Abstract

BackgroundTreadmill training, with or without body-weight support (BWSTT), typically involves high step count, faster walking speed, and higher heart-rate intensity than overground walking training. The addition of challenging mobility skill practice may offer increased opportunities to improve walking and balance skills. Here we compare walking and balance outcomes of chronic stroke survivors performing BWSTT with BWSTT including challenging mobility skills.MethodsSingle-blind randomized clinical trial comparing two BWSTT interventions performed in a rehabilitation research laboratory facility over 6 weeks. Participants were 18+ years of age with chronic (≥5 months) poststroke hemiparesis due to a cortical or subcortical ischemic or hemorrhagic stroke and walking speeds < 1.1 m/s at baseline. A hands-free group (HF; n = 15) performed BWSTT without assistance from handrails or assistive devices, and a hands-free plus challenge group (HF + C; n = 14) performed the same protocol while additionally practicing challenging mobility skills. The primary outcome was change in comfortable walking speed (CWS), with secondary outcomes of fast walk speed (FWS), six-minute walk distance, Berg Balance Scale (BBS) scores, and Activities Specific Balance Confidence (ABC) scores.ResultsSignificant pre-post improvement of CWS (Z = − 4.2, p ≤ 0.0001) from a median of 0.35 m/s (range 0.10 to 1.09) to a median of 0.54 m/s (range 0.1 to 1.17), but no difference observed between groups (U = 96.0, p = 0.69). Pre-post improvements across all participants resulted in reclassified baseline ambulation status from sixteen to ten household ambulators, three to seven limited community ambulators, and ten to twelve community ambulators. Secondary outcomes showed similar pre-post improvements with no between-group differences.ConclusionsThe addition of challenging mobility skills to a hands-free BWSTT protocol did not lead to greater improvements in CWS following 6 weeks of training. One reason for lack of group differences may be that both groups were adequately challenged by walking in an active, self-driven treadmill environment without use of handrails or assistive devices.Trial registrationNCT02787759 Falls-based Training for Walking Post-Stroke (FBT); retrospectively registered June 1st, 2016.

Highlights

  • A major focus of stroke rehabilitation is to improve walking function to a safe level for community ambulation

  • We secondarily explored changes in fast walk speeds (FWS), six-minute walk distance, Berg Balance Scale (BBS) scores, and Activities-Specific Balance Confidence (ABC) scores

  • The nine mobility skills used in this study offered participants this experience; practicing these skills was not essential to engender improvements in walking function for these chronic stroke survivors

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Summary

Introduction

A major focus of stroke rehabilitation is to improve walking function to a safe level for community ambulation. Body-weight-supported treadmill training (BWSTT) is a technique that yields moderate improvements in walking function for individuals in both subacute and chronic phases poststroke [1,2,3,4,5]. The LEAPS trial [9] and other smaller studies [3, 10, 11] incorporated overground mobility skills into their protocols and saw large improvements in walking speed (i.e., > 0.2 m/s). With or without body-weight support (BWSTT), typically involves high step count, faster walking speed, and higher heart-rate intensity than overground walking training. We compare walking and balance outcomes of chronic stroke survivors performing BWSTT with BWSTT including challenging mobility skills

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