Abstract
Impairments in walking speed, capacity, and endurance are commonly seen after stroke. Treadmill training improves endurance and gait speed. However, the lack of variable training speed and automated speed progression increases the risk of backward displacement and falling. An automated, speed-sensing treadmill prototype with partial body weight support, the Variable Automated Speed and Sensing Treadmill II (VASST II), was tested in an outpatient rehabilitation setting. Eleven subacute or chronic hemiplegics who could ambulate at > 0.2 m/s for >50 m participated in the study. All subjects underwent physiotherapist-supervised training on VASST II for 60 min daily, 3 times per week, for 5 weeks (total 15 h). Outcome measures at Week 3 (mid-VASST II training), Week 6 (post-VASST II training), Week 12 (first follow-up), and Week 24 (second follow-up) included the 6 minute walk test (6 MWT), 10 meter walk test (10 MWT), Berg Balance Scale (BBS) score, and Functional Ambulation category (FAC) score. User acceptability of VASST II for both study subjects and physiotherapists were also assessed. All subjects [median (IQR) age: 53.0 (22) years; median (IQR) duration post-stroke: 524 (811) days] completed VASST II training. At baseline, mean ± SD 6 MWT was 114 ± 50.9 m; mean ± SD 10 MWT was 0.37 ± 0.18 m/s; mean ± SD BBS score was 40 ± 10; and, mean ± SD FAC score was 4 ± 1. At Week 6, there were significant improvements in the 6 MWT [158.91 ± 88.69 m; P = 0.003], 10 MWT [0.49 ± 0.30 m/s; P = 0.016], and BBS score [42 ± 10; P = 0.003]. Improvements in 6 MWT and BBS scores were sustained at Week 24, but not in the 10 MWT. No VASST II-training related falls were reported. All subjects rated their VASST II training positively and indicated that it improved their current walking ability. VASST II training was effective, feasible, and safe in patients with subacute or chronic post-stroke hemiparetic gait, with sustained gains in distance walked (6 MWT) and functional balance (BBS score) up to 19 weeks post-intervention.
Highlights
Stroke remains a leading cause of death and disability globally
A prospective, single arm, open-label pilot feasibility study of subjects with sub-acute and chronic stroke was conducted in a tertiary rehabilitation center with close affiliations to an acute stroke unit
Written, informed consent was obtained from all subjects prior to all research interventions
Summary
Stroke remains a leading cause of death and disability globally. Findings from the Global Burden of Disease Study 2017 indicate that stroke was the third leading cause of mortality (accounting for over 6.1 million deaths), and one of 5 leading causes of morbidity, accounting for 132 million disability- adjusted lifeyears (DALYs) worldwide in 2017 [1, 2]. Treadmill training is postulated to confer beneficial locomotor benefits by enhancing repetitive stepping practice and task-specific training, compared to traditional overground training sessions supervised by physiotherapists [5] This is further corroborated by the findings of a systematic review of studies involving ambulatory sub-acute/chronic stroke patients [Functional Ambulation Category (FAC) score ≥3 and baseline walking speed ≥0.2 m/s], whereby treadmill training improved gait speed by 0.14 m/s [measured by the 10 meter walk test (10 MWT)] and distance walked by 40 m [measured by the 6 minute walk test (6 MWT)] immediately post-intervention [12, 19].
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