Comparison of training effects between underwater treadmill gait training and overground gait training on the walking ability and respiratory function in patients with chronic severe hemiplegic stroke: A randomized, controlled, preliminary trial.

BACKGROUND: The need to develop a more effective intervention to obtain a functional recovery of stroke patients who are unable to perform land-based treadmill gait training has been widely reported. Thus, this pilot study aimed to identify a gait training type that could lead to improved gait and respiratory functioning in adult patients with chronic severe hemiplegic stroke. OBJECTIVES: To examine whether underwater treadmill or/and overground gait training could be more effective in stroke patients. METHODS: In this single-blinded, randomized, controlled, comparative study, 22 patients with severe hemiplegic stroke in a rehabilitation hospital were randomly assigned to the experimental (underwater treadmill gait training) or control group (overground gait training). All participants performed a 60-min neurodevelopmental treatment (five times/week for 12 weeks). Each group performed 30-min underwater or overground gait training (two times/week for 12 weeks). Gait and respiratory function were measured before and after the 12-week training. RESULTS: For the walking variables, step-time difference changes post-training showed significant differences between the groups (-.06 vs. +.04 s, p < .05). Both groups showed significant increases in the maximal voluntary volume (MVV) at post compared to pre training (p < .05). The post-training MVV values were significantly different between the two groups (+23.35 vs. +4.76 L, p < .05). CONCLUSIONS: In severe stroke patients, underwater treadmill gait training can be more effective in improving gait and respiratory function than overground gait training and could be an effective clinical intervention tool for the training of such patients.

Effects of Trunk Stabilization Exercise While Wearing a Pelvic Compression Belt on Walking and Balancing Abilities in Patients With Stroke: An Assessor Blinded, Preliminary, Randomized, Controlled Study.

OBJECTIVE: The aim of this study was to investigate the effects of wearing a pelvic compression belt during trunk stability exercise on balance and gait ability in patients with stroke. DESIGN: Thirty-six patients with stroke participated and were randomly allocated to three groups: the paretic group (trunk stability exercise wearing a pelvic belt on the paretic side), the nonparetic group (trunk stability exercise wearing a pelvic belt on the nonparetic side), or the control group (trunk stability exercise without a pelvic belt). Walking and balancing abilities were assessed before and after trunk stabilization exercise. RESULTS: Significantly larger gains were identified in the paretic group than in the control group for all variables (P < 0.017). In addition, significantly larger gains were observed in the paretic group than in the nonparetic group (P < 0.017) (limit of stability, 15.6%; stance phase of paretic side, 4.1%; 10-m walking test, -10.1%; 6-min walking test, 4.6%). CONCLUSION: Wearing a pelvic belt on the paretic side during trunk stabilization exercise seems to be more effective at improving the balancing and walking abilities of patients with stroke than wearing a pelvic compression belt on the nonparetic side or not wearing a pelvic belt.

Comparison of underwater gait training and overground gait training for improving the walking and balancing ability of patients with severe hemiplegic stroke: A randomized controlled pilot trial.

BACKGROUND: Walking training is an essential intervention to improve the function in stroke patients. However, only a limited number of gait training strategies are available for stroke patients with relatively severe disabilities. RESEARCH QUESTION: Is underwater gait training or overground gait training more effective in severe stroke patients? METHODS: A total of 21 patients with severe hemiplegic stroke were randomly assigned to the experimental and control groups. All participants (n = 21) received 60-minute sessions of general physical therapy, 5 times a week for a period of 12 weeks. Additionally, the experimental and control groups underwent underwater and overground walking training, respectively, for 30 min twice times a week for 12 weeks. Postural assessment for stroke score, center of pressure path length and velocity, step time and step length difference, and walking velocity were measured before and after the 12-week training. RESULTS: Both groups showed a significant decrease in the center of pressure path length and velocity after the intervention compared to the values before the intervention (p < .05). However, there was no significant difference in the center of pressure path length and velocity changes after training between the two groups (p > .05). In the walking variables, the step length difference changes after training between the two groups showed a significant difference (p < .05). In the experimental group, the step length difference increased after the intervention compared to that before the intervention (+4.55 cm), whereas that of the control group decreased (-1.25 cm). SIGNIFICANCE: In severe stroke patients, underwater gait training can be effective for improving balancing ability, but it may be less effective on the improvement of gait function than overground walking. CLINICAL TRIAL REGISTRATION NUMBER: KCT0002587 (https://cris.nih.go.kr).

Effect of proprioceptive stimulation induced by footplate during center of pressure movement tracking training on the balance abilities of patients with chronic hemiplegic stroke: a randomized, controlled, pilot study.

Background: Balance requires highly complex interactions involving muscle strength, joint flexibility, visual, vestibular, and proprioceptive senses.Objective: The purpose of this pilot study was to compare the effects of COP (center of pressure) movement tracking training conducted using the Biodex Balance System SD® in static and dynamic modes on balance ability in stroke patients.Methods: Twenty-six stroke patients were randomly assigned to a control group (COP movement tracking training in static mode ; stable; n = 13 or an experimental group (COP movement tracking training in dynamic mode; unstable; n = 13). Both groups underwent neurodevelopmental therapy followed by an additional 15 min of COP movement training three times a week for 6 consecutive weeks. The timed-up and go test, COP pathway velocity, COP pathway length, and limit of stability were measured before and after intervention.Results: The experimental group showed greater reductions in COP pathway length and COP pathway velocity than the control group (5%, F (1, 24) = 6.125, p = .021, η2 = .203; 5.4%, F (1, 24) = 6.661, p = .016, η2 = .217, respectively). No significant intergroup difference was observed for the timed-up and go test or limit of stability results.Conclusion: COP movement tracking training in dynamic mode was found to be a more effective intervention for improving the static balancing abilities of stroke patients than training in static mode.

Effects of gait training with auditory feedback on walking and balancing ability in adults after hemiplegic stroke: a preliminary, randomized, controlled study.

The aim of this study was to identify a gait training type that better improves the walking and balancing abilities of adult patients with chronic hemiplegic stroke. Single-blinded, randomized, controlled, comparative preliminary study was carried out. Patients were recruited from the inpatient unit of a Rehabilitation Hospital. Thirty-one patients who had experienced hemiplegic stroke were randomly assigned to three groups: the heel group (gait training by active weight bearing on the paretic heel with auditory feedback), the forefoot group (gait training with auditory feedback from paretic metatarsals), and the control group (general gait intervention). All patients performed 30 min of comprehensive rehabilitation therapy followed by an additional 20 min of gait intervention with or without auditory feedback three times a week for 6 weeks. Significant improvements in walking and balancing variables were observed after gait training in all three groups (P<0.05). However, significantly larger gains were identified in the heel group than in the control group (center of loading path length, -29.4 vs. -11.4%, d=-1.0; center of loading path velocity, -35.8 vs. -19.6%, d=-1.4). In addition, significantly larger gains were observed in the forefoot group than in the control group (functional gait assessment, +42.6 vs. +20.1%, d=1.3; center of loading path length, -37.2 vs. -11.4%, d=-1.8; center of loading path velocity, -36.0 vs. -19.6%, d=-1.3). Auditory feedback during active weight bearing on paretic feet appears to more effectively improve the walking and balancing abilities of hemiplegic stroke patients than general gait training.

Effect of gait training with constrained-induced movement therapy (CIMT) on the balance of stroke patients.

[Purpose] The purpose of the present study was to examine the effect of intensive gait training using a constrained induced movement therapy (CIMT) technique applied to the non-paretic upper extremity on the balance ability of stroke patients. [Subjects and Methods] Twenty stroke patients were randomly assigned to an experimental group or a control group. The experimental group received gait training with CIMT for 30 minutes per session, three sessions per week for four weeks, and the control group received gait training alone. [Results] The experimental group showed improvements in dynamic balance and the degree of improvement in this group was greater than that observed in the control group. Furthermore, the experimental group showed improvements in movement distances to the paretic side. On the other hand, the control group showed no significant improvements in balance indices after the intervention. [Conclusion] Gait training of stroke patients using CIMT techniques should be regarded as a treatment that can improve the balance of stroke patients.