Table 3.
Effect of treadmill training on walking.
| Author | Subjects | Program description | Results |
|---|---|---|---|
| Early post-stroke (inpatient rehabilitation) | |||
| Richards et al. [58] 1993 |
N=27 Inpatient rehabilitation |
All groups received conventional rehabilitation, plus one of three physiotherapy groups: Group 1: Early and intensive therapy (treadmill without body weight support, isokinetic device, tilt table, limb-load monitor) (n=10) Group 2: Early neurophysiological physiotherapy (n=8) Group 3: Neurophysiological physiotherapy (n=9) Groups 1 and 2 started mean 8 days and Group 3 started 13 days post-stroke. |
Gait speed: Intensive group had faster (but not significant) speed at 6 weeks post-stroke compared to other 2 groups. Note: percent of time on treadmill was not described. |
| Visintin et al. [68] 1998 Barbeau et al. [125] 2003 |
N=100 Inpatient rehab Mod-severe impairment as initial mean gait was < 0.2 m/s |
6 weeks gait training, 20 min, 4X/week in addition to standard of care Group 1 (n=50): BWSTT with 1 therapist for support and 1 therapist to assist with stepping movement. Started body-weight between 0–40%. Task was progressed with increasing treadmill speed and reducing body-weight. Group 2 (n=50): Control Group of Treadmill without body-weight support |
At 6 weeks Gait speed*: BWSTT+79%, control+56% Walking endurance distance*: BWSTT+230%, control+127% BWSTT allowed earlier gait training At 3 months: group differences persisted. |
| Kosak and Reding [69] 2000 |
N=56 Inpatient rehabilitation Moderate assistance for walking Mean 40 days post-stroke |
Both groups had 45 min conventional therapy, 5X/week Group 1 (n=22): additional 45 min BWSTT 5X/week. 2 person assist with leg advancement and foot placement. Group 2 (n=34): additional 45 min aggressive bracing assisted walking |
No group differences for gait speed or distance over 6 weeks. |
| Nilsson et al. [70] 2001 |
N=73 Within 8 weeks post-stroke 10 m walk > 14 seconds |
Group 1 (n=36): BWSTT, 30 min, 5X/day with 1 or 2 person assist with leg advancement plus conventional rehabilitation. Gradual reduction of support and increase in speed. Group 2 (n=37): Control. Individual walking practice (motor re-learning) plus conventional rehabilitation. |
No group difference for gait speed and functional ambulation category at discharge and 10 month follow-up. |
| Laufer el al. [71] 2001 |
N=25 Inpatient rehabilitation < 90 days post-stroke Can walk on treadmill 0.2 km/hr |
Group 1 (n=13): 3 weeks treadmill training without body weight support (hip flexion and foot placement assistance from therapist) + conventional rehabilitation. Group 2 (n=12): 3 weeks overground gait training + conventional rehabilitation Both groups progressed from 4 to 8 min/day of walking. |
Functional ambulation category*: Treadmill+75%, Overground+43% No group difference in walking speed. |
| Pohl et al. [72] 2002 |
N=60 Inpatient rehabilitation > 4 weeks post-stroke No or little spasticity Able to walk without assistance |
4 weeks, 12 sessions Group 1: 30 min sessions of Structured speed-dependent treadmill training (STT) (n=20). 10 sec bouts of maximal waking speed with 10% increases on next bout if they felt safe. Group 2: 30 min sessions of Limited progressive treadmill training (LTT) (n=20) Up to 5% increase in speed each week. Group 3: 45 min sessions of Bobath/NDT gait training (n=20) Up to 10% body weight support provided in first 3 sessions of Group 1 and 2. In addition, all 3 groups received 8 sessions of 45 min conventional physiotherapy. |
Gait speed*: STT+167%, LTT+85%, Bobath+47% Functional ambulation category*: STT+35%, LTT+24%, Bobath+10% |
| Da Cunha Filho et al. [73,126] 2001;2002 |
N=15 (2 drop-outs) Inpatient rehabilitation (< 6 weeks post-stroke) Can take 1 or more steps with or without assistance |
Group 1 (n=6): 20 min, 5X/week BWSTT (up to 30% body support and progressively decreased with increases in speed) + conventional interdisciplinary rehab Group 2 (n=7): conventional rehab Treatment time same in each group. |
No group differences for gait speed, 5MWT, gait energy expenditure or gait energy cost, Locomotor score of FIM or Functional Ambulation Category. |
| Werner et al. [74] 2002 |
N=30 Non-ambulatory 4–12 weeks post-stroke Inpatient rehabilitation |
Cross-over design. 6 weeks of A-B-A (n=15) or B-A-B (n=15) where: RX A: 2 weeks, 15–25 min, 5X/week, Gait trainer with body weight support (has reciprocally moving footplates and 1 person assist) RX B: 2 weeks, 15–25 min, 5X/week, BWSTT with 2 person assist Conventional physiotherapy was also provided to all subjects during the 6 weeks. |
No group effects for gait speed. Less therapist assistance required for gait trainer. |
| Werner et al. [75] 2002 |
N=28 8 weeks to 9 months post-stroke Inpatient rehabilitation Non-ambulatory |
3 weeks of conventional therapy followed by: Group 1 (n=14): 3 weeks BWSTT 30 min, 5X/week, plus 40 min physiotherapy Group 2 (n=14): 3 weeks BWSTT 30 min, 5X/week |
Functional ambulation category*: Combined group+390%; BWSTT only+100% No group effect for gait speed. Note: Therapy hours per group differed. |
| Eich et al. [111] 2004 |
N=50 Inpatient rehabilitation Able to walk 12 m with or without assistance Can pedal at least 50 W |
Group 1 (n=25): 6 weeks, 30 min, treadmill (maximum 15% body-weight) + 30 min Bobath physiotherapy (tone-inhibiting and gait preparatory maneuvers, walking practice on floor and stairs) Group 2 (n=25): 6 weeks, 60 min Bobath physiotherapy |
Gait speed*: Treadmill Group+78%, Control+36% 6MWT*: Treadmill Group+84%, Control+51% Differences persisted at 18 weeks post-admission. |
| Richards et al. [76] 2004 |
N=63 Inpatient rehabilitation Gait speed between .1 and .6 m/s |
Both groups had interdisciplinary rehabilitation. Group 1 (n=32): gait training with tilt table, Kinetron and treadmill (no body weight support). Treadmill use was mean 11 min/session. Group 2 (n=31): conventional physiotherapy (no treadmill) |
No group differences in gait speed at discharge or after 2 months therapy. |
| Yagura et al. [77] 2006 |
N=49 < 3 months post-stroke Inpatient rehabilitation Required physical assistance for gait after 4 weeks rehabilitation. |
6 weeks (week 5–10 of inpatient rehab), 20 min, 3X/week Group 1 (n=23): BWSTT with facilitation (manual facilitation of hip and pelvis movements to ensure stable swing and stance) Group 2 (n=26): BWSTT with assistance to paretic foot |
No group difference in gait speed or FIM gait score at week 10 or week 16. Facilitation group required more resources. |
| Husemann et al. [78] 2007 |
N=30 Need for personal assistance in walking. 28–200 days post-stroke Inpatient rehabilitation |
Group 1 (n=16): Treadmill training with Robotic-driven orthosis (Lokomat), 30 min, 5X/week Group 2 (n=14): Conventional physiotherapy (treadmill training added if possible), 30 min, 5X/week Both groups also had an additional 30 min conventional physiotherapy. |
No group difference in gait speed or Functional ambulatory category after 4 weeks of training. Lokomat group improved duration of single limb support time more than conventional physiotherapy. |
| > 6 months post-stroke | |||
| Sullivan el al. [79] 2002 |
N=24 > 6 months post-stroke Can walk 10 at least with standby physical assistance. |
12 sessions of 20 min (4–5min bouts) BWSTT over 4–5 weeks training Group 1 (n=8): fast (2.0 mph) BWSTT Group 2 (n=8): slow (.5 mph) BWSTT Group 3 (n= 8): variable speed BWSTT |
Gait speed*:fast+26% different from slow+11% and variable+13% Improvement continued at 1 month and maintained at 3 month follow-up. |
| Ada et al. [80] 2003 |
6 months to 5 years post-stroke Walked independently 10 m N=27 |
3X/week, 4 weeks, 45 min Group 1 (n=13): treadmill without body weight support. Challenges to speed, step length, balance and cognitive tasks (80–50% of time). Overground walking included varying directions, speeds and step lengths, stairs, balance challenges, outdoor circuit (curbs, slopes, varying terrain) (20–50% of time) Group 2 (n=14): Control. Low intensity home exercise of stretching and strengthening leg muscles, recommended daily walk, balance exercises. |
Gait speed*: Treadmill Group+21%, Control +6% 6MWT*: Treadmill Group+ 28%, Control +5% At 3 months post-intervention, these group differences persisted. |
| Jaffe et al. [81] 2004 |
N=20 > 6 months post-stroke Could walk independently or with supervision |
Group 1 (n=10): 6-1 hour sessions over 2 weeks treadmill training stepping over foam objects Group 2 (n=10): 2 weeks treadmill training stepping over virtual objects with feedback Neither group used body weight support on the treadmill. |
Maximum gait speed*:Virtual +20%% Foam+12% No group differences for self-selected gait speed or 6MWT Both groups retained improvements 2 weeks post-training. |
| Macko et al. [82] 2005 |
N=61 > 6 months post-stroke Could complete 3 min treadmill walking at 0.22 m/sec |
40 min sessions 3X/week for 6 months Group 1 (n=25): Treadmill aerobic training (without body weight support). Progressed from 40% to 60–70% HRR at 5% heart rate reserve (HRR) every 2 weeks. Group 2 (n=20): Control Group. Stretching and 5 min low intensity treadmill walking (30–40% HRR). |
6MWT*: Treadmill Group+21%, Control+2% Self-report walking distance scale*:Treadmill Group+56%, Control+12% No group differences for usual or fast gait speed |
| Yen et al. [83] 2007 |
N=14 > 6 months post-stroke Could walk 10 m with or without assistance |
Group 1 (n=7): 4 weeks of 50 min, 2–5X/week of general physical therapy and 30 min, 3X/week of BWSTT with 1 or 2 assistants. Body weight support was less than 40% and was decreased with progression. Group 2 (n=7): Control group of general physical therapy (4 weeks, 50 min, 2–5X/week of stretching, strengthening, overground gait) |
Gait speed*: Treadmill Group+34%, Control +11% Note: Therapy hours per group differed. |
+/− % indicates percent increase or decrease from baseline.
*
indicates significant comparison reported in study.