Speed-Dependent Treadmill Training in Ambulatory Hemiparetic Stroke Patients

Pohl, Marcus; Mehrholz, Jan; Ritschel, Claudia; Rückriem, Stefan

doi:10.1161/hs0202.102365

Cited by 450 publications

(352 citation statements)

References 32 publications

(51 reference statements)

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“…25,26 Positive effects of higher speed on gait quality have been reported on the treadmill. 22,23 On the Lokomat, faster training speed is possible compared with conventional gait training. The transfer of improved gait quality during treadmill training to walking on the floor has yet to be demonstrated.…”

Section: Discussionmentioning

confidence: 99%

Effects of Locomotion Training With Assistance of a Robot-Driven Gait Orthosis in Hemiparetic Patients After Stroke

Husemann

Müller

Krewer

et al. 2007

Stroke

368

271

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Background and Purpose-The success of gait rehabilitation after stroke depends on active walking exercises. However, the disabling after-effects of stroke often make such exercises impossible at the onset of therapy. To facilitate treadmill training of paraparetic patients, a robot-driven gait orthosis (Lokomat) was developed. We investigated the effects of the Lokomat when used with hemiparetic patients. Methods-The authors conducted a randomized, controlled pilot study of 30 acute stroke survivors. The treatment group received 30 minutes of robotic training daily and the control group 30 minutes of conventional physiotherapy daily in addition to 30 minutes of conventional physiotherapy for each group. Outcome measures were independence of gait, gait speed, gait parameters, and body tissue composition. Results-After 4 weeks of therapy, the walking ability of the Lokomat group and the control group expressed as the functional ambulation classification was significantly improved. The functional ambulation category (medianϮ interquartile range) was at baseline 0Ϯ0 in control and 0Ϯ1 in the therapy group and increased after therapy to 1Ϯ3 in both groups significantly (Pϭ0.01). There was no significant difference in gain of these parameters between the groups. The Lokomat group had a significantly longer single stance phase (sec; meanϮSEM) on the paretic leg when walking on the floor. At baseline, it was 0.19Ϯ0.17 and after therapy 0.49Ϯ0.07 (Pϭ0.014). The control group had increased their body weight approximately 1.33Ϯ1.40 kg (meanϮSEM; Pϭ0.046), mostly as fat mass, whereas the Lokomat group had lost fat mass approximately Ϫ2.9Ϯ1.0 kg (meanϮSEM; Pϭ0.016) and increased their muscle mass approximately 3.36Ϯ1.4 kg (meanϮ SEM; Pϭ0.031). Conclusions-This pilot study indicates that Lokomat therapy is a promising intervention for gait rehabilitation. Although there was no difference between groups in gain of functional scores, the Lokomat group showed an advantage of robotic training over conventional physiotherapy in improvement of gait abnormality and body tissue composition. (Stroke.

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Section: Discussionmentioning

confidence: 99%

Effects of Locomotion Training With Assistance of a Robot-Driven Gait Orthosis in Hemiparetic Patients After Stroke

Husemann

Müller

Krewer

et al. 2007

Stroke

368

271

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“…Specifically, consideration must be made in terms of intensity and duration of the TM training stimulus that may affect outcomes in the realms of function and metabolism. Followup studies are currently underway that build upon the work of Pohl et al [57] and others [58][59] by randomizing …”

Section: Summary and Future Researchmentioning

confidence: 99%

Task-oriented treadmill exercise training in chronic hemiparetic stroke

Ivey

Hafer‐Macko²,

Macko³

2008

JRRD

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Abstract-Patients with stroke have elevated hemiparetic gait costs secondary to low activity levels and are often severely deconditioned. Decrements in peak aerobic capacity affect functional ability and cardiovascular-metabolic health and may be partially mediated by molecular changes in hemiparetic skeletal muscle. Conventional rehabilitation is time delimited in the subacute stroke phase and does not provide adequate aerobic intensity to reverse the profound detriments to fitness and function that result from stroke. Hence, we have studied progressive full body weight-support treadmill (TM) training as an adjunct therapy in the chronic stroke phase. Task-oriented TM training has produced measurable changes in fitness, function, and indices of cardiovascular-metabolic health after stroke, but the precise mechanisms for these changes remain under investigation. Further, the optimal dose of this therapy has yet to be identified for individuals with stroke and may vary as a function of deficit severity and outcome goals. This article summarizes the functional and metabolic decline caused by inactivity after stroke and provides current evidence that supports the use of TM training during the chronic stroke phase, with protocols and inclusion/exclusion criteria described. Our research findings are discussed in relation to associated research.Key words: aerobic activity, ambulatory function, cardiovascular disease risk, exercise training, hemiplegia, metabolic health, physical deconditioning, rehabilitation, stroke, treadmill. PROBLEM OF POSTSTROKE DECONDITIONINGStroke is a leading cause of disability [1][2][3][4], with residual neurological deficits that persistently impair function and lead to profound physical deconditioning [5][6]. By limiting mobility and increasing fall risk, the hemiparetic gait that accompanies chronic stroke promotes a sedentary lifestyle, which leads to disability through deconditioning and "learned non-use" [7][8]. Peak cardiovascular fitness levels following hemiparetic stroke are roughly half those of age-matched sedentary individuals [5,[9][10]. Further, the energy requirements of hemiparetic gait are elevated by 55 to 100 percent compared with age-matched control subjects [11][12]. This detrimental combination of poor peak exercise capacity and elevated energy demands for hemiparetic gait is termed diminished physiological fitness reserve [13]. The cardiovascular deconditioning coupled with the secondary body composition abnormalities that follow stroke Abbreviations: ACSM = American College of Sports Medicine, ADL = activities of daily living, BMI = body mass index, CVD = cardiovascular disease, ECG = electrocardiogram, HR = heart rate, HRR = HR reserve, IGT = impaired glucose tolerance, MHC = myosin heavy chain, T2DM = type 2 diabetes mellitus, TM = treadmill, TNF-α = tumor necrosis factor-α, WIQ = Walking Impairment Questionnaire, VA = Department of Veterans Affairs, VO 2 = peak oxygen consumption.

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“…15 In another study, ambulatory hemiparetic patients even tolerated speed-dependent treadmill training with maximum belt velocities of up to 1.5 m/s. 16 Treatment duration/session was 15 to 20 minutes with an optional break after 10 minutes. Physical help, eg, for the control of the paretic knee or assistance of hip extension, in the stance phase was administered according to individual needs.…”

Section: Therapy On the Gait Trainermentioning

confidence: 99%

Treadmill training with partial body weight support and physiotherapy in stroke patients: a preliminary comparison

Werner

Bardeleben

Kirker

et al. 2002

Euro J of Neurology

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Background and Purpose-The purpose of this study was to compare treadmill and electromechanical gait trainer therapy in subacute, nonambulatory stroke survivors. The gait trainer was designed to provide nonambulatory subjects the repetitive practice of a gait-like movement without overexerting therapists. Methods-This was a randomized, controlled study with a crossover design following an A-B-A versus a B-A-B pattern.A consisted of 2 weeks of gait trainer therapy, and B consisted of 2 weeks of treadmill therapy. Thirty nonambulatory hemiparetic patients, 4 to 12 weeks after stroke, were randomly assigned to 1 of the 2 groups receiving locomotor therapy every workday for 15 to 20 minutes for 6 weeks. Weekly gait ability (functional ambulation category [FAC]), gait velocity, and the required physical assistance during both kinds of locomotor therapy were the primary outcome measures, and other motor functions (Rivermead motor assessment score) and ankle spasticity (modified Ashworth score) were the secondary outcome measures. Follow-up occurred 6 months later. Results-The groups did not differ at study onset with respect to the clinical characteristics and effector variables. During treatment, the FAC, gait velocity, and Rivermead scores improved in both groups, and ankle spasticity did not change. Median FAC level was 4 (3 to 4) in group A compared with 3 (2 to 3) in group B at the end of treatment (Pϭ0.018), but the difference at 6-month follow up was not significant. The therapeutic effort was less on the gait trainer, with 1 instead of 2 therapists assisting the patient at study onset. All but seven patients preferred the gait trainer. Conclusions-The newly developed gait trainer was at least as effective as treadmill therapy with partial body weight support while requiring less input from the therapist. Further studies are warranted.

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Speed-Dependent Treadmill Training in Ambulatory Hemiparetic Stroke Patients

Cited by 450 publications

References 32 publications

Effects of Locomotion Training With Assistance of a Robot-Driven Gait Orthosis in Hemiparetic Patients After Stroke

Effects of Locomotion Training With Assistance of a Robot-Driven Gait Orthosis in Hemiparetic Patients After Stroke

Task-oriented treadmill exercise training in chronic hemiparetic stroke

Treadmill training with partial body weight support and physiotherapy in stroke patients: a preliminary comparison

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