Posts Tagged treadmill
[REVIEW] Mobility and the Lower Extremity | EBRSR – Evidence-Based Review of Stroke Rehabilitation – Full Text PDF
Posted by Kostas Pantremenos in Gait Rehabilitation - Foot Drop on October 5, 2016
Mobility and the Lower Extremity
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Source: Mobility and the Lower Extremity | EBRSR – Evidence-Based Review of Stroke Rehabilitation
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[Abstract] Constraining movement reveals motor capability in chronic stroke: An initial study
Posted by Kostas Pantremenos in Constraint induced movement therapy CIMT, Gait Rehabilitation - Foot Drop on September 6, 2016
Abstract
Objective: To determine if persons with chronic stroke and decreased hip and knee flexion during swing can walk with improved swing-phase kinematics when the task demands constrained gait to the sagittal plane.
Design: A one-day, within-subject design comparing gait kinematics under two conditions: Unconstrained treadmill walking and a constrained condition in which the treadmill walking space is reduced to limit limb advancement to occur in the sagittal plane.
Setting: Outpatient physical therapy clinic.
Subjects: Eight individuals (mean age, 64.1 ±9.3, 2 F) with mild-moderate paresis were enrolled.
Main measures: Spatiotemporal gait characteristics and swing-phase hip and knee range of motion during unconstrained and constrained treadmill walking were compared using paired t-test and Cohen’s d (d) to determine effect size.
Results: There was a significant, moderate-to-large effect of the constraint on hip flexion (p < 0.001, d = –1.1) during initial swing, and hip (p < 0.05, d = –0.8) and knee (p < 0.001, d = –1.1) flexion during midswing. There was a moderate effect of constraint on terminal swing knee flexion (p = 0.238, d = –0.6). Immediate and significant changes in step width (p < 0.05, d = 0.9) and paretic step length (p < 0.05, d = –0.5) were noted in the constrained condition compared with unconstrained.
Conclusion: Constraining the treadmill walking path altered the gait patterns among the study’s participants. The immediate change during constrained walking suggests that patients with chronic stroke may have underlying movement capability that they do not preferentially utilize.
Source: Constraining movement reveals motor capability in chronic stroke: An initial study
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[Abstract] High-intensity treadmill training improves gait ability, VO2peak and cost of walking in stroke survivors: preliminary results of a pilot randomized controlled trial. – Europe PMC
Posted by Kostas Pantremenos in Gait Rehabilitation - Foot Drop on September 5, 2016
Abstract
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[Clinical Study] Exploiting Interlimb Arm and Leg Connections for Walking Rehabilitation: A Training Intervention in Stroke. – Full Text
Posted by Kostas Pantremenos in Gait Rehabilitation - Foot Drop, Neuroplasticity on June 19, 2016
Abstract
Rhythmic arm and leg (A&L) movements share common elements of neural control. The extent to which A&L cycling training can lead to training adaptations which transfer to improved walking function remains untested. The purpose of this study was to test the efficacy of A&L cycling training as a modality to improve locomotor function after stroke. Nineteen chronic stroke (>six months) participants were recruited and performed 30 minutes of A&L cycling training three times a week for five weeks. Changes in walking function were assessed with (1) clinical tests; (2) strength during isometric contractions; and (3) treadmill walking performance and cutaneous reflex modulation. A multiple baseline (3 pretests) within-subject control design was used. Data show that A&L cycling training improved clinical walking status increased strength by ~25%, improved modulation of muscle activity by ~25%, increased range of motion by ~20%, decreased stride duration, increased frequency, and improved modulation of cutaneous reflexes during treadmill walking. On most variables, the majority of participants showed a significant improvement in walking ability. These results suggest that exploiting arm and leg connections with A&L cycling training, an accessible and cost-effective training modality, could be used to improve walking ability after stroke.
1. Introduction
Body weight supported treadmill training therapy can be used for the recovery of walking after neurological damage. In this rehabilitation paradigm, participants walk on a motorized treadmill with a harness system allowing the weakened leg muscles to be freed from the necessity of body weight support and stepping is performed with the help of robotic interfaces or therapists. This protocol was initially utilized after spinal cord injury and may be equally beneficial for recovery of walking after stroke [1–5].
Results from this therapy are positive, but there are significant limitations that limit access for the broader stroke population. Body weight supported treadmill training therapy has significant labour requirements, requires specialized equipment, and is typically only available in restricted environments such as in rehabilitation centers [6, 7]. In addition, body weight supported treadmill training offers no additional benefit over conventional physical therapy, as demonstrated in a large randomized clinical trial [2]. A more cost-effective and generally accessible protocol based upon a device (e.g., arm and leg ergometer or a recumbent stepper) that could be more readily used in therapy would be of great benefit where less training is required for physical therapists to supervise training and participants may be more likely to comply with a community-based training regimen [2, 8].
In addition to finding a rehabilitation program that is widely accessible, exploiting the neural and mechanical linkages between the arms and legs that are inherent parts of human locomotion could enhance the recovery of walking [6, 9, 10]. Therefore, incorporating rhythmic arm movement paradigms for locomotor rehabilitation, such as with arm and leg (A&L) cycling, could be very beneficial to stroke locomotor recovery. Although there are differences in kinematics, balance requirements, and loading of the arms between walking and A&L cycling, this type of training activates similar neural networks that are engaged during walking [11]. We have recently shown that, even following a stroke, neural commonalities between A&L cycling and walking persist, despite altered descending supraspinal input from the stroke lesion [12]. Given that A&L cycling and walking share common neural elements and that this persists following stroke, there is a reasonable basis for expectation of training transfer to improve walking.
The extent to which A&L cycling training can lead to training adaptations which transfer to improved walking function remains untested. Thus, the objective of this project was to test the efficacy of A&L cycling training to enhance walking after stroke. Given that A&L cycling and walking share a common core of subcortical regulation, we hypothesize that A&L cycling training will transfer to an improvement in walking. Improvements in walking function were gauged by changes in clinical walking status, strength, and walking performance. If indirect training with A&L cycling does improve walking function, this adjunct therapy could be used as an additional modality to improve walking ability after stroke.
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[ARTICLE] Effects of task-oriented treadmill-walking training on walking ability of stoke patients
Posted by Kostas Pantremenos in Gait Rehabilitation - Foot Drop on May 10, 2015
Abstract
Background: Generally, treadmill-walking training focuses on weight bearing and the speed of walking. However, changes in direction, speed, and slope while walking require adaptation.
Objective: The effects of task-oriented treadmill-walking training (TOTWT) on the walking ability of stroke patients were evaluated.
Methods: Subjects were randomly divided into two groups: the task-oriented treadmill-walking training (TOTWT) group and the conventional treadmill-walking training (CTWT) group. Evaluation was performed before the commencement of the training and again 4 and 8 wk after training was initiated. The OptoGait system measured gait parameters. The Timed Up and Go test and 6-min walk test were also performed.
Results: Within each group, both the TOTWT and the CTWT groups significantly differed before and after the intervention in all tests (P < 0.05); the CTWT group showed greater improvement in all tests following TOTWT (P < 0.05).
Conclusion: TOTWT improves gait and rehabilitation in the stroke-affected limb, and also improves general gait characteristics.
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[REVIEW] Mobility and the Lower Extremity | EBRSR – Evidence-Based Review of Stroke Rehabilitation – Full Text PDF
Posted by Kostas Pantremenos in Gait Rehabilitation - Foot Drop, REHABILITATION on January 24, 2015
Abstract
Rehabilitation techniques of sensorimotor complications post stroke fall loosely into one of two categories; the compensatory approach or the restorative approach. While some overlap exists, the underlying philosophies of care are what set them apart. The goal of the compensatory approach towards treatment is not necessarily on improving motor recovery or reducing impairments but rather on teaching patients a new skill, even if it only involves pragmatically using the non-involved side (Gresham et al. 1995). The restorative approach focuses on traditional physical therapy exercises and neuromuscular facilitation, which involves sensorimotor stimulation, exercises and resistance training, designed to enhance motor recovery and maximize brain recovery of the neurological impairment (Gresham et al. 1995). In this review, rehabilitation of mobility and lower extremity complications is assessed. An overview of literature pertaining to the compensatory approach and the restorative approach is provided. Treatment targets discussed include balance retraining, gait retraining, strength training, cardiovascular conditioning and treatment of contractures in the lower extremities. Technologies used to aid rehabilitation include assistive devices, electrical stimulation, and splints.
via Mobility and the Lower Extremity | EBRSR – Evidence-Based Review of Stroke Rehabilitation.
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[ARTICLE] Gait training strategies to optimize walking ability in people with stroke: A synthesis of the evidence. – Full Text
Posted by Kostas Pantremenos in Gait Rehabilitation - Foot Drop on October 24, 2014
…This paper systematically reviews common gait training strategies (neurodevelopmental techniques, muscle strengthening, treadmill training, intensive mobility exercises) to improve walking ability. The results (descriptive summaries as well as pooled effect sizes) from randomized controlled trials are presented and implications for optimal gait training strategies are discussed. Novel and emerging gait training strategies are highlighted and research directions proposed to enable the optimal recovery and maintenance of walking ability…
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[ARTICLE] Turning-Based Treadmill Training Improves Turning Performance and Gait Symmetry After Stroke
Posted by Kostas Pantremenos in Gait Rehabilitation - Foot Drop on September 26, 2014
Abstract
Background. Turning is a challenging task for stroke patients. Programs that effectively target turning, however, have not been established.
Objective. This study examined the effects of a novel turning-based treadmill training on turning performance, gait symmetry, balance, and muscle strength in patients with chronic stroke.
Methods. Thirty participants were randomly assigned to the experimental group that received 30 minutes of turning-based treadmill training or to the control group that received 30 minutes of regular treadmill training, followed by a 10-minute general exercise program for 12 sessions over 4 weeks. Primary outcomes (overground turning speed and temporal–spatial characteristics of straight walking) and secondary outcomes (balance and muscle strength) were assessed at baseline, after training, and at 1-month follow-up.
Results. Fifteen participants per group were 54.2 ± 9.6 years old, poststroke 2.6 ± 1.9 years, and walked overground at 0.59 ± 0.28 m/s. Sixteen had an ischemic and 14 a hemorrhagic stroke. There were significant interaction effects between groups and time on turning speed regardless of turning direction, straight-walking performance (speed and temporal symmetry), strength of hip muscles and ankle dorsiflexors, and balance control (Berg Balance Scale, weight shifting in the forward direction and vestibular function). Compared with the control group, the experimental group showed greater improvements in these measures following training. These improvements persisted at the 1-month follow-up evaluation.
Conclusions. Turning-based treadmill training may be a feasible and effective strategy to improve turning ability, gait symmetry, muscle strength, and balance control for individuals with chronic stroke.
more–> Turning-Based Treadmill Training Improves Turning Performance and Gait Symmetry After Stroke.
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