Poster 79: Task-Oriented Locomotor Training With and Without Load at the Ankle in Stroke Individuals

Abstract

Objective: To test the impact of a load placed at the ankle during treadmill locomotor training on the paretic hip muscle strength and gait performance in stroke patients. Design: Cross-design study. Setting: Research laboratory at a university-affiliated inpatient rehabilitation hospital. Participants: 10 chronic-stroke participants (56.3±10.5y) with hip weakness on the paretic side and reduced gait speed (0.66±0.19m.s-1). Intervention: Treadmill gait training during two 4-week training periods, separated by 2 weeks of rest. A load of 1.5kg was added at the paretic ankle during one of the two 4-week training periods. Training consisted of three 1-hour sessions per week, including 20 minutes of strenuous walking. Main Outcome Measures: Natural and maximal gait speed measured over a 10-m, 6-minute walk test, maximal flexor and extensor strength at the hemiparetic hip. Results: Over the 8-week training period, the natural gait speed increased from 0.66±0.19 to 0.79±0.29m.s-1 (P=.039, effect size ([ES])=0.53), and maximal gait speed from 0.85±0.35 to 1.05±0.46m.s-1 (P=0.013, ES=0.49), while the six-minute walk test did not improve significantly (from 236.2±93.6 to 290.3±126.4m, P=0.077, ES=0.49). Within this 8-week period, effect sizes were slightly larger for the no-load (0.31<ES<0.41) than the load condition (0.12<ES<0.18), for gait speeds and endurance. However, hip muscle strength increased more with the load than the no-load condition, both for flexors (ES=0.49 vs 0.09) and extensors (ES=0.31 vs 0.13). Conclusions: Despite higher gains in strength obtained during treadmill training with a load at the ankle, gait performances did not improve accordingly during this period. A detailed biomechanical gait analysis will be required to further explain these findings.