the gait of stroke patients

[Purpose] The purpose of this study was to investigate how the use of handrails during treadmill walking affects the gait parameters of stroke patients. [Subjects and Methods] The participants, 30 hemiplegic stroke patients, were randomly allocated to one of three groups: the NHG group (No Handrail group, n=10), the FHG group (Front handrail group, n=10), and BHG group (Bilateral Handrail group, n=10). All the subjects’ performed treadmill walking for 30 min, five days a week, for a period of eight weeks. Gait parameters were evaluated using the RS-scan system. [Results] A statistically significant difference in the HM (heel-medial) area of plantar foot pressure was observed between BHG and NHG. Statistically significant difference in the HL (heel-lateral) area of plantar foot pressure was observed between BHG and NHG, and between FHG and NHG. A statistically significant difference in contact area of the rear foot was observed between BHG and NHG. [Conclusion] The results of this study show that holding handrails during treadmill training may enhance the improvement in the quality of patients’ gait (plantar foot pressure, contact area of foot).Key words: Treadmill training, Handrails, Stroke     

Virtual dual-task treadmill training using video recording for gait of chronic stroke survivors: a randomized controlled trial

[Purpose] The aim of this study was to examine the effects of virtual dual-task treadmill training using a real-world video recording of the gait of individuals with chronic stroke. [Subjects] Forty chronic stroke survivors were randomly divided into two groups of 20 subjects each. [Methods] The experimental group performed virtual dual-task treadmill training using a video recording for 30 minutes per session, three times a week for 4 weeks, whereas the control group performed only treadmill training for 30 minutes per session, three times a week for 4 weeks. A video recording was performed in a large supermarket, and the subjects could walk at their favorable speed on a treadmill. The temporospatial gait variables were measured to examine the training effect. [Results] The experimental and control groups showed statistically significant improvements in the gait variables after training. The enhancement of gait ability was statistically better in the experimental group than in the control group. [Conclusion] Our findings suggest that virtual dual-task treadmill training using a video recording can improve the gait parameters of chronic stroke survivors.Key words: Stroke, Gait, Video recording     

Body weight support treadmill and overground ambulation training for two patients with chronic disability secondary to stroke.

BACKGROUND AND PURPOSE: Body weight support (BWS) treadmill training has recently been shown to be effective for gait training following stroke, but few researchers have measured the usefulness of this intervention in enhancing function, and there are no reports in which BWS overground ambulation was studied. The purposes of this case report were (1) to report the feasibility and patient tolerance for using a BWS system for overground ambulation, (2) to measure the function of patients with chronic stroke (2 years post-stroke) prior to and following BWS treadmill and overground ambulation training, and (3) to describe a protocol used for patient treatment progression using BWS treadmill training. CASE DESCRIPTIONS: The participants were 2 women, aged 87 and 93 years, who had strokes more than 2 years before data collection. A 10-m timed walk test, the Berg Balance Scale, the gait portion of the Tinetti Gait and Balance Assessment, and a measure of step length were administered. Intervention consisted of BWS ambulation training 3 times a week for 6 to 7 weeks. Each day there was BWS treadmill and overground training. OUTCOMES: Participant A improved most in 10-m walking time and Berg Balance Scale score. Participant B exhibited improvements in step length and 10-m walking time. DISCUSSION: The outcomes suggest that very old patients with chronic functional deficits secondary to cerebrovascular accident tolerated BWS treadmill and overground ambulation training and made improvements following this intervention.     

Supported treadmill ambulation training after spinal cord injury: a pilot study

OBJECTIVES: To conduct a pilot study of weight-supported ambulation training after incomplete spinal cord injury (SCI), and to assess its safety. DESIGN: Quasiexperimental, repeated measures, single group. SETTING: Veterans Affairs medical center. PATIENTS: Three subjects with incomplete, chronic, thoracic SCIs; 2 classified as D on the American Spinal Injury Association (ASIA) impairment scale and 1 as ASIA impairment scale C. INTERVENTION: Subjects participated in 12 weeks of training assisted by 2 physical therapists. The training consisted of walking on a treadmill while supported by a harness and a pneumatic suspension device. Support started at 40% of body weight and a treadmill speed of.16kmph, and progressed by reducing support and increasing treadmill speed and continuous treadmill walking time up to 20 minutes. Training was conducted for 1 hour per day, 5 days per week for 3 months. Treadmill walking occurred for 20 minutes during the sessions. MAIN OUTCOME MEASURES: Gait function (speed, endurance, walking status, use of assistive device and orthotics); oxygen costs of walking; brain motor control assessment; self-report indices; ASIA classification; muscle function test; and safety. RESULTS: All 3 subjects increased gait speed (.118m/s initially to.318m/s after training 12wk), and gait endurance (20.3m/5min initially to 63.5m/5min). The oxygen costs decreased from 1.96 to 1.33mL x kg(-1) x m(-1) after 12 weeks of training. CONCLUSIONS: This pilot study suggests that supported treadmill ambulation training can improve gait for individuals with incomplete SCIs by using objective gait measures. The self-report indices used have promise as patient-centered outcome measures of this new form of gait training. A larger, controlled study of this technique is warranted.     

The Effect of Underwater Gait Training on Balance Ability of Stroke Patients

[Purpose] The purpose of this study was to investigate the effects of underwater treadmill gait training on the balance ability of stroke patients. [Subjects] Twenty-two patients with stroke were randomly assigned to an underwater treadmill group (n =11) or a control group (n =11). [Methods] Both groups received general rehabilitation for 30 min per session, 5 times per week, over a 4-week period. The underwater treadmill group received additional underwater gait training for 30 min per session, 5 times per week, over the same 4-week period. Static and dynamic balances were evaluated before and after the intervention. [Results] The means of static and dynamic balance ability increased significantly in both groups, but there was no significant difference between the two groups. [Conclusion] Compared to the general rehabilitation program, underwater treadmill gait training was not more effective at improving the balance ability of stroke patients than land-based training.Key words: Stroke, Gait, Stability     

Treadmill training improves fitness reserve in chronic stroke patients.

OBJECTIVE: To investigate the hypothesis that treadmill training will improve peak fitness, while lowering the energy cost of hemiparetic gait in chronic stroke patients. DESIGN: Noncontrolled exercise intervention study with repeated-measures analysis. SETTING: Hospital-based senior exercise research center. PARTICIPANTS: Twenty-three patients (mean age +/- standard deviation [SD] 67 +/- 8 yr) with chronic hemiparetic gait after remote (>6 mo) ischemic stroke. INTERVENTION: Three 40-minute sessions of treadmill exercise weekly for 6 months. MAIN OUTCOME MEASURES: Peak exercise capacity (VO2peak) and rate of oxygen consumption during submaximal effort treadmill walking (economy of gait) by open circuit spirometry and ambulatory workload capacity before and after 3 and 6 months of training. RESULTS: Patients who completed 3 months of training (n = 21) increased their VO2peak +/- SD from 15.4 +/- 2.9 mL x kg(-1) x min(-1) to 17.0 +/- 4.4 mL x kg(-1) x min(-1) (p <.02) and lowered their oxygen demands of submaximal effort ambulation from 9.3 +/- 2 mL x kg(-1) x min(-1) to 7.9 +/- 1.5 mL x kg(-1) x min(-1) (p =.002), which enabled them to perform the same constant-load treadmill task using 20% less of their peak exercise capacity (62.3% +/- 17.2% vs 49.9% +/- 19.3%, p <.002). Gains in VO2peak and economy of gait plateaued by 3 months, while peak ambulatory workload capacity progressively increased by 39% (p <.001) over 6 months. CONCLUSIONS: Treadmill training improves physiologic fitness reserve in chronic stroke patients by increasing VO2peak while lowering the energy cost of hemiparetic gait, and increases peak ambulatory workload capacity. These improvements may enhance functional mobility in chronic stroke patients.     

Effects of Hippotherapy on Recovery of Gait and Balance Ability in Patients with Stroke

[Purpose] The aim of this study was to examine the the effects of hippotherapy on gait and balance ability in patients with stroke. [Subjects and Methods] Thirty stroke patients were randomly divided into a hippotherapy group and a treadmill group and they conducted exercise for eight weeks. [Results] Berg Balance Scale score, gait velocity, and step length asymmetry ratio were significantly improved in the group receiving hippotherapy training. However, in the group receiving treadmill training, only step length asymmetry ratio was significantly improved. In the comparison between the hippotherapy group and treadmill group, there was no significant difference in Berg Balance Scale score, but a significant difference was found in gait velocity and step length asymmetry ratio. [Conclusion] The results of this study indicated that hippotherapy is a helpful treatment for stroke patients.Key words: Stroke, Balance, Hippotherapy     

An efficacy study on improving balance and gait in subacute stroke patients by balance training with additional motor imagery: a pilot study

[Purpose] The few studies conducted on subacute stroke patients have focused only on gait function improvement. This study therefore aimed to confirm the effect of balance training with additional motor imagery on balance and gait improvement in subacute stroke patients. [Subjects and Methods] Participants were divided into an experimental or control group. The experimental group received balance training for 20 minutes/day with mental imagery for 10 minutes/day, three days/week, for four weeks. The control group received only balance training for 30 minutes. Before and after the 12 sessions, balance and gait ability were assessed by the researcher and a physical therapist. [Results] After completion of the 4-week intervention, Berg Balance Scale, Timed Up and Go test, Functional Reach Test, and Four Square Step test scores significantly increased in the experimental group. In the control group, Berg Balance Scale and Functional Reach Test scores significantly improved. Changes in the Timed Up and Go test, Functional Reach Test, and Four Square Step Test scores after intervention were significantly higher in the experimental than in the control group. [Conclusion] Specific balance training with additional motor imagery may result in better rehabilitation outcomes of gait and balance ability than balance training alone.Key words: Balance, Gait, Motor imagery     

Relationships of Stroke Patients’ Gait Parameters with Fear of Falling

[Purpose] The purpose of this study was to assess the correlation of gait parameters with fear of falling in stroke survivors. [Subjects] In total, 12 patients with stroke participated. [Methods] The subjects performed on a Biodex Gait Trainer 2 for 5 min to evaluate characteristic gait parameters. The kinematic gait parameters measured were gait speed, step cycle, step length, and time on each foot (step symmetry). All the subjects also completed a fall anxiety survey. [Results] Correlations between gait parameters and fear of falling scores were calculated. There was a moderate degree of correlation between fear of falling scores and the step cycle item of gait parameters. [Conclusions] According to our results, the step cycle gait parameter may be related to increased fall anxiety.Key words: Fall anxiety, Gait parameter, Stroke     

Effect of Dual-task Rehabilitative Training on Cognitive and Motor Function of Stroke Patients

[Purpose] To determine the effect of dual-task training with cognitive tasks on cognitive and walking ability after stroke. [Subjects and Methods] Twenty patients diagnosed with stroke participated in this study. All participants were receiving a traditional rehabilitation program 5 days a week. Dual-task and single-task training were additionally performed for 4 weeks, 3 days a week. The Stroop test, Timed Up and Go (TUG) test, 10-Meter Walk Test (10MWT), and Figure-of-8 Walk Test (F8WT) were used to measure cognitive and walking abilities and were evaluated 3 times (before and after training and at the 2-week follow-up). [Results] Dual-task training improved cognitive and walking abilities, and dual-task training subjects’ performance was better than single-task training subjects’ performance. In addition, these training benefits were maintained for 2 weeks. [Conclusion] Dual-task training improves cognitive and walking abilities of patients with stroke.Key words: Cognitive, Gait, Dual task     

综合康复治疗对脑卒中急性期运动功能的疗效观察

目的：观察不同步行训练方法对脑卒中患者步行能力的疗效。方法：脑卒中患者60例,随机分为传统步行训练组（CGT组）、减重步行训练组（BWSTT组）和减重步行机器人训练组（GRT组）各20例。3组均行常规康复训练并行相应的步行训练。训练前后分别应用Berg平衡量表（BBS）、10米步行能力测试（10mWT）、足印法步态分析（GAF）、3min步行测试（3minWT）评估患者平衡及步行能力。结果：治疗8周后,3组BBS评分、步速、步长比均较治疗前明显提高,生理消耗指数（PCI）评分均较治疗前明显降低（均P〈0．05）;GRT组和BWSTT组的步速、步长比、PCI评分均明显优于CGT组（均P〈0．05）。治疗期间,GRT组所需的人工总量明显低于BWSTT组和CGT组（均P〈0．05）。结论：减重机器人步行训练能提高脑卒中患者的平衡和步行能力,并且节省人工。     

Effects of trunk rotation induced treadmill gait training on gait of stroke patients: a randomized controlled trial

[Purpose] This study was conducted to find out the effect of arm swing during treadmill training on the gait of stroke patients. [Subjects and Methods] This study subjects were 20 stroke subjects patients who were randomly assigned to either the experimental group (EG) or the control group (CG), 10 subjects in each group. Therapists induced arm swing of affected side of EG subjects using Nordic poles, while subjects in CG had the affected arm restricted to prevent arm swing. Training was performed for 30 minutes, 3 times a week for 4 weeks. The timed up and go test (TUG), the dynamic gait index (DGI) and the 6-minute walk test (6MWT) were assessed before and after the training. [Results] After the training, there were no significant differences in the TUG times of EG and CG. There were significant differences in the DGI and the 6-minute walking distance of EG, but not of CG. There were also significant differences in the improvements of the DGI and the 6-minute walking distance between the groups. [Conclusion] Arm swing training had a positive effect on patients’ gait ability. Further studies are required to generalize the results of this study.Key words: Arm swing, Gait, Stroke     

Effect of hybrid assistive limb treatment on maximal walking speed and six-minute walking distance during stroke rehabilitation: a pilot study

[Purpose] In stroke rehabilitation, gait assessment measures the maximal walking speed and six-minute walking distance, both of which have not been thoroughly investigated as determinants of walking ability. Here, we assessed the methods for evaluating these gait parameters using clinical data on hybrid assistive limb treatment compared with conventional training. [Participants and Methods] In total, 20 stroke patients (hybrid assistive limb group, n=9; conventional group, n=11) participated in this randomized controlled trial. For 12 sessions (three times per week in 4 weeks), the hybrid assistive limb and conventional groups performed gait treatment with hybrid assistive limb and conventional gait training, respectively. Short physical performance battery and walking ability (maximal walking speed and six-minute walking distance) were evaluated pre- and post-intervention. Subsequently, the patients were divided further into two groups: low- and high-balance score groups. [Results] Maximum walking speed and six-minute walking distance were significantly associated, with a positive relationship observed post-intervention. The high-balance score group showed a significant improvement in the six-minute walking distance compared to the low-balance score group. However, no significant improvement in maximum walking speed was observed between both groups. [Conclusion] Due to its sensitivity in detecting differences in balance, six-minute walking distance may be a useful assessment parameter for stroke rehabilitation, particularly in the recovery of physiological walking ability.Key words: Gait assessment, Stroke rehabilitation, Hybrid assistive limb     

How effective is the early fast treadmill gait speed training for stroke patients at the 2nd week after admission: comparison with comfortable gait speed at the 6th week

[Purpose] The purpose of this study was to find whether a fast treadmill gait training speed is effective for the gait training of stroke patients in the early rehabilitation stage. [Subjects and Methods] Thirty-nine stroke patients were the subjects of our investigation. They walked on a treadmill with handrail supports at a fast speed (130% of their comfortable gait speed in the 2nd week). The treadmill gaits of the patients were recorded using a 3-dimensional analysis system at two and six weeks after their admissions. Intraclass Correlation Coefficients (ICC) of the temporal and spatial parameters of the two periods were statistically analyzed. [Results] For all of the patients, the ICCs of the measured parameters were greater than 0.58. In the case of patients whose gait speeds of the two periods were close, the ICC units were greater than 0.7. [Conclusion] The fast gait speed training allowed us to expose the patients to a gait speed that they were expected to acquire at a later stage of their rehabilitation. This training method was found to be beneficial for the mildly paralyzed patients.Key words: Stroke, Treadmill, Fast speed