Walking gait changes after stepping-in-place training using a foot lifting device in chronic stroke patients

Effects of rhythmic auditory cueing on stepping in place in patients with Parkinson's disease

BACKGROUND

Stepping in place (SIP) is a useful locomotor training intervention. The purpose of this study was to investigate the effects of single auditory-cued SIP training on cortical excitability, rhythmic movements and walking ability in patients with Parkinson's disease(PD).

METHODS

Cross-over randomized control trial. Each participant completed two interventions with at least one-week washout period in between: (1) SIP with concurrent auditory cues (AC condition) and (2) SIP without auditory cues (NC condition).

RESULTS

In the primary outcome, the cortical silent period (CSP) duration increased (P = .005), whereas short intracortical inhibition (SICI) decreased after training (P = .001). Freezers demonstrated enhanced inhibition in the resting motor threshold and CSP duration. SICI and intracortical facilitation were modulated in both groups under the AC condition. In the secondary outcomes, the stepping variability decreased significantly (AC: P = .033; NC: P = .009), whereas walking cadence increased after training (AC: P = .019; NC: P = .0023).

CONCLUSIONS

Auditory-cued SIP training improved the lower-limb movement variability and modulated the cortical excitability in patients with PD. Freezers may benefit more from this training than nonfreezers.

Assessment of two gait training models: conventional physical therapy and treadmill exercise, in terms of their effectiveness after stroke

BACKGROUND

Rehabilitation provided to patients after stroke mainly aims at improvement in gait function. The most common gait training strategies include treadmill exercise and traditional overground gait training. The study was designed to assess the effectiveness of two models of gait re-education in post-stroke patients, namely conventional physical therapy and treadmill training.

METHODS

A systematic literature review was performed, taking into account the online databases of Medline (PubMed), Science Direct, Web of Science, Google Scholar, and clinical trials registries. The following inclusion criteria were applied: studies published from 2008 to 2018, written in English, involving treatment and control groups, investigating conventional physical therapy and treadmill training administered for gait re-education after stroke.

RESULTS

Out of 160 articles identified, 23 met the inclusion criteria and were reviewed and analyzed. One hundred fifteen projects involving clinical trials were identified; out of these nine reports from the last five years are included in the review. The number of participants in all the studies totaled at 1,772. The participants in all the studies represented both sexes, and their age ranged from 18 to the late 80s, with an average of 60+ years of age. In most cases, the patients examined were at a chronic stage post-stroke, i.e., more than six months following stroke onset. The most frequently applied types of treadmill training included: high-intensity aerobic treadmill training and treadmill training with or without body weight support. Most interventions involved participation in 30- or 60-minute sessions, from three to five times weekly, for the duration of six to 16 weeks.

CONCLUSIONS

Treadmill training seems to be a valuable and effective method of gait re-education, which can be used at various periods following a stroke, and mainly leads to improvement in walking speed and walking capacity. However, no standard has been defined so far with regard to treadmill-supported recovery of gait function in patients after stroke. We still do not know the optimum duration and frequency of exercise. Further study should investigate long-term effects and the way treadmill training impacts on patients' daily activities. HIPPOKRATIA 2018, 22(2): 51-59.