Six-Week Nordic Treadmill Training Compared with Treadmill Training on Balance, Gait, and Activities of Daily Living for Stroke Patients: A Randomized Controlled Trial

Effect of using an 8-figure shoulder brace on arm swing angle and gait parameters in chronic stroke patients: a pilot randomized controlled study

BACKGROUND

The 8-figure shoulder brace during treadmill training (8-FSBTT) intervention can stabilize the shoulder joint, improve the upright of the thoracic spine, induces a change in the angle of the arm during walking, and consequently improve walking ability in stroke patients.

OBJECTIVES

Our objective is to compare the effects of a 4-week program of 8-FSBTT with those of only treadmill training (OT) on arm swing angle, and gait parameters (gait speed, cadence, and both side stride lengths) in chronic stroke patients.

METHODS

Participants were randomized to either the 8-FSBTT (n = 11) or OT (n = 11) group. Patients in both groups underwent standard physiotherapy for 30 min per session. In addition, 8-FSBTT and OT interventions were performed 10 min, 5 times per week for 4 weeks. Arm swing angle, gait speed, cadence, and both side stride lengths were measured after 4 weeks of training.

RESULTS

After 4 weeks of training, the 8-FSBTT group showed significant improvement in all outcome measures compared with baseline (p < 0.05). Furthermore, Arm swing angle, gait speed, cadence, and both side stride lengths showed greater improvement in the 8-FSBTT group compared to the OT group (p < 0.05).

CONCLUSIONS

This study demonstrated that 8-FSBTT training, combined with standard physiotherapy, improved Arm swing angle, gait speed, cadence, and both side stride lengths in the chronic stroke patients.

Clinical Study of a Wearable Remote Rehabilitation Training System for Patients With Stroke: Randomized Controlled Pilot Trial

BACKGROUND

In contrast to the large and increasing number of patients with stroke, clinical rehabilitation resources cannot meet their rehabilitation needs. Especially for those discharged, ways to carry out effective rehabilitation training without the supervision of physicians and receive guidance from physicians remain urgent problems to be solved in clinical rehabilitation and have become a research hot spot at home and abroad. At present, there are many studies on home rehabilitation training based on wearable devices, Kinect, among others, but these have disadvantages (eg, complex systems, high price, and unsatisfactory rehabilitation effects).

OBJECTIVE

This study aims to design a remote intelligent rehabilitation training system based on wearable devices and human-computer interaction training tasks, and to evaluate the effectiveness and safety of the remote rehabilitation training system for nonphysician-supervised motor rehabilitation training of patients with stroke through a clinical trial study.

METHODS

A total of 120 inpatients with stroke having limb motor dysfunction were enrolled via a randomized, parallel-controlled method in the rehabilitation institutions, and a 3-week clinical trial was conducted in the rehabilitation hall with 60 patients in the experimental group and 60 in the control group. The patients in the experimental group used the remote rehabilitation training system for rehabilitation training and routine clinical physical therapy (PT) training and received routine drug treatment every day. The patients in the control group received routine clinical occupational therapy (OT) training and routine clinical PT training and routine drug treatment every day. At the beginning of the training (baseline) and after 3 weeks, the Fugl-Meyer Motor Function Rating scale was scored by rehabilitation physicians, and the results were compared and analyzed.

RESULTS

Statistics were performed using SAS software (version 9.4). The total mean Fugl-Meyer score improved by 11.98 (SD 8.46; 95% CI 9.69-14.27) in the control group and 17.56 (SD 11.65; 95% CI 14.37-20.74) in the experimental group, and the difference between the 2 groups was statistically significant (P=.005). Among them, the mean Fugl-Meyer upper extremity score improved by 7.45 (SD 7.24; 95% CI 5.50-9.41) in the control group and 11.28 (SD 8.59; 95% CI 8.93-13.62) in the experimental group, and the difference between the 2 groups was statistically significant (P=.01). The mean Fugl-Meyer lower extremity score improved by 4.53 (SD 4.42; 95% CI 3.33-5.72) in the control group and 6.28 (SD 5.28; 95% CI 4.84-7.72) in the experimental group, and there was no significant difference between the 2 groups (P=.06). The test results showed that the experimental group was better than the control group, and that the patients' motor ability was improved.

CONCLUSIONS

The remote rehabilitation training system designed based on wearable devices and human-computer interaction training tasks can replace routine clinical OT training. In the future, through medical device registration certification, the system will be used without the participation of physicians or therapists, such as in rehabilitation training halls, and in remote environments, such as communities and homes.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR2200061310; https://tinyurl.com/34ka2725.

Associations Between Time After Stroke and Exercise Training Outcomes: A Meta-Regression Analysis

Background Knowledge gaps exist regarding the effect of time elapsed after stroke on the effectiveness of exercise training interventions, offering incomplete guidance to clinicians. Methods and Results To determine the associations between time after stroke and 6-minute walk distance, 10-meter walk time, cardiorespiratory fitness and balance (Berg Balance Scale score [BBS]) in exercise training interventions, relevant studies in post-stroke populations were identified by systematic review. Time after stroke as continuous or dichotomized (≤3 months versus >3 months, and ≤6 months versus >6 months) variables and weighted mean differences in postintervention outcomes were examined in meta-regression analyses adjusted for study baseline mean values (pre-post comparisons) or baseline mean values and baseline control-intervention differences (controlled comparisons). Secondary models were adjusted additionally for mean age, sex, and aerobic exercise intensity, dose, and modality. We included 148 studies. Earlier exercise training initiation was associated with larger pre-post differences in mobility; studies initiated ≤3 months versus >3 months after stroke were associated with larger differences (weighted mean differences [95% confidence interval]) in 6-minute walk distance (36.3 meters; 95% CI, 14.2-58.5), comfortable 10-meter walk time (0.13 m/s; 95% CI, 0.06-0.19) and fast 10-meter walk time (0.16 m/s; 95% CI, 0.03-0.3), in fully adjusted models. Initiation ≤3 months versus >3 months was not associated with cardiorespiratory fitness but was associated with a higher but not clinically important Berg Balance Scale score difference (2.9 points; 95% CI, 0.41-5.5). In exercise training versus control studies, initiation ≤3 months was associated with a greater difference in only postintervention 6-minute walk distance (baseline-adjusted 27.3 meters; 95% CI, 6.1-48.5; fully adjusted, 24.9 meters; 95% CI, 0.82-49.1; a similar association was seen for ≤6 months versus >6 months after stroke (fully adjusted, 26.6 meters; 95% CI, 2.6-50.6). Conclusions There may be a clinically meaningful benefit to mobility outcomes when exercise is initiated within 3 months and up to 6 months after stroke.

Comparing the effects of multicomponent exercise with or without power training on the cardiorespiratory fitness, physical function, and muscular strength of patients with stroke: a randomized controlled trial

BACKGROUND

Literature studies concerning the effect of implementing a multicomponent program with different individual exercise intensities are insufficient. This study aimed to examine the effects of performing a multicomponent exercise program incorporating high-speed power training on cardiorespiratory fitness, physical function, and muscular strength in post-stroke patients. We compared the results of two different exercise regimens: high-speed power training and traditional low-speed strength training.

METHODS

Forty-five post-stroke patients were randomly assigned to the high-speed, low-speed, and control groups. A 60-min multicomponent exercise program was conducted three times per week for 8 weeks in the two exercise groups, whereas static stretching was performed in the control group. Cardiorespiratory fitness, physical function, and muscular strength were assessed before and after the intervention.

RESULTS

Significant improvements were observed in the peak oxygen consumption values and results of the Berg balance scale, Korean version of the Trunk Impairment Scale, and Timed Up-and-Go test. The aforementioned were evaluated as a measure of cardiorespiratory function and functional ability in the exercise groups and compared to those obtained in the control group. High-speed power training led to greater improvement in patients compared with low-speed strength training.

CONCLUSIONS

Multicomponent exercise involving high-speed power training was beneficial in helping patients with stroke regain cardiorespiratory fitness, physical function, and muscular strength.

Clinical Practice Guideline to Improve Locomotor Function Following Chronic Stroke, Incomplete Spinal Cord Injury, and Brain Injury

BACKGROUND

Individuals with acute-onset central nervous system (CNS) injury, including stroke, motor incomplete spinal cord injury, or traumatic brain injury, often experience lasting locomotor deficits, as quantified by decreases in gait speed and distance walked over a specific duration (timed distance). The goal of the present clinical practice guideline was to delineate the relative efficacy of various interventions to improve walking speed and timed distance in ambulatory individuals greater than 6 months following these specific diagnoses.

METHODS

A systematic review of the literature published between 1995 and 2016 was performed in 4 databases for randomized controlled clinical trials focused on these specific patient populations, at least 6 months postinjury and with specific outcomes of walking speed and timed distance. For all studies, specific parameters of training interventions including frequency, intensity, time, and type were detailed as possible. Recommendations were determined on the basis of the strength of the evidence and the potential harm, risks, or costs of providing a specific training paradigm, particularly when another intervention may be available and can provide greater benefit.

RESULTS

Strong evidence indicates that clinicians should offer walking training at moderate to high intensities or virtual reality-based training to ambulatory individuals greater than 6 months following acute-onset CNS injury to improve walking speed or distance. In contrast, weak evidence suggests that strength training, circuit (ie, combined) training or cycling training at moderate to high intensities, and virtual reality-based balance training may improve walking speed and distance in these patient groups. Finally, strong evidence suggests that body weight-supported treadmill training, robotic-assisted training, or sitting/standing balance training without virtual reality should not be performed to improve walking speed or distance in ambulatory individuals greater than 6 months following acute-onset CNS injury to improve walking speed or distance.

DISCUSSION

The collective findings suggest that large amounts of task-specific (ie, locomotor) practice may be critical for improvements in walking function, although only at higher cardiovascular intensities or with augmented feedback to increase patient's engagement. Lower-intensity walking interventions or impairment-based training strategies demonstrated equivocal or limited efficacy.

LIMITATIONS

As walking speed and distance were primary outcomes, the research participants included in the studies walked without substantial physical assistance. This guideline may not apply to patients with limited ambulatory function, where provision of walking training may require substantial physical assistance.

SUMMARY

The guideline suggests that task-specific walking training should be performed to improve walking speed and distance in those with acute-onset CNS injury although only at higher intensities or with augmented feedback. Future studies should clarify the potential utility of specific training parameters that lead to improved walking speed and distance in these populations in both chronic and subacute stages following injury.

DISCLAIMER

These recommendations are intended as a guide for clinicians to optimize rehabilitation outcomes for persons with chronic stroke, incomplete spinal cord injury, and traumatic brain injury to improve walking speed and distance.

Unique controlling mechanisms underlying walking with two handheld poles in contrast to those of conventional walking as revealed by split-belt locomotor adaptation

Pole walking (PW), a form of locomotion in which a person holds a pole in each hand, enhances the involvement of alternating upper-limb movement. While this quadruped-like walking increases postural stability for bipedal conventional walking (CW), in terms of the neural controlling mechanisms underlying the two locomotion forms (PW and CW), the similarities and differences remain unknown. The purpose of this study was to compare the neural control of PW and CW from the perspective of locomotor adaptation to a novel environment on a split-belt treadmill. We measured the anterior component of the ground reaction (braking) force during and after split-belt treadmill walking in 12 healthy subjects. The results demonstrated that (1) PW delayed locomotor adaptation when compared with CW; (2) the degrees of transfer of the acquired movement pattern to CW and PW were not different, regardless of whether the novel movement pattern was learned in CW or PW; and (3) the movement pattern learned in CW was washed out by subsequent execution in PW, whereas the movement pattern learned in PW was not completely washed out by subsequent execution in CW. These results suggest that the neural control mechanisms of PW and CW are not independent, and it is possible that PW could be a locomotor behavior built upon a basic locomotor pattern of CW.

Effects of a 4-Week Self-Ankle Mobilization with Movement Intervention on Ankle Passive Range of Motion, Balance, Gait, and Activities of Daily Living in Patients with Chronic Stroke: A Randomized Controlled Study

GOAL

To compare the effects of a 4-week self-ankle mobilization with movement training program with those of self-ankle mobilization with movement with a 10° inclined board in patients with chronic stroke.

MATERIALS AND METHODS

A randomized controlled assessor-blind trial was conducted. The patients were randomized into 2 arms. Subjects were 28 chronic stroke patients with hemiplegia. Both arms attended standard rehabilitation therapy for 30 minutes per session. In addition, self-ankle mobilization with movement and self-ankle mobilization with movement with a 10° inclined board trainings were performed 3 times per week for 4 weeks. Ankle dorsiflexion passive range of motion, static balance ability, Berg balance scale, gait parameters (walking speed, cadence, and step length), and activities of daily living were used to assess changes in motor function after training.

FINDINGS

After 4 weeks of training, all dependent variables were significantly improved in both arms as compared with their baseline values. Furthermore, relative to the self-ankle mobilization with movement arm, the self-ankle mobilization with movement with a 10° inclined board arm demonstrated significantly improved ankle dorsiflexion passive range of motion, static balance ability, gait speed, cadence, and affected-side step length.

CONCLUSIONS

Our results support the hypothesis that self-ankle mobilization with movement with a 10° inclined board combined with standard rehabilitation was superior to self-ankle mobilization with movement combined with standard rehabilitation with respect to the improvement in motor function in the patients with chronic stroke.

Effects of an intensive Nordic walking intervention on the balance function and walking ability of individuals with Parkinson's disease: a randomized controlled pilot trial

BACKGROUND

Parkinson's disease (PD) is associated with impairment in balance and postural control, accompanied by a progressive reduction in the speed and amplitude of movement.

AIMS

The aim of our study was to evaluate the therapeutic effects of Nordic walking on a treadmill on the balance function and walking ability of individuals with PD.

METHOD

Twenty participants with stage 1-3 PD in the Hoehn and Yahr scale were randomly allocated to the Nordic walking training (NWT) group and treadmill training (TT) group, with ten participants per group. Measured outcomes included: the motor subscale of the Unified Parkinson's Disease Rating Scale (UPDRS-M), the Berg balance scale (BBS), the Timed Up-and-go test (TUG), the 10-meter walk test (10 MWT), and the 6-minute walk test (6 MWT).

RESULTS

Improvement on all outcome measures was identified from pre-to-post intervention for both groups (p < 0.05). Post-intervention, there was a significant between-group difference on measured outcomes (p < 0.05). The NWT group exhibited greater improvement in the UPDRS-M (p = 0.006; 95 % CI 0.825-4.374), BBS (p = 0.002; 95 % CI 1.307-5.092), TUG (p = 0.048; 95 % CI 0.028-2.582), 10 MWT (p = 0.047; 95 % CI 0.108-2.306), and 6 MWT (p = 0.003; 95 % CI 20.302-42.097) compared to the TT group.

CONCLUSIONS

Our outcomes provide evidence of the therapeutic benefit of Nordic walking on a treadmill to improve balance function and walking ability in individuals with PD.

Nordic Walking for the Management of People With Parkinson Disease: A Systematic Review

BACKGROUND

It is well known that physical exercise is the main therapeutic element of rehabilitation programs for people with Parkinson disease (PD). As traditional forms of exercise can guarantee significant health benefits, the emergence of nonconventional physical activities, such as Nordic walking (NW), may add positive effects.

OBJECTIVE

To appraise the available evidence on the main effects of NW in the rehabilitation programs for people with PD and to propose a design for upcoming research that might improve the uniformity of future trials.

STUDY DESIGN

Systematic review.

LITERATURE SURVEY

A literature search of 5 established databases (PubMed, MEDLINE, Scopus, Web of Science, and Cochrane) was conducted.

METHODOLOGY

Any relevant randomized controlled trials pertinent to NW in PD published in English from inception to February 2017 were included. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed, and the methodologic quality of each study was assessed by the Physiotherapy Evidence Database scale.

DATA SYNTHESIS

Sixty-six studies were retrieved, and 6 randomized controlled trials (221 subjects) were entered into the qualitative synthesis. Overall, these studies portrayed NW as feasible and likely to be effective in improving the functional and clinical outcomes of people with PD. When we compared NW with other exercise-based interventions, such as treadmill training, free walking, a program of standardized whole-body movements with maximal amplitude (Lee Silverman Voice Treatment BIG training), or a home-based exercise program, the findings proved controversial.

CONCLUSIONS

High heterogeneity and methodologic discrepancies among the studies prevent us from drawing firm conclusions on the effectiveness of NW in comparison with other exercise-based interventions currently used by people with PD. Further investigations with a common design are necessary to verify whether NW may be included within conventional rehabilitation programs commonly recommended to people with PD.

LEVEL OF EVIDENCE

II.

The efficacy of treadmill training on balance dysfunction in individuals with chronic stroke: a systematic review

BACKGROUND

Physical activity and exercise interventions are useful in facilitating the functional recovery of those with chronic stroke and, routinely, are gait-specific. While treadmill training has proven useful in gait performance recovery post-stroke, its efficacy on balance dysfunction has not been  systematically reviewed.

OBJECTIVES

The purpose of this systematic review was to determine the effect of treadmill training (TT) interventions on balance dysfunction in individuals with chronic stroke.

METHODS

A systematic literature search of PubMed, EMBASE, and CINAHL was performed. Eligible randomized controlled trials were published between 2007 and 2016. Selected trials investigated TT interventions in persons with chronic stroke and implemented at least one objective balance measure. Methodological quality was assessed using PEDro criteria.

RESULTS

Eight studies met eligibility criteria and were included in the qualitative analysis. Studies differed in TT implementation and use of adjunctive treatments; however, all trials demonstrated improvements in balance measures that were as effective, if not more so, than conventional physical therapy treatments, including targeted balance training.

CONCLUSIONS

This review recognized moderate evidence in favor of TT interventions in balance and stroke rehabilitation programs. With TT, intensity may be a more critical factor than specificity and may offer additional carryover to recovery parameters of postural control and balance, beyond gait performance. It is recommended that clinicians utilizing TT incorporate objective measures of balance to assess the potential for skill transference and improvements in balance. Higher quality studies and additional research are needed to denote critical parameters by which improvements in balance may be optimized.

Kinematic head and trunk strategies used by hemiplegic stroke patients crossing over obstacles of different heights

[Purpose] The purpose of this study was to compare kinematic data regarding the head, trunk, and pelvis strategies used by individuals with hemiplegia when crossing over obstacles of different heights. [Subjects and Methods] Nine adults with hemiplegia from stroke (7 males and 2 females) participated in this study. A motion analysis system with six infrared cameras was used to measure the kinematic data of the head, trunk, and pelvis while the subjects crossed over obstacles of different heights. Repeated measures ANOVA analysis was performed to compare the resulting kinematic data. [Results] An increase in the magnitude of the kinematic data of the head, trunk, and pelvis of the hemiparetic stroke patients was observed when the height of the obstacles, which they crossed over, increased. [Conclusion] This study described the kinematic strategies, with regard to the head, trunk, and pelvis, used by hemiplegic patients crossing over obstacles of different heights. The results indicate that these kinematic strategies primarily change when the obstacle height was 20% of the height of the subjects.