Changes in Gait Symmetry After Training on a Treadmill with Biofeedback in Chronic Stroke Patients: A 6-Month Follow-Up From a Randomized Controlled Trial

Abstract

BackgroundOne of the most significant challenges for patients who survive a stroke is relearning basic motor tasks such as walking. The goal of this study was to evaluate whether training on a treadmill with visual biofeedback improves gait symmetry, as well as spatiotemporal and kinematic gait parameters, in stroke patients.Material/MethodsThirty patients in the chronic phase after a stroke were randomly allocated into groups with a rehabilitation program of treadmill training with or without visual biofeedback. The training program lasted 10 days. Spatiotemporal and kinematic gait parameters were evaluated. For all parameters analyzed, a symmetrical index was calculated. Follow-up studies were performed 6 months after completion of the program.ResultsThe symmetrical index had significantly normalized in terms of the step length (p=0.006), stance phase time, and inter-limb ratio in the intervention group. After 6 months, the improvement in the symmetry of the step length had been maintained. In the control group, no statistically significant change was observed in any of the parameters tested. There was no significant difference between the intervention group and the control group on completion of the program or at 6 months following the completion of the program.ConclusionsTraining on a treadmill has a significant effect on the improvement of spatiotemporal parameters and symmetry of gait in patients with chronic stroke. In the group with the treadmill training using visual biofeedback, no significantly greater improvement was observed.

A Study of Biofeedback Gait Training in Cerebral Stroke Patients in the Early Recovery Phase with Stance Phase as Target Parameter

“…Positive changes in walking biomechanics were noted in both groups. An earlier study by the same authors demonstrated improvement in gait symmetry and spatiotemporal parameters [18]. Other researchers [19] demonstrated a positive response to BFB training using a specific parameter (stance phase).…”

“…In a study carried out by Druzbicki et al [17], no significant effect of BFB training was noted. However, some effect was noted in their earlier study [18]. In the research of Gente et al [12], training was based on the ground reaction force at the end of the stance phase, with both visual and auditory feedback.…”

Biofeedback for Post-stroke Gait Retraining: A Review of Current Evidence and Future Research Directions in the Context of Emerging Technologies

“…Overall lower extremity motor deficit is another patient selection criterion, but the measurement tools and cutoff points used to quantify level of deficit vary widely ( 1 , 8 , 23 ). Past studies have included stroke survivors at a specific Brunnstrom stage of recovery ( 21 , 22 ) or with ability to ambulate a predetermined distance or time ( 1 , 23 , 24 ).…”

“…However, most stroke studies consider cognition, level of gross motor deficit, and level of visual deficit when selecting patients. Exclusion criteria for cognitive deficits have the highest degree of uniformity, with several studies setting a mini-mental state exam score cutoff at 24 for inclusion (21)(22)(23).…”

“…Importantly,Druzbicki et al's (21) study differed from many other biofeedback RCTs by involving patients in the sub-acute phase of recovery and combined biofeedback with body weight supported gait training. The same study team also performed another highquality RCT using similar feedback parameters (visual feedback targeting paretic step length during treadmill training) on individuals with chronic stroke, and found no significant longterm increases in step length and step symmetry compared to a control group of post-stroke individuals performing treadmill training without biofeedback when initial values were compared to those gathered after 6-month(22,36). Similarly, Brasileiro et al(25) found no significant improvement in stride length in post stroke individuals with the addition of spatiotemporal biofeedback to partial bodyweight supported treadmill training program.…”