Universitätsklinik für Neurologie Medizinische Universität Graz The effect on walking performance of fast treadmill training with partial body weight support in individuals with chronic stroke Christian Enzinger (1,2,5), Helen Dawes (2,3), Claire Guy (3), Marco Bogdanovic (4), Paul Matthews (2, 4), Hooshang Izadi (3), Johnny Collett (3), Franz Fazekas (1,5), Derick Wade (6) (1) Dept. of Neurology, Medical University Graz, Austria; (2) Centre for Functional MRI of the Brain, Oxford, UK; (3) Movement Science Group, School of Biological and Molecular Sciences, Oxford Brookes University, UK; (4) Dept. of Clinical Neurology, Oxford University, UK; (5) Section of Neuroradiology, Dept. of Radiology, Medical University Graz, Austria; (6) Oxford Center for Enablement (formerly Rivermead Disability Center), Oxford, UK References. [1] Moseley A et al. Treadmill training and body weight support for walking after stroke (Cochrane Review). The Cochrane Library, [2] Van Peppen RP et al. The impact of physical therapy on functional outcomes after stroke: what's the evidence? Clin Rehabil, (8): [3] Visintin M et al. A new approach to retrain gait in stroke patients through body weight support and treadmill stimulation. Stroke 1998; 29(6): [4] Sullivan KJ et al. Step training with body weight support: Effect of treadmill speed and practice paradigms. Arch Phys Med Rehab (5): [5] Pohl M, et al. Speed-dependent treadmill training in ambulatory hemiparetic stroke patients - A randomized controlled trial. Stroke 2002; 33(2): [6] Laufer Y et al. The effect of treadmill training on the ambulation of stroke survivors. J Rehab Res Development, (1): p Address for correspondence: Christian Enzinger, Dept. of Neurology, Medical University Graz, Auenbruggerplatz 22, 8020 Graz, Austria. Background and Purpose: We set out to investigate the effect on walking performance of an intervention of four weeks (12 sessions) fast treadmill training with partial body weight support (PBWS) in a prospective single-centre pre-post intervention experimental design in subjects with residual gait impairment related to chronic ischemic subcortical strokes. Subjects: Eighteen subjects (10M/8 F) with a singular subcortical ischemic stroke at least 6 months prior to study entry (mean interval: 3.1+/-3 yrs; range ) and no longer in rehabilitation. Their mean age was 59+/-13 yrs (range 32-74), the mean Barthel Index (0-20) was 19+/-2 (range 5-20), the mean Rivermead mobility Index (0- 15) was 12+/-5 (range 9-15), the mean motricity score of the affected leg was 77.7+/ (58-91). Right hemiparesis was present in 7 and leftt hemiparesis in 11 subjects. Thirteen subjects did not use walking aids, 5 used a stick outdoors only (28%), 1 used a stick in- & outdoors, 6 used a tripod (33%), and 1 used an ankle foot orthosis (6%). Figure 2. Time series plots of training speed (m s –1) achieved for the group of stroke patients 2A – eight patients reaching a plateau by week 6 2B – 10 patients who did not plateau within 8 weeks Figure 1. Average training profile: proportion of partial body support (PBWS) and walking speed. Solid and dashed line represents the mean training speed and PBWS for each session respectively, including standard deviation represented by the error bars. Medical University of Graz, Austria University of Oxford, UK Training Protocol. Individuals followed a protocol based on that reported by Sullivan et al. Subjects completed 12 sessions, made up of 4 x 5 minutes, 3 times per week for 4 weeks, walking on a motorised treadmill with partial body weight support (PBWS). An initial PBWS of 0-30% was determined according to ability so that individuals walked whilst maintaining normal limb kinematics throughout stance and swing with two-therapists´ assistance. PBWS was limited to 30% at most to prevent the reduction of activity in antigravity muscles. Participants were fitted with a harness supplied with the Biodex Offset Unweighing System and connected to the overhead suspension system positioned over a calibrated Power jog treadmill. The therapist encouraged a symmetrical gait pattern with reciprocal arm swing throughout training. During training individuals were encouraged to achieve a walking speed of 2 mph (0.89 m s־¹) as soon as possible utilizing therapist assistance at the foot or pelvis or both. PBWS was progressively decreased whilst maintaining walking speed and a normal style. (Figure 1) To assess walking speed-and endurance, the 10-metre timed walk and the 2-minute walk were used respectively. Temporal and spatial parameters of gait were recorded using a GAITRite® mat (180 x 35.5 inches) positioned on the track during the 2 minute walk when individuals had established a comfortable rhythm at their self-selected overground walking speed. Results: We found irrespective of age, individuals significantly increased ground walking speed and endurance after training (p<0.05; see table on the left and figures 2A and 2B). Two minute-walking distance following the intervention was predictable from pre- test results. Age and time since stroke were not strong predictors of outcome (Predicted 2 minute time = age b-2min Interval). Conclusion: A treadmill training intervention, aiming for fast training speeds using PBWS, is effective at improving walking performance in individuals with subcortical strokes whatever their age, walking ability or the time since their stroke.