[ARTICLE] Effects of inclined treadmill walking training with rhythmic auditory stimulation on balance and gait in stroke patients – Full Text PDF

Abstract.

[Purpose] The purpose of this study was to determine if an inclined treadmill with rhythmic auditory stimulation gait training can improve balance and gait ability in stroke patients.

[Subjects and Methods] Thirty participants were randomly divided into three groups: inclined treadmill with rhythmic auditory stimulation training group (n=10), inclined treadmill training group (n=10), and treadmill training group (n=10). For all groups, the training was conducted for 4 weeks, 30 minutes per session, 5 times per week. Two subjects dropped out before study completion.

[Results] All variables of balance and gait, except for the timed up and go test in the treadmill group, significantly improved in all groups. Moreover, all variables showed a more significant improvement in the inclined treadmill with rhythmic auditory stimulation group when compared with the other groups. Timed up and go test, Berg balance scale, 6 m walking test, walking speed, and symmetric index were significantly improved in the inclined treadmill group when compared with the treadmill group.

[Conclusion] Thus, for stroke patients receiving gait training, inclined treadmill with rhythmic auditory stimulation training was more effective in maintaining balance and gait than inclined treadmill without rhythmic auditory stimulation or only treadmill training.

INTRODUCTION
Patients with stroke show various muscle abnormalities, including a combination of denervation, disuse, remodeling, and spasticity1). These reduce their balance ability and lead to gait disorders2). Abnormal gaits cause flexion and extension synergy patterns due to compensatory actions of muscles, etc., on the unaffected side, impairment of proprioceptive sensibility, and abnormal coordination of stiffened muscles of the lower limb3). As a substitute of stair climbing exercise, inclined treadmill walking training, which is aimed at improving these gait disorders, is being considered as an essential means for indoor and outdoor movements of the disabled, the elderly, or pregnant women who are unable to use stairs4). However, Rhea et al.5) stated that treadmill walking training, compared with walking on flat ground, is characterized by a shorter step length. Oh, Kim, and Woo6) argued that treadmill walking training has negative effects on gait asymmetry. Sensory elements play an important part in compensating for these weaknesses7), and rhythmic auditory stimulation (RAS) can be used as a complementing intervention8). In this intervention, the external auditory sense of rhythms generates rhythmic and more symmetrical alternate movements in the lower limbs of stroke patients who show gait asymmetry6, 9). Existing studies have not shown consistent results regarding the effects of treadmill walking training on the gait of stroke patients. In particular, with regard to balance and gait, which are essential for the activity and participation of stroke patients, there are no systematic studies showing the effects of inclined treadmill walking training with RAS thus far.[…]

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