Serial Backward Locomotor Treadmill Training Improves Bidirectional Walking Performance in Chronic Stroke.

Brett M Kissela,Pierce Boyne,Kari Dunning,Bridget A Rizik,Oluwole O Awosika,Heidi J Sucharew,Amit Bhattacharya,Dorothy Chan

doi:10.3389/fneur.2022.800757

Brett M Kissela, Pierce Boyne + Show 6 more

Open Access

https://doi.org/10.3389/fneur.2022.800757

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Abstract

Background and Research QuestionWalking impairment remains a major limitation to functional independence after stroke. Yet, comprehensive and effective strategies to improve walking function after stroke are presently limited. Backward Locomotor Treadmill Training (BLTT) is a promising training approach for improving walking function; however, little is known about its mechanism of effect or the relationship between backward walking training and resulting overground forward walking performance. This study aims to determine the effects of serial BLTT on spatial aspects of backward and forward walking in chronic post-stroke individuals with residual walking impairment.MethodsThirty-nine adults (>6 months post-stroke) underwent 6 days of BLTT (3 × /week) over 2 weeks. Outcome measures included PRE-POST changes in backward and forward walking speeds, paretic and non-paretic step lengths, and single-support center of pressure distances. To determine the association between BLTT and overground walking, correlation analyses comparing training-related changes in these variables were performed.ResultsWe report an overall improvement in BLTT and overground walking speeds, bilateral step lengths, and single-support center of pressure distances over six training sessions. Further, there were weak positive associations between PRE-POST changes in BLTT speed, BLTT paretic step length, and overground forward walking speed.Conclusion and SignificanceOur findings suggest that individuals with chronic post-stroke walking impairment experience improvements in spatial walking measures during BLTT and overground. Therefore, BLTT may be a potential adjunctive training approach for post-stroke walking rehabilitation.

Highlights

Walking impairment resulting from stroke significantly reduces functional ambulatory independence and is a significant public health issue worldwide [1]
Functional neuroimaging and electrocorticography studies report greater cerebral activity in the supplementary motor area, pre-central gyrus, and superior parietal lobule during backward compared to forward walking, suggesting that backward walking presents more of a challenge to the nervous system and may provide greater neuronal connectivity, which may contribute to enhancing corticomotor plasticity [15–17]
Thirty-nine chronic stroke survivors with residual walking impairment were recruited from the community and gave written informed consent prior to enrollment, in accordance with the recommendations of the Declaration of Helsinki

Summary

Introduction

Walking impairment resulting from stroke significantly reduces functional ambulatory independence and is a significant public health issue worldwide [1]. While most post-stroke survivors have some residual walking ability,

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