Does Treadmill Training Improve Gait in Individuals Post-Stroke?
My thoughts are very different than what you'll see in the abstract. What kind of treadmill was used for the experimental arm?
The reason that I ask is because I have a treadmill with GaitSens 2000. (I am not being paid to mention this product. I truly do use it in the clinic with a variety of patients.) The really cool thing about combining force platform technology with a treadmill is the capability for me to really track changes. The other aspect that is awesome is the immediate feedback a patient receives when reaching goals that I set to improve their quality of gait. The immediate feedback is far faster than I can speak. (And if you know me, that is a feat in and of itself.) The other neat thing is that with goals, the auditory cues when goals are met and with repetition, the patient's gait actually changes when walking in the clinic. With patients who have a neurological condition, the gait characteristics may not be perfect, but I can readily prove the changes via session reports.
The other aspect to consider... typically, when a patient is walking on the treadmill, the person is holding onto the side rails. Well, from what I have seen, the gait characteristics on the floor don't tend to change as much until I begin having the patient let go of the side rails and walk. Yes, it is quite stumbly and unsteady and scary for the patient. The timing of movement patterns is not conducive to smooth, coordinated movement. For that reason, I have the patient in a harness which is connected via a rope block and tackle to an eyelet in the ceiling.
Anyways, I thought I'd bring in another perspective to provoke thinking. I tend to disagree that including sessions on a treadmill do not lead to better outcomes. What matters is immediate feedback and increasing the challenge while keeping the patient safe.
Below you will find a quick view of the abstract.
Treadmill training to improve mobility for people with sub-acute stroke: a phase II feasibility randomized controlled trial.
This phase II study investigated the feasibility and potential effectiveness of treadmill training versus normal gait re-education for ambulant and non-ambulant people with sub-acute stroke delivered as part of normal clinical practice.
A single-blind, feasibility randomized controlled trial.
Four hospital-based stroke units.
Participants within three months of stroke onset.
Participants were randomized to treadmill training (minimum twice weekly) plus normal gait re-education or normal gait re-education only (control) for up to eight weeks.
Measures were taken at baseline, after eight weeks of intervention and at six-month follow-up. The primary outcome was the Rivermead Mobility Index. Other measures included the Functional Ambulation Category, 10-metre walk, 6-minute walk, Barthel Index, Motor Assessment Scale, Stroke Impact Scale and a measure of confidence in walking.
In all, 77 patients were randomized, 39 to treadmill and 38 to control. It was feasible to deliver treadmill training to people with sub-acute stroke. Only two adverse events occurred. No statistically significant differences were found between groups. For example, Rivermead Mobility Index, median (interquartile range (IQR)): after eight weeks treadmill 5 (4-9), control 6 (4-11) p = 0.33; or six-month follow-up treadmill 8.5 (3-12), control 8 (6-12.5) p = 0.42. The frequency and intensity of intervention was low.
Treadmill training in sub-acute stroke patients was feasible but showed no significant difference in outcomes when compared to normal gait re-education. A large definitive randomized trial is now required to explore treadmill training in normal clinical practice.
Clin Rehabil.2017 Jul 1:269215517720486. doi: 10.1177/0269215517720486. [Epub ahead of print]