DOI QR코드

DOI QR Code

The Effects of Treadmill Obstacle-Stepping on Physical Activity in Ambulatory Patients After Stroke

  • Kim, Jeong-soo (Dept. of Physical Therapy, Seoul Rehabilitation Hospital) ;
  • Jeong, Yeon-gyu (Dept. of Physical Therapy, Dongguk University Ilsan Hospital)
  • Received : 2015.09.17
  • Accepted : 2015.11.04
  • Published : 2015.11.19

Abstract

Previous studies have investigated stepping over obstacles in treadmill walking training (TWT-OS) and treadmill walking training (TWT) alone for walking capacity not considering real physical activity. As such, we investigated the effects of TWT-OS on physical activity and changes in different levels of physical activity based on community ambulation in stroke patients. Thirty subjects were randomly assigned to either the experimental group or the control group, with 15 and 15 subjects, respectively. However, one subject from the control group was excluded because of inadequate treatment sessions. All subjects underwent routine physical therapy in the form of treadmill walking. The subjects in the experimental group underwent simultaneous training in obstacle-stepping while walking on the treadmill for 30 min/day, five times/week, for four weeks. Subjects were given a three-axis accelerometer to wear at the hip on a belt for one-week pre- and post-training physical activity. Step counts for seven days, average daily step counts, and the average of minutes spent in sedentary, light, and above moderate activity were chosen as outcome measures of physical activity. No significant differences between the groups were found in terms of step counts for seven days, average daily activity, or daily activity spent at sedentary levels after four-week interventions. However, the average daily activity spent at light levels (-42.60 min vs. -6.71 min) was significantly lower in the experimental group than in the controls. Conversely, average daily activity spent at above moderate levels was higher (19.86 min vs. 11.07 min) (p<.05) after adjusting for each baseline value. Significant pre- and post-training differences were found in all variables of the experimental group (p<.05). Thus, TWT-OS could improve physical levels above moderate activity as a community-oriented task more than simple repetitive waking on a treadmill, and it could provide an opportunity for patients ambulatory after stroke to participate in the community again.

Keywords

References

  1. Bogey R, Hornby GT. Gait training strategies utilized in poststroke rehabilitation: Are we really making a difference? Top Stroke Rehabil. 2007;14(6):1-8. http://dx.doi.org/10.1310/tsr1406-1
  2. Chou LS, Kaufman KR, Brey RH, et al. Motion of the whole body's center of mass when stepping over obstacles of different heights. Gait Posture. 2001;13(1):17-26. https://doi.org/10.1016/S0966-6362(00)00087-4
  3. Combs SA, Dugan EL, Passmore M, et al. Balance, balance confidence, and health-related quality of life in persons with chronic stroke after body weight-supported treadmill training. Arch Phys Med Rehabil. 2010;91(12):1914-1919. http://dx.doi.org/10.1016/j.apmr.2010.08.025
  4. Combs SA, Van Puymbroeck M, Altenburger PA, et al. Is walking faster or walking farther more important to persons with chronic stroke? Disabil Rehabil. 2013;35(10):860-867. http://dx.doi.org/10.3109/09638288.2012.717575
  5. Davis MG, Fox KR. Physical activity patterns assessed by accelerometry in older people. Eur J Appl Physiol. 2007;100(5):581-589. https://doi.org/10.1007/s00421-006-0320-8
  6. DePaul VG, Wishart LR, Richardson J, et al. Varied overground walking-task practice versus body-weight-supported treadmill training in ambulatory adults within one year of stroke: A randomized controlled trial protocol. BMC Neurol. 2011;11:129. http://dx.doi.org/10.1186/1471-2377-11-129
  7. Esliger DW, Probert A, Connor Gorber S, et al. Validity of the actical accelerometer step-count function. Med Sci Sports Exerc. 2007;39(7):1200-1204. https://doi.org/10.1249/mss.0b013e3804ec4e9
  8. 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(3):189-198. https://doi.org/10.1016/0022-3956(75)90026-6
  9. Forster A, Young J. Incidence and consequences of falls due to stroke: A systematic inquiry. BMJ. 1995;311(6997):83-86. https://doi.org/10.1136/bmj.311.6997.83
  10. Globas C, Becker C, Cerny J, et al. Chronic stroke survivors benefit from high-intensity aerobic treadmill exercise: A randomized control trial. Neurorehabil Neural Repair. 2012;26(1):85-95. http://dx.doi.org/10.1177/1545968311418675
  11. Hornby TG, Straube DS, Kinnaird CR, et al. Importance of specificity, amount, and intensity of locomotor training to improve ambulatory function in patients poststroke. Top Stroke Rehabil. 2011;18(4):293-307. http://dx.doi.org/10.1310/tsr1804-293
  12. Jeong YG, Jeong YJ, Kim HS. Comparison of the effect of treadmill walking combined with obstacle-crossing on walking function in stroke patients. Phys Ther Korea. 2013;20(3):9-18. http://dx.doi.org/10.12674/ptk.2013.20.3.009
  13. Lord S, McPherson KM, McNaughton HK, et al. How feasible is the attainment of community ambulation after stroke? A pilot randomized controlled trial to evaluate community-based physiotherapy in subacute stroke. Clin Rehabil. 2008;22(3):215-225. http://dx.doi.org/10.1177/0269215507081922
  14. Mehrholz J, Elsner B, Werner C, et al. Electromechanical-assisted training for walking after stroke. Cochrane Database Syst Rev. 2013;7:CD006185. http://dx.doi.org/10.1002/14651858.CD006185.pub3
  15. Moseley AM, Stark A, Cameron ID, et al. Treadmill training and body weight support for walking after stroke. Cochrane Database Syst Rev. 2005;(4):CD002840.
  16. Pang MY, Eng JJ, Dawson AS. Relationship between ambulatory capacity and cardiorespiratory fitness in chronic stroke: Influence of stroke-specific impairments. Chest. 2005;127(2):495-501. https://doi.org/10.1378/chest.127.2.495
  17. Said CM, Goldie PA, Patla AE, et al. Obstacle crossing in subjects with stroke. Arch Phys Med Rehabil. 1999;80(9):1054-1059. https://doi.org/10.1016/S0003-9993(99)90060-6
  18. Schmid A, Duncan PW, Studenski S, et al. Improvements in speed-based gait classifications are meaningful. Stroke. 2007;38(7):2096-2100. https://doi.org/10.1161/STROKEAHA.106.475921
  19. Shumway-Cook A, Patla AE, Stewart A, et al. Environmental demands associated with community mobility in older adults with and without mobility disabilities. Phys Ther. 2002;82(7):670-681.
  20. Strycker LA, Duncan SC, Chaumeton NR, et al. Reliability of pedometer data in samples of youth and older women. Int J Behav Nutr Phys Act. 2007;4:4. https://doi.org/10.1186/1479-5868-4-4
  21. Stuart M, Benvenuti F, Macko R, et al. Community-based adaptive physical activity program for chronic stroke: Feasibility, safety, and efficacy of the empoli model. Neurorehabil Neural Repair. 2009;23(7):726-734. http://dx.doi.org/10.1177/1545968309332734
  22. Sullivan KJ, Brown DA, Klassen T, et al. Effects of task-specific locomotor and strength training in adults who were ambulatory after stroke: Results of the STEPS randomized clinical trial. Phys Ther. 2007;87(12):1580-1602. https://doi.org/10.2522/ptj.20060310
  23. Sullivan KJ, Knowlton BJ, Dobkin BH. Step training with body weight support: Effect of treadmill speed and practice paradigms on poststroke locomotor recovery. Arch Phys Med Rehabil. 2002;83(5):683-691. https://doi.org/10.1053/apmr.2002.32488
  24. Walker ML, Ringleb SI, Maihafer GC, et al. Virtual reality-enhanced partial body weight-supported treadmill training poststroke: Feasibility and effectiveness in 6 subjects. Arch Phys Med Rehabil. 2010;91(1):115-122. http://dx.doi.org/10.1016/j.apmr.2009.09.009