Acute stroke rehabilitation outcomes with supported treadmill ambulation training

Filho, Inacio Teixeira da Cunha
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Objective. To investigate gait, exercise, and functional outcomes with supported treadmill ambulation training (STAT) associated with regular rehabilitation in acute stroke survivors. Design. Randomized, controlled, pilot study. Setting. Rehabilitation Medicine Service, the Veterans Affairs Medical Center, Houston, Texas. Subjects. Seven acute stroke survivors assigned to regular intervention group (RI) and 6 patients assigned to STAT intervention. Methods. Regular intervention consisted of 3 hours daily of physical therapy, kinesiotherapy, and occupational therapy. STAT group received regular rehabilitation with STAT substituted for usual gait training. Participants were tested at baseline, treated for an average of 3 weeks and re-tested upon discharge. The ANCOVA procedure was utilized for differences between the two approaches. Main outcome measures. (1) Gait parameters: Functional Ambulation Category (FAC) scale, gait speed (GS), walk distance (WD), gait energy expenditure (GEE), gait energy cost (GEC); (2) criterion-limited oxygen consumption (clVO2) obtained with the bike protocol, total workload and time pedaling the cycle ergometer; and (3) Measure of functional locomotion (FIM-L). Results. The small sample size did not generate enough power to detect significant differences in any gait parameter variables between the two groups. However, medium to large effect sizes of 0.7 and 1.16 standard deviation units for GEC and WD, respectively, were observed. Criterion-limited VO2 was statistically higher with the STAT intervention (11.34 ± 0.88 vs 8.32 ± 0.88 ml/kg/min, p = 0.039). Highest workload and time pedaling the cycle ergometer were not statistically different between the two groups: 62.50 ± 26.22 watts for STAT versus 41.67 ± 12.91 watts for regular (p = 0.27); and 338.33 ± 31.21 seconds versus 162.00 ± 66.27 seconds (p = 0.13), for STAT and regular group, respectively. FIM-L scores were not different between the two groups after intervention. Conclusions. This study demonstrated the adequacy of the gait parameters and the exercise protocol in evaluating performance with acute stroke survivors. STAT is a safe, feasible and promising intervention for acute stroke survivors, that can be utilized to provide gait training for this population. Future studies with larger sample sizes are warranted for statistical relevance.

Health and environmental sciences, Ambulation training, Exercise, Gait, Rehabilitation, Stroke, Treadmill