Treadmill Training after a stroke
Treadmill training
There are a few different variations of treadmill training in stroke rehab.
- body-weight supported treadmill training – (BWS) uses a harness to support all, or a portion of, the patient’s body-weight, allowing them to focus on walking, rather than simply trying not to fall on their face.
- robot-assisted treadmill training – a machine actually moves your limb, or limbs for you…or at least gives you just enough assistance to make walking happen
- electrical-stimulation assisted treadmill training – a functional e-stim device causes contraction of your muscles at certain points in the walking cycle, in order to improve timing and efficiency
- physical therapist assisted treadmill training – a PT provides hands-on techniques to cue certain muscles or movements in order to improve the precision of the patient’s walking pattern
- and then you’ve got your standard just get on a treadmill and walk thing.
example of a BWS treadmill at Madonna Rehab Hospital in Lincoln, NE
It seems pretty obvious to me that if a patient cannot physically hold her body upright and walk, then using a harness to hold her up and allow her to take steps on a treadmill should be more beneficial then letting her sit in their wheelchair all day. Right? Right. Treadmill training with various forms of assistance can also be used for those who are able to walk, but it just doesn’t look very pretty. In other words, they are getting from point A to point B, but they might not be doing so with reasonable quickness, efficiency of movement, or safety.
It is theorized that facilitated treadmill walking (using one of the methods listed above) produces more normal patterns of brain activation than treadmill walking without facilitation. It is quite possible that firing nerve cells in a “more normal” pattern is more beneficial for producing plastic changes in the brain that would promote “normalizing” of your gait pattern.
Does It Work?
Journal of Physiotherapy 2010 published a systematic review of 6 different studies, all comparing some type of mechanically assisted walking with un-assisted walking overground. (some studies used body weight supported treadmills, and others used body weight supported gait trainers). They found that “mechanically assisted walking with body weight support is more effective than overground walking at increasing independent walking in non-ambulatory patients early after stroke.”
A cochrane database systematic review in 2005 compared the results of 15 different studies on the effectiveness of treadmill training with body-weight support vs walking overground. They found that “there were no statistically significant differences between treadmill training, with or without body weight support, and other interventions for walking speed or dependence. Overall no statistically significant effect of treadmill training with or without body weight support was detected. Although individual studies suggested that treadmill training with body weight support may be more effective than treadmill training alone and that treadmill training plus task-oriented exercise may be more effective than sham exercises, further trials are required to confirm these findings.”
NOTE, they did not say that treadmill training was in-effective. They are simply saying that when analyzing the results of all 15 studies, across all levels of stroke studied (acute and chronic), walking training on the ground seems to be AS effective as using a body-weight supported treadmill. However this doesn’t take into consideration the individual needs of a stroke recoverer…..for example, can he safely put in enough walking practice without assistance? Also, the walking pattern of some stroker recoverers is so completely dysfunctional that by practicing that pattern over and over they are not re-training their brain for normal walking.
Archives of Physical Medicine in 2003 compared gait retraining with 40% of their body-weight supported to gait training without any body-weight support. They found “retraining gait in severely impaired stroke subjects with a percentage of their body weight supported resulted in better walking and postural abilities than did gait training in patients bearing their full weight. It appears that subjects with greater gait impairments benefited the most from training with BWS, as did the older patients with stroke. There is evidence of transfer from treadmill training to overground locomotion.”
In 2002 the journal Physical Therapy published a small case study of 2 patients who participated in body-weight supported treadmill training more than 2 years after their stroke. Their “outcomes suggest that very old patients with chronic functional deficits secondary to cerebrovascular accident tolerated BWS treadmill and overground ambulation training and made improvements following this intervention.”
The journal Physical Therapy in 2011 published a study that investigated the effects of increasing the speed of the treadmill training on quality and speed of gait after a stroke. They found that a more normal gait pattern was facilitated with faster treadmill training speeds. The increase in speed of the treadmill was only between 0.1 and 0.5 mph faster than their self-selected speed. In other words, simply increasing the speed slightly beyond the patient’s relaxed walking speed provided improvements in walking. However, caution should be used to avoid unsafe speeds. Consult your doctor or rehab professional before trying this type of training.