Treadmill Gait Training Research Articles

A treadmill training program in a gamified virtual reality environment combined with transcranial direct current stimulation in Parkinson's Disease: Study protocol for a randomized controlled trial.

Parkinson's Disease (PD) affects movement and cognition, and physiotherapy, particularly treadmill gait training, has potential in addressing movement dysfunctions in PD. However, treadmill training falls short in addressing cognitive aspects and adherence. Virtual reality (VR) and gamification can enhance motor and cognitive retraining and improve adherence. People with Parkinson's Disease (PWPD) have decreased motor skill learning efficiency, but tDCS can improve motor and cognitive learning. 78 participants with PD will be randomly allocated in a 1:1:1 ratio to one of three groups: (1) treadmill + Gamified Virtual Reality Environment (GVRE) + tDCS training group; (2) treadmill + GVRE training group or (3) treadmill training group. Participants will follow a 6-week, 12-session treadmill gait training plan, gradually increasing session duration from 20 to 45 minutes. Participants in (1) and (2) will undergo a GVRE training protocol, with (1) also receiving tDCS for the first 20 minutes of each session. Assessments will occur at baseline, post-intervention, and at a 6-week follow-up. The primary outcome measure will be gait speed during single and dual-task performance. Secondary measures will include additional gait parameters, executive tests for cognitive performance, and clinical outcomes for disease stage, cognitive status, and physical condition. This randomized clinical trial presents an innovative neurorehabilitation protocol that aims to improve gait and cognition in PWPD. The study also examines how tDCS can enhance motor and cognitive training. Results could contribute to enhancing the motor and cognitive state of PWPD through a GVRE and tDCS-based neurorehabilitation protocol. NCT05243394. 28/02/2024 -v3.2.

Effects of the EXECP Intervention on Motor Function, Muscle Strength and Joint Flexibility in Individuals with Cerebral Palsy.

Numerous exercise interventions to enhance motor function in cerebral palsy (CP) have been proposed, with varying degrees of effectiveness. Since motor function requires a combination of muscle strength, joint flexibility and motor coordination, we designed a supervised multicomponent exercise intervention (EXECP) for individuals with CP. Our aim was to evaluate the effects of the EXECP intervention and its retention after it ceased. The EXECP intervention combined strength training for the lower limbs and trunk muscles, passive stretching for the lower limb muscles and inclined treadmill gait training. Eighteen participants with CP (mean age: 14, 13 males) were tested twice before the three-month intervention and twice after the intervention, each test separated by three months. Seventeen typically developing age and sex-matched controls were tested twice. Motor function was assessed with the six minutes walking test (6MWT) and the gross motor function measure (GMFM) dimensions D and E. Passive joint flexibility was measured with goniometry. Isometric and concentric muscle strength were assessed at the knee, ankle and trunk joints. The EXECP intervention successfully increased 6MWT (p < 0.001), GMFM (p = 0.004) and muscle strength for knee and trunk muscles (p < 0.05), although no changes were observed for ankle joint muscles. Hip and knee joint flexibility also increased (p < 0.05). After the retention period, all tested variables except the 6MWT and knee joint flexibility regressed and were not different from the pre-tests. The improvements in strength, flexibility, and possibly motor coordination brought by the EXECP intervention were transferred to significant functional gains. The regression towards baseline after the intervention highlights that training must be a life-long decision for individuals with CP.

Treadmill versus overground gait training in patients with lower limb burn injury: A comparative study.

The primary goal of the rehabilitation services offered to patients with lower limb burns is to enhance gait function. Exercise on a treadmill and conventional overground gait training are the two most widespread gait-training methods. Numerous studies have been published in the literature that claim treadmill training helps people walk more easily. Therefore, it would be intriguing to investigate whether treadmill gait training affects the progress made by post-lower limb burn patients compared to traditional overground gait training. The goal of the current study was to compare the effectiveness of treadmill training and traditional physical therapy therapies for improving gait after lower limb burn injury. A comparative study, was conducted between January to August 2022 at a burns care unit,in Islamabad. All the participants were informed about the study procedure and consent was taken before initiating the study. All the participants received the set standard of Burn Rehabilitation by the American Burn Association (ABA). The program consists of ROM exercises, mobilization, functional mobility, stretching, balance training,and resisted exercises for enhancing muscle power. Statistical analyses were performed using IBM SPSS 24.0 software. The study subjects selected were 30 burn patients, aged above 18 years, vitally stable and had lower limb burn injuries with an average TBSA (total burn surface area) of 20-30%.The mean for Experimental is 18.86 and control group is 21.13. Patients were randomly either assigned to an experimental group or a control group. The Experimental group had a lower Time Up and Go test score of 11.86±3.58 (9.50-24.07)as compared to the control group's TUG score(of 12.78±4.41(6.30-24.07). Functional mobility significantly improved as the p<0.05. The total mean scores calculated on the Tampa Kinesiophobia scale for the Experimental group were 35.66±6.32 which was less compared with those of the control group 37.93± 6.36. It demonstrates that fear of movement was reduced for treadmill training participants. Comparison of pre-distance (350.9±86.82) , pre-velocity (62.78±20.20) and post distance (385.02±32.29), post-velocity 40.48±21.91 of the experimental group with the control group pre-distance (339.26±98.17, pre-velocity (55.07±22.63) and post-distance (383.07±36.914) post-velocity (40.57±21.95) showed significant changes in results. In contrast to traditional gait training, treadmill training significantly improves walking ability in burn patients with lower limb damage.

Lower Body Positive Pressure Treadmill Gait Training for Walking Recovery After Stroke

Lower Body Positive Pressure Treadmill Gait Training for Walking Recovery After Stroke

The Effectiveness of Lower-Body Positive Pressure Treadmill Gait Training on Mobility Function and Quality of Life in Individuals with Chronic Stroke: Prospective Cohort Study

Background: Lower body positive pressure (LBPP) emerges for rehabilitation practice tool for athletic and orthopedic conditions. However, LBPP may provide an opportunity therapeutic intervention for gait training in neurological conditions. Objectives: To assess the effectiveness of LBPP gait training on ambulation ability, gait speed, walking endurance, dynamic and static balance, and quality of life in individuals with chronic stroke. Methods: Participants performed LBPP gait training three days a week for six weeks. The main outcome measures were functional ambulation categories (FAC), 10-meter walk test (10-MWT), 6 minutes walking test (6MWT), timed up and go (TUG), functional reach test (FRT), and short-form (SF-36) health survey. Results: Nine chronic stroke (one female, eight males) aged 57 ± 15.4 years with stroke since 4.8 ± 3.9 years participated in LBPP gait training. participants showed significant improvement in FAC (pre, 4 ± 2; post, 5 ± 1; P = 0.034); 10-MWT (pre, 16.35 ± 9.34 s; post, 13.25 ± 7.57 s; P = 0.021) and 6 MWT (pre, 166.22 ± 94.15; post, 206.66 ± 103.64; P = 0.048). No significant differences were observed in the other outcomes. Conclusions: Six weeks of LBPP gait training may potentially improve ambulation ability, gait speed, and walking endurance in individuals with chronic stroke.

Muscle activation and rating of perceived exertion of typically developing children during DRY and aquatic treadmill walking.

Aquatic treadmill gait training is a poorly understood rehabilitation method that alters bodyweight support, increases lower limb resistance, and assists with postural stability. This training could be an attractive tool for clinical populations with balance control issues or limited weight-bearing prescriptions for the lower limb. As a first step, the purpose of this study was to quantify differences in mean muscle activity of the tibialis anterior, rectus femoris, medial gastrocnemius, and semitendinosus, and perceived exertion (RPE) in typically developing children (7:8 M:F, age=11.3±4.1years, 1.46±0.18m, and 44.2±16.8kg) during dry and aquatic treadmill walking at 75%, 100%, and 125% self-selected speed. We hypothesized that the greatest mean muscle activity, normalized to percent maximum voluntary contraction and averaged across all strides, would be observed during 125% dry treadmill walking and that aquatic treadmill walking would produce lower RPE. Overall, aquatic treadmill walking reduced mean medial gastrocnemius activity by 50.2% (padj<0.001), increased mean rectus femoris activity at least 32.8% (padj<0.006), and produced 78.0% (padj=0.007) greater RPE compared to dry treadmill walking. This study provides normative pediatric data for future aquatic treadmill walking studies in clinical populations to help inform gait rehabilitation protocols.

Effects of Wearing a Weight-Bearing Jacket versus Increasing Speed during Treadmill Gait Training on Gait Parameters in Stroke Patients

Effects of Wearing a Weight-Bearing Jacket versus Increasing Speed during Treadmill Gait Training on Gait Parameters in Stroke Patients

Comparison of ground reaction force and marker-based methods to estimate mediolateral center of mass displacement and margins of stability during walking

Dynamic balance control during human walking can be described by the distance between the mediolateral (ML) extrapolated center of mass (XCoM) position and the base of support, the margin of stability (MoS). The ML center of mass (CoM) position during treadmill walking can be estimated based on kinematic data (marker-based method) and a combination of ground reaction forces and center of pressure positions (GRF-based method). Here, we compare a GRF-based method with a full-body marker-based method for estimating the ML CoM, ML XCoM and ML MoS. Fifteen healthy adults walked on a dual-belt treadmill at comfortable walking speed for three minutes. Kinetic and kinematic data were collected and analyzed using a GRF-based and marker-based method to compare the ML CoM, ML XCoM and ML MoS. High correlation coefficients (r > 0.98) and small differences (Root Mean Square Difference < 0.0072 m) in ML CoM and ML XCoM were found between the GRF-based and marker-based methods. The GRF-based method resulted in larger ML XCoM excursion (0.0118 ± 0.0074 m) and smaller ML MoS values (0.0062 ± 0.0028 m) than the marker-based method, but these differences were consistent across participants. In conclusion, the GRF-based method is a valid method to determine the ML CoM, XCoM and MoS. One should be aware of higher ML XCoM and smaller ML MoS values in the GRF-based method when comparing absolute values between studies. The GRF-based method strongly reduces measurement times and can be used to provide real-time CoM-CoP feedback during treadmill gait training.

Effect of Treadmill Training with Visual Biofeedback on Selected Gait Parameters in Subacute Hemiparetic Stroke Patients

Functional limitations after a stroke are unique to each person and often include impaired independent mobility. A reduction in existing gait deficits after a stroke is often one of the main goals of rehabilitation. Gait re-education after stroke is a complex process, which consists of the effects of many therapeutic interventions. The study aimed to analyze the effects of using a treadmill with visual feedback in gait re-education in the sub-acute stroke period and assess the impact of biofeedback treadmill training on selected gait parameters, improving static balance and reducing the need for orthopedic aids. The study included 92 patients (F: 45, M: 47) aged 63 ± 12 years, with post-ischemic sub-acute (within six months onset) stroke hemiparesis, treated at a neurological rehabilitation ward. All patients participated in a specific rehabilitation program, and in addition, patients in the study group (n = 62) have a further 10 min of treadmill training with visual feedback. Patients in the control group (n = 30) participated in additional conventional gait training under the direct supervision of a physiotherapist. The evaluation of static balance was assessed with the Romberg Test. A Biodex Gait Trainer 3 treadmill with biofeedback function was used to evaluate selected gait parameters (walking speed, step length, % limb loading, and traveled distance). The use of an orthopedic aid (walker or a crutch) was noted. After four weeks of rehabilitation, step length, walking speed, traveled distance, and static balance were significantly improved for the study and control group (p < 0.05). Treadmill gait training yielded significantly better results than a conventional rehabilitation program. Only the study group observed a corrected walking base (p < 0.001). All participants showed a reduction in the use of walking aids (p = 0.006). There was no asymmetry in the % of limb loading for either group prior to or following rehabilitation. The treadmill with visual biofeedback as conventional gait training has resulted in a significant improvement in parameters such as step length, walking speed, static balance, and a reduction in the use of locomotion aids. However, the achieved improvement in gait parameters is still not in line with the physiological norm.

Randomized Controlled Trial of Robot-Assisted Gait Training versus Therapist-Assisted Treadmill Gait Training as Add-on Therapy in Early Subacute Stroke Patients: The GAITFAST Study Protocol.

The GAITFAST study (gait recovery in patients after acute ischemic stroke) aims to compare the effects of treadmill-based robot-assisted gait training (RTGT) and therapist-assisted treadmill gait training (TTGT) added to conventional physical therapy in first-ever ischemic stroke patients. GAITFAST (Clinicaltrials.gov identifier: NCT04824482) was designed as a single-blind single-center prospective randomized clinical trial with two parallel groups and a primary endpoint of gait speed recovery up to 6 months after ischemic stroke. A total of 120 eligible and enrolled participants will be randomly allocated (1:1) in TTGT or RTGT. All enrolled patients will undergo a 2-week intensive inpatient rehabilitation including TTGT or RTGT followed by four clinical assessments (at the beginning of inpatient rehabilitation 8-15 days after stroke onset, after 2 weeks, and 3 and 6 months after the first assessment). Every clinical assessment will include the assessment of gait speed and walking dependency, fMRI activation measures, neurological and sensorimotor impairments, and gait biomechanics. In a random selection (1:2) of the 120 enrolled patients, multimodal magnetic resonance imaging (MRI) data will be acquired and analyzed. This study will provide insight into the mechanisms behind poststroke gait behavioral changes resulting from intensive rehabilitation including assisted gait training (RTGT or TTGT) in early subacute IS patients.

Long-Term Retention of Robotic Gait Training: Transference From The Laboratory To The Real-World

<h3>Research Objectives</h3> Investigate the long-term retention of effects on gait and mobility after a robotic treadmill gait training protocol (TT) plus a transfer package (TP). <h3>Design</h3> Preliminary RCT findings of a six-week robotic treadmill training combined with behavioral strategies. Outcomes measured pre-, immediately after (post), and at 3-month follow-up (FU). <h3>Setting</h3> Clinical Research Unit. <h3>Participants</h3> 7 participants (>6 months poststroke); walking impairment, can walk ≤10 feet. Randomized to experimental (n=4) or control groups (n=3). <h3>Interventions</h3> All participants receive the same TT protocol. The experimental group (TT+TP) receives TT, and 30 minutes of behavioral strategies (TP) application to enhance motor skill transference outside clinical settings. Controls (TT) receive home exercise handouts plus TT. The 6-week intervention involves three 30-minute TT sessions a week targeting endurance, strength, and speed. <h3>Main Outcome Measures</h3> Lower Extremity Motor Activity Log (LE-MAL), Berg Balance Scale (BBS), 10MWT, 6MWT, Fear of Falling Avoidance Questionnaire (FFABQ). <h3>Results</h3> On average, all participants improved on all post-pre assessments. TT+TP participants showed continuous improvement at FU. LE-MAL (TT post-pre: 0.6 and: -0.6; TT+TP post-pre: 1.0 and FU: 0.2), BBS (TT post-pre: 1.3 and FU: -1.0; TT+TP post-pre: 1.5 and FU: 0.7), 10MWT self-selected speed: TT post-pre: 0.03m/s and FU: -0.15m/s; TT+TP post-pre: 0.01m/s and FU: 0.04 m/s, 10MWT fast speed: TT post-pre: 0.02 m/s and FU: 0.0.3 m/s; TT+TP post-pre: -0.01 m/s and FU: 0.08 m/s, 6MWT TT post-pre: 22.2 m and FU: 10.7 m/s; TT+TP post-pre: 13.8 m and FU: 17.4 m, and FFABQ (lower scores mean lower avoidance behavior), TT post-pre: -5 and FU: 0.7; TT+TP post-pre: -3.3 and FU: -3.25. <h3>Conclusions</h3> This preliminary analysis suggests the TT+TP group retains TT improvements. Adding behavioral strategies to robotic gait training may induce long-term retention of improvements in TT, endurance, balance, and confidence. <h3>Author(s) Disclosures</h3> DB has a potential conflict of interest, please refer to author disclosure of information for details. The other authors have no conflict of interest to declare.

Novel Robotics-Treadmill-Platform Application To Improve Walking In A Person With Parkinson's Disease: A Case Report

<h3>Research Objectives</h3> Illustrate the potential benefits of a 6-week novel Robotic treadmill system training protocol, focused on implicit learning of challenging tasks, on walking performance in an older adult with Parkinson's Disease. <h3>Design</h3> A single-subject case report. <h3>Setting</h3> Outpatient rehabilitation clinic in the southwestern U.S. <h3>Participants</h3> An 82-year-old-female with a 3-year history of Parkinson's disease (PD) on carbidopa/levodopa (Hoehn and Yahr stage 1) was referred to physical therapy (PT) to improve performance and safety of walking. <h3>Interventions</h3> Twelve twice-weekly PT sessions on the walking robotics platform (KineAssist). The platform allows "self-driven"/intentional movement on the treadmill with body weight support, catching after loss of balance, and including full freedom of movement. The protocol emphasized progressive Endurance, Strength, Speed, and Perturbation exercises individualized to her abilities. <h3>Main Outcome Measures</h3> . The primary outcomes were the overground 6-Min-Walk Test (6MWT), TUG, TUG Carry, TUG Cognitive, and Mini-Best test. Secondary outcomes included 10-Meter-Walk-Test (10MWT) self-selected and max walking speeds assessed via the Robotic treadmill system. <h3>Results</h3> The 6MWT improved 51% (318-481m); the TUG score improved 53% (10.3-5.5 sec); the TUG Carry, 50% faster (13.7- 6.8 sec); the TUG Cognitive, 50% faster (13.2- 6.5 sec), the Mini-Best Test improved 8 points (18/28-26/28). The self-selected 10MWT speed improved 196% (0.27- 0.8 m/s) and max gait speed by 120% (1.0-2.2 m/s). <h3>Conclusions</h3> An individualized robotic treadmill gait training protocol was used successfully with an older patient with PD, with marked improvement in her walking, exceeding available minimal clinically important distances for all outcome measures. An implicit learning approach, combined with a robotic treadmill, may enable individuals to perform challenging tasks without fear of physical harm and to develop strategies for safe mobility in their environment. <h3>Author(s) Disclosures</h3> The authors declare that they have no relevant or material financial interests related to the research described in this abstract. Dr. Brown is a Co-inventor of a device described in the presentation, but he currently DOES NOT receive any royalties.

Effect of the Treadmill Gait Training Program Combined with the Thoracic Mobility Exercise on Gait and Balance in Stroke Patients: A Preliminary Randomized, Controlled Study

Effect of the Treadmill Gait Training Program Combined with the Thoracic Mobility Exercise on Gait and Balance in Stroke Patients: A Preliminary Randomized, Controlled Study

Users’ experiences of intensive robotic-assisted gait training post-stroke – “a push forward or feeling pushed around?”

Purpose Robotic-assisted gait training (RAGT) is suggested to improve walking ability after stroke. The purpose of this study was to describe experiences of robotic-assisted gait training as part of a gait training intervention among persons in the chronic phase after stroke. Materials and methods Semi-structured interviews were performed with 13 participants after a 6-week intervention including treadmill gait training with the Hybrid Assistive Limb® (HAL) exoskeleton. Data were analysed using qualitative content analysis. Results Four categories emerged: (1) A rare opportunity for potential improvements describes the mindset before the start of the intervention; (2) Being pushed to the limit represents the experience of engaging in intensive gait training; (3) Walking with both resistance and constraints reveals barriers and facilitators during HAL training; (4) Reaching the end and taking the next step alone illustrates feelings of confidence or concern as the intervention ended. Conclusions The gait training intervention including RAGT was considered demanding but appreciated. Support and concrete, individual feedback was crucial for motivation, whilst the lack of variation was a barrier. Results encourage further development of exoskeletons that are comfortable to wear and stimulate active participation by enabling smoothly synchronised movements performed during task-specific activities in different environments. IMPLICATIONS FOR REHABILITATION When provided in a suitable context, the mental and physical challenges of intensive robotic-assisted gait training can be both inspiring and motivating. Support and engagement along with informative feedback from therapists are suggested crucial for motivation. Intensive task-specific gait training may preferably be performed in an enriched environment and combined with other physiotherapy treatments to stimulate engagement.

Effectiveness of virtual reality on functional mobility during treadmill training in children with cerebral palsy: a single-blind, two-arm parallel group randomised clinical trial (VirtWalkCP Project)

IntroductionTreadmill training and virtual reality have been investigated in children with cerebral palsy. However, few studies have assessed the effectiveness of the combination of both treatments on children’s functional and...

Effect of Antigravity Treadmill Gait Training on Gait Function and Fall Risk in Stroke Patients.

Objective To investigate the effect of antigravity treadmill gait training (AGT) on gait function, balance, and fall risk in stroke patients.MethodsThis study included 30 patients with stroke (mean age, 73 years). All subjects were randomly divided into two groups. The intervention group (n=15) performed AGT for 20 minutes, five times per week for 4 weeks. The control group (n=15) received conventional gait training for the same duration. To assess fall risk, the Tinetti Performance-Oriented Mobility Assessment (POMA) was measured. The Berg Balance Scale (BBS), Timed Up and Go test (TUG), and 10-m walk test (10mWT) were measured to assess dynamic balance. All scales were measured before intervention (T0) and at 4 weeks (T1) and 12 weeks (T2) after intervention.ResultsResults showed that the total POMA score, BBS, and 10mWT scores improved significantly (p<0.05) at T1 and T2 in both groups. The POMA gait score (4.20±1.37 at T1, 4.87±1.36 at T2) and TUG (4.52±4.30 at T1, 5.73±4.97 at T2) significantly improved (p<0.05) only in the intervention group. The changes in total POMA score and BBS of the intervention group (7.20±2.37, 7.47±3.07) improved more significantly (p<0.05) between T0 and T2 than the control group (2.53±2.10, 2.87±2.53).ConclusionOur study showed that AGT enhances dynamic balance and gait speed and effectively lowers fall risk in stroke patients. Compared to conventional gait therapy, AGT would improve gait function and balance in stroke patients more effectively.

Bicephalic Transcranial Direct-Current Stimulation Does Not Add Benefits to a Footdrop Stimulator for Improving Functional Mobility in People With Chronic Hemiparesis After Stroke: A Double-Blind, Randomized Controlled Trial.

The aim of this study was to assess the effects of applying transcranial direct-current stimulation (tDCS), a footdrop stimulator (FDS), and gait training simultaneously on functional mobility in people with chronic hemiparesis after stroke. In this double-blind controlled trial, 32 individuals with mild, moderate, and severe chronic hemiparesis after stroke were randomized to tDCS plus FDS or sham tDCS plus FDS groups. Both groups underwent 10 concurrent tDCS and FDS gait training sessions 5 times per week for 2weeks. Functional mobility was evaluated by the Timed "Up & Go" test (TUG). Secondary outcomes included spasticity of plantarflexors, knee extensors, and hip adductors; quality of life; and walking endurance (distance covered during each treadmill gait training session). Clinical assessments were performed before treatment, after treatment, and at a 1-month follow-up. A generalized estimating equation was used to compare the effects of time, group, and time × group interaction. No difference between groups was observed during performance of the TUG or other outcomes. TUG performance was improved in both the tDCS plus FDS group (before treatment = 24.29 [95% CI = 17.72-33.28]; after treatment = 21.75 [95% CI = 15.75-30.08]) and the sham tDCS plus FDS group (before treatment = 19.63 [95% CI = 16.06-23.0]; after treatment = 18.45 [95% CI = 15.26-22.3]). This improvement remained at the follow-up evaluation. Both groups also showed reduced spasticity of plantarflexors and knee extensors, increased quality of life, and increased total distance walked. This study provided no evidence that bicephalic tDCS improves functional mobility, spasticity, quality of life, or walking endurance in people with chronic hemiparesis after stroke. Bicephalic tDCS does not add relevant benefits to FDS and gait training in people who have chronic hemiparesis after stroke. Given that tDCS has few additional effects and given its costs for clinical practice, tDCS for rehabilitation in people with chronic hemiparesis after stroke is discouraged. FDS and gait training improve functional mobility, walking resistance, and quality of life in people with chronic hemiparesis after stroke.

Differences in Temporal Gait Parameters When Walking on Even Surface Walkway, Treadmill, and Pushing a Constant Resistant Sled

Motorized treadmills and weighted sleds are employed in clinical settings to improve lower extremity strength, power, and endurance. However, little is known about how the spatio-temporal parameters compare when walking on an even surface walkway, walking on a treadmill, or pushing a sled. This study aimed to examine the variations in spatial and temporal gait parameters when walking on an even surface walkway (EW), on a treadmill (TW), and while pushing a sled (SP). Forty healthy subjects participated in this pilot study. The mean age and BMI of all participants were 24.39 (± 2.86) years and 68.26 (± 13.92) kg/m^2, respectively. Spatio-temporal parameters were gathered using the Mobility Lab ADPM software and six sensors containing accelerometers and gyroscopes. Participants were directed to walk at a normal and comfortable speed for 7 m on an even surface walkway for two trials. Next, the subjects walked on the treadmill for two trials at a speed based on age. For males aged &lt;30 and females 20-40 years of age, the speed was 1.3 m/s. While for males aged 30 or older, the speed was set to 1.4 m/s. Finally, participants were instructed to walk at their normal pace while pushing a 60 lb sled for 9.1 meters (m). Treadmill walking provoked a significant increase in temporal variables, whereas pushing a sled significantly reduced the temporal variables. Treadmill walking resulted in a decrease in double limb support time and an increase in single-limb support time compared with even surface walking. Although cadence was greater when walking on a treadmill versus an even surface walkway, the difference may be attributed to a fixed speed on the treadmill, which was determined by age. Treadmill gait training is recommended for subjects that could benefit from an increase single limb support time to improve dynamic balance such as Parkinson patients. On the other hand, for those participants that dynamic activities are challenging, such as concussion and vestibular patients, pushing the sled will slow down gait parameters allowing gait training with an added resistance benefit. Finally, it has been proposed that further investigation should focus on the differences in lower extremity muscle activation and recruitment patterns under various walking conditions.

Multichannel Transcranial Direct Current Stimulation Combined With Treadmill Gait Training in Patients With Parkinson's Disease: A Pilot Study.

BackgroundGait problems are critical impairments in Parkinson's disease (PD) and are related to increased risk of fall and negatively impact activities of daily life. Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that can modify the cortical excitability of gait-related brain regions. In this study, we investigated whether multichannel tDCS with simultaneous treadmill gait training could improve gait in PD.MethodsTwenty-four patients with PD were assigned randomly to a real or sham tDCS group. Before intervention, one patient of the real tDCS group was dropped out, leaving 23 patients to be analyzed in this study. Each patient underwent 30 min of treadmill gait training for 10 sessions over four consecutive weeks. Multichannel 4x1 tDCS was applied using five 6-cm-diameter round electrodes. One anode was placed on the CZ, and four cathodes were positioned symmetrically over the FZ, C5, C6, and PZ. Anodal tDCS (2mA) and sham tDCS were delivered for 20 min. The secondary outcomes were gait performance, as measured by the timed up and go test (TUG) and freezing of gait questionnaire (FOG-Q), and balance was assessed using the dynamic gait index (DGI), Berg balance scale (BBS), and functional reach test (FRT). Motor and non-motor performance of patients with PD were assessed using the Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS). Participants were assessed before the intervention, immediately after the intervention, and 4 weeks after completion of the intervention.ResultsThe real tDCS group showed a significant improvement in the 10-m walk test, but the sham group did not. Among the secondary outcome measures, MDS-UPDRS part II, TUG, and BBS were improved only in the real tDCS group. Particularly, MDS-UPDRS part II showed a significant group*time interaction effect, indicating that real tDCS demonstrated a better effect on the activities of daily living patients with PD.ConclusionsThe results of this pilot study suggest that multichannel tDCS applied on the leg motor cortex during treadmill gait training is a safe and effective means to improve gait velocity in patients with PD. Additional rigorous, large-sample, multicenter, randomized controlled trials are needed to confirm the effect of tDCS as a therapeutic adjunct for gait rehabilitation of patients with PD.

What about the role of the cerebellum in music-associated functional recovery? A secondary EEG analysis of a randomized clinical trial in patients with Parkinson disease

Rhythmic Auditory Stimulation (RAS) has been shown to be of help in an effective gait training of people with idiopathic Parkinson's disease (PD). The cerebellum may play an important role in RAS aftereffects by compensating the detrimental internal clock for automatic and rhythmic motricity. However, the neurophysiological mechanisms underlying RAS aftereffects are still poorly understood. In the present study, we tested the contribution of the cerebellum to RAS-based gait training aftereffects in people with PD by examining cerebellum-cerebral connectivity indices using standard EEG recording. We enrolled 50 patients with PD who were randomly assigned to two different modalities of treadmill gait training using GaitTrainer3 with and without RAS (non_RAS) during an 8-week training program. We measured clinical and kinematic gait indices and electrophysiological data (standard EEG recording during walking on GaitTrainer3) of both the gait trainings. We found that the greater improvement in gait performance following RAS than non_RAS training, as per clinical and kinematic assessment, was paralleled by a more evident reshape of cerebellum-brain functional connectivity with regard to specific brain areas (pre-motor, sensorimotor and temporal cortices) and gait-cycle phases (mainly 25–75% of the gait cycle duration). These findings suggest that the cerebellum mediates the reshape of sensorimotor rhythms and fronto-centroparietal connectivity in relation to specific gait-cycle phases. This may be consistent with a recovery of the internal timing mechanisms generating and controlling motor rhythmicity, eventually improving gait performance. The precise definition of the cerebellar role to gait functional recovery in people with PD may be crucial to create patient-tailored rehabilitative approaches.