Awosika Oluwole O, Chan Dorothy, Sucharew Heidi J, Boyne Pierce, Bhattacharya Amit, Dunning Kari, Kissela Brett M
Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45221, USA.
Cincinnati Children's Hospital Medical Center, Division of Biostatistics and Epidemiology, Cincinnati, OH 45229, USA.
Brain Sci. 2022 Jan 19;12(2):133. doi: 10.3390/brainsci12020133.
Post-stroke walking impairment is a significant cause of chronic disability worldwide and often leads to loss of life roles for survivors and their caregivers. Walking impairment is traditionally classified into mild (>0.8 m/s), moderate (0.41-0.8 m/s), and severe (≤0.4 m/s), and those categorized as "severe" are more likely to be homebound and at greater risk of falls, fractures, and rehospitalization. In addition, there are minimal effective walking rehabilitation strategies currently available for this subgroup. Backward locomotor treadmill training (BLTT) is a novel and promising training approach that has been demonstrated to be safe and feasible across all levels of impairment; however, its benefits across baseline walking impairment levels (severe (≤0.4 m/s) vs. mild-moderate (>0.4 m/s)) have not been examined.
Thirty-nine adults (>6 months post-stroke) underwent 6 days of BLTT (3×/week) over 2 weeks. Baseline and PRE to POST changes were measured during treadmill training and overground walking.
Individuals with baseline severe walking impairment were at a more significant functional disadvantage across all spatiotemporal walking measures at baseline and demonstrated fewer overall gains post-training. However, contrary to our working hypothesis, both groups experienced comparable increases in cadence, bilateral percent single support times, and step lengths.
BLTT is well tolerated and beneficial across all walking impairment levels, and baseline walking speed (≤0.4 m/s) should serve as a covariate in the design of future walking rehabilitation trials.
中风后步行障碍是全球慢性残疾的一个重要原因，常常导致幸存者及其照料者失去生活角色。传统上，步行障碍分为轻度（>0.8米/秒）、中度（0.41 - 0.8米/秒）和重度（≤0.4米/秒），被归类为“重度”的患者更有可能居家不出，且跌倒、骨折和再次住院的风险更高。此外，目前针对这一亚组患者有效的步行康复策略极少。反向运动跑步机训练（BLTT）是一种新颖且有前景的训练方法，已被证明在所有损伤程度水平上都是安全可行的；然而，其在不同基线步行障碍水平（重度（≤0.4米/秒）与轻度至中度（>0.4米/秒））下的益处尚未得到研究。
39名成年人（中风后>6个月）在2周内接受了6天的BLTT训练（每周3次）。在跑步机训练和地面行走过程中测量基线以及训练前到训练后的变化。
基线时存在严重步行障碍的个体在所有时空步行指标上，在基线时功能劣势更显著，且训练后总体改善较少。然而，与我们的工作假设相反，两组在步频、双侧单支撑时间百分比和步长方面的增加相当。
BLTT在所有步行障碍水平上耐受性良好且有益，基线步行速度（≤0.4米/秒）应作为未来步行康复试验设计中的一个协变量。
