Journal of the Korean Society of Physical Medicine (대한물리의학회지)

The Korean Society of Physical Medicine (대한물리의학회)
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The Effect of the Task-oriented Treadmill Gait on the Improvement in Gait Function, Balance Ability and Functional Activities in Subacute Stroke Patients: Results of a Randomized Controlled Trial

과제지향적 트레드밀 보행이 아급성기 뇌졸중 환자의 보행기능, 균형능력 및 기능적 활동 향상에 미치는 영향: 무작위 대조 실험

  • Myoung-Ho Lee (Department of Rehabilitation Sciences, Graduate School, Daegu University) ;
  • Youg-Bum Jung (Department of Rehabilitation Sciences, Graduate School, Daegu University) ;
  • Se-Don Hwang (Strong Friends Company ) ;
  • Yae-Ji Kim (Department of Physical Therapy, College of Rehabilitation Sciences, Daegu University) ;
  • Myoung-Kwon Kim (Department of Physical Therapy, College of Rehabilitation Sciences, Daegu University)
  • 이명호 (대구대학교 일반대학원 재활과학과 ) ;
  • 정용범 (대구대학교 일반대학원 재활과학과 ) ;
  • 황세돈 ((주)건강한 친구) ;
  • 김예지 (대구대학교 재활과학대학 물리치료학과) ;
  • 김명권 (대구대학교 재활과학대학 물리치료학과)
  • Received : 2023.10.22
  • Accepted : 2023.11.08
  • Published : 2023.11.30
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Abstract

PURPOSE: This study aimed to determine the effects of task-oriented treadmill training on the gait and balance ability and functional activity in 20 patients with subacute stroke. METHODS: The study subjects were twenty stroke patients, ten randomly placed in the experimental group and ten in the control group. Both the experimental and control groups received 30 minutes of traditional physical therapy and an additional 15 minutes of functional electrical stimulation therapy. The experimental group was given task-oriented treadmill training, while the control group received general treadmill training. Each session lasted for 25 minutes, three times a week, over four weeks, totaling 12 sessions. RESULTS: Both groups showed statistically significant differences in the 10-metre walk test (10MWT), timed up and go test (TUG), Fugl-Meyer Assessment (FMA), and Modified Barthel index (MBI). However, statistically significant differences in the Functional Ambulation Categories (FAC) and Berg Balance Scale (BBS) were seen only in the experimental group. There were statistically significant differences in the between-group differences value comparisons in the 10MWT, BBS, TUG, FMA, and MBI. CONCLUSION: Task-oriented treadmill training positively impacts gait, balance, and daily function in subacute stroke patients. This study highlights the benefits of training on unstable surfaces and offers valuable insights for stroke rehabilitation and gait training.

Keywords

Acknowledgement

본 연구는 2023년도 중소벤처기업부의 기술개발사업 지원에 의한 연구임[RS-2023-00227266].

References

  1. Srinayanti Y, Widianti W, Andriani D, et al. Range of motion exercise to improve muscle strength among stroke patients: A literature review. IJNHS. 2021;4(3):332-43.  https://doi.org/10.35654/ijnhs.v4i3.464
  2. Zhang B, Li D, Liu Y, et al. Virtual reality for limb motor function, balance, gait, cognition and daily function of stroke patients: a systematic review and meta-analysis. J Adv Nurs. 2021;77(8):3255-73.  https://doi.org/10.1111/jan.14800
  3. Park S, Jeong H, Kim B. Effects of vibration rolling on ankle range of motion and ankle muscle stiffness in stroke patients: a randomized crossover study. JIAPTR. 2021;12(1):2272-8.  https://doi.org/10.20540/JIAPTR.2021.12.1.2272
  4. Dickstein R, Dunsky A, Marcovitz E. Motor imagery for gait rehabilitation in post-stroke hemiparesis. Phys Ther. 2004;84(12):1167-77.  https://doi.org/10.1093/ptj/84.12.1167
  5. Olney SJ, Richards C. Hemiparetic gait following stroke. part i: characteristics. Gait Posture. 1996;4(2):136-48.  https://doi.org/10.1016/0966-6362(96)01063-6
  6. Aaslund MK, Helbostad JL, Moe-Nilssen R. Walking during body-weight-supported treadmill training and acute responses to varying walking speed and body-weight support in ambulatory patients post-stroke. Physiother Theory Pract. 2013;29(4):278-89.  https://doi.org/10.3109/09593985.2012.727526
  7. Fung J, Richards CL, Malouin F, et al. A treadmill and motion coupled virtual reality system for gait training post-stroke. Cyberpsychol Behav. 2006;9(2):157-62.  https://doi.org/10.1089/cpb.2006.9.157
  8. Smith PS, Thompson M. Treadmill training post stroke: Are there any secondary benefits? A pilot study. Clin Rehabil. 2008;22(10-11):997-1002.  https://doi.org/10.1177/0269215508088988
  9. Pollock AS, Durward BR, Rowe PJ, et al. What is balance? Clin Rehabil. 2000;14(4):402-6.  https://doi.org/10.1191/0269215500cr342oa
  10. Horak FB, Wrisley DM, Frank J. The balance evaluation systems test (bestest) to differentiate balance deficits. Phys Ther. 2009;89(5):484-98.  https://doi.org/10.2522/ptj.20080071
  11. Bland MD, Sturmoski A, Whitson M, et al. Prediction of discharge walking ability from initial assessment in a stroke inpatient rehabilitation facility population. Arch Phys Med Rehabil. 2012;93(8):1441-7.  https://doi.org/10.1016/j.apmr.2012.02.029
  12. Xu T, Clemson L, O'Loughlin K, et al. Risk factors for falls in community stroke survivors: A systematic review and meta-analysis. Arch Phys Med Rehabil. 2018;99(3):563-73. e565.  https://doi.org/10.1016/j.apmr.2017.06.032
  13. Shamay NS, William TW, Patrick KW, et al. Sensorimotor impairments of paretic upper limb correlates with activities of daily living in subjects with chronic stroke. S Afr J Physiother. 2011;67(1):9-16.  https://doi.org/10.4102/sajp.v67i1.34
  14. Crichton SL, Bray BD, McKevitt C, et al. Patient outcomes up to 15 years after stroke: Survival, disability, quality of life, cognition and mental health. J Neurol Neurosurg Psychiatry. 2016;87(10):1091-8.  https://doi.org/10.1136/jnnp-2016-313361
  15. Mayo NE, Wood-Dauphinee S, Cote R, et al. Activity, participation, and quality of life 6 months poststroke. Arch Phys Med Rehabil. 2002;83(8):1035-42.  https://doi.org/10.1053/apmr.2002.33984
  16. Mast BT, Azar AR, MacNeill SE, et al. Depression and activities of daily living predict rehospitalization within 6 months of discharge from geriatric rehabilitation. Rehabil Psychol. 2004;49(3):219. 
  17. Sager MA, Franke T, Inouye SK, et al. Functional outcomes of acute medical illness and hospitalization in older persons. Arch Intern Med. 1996;156(6):645-52.  https://doi.org/10.1001/archinte.1996.00440060067008
  18. Ivey FM, Hafer-Macko CE, Macko RF. Task-oriented treadmill exercise training in chronic hemiparetic stroke. J Rehabil Res Dev. 2008;45(2):249. 
  19. Oujamaa L, Relave I, Froger J, et al. Rehabilitation of arm function after stroke. literature review. Ann Phys Rehabil Med. 2009;52(3):269-93.  https://doi.org/10.1016/j.rehab.2008.10.003
  20. Jeong GY, Im BJ, Park CD, et al. The effects and trends of full-body vibration devices integrated with virtual reality in IT converged medical device technology. State of the Art Report. 2011;23(1):24-32. 
  21. Jochymczyk-Wozniak K, Nowakowska K, Polechonski J, et al. Physiological gait versus gait in vr on multidirectional treadmill-comparative analysis. Medicina. 2019;55(9):517. 
  22. Malatesta D, Canepa M, Menendez Fernandez A. The effect of treadmill and overground walking on preferred walking speed and gait kinematics in healthy, physically active older adults. Eur J Appl Physiol. 2017;117:1833-43.  https://doi.org/10.1007/s00421-017-3672-3
  23. Traballesi M, Porcacchia P, Averna T, et al. Energy cost of walking measurements in subjects with lower limb amputations: A comparison study between floor and treadmill test. Gait Posture. 2008;27(1):70-5.  https://doi.org/10.1016/j.gaitpost.2007.01.006
  24. Hollman JH, Watkins MK, Imhoff AC, et al. A comparison of variability in spatiotemporal gait parameters between treadmill and overground walking conditions. Gait Posture. 2016;43:204-9.  https://doi.org/10.1016/j.gaitpost.2015.09.024
  25. Bishop L, Khan M, Martelli D, et al. Exploration of two training paradigms using forced induced weight shifting with the tethered pelvic assist device to reduce asymmetry in individuals after stroke. Am J Phys Med Rehabil. 2017;96(10):S135-S40.  https://doi.org/10.1097/PHM.0000000000000779
  26. Lindquist AR, Prado CL, Barros RM, et al. Gait training combining partial body-weight support, a treadmill, and functional electrical stimulation: effects on poststroke gait. Phys Ther. 2007;87(9):1144-54.  https://doi.org/10.2522/ptj.20050384
  27. Lancu I, Olmer A. The minimental state examination--an up-to-date review. Harefuah. 2006;145(9):687-90. 
  28. Yang CY, Kim TJ, Lee JH, et al. The effect of functional electrical stimulation on the motor function of lower limb in hemiplegic patients. Journal of the Korean Academy of Rehabilitation Medicine. 2009;33(1):29-35. 
  29. Kim J-H, Uhm Y-H. The effects of biofeedback fusion postural control training using functional electrical stimulation on the muscle activity and balance ability of the stroke patient. Convergence. 2019;17(12):319-27. 
  30. Duncan PW, Propst M, Nelson SG. Reliability of the fugl-meyer assessment of sensorimotor recovery following cerebrovascular accident. Phys Ther. 1983;63(10):1606-10.  https://doi.org/10.1093/ptj/63.10.1606
  31. Sanford J, Moreland J, Swanson LR, et al. Reliability of the fugl-meyer assessment for testing motor performance in patients following stroke. Phys Ther. 1993;73(7):447-54.  https://doi.org/10.1093/ptj/73.7.447
  32. Yang Y-R, Tsai M-P, Chuang T-Y, et al. Virtual reality-based training improves community ambulation in individuals with stroke: A randomized controlled trial. Gait Posture. 2008;28(2):201-6.  https://doi.org/10.1016/j.gaitpost.2007.11.007
  33. Ditor DS, Kamath MV, MacDonald MJ, et al. Effects of body weight-supported treadmill training on heart rate variability and blood pressure variability in individuals with spinal cord injury. J Appl Physiol. 2005;98(4):1519-25.  https://doi.org/10.1152/japplphysiol.01004.2004
  34. Mehrholz J, Wagner K, Rutte K, et al. Predictive validity and responsiveness of the functional ambulation category in hemiparetic patients after stroke. Arch Phys Med Rehabil. 2007;88(10):1314-9.  https://doi.org/10.1016/j.apmr.2007.06.764
  35. Liston RA, Brouwer BJ. Reliability and validity of measures obtained from stroke patients using the balance master. Arch Phys Med Rehabil. 1996;77(5):425-30.  https://doi.org/10.1016/S0003-9993(96)90028-3
  36. Berg K, Wood-Dauphinee S, Williams J. The balance scale: reliability assessment with elderly residents and patients with an acute stroke. Scand J Rehabil Med. 1995;27(1):27-36. 
  37. Lin J-H, Hsueh I-P, Sheu C-F, et al. Psychometric properties of the sensory scale of the fugl-meyer assessment in stroke patients. Clin Rehabil. 2004;18(4):391-7.  https://doi.org/10.1191/0269215504cr737oa
  38. Shah S, Vanclay F, Cooper B. Improving the sensitivity of the barthel index for stroke rehabilitation. J Clin Epidemiol. 1989;42(8):703-9.  https://doi.org/10.1016/0895-4356(89)90065-6
  39. Hobart J, Thompson A. The five item barthel index. J Neurol Neurosurg Psychiatry. 2001;71(2):225-30.  https://doi.org/10.1136/jnnp.71.2.225
  40. Flansbjer U-B, Holmback AM, Downham D, et al. Reliability of gait performance tests in men and women with hemiparesis after stroke. J Rehabil Med. 2005;37(2):75-82.  https://doi.org/10.1080/16501970410017215
  41. Perry J, Garrett M, Gronley JK, et al. Classification of walking handicap in the stroke population. Stroke. 1995;26(6):982-9.  https://doi.org/10.1161/01.STR.26.6.982
  42. Kim Y. The factors related to the community mobility in disabled person. Disabil Rehabil. 2007;11(3):146-67. 
  43. Sekiguchi Y, Honda K, Izumi S-I. Effect of walking adaptability on an uneven surface by a stepping pattern on walking activity after stroke. Front Hum Neurosci. 2022;15:762223. 
  44. Rhyu H-S, Rhi S-Y. The effects of training on different surfaces, on balance and gait performance in stroke hemiplegia. Revista Brasileira de Medicina do Esporte. 2021;27:592-6.  https://doi.org/10.1590/1517-8692202127062020_0089
  45. van Duijnhoven HJ, Heeren A, Peters MA, et al. Effects of exercise therapy on balance capacity in chronic stroke: Systematic review and meta-analysis. Stroke. 2016;47(10):2603-10.  https://doi.org/10.1161/STROKEAHA.116.013839
  46. Hsiao H, Awad LN, Palmer JA, et al. Contribution of paretic and nonparetic limb peak propulsive forces to changes in walking speed in individuals poststroke. Neurorehabil Neural Repair. 2016;30(8):743-52.  https://doi.org/10.1177/1545968315624780
  47. Pohl M, Mehrholz J, Ritschel C, et al. Speed-dependent treadmill training in ambulatory hemiparetic stroke patients: a randomized controlled trial. Stroke. 2002;33(2):553-8.  https://doi.org/10.1161/hs0202.102365
  48. Sohn R, Choi H, Son J, et al. The comparison of overground walking and treadmill walking according to the walking speed: Motion analysis and energy consumption. J Biomed Eng Res. 2009;30(3):226-32. 
  49. AM M. Treadmill training and body weight support for walking after stroke (review). The cochrane library. The Cochrane Collaboration. 2007;3. 
  50. Dean CM, Richards CL, Malouin F. Task-related circuit training improves performance of locomotor tasks in chronic stroke: A randomized, controlled pilot trial. Arch Phys Med Rehabil. 2000;81(4):409-17.  https://doi.org/10.1053/mr.2000.3839
  51. Mudge S, Rochester L, Recordon A. The effect of treadmill training on gait, balance and trunk control in a hemiplegic subject: a single system design. Disabil Rehabil. 2003;25(17):1000-7.  https://doi.org/10.1080/0963828031000122320
  52. Kim CY, Park IM, Oh DW. Comparison of the effect of treadmill gait training and overground gait training on gait function in stroke patients. Kor J Neuromuscul Rehabil. 2011;1(1):13-20. 
  53. Liu M, Chen J, Fan W, et al. Effects of modified sit-to-stand training on balance control in hemiplegic stroke patients: A randomized controlled trial. Clin Rehabil. 2016;30(7): 627-36.  https://doi.org/10.1177/0269215515600505
  54. Langhorne P, Bernhardt J, Kwakkel G. Stroke rehabilitation. The Lancet. 2011;377(9778):1693-702.  https://doi.org/10.1016/S0140-6736(11)60325-5
  55. Beyaert C, Vasa R, Frykberg GE. Gait post-stroke: Pathophysiology and rehabilitation strategies. Neurophysiol Clin. 2015;45(4-5):335-55.  https://doi.org/10.1016/j.neucli.2015.09.005
  56. Hwang B-H, Kim T-H. The effects of sand surface training on changes in the muscle activity of the paretic side lower limb and the improvement of dynamic stability and gait endurance in stroke patients. J Exerc Rehabil. 2019;15(3):439. 
  57. Mochizuki L, Bigongiari A, Franciulli PM, et al. The effect of gait training and exercise programs on gait and balance in post-stroke patients. MedicalExpress. 2015;2.