BODY WEIGHT SUPPORT TREADMILL TRAINING IN COMMUNITY REHABILITATION PROGRAM IMPROVES WALKING IN SEVERELY DISABLED STROKE

Abstract

Purpose/Hypothesis: Although Body Weight Support Treadmill Training (BWSTT) has been shown to improve walking velocity, balance and functional status in stroke patients treated in research settings, there are few reports of outcomes for stroke patients treated with BWSTT in a community based outpatient rehab program. The purpose of this study is to determine whether the use of BWSTT in an outpatient rehab program is an effective means of improving patients' functional mobility. Number of Subjects: Twenty-seven (27) stroke patients (22 ischemic, 5 hemorrhagic), with a mean age of 59 (range 21–90), who participated in an outpatient rehab program between 2/02 and 12/04 were selected for this study. Selection was based solely on their diagnosis and their inability to ambulate independently on a treadmill. Four (4) patients were excluded from analysis because of incomplete outcome measurements. Of the remaining twenty-three subjects, baseline modified Rankin scale score was 4 for twenty-two patients and 3 for one patient. Materials/Methods: Participants received BWSTT 1 to 3 times per week, for an average of 12 weeks (range 2–30). The Six Minute Walk Test (SMWT), the Timed Up and Go (TUG) and the Timed Sit to Stand Test (TSST) were administered prior to the start and upon discontinuation of treatment. Results: All patients improved on the SMWT, 20/23 improved on the TUG, and 22/23 improved on the TSST. The average pre-treatment distance walked for the SMWT was 440 feet (range 40–1035), the average post-treatment distance walked was 801 feet (range 70–1500), and the average improvement was 132% (range 3% to 850%). The average initial time on the TUG was 34 seconds (range 8–182), the average post-treatment time was 18 seconds (range 8–111), and the average improvement was 42% (range −15% to 127%). The average initial time to complete the TSST was 33 seconds (range 13–88), the average post-treatment time was 18 seconds (range 9–31), and the average improvement was 38% (range −29% to 85%). Fifteen (15) of the 23 patients achieved independent or supervised ambulation on the treadmill without body weight support. Conclusions: Stroke patients with severe neurologic deficits treated with BWSTT in a community-based rehab program achieved improved walking endurance, balance and functional lower extremity strength by demonstrating improved scores on the tests administered. Clinical Relevance: With greater limitations to outpatient physical therapy, BWSTT is a effective and efficient way to assist stroke patients with a return to safe and independent functional mobility even for those with significant neurologic deficits. The achievement of independent ambulation on a treadmill allows patients to participate in community cardiovascular exercise programs. Ongoing treadmill walking, once patients are discharged from therapy, may further improve their gait pattern, speed and independence.