Immediate effect of treadmill walking practice versus overground walking practice on overground walking pattern in ambulatory stroke patients: an experimental study

Abstract

Objective: To determine whether 10 minutes of treadmill walking had a different effect on overground walking pattern compared with 10 minutes of overground walking in newly ambulatory stroke patients. Are any changes influenced by walking ability?

Design: A within-participant, repeated measures experimental study was conducted. Each participant carried out 10 minutes of overground walking practice followed by 10 minutes of treadmill walking practice at matched heart rate on separate days. Setting: An inpatient rehabilitation facility.

Subjects: Twenty-one participants receiving inpatient rehabilitation following stroke.

Measures: Overground walking pattern was measured as linear and angular kinematics using GAITRite and a two-dimensional webcam application respectively.

Results: Following treadmill walking practice, there was 6 degrees (95% confidence interval (CI) 2 to 10) more knee extension at heel strike during overground walking than following overground walking practice. Poorer walkers increased non-paretic limb step length following treadmill walking practice more than those with better walking ability (mean difference 2.2 cm, 95% CI 0 to 5).

Conclusions: Ten minutes of treadmill walking practice resulted in a similar overground walking pattern compared with overground walking practice in newly ambulatory stroke patients undergoing rehabilitation, regardless of walking ability.

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References

Moseley AM , Stark A. , Cameron ID , Pollock A. Treadmill training and body weight support for walking after stroke. Cochrane Database Syst Rev 2005, Issue 4. Art. No.: CD002840.

Hesse S. Treadmill training with partial body weight support after stroke: A review . Neurorehabilitation 2008; 23: 55-65.

Davies PM Weight-supported treadmill training. Neurorehabil Neural Repair 1999; 3: 167-69. 4 Malouin F. , Richards CL Assessment and training of locomotion after stroke: evolving concepts. In Refshauge KM, Ada L, Ellis E eds. Science-based rehabilitation: theories into practice. Butterworth Heinemann, 2005: 185-222.

Collett J. , Dawes H. , Howells K. , Elsworth C. , Izadi H. , Sackley C. Anomalous centre of mass energy fluctuations during treadmill walking in healthy individuals. Gait Posture 2007; 26: 400-406.

Harris-Love ML , Forrester LW , Macko RF , Silver KH , Smith GV Hemiparetic gait parameters in overground versus treadmill walking. Neurorehabil Neural Repair 2001; 15: 105-12.

Hesse S. , Konrad M. , Uhlenbrock D. Treadmill walking with partial body weight support versus floor walking in hemiparetic subjects. Arch Phys Med Rehabil 1999; 80: 421-27.

Kuys SS , Brauer SG , Ada L. , Russell TG Increasing intensity of treadmill walking does not adversely affect walking pattern or quality in newly-ambulating stroke patients: an experimental study . Aust Physiother 2008; 54: 49-54.

Van Ingen Schenau GJ. Some fundamental aspects of the biomechanics of overground versus treadmill locomotion. Med Sci Sports Exer 1980; 12: 257-61.

Bayat R. , Barbeau H. , Lamontagne A. Speed and temporal-distance adaptations during treadmill and overground walking following stroke. Neurorehabil Neural Repair 2005; 19: 115-24.

10.

Wass E. , Taylor NF , Matsas A. Familiarisation to treadmill walking in unimpaired older people. Gait Posture 2005; 21: 72-79.

11.

Zamparo P. , Francescato MP , De Luca G. , Lovati L. , di Prampero PE The energy cost of level walking in patients with hemiplegia. Scand J Med Sci Sports 1995; 5: 348-52.

12.

Hesse S. , Werner C. , Paul T. , Bardeleben A. , Chaler J. Influence of walking speed on lower limb muscle activity and energy consumption during treadmill walking of hemiparetic patients. Arch Phys Med Rehabil 2001; 82: 1547-50.

13.

Pearce ME , Cunningham DA , Donner AP , Rechnitzer PA , Fullerton GM , Howard JH Energy cost of treadmill and floor walking at self-selected paces. Eur J Appl Physiol Occup Physiol 1983; 52: 115-19.

14.

Greig C. , Butler F. , Skelton D. , Mahmud S. , Young A. Treadmill walking in old age may not reproduce the real life situation. J Am Geriatr Soc 1993; 41: 15-18.

15.

Olney SJ , Richards CL Hemiparetic gait following stroke. Part 1: Characteristics. Gait Posture 1996; 4: 136-48.

16.

Olney SJ , Griffin MP , McBride ID Temporal, kinematic, and kinetic variables related to gait speed in subjects with hemiplegia: a regression approach. Phys Ther 1994; 74: 872-85.

17.

Lord SE , McPherson K. , McNaughton HK , Rochester L. , Weatherall M. Community ambulation after stroke: how important and obtainable is it and what measures appear predictive? Arch Phys Med Rehabil 2004; 85: 234-39.

18.

American College of Sports Medicine: ACSM's Guidelines for Exercise Testing and Prescription, sixth edition. Lippincott Williams & Wilkins, 2000.

19.

Cohen-Solal A. , Baleynaud S. , Laperche T. , Sebag C. , Gourgon R. Cardiopulmonary response during exercise of a β1-selective β blocker (atenolol) and a calcium-channel blocker (diltiazem) in untrained subjects with hypertension. J Cardiovasc Pharm 1993; 22: 33-38.

20.

Pollack ML , Lowenthal DT , Foster C. et al. Acute and chronic responses to exercise in patients treated with beta blockers. J Cardiopul Rehabil 1991 ; 11: 132-44.

21.

Carr JH , Shepherd RB , Nordholm L. , Lynne D. Investigation of a new motor assessment scale for stroke patients. Phys Ther 1985; 65: 175-80.

22.

Bohannon RW Comfortable and maximum walking speed of adults aged 20-79 years: reference values and determinants. Age Ageing 1997; 26: 15-19.

23.

Kidd D. , Stewart G. , Baldry et al. The functional independence measure: a comparative validity and reliability study. Disabil Rehabil 1995; 17: 10-14.

24.

Folstein MF , Folstein SE , McHugh PR Mini-Mental State: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12: 189-98.

25.

McDonough AL , Batavia M. , Chen FC , Kwon S. , Ziai J. The validity and reliability of the GAITRite system's measurements: A preliminary evaluation. Arch Phys Med Rehabil 2001; 82: 419-25.

26.

Bilney B. , Morris M. , Webster K. Concurrent related validity of the GAITRite walkway system for quantification of the spatial and temporal parameters of gait. Gait Posture 2003; 17: 68-74.

27.

Batey P. , Rome K. , Finn P. , Hanchard N. Assessing reliability of measurement of gait velocity. Physiotherapy 2003; 89: 313-17.

28.

Menz HB , Latt MD , Tiedemann A. , Mun San Kwan M. , Lord SR Reliability of the GAITRite walkway system for the quantification of temporo-spatial parameters of gait in young and older people. Gait Posture 2004; 20: 20-25.

29.

Rao AK , Quinn L. , Marder KS Reliability of spatiotemporal gait outcome measures in Huntington's disease . Mov Disord 2005; 20: 1033-37.

30.

Chien SL , Lin SZ , Liang CC et al. The efficacy of quantitative gait analysis by the GAITRite system in evaluation of parkinsonian bradykinesia. Parkinsonism Relat Disord 2006; 12: 438-42.

31.

Yang YR , Chen YC , Lee CS , Cheng SJ , Wang RY Dual-task-related gait changes in individuals with stroke. Gait Posture 2007; 25: 185-90.

32.

Lin PY , Yang YR , Cheng SJ , Wang RY The relation between ankle impairments and gait velocity and symmetry in people with stroke. Arch Phys Med Rehabil 2006; 87: 562-68.

33.

Russell TG , Wootton R. , Jull GA Physical outcome measurements via the Internet: reliability at two Internet speeds. J Telemed Telecare 2002; 8(S3): 50-52.

34.

Russell TG , Jull GA , Wootton R. Can the Internet be used as a medium to evaluate knee angle? Man Ther 2003; 8: 242-46.

35.

Russell TG Goniometry via the Internet [summary]. Aust Physiother 2007; 53: 136.

36.

Moore S. , Schurr K. , Wales A. , Moseley A. , Herbert R. Observation and analysis of hemiplegic gait: swing phase. Austr J Physiother 1993; 39: 271-78.

37.

Eich HJ , Mach H. , Werner C. , Hesse S. Aerobic treadmill plus Bobath walking training improves walking in subacute stroke: a randomized controlled trial. Clin Rehabil 2004; 18: 640-51.

38.

Pohl M. , Mehrholz J. , Ritschel C. , Ruckriem S. Speed-dependent treadmill training in ambulatory hemiparetic stroke patients: a randomized controlled trial. Stroke 2002 ; 33: 553-58.