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.     

The effects of balance training and ankle training on the gait of elderly people who have fallen

[Purpose] The aim of this study was to examine the effects of balance training and muscle training around the ankle joints on the gait of elderly people who have experienced a fall. [Subjects] Twenty-six elderly people with a risk of falling and a Berg Balance Scale score of 37 to 50 points who had experienced a fall in the last year were randomly and equally assigned to either a balance training group or an ankle training group. The balance training group received training on a hard floor, training while maintaining balance on a cushion ball in a standing position, and training while maintaining balance on an unstable platform in a standing position; the ankle training group received training to strengthen the muscles around the ankle joints and conducted stretch exercise for the muscles around the ankle joints. [Results] There were significant changes in gait velocity, step length, and stride length in the balance training group after the intervention; there were significant changes in gait velocity, cadence, step time, cycle time, step length, and stride length in the ankle training group after the intervention. In a between-group comparison, the gait velocity of the balance training group showed a significant improvement compared with the ankle training group. [Conclusion] Both balance training and ankle joint training are effective in enhancing the gait ability of elderly people with a risk of falling; in particular, balance training is effective in improving the gait velocity of elderly people who have experienced a fall compared with ankle joint training.Key words: Elderly people, Balance training, Ankle training     

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     

The Effects of Hippotherapy on Elderly Persons’ Static Balance and Gait

[Purpose] The aim of this study was to examine the effects of hippotherapy on elderly persons’ static balance and gait. [Subjects and Methods] Twenty-two elderly persons residing in the community were randomly divided into a hippotherapy group and a treadmill group and they conducted exercise for eight weeks. [Results] Step lengths increased significantly, and step time and sway path lengths significantly decreased in both groups. A comparison of sway path lengths after the intervention between the two groups revealed that the hippotherapy group showed larger decreases than the treadmill group. [Conclusion] The results of this study indicate that hippotherapy may improve the static balance and gait of elderly persons residing in the community.Key words: Elderly, Balance, Hippotherapy     

Effect of coordination movement using the PNF pattern underwater on the balance and gait of stroke patients

[Purpose] To investigate the effect of coordination movement using the Proprioceptive Neuromuscular Facilitation pattern underwater on the balance and gait of stroke patients. [Subjects and Methods] Twenty stroke patients were randomly assigned to an experimental group that performed coordination movement using the Proprioceptive Neuromuscular Facilitation pattern underwater and a control group (n =10 each). Both the groups underwent neurodevelopmental treatment, and the experimental group performed coordination movement using the Proprioceptive neuromuscular facilitation pattern underwater. Balance was measured using the Berg Balance Scale and Functional Reach Test, and gait was measured using the 10-Meter Walk Test and Timed Up and Go Test. To compare in-group data before and after the intervention, paired t-test was used. Independent t-test was used to compare differences in the results of the Berg Balance Scale, Functional Reach Test, 10-Meter Walk Test, and Timed Up and Go Test before and after the intervention between the groups. [Results] Comparison within the groups showed significant differences in the results of the Berg Balance Scale, Functional Reach Test, 10-Meter Walk Test, and Timed Up and Go Test before and after the experimental intervention. On comparison between the groups, there were greater improvements in the scores of the Berg Balance Scale, Functional Reach Test, 10-Meter Walk Test, and Timed Up and Go Test in the experimental group. [Conclusion] The findings demonstrate that coordination movement using the Proprioceptive Neuromuscular Facilitation pattern under water has a significant effect on the balance and gait of stroke patients.Key words: Coordination movement using the PNF pattern, Balance, Gait     

Augmented reality-based postural control training improves gait function in patients with stroke: Randomized controlled trial

The purpose of this study was to determine the effects of augmented reality (AR)-based postural control training on balance and gait function in stroke patients. Twenty-one stroke patients were assigned to either an experimental group (n = 10) or a control group (n = 11). Patients in both groups received a general physical therapy program for a duration of 30 minutes per session, 5 days per week, for a period of 4 weeks. Participants in the experimental group received additional AR-based postural control training for 30 minutes per day, 3 days per week, for a period of 4 weeks. Patients were assessed with the timed up-and-go test, Berg Balance Scale test, and spatiotemporal parameters using the GAITRite system. Results of repeated-measures analysis of covariance showed a significant main effect of time on timed up-and-go test, Berg Balance Scale, velocity, cadence, step length and stride length of paretic and nonparetic sides. In addition, walking velocity, step length, and stride length on both the paretic and nonparetic sides showed a significant group × time interaction effect. The results of this study provide evidence in support of incorporating an AR environment into postural control training for improving gait of stroke patients.     

Effects of robot-assisted gait training on the balance and gait of chronic stroke patients: focus on dependent ambulators

[Purpose] The purpose of this study was to confirm the effect of robot-assisted gait training on the balance and gait ability of stroke patients who were dependent ambulators. [Subjects and Methods] Twenty stroke patients participated in this study. The participants were allocated to either group 1, which received robot-assisted gait training for 4 weeks followed by conventional physical therapy for 4 weeks, or group 2, which received the same treatments in the reverse order. Robot-assisted gait training was conducted for 30 min, 3 times a week for 4 weeks. The Berg Balance Scale, Modified Functional Reach Test, Functional Ambulation Category, Modified Ashworth Scale, Fugl-Meyer Assessment, Motricity Index, and Modified Barthel Index were assessed before and after treatment. To confirm the characteristics of patients who showed a significant increase in Berg Balance Scale after robot-assisted gait training as compared with physical therapy, subgroup analysis was conducted. [Results] Only lateral reaching and the Functional Ambulation Category were significantly increased following robot-assisted gait training. Subscale analyses identified 3 patient subgroups that responded well to robot-assisted gait training: a subgroup with hemiplegia, a subgroup in which the guidance force needed to be decreased to needed to be decreased to ≤45%, and a subgroup in which weight bearing was decreased to ≤21%. [Conclusion] The present study showed that robot-assisted gait training is not only effective in improving balance and gait performance but also improves trunk balance and motor skills required by high-severity stroke patients to perform activities daily living. Moreover, subscale analyses identified subgroups that responded well to robot-assisted gait training.Key words: Stroke, Robotics, Gait     

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     

Effect of a virtual reality exercise program accompanied by cognitive tasks on the balance and gait of stroke patients

[Purpose] This study aimed to assess the effect of a virtual reality exercise program accompanied by cognitive tasks on the balance and gait of stroke patients. [Subjects] Twenty stroke patients were randomly assigned to two groups 10 to an experimental group that performed a virtual reality exercise program accompanied by cognitive tasks and 10 to a control group. The control group performed a proprioceptive neuromuscular facilitation exercise program. Balance was measured with the Berg Balance Scale. Gait was assessed using the Timed Up and Go Test. The paired t-test was used to compare groups before and after the experiment. The independent t-test was conducted to assess differences in the degree of change between the two groups before and after the experiment. [Results] Within-group comparison in the experimental group showed significant differences in the Berg Balance Scale and Timed Up and Go Test. In a comparison between groups, the differences in the Berg Balance Scale and Timed Up and Go Test in the experimental group appeared significant compared with the control group. [Conclusion] The results of the experiment indicate that a virtual reality exercise program accompanied by cognitive tasks has a positive effect on the balance and gait of stroke patients.Key words: Virtual reality exercise program accompanied by cognitive tasks, Balance, Gait     

The Effect of Muscle Facilitation Using Kinesio Taping on Walking and Balance of Stroke Patients

[Purpose] The aim of this study was to evaluate the changes in function and balance after Kinesio Taping application in stroke patients. [Subjects and Methods] Thirty subjects were randomly divided into an experimental group and control group. The experimental group was applied taping before therapeutic exercise, and the control group received only therapeutic exercise. Functional gait was measured using the straight line walking test, and dynamic balance ability was measured using the Berg Balance Scale. Walking velocity was measured with the 10 m walking test. [Results] There were statistically significant differences between the results of the straight line walking and 10 m walking tests in the pre-post analysis for the experimental group. There were a statistically significant difference in the Berg Balance Scale and 10 m walking test between the two groups. [Conclusion] Application of taping to the paralyzed parts of a stroke patient has a positive effect on improvement of typical asymmetric gait and walking speed.Key words: Kinesio taping, Stroke, Gait     

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。     

The Effects of Augmented Reality-based Otago Exercise on Balance,Gait, and Falls Efficacy of Elderly Women

[Purpose] The purpose of this study was to determine the effects of augmented reality-based Otago exercise on balance, gait, and falls efficacy of elderly women. [Subjects] The subjects were 21 elderly women, who were randomly divided into two groups: an augmented reality-based Otago exercise group of 10 subjects and an Otago exercise group of 11 subjects. [Methods] All subjects were evaluated for balance (Berg Balance Scale, BBS), gait parameters (velocity, cadence, step length, and stride length), and falls efficacy. Within 12 weeks, Otago exercise for muscle strengthening and balance training was conducted three times, for a period of 60 minutes each, and subjects in the experimental group performed augmented reality-based Otago exercise. [Results] Following intervention, the augmented reality-based Otago exercise group showed significant increases in BBS, velocity, cadence, step length (right side), stride length (right side and left side) and falls efficacy. [Conclusion] The results of this study suggest the feasibility and suitability of this augmented reality-based Otago exercise for elderly women.Key words: Augmented reality, Otago exercise, Falls efficacy     

Effects of treadmill training with the eyes closed on gait and balance ability of chronic stroke patients

[Purpose] The purpose of this study was to compare the effect of treadmill walking with the eyes closed and open on the gait and balance abilities of chronic stroke patients. [Subjects and Methods] Thirty patients with chronic stroke participated in this study. The treadmill gait training for each group lasted 40 minutes, and sessions were held 3 times a week for 4 weeks. Gait ability was measured using a Biodex Gait Trainer Treadmill System. Balance ability was measured using a Biodex Balance System. [Results] After the treadmill training‚ the treadmill training with eyes closed (TEC) group showed significant improvements in walking distance‚ step length‚ coefficient of variation‚ and limit of stability (overall‚ lateral affected‚ forward lateral unaffected) compared to the treadmill training with eyes open (TEO) group. [Conclusion] The walking and balance abilities of the TEC participants showed more improvement after the treadmill walking sessions than those of the TEO participants. Therefore‚ treadmill walking with visual deprivation may be useful for the rehabilitation of patients with chronic stroke.Key words: Stroke, Treadmill training, Visual blocking     

Therapeutic effects of reaching with forward bending of trunk on postural stability,dynamic balance,and gait in individuals with chronic hemiparetic stroke

[Purpose] The objective of this study was to perform forward bending of the trunk and reaching training in chronic stroke patients and to investigate subsequent changes in trunk control, dynamic balance, and gait. [Subject] Twenty-three chronic stroke patients were randomly divided into two groups, with 10 patients in the forward bending of the trunk and reaching group and 13 patients in the control group. [Methods] Both groups underwent 30 minutes of rehabilitation therapy, five days a week, for four weeks. The forward bending of the trunk and reaching group additionally performed forward bending of the trunk and reaching training five times a week for four weeks, which involved four sets of pressing buttons 35 times, for a total of 140 button presses per session. The subjects were tested before and after training using the Trunk Impairment Scale, Berg Balance Scale, Timed Up and Go Test, Six-Minute Walking Test, and 10-Meter Walking Test. Trunk control, dynamic balance, and walking ability were compared between the two groups. [Result] The results of the study showed that the results of the Trunk Impairment Scale, Berg Balance Scale, Timed Up and Go Test, Six-Minute Walking Test improved significantly in the FBR group, while there were no significant differences in the control group. [Conclusion] This study results suggest that forward bending of the trunk and reaching training can be an effective exercise method for chronic stroke patients.Key words: Postural control, Stroke, Trunk     

虚拟现实与同步减重训练对脑卒中患者步态影响的对照研究

目的:评估虚拟现实与同步减重步态训练(VR+BWSTT)对脑卒中患者步态的影响。方法:将12例发病3个月内的脑卒中患者随机分配至实验组(VR+BWSTT)和常规组(常规物理治疗)各6例,另6例正常人作为正常组。训练前后以三维步态分析对以下参数进行对比:步行速度、步长不对称性、单腿支撑时间不对称性、髋关节最大后伸角度、髋关节最大屈曲角度、膝关节最大屈曲角度、支撑相膝关节最大伸展角度、支撑相踝关节最大背伸角度。结果:训练前两组脑卒中患者的性别、年龄、病程、脑卒中性质、偏瘫侧、患侧下肢肌力、肌张力、步行速度、步长不对称性、单腿支撑时间不对称性及患侧下肢各关节角度差异无显著性。脑卒中患者步行速度、髋关节最大后伸角度、膝关节最大屈曲角度低于正常组,步长不对称性、单腿支撑时间不对称性高于正常组(P<0.05)。训练后两组患者的步行速度、单腿支撑时间不对称性均有改善,实验组的步长不对称性、髋关节最大后伸角度有改善(P<0.05)。结论:VR与同步BWSTT可改善亚急性期脑卒中患者的步态,在改善脑卒中的步长不对称性、髋关节最大后伸角度方面较常规物理治疗有优势。     

基于FES控制下的踏车训练应用于脑卒中偏瘫患者的效果观察

目的 探究对脑卒中偏瘫患者进行基于多通道功能性电刺激(FES)控制下的踏车训练的效果.方法 选取2018年8月至2020年12月来中风二科就诊的103例脑卒中偏瘫患者,采用随机数字表分组.对照组51例进行常规治疗和康复训练,观察组52例增加FES控制下的踏车训练,观察两组康复效果.结果 干预后观察组双膝屈曲最大平均值(...     

Effects of Robot-assisted Gait Training Combined with Functional Electrical Stimulation on Recovery of Locomotor Mobility in Chronic Stroke Patients: A Randomized Controlled Trial

[Purpose] The purpose of the present study was to investigate the effects of robot-assisted gait training combined with functional electrical stimulation on locomotor recovery in patients with chronic stroke. [Subjects] The 20 subjects were randomly assigned into either an experimental group (n = 10) that received a combination of robot-assisted gait training and functional electrical stimulation on the ankle dorsiflexor of the affected side or a control group (n = 10) that received robot-assisted gait training only. [Methods] Both groups received the respective therapies for 30 min/day, 3 days/week for 5 weeks. The outcome was measured using the Modified Motor Assessment Scale (MMAS), Timed Up-and-Go Test (TUG), Berg Balance Scale (BBS), and gait parameters through gait analysis (Vicon 370 motion analysis system, Oxford Metrics Ltd., Oxford, UK). All the variables were measured before and after training. [Results] Step length and maximal knee extension were significantly greater than those before training in the experimental group only. Maximal Knee flexion showed a significant difference between the experimental and control groups. The MMAS, BBS, and TUG scores improved significantly after training compared with before training in both groups. [Conclusion] We suggest that the combination of robot-assisted gait training and functional electrical stimulation encourages patients to actively participate in training because it facilitates locomotor recovery without the risk of adverse effects.Key words: Robot-assisted gait training, Functional electrical stimulation, Chronic stroke     

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     

Effect of space balance 3D training using visual feedback on balance and mobility in acute stroke patients

[Purpose] The purpose of the study was to determine the effects of balance training with Space Balance 3D, which is a computerized measurement and visual feedback balance assessment system, on balance and mobility in acute stroke patients. [Subjects and Methods] This was a randomized controlled trial in which 52 subjects were assigned randomly into either an experimental group or a control group. The experimental group, which contained 26 subjects, received balance training with a Space Balance 3D exercise program and conventional physical therapy interventions 5 times per week during 3 weeks. Outcome measures were examined before and after the 3-week interventions using the Berg Balance Scale (BBS), Timed Up and Go (TUG) test, and Postural Assessment Scale for Stroke Patients (PASS). The data were analyzed by a two-way repeated measures ANOVA using SPSS 19.0. [Results] The results revealed a nonsignificant interaction effect between group and time period for both groups before and after the interventions in the BBS score, TUG score, and PASS score. In addition, the experimental group showed more improvement than the control group in the BBS, TUG and PASS scores, but the differences were not significant. In the comparisons within the groups by time, both groups showed significant improvement in BBS, TUG, and PASS scores. [Conclusion] The Space Balance 3D training with conventional physical therapy intervention is recommended for improvement of balance and mobility in acute stroke patients.Key words: Balance training, Visual feedback, Acute stroke patients     

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.