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     

Optimal outcomes obtained with body-weight support combined with treadmill training in stroke subjects

OBJECTIVES: To identify stroke patients who are most likely to benefit from locomotor training with body-weight support (BWS), to determine the extent of carryover from treadmill training to overground locomotion, and to determine the variables that are most likely to influence the recovery of locomotion. DESIGN: A randomized clinical trial. SETTING: Inpatient rehabilitation hospital. PARTICIPANTS: Of 100 stroke subjects, 50 were randomized to receive locomotor training with BWS (BWS group), and 50 were randomized to receive locomotor training with full weight bearing (no-BWS group). The subjects were stratified according to their initial overground walking speed and endurance, initial treadmill speed and endurance, functional balance, motor recovery, side of the lesion, and age. INTERVENTION: Fifty subjects were trained to walk on a treadmill with up to 40% of their body weight supported by a BWS system with an overhead harness (BWS group), and 50 subjects were trained to walk while bearing their full weight (no-BWS group). MAIN OUTCOME MEASURES: Clinical outcome measures included overground walking speed and endurance, functional balance, and motor recovery. The effect of confounding variables such as age, comorbidity, and depression on locomotor outcome was also investigated. RESULTS: After 6 weeks of locomotor training, the BWS group scored significantly higher in all clinical outcomes. When the subjects were stratified according to their initial overground walking speed, endurance, balance, and motor recovery, a significant statistical difference in gait and balance dysfunction of all outcomes occurred in the more severely impaired subjects. An important transfer from treadmill speed to overground walking speed was observed in subjects in the BWS group. Finally, a significantly greater effect was observed in older subjects (65-85y) in the BWS group. CONCLUSIONS: Retraining gait in severely impaired stroke subjects with a percentage of their body weight supported resulted in better walking and postural abilities than did gait training in patients bearing their full weight. It appears that subjects with greater gait impairments benefited the most from training with BWS, as did the older patients with stroke. There is evidence of transfer from treadmill training to overground locomotion.     

Gait training of patients after stroke using an electromechanical gait trainer combined with simultaneous functional electrical stimulation

BACKGROUND AND PURPOSE: This case report describes the implementation of gait training intervention that used an electromechanical gait trainer with simultaneous functional electrical stimulation (FES) for 2 patients with acute ischemic stroke. CASE DESCRIPTION: Two individuals with post-stroke hemiplegia of less than 6 weeks' duration participated in a 4-week gait training program as an adjunct to physical therapy received at a hospital. After the 4-week intervention, both patients were discharged from the hospital, and they returned after 6 months for a follow-up evaluation. OUTCOMES: By the end of the 4-week intervention, both patients had shown improvements in scores on the Barthel Index, Berg Balance Scale, Functional Ambulation Categories Scale, 5-m timed walking test, and Motricity Index. In the 6-month follow-up evaluation, both patients continued to have improvements in all outcome measures. DISCUSSION: This case report shows that, following the use of an electromechanical gait trainer simultaneously with FES, patients after acute stroke had improvements in gait performance, functional activities, balance, and motor control in the long term.     

Motor and functional outcomes of a patient post-stroke following combined activity and impairment level training

The purpose of this single-subject report was to determine the effect of a targeted training regimen aimed at improving motor and functional outcomes for a patient with chronic deficits after stroke. A 51-year-old woman with hemiparesis, 6 months post-stroke, participated in this prospective study. During the baseline, intervention, and immediate retention phases, performance was established by using repeated measures of four dependent variables: Fugl-Meyer assessment, Berg Balance Scale, 10-meter walk, and 6-minute walk. Two standard deviation band analyses were conducted on the four dependent variables with repeated measures. The Frenchay Activities Index and step length/single-limb support time measured at baseline and immediate retention were compared. During intervention, the participant was involved in a combined treatment protocol including body weight supported (BWS) treadmill training and strengthening exercises. Results indicated significant improvements in motor activity, balance, gait speed, and endurance. Progression was found in self-perceived participation. Although an improvement in step length symmetry occurred following training, a decrease in single-limb support time symmetry was found. BWS treadmill training, combined with strength training, significantly improved motor and functional performance in this participant with chronic deficits after stroke.     

高强度间歇跑台训练对脑卒中慢性期偏瘫患者步行能力的影响

目的:探讨高强度间歇跑台训练对脑卒中慢性期偏瘫患者步行能力的有效性和安全性。方法:将脑卒中慢性期患者50例随机分为观察组25例(采用高强度间歇跑台进行训练)和对照组25例(采用传统康复治疗技术训练),比较2组患者训练前和训练后2周的功能性步行分级量表(FAC)、Berg平衡量表(BBS)、10m步行测试(10MWT)、6min步行测试(6MWT)、简式Fugl-Meyer功能量表下肢部分(FMA-LE)。结果:训练2周后,2组患者组内比较观察组FAC、BBS、10MWT、6MWT评分较治疗前有明显提高(P<0.05),且观察组上述评分明显高于对照组(P<0.05),治疗后2组患者FMA-LE评分比较差异无统计学意义。除训练后观察组患者治疗期间出现2例大腿酸痛外,其余无不良反应。结论:高强度间歇跑台训练可以在较短时间内改善脑卒中慢性期偏瘫患者的步行能力且训练过程安全无严重不良反应。     

慢速活动平板训练对脑卒中偏瘫患者下肢功能的影响

目的探讨慢速活动平板训练对脑卒中偏瘫患者下肢功能的影响。方法脑卒中偏瘫患者26例分成治疗组14例及对照组12例。两组患者均给予常规康复训练,治疗组在此基础上进行3个月慢速活动平板训练。分别于治疗前后进行Fugl-Meyer运动功能评定(FMA)、Berg平衡量表(BBS)评定,10 m最大步行速度、自由步行速度及6 min步行距离测定。结果治疗后,两组患者FMA、BBS评分,10 m最大步行速度、自由步行速及6 min步行距离均比治疗前提高(P<0.05),治疗组FMA、BBS评分,10 m自由步行速度及6 min步行距离优于对照组(P<0.05)。结论慢速活动平板训练能改善脑卒中偏瘫患者步行功能及平衡能力。     

Relationship between the weight-bearing ratio on the affected lower extremity and gait ability using a portable electronic foot sensor shoe (Step Aid?) in hemiplegic stroke patients

[Purpose] This study investigated the association between the weight-bearing ratio (WBR) and gait ability of a paretic lower limb while walking using a shoe-type load-measuring apparatus. [Subjects] The Subjects comprised 17 stroke patients who were classified into the following two groups: the independent walking group, and the non-independent walking group. [Methods] The 10-m walking time (inside and outside parallel bars) and the Berg Balance Scale (BBS) were measured. The WBR of the paretic lower limb was measured during static standing and while walking inside and outside parallel bars, and the coefficient of variation (CV) was calculated. WBR was evaluated using the Step Aid. [Results] The BBS and WBR were significantly decreased in the non-independent walking group, while the 10-m walking time and the CV were significantly increased in the non-independent walking group. [Conclusion] The CV and WBR of a paretic lower limb while walking appear to be important indices of achievement of independent gait in hemiplegic stroke patients, and they may be used in gait rehabilitation for diseases requiring weight-bearing training to follow the course of training using a shoe-type load-measuring apparatus.Key words: Stroke, Weight-bearing ratio, Shoe-type load-measuring apparatus     

Prediction of discharge walking ability from initial assessment in a stroke inpatient rehabilitation facility population

Bland MD, Sturmoski A, Whitson M, Connor LT, Fucetola R, Huskey T, Corbetta M, Lang CE. Prediction of discharge walking ability from initial assessment in a stroke inpatient rehabilitation facility population.ObjectivesTo (1) determine which clinical assessments at admission to an inpatient rehabilitation facility (IRF) most simply predict discharge walking ability, and (2) identify a clinical decision rule to differentiate household versus community ambulators at discharge from an IRF.DesignRetrospective cohort study.SettingIRF.ParticipantsTwo samples of participants (n=110 and 159) admitted with stroke.InterventionsA multiple regression determined which variables obtained at admission (age, time from stroke to assessment, Motricity Index, somatosensation, Modified Ashworth Scale, FIM, Berg Balance Scale, 10-m walk speed) could most simply predict discharge walking ability (10-m walk speed). A logistic regression determined the likelihood of a participant achieving household (<0.4m/s) versus community (≥0.4–0.8m/s; >0.8m/s) ambulation at the time of discharge. Validity of the results was evaluated on a second sample of participants.Main Outcome MeasureDischarge 10-m walk speed.ResultsAdmission Berg Balance Scale and FIM walk item scores explained most of the variance in discharge walk speed. The odds ratio of achieving only household ambulation at discharge was 20 (95% confidence interval [CI], 6–63) for sample 1 and 32 (95% CI, 10–96) for sample 2 when the combination of having a Berg Balance Scale score of ≤20 and a FIM walk item score of 1 or 2 was present.ConclusionsA Berg Balance Scale score of ≤20 and a FIM walk item score of 1 or 2 at admission indicates that a person with stroke is highly likely to only achieve household ambulation speeds at discharge from an IRF.     

Gait training with partial body weight support during overground walking for individuals with chronic stroke: a pilot study

Background

It is not yet established if the use of body weight support (BWS) systems for gait training is effective per se or if it is the combination of BWS and treadmill that improves the locomotion of individuals with gait impairment. This study investigated the effects of gait training on ground level with partial BWS in individuals with stroke during overground walking with no BWS.

Methods

Twelve individuals with chronic stroke (53.17 ± 7.52 years old) participated of a gait training program with BWS during overground walking, and were evaluated before and after the gait training period. In both evaluations, individuals were videotaped walking at a self-selected comfortable speed with no BWS. Measurements were obtained for mean walking speed, step length, stride length and speed, toe-clearance, durations of total double stance and single-limb support, and minimum and maximum foot, shank, thigh, and trunk segmental angles.

Results

After gait training, individuals walked faster, with symmetrical steps, longer and faster strides, and increased toe-clearance. Also, they displayed increased rotation of foot, shank, thigh, and trunk segmental angles on both sides of the body. However, the duration of single-limb support remained asymmetrical between each side of the body after gait training.

Conclusions

Gait training individuals with chronic stroke with BWS during overground walking improved walking in terms of temporal-spatial parameters and segmental angles. This training strategy might be adopted as a safe, specific and promising strategy for gait rehabilitation after stroke.

     

Locomotor training using body-weight support on a treadmill in conjunction with ongoing physical therapy in a child with severe cerebellar ataxia

BACKGROUND AND PURPOSE: This case report describes the effects of locomotor training using body-weight support (BWS) on a treadmill and during overground walking on mobility in a child with severe cerebellar ataxia who was nonambulatory. To date, no studies have examined the efficacy of this intervention in people with cerebellar ataxia. CASE DESCRIPTION: The patient was a 13-year-old girl who had a cerebellar/brainstem infarct 16 months before the intervention. Her long-term goal was to walk independently in her home with a walker. INTERVENTION: Locomotor training using a BWS system both on the treadmill and during overground walking was implemented 5 days a week for 4 weeks in a clinic. Locomotor training using BWS on a treadmill was continued 5 days a week for 4 months at home. OUTCOMES: Prior to training, she was able to take steps on her own with the help of another person, but did not take full weight on her feet or walk on a regular basis. At 6 months, she walked for household distances. Prior to training, her Pediatric Functional Independence Measure scores were 3 (moderate assistance) for all transfers, 2 (maximal assistance) for walking, and 1 (total assistance) for stairs. At 6 months, her scores were 6 (modified independence) for transfers, 5 (supervision) for walking, and 4 (minimal assistance) for stairs. Prior to training, she was unable to take independent steps during treadmill walking; at 6 months, all of her steps were unassisted. DISCUSSION AND CONCLUSION: Locomotor training using BWS on a treadmill in conjunction with overground gait training may be an effective way to improve ambulatory function in individuals with severe cerebellar ataxia, but the intensity and duration of training required for functionally significant improvements may be prolonged.     

Balance, balance confidence, and health-related quality of life in persons with chronic stroke after body weight-supported treadmill training

Combs SA, Dugan EL, Passmore M, Riesner C, Whipker D, Yingling E, Curtis AB. Balance, balance confidence, and health-related quality of life in persons with chronic stroke after body weight–supported treadmill training.ObjectivesTo examine changes in balance, balance confidence, and health-related quality of life immediately and 6 months after body weight–supported treadmill training (BWSTT) for persons with chronic stroke (primary objective) and to determine whether changes in gait speed after BWSTT were associated with changes in these dimensions of health (secondary objective).DesignProspective pre-/posttest pilot study with 6 months retention.SettingUniversity research laboratory settings.ParticipantsA convenience sample of participants (N=19; at least 6mo poststroke; able to ambulate 0.4–0.8m/s) were recruited.InterventionBWSTT was provided for 24 sessions over 8 weeks with 20 minutes of total walking each session.Main Outcome MeasuresBerg Balance Scale (BBS), Activities-Specific Balance Confidence (ABC) Scale, Stroke Impact Scale (SIS), comfortable 10-m walk test (CWT), and fast 10-m walk test (FWT). Proportions of participants who achieved minimal detectable changes (MDCs) were examined for all measures.ResultsStatistically significant improvements were found from pre- to posttest for BBS, ABC, SIS mobility, SIS stroke recovery, and CWT scores (P<.05) and from pretest to retention on BBS, ABC, CWT, and FWT scores (P<.05). For most participants, improvements did not exceed MDCs. Changes in gait speed and BBS, ABC, and SIS scores were not associated.ConclusionsThe findings of this study suggest that effects of BWSTT may transfer beyond gait to positively influence balance, balance confidence, and health-related quality of life. However, for most participants, BWSTT was not sufficient to induce improvements in balance and balance confidence beyond measurement error or long-term retention of enhanced perceptions of quality of life.     

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     

The effects of incremental speed-dependent treadmill training on postural instability and fear of falling in Parkinson's disease

OBJECTIVE: To detect the effectiveness of incremental speed-dependent treadmill training on postural instability, dynamic balance and fear of falling in patients with idiopathic Parkinson's disease. DESIGN: Randomized controlled trial. SETTING: Ankara Education and Research Hospital, 2nd PM&R Clinic, Cardiopulmonary Rehabilitation Unit. SUBJECTS: Fifty-four patients with idiopathic Parkinson's disease in stage 2 or 3 of the Hoehn Yahr staging entered, and 31 patients (21 training, 10 control) had outcome data. INTERVENTIONS: Postural instability of patients with Parkinson's disease was assessed using the motor component of the Unified Parkinson's Disease Rating Scale (UPDRS), Berg Balance Test, Dynamic Gait Index and Falls Efficacy Scale. Twenty-one patients with Parkinson's disease participated in an eight-week exercise programme using incremental speed-dependent treadmill training. Before and after the training programme, balance, gait, fear of falling and walking distance and speed on treadmill were assessed in both Parkinson's disease groups. MAIN MEASURES: Walking distance and speed on treadmill, UPDRS, Berg Balance Test, Dynamic Gait Index and Falls Efficacy Scale. RESULTS: Initial total walking distance of the training group on treadmill was 266.45 +/- 82.14 m and this was progressively increased to 726.36 +/- 93.1 m after 16 training session (P < 0.001). Tolerated maximum speed of the training group on treadmill at baseline was 1.9 +/- 0.75 km/h and improved to 2.61 +/- 0.77 km/h (P < 0.001). Berg Balance Test, Dynamic Gait Index and Falls Efficacy Scale scores of the training group were improved significantly after the training programme (P < 0.01). There was no significant improvement in any of the outcome measurements in the control group (P > 0.05). CONCLUSIONS: Specific exercise programmes using incremental speed-dependent treadmill training may improve mobility, reduce postural instability and fear of falling in patients with Parkinson's disease.     

The effects of backward walking training on balance and mobility in an individual with chronic incomplete spinal cord injury: A case report

Background/Purpose: Individuals with incomplete spinal cord injuries (ISCIs) commonly face persistent gait impairments. Backward walking training may be a useful rehabilitation approach, providing novel gait and balance challenges. However, little is known about the effects of this approach for individuals with ISCIs. The purpose of this case report was to describe the effects of backward walking training on strength, balance, and upright mobility in an individual with chronic ISCI. Methods: A 28-year-old female, 11-years post ISCI (C4, AIS D) completed 18-sessions of backward walking training on a treadmill with partial body-weight support and overground. Training emphasized stepping practice, speed, and kinematics. Outcome measures included: Lower Extremity Motor Score, Berg Balance Scale (BBS), Sensory Organization Test (SOT), 10-Meter Walk Test (10MWT), 3-meter backward walking test, Timed Up and Go (TUG), and Activities-Specific Balance Confidence (ABC) Scale. Results: Strength did not change. Improved balance was evident based on BBS (20 to 37/56) and SOT scores (27 to 40/100). Upright mobility improved based on TUG times (57 to 32.7 s), increased 10MWT speed (0.23 to 0.31 m/s), and backward gait speed (0.07 to 0.12 m/s). Additionally, self-reported balance confidence (ABC Scale) increased from 36.9% to 49.6%. Conclusions: The results suggest that backward walking may be a beneficial rehabilitation approach; examination of the clinical efficacy is warranted.     

Locomotor treadmill training with partial body-weight support before overground gait in adults with acute stroke: a pilot study

McCain KJ, Pollo FE, Baum BS, Coleman SC, Baker S, Smith PS. Locomotor treadmill training with partial body-weight support before overground gait in adults with acute stroke: a pilot study.

Objective

To investigate the impact of locomotor treadmill training with partial body-weight support (BWS) before the initiation of overground gait for adults less than 6 weeks poststroke.

Design

Parallel group, posttest only.

Setting

Inpatient rehabilitation center.

Participants

Adults after first stroke admitted to an inpatient rehabilitation unit: treadmill group (n=7) and comparison group (n=7).

Interventions

Locomotor treadmill training with partial BWS or traditional gait training methods.

Main Outcome Measures

Gait kinematics, symmetry, velocity, and endurance at least 6 months postinsult.

Results

Data from 3-dimensional gait analysis and 6-minute walk test (6MWT) supported improved gait for adults postacute stroke who practiced gait on a treadmill before walking over ground. Gait analysis showed increased knee flexion during swing and absence of knee hyperextension in stance for the treadmill group. In addition, more normal ankle kinematics at initial contact and terminal stance were observed in the treadmill group. Improved gait symmetry in the treadmill group was confirmed by measures of single support time, hip flexion at initial contact, maximum knee flexion, and maximum knee extension during stance. The treadmill group also walked further and faster in the 6MWT than the comparison group.

Conclusions

Application of locomotor treadmill training with partial BWS before overground gait training may be more effective in establishing symmetric and efficient gait in adults postacute stroke than traditional gait training methods in acute rehabilitation.     

Effectiveness of gait training using an electromechanical gait trainer, with and without functional electric stimulation, in subacute stroke: a randomized controlled trial

OBJECTIVE: To compare the therapeutic effects of conventional gait training (CGT), gait training using an electromechanical gait trainer (EGT), and gait training using an electromechanical gait trainer with functional electric stimulation (EGT-FES) in people with subacute stroke. DESIGN: Nonblinded randomized controlled trial. SETTING: Rehabilitation hospital for adults. PARTICIPANTS: Fifty patients were recruited within 6 weeks after stroke onset; 46 of these completed the 4-week training period. INTERVENTION: Participants were randomly assigned to 1 of 3 gait intervention groups: CGT, EGT, or EGT-FES. The experimental intervention was a 20-minute session per day, 5 days a week (weekdays) for 4 weeks. In addition, all participants received their 40-minute sessions of regular physical therapy every weekday as part of their treatment by the hospital. MAIN OUTCOME MEASURES: Five-meter walking speed test, Elderly Mobility Scale (EMS), Berg Balance Scale, Functional Ambulatory Category (FAC), Motricity Index leg subscale, FIM instrument score, and Barthel Index. RESULTS: The EGT and EGT-FES groups had statistically significantly more improvement than the CGT group in the 5-m walking speed test (CGT vs EGT, P=.011; CGT vs EGT-FES, P=.001), Motricity Index (CGT vs EGT-FES, P=.011), EMS (CGT vs EGT, P=.006; CGT vs EGT-FES, P=.009), and FAC (CGT vs EGT, P=.005; CGT vs EGT-FES, P=.002) after the 4 weeks of training. No statistically significant differences were found between the EGT and EGT-FES groups in all outcome measures. CONCLUSIONS: In this sample with subacute stroke, participants who trained on the electromechanical gait trainer with body-weight support, with or without FES, had a faster gait, better mobility, and improvement in functional ambulation than participants who underwent conventional gait training. Future studies with assessor blinding and larger sample sizes are warranted.     

Gait training of subacute stroke patients using a hybrid assistive limb: a pilot study

Purpose To determine whether gait training with a hybrid assistive limb (HAL) as an exoskeleton robotic device was safe and could increase functional mobility and gait ability in subacute stroke patients. Methods The participants were eight patients with post-stroke hemiparesis whose walking impairment and gait recovery curves had plateaued. The intervention program was gait training using HAL and a walker for 20?min daily 5 days a week for 5 weeks. The 10-m maximum walking speed (MWS), self-selected walking speed (SWS) and 2-min-walk test (2MT) without HAL were used as primary outcome measures to determine the effects of training. The Berg Balance Scale (BBS), Fugl-Meyer Assessment of Motor Recovery after Stroke (FMA) and functional ambulation category (FAC) were assessed as secondary outcomes. These measures were assessed before and after the 5-week intervention program and were analyzed statistically using a paired t-test. Results All eight participants completed the intervention program with no adverse events. There were significant increases in MWS, SWS and 2MT. BBS, FMA and FAC also increased, but not significantly. Conclusion The new HAL exoskeleton robotic device was efficient and safe for improving motor function and gait in patients in the subacute stage after stroke.

• Implications for Rehabilitation

• Gait training using HAL will improve gait ability of individuals with post stroke.

• The HAL achieve intensive gait training without increase spasticity and abnormal gait pattern.

     

Gait training combining partial body-weight support, a treadmill, and functional electrical stimulation: effects on poststroke gait

BACKGROUND AND PURPOSE: Treadmill training with harness support is a promising, task-oriented approach to restoring locomotor function in people with poststroke hemiparesis. Although the combined use of functional electrical stimulation (FES) and treadmill training with body-weight support (BWS) has been studied before, this combined intervention was compared with the Bobath approach as opposed to BWS alone. The purpose of this study was to evaluate the effects of the combined use of FES and treadmill training with BWS on walking functions and voluntary limb control in people with chronic hemiparesis. SUBJECTS: Eight people who were ambulatory after chronic stroke were evaluated. METHODS: An A(1)-B-A(2) single-case study design was applied. Phases A(1) and A(2) included 3 weeks of gait training on a treadmill with BWS, and phase B included 3 weeks of treadmill training plus FES applied to the peroneal nerve. The Stroke Rehabilitation Assessment of Movement was used to assess motor recovery, and a videography analysis was used to assess gait parameters. RESULTS: An improvement (from 54.9% to 71.0%) in motor function was found during phase B. The spatial and temporal variables cycle duration, stance duration, and cadence as well as cycle length symmetry showed improvements when phase B was compared with phases A(1) and A(2). DISCUSSION AND CONCLUSION: The combined use of FES and treadmill training with BWS led to an improvement in motor recovery and seemed to improve the gait pattern of subjects with hemiparesis, indicating the utility of this combination method during gait rehabilitation. In addition, this single-case series showed that this alternative method of gait training--treadmill training with BWS and FES--may decrease the number of people required to carry out the training.     

Use of trunk stabilization and locomotor training in an adult with cerebellar ataxia: A single system design

The purpose of this study is to describe the effects of trunk stabilization training and locomotor training (LT) using body-weight support on a treadmill (BWST) and overground walking on balance, gait, self-reported function, and trunk muscle performance in an adult with severe ataxia secondary to brain injury. There are no studies on the effectiveness of these combined interventions in persons with ataxia. The subject was a 23-year-old male who had a traumatic brain injury 13 months prior. An A-B-A withdrawal single-system design was used. Outcome measures were Berg Balance Test (BBT), timed unsupported stance, Functional Ambulation Category (FAC), 10-meter walk test (10-MWT), Outpatient Physical Therapy Improvement in Movement Assessment Log (OPTIMAL), transverse abdominis (TrA) thickness, and isometric trunk endurance tests. Performance on the BBT, timed unsupported stance, FAC, 10-MWT, and OPTIMAL each improved after 10 weeks of intervention. In additions, TrA symmetry at rest improved as did right side-bridge endurance time. LT, using BWST and overground walking, and trunk stabilization training may be effective in improving balance, gait, function, and trunk performance in individuals with severe ataxia. Further research with additional subjects is indicated.     

Relationship Between ASIA Examination and Functional Outcomes in the NeuroRecovery Network Locomotor Training Program

Buehner JJ, Forrest GF, Schmidt-Read M, White S, Tansey K, Basso DM. Relationship between ASIA examination and functional outcomes in the NeuroRecovery Network Locomotor Training Program.ObjectiveTo determine the effects of locomotor training on: (1) the International Standards for Neurological Classification of Spinal Cord Injury examination; (2) locomotion (gait speed, distance); (3) balance; and (4) functional gait speed stratifications after chronic incomplete spinal cord injury (SCI).DesignProspective observational cohort.SettingOutpatient rehabilitation centers in the NeuroRecovery Network (NRN).ParticipantsIndividuals (n=225) with American Spinal Injury Association Impairment Scale (AIS) grade C or D chronic motor incomplete SCI having completed locomotor training in the NRN.InterventionThe NRN Locomotor Training Program consists of manual-facilitated body weight–supported standing and stepping on a treadmill and overground.Main Outcome MeasuresAIS classification, lower extremity pin prick, light touch and motor scores, ten-meter walk and six-minute walk tests, and the Berg Balance Scale.ResultsSignificant gains occurred in lower extremity motor scores but not in sensory scores, and these were only weakly related to gait speed and distance. Final Berg Balance Scale scores and initial lower extremity motor scores were positively related. Although 70% of subjects showed significantly improved gait speed after locomotor training, only 8% showed AIS category conversion.ConclusionsLocomotor training improves gait speed to levels sufficient for independent in-home or community ambulation after chronic motor incomplete SCI. Changes in lower extremity motor and sensory scores do not capture the full extent of functional recovery, nor predict responsiveness to locomotor training. Functional classification based on gait speed may provide an effective measure of treatment efficacy or functional improvement after incomplete SCI.