Task-oriented treadmill exercise training in chronic hemiparetic stroke

Abstract

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.

ZeroG: Overground gait and balance training system

“…Varying BWS can also be used to alter the intensity of gait therapy since unloading the patient decreases both muscle demands and, subsequently, muscle forces throughout the lower limbs [6][7][8]. This can be particularly important during the early stages of neurological injury when patients are often sick and have poor cardiovascular endurance [9].…”

Chronic Ambulatory Stroke Survivors: Is It Safe to Walk Faster?

“…Based on the observation from the literature, the desired outcomes following specialized stroke rehabilitation basically depend on two key elements: Training intensity and task-specificity [21]. Treadmill Training is a gaitoriented exercise model that focuses on multiple physiological systems to improve mobility recovery in terms of increase walking speed by providing a task-repetitive locomotor training to patients following stroke [22]. Generally, the task specificity of treadmill training is represented by several perspectives: (1) specificity and variability of practice, (2) timing (inter-limb coordination) (3) improved capacity and quality for walking (speed, strength and balance) and (4) cardiovascular training (endurance) [22].…”

“…Treadmill Training is a gaitoriented exercise model that focuses on multiple physiological systems to improve mobility recovery in terms of increase walking speed by providing a task-repetitive locomotor training to patients following stroke [22]. Generally, the task specificity of treadmill training is represented by several perspectives: (1) specificity and variability of practice, (2) timing (inter-limb coordination) (3) improved capacity and quality for walking (speed, strength and balance) and (4) cardiovascular training (endurance) [22]. The training intensity varied as various treadmill training intensities have been proposed.…”

The effect of treadmill gait training with patellar taping on gait abilities in chronic stroke patients

“…Recently, treadmill gait training is frequently used as a therapeutic approach to improve gait patterns of stroke patients within the clinic [16][17][18]. Also, treadmill gait training is used for rehabilitation of stroke patients or patients who have gait disturbances clinically [19].…”