Body-Weight–Supported Treadmill Rehabilitation after Stroke

Abstract

BACKGROUND Locomotor training, including the use of body-weight support in treadmill stepping, is a physical therapy intervention used to improve recovery of the ability to walk after stroke. The effectiveness and appropriate timing of this intervention have not been established. METHODS We stratified 408 participants who had had a stroke 2 months earlier according to the extent of walking impairment — moderate (able to walk 0.4 to <0.8 m per second) or severe (able to walk <0.4 m per second) — and randomly assigned them to one of three training groups. One group received training on a treadmill with the use of body-weight support 2 months after the stroke had occurred (early locomotor training), the second group received this training 6 months after the stroke had occurred (late locomotor training), and the third group participated in an exercise program at home managed by a physical therapist 2 months after the stroke (home-exercise program). Each intervention included 36 sessions of 90 minutes each for 12 to 16 weeks. The primary outcome was the proportion of participants in each group who had an improvement in functional walking ability 1 year after the stroke. RESULTS At 1 year, 52.0% of all participants had increased functional walking ability. No significant differences in improvement were found between early locomotor training and home exercise (adjusted odds ratio for the primary outcome, 0.83; 95% confidence interval [CI], 0.50 to 1.39) or between late locomotor training and home exercise (adjusted odds ratio, 1.19; 95% CI, 0.72 to 1.99). All groups had similar improvements in walking speed, motor recovery, balance, functional status, and quality of life. Neither the delay in initiating the late locomotor training nor the severity of the initial impairment affected the outcome at 1 year. Ten related serious adverse events were reported (occurring in 2.2% of participants undergoing early locomotor training, 3.5% of those undergoing late locomotor training, and 1.6% of those engaging in home exercise). As compared with the home-exercise group, each of the groups receiving locomotor training had a higher frequency of dizziness or faintness during treatment (P=0.008). Among patients with severe walking impairment, multiple falls were more common in the group receiving early locomotor training than in the other two groups (P = 0.02). CONCLUSIONS Locomotor training, including the use of body-weight support in stepping on a treadmill, was not shown to be superior to progressive exercise at home managed by a physical therapist. (Funded by the National Institute of Neurological Disorders and Stroke and the National Center for Medical Rehabilitation Research; LEAPS ClinicalTrials.gov number, NCT00243919.)

Randomized Trial on the Effects of Attentional Focus on Motor Training of the Upper Extremity Using Robotics With Individuals After Chronic Stroke

“…[42][43][44] It is worth noting that the participants in the EF group completed more repetitions per session (mean, 935.1) than the IF group (mean, 883.8). Reasons for reduced dosage for both groups included arriving late/transportation issues and complaints of fatigue (especially during early sessions; this improved over time as subjects got used to the protocol).…”

Rehabilitación de la marcha en el paciente con ictus. Revisión bibliográfica

“…Atendiendo a la puntuación mínima establecida por cada escala para determinar que un estudio tiene una calidad metodológica aceptable (≥ 7 para la escala PEDro, ≥ 3 para la escala Jadad), cinco investigaciones superaron ambas puntuaciones (Combs-Miller et al, 2014;De Paul et al, 2015;Duncan et al, 2011;MacKay-Lyons et al, 2013;Middleton et al, 2014), otras dos (Høyery et al, 2012;Mao et al, 2015;) superaron la puntuación de la escala PEDro pero no la de la escala Jadad y una (Takami & Wakayama, 2010) superó la de la escala Jadad, pero no la de la escala PEDro. Así pues, de los once artículos incluidos en esta revisión, solo tres (Middleton et al, 2014;Ribeiro et al, 2013;Park et al, 2015) no presentaron una calidad metodológica aceptable.…”

“…En siete estudios (Combs-Miller et al, 2014;De Paul et al, 2015;Duncan et al, 2011;Høyer et al, 2012;Langhammer & Stanghelle, 2010;MacKay-Lyons et al, 2013;Middleton et al, 2014;) se evaluó la capacidad funcional mediante el test 6 minutos marcha. Aunque en los siete estudios la mejoría fue mayor en el grupo EMSP, solo en el trabajo de MacKay-Lyons et al, (2013) las diferencias fueron estadísticamente significativas a favor del grupo EMSP.…”

“…Cuatro de los once estudios incluidos en esta revisión valoraron el equilibrio (Duncan et al, 2011;MacKay-Lyons et al, 2013;Middleton et al, 2014;Takami & Wakayama, 2010) utilizando la escala de Berg. Ningún estudio encontró diferencias estadísticamente significativas, aunque en tres de los cuatro estudios el grupo ECM obtuvo mejor puntuación que el grupo EMSP y, solo en el trabajo de Takami y Wakayama (2010) ocurrió lo contrario.…”

Can We Improve Real World Walking After Stroke? A Systematic Review and Meta-Analysis

“…Several randomised controlled trials have investigated the use of exercise-based interventions to improve walking for people with stroke (10)(11)(12)(13)(14). Most studies report similar findings with gains in the ability to walk further and/or faster in the indoor clinic setting (10,(12)(13)(14).…”