Treadmill walking with body weight support in subacute non-ambulatory stroke improves walking capacity more than overground walking: a randomised trial. Treadmill training with body weight support: its effect on Parkinson's disease. New intervention program for preventing falls among frail elderly people: the effects of perturbed walking exercise using a bilateral separated treadmill. Superiority of treadmill walking exercise versus strength training for patients with peripheral arterial disease. Implications for the mechanism of the training response. Functional electric stimulation to augment partial weight-bearing supported treadmill training for patients with acute incomplete spinal cord injury: A pilot study. Weight-supported treadmill vs over-ground training for walking after acute incomplete SCI. The effect of treadmill training on the ambulation of stroke survivors in the early stages of rehabilitation: a randomized study. Does treadmill training improve lower-extremity tasks in Parkinson disease? A randomized controlled trial. Effect of treadmill training with body weight support on gait and gross motor function in children with spastic cerebral palsy. Treadmill training post stroke: are there any secondary benefits? A pilot study. Effect of treadmill training and supramalleolar orthosis use on motor skill development in infants with Down syndrome: a randomized clinical trial. Treadmill training with partial body weight support and an electromechanical gait trainer for restoration of gait in subacute stroke patients: a randomized crossover study. Pilot study of Lokomat versus manual-assisted treadmill training for locomotor recovery post-stroke.
Is treadmill walking with body weight support during inpatient rehabilitation detrimental to walking quality compared with assisted overground walking? Does it result in better walking capacity, perception of walking or community participation?
                Analysis of secondary outcomes of a randomised trial with concealed allocation, assessor blinding and intention-to-treat analysis.
                126 patients unable to walk within 4 weeks of a stroke who were undergoing inpatient rehabilitation.
                The experimental group undertook up to 30 minutes of treadmill walking with body weight support via an overhead harness per day while the control group undertook up to 30 minutes of overground walking.
                The secondary outcomes were walking quality and capacity, walking perception, community participation and falls.
                Six months after entering the study, there was no difference between the groups of independent walkers in terms of speed (MD 0.10 m/s, 95% CI -0.06 to 0.26) or stride (MD 6 cm, 95% CI -7 to 19). The independent walkers in the experimental group walked 57 m further (95% CI 1 to 113) in the 6 min walk than those in the control group. The experimental group (walkers and non-walkers) rated their walking 1 point out of 10 (95% CI 0.1 to 1.9) higher than the control group. There was no difference between the groups in community participation or number of falls.
                Treadmill training with body weight support results in better walking capacity and perception of walking compared to overground walking without deleterious effects on walking quality. To test whether body weight-supported treadmill training (BWSTT) is effective in improving functional outcome of patients with Parkinson's disease.
                Prospective crossover trial. Patients were randomized to receive either a 4-week program of BWSTT with up to 20% of their body weight supported followed by 4 weeks of conventional physical therapy (PT), or the same treatments in the opposite order. Medications for parkinsonism were not modified throughout the study.
                Inpatient rehabilitation unit for neurologic diseases.
                Ten patients (5 men, 5 women) with Hoehn and Yahr stage 2.5 or 3 parkinsonism; mean age 67.6 years, mean duration of Parkinson's disease 4.2 years.
                The Unified Parkinson's Disease Rating Scale (UPDRS), ambulation endurance and speed (sec/10 m), and number of steps for 10-meter walk.
                The mean total UPDRS before/after BWSTT was 31.6/25.6, and before/after PT was 29.1/28.0. Analysis of covariance for improvement of UPDRS demonstrated a significant effect of type of therapy (F(1, 16) = 42.779, p < .0001) but not order of therapy (F(1, 16) = 0.157, p = .697 1). Patients also had significantly greater improvement with BWSTT than with PT in ambulation speed (BWSTT, before/after = 10.0/8.3; PT, 9.5/8.9), and number of steps (BWSTT, 22.3/19.6; PT, 21.5/20.8).
                In persons with Parkinson's disease, treadmill training with body weight support produces greater improvement in activities of daily living, motor performance, and ambulation than does physical therapy. To determine the effects of a perturbed walking exercise using a bilateral separated treadmill in physically disabled elderly.
                Participants of the study were 32 long-term care facility residents and outpatients aged 66-98 yrs. Participants were randomly assigned to a usual exercise group or to a treadmill exercise group. Perturbed gait exercise on a treadmill continued for 6 mos. Number of falls and time to first fall during a 6-mo period, balance and gait functions, and reaction time were evaluated before and after intervention.
                The treadmill exercise group showed significant improvement in balance and reaction time when compared with the usual exercise group. Number of falls in the treadmill exercise group was 21% lower than that in the usual exercise group. However, this difference was not significant. No significant differences were seen in time to first fall.
                Gait training with unexpected perturbation seems to have a beneficial impact on physical function in disabled elderly individuals. The results suggest that this program may be used as an exercise intervention to reduce falls in institutional settings. In patients with intermittent claudication, a supervised walking exercise program increases peak exercise performance and community-based functional status. Patients with peripheral arterial disease also have muscle weakness in the affected extremity that may contribute to the walking impairment. However, the potential benefits of training modalities other than walking exercise, such as strength training, have not been critically evaluated in this patient population. The present study tested the hypothesis that a strength training program would be as effective as treadmill walking exercise and that combinations of strengthening and walking exercise would be more effective than either alone in improving exercise performance.
                Twenty-nine patients with disabling claudication were randomized to 12 weeks of supervised walking exercise on a treadmill (3 h/wk at a work intensity sufficient to produce claudication), strength training (3 h/wk of resistive training of five muscle groups of each leg), or a nonexercising control group. Graded treadmill testing was performed to maximally tolerated claudication pain to define changes in peak exercise performance. After 12 weeks, patients in the treadmill training program had a 74 +/- 58% increase in peak walking time as well as improvements in peak oxygen consumption (VO2) and the onset of claudication pain. Patients in the strength-trained group had a 36 +/- 48% increase in peak walking time but no change in peak VO2 or claudication onset time. Control subjects had no changes in any of these measures over the 12-week period. After the first 12 weeks, patients in the initial walking exercise group continued for 12 more weeks of supervised treadmill training. This resulted in an additional 49 +/- 53% increase in peak walking time (total of 128 +/- 99% increase over the 24 weeks). After the initial 12 weeks, patients in the strength-trained group began 12 weeks of supervised treadmill training, and patients in the control group participated in a 12-week combined program of strengthening and treadmill walking exercise. The combined strength and treadmill training program and treadmill training after 12 weeks of strength training resulted in increases in peak exercise performance similar to those observed with 12 weeks of treadmill training alone.
                A supervised treadmill walking exercise program is an effective means to improve exercise performance in patients with intermittent claudication, with continued improvement over 24 weeks of training. In contrast, 12 weeks of strength training was less effective than 12 weeks of supervised treadmill walking exercise. Finally, strength training, whether sequential or concomitant, did not augment the response to a walking exercise program. To study the application of partial weight-bearing (PWB) supported treadmill gait training augmented by functional electric stimulation (FES) in subjects with acute incomplete spinal cord injury (SCI).
                Before-after crossover trial with control (A) and intervention (B) periods.
                Physiotherapy (PT) department of a spinal injuries unit in Scotland.
                Fourteen inpatients with acute incomplete SCI with American Spinal Injury Association class C or D injury.
                Training consisted of treadmill walking with PWB support augmented by FES. Subjects walked on the treadmill for up to 25 minutes a day, 5 days a week for 4 weeks. The intervention was compared with a 4-week control period in which standard PT was given.
                Overground walking endurance and speed, cadence, stride length, and observational gait analysis and walking speed, distance, and percentage PWB support on the treadmill.
                A greater increase in overground walking endurance was achieved after the intervention (AB group mean, 72.2m; confidence interval [CI], 39.8-104.6m; BA group mean, 63.8m; CI, -10.2 to 137.9m), as compared with after standard PT (AB group mean, 38.4m; CI, 1.8-75.0m; BA group mean, 60.1m; CI, 9.2-110.9m). A similar pattern was observed for overground walking speed.
                This pilot study indicated that PWB supported treadmill training with FES had a positive effect on overground gait parameters and could potentially accelerate gait training in subjects with incomplete SCI. A larger randomized trial is required to substantiate these findings. To compare the efficacy of step training with body weight support on a treadmill (BWSTT) with over-ground practice to the efficacy of a defined over-ground mobility therapy (CONT) in patients with incomplete spinal cord injury (SCI) admitted for inpatient rehabilitation.
                A total of 146 subjects from six regional centers within 8 weeks of SCI were entered in a single-blinded, multicenter, randomized clinical trial (MRCT). Subjects were graded on the American Spinal Injury Association Impairment Scale (ASIA) as B, C, or D with levels from C5 to L3 and had a Functional Independence Measure for locomotion (FIM-L) score < 4. They received 12 weeks of equal time of BWSTT or CONT. Primary outcomes were FIM-L for ASIA B and C subjects and walking speed for ASIA C and D subjects 6 months after SCI.
                No significant differences were found at entry between treatment groups or at 6 months for FIM-L (n = 108) or walking speed and distance (n = 72). In the upper motor neuron (UMN) subjects, 35% of ASIA B, 92% of ASIA C, and all ASIA D subjects walked independently. Velocities for UMN ASIA C and D subjects were not significantly different for BWSTT (1.1 +/- 0.6 m/s, n = 30) and CONT (1.1 +/- 0.7, n = 25) groups.
                The physical therapy strategies of body weight support on a treadmill and defined overground mobility therapy did not produce different outcomes. This finding was partly due to the unexpectedly high percentage of American Spinal Injury Association C subjects who achieved functional walking speeds, irrespective of treatment. The results provide new insight into disability after incomplete spinal cord injury and affirm the importance of the multicenter, randomized clinical trial to test rehabilitation strategies. The objective of this study was to compare the effects of conventional over-ground gait training with treadmill training on the restoration of gait in people with hemiparesis following a stroke. Twenty-five individuals in the early stages of rehabilitation were alternately assigned to one of two treatment groups. In addition to conventional physical therapy, the experimental group participated in 15 treadmill-training sessions in which a handrail was used for external support. The control group received the same number of equal length sessions of over-ground ambulation. Treatment effects were established by pre- and posttreatment assessment of: 1) functional walking ability, 2) walking speed, 3) stride length, 4) temporal characteristics of gait, and 5) electromyographic activity of calf muscles. Normal values were obtained from eight healthy individuals of approximately the same age as the stroke survivors. The study demonstrates that individuals following a stroke are well able to tolerate treadmill training in the early stage of their rehabilitation process without the use of a weight support apparatus. Furthermore, the findings suggest that treadmill training may be more effective than conventional gait training for improving some gait parameters such as functional ambulation, stride length, percentage of paretic single stance period, and gastrocnemius muscular activity. To investigate whether gait training with treadmill improves functional tasks of lower extremities in patients with Parkinson disease (PD).
                Randomized controlled trial including two groups, the treadmill training group and the nonintervention group.
                University hospital.
                Thirty consecutive patients diagnosed with idiopathic PD, who were on stable regimens of antiparkinsonian medication, able to walk independently, and had not participated in a rehabilitation program in the previous 3 months. Patients with severe cognitive impairments or severe musculoskeletal, cardiopulmonary, neurologic, or other systemic disorders were excluded. Twenty-four patients completed the study.
                Group I attended a training program on a treadmill for 6 weeks, and group II served as the control group. Both groups were instructed in home mobility exercises.
                The primary study outcome measures were timed functional lower-extremity tasks (walking at a corridor, U-turn, turning around a chair, stairs, standing on one foot, standing from a chair), and secondary outcome measures were exercise test and patient's global assessment. Assessments were performed at baseline and at the end of the study.
                There were significant improvements in functional lower-extremity tests, exercise test parameters, and patients' global assessment in group I, whereas no significant improvements were observed in group II.
                Even though long-term effects remain unknown and the study sample was small, it was concluded that treadmill training in PD patients led to improvements in lower-extremity tasks, thus improving patients' physical well-being in daily life. To examine the effect of treadmill training with body weight support (TBWS) on gait and gross motor function in children with spastic cerebral palsy (CP).
                Eight children with spastic CP participated in the study. Their temporal-distance gait parameters, Gross Motor Function Measure, muscle tone, and selective motor control were assessed three times: two times under their regular therapeutic treatment (condition A), and one time after receiving the TBWS treatment in addition to their regular therapeutic treatments (condition B). There were two treatment schedules, AAB and ABA. Except for the first one (taken at study entry), the assessments were always taken after 12 wks of treatment. The children were equally divided into two groups and randomly assigned to the two schedules. The two groups were matched according to category of the Gross Motor Function Classification System.
                The TBWS treatment significantly improved the children's gait (increases in stride length and decreases in double-limb support percentage of gait cycle) and their Gross Motor Function Measure (dimension D and E scores as well as the total score). No significant improvements on muscle tone or selective motor control were noted.
                The TBWS treatment improved some gait parameters and gross motor functions in children with spastic CP. To explore the secondary benefits of treadmill training for people in the chronic stage of recovery from stroke.
                Modified random assignment, matched-pair control group design with repeated measures.
                Outpatient stroke centre.
                Twenty individuals post first stroke who acknowledged walking slower than pre stroke. Participants matched by side of hemiparesis and motor impairment.
                Twelve 20-minute sessions of walking on a treadmill or weekly phone call.
                Depression (Beck Depression Index), mobility and social participation (Stroke Impact Scale 3.0 subscales) were assessed initially, at the end of 12 treatments (four weeks) and six weeks later.
                No significant difference was found between groups for any dependent measure. The ANOVA to investigate main effects in each group found no significant findings in the control group; however in the treatment group significant improvements over time for depression (P = 0.005, P < 0.001), mobility (P = 0.008) and social participation (P = 0.004) were demonstrated.
                A task-specific intervention designed to improve gait speed may potentially provide secondary benefits by positively impacting depression, mobility and social participation for people post stroke. Children with Down syndrome (DS) often display delayed onset of independent walking. Treadmill training is an effective intervention that leads to an earlier walking onset. In addition, orthoses often are provided to infants with DS to increase stability and promote earlier independent walking. However, this early use of orthoses has not been scientifically verified in infants with DS.
                The purpose of this study was to provide insight into the developmental outcomes of early orthosis use in combination with treadmill training in infants with DS compared with treadmill training alone.
                This study was a randomized controlled trial.
                This study was conducted in participants' homes and in the motor development laboratory.
                Seventeen infants with DS entered the study when they could pull themselves to a standing position. They were randomly assigned to either a control group (which received treadmill training) or an experimental group (which received treadmill training and orthoses). During monthly visits to the infants' homes, 3 minutes of treadmill stepping was recorded and each child's motor development skills were tested. The treadmill training ended once the child took 3 independent steps. One month following walking onset, developmental tests were readministered.
                The Gross Motor Function Measure (GMFM) was used to test motor skill development.
                The average (SD) time in the study was 268 (88) days for the control group and 206 (109) days for the experimental group. All infants showed significantly increased GMFM scores over time. At 1 month of walking experience, the control group had higher GMFM scores than the experimental group, with higher standing and walking, running, and jumping subscale scores.
                Limitations of this study included a small sample of convenience, a statistical model that may have reduced validity at the tail end, and a lack of blinding in the GMFM scorer.
                Orthoses may have a detrimental effect on overall gross motor skill development. The purpose of this study was to compare treadmill and electromechanical gait trainer therapy in subacute, nonambulatory stroke survivors. The gait trainer was designed to provide nonambulatory subjects the repetitive practice of a gait-like movement without overexerting therapists.
                This was a randomized, controlled study with a crossover design following an A-B-A versus a B-A-B pattern. A consisted of 2 weeks of gait trainer therapy, and B consisted of 2 weeks of treadmill therapy. Thirty nonambulatory hemiparetic patients, 4 to 12 weeks after stroke, were randomly assigned to 1 of the 2 groups receiving locomotor therapy every workday for 15 to 20 minutes for 6 weeks. Weekly gait ability (functional ambulation category [FAC]), gait velocity, and the required physical assistance during both kinds of locomotor therapy were the primary outcome measures, and other motor functions (Rivermead motor assessment score) and ankle spasticity (modified Ashworth score) were the secondary outcome measures. Follow-up occurred 6 months later.
                The groups did not differ at study onset with respect to the clinical characteristics and effector variables. During treatment, the FAC, gait velocity, and Rivermead scores improved in both groups, and ankle spasticity did not change. Median FAC level was 4 (3 to 4) in group A compared with 3 (2 to 3) in group B at the end of treatment (P=0.018), but the difference at 6-month follow up was not significant. The therapeutic effort was less on the gait trainer, with 1 instead of 2 therapists assisting the patient at study onset. All but seven patients preferred the gait trainer.
                The newly developed gait trainer was at least as effective as treadmill therapy with partial body weight support while requiring less input from the therapist. Further studies are warranted. While manually-assisted body-weight supported treadmill training (BWSTT) has revealed improved locomotor function in persons with post-stroke hemiparesis, outcomes are inconsistent and it is very labor intensive. Thus an alternate treatment approach is desirable. Objectives of this pilot study were to: 1) compare the efficacy of body-weight supported treadmill training (BWSTT) combined with the Lokomat robotic gait orthosis versus manually-assisted BWSTT for locomotor training post-stroke, and 2) assess effects of fast versus slow treadmill training speed.
                Sixteen volunteers with chronic hemiparetic gait (0.62 +/- 0.30 m/s) post-stroke were randomly allocated to Lokomat (n = 8) or manual-BWSTT (n = 8) 3x/wk for 4 weeks. Groups were also stratified by fast (mean 0.92 +/- 0.15 m/s) or slow (0.58 +/- 0.12 m/s) training speeds. The primary outcomes were self-selected overground walking speed and paretic step length ratio. Secondary outcomes included: fast overground walking speed, 6-minute walk test, and a battery of clinical measures.
                No significant differences in primary outcomes were revealed between Lokomat and manual groups as a result of training. However, within the Lokomat group, self-selected walk speed, paretic step length ratio, and four of the six secondary measures improved (p = 0.04-0.05, effect sizes = 0.19-0.60). Within the manual group, only balance scores improved (p = 0.02, effect size = 0.57). Group differences between fast and slow training groups were not revealed (p > or = 0.28).
                Results suggest that Lokomat training may have advantages over manual-BWSTT following a modest intervention dose in chronic hemiparetic persons and further, that our training speeds produce similar gait improvements. Suggestions for a larger randomized controlled trial with optimal study parameters are provided.
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.