Effects of treadmill training with partial body weight support and the proprioceptive neuromuscular facilitation method on hemiparetic gait: a randomized controlled study

Abstract

Background: Gait disturbance is common after stroke; however, there is no consensus regarding the optimal therapeutic rehabilitation of hemiparetic gait.

Aim: To compare the effects of the treadmill training with partial body-weight support (TPBWS) and Proprioceptive Neuromuscular Facilitation (PNF) method on gait of subjects with chronic stroke.

Design: Randomized clinical trial, comparing two experimental groups (comparative study).

Setting: Laboratory for Human Movement Analysis of UFRN.

Population: Twenty-three subjects, with a mean age of 56.7±8.0 years and a mean time since the onset of the stroke of 27.7±20.3 months, able to walk with personal assistance or assistive devices.

Methods: Two experimental groups underwent gait training based on PNF method (N.=11) or using the TPBWS (N.=12), for twelve sessions. Evaluation of motor function (using the STREAM and motor FIM), and kinematic gait analysis were carried out before and after the interventions.

Results: Increases in the STREAM scores (F=49.189, P<0.001) and in motor FIM scores (F=7.093, P=0.016), as well as improvement in symmetry ratio-swing time of the paretic leg/swing time of non-paretic leg--(F=7.729, P=0.012), were observed for both groups. Speed, stride length and double-support time showed no change after training. Differences between groups were observed only for the maximum ankle dorsiflexion over the swing phase (F=6.046, P=0.024), which showed an increase for the PNF group. Other angular parameters remain unchanged.

Conclusion: Improvement in motor function and in gait symmetry was observed for both groups, suggesting similarity of interventions. However, the sample size should be carefully considered in generalizing the results to other populations.

Clinical rehabilitation impact: The results showed some equivalence between these two approaches with regard to motor recovery, functionality and temporal symmetry of hemiparetic gait, suggesting that the cost-effectiveness of each treatment may have a important role in this choice.