Treadmill-Based Locomotor Training with Leg Weights to Enhance Functional Ambulation in People with Chronic Stroke: A Pilot Study

Background and Purpose: Novel locomotor training strategies for individuals with disorders of the central nervous system have been associated with improved locomotor function. The purpose of this study was to investigate the effects of treadmill-based locomotor training combined with leg weights on functional ambulation in individuals with chronic stroke. We assessed functional ambulation and muscle activity in ambulatory individuals with chronic stroke. Methods: We used a pre/posttest design. Six individuals with chronic stroke who were community ambulators were recruited. Participants underwent a 30-minute treadmill-based locomotor training sessions three times per week for four to 12 weeks. The training program involved treadmill walking for 30 minutes with partial body weight support as needed. Leg weights, equivalent to 5% of body weight, were affixed around the paretic leg. Outcome measures consisted of the 10-m walk test, the modified Emory Functional Ambulation Profile, and temporal gait parameters. Results: Improvements were observed in functional ambulation measures, particularly the stairs subscore of the modified Emory Functional Ambulation Profile. Participants also exhibited an increase in the proportion of time the paretic leg spent in swing. No significant improvements were observed in the 10-m walk test. Conclusions: This pilot study demonstrates that the combination of leg weights and treadmill training is a feasible approach, that is well tolerated by participants. This approach may have the potential to improve some aspects of functional ambulation and the performance of activities requiring hip and knee flexion.

[1]  R G Luckwill,et al.  Phase-dependent responses in locomotor muscles of walking man. , 1990, Journal of biomedical engineering.

[2]  A. Wernig,et al.  Laufband Therapy Based on‘Rules of Spinal Locomotion’is Effective in Spinal Cord Injured Persons , 1995, The European journal of neuroscience.

[3]  V. Dietz,et al.  Swing Phase Resistance Enhances Flexor Muscle Activity During Treadmill Locomotion in Incomplete Spinal Cord Injury , 2008, Neurorehabilitation and neural repair.

[4]  S. Studenski,et al.  Meaningful Change and Responsiveness in Common Physical Performance Measures in Older Adults , 2006, Journal of the American Geriatrics Society.

[5]  Keir G. Pearson,et al.  Sartorius muscle afferents influence the amplitude and timing of flexor activity in walking decerebrate cats , 2002, Experimental Brain Research.

[6]  Shawnna L. Patterson,et al.  Effect of treadmill exercise training on spatial and temporal gait parameters in subjects with chronic stroke: a preliminary report. , 2008, Journal of rehabilitation research and development.

[7]  A. Patla,et al.  Control of lead and trail limbs during obstacle crossing following stroke. , 2005, Physical therapy.

[8]  G. M. Ghori,et al.  Pattern of reflex responses in lower limb muscles to a resistance in walking man , 2006, European Journal of Applied Physiology and Occupational Physiology.

[9]  Roger P. Woods,et al.  Ankle dorsiflexion as an fMRI paradigm to assay motor control for walking during rehabilitation , 2004, NeuroImage.

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

[11]  Maarten J. IJzerman,et al.  The orthotic effect of functional electrical stimulation on the improvement of walking in stroke patients with a dropped foot: a systematic review. , 2004, Artificial organs.

[12]  K. Pearson,et al.  Proprioceptive modulation of hip flexor activity during the swing phase of locomotion in decerebrate cats. , 2001, Journal of neurophysiology.

[13]  A. Luft,et al.  Treadmill Exercise Activates Subcortical Neural Networks and Improves Walking After Stroke: A Randomized Controlled Trial , 2008, Stroke.

[14]  Claire Wolstenholme,et al.  How do infants adapt to loading of the limb during the swing phase of stepping? , 2003, Journal of neurophysiology.

[15]  B. Brouwer,et al.  Isokinetic strength training of the hemiparetic knee: effects on function and spasticity. , 1997, Archives of physical medicine and rehabilitation.

[16]  D. Wood,et al.  The effects of common peroneal stimulation on the effort and speed of walking: a randomized controlled trial with chronic hemiplegic patients , 1997, Clinical rehabilitation.

[17]  A. Curt,et al.  Corticospinal input in human gait: modulation of magnetically evoked motor responses , 1997, Experimental Brain Research.

[18]  Sandra B. Davis,et al.  Locomotor training progression and outcomes after incomplete spinal cord injury. , 2005, Physical therapy.

[19]  C. Hsieh,et al.  Psychometric properties of the modified Emory Functional Ambulation Profile in stroke patients , 2006, Clinical rehabilitation.

[20]  T. Hornby,et al.  Robotic-assisted, body-weight-supported treadmill training in individuals following motor incomplete spinal cord injury. , 2005, Physical therapy.

[21]  E. Field-Fote Combined use of body weight support, functional electric stimulation, and treadmill training to improve walking ability in individuals with chronic incomplete spinal cord injury. , 2001, Archives of physical medicine and rehabilitation.

[22]  R. Brissot,et al.  Clinical experience with functional electrical stimulation-assisted gait with Parastep in spinal cord-injured patients. , 2000, Spine.

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

[24]  J. Barbenel,et al.  Peroneal stimulator; evaluation for the correction of spastic drop foot in hemiplegia. , 1996, Archives of physical medicine and rehabilitation.

[25]  Yea-Ru Yang,et al.  Gait Training—Induced Change in Corticomotor Excitability in Patients With Chronic Stroke , 2008, Neurorehabilitation and neural repair.

[26]  P. Stratford,et al.  Measuring Physical Impairment and Disability With the Chedoke‐McMaster Stroke Assessment , 1993, Stroke.

[27]  B. Andrews,et al.  Improving limb flexion in FES gait using the flexion withdrawal response for the spinal cord injured person. , 1993, Journal of biomedical engineering.

[28]  M. Pett Nonparametric Statistics for Health Care Research: Statistics for Small Samples and Unusual Distributions , 1997 .

[29]  J. Quintern,et al.  Obstruction of the swing phase during gait: phase-dependent bilateral leg muscle coordination , 1986, Brain Research.

[30]  D.J. Reinkensmeyer,et al.  Robot-enhanced motor learning: accelerating internal model formation during locomotion by transient dynamic amplification , 2005, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[31]  Obstacle training programme for individuals post stroke: feasibility study , 2003, Clinical rehabilitation.

[32]  L. Ada,et al.  A treadmill and overground walking program improves walking in persons residing in the community after stroke: a placebo-controlled, randomized trial. , 2003, Archives of physical medicine and rehabilitation.

[33]  Variability of the dishabituation of flexion reflexes for FES assisted gait in spinal injured man. , 1998, Medical engineering & physics.

[34]  J. Williamson,et al.  Characterization of Older Adults Who Attribute Functional Decrements to “Old Age” , 1996, Journal of the American Geriatrics Society.

[35]  J. Lehmann,et al.  Gait abnormalities in hemiplegia: their correction by ankle-foot orthoses. , 1987, Archives of physical medicine and rehabilitation.

[36]  J. Duysens,et al.  Step characteristics during obstacle avoidance in hemiplegic stroke , 2005, Experimental Brain Research.

[37]  J. Bean,et al.  High intensity strength training improves strength and functional performance after stroke. , 2000, American journal of physical medicine & rehabilitation.

[38]  Liberson Wt,et al.  Functional electrotherapy: stimulation of the peroneal nerve synchronized with the swing phase of the gait of hemiplegic patients. , 1961, Archives of physical medicine and rehabilitation.

[39]  Daniel F Hanley,et al.  Effects of treadmill exercise on transcranial magnetic stimulation-induced excitability to quadriceps after stroke. , 2006, Archives of physical medicine and rehabilitation.

[40]  A. Wernig,et al.  Maintenance of locomotor abilities following Laufband (treadmill) therapy in para- and tetraplegic persons: follow-up studies , 1998, Spinal Cord.

[41]  V. Dietz,et al.  Contribution of feedback and feedforward strategies to locomotor adaptations. , 2006, Journal of neurophysiology.

[42]  C. Capaday,et al.  Studies on the corticospinal control of human walking. I. Responses to focal transcranial magnetic stimulation of the motor cortex. , 1999, Journal of neurophysiology.

[43]  R. G. Luckwill,et al.  Role of reflex responses of knee musculature during the swing phase of walking in man , 2004, European Journal of Applied Physiology and Occupational Physiology.

[44]  J. Nielsen,et al.  Suppression of EMG activity by transcranial magnetic stimulation in human subjects during walking , 2001, The Journal of physiology.

[45]  H. Ring,et al.  Activities, participation and satisfaction one-year post stroke , 2007, Disability and rehabilitation.

[46]  JoAnne K. Gronley,et al.  Classification of walking handicap in the stroke population. , 1995, Stroke.

[47]  J. Mehrholz,et al.  Speed-Dependent Treadmill Training in Ambulatory Hemiparetic Stroke Patients: A Randomized Controlled Trial , 2002, Stroke.

[48]  D A Winter,et al.  Electromyographic temporal analysis of gait: hemiplegic locomotion. , 1976, Archives of physical medicine and rehabilitation.

[49]  H Barbeau,et al.  The role of rehabilitation in the recovery of walking in the neurological population , 2001, Current opinion in neurology.

[50]  G. Borg Psychophysical bases of perceived exertion. , 1982, Medicine and science in sports and exercise.

[51]  M. Bonnard,et al.  Task‐induced modulation of motor evoked potentials in upper‐leg muscles during human gait: a TMS study , 2002, The European journal of neuroscience.

[52]  R. Tallis,et al.  Conventional physiotherapy and treadmill re-training for higher-level gait disorders in cerebrovascular disease. , 2000, Age and ageing.

[53]  V. Dietz,et al.  Effectiveness of automated locomotor training in patients with chronic incomplete spinal cord injury: a multicenter trial. , 2005, Archives of physical medicine and rehabilitation.

[54]  R. Stein,et al.  Multicenter evaluation of electrical stimulation systems for walking. , 1999, Archives of physical medicine and rehabilitation.

[55]  J. Lehmann,et al.  Plastic ankle-foot orthoses: evaluation of function. , 1983, Archives of physical medicine and rehabilitation.

[56]  E Byron Marsolais,et al.  Response of sagittal plane gait kinematics to weight-supported treadmill training and functional neuromuscular stimulation following stroke. , 2004, Journal of rehabilitation research and development.

[57]  L. Forrester,et al.  Treadmill Exercise Rehabilitation Improves Ambulatory Function and Cardiovascular Fitness in Patients With Chronic Stroke: A Randomized, Controlled Trial , 2005, Stroke.

[58]  C. Granger,et al.  Functional task benchmarks for stroke rehabilitation. , 1998, Archives of physical medicine and rehabilitation.

[59]  J. Duysens,et al.  Load-regulating mechanisms in gait and posture: comparative aspects. , 2000, Physiological reviews.

[60]  G. Kwakkel,et al.  Effects of overloading of the lower hemiparetic extremity on walking speed in chronic stroke patients: A pilot study. , 2000, NeuroRehabilitation.

[61]  B. Dobkin,et al.  Human lumbosacral spinal cord interprets loading during stepping. , 1997, Journal of neurophysiology.

[62]  T. Yan,et al.  Functional Electrical Stimulation Improves Motor Recovery of the Lower Extremity and Walking Ability of Subjects With First Acute Stroke: A Randomized Placebo-Controlled Trial , 2005, Stroke.

[63]  C. Richards,et al.  Task-related circuit training improves performance of locomotor tasks in chronic stroke: a randomized, controlled pilot trial. , 2000, Archives of physical medicine and rehabilitation.

[64]  E. Field-Fote,et al.  Improved intralimb coordination in people with incomplete spinal cord injury following training with body weight support and electrical stimulation. , 2002, Physical therapy.

[65]  D A Winter,et al.  Electromyographic temporal analysis of gait: normal human locomotion. , 1976, Archives of physical medicine and rehabilitation.

[66]  S L Wolf,et al.  Modified Emory Functional Ambulation Profile: An Outcome Measure for the Rehabilitation of Poststroke Gait Dysfunction , 2001, Stroke.

[67]  E. Field-Fote,et al.  Locomotor Training Approaches for Individuals with Spinal Cord Injury: A Preliminary Report of Walking‐related Outcomes , 2005, Journal of neurologic physical therapy : JNPT.

[68]  S. Prentice,et al.  Adaptation to unilateral change in lower limb mechanical properties during human walking , 2006, Experimental Brain Research.

[69]  A E Patla,et al.  Obstacle crossing in subjects with stroke. , 1999, Archives of physical medicine and rehabilitation.

[70]  Ricardo M L Barros,et al.  Gait Training Combining Partial Body-Weight Support, a Treadmill, and Functional Electrical Stimulation: Effects on Poststroke Gait , 2007, Physical Therapy.

[71]  R. Brissot,et al.  Restoration of gait by functional electrical stimulation for spinal cord injured patients , 1995, Paraplegia.