Speed and Temporal-Distance Adaptations during Treadmill and Overground Walking Following Stroke

Objective. To compare the maximum gait speed of stroke subjects attained during treadmill and overground in stroke subjects and to identify the temporal-distance determinants of the maximal gait speed. Methods. Ten individuals with hemiparetic gait deficits and whose walking speeds ranged between 0.24 m/s and 0.82 m/s participated. Five healthy age-matched controls were also tested to provide comparative data for the gait speed transfer between the 2 modes of locomotion. Following a brief habituation process to walking on the treadmill, subjects were tested while walking at comfortable and maximal speeds on the treadmill and overground, in a random order. Main Outcome Measure. Self-selected comfortable and maximum gait speed and temporal-distance factors were acquired using a 6-camera Vicon™ motion analysis system and compared between treadmill and overground walking at a similar speed. Results. Overground walking resulted in higher maximal speeds (P < 0.001), greater stride lengths (P < 0.001), and a lower cadence (P < 0.02), as compared to tread-mill. The comfortable gait speed and the maximum stride length proved to be strong determinants for the maximal speed on both modes of locomotion (P < 0.01), but the maximum cadence was correlated to maximum speed only for overground locomotion (P < 0.05). Conclusions. Stroke subjects walked slower on the treadmill as compared to overground. They also used a different strategy to increase gait speed, relying mostly on increasing the stride length during treadmill ambulation.

[1]  M P Murray,et al.  COMPARISON OF FREE AND FAST SPEED WALKING PATTERNS OF NORMAL MEN , 1966, American journal of physical medicine.

[2]  P. Zamparo,et al.  The energy cost of level walking in patients with hemiplegia , 1995, Scandinavian journal of medicine & science in sports.

[3]  Diane Podsiadlo,et al.  The Timed “Up & Go”: A Test of Basic Functional Mobility for Frail Elderly Persons , 1991, Journal of the American Geriatrics Society.

[4]  H. Barbeau,et al.  A new approach to retrain gait in stroke patients through body weight support and treadmill stimulation. , 1998, Stroke.

[5]  Stefan Hesse,et al.  Treadmill Training with Partial Body Weight Support: Influence of Body Weight Release on the Gait of Hemiparetic Patients , 1997 .

[6]  C. Richards,et al.  Task-specific physical therapy for optimization of gait recovery in acute stroke patients. , 1993, Archives of physical medicine and rehabilitation.

[7]  G. Brengelmann,et al.  Effects of plastic and metal leg braces on speed and energy cost of hemiparetic ambulation. , 1970, Archives of physical medicine and rehabilitation.

[8]  Corcoran Pj,et al.  Effects of plastic and metal leg braces on speed and energy cost of hemiparetic ambulation. , 1970 .

[9]  Murray Mp,et al.  Kinematic and EMG patterns during slow, free, and fast walking , 1984, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[10]  V. L. Nickel,et al.  Gait parameters following stroke: a practical assessment. , 1995, Journal of rehabilitation research and development.

[11]  F. Collen.  The measurement of standing balance after stroke , 1995 .

[12]  R W Bohannon,et al.  Walking after stroke: comfortable versus maximum safe speed , 1992, International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation.

[13]  P. Beek,et al.  Coordination Between Arm and Leg Movements During Locomotion , 2001, Journal of motor behavior.

[14]  The kinematics of idiopathic gait disorder. A comparison with healthy young and elderly females. , 1991, Scandinavian journal of rehabilitation medicine.

[15]  J. C. Wall,et al.  The process of habituation to treadmill walking at different velocities. , 1980, Ergonomics.

[16]  R T Linn,et al.  Admission balance and outcomes of patients admitted for acute inpatient rehabilitation. , 1998, American journal of physical medicine & rehabilitation.

[17]  L. Jongbloed,et al.  Stroke rehabilitation: sensorimotor integrative treatment versus functional treatment. , 1989, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[18]  Murray Mp,et al.  Treadmill vs. floor walking: kinematics, electromyogram, and heart rate. , 1985, Journal of applied physiology.

[19]  S Hesse,et al.  Treadmill walking with partial body weight support versus floor walking in hemiparetic subjects. , 1999, Archives of physical medicine and rehabilitation.

[20]  S. Nadeau,et al.  Analysis of the clinical factors determining natural and maximal gait speeds in adults with a stroke. , 1999, American journal of physical medicine & rehabilitation.

[21]  L. Nashner.  Adaptation of human movement to altered environments , 1982, Trends in Neurosciences.

[22]  D. De Clercq,et al.  Treadmill Exercise Negatively Affects Visual Contribution to Static Postural Stability , 2002, International journal of sports medicine.

[23]  J. C. Wall,et al.  A kinematic study of long-term habituation to treadmill walking. , 1981, Ergonomics.

[24]  D A Winter,et al.  Treadmill versus walkway locomotion in humans: an EMG study. , 1986, Ergonomics.

[25]  S. Olney,et al.  Temporal, kinematic, and kinetic variables related to gait speed in subjects with hemiplegia: a regression approach. , 1994, Physical therapy.

[26]  H. Barbeau,et al.  Optimal outcomes obtained with body-weight support combined with treadmill training in stroke subjects. , 2003, Archives of physical medicine and rehabilitation.

[27]  B. Dobkin,et al.  Improved Gait Symmetry in Hemiparetic Stroke Patients Induced During Body Weight-Supported Treadmill Stepping , 1997 .

[28]  M L Latash,et al.  Anticipatory postural adjustments in conditions of postural instability. , 1998, Electroencephalography and clinical neurophysiology.

[29]  C. Gowland,et al.  Hemiplegic gait: analysis of temporal variables. , 1983, Archives of physical medicine and rehabilitation.

[30]  S. Hesse,et al.  Influence of walking speed on lower limb muscle activity and energy consumption during treadmill walking of hemiparetic patients. , 2001, Archives of physical medicine and rehabilitation.

[31]  J C Wall,et al.  A comparison of the range of walking speeds between normal and hemiplegic subjects. , 1995, Scandinavian journal of rehabilitation medicine.

[32]  W. J. Beek,et al.  Hemiplegic gait: a kinematic analysis using walking speed as a basis. , 1992, Journal of biomechanics.

[33]  Gerald V. Smith,et al.  Hemiparetic Gait Parameters in Overground Versus Treadmill Walking , 2001, Neurorehabilitation and neural repair.

[34]  Mark G. Carpenter,et al.  Fear of falling modifies anticipatory postural control , 2002, Experimental Brain Research.

[35]  JanMehrholz,et al.  Speed-Dependent Treadmill Training in Ambulatory Hemiparetic Stroke Patients , 2002 .

[36]  S. Olney,et al.  Hemiparetic gait following stroke. Part I: Characteristics , 1996 .

[37]  Y Laufer,et al.  The effect of treadmill training on the ambulation of stroke survivors in the early stages of rehabilitation: a randomized study. , 2001, Journal of rehabilitation research and development.