Comparison of training effects between underwater treadmill gait training and overground gait training on the walking ability and respiratory function in patients with chronic severe hemiplegic stroke: A randomized, controlled, preliminary trial.

BACKGROUND: The need to develop a more effective intervention to obtain a functional recovery of stroke patients who are unable to perform land-based treadmill gait training has been widely reported. Thus, this pilot study aimed to identify a gait training type that could lead to improved gait and respiratory functioning in adult patients with chronic severe hemiplegic stroke. OBJECTIVES: To examine whether underwater treadmill or/and overground gait training could be more effective in stroke patients. METHODS: In this single-blinded, randomized, controlled, comparative study, 22 patients with severe hemiplegic stroke in a rehabilitation hospital were randomly assigned to the experimental (underwater treadmill gait training) or control group (overground gait training). All participants performed a 60-min neurodevelopmental treatment (five times/week for 12 weeks). Each group performed 30-min underwater or overground gait training (two times/week for 12 weeks). Gait and respiratory function were measured before and after the 12-week training. RESULTS: For the walking variables, step-time difference changes post-training showed significant differences between the groups (-.06 vs. +.04 s, p < .05). Both groups showed significant increases in the maximal voluntary volume (MVV) at post compared to pre training (p < .05). The post-training MVV values were significantly different between the two groups (+23.35 vs. +4.76 L, p < .05). CONCLUSIONS: In severe stroke patients, underwater treadmill gait training can be more effective in improving gait and respiratory function than overground gait training and could be an effective clinical intervention tool for the training of such patients.

Effects of gait training with auditory feedback on walking and balancing ability in adults after hemiplegic stroke: a preliminary, randomized, controlled study.

The aim of this study was to identify a gait training type that better improves the walking and balancing abilities of adult patients with chronic hemiplegic stroke. Single-blinded, randomized, controlled, comparative preliminary study was carried out. Patients were recruited from the inpatient unit of a Rehabilitation Hospital. Thirty-one patients who had experienced hemiplegic stroke were randomly assigned to three groups: the heel group (gait training by active weight bearing on the paretic heel with auditory feedback), the forefoot group (gait training with auditory feedback from paretic metatarsals), and the control group (general gait intervention). All patients performed 30 min of comprehensive rehabilitation therapy followed by an additional 20 min of gait intervention with or without auditory feedback three times a week for 6 weeks. Significant improvements in walking and balancing variables were observed after gait training in all three groups (P<0.05). However, significantly larger gains were identified in the heel group than in the control group (center of loading path length, -29.4 vs. -11.4%, d=-1.0; center of loading path velocity, -35.8 vs. -19.6%, d=-1.4). In addition, significantly larger gains were observed in the forefoot group than in the control group (functional gait assessment, +42.6 vs. +20.1%, d=1.3; center of loading path length, -37.2 vs. -11.4%, d=-1.8; center of loading path velocity, -36.0 vs. -19.6%, d=-1.3). Auditory feedback during active weight bearing on paretic feet appears to more effectively improve the walking and balancing abilities of hemiplegic stroke patients than general gait training.