Departments of Physical and Occupational Therapy, University of Alabama at Birmingham, Building 516 20th Street South, Birmingham, AL, 35233-4555, USA.
Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
J Neuroeng Rehabil. 2018 Nov 1;15(1):92. doi: 10.1186/s12984-018-0442-3.
Treadmill training, with or without body-weight support (BWSTT), typically involves high step count, faster walking speed, and higher heart-rate intensity than overground walking training. The addition of challenging mobility skill practice may offer increased opportunities to improve walking and balance skills. Here we compare walking and balance outcomes of chronic stroke survivors performing BWSTT with BWSTT including challenging mobility skills.
Single-blind randomized clinical trial comparing two BWSTT interventions performed in a rehabilitation research laboratory facility over 6 weeks. Participants were 18+ years of age with chronic (≥5 months) poststroke hemiparesis due to a cortical or subcortical ischemic or hemorrhagic stroke and walking speeds < 1.1 m/s at baseline. A hands-free group (HF; n = 15) performed BWSTT without assistance from handrails or assistive devices, and a hands-free plus challenge group (HF + C; n = 14) performed the same protocol while additionally practicing challenging mobility skills. The primary outcome was change in comfortable walking speed (CWS), with secondary outcomes of fast walk speed (FWS), six-minute walk distance, Berg Balance Scale (BBS) scores, and Activities Specific Balance Confidence (ABC) scores.
Significant pre-post improvement of CWS (Z = - 4.2, p ≤ 0.0001) from a median of 0.35 m/s (range 0.10 to 1.09) to a median of 0.54 m/s (range 0.1 to 1.17), but no difference observed between groups (U = 96.0, p = 0.69). Pre-post improvements across all participants resulted in reclassified baseline ambulation status from sixteen to ten household ambulators, three to seven limited community ambulators, and ten to twelve community ambulators. Secondary outcomes showed similar pre-post improvements with no between-group differences.
The addition of challenging mobility skills to a hands-free BWSTT protocol did not lead to greater improvements in CWS following 6 weeks of training. One reason for lack of group differences may be that both groups were adequately challenged by walking in an active, self-driven treadmill environment without use of handrails or assistive devices.
NCT02787759 Falls-based Training for Walking Post-Stroke (FBT); retrospectively registered June 1st, 2016.
跑步机训练，无论是否有身体重量支持（BWSTT），通常涉及更高的步频、更快的步行速度和更高的心率强度，而高于地面的步行训练。增加具有挑战性的移动技能练习可能会提供更多改善步行和平衡技能的机会。在这里，我们比较了在康复研究实验室设施中进行 BWSTT 加挑战性移动技能练习的慢性中风幸存者的步行和平衡结果。
一项单盲随机临床试验，比较了在康复研究实验室设施中进行的两种 BWSTT 干预措施，持续 6 周。参与者年龄在 18 岁以上，患有因皮质或皮质下缺血性或出血性中风导致的慢性（≥5 个月）偏瘫，且基线步行速度<1.1m/s。无扶手组（HF；n=15）在没有扶手或辅助设备帮助的情况下进行 BWSTT，无扶手加挑战组（HF+C；n=14）在进行相同方案的同时，还练习具有挑战性的移动技能。主要结果是舒适步行速度（CWS）的变化，次要结果是快速步行速度（FWS）、6 分钟步行距离、伯格平衡量表（BBS）评分和活动特定平衡信心（ABC）评分。
从中位数 0.35m/s（范围 0.10 至 1.09）到中位数 0.54m/s（范围 0.1 至 1.17），CWS 有显著的前后改善（Z=-4.2，p≤0.0001），但组间无差异（U=96.0，p=0.69）。所有参与者的前后改善结果导致基线活动状态从 16 位家庭步行者重新分类为 10 位，7 位有限社区步行者，12 位社区步行者。次要结果显示类似的前后改善，组间无差异。
在无扶手 BWSTT 方案中增加具有挑战性的移动技能并没有导致 6 周训练后 CWS 的更大改善。组间差异不明显的一个原因可能是，两组在没有使用扶手或辅助设备的情况下，在主动、自我驱动的跑步机环境中行走，都受到了足够的挑战。
NCT02787759 基于跌倒的中风后步行训练（FBT）；2016 年 6 月 1 日回顾性注册。
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