Walking and balance outcomes for stroke survivors: a randomized clinical trial comparing body-weight-supported treadmill training with versus without challenging mobility skills

Abstract

Background: Treadmill training, with or without body-weight support (BWSTT), typically involves high step count, faster walking speed, and higher heart-rate intensity than overground walking training. The addition of challenging mobility skill practice may offer increased opportunities to improve walking and balance skills. Here we compare walking and balance outcomes of chronic stroke survivors performing BWSTT with BWSTT including challenging mobility skills.

Methods: Single-blind randomized clinical trial comparing two BWSTT interventions performed in a rehabilitation research laboratory facility over 6 weeks. Participants were 18+ years of age with chronic (≥5 months) poststroke hemiparesis due to a cortical or subcortical ischemic or hemorrhagic stroke and walking speeds < 1.1 m/s at baseline. A hands-free group (HF; n = 15) performed BWSTT without assistance from handrails or assistive devices, and a hands-free plus challenge group (HF + C; n = 14) performed the same protocol while additionally practicing challenging mobility skills. The primary outcome was change in comfortable walking speed (CWS), with secondary outcomes of fast walk speed (FWS), six-minute walk distance, Berg Balance Scale (BBS) scores, and Activities Specific Balance Confidence (ABC) scores.

Results: Significant pre-post improvement of CWS (Z = - 4.2, p ≤ 0.0001) from a median of 0.35 m/s (range 0.10 to 1.09) to a median of 0.54 m/s (range 0.1 to 1.17), but no difference observed between groups (U = 96.0, p = 0.69). Pre-post improvements across all participants resulted in reclassified baseline ambulation status from sixteen to ten household ambulators, three to seven limited community ambulators, and ten to twelve community ambulators. Secondary outcomes showed similar pre-post improvements with no between-group differences.

Conclusions: The addition of challenging mobility skills to a hands-free BWSTT protocol did not lead to greater improvements in CWS following 6 weeks of training. One reason for lack of group differences may be that both groups were adequately challenged by walking in an active, self-driven treadmill environment without use of handrails or assistive devices.

Trial registration: NCT02787759 Falls-based Training for Walking Post-Stroke (FBT); retrospectively registered June 1st, 2016.

Keywords: Balance; Body-weight-support treadmill training; Hemiparesis; Mobility skills; Poststroke rehabilitation; Robotics; Walking.

Conflict of interest statement

Ethics approval and consent to participate

All participants gave informed consent as approved by the Institutional Review Board of the University of Alabama at Birmingham prior to initial assessment (protocol #: F120425008).

Consent for publication

All participants gave informed consent to the following statement, “Your information from this research may be published for scientific purposes; however, your identity will not be given out.”

Competing interests

David A. Brown receives royalties on sales of the KineAssist device. Sarah A. Graham and Elliot J. Roth declare no conflicts of interest.

Publisher’s Note

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Figures

Fig. 1

Consort diagram for participant flow through study

Fig. 2

Baseline, mid, and post CWS measurements for n = 15 participants in the HF group (left) and n = 14 HF + C group (right). Participants with the midpoint measurement carried forward are marked with a † at post