title: Speed-Dependent Treadmill Training in Ambulatory Hemiparetic Stroke Patients: A Randomized Controlled Trial Analysis and Comparison of the Psychometric Properties of Three Balance Measures for Stroke Patients A treadmill and overground walking program improves walking in persons residing in the community after stroke: a placebo-controlled, randomized trial. Balance training following stroke: effects of task-oriented exercises with and without altered sensory input Responsiveness and predictability of gait speed and other disability measures in acute stroke. Repetitive locomotor training and physiotherapy improve walking and basic activities of daily living after stroke: a single-blind, randomized multicentre trial (DEutsche GAngtrainerStudie, DEGAS) Improvements in Speed-Based Gait Classifications Are Meaningful A task-orientated intervention enhances walking distance and speed in the first year post stroke: a randomized controlled trial Time dependency of walking classification in stroke. The effect of a task-oriented walking intervention on improving balance self-efficacy poststroke: a randomized, controlled trial. Physical activity and stroke incidence: the Harvard Alumni Health Study. The effects of balance training on gait late after stroke: a randomized controlled trial Additional task-related practice improves mobility and upper limb function early after stroke: a randomised controlled trial. Circuit class therapy versus individual physiotherapy sessions during inpatient stroke rehabilitation: a controlled trial. A community-based group exercise program for persons with chronic stroke. Task-related circuit training improves performance of locomotor tasks in chronic stroke: a randomized, controlled pilot trial. Circuit training in community-living "younger" men after stroke. Reliability of the PEDro scale for rating quality of randomized controlled trials. Gait recovery after hemiplegic stroke. A community-based fitness and mobility exercise program for older adults with chronic stroke: a randomized, controlled trial. Can augmented physiotherapy input enhance recovery of mobility after stroke? A randomized controlled trial Detecting change in patients with stroke using the Berg Balance Scale. Recovery of walking function in stroke patients: the Copenhagen Stroke Study. PEDro. A database of randomized trials and systematic reviews in physiotherapy. Task-specific physical therapy for optimization of gait recovery in acute stroke patients. Stroke: a randomized trial of exercise or relaxation. Effects of Task-Specific Locomotor and Strength Training in Adults Who Were Ambulatory After Stroke: Results of the STEPS Randomized Clinical Trial Task-oriented progressive resistance strength training improves muscle strength and functional performance in individuals with stroke Physiological outcomes of aerobic exercise training in hemiparetic stroke patients.
abstract: Background and Purpose — A new gait training strategy for patients with stroke seeks to increase walking speed through treadmill training . This study compares the effects of structured speed-dependent treadmill training ( STT ) ( with the use of an interval paradigm to increase the treadmill speed stepwise according to principles of sport physiology ) with limited progressive treadmill training ( LTT ) and conventional gait training ( CGT ) on clinical outcome measures for patients with hemiparesis . Methods — Sixty ambulatory poststroke patients were each r and omly selected to receive 1 of the 3 different gait therapies : 20 subjects were treated with STT , 20 subjects were trained to walk on a treadmill with a 20 % increase of belt speed over the treatment period ( LTT ) , and 20 subjects were treated with CGT . Treatment outcomes were assessed on the basis of overground walking speed , cadence , stride length , and Functional Ambulation Category scores . Results — After a 4-week training period , the STT group scored significantly higher than the LTT and CGT groups for overground walking speed ( STT versus LTT , P < 0.001 ; STT versus CGT , P < 0.001 ) , cadence ( STT versus LTT , P = 0.007 ; STT versus CGT , P < 0.001 ) , stride length ( STT versus LTT , P < 0.001 ; STT versus CGT , P < 0.001 ) , and Functional Ambulation Category scores ( STT versus LTT , P = 0.007 ; STT versus CGT , P < 0.001 ) . Conclusions — Structured STT in poststroke patients result ed in better walking abilities than LTT or CGT . This gait training strategy provides a dynamic and integrative approach for the treatment of gait dysfunction after stroke Background and Purpose — This study compared the psychometric properties of 3 clinical balance measures , the  Berg Balance Scale ( BBS ) , the Balance subscale of the Fugl-Meyer test ( FM-B ) , and the Postural Assessment Scale for Stroke Patients ( PASS ) , in stroke patients with a broad range of neurological and functional impairment from the acute stage up to 180 days after onset . Methods — One hundred twenty-three stroke patients were followed up prospect ively with the 3 balance measures 14 , 30 , 90 , and 180 days after stroke onset ( DAS ) . Reliability ( interrater reliability and internal consistency ) and validity ( concurrent validity , convergent validity , and predictive validity ) of each measure were examined . A comparison of the responsiveness of each of the 3 measures was made on the basis of the entire group of patients and 3 separate groups classified by degree of neurological severity . Results — The FM-B and BBS showed a significant floor or ceiling effect at some DAS points , whereas the PASS did not show these effects . The BBS , FM-B , and PASS all had good reliability and validity for patients at different recovery stages after stroke . The results of effect size demonstrated fair to good responsiveness of all 3 measures within the first 90 DAS but , as expected , only a low level of responsiveness at 90 to 180 DAS . The PASS was more responsive to changes in severe stroke patients at the earliest period after stroke onset , 14 to 30 DAS . Conclusions — All 3 measures tested showed very acceptable levels of reliability , validity , and responsiveness for both clinicians and research ers . The PASS showed slightly better psychometric characteristics than the other 2 measures OBJECTIVE To evaluate the effectiveness of a treadmill and overground walking program in reducing the disability and h and icap associated with poor walking performance after stroke . DESIGN R and omized , placebo-controlled clinical trial with a 3-month follow-up . SETTING General community . PARTICIPANTS A volunteer sample of 29 ambulatory individuals ( less 2 dropouts ) who were living in the community after having suffered a stroke more than 6 months previously . INTERVENTIONS The experimental group participated in a 30-minute treadmill and overground walking program , 3 times a week for 4 weeks . The control group received a placebo consisting of a low-intensity , home exercise program and regular telephone contact . MAIN OUTCOME MEASURES Walking speed ( over 10 m ) , walking capacity ( distance over 6 min ) , and h and icap ( stroke-adapted 30-item version of the Sickness Impact Profile ) measured by a blinded assessor . RESULTS The 4-week treadmill and overground walking program significantly increased walking speed ( P=.02 ) and walking capacity ( P<.001 ) , but did not decrease h and icap ( P=.85 ) compared with the placebo program . These gains were largely maintained 3 months after the cessation of training ( P</=.05 ) . CONCLUSIONS The treadmill and overground walking program was effective in improving walking in persons residing in the community after stroke . This suggests that the routine provision of accessible , long-term , community-based walking programs would be beneficial in reducing disability after stroke The purpose of this study was to compare the effects of a task-oriented exercise program with and without altered sensory input on postural stability in subjects with stroke . Sixteen hemiparetic subjects , at least 6 months post-stroke , were r and omly assigned to the experimental or control group , and participated in an 8-week task-oriented exercise program focusing on balance and mobility exercises . Exercises were performed under normal conditions by the control group , and under conditions of vision and surface manipulation by the experimental group . Pre- and post-test assessment s involved the measurement of the center of pressure ( COP ) displacement during double-legged stance and sit-to-st and under four sensory conditions : ( 1 ) eyes open , normal surface ; ( 2 ) eyes open , soft surface ; ( 3 ) eyes closed , normal surface ; and ( 4 ) eyes closed , soft surface , as well as the 10-m walking test . Results showed significant improvements ( P<0.05 ) in COP displacement under sensory conditions ( 1 ) and ( 2 ) for the experimental group only , and limited changes for the sit-to-st and in both groups after training . Significant improvements ( P<0.05 ) were also found in both groups for the walking test . It is concluded that a task-oriented exercise program , assisted by sensory manipulation , is more effective at improving the st and ing balance of stroke subjects than a conventional task-oriented program . Die vorliegende Studie vergleicht die Wirkung eines anforderungsspezifischen Übungsprogramms mit und ohne Sinnesreizänderung auf die posturale Stabilität von Schlaganfallpatienten . Insgesamt 16 Hemiparetiker wurden mindestens sechs Monate nach dem Schlaganfall r and omisiert der Versuchs- oder der Kontrollgruppe zugeordnet , innerhalb derer sie acht Wochen an einem anforderungsspezifischen Programm mit speziellen Gleichgewichts- und Mobilitätsübungen teilnahmen . Die Kontrollgruppe führte die Übungen unter normalen Bedingungen durch , die Versuchsgruppe dagegen unter Manipulation der Aspekte Sicht und Gehflächen . Bei den Bewertungen vor und nach dem Test wurde die Verlagerung des Druckmittelpunkts ( COP ) während der zweibeinigen Haltung und der Aufstehübung anh and von vier Sinneszuständen gemessen : ( 1 ) offene Augen , normale Fläche , ( 2 ) offene Augen , weiche Fläche , ( 3 ) geschlossene Augen , normale Fläche und ( 4 ) geschlossene Augen , weiche Fläche sowie anh and des 10 m Gehtests . Die Ergebnisse wiesen nur bei der Versuchsgruppe bei der COP-Verlagerung unter den Sinneszuständen ( 1 ) und ( 2 ) beachtliche Verbesserungen ( P<0,05 ) auf und bei beiden Gruppen in beschränktem Maß Veränderungen bei der Aufstehübung . Bei beiden Gruppen wurden auch signifikante Verbesserungen ( P<0,05 ) beim Gehtest beobachtet . Daraus schließt sich , dass ein anforderungsspezifisches Übungsprogramm mit begleitender Sinnesmanipulation das Gleichgewicht von Schlaganfallpatienten bei aufrechter Körperhaltung effektiver verbessert als ein herkömmliches anforderungsspezifisches Programm . El propósito de este estudio fue comparar los efectos de un programa de ejercicios dirigidos , con estimulación sensorial alterada o sin ella , sobre la estabilidad postural de sujetos con accidente vascular cerebral . Dieciséis sujetos hemiparéticos que habían sufrido un accidente vascular cerebral hacía al menos 6 meses , fueron distribuidos al azar en dos grupos : uno experimental y uno control . Los mismos participaron durante 8 semanas en un programa de ejercicios dirigidos , el cual se centraba en ejercicios de balance y de movilidad . El grupo control realizó los ejercicios en condiciones normales , mientras que el grupo experimental los realizó en condiciones en que la visión y las superficies fueron alteradas . En las evaluaciones realizadas antes y después de los ejercicios se midió la desviación del centro de presión ( CP ) durante la postura de pie utiliz and o ambas piernas , así como en la postura sentada , listo para ponerse de pie , bajo cuatro condiciones sensoriales deferentes : 1 ) ojos abiertos , superficie normal ;  2  ) ojos abiertos , superficie bl and a ;  3  ) ojos cerrados , superficie normal ;  y  4 ) ojos cerrados , superficie bl and a. Se realizó además la prueba de la marcha de los 10 m. Los result ados mostraron mejoras significativas ( P<0,05 ) en la desviación del CP en ambos grupos durante la prueba de la marcha . Se concluyó que un programa de ejercicios dirigidos , en los que se utilicen manipulaciones sensoriales , es más efectivo que un programa convencional de ejercicios dirigidos para mejorar el balance durante la postura de pie en sujetos con accidente vascular cerebral . Le but de cette étude était de comparer les effets d'un programme d'exercices fonctionnels assistés ou non de stimulations sensorielles sur la stabilité posturale de sujets atteints d'un accident vasculaire cérébral ( AVC ) . Seize sujets hémiparétiques atteints d'un AVC depuis au moins 6 mois et répartis de façon aléatoire au sein du groupe expérimental et du groupe témoin ont participé à un programme d'exercices fonctionnels de huit semaines portant sur des exercices d'équilibre et de mobilité . Les exercices étaient exécutés en situation normale par le groupe témoin et en situation de manipulation de la vision et de la surface de support par le groupe expérimental . Les évaluations pré et post exercices ont été effectuées à l'aide de la mesure du déplacement du centre de pression ( CP ) lors du maintien de la position debout en appui bipodal et du transfert assis-debout selon les quatre conditions sensorielles suivantes : yeux ouverts , surface normale ( 1 ) ; yeux ouverts , surface moelleuse ( 2 ) ; yeux fermés , surface normale ( 3 ) ; yeux fermés , surface moelleuse ( 4 ) . Le test de marche de 10 mètres a aussi été inclus dans l'évaluation . Les résultats ont démontré une amélioration significative ( P<0.05 ) du déplacement du CP dans les conditions 1 et 2 pour le groupe expérimental seulement ainsi que des changements limités pour le transfert assis-debout chez les deux groupes de sujets à la suite de l'entraînement . Une amélioration significative ( P<0.05 ) a été observée au niveau du test de marche chez les deux groupes de sujets . Cette étude a démontré qu'un programme d'exercices fonctionnels assistés de stimulations sensorielles est plus efficace pour l'amélioration du maintien de l'équilibre en position debout chez les sujets atteints d'un AVC qu'un programme d'exercices fonctionnels conventionnnel OBJECTIVES To identify the most responsive method of measuring gait speed , to estimate the responsiveness of other outcome measures , and to determine whether gait speed predicts discharge destination in acute stroke . DESIGN A prospect i ve cohort study . SETTING Five acute-care hospitals . PATIENTS Fifty subjects with residual gait deficits after a first-time stroke . INTERVENTIONS Five- ( 5mWT ) and 10-meter walk tests ( 10mWT ) at comfortable and maximum speeds , with 2 evaluations conducted an average + /- st and ard deviation ( SD ) of 8 + /- 3 and 38 + /- 5 days poststroke . MAIN OUTCOME MEASURE St and ardized response mean ( SRM = mean change/SD of change ) was used to estimate responsiveness for each walk test , the Berg Balance Scale , the Barthel Index , the Stroke Rehabilitation Assessment of Movement ( STREAM ) , and the Timed Up and Go ( TUG ) . RESULTS The SRMs were 1.22 and 1.00 for the 5mWT , and .92 and .83 for the 10mWT performed at a comfortable and maximum pace , respectively . The SRMs for the Berg Balance Scale , the Barthel Index , the STREAM , and the TUG were 1.04,.99,.89 , and .73 , respectively . The probability of discharge to a rehabilitation center for persons walking at < or = 0.3 m/s or > 0.6 m/s at the first evaluation was.95 and .22 , respectively . CONCLUSIONS The 5mWT at a comfortable pace is recommended as the measure of choice for clinicians and research ers who need to detect longitudinal change in walking disability in the first 5 weeks poststroke Objective : To evaluate the effect of repetitive locomotor training on an electromechanical gait trainer plus physiotherapy in subacute stroke patients . Design : R and omized controlled trial . Setting : Four German neurological rehabilitation centres . Subjects : One hundred and fifty-five non-ambulatory patients ( first-time stroke < 60 days ) . Intervention : Group A received 20 min locomotor training and 25 min physiotherapy ; group B had 45 min physiotherapy every week day for four weeks . Main outcome measures : Primary variables were gait ability ( Functional Ambulation Category , 0 - 5 ) and the Barthel Index ( 0 - 100 ) , blindly assessed at study onset , end , and six months later for follow-up . Responders to the therapy had to become ambulatory ( Functional Ambulation Category 4 or 5 ) or reach a Barthel Index of ≥ 75 . Secondary variables were walking velocity , endurance , mobility and leg power . Results : The intention-to-treat analysis revealed that significantly greater number of patients in group A could walk independently : 41 of 77 versus 17 of 78 in group B ( P B < 0.0001 ) at treatment end . Also , significantly more group A patients had reached a Barthel Index ≥ 75 : 44 of 77 versus 21 of 78 ( P B < 0.0001 ) . At six-month follow-up , the superior gait ability in group A persisted ( 54 of 77 versus 28 of 78 , P B < 0.0001 ) , while the Barthel Index responder rate did not differ . For all secondary variables , group A patients had improved significantly more ( P B < 0.0001 ) during the treatment period , but not during follow-up . Conclusions : Intensive locomotor training plus physiotherapy result ed in a significantly better gait ability and daily living competence in subacute stroke patients  compared with physiotherapy alone Background and Purpose — Gait velocity is a powerful indicator of function and prognosis after stroke . Gait velocity can be stratified into clinical ly meaningful functional ambulation classes , such as household ambulation ( < 0.4 m/s ) , limited community ambulation ( 0.4 to 0.8 m/s ) , and full community ambulation ( > 0.8 m/s ) . The purpose of the current study was to determine whether changes in velocity-based community ambulation classification were related to clinical ly meaningful changes in stroke-related function and quality of life . Methods — In subacute stroke survivors with mild to moderate deficits who participated in a r and omized clinical trial of stroke rehabilitation and had a baseline gait velocity of 0.8 m/s or less , we assessed the effect of success versus failure to achieve a transition to the next class on function and quality of life according to domains of the Stroke Impact Scale ( SIS ) . Results — Of 64 eligible participants , 19 were initially household ambulators , and 12 of them ( 68 % ) transitioned to limited community ambulation , whereas of 45 initially limited community ambulators , 17 ( 38 % ) became full community ambulators . Function and quality -of-life SIS scores after treatment were significantly higher among survivors who achieved a favorable transition compared with those who did not . Among household ambulators , those who transitioned to limited or full community ambulation had significantly better SIS scores in mobility ( P=0.0299 ) and participation ( P=0.0277 ) . Among limited community ambulators , those who achieved the transition to full community ambulatory status had significantly better scores in SIS participation ( P=0.0085 ) . Conclusions — A gait velocity gain that results in a transition to a higher class of ambulation results in better function and quality of life , especially for household ambulators . Household ambulators possibly had more severe stroke deficits , reducing the risk of “ ceiling ” effects in SIS-measured activities of daily living and instrumental activities of daily living . Outcome assessment based on transitions within a mobility classification scheme that is rooted in gait velocity yields potentially meaningful indicators of clinical benefit . Outcomes should be selected that are clinical ly meaningful for all levels of severity Objective : To evaluate the efficacy of a task-orientated intervention in enhancing competence in walking in people with stroke . Design : Two-centre observer-blinded stratified block-r and omized controlled trial . Setting : General community . Subjects : Between May 2000 and February 2003 , 91 individuals with a residual walking deficit within one year of a first or recurrent stroke consented to participate . Interventions : The experimental intervention comprised 10 functional tasks design ed to strengthen the lower extremities and enhance walking balance , speed and distance . The control intervention involved the practice of upper extremity activities . Subjects in both groups attended sessions three times a week for six weeks . Main measures : Six-minute walk test ( SMWT ) , 5-m walk ( comfortable and maximum pace ) , Berg Balance Scale , timed ‘ up and go ’ . Results : At baseline , subjects in the experimental ( n = 44 ) and control ( n = 47 ) groups walked an average distance of 209 m ( SD = 126 ) and 204 m ( SD = 131 ) , respectively , on the SMWT . Mean improvements of 40 m ( SD = 72 ) , and 5 m ( SD = 66 ) were observed following the experimental and control interventions , respectively . The between-group difference was 35 m ( 95 % confidence interval ( CI ) 7 , 64 ) . Significant between-group effects of 0.21 m/s ( 95 % CI 0.12 , 0.30 ) and of 0.11 m/s ( 95 % CI 0.03 , 0.19 ) in maximum and comfortable walking speed , respectively , were observed . People with a mild , moderate or severe walking deficit at baseline improved an average of 36 ( SD = 96 ) , 55 ( SD = 56 ) and 18 m ( SD = 23 ) , respectively , in SMWT performance following the experimental intervention . Conclusions : Study findings support the efficacy of a task-orientated intervention in enhancing walking distance and speed in the first year post stroke , particularly in people with moderate walking deficits BACKGROUND AND PURPOSE To facilitate optimal stroke rehabilitation , valid interpretation of observed functional recovery is required . The purpose of this study was to examine the longitudinal relationship between comfortable walking speed and  Functional Ambulation Categories ( FAC ) scores for physically independent gait . SUBJECTS This study was a prospect i ve cohort study with 73 subjects who were severely affected by acute stroke . METHODS Functional Ambulation Categories classification and walking speed were measured between weeks 4 and 26 after stroke . The responsiveness of walking speed  measurements for detecting clinical ly important speed changes was determined , and the longitudinal association between walking speed and FAC scores and its time dependency were established . This relationship subsequently was scrutinized for possible speed changes occurring within specific FAC scores . Responsiveness ratios , r and om coefficient analysis , paired Student t tests , and the Cohen kappa statistic were used for statistical analyses . RESULTS Responsiveness ratios exceeded the smallest detectable differences . R and om coefficient analysis demonstrated a significant between- and within-subject coefficient and a significant negative interaction between timing of measurements and FAC scores . Paired Student t tests revealed mostly significant pretest-posttest differences in walking speeds , and all kappa values for pretest-posttest FAC scores were significant . DISCUSSION AND CONCLUSION Walking speed measurements are sensitive for detecting clinical ly important changes . Functional Ambulation Categories scores are dependent on the timing of comfortable walking speed measurements after stroke . Moreover , there are indications that , in this relationship , repeated FAC appraisal s are not only based on steady walking speeds , but that the walking speeds related to a specific FAC appraisal also change and , over time , may shift gradually from higher to lower speeds OBJECTIVES To evaluate the efficacy of a task-oriented walking intervention in improving balance self-efficacy in persons with stroke and to determine whether effects were task-specific , influenced by baseline level of self-efficacy and associated with changes in walking and balance capacity . DESIGN Secondary analysis of a two-center , observer-blinded , r and omized , controlled trial . SETTING General community . PARTICIPANTS Ninety-one individuals with a residual walking deficit within 1 year of a first or recurrent stroke . INTERVENTION Task-oriented interventions targeting walking or upper extremity ( UE ) function were provided three times a week for 6 weeks . MEASUREMENTS Activities-specific Balance Confidence Scale , Six-Minute Walk Test , 5-m walk , Berg Balance Scale , and Timed " Up and Go " administered at baseline and postintervention . RESULTS The walking intervention was associated with a significantly greater average proportional change in balance self-efficacy than the UE intervention . Treatment effects were largest in persons with low self-efficacy at baseline and for activities relating to tasks practice d. In the walking group , change in balance self-efficacy correlated with change in functional walking capacity ( correlation coefficient=0.45 , 95 % confidence interval=0.16 - 0.68 ) . Results of multivariable modeling suggested effect modification by the baseline level of depressive symptoms and a prognostic influence of age , sex , comorbidity , time poststroke , and functional mobility on change in self-efficacy . CONCLUSION Task-oriented walking retraining enhances balance self-efficacy in community-dwelling individuals with chronic stroke . Benefits may be partially the result of improvement in walking capacity . The influence of baseline level of self-efficacy , depressive symptoms , and prognostic variables on treatment effects are of clinical importance and must be verified in future studies BACKGROUND AND PURPOSE Physiologically , it appears plausible for physical activity to decrease stroke risk ; however , epidemiological studies have produced mixed findings . Furthermore , few studies have examined specific kinds and intensities of activities . The purpose of this study was to examine the association between physical activity , including its various components ( walking , climbing stairs , participation in sports and recreational activities ) , and stroke risk . METHODS This was a prospect i ve cohort study of 11 130 Harvard University alumni ( mean age , 58 years ) without cardiovascular disease and cancer at baseline . Men reported their walking , stair climbing , and participation in sports or recreation on baseline question naires in 1977 . Stroke occurrence was assessed with another question naire in 1988 . Death certificates were obtained for decedents through 1990 to determine strokes not previously reported ( total strokes=378 ) . We used Cox proportional hazards regression to estimate the relative risks and 95 % CIs for stroke occurrence associated with physical activity . RESULTS After adjustment for age , smoking , alcohol intake , and early parental death , the relative risks of stroke associated with < 1000 , 1000 to 1999 , 2000 to 2999 , 3000 to 3999 , and > /=4000 kcal/wk of energy expenditure at baseline were 1.00 ( referent ) , 0.76 ( 95 % CI , 0.59 to 0.98 ) , 0.54 ( 0.38 to 0 . 76 ) , 0.78 ( 0.53 to 1.15 ) , and 0.82 ( 0.58 to 1.14 ) , respectively ; P=0 . 05 for linear trend . Walking > /=20 km/wk was associated with significantly lower risk , independent of other physical activity components . Climbing stairs and activities of at least moderate intensity ( > /=4.5 METs , or multiples of resting metabolic rate ) each showed U-shaped relations to stroke risk , with the risk being significantly lower at the nadir of the curve . Light intensity activities ( < 4.5 METs ) , however , were unrelated to stroke risk . CONCLUSIONS Physical activity is associated with decreased stroke risk in men . A decreased risk was observed at energy expenditures of 1000 to 1999 kcal/wk , with further risk decrement seen at 2000 to 2999 kcal/wk but not beyond . Confirmation of the U-shaped relation observed in these data requires similar observations in other population Objective : To investigate the effects of balance training , using force platform biofeedback , on quantitative gait characteristics of hemiparetic patients late after stroke . Design : R and omized , controlled , assessor-blinded trial . Setting : Rehabilitation ward and gait laboratory of a university hospital . Subjects : Forty-one patients ( mean ( st and ard deviation ; SD ) age of 60.9 ( 11.7 ) years ) with hemiparesis late after stroke ( median time since stroke six months ) were r and omly assigned to an experimental or a control group . Interventions : The control group ( n = 19 ) participated in a conventional stroke inpatient rehabilitation programme , whereas the experimental group ( n = 22 ) received 15 sessions of balance training ( using force platform biofeedback ) in addition to the conventional programme . Main outcome measures : Selected paretic side time-distance , kinematic and kinetic gait parameters in sagittal , frontal and transverse planes were measured using a three-dimensional computerized gait analysis system , one week before and after the experimental treatment programme . Results : The control group did not show any statistically significant difference regarding gait characteristics . Pelvic excursion in frontal plane improved significantly ( P = 0.021 ) in the experimental group . The difference between before-after change scores of the groups was significant for pelvic excursion in frontal plane ( P = 0.039 ) and vertical ground reaction force ( P = 0.030 ) in favour of experimental group . Conclusion : Balance training using force platform biofeedback in addition to a conventional inpatient stroke rehabilitation programme is beneficial in improving postural control and weight-bearing on the paretic side while walking late after stroke The purpose of this study was to investigate whether additional practice of either upper limb or mobility tasks improved functional outcome during inpatient stroke rehabilitation . This prospect i ve , r and omised , single blind clinical trial recruited 30 stroke subjects into either an Upper Limb or a Mobility Group . All subjects received their usual rehabilitation and an additional session of task-related practice using a circuit class format . Independent assessors , blinded to group allocation , tested all subjects . Outcome measures used were three items of the Jebsen Taylor H and Function Test ( JTHFT ) , two  arm items  of the Motor Assessment Scale ( MAS ) , and three mobility measures , the Timed Up and Go Test ( TUGT ) , Step Test , and Six Minute Walk Test ( 6MWT ) . Both groups improved significantly between pre- and post-tests on all of the mobility measures , however only the Upper Limb Group made a significant improvement on the JTHFT and MAS upper arm items . Following four weeks training , the Mobility Group had better locomotor ability than the Upper Limb Group ( between-group differences in the 6MWT of 116.4 m , 95 % CI 31.4 to 201.3 m , Step Test 2.6 repetitions , 95 % CI -1.0 to 6.2 repetitions , and TUGT -7.6 sec , 95 % CI -15.5 to 0.2 sec ) . The JTHFT dexterity scores in the Upper Limb Group were 6.5 sec ( 95 % CI -7.4 to 20.4 sec ) faster than the Mobility Group . Our findings support the use of additional task-related practice during inpatient stroke rehabilitation . The circuit class format was a practical and effective means to provide supervised additional practice that led to significant and meaningful functional gains OBJECTIVE To compare the effectiveness of circuit class therapy and individual physiotherapy ( PT ) sessions in improving walking ability and functional balance for people recovering from stroke . DESIGN Nonr and omized , single-blind controlled trial . SETTING Medical rehabilitation ward of a rehabilitation hospital . PARTICIPANTS Sixty-eight persons receiving inpatient rehabilitation after a stroke . INTERVENTIONS Subjects received group circuit class therapy or individual treatment sessions as the sole method of PT service delivery for the duration of their inpatient stay . MAIN OUTCOME MEASURES Five-meter walk test ( 5MWT ) , two-minute walk test ( 2MWT ) , and the Berg Balance Scale ( BBS ) measured 4 weeks after admission . Secondary outcome measures included the Iowa Level of Assistance Scale , Motor Assessment Scale upper-limb items , and patient satisfaction . Measures were taken on admission and 4 weeks later . RESULTS Subjects in both groups showed significant improvements between admission and week 4 in all primary outcome measures . There were no significant between group differences in the primary outcome measures at week 4 ( 5MWT mean difference , .07 m/s ; 2MWT mean difference , 1.8 m ; BBS mean difference , 3.9 points ) . A significantly higher proportion of subjects in the circuit class therapy group were able to walk independently at discharge ( P=.01 ) and were satisfied with the amount of therapy received ( P=.007 ) . CONCLUSIONS Circuit class therapy appeared as effective as individual PT sessions for this sample of subjects receiving inpatient rehabilitation poststroke . Favorable results for circuit classes in terms of increased walking independence and patient satisfaction suggest this model of service delivery warrants further investigation PURPOSE The purpose of this study was to evaluate the physical and psychosocial effects of an 8-wk community-based functional exercise program in a group of individuals with chronic stroke . METHODS Twenty-five subjects ( mean age 63 yr ) participated in a repeated measures design that evaluated the subjects with two baseline assessment s 1 month apart , one postintervention assessment , and one retention assessment 1 month postintervention . Physical outcome measures assessed were the Berg Balance Test , 12-Minute Walk Test distance , gait speed , and stair climbing speed . Psychosocial measures assessed were the Reintegration to Normal Living Index ( RNL ) and Canadian Occupational Performance Measure ( COPM ) . The 8-wk training consisted of a 60-min , 3 x wk-1 group program that focused on balance , mobility , functional strength , and functional capacity . The program was design ed to be accessible by reducing the need for costly one-on-one supervision , specialized setting s , and expensive equipment . RESULTS Improvements from the exercise program were found for all physical measures and these effects were retained 1-month postintervention . Subjects with lower function improved the most relative to their initial physical status . Significant effects were found for the COPM , but not the RNL Index ; however , subjects with lower RNL improved the most relative to their initial RNL Score . CONCLUSION A short-term community-based exercise program can improve and retain mobility , functional capacity , and balance and result in a demonstrable impact upon the performance of activities and abilities that were considered meaningful to the subjects . Implementation of such community-based programs has potential for improving activity tolerance and reducing the risk for secondary complications common to stroke ( e.g. , falls result ing in fractures and cardiac events ) OBJECTIVE To evaluate the immediate and retention effects of a 4-week training program on the performance of locomotor-related tasks in chronic stroke . DESIGN R and omized , controlled pilot study with 2-month follow-up . SETTING Rehabilitation center . SUBJECTS A convenience sample consisting of 12 chronic stroke subjects was used . Subjects were r and omly assigned to the experimental or the control group . Three subjects withdrew from the study . INTERVENTION Both experimental and control groups participated in exercise classes three times a week for 4 weeks . The exercise class for the experimental group focused on strengthening the affected lower limb and practicing functional tasks involving the lower limbs , while the control group practice d upper-limb tasks . MAIN OUTCOME MEASURES Lower-limb function was evaluated by measuring walking speed and endurance , peak vertical ground reaction force through the affected foot during sit-to-st and , and the step test . RESULTS The experimental group demonstrated significant immediate and retained ( 2-month follow-up ) improvement ( p < or = .05 ) compared with the control group in walking speed and endurance , force production through the affected leg during sit-to-st and , and the number of repetitions of the step test . CONCLUSION The pilot study provides evidence for the efficacy of a task-related circuit class at improving locomotor function in chronic stroke OBJECTIVES We sought to assess a training program focused on muscle strength and endurance in persons with prior stroke . METHODS Thirty men with a slight hemiparesis caused by a first occurrence of stroke at least 6 months earlier were included with an average age of 54 years . The following was assessed before and after an 8-week period : muscle strength , endurance , work capacity , and activity level . The training group consisted of 21 persons and 9 served as control subjects . There were no differences between the groups in the various assessment s from the start . The training was set up as circuit training with 5 stations aim ing to strengthen the muscles and increase endurance in the bilateral lower limbs . The session lasted for 45 minutes , 3 times per week , for 8 weeks . On eligible persons in the training group , double-sided muscle biopsies were also performed before and after . RESULTS There was significance in improved muscle strength and improved peak oxygen uptake for the paretic leg , which was reflected in the muscle enzymes . The nonparetic side also showed improvement , but to a lesser extent . The control group remained unchanged . CONCLUSIONS Stroke survivors can improve muscle strength , endurance , and work capacity in both the paretic and nonparetic leg with a circuit training program BACKGROUND AND PURPOSE Assessment of the quality of r and omized controlled trials ( RCTs ) is common practice in systematic review s. However , the reliability of data obtained with most quality assessment scales has not been established . This report describes 2 studies design ed to investigate the reliability of data obtained with the Physiotherapy Evidence Data base ( PEDro ) scale developed to rate the quality of RCTs evaluating physical therapist interventions . METHOD In the first study , 11 raters independently rated 25 RCTs r and omly selected from the PEDro data base . In the second study , 2 raters rated 120 RCTs r and omly selected from the PEDro data base , and disagreements were resolved by a third rater ; this generated a set of individual rater and consensus ratings . The process was repeated by independent raters to create a second set of individual and consensus ratings . Reliability of ratings of PEDro scale items was calculated using multirater kappas , and reliability of the total ( summed ) score was calculated using intraclass correlation coefficients ( ICC [ 1,1 ] ) . RESULTS The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters . The ICC for the total score was.56 ( 95 % confidence interval=.47-.65 ) for ratings by individuals , and the ICC for consensus ratings was.68 ( 95 % confidence interval=.57-.76 ) . DISCUSSION AND CONCLUSION The reliability of ratings of PEDro scale items varied from " fair " to " substantial , " and the reliability of the total PEDro score was " fair " to " good . We prospect ively evaluated gait recovery in 197 elderly subjects after hemiplegic stroke by measuring  serial walking speed .  Fifty-seven per cent of subjects ( 113/197 ) could not walk without human assistance on day 7 post-stroke . About 40 % of this group achieved gait independence at months 1 , 2 , 3 , and 4 post-stroke . In contrast , about 95 % of those walking on day 7 maintained gait independence 1 , 2 , 3 , and 4 months post-stroke . Using multiple logistic regression , the best predictors of independent ambulation among the 113 subjects not walking on day 7 were age , line bisection error , and leg power OBJECTIVES To examine the effects of a community-based group exercise program for older individuals with chronic stroke . DESIGN Prospect i ve , single-blind , r and omized , controlled intervention trial . SETTING Intervention was community-based . Data collection was performed in a research laboratory located in a rehabilitation hospital . PARTICIPANTS Sixty-three older individuals ( aged > or = 50 ) with chronic stroke ( poststroke duration > or = 1 year ) who were living in the community . INTERVENTION Participants were r and omized into intervention group ( n=32 ) or control group ( n=31 ) . The intervention group underwent a fitness and mobility exercise ( FAME ) program design ed to improve cardiorespiratory fitness , mobility , leg muscle strength , balance , and hip bone mineral density ( BMD ) ( 1-hour sessions , three sessions/week , for 19 weeks ) . The control group underwent a seated upper extremity program . MEASUREMENTS Cardiorespiratory fitness ( maximal oxygen consumption ) , mobility ( 6-minute walk test ) , leg muscle strength ( isometric knee extension ) , balance ( Berg Balance Scale ) , activity and participation ( Physical Activity Scale for Individuals with Physical Disabilities ) , and femoral neck BMD ( using dual-energy x-ray absorptiometry ) . RESULTS The intervention group had significantly more gains in cardiorespiratory fitness , mobility , and paretic leg muscle strength than controls . Femoral neck BMD of the paretic leg was maintained in the intervention group , whereas a significant decline of the same occurred in controls . There was no significant time-by-group interaction for balance , activity and participation , nonparetic leg muscle strength , or nonparetic femoral neck BMD . CONCLUSION The FAME program is feasible and beneficial for improving some of the secondary complications result ing from physical inactivity in older adults living with stroke . It may serve as a good model of a community-based fitness program for preventing secondary diseases in older adults living with chronic conditions Objective : To discover if the provision of additional  inpatient physiotherapy after stroke speeds the recovery of mobility . Design : A multisite single-blind r and omized controlled trial ( RCT ) comparing the effects of augmented physiotherapy input with normal input on the recovery of mobility after stroke . Setting : Three rehabilitation hospitals in North Glasgow , Scotl and . Subjects : Patients admitted to hospital with a clinical diagnosis of stroke , who were able to tolerate and benefit from mobility rehabilitation .  Intervention : We aim ed to provide double the amount of physiotherapy to the augmented group . Main measures : Primary outcomes were mobility milestones ( ability to st and , step and walk ) , Rivermead Mobility Index ( RMI ) and walking speed . Results : Seventy patients were recruited . The augmented therapy group received more direct contact with a physiotherapist ( 62 versus 35 minutes per weekday ) and were more active ( 8.0 % versus 4.8 % time st and ing or walking ) than normal therapy controls . The augmented group tended to achieve independent walking earlier ( hazard ratio 1.48 , 95 % confidence interval 0.90–2.43 ; p=0.12 ) and had higher Rivermead Mobility Index scores at three months ( mean difference 1.6 ; 0.1 to 3.3 ; p=0.068 ) but these differences did not reach statistical significance . There was no significant difference in any other outcome . Conclusions : A modest augmented physiotherapy programme result ed in patients having more direct physiotherapy time and being more active . The inability to show statistically significant changes in outcome measures could indicate either that this intervention is ineffective or that our study could not detect modest changes The  Berg Balance Scale ( BBS ) was design ed to help determine change in functional st and ing balance over time . The purpose of this paper was to estimate the minimum detectable change score ( MDC ) using the st and ard error of measure ( SEM ) , thereby providing a means to decide if genuine change had occurred . Calculation of the agreement regarding the presence of change as determined by the MDC and clinicians ' perceptions was performed to give an indication of the validity of this criterion value . Forty-eight subjects who were receiving inpatient rehabilitation after stroke were assessed on consecutive days by two raters using the BBS . The MDC analysis suggests that a change of + /- 6 BBS points is necessary to be 90 % confident of genuine change . Only 25/45 subjects showed agreement between the statistically derived presence of change and clinicians ' perceptions of change . The lack of agreement may relate to the validity of the SEM/MDC methodology to determine the criterion BBS value , the heterogeneity of the subjects , or the use of clinician gestalt impressions of change Time course and degree of the recovery of walking function after stroke and the influence of initial lower extremity ( LE ) paresis were studied prospect ively in a community-based population of 804 consecutive acute stroke patients .  Walking function and degree of LE paresis were assessed weekly using the Barthel index and the Sc and inavian Neurological Stroke scale , respectively . Initially , 51 % had no walking function , 12 % could walk with assistance , and 37 % had independent walking function . At the end of rehabilitation , 21 % had died , 18 % had no walking function , 11 % could walk with assistance , and 50 % had independent walking function . Recovery of walking function occurs in 95 % of the patients within the first 11 weeks after stroke . The time and the degree of recovery are related to both the degree of initial impairment of walking function and to the severity of LE paresis , p < .0001 . A valid prognosis of walking function in patients with initially no/mild/moderate leg paresis can be made in 3 weeks , and further recovery should not be expected after 9 weeks . A valid prognosis of walking function in patients with initially severe leg paresis or paralysis can be made in 6 weeks , and further improvement of walking function should not be expected later than 11 weeks after stroke This paper describes PEDro , the Physiotherapy Evidence Data base . PEDro is a web-based data base of r and omized controlled trials and systematic review s in physiotherapy . It can be accessed free of charge at http://ptwww.cchs.usyd.edu.au/pedro . The data base contains bibliographic details and abstract s of most English- language r and omized trials and systematic review s in physiotherapy , and of many trials and review s in other language s. Trials on the data base are rated on the basis of their method ological quality so that users of the data base can quickly identify trials of high quality . Trials and systematic review s are extensively indexed to facilitate search ing . PEDro provides an important information re source to support evidence -based clinical practice A r and omized controlled pilot trial was conducted to estimate the effects of early , intensive , gait-focused physical therapy on ambulatory ability in acute , stroke patients . Twenty-seven patients with middle cerebral artery infa rct of thromboembolic origin confirmed by computed axial tomography scan were stratified and r and omly assigned to the experimental group , to a control group that received early , intensive and conventional therapy , or to a group receiving routine conventional therapy that started later and was not intense . Assessment s at entry , six weeks , and three and six months by independent evaluators permitted comparisons with reference to clinical measures of motor performance , balance , and functional capacity , and laboratory measures of gait movements . Group results at six weeks demonstrated that gait velocity was similar in the two conventional groups thereby eliminating the timing of the interventions as an important factor . At that point , gait velocity was faster in the experimental group . The difference translated into a moderate effect size of 0.58 . The time dedicated to gait training but not to total therapy time was correlated ( rs = 0.63 ) to gait velocity . This effect disappeared at three and six months after stroke . These pilot results justify planning a large trial to test the effectiveness of a therapeutic protocol that focuses on early and intense gait therapy in an effort to facilitate early ambulation following stroke OBJECTIVES To determine the feasibility and effect of exercise training after stroke . DESIGN R and omized exploratory trial comparing exercise training ( including progressive endurance and resistance training ) with relaxation ( attention control ) . SETTING Interventions were performed in a rehabilitation hospital . PARTICIPANTS Sixty-six independently ambulatory patients ( mean age 72 , 36 men ) without significant dysphasia , confusion , or medical contraindications to exercise training who had completed their usual rehabilitation and had been discharged from hospital . INTERVENTION Both interventions were held three times a week for 12 weeks . Up to seven patients attended each session . MEASUREMENTS The Functional Independence Measure ; Nottingham Extended Activities of Daily Living ; Rivermead Mobility Index ; functional reach ; sit-to-st and ; elderly mobility score ; timed up- and -go ; Medical Outcomes Study 36-Item Short Form Question naire , version 2 ( SF-36 ) ; Hospital Anxiety and Depression Score ; aspects of physical fitness ( comfortable walking speed , walking economy , and explosive leg extensor power ) were measured at baseline , immediately after interventions ( 3 months ) , and 7 months after baseline . RESULTS The median number of intervention sessions attended was 36 ( interquartile range ( IQR ) 30.00 - 36.75 ) for exercise and 36 ( IQR 30.50 - 37.00 ) for relaxation .  Adherence to the individual exercises ranged from 94 % to 99 % . At 3 months , role-physical ( an item in SF-36 ) , timed up- and -go , and walking economy were significantly better in the exercise group ( analysis of covariance ) . At 7 months , role-physical was the only significant difference between groups . CONCLUSION Exercise training for ambulatory stroke patients was feasible and led to significantly greater benefits in aspects of physical function and perceived effect of physical health on daily life Background and Purpose : A phase II , single-blinded , r and omized clinical trial was conducted to determine the effects of combined task-specific and lower-extremity ( LE ) strength training to improve walking ability after stroke . Subjects : The participants were 80 adults who were ambulatory 4 months to 5 years after a unilateral stroke . Method : The exercise interventions consisted of body-weight – supported treadmill training ( BWSTT ) , limb-loaded resistive leg cycling ( CYCLE ) , LE muscle-specific progressive-resistive exercise ( LE-EX ) , and upper-extremity ergometry ( UE-EX ) . After baseline assessment s , participants were r and omly assigned to a combined exercise program that included an exercise pair . The exercise pairs were : BWSTT/UE-EX , CYCLE/UE-EX , BWSTT/CYCLE , and BWSTT/LE-EX . Exercise sessions were 4 times per week for 6 weeks ( total of 24 sessions ) , with exercise type completed on alternate days . Outcomes were self-selected walking speed , fast walking speed , and 6-minute walk distance measured before and after intervention and at a 6-month follow-up . Results : The BWSTT/UE-EX group had significantly greater walking speed increases compared with the CYCLE/UE-EX group ; both groups improved in distance walked . All BWSTT groups increased walking speed and distance whether BWSTT was combined with LE strength training or not . Discussion and Conclusion : After chronic stroke , task-specific training during treadmill walking with body-weight support is more effective in improving walking speed and maintaining these gains at 6 months than resisted leg cycling alone . Consistent with the overtraining literature , LE strength training alternated daily with BWSTT walking did not provide an added benefit to walking outcomes Objective : To examine the effectiveness of task-oriented progressive resistance strength training on lower extremity strength and functional performance in chronic stroke subjects . Design : Single-blind , r and omized controlled trial . Setting : Medical centre and district hospital . Subjects : Forty-eight subjects at least one year post stroke . Interventions : Participants r and omly allocated to two groups , control  ( n-/24 ) and experimental  ( n-/24 ) . Subjects in the control group did not receive any rehabilitation training . Subjects in the experimental group were put on a four-week task-oriented progressive resistance strength training . Main measures : Lower extremity muscle strength , gait velocity , cadence , stride length , six-minute walk test , step test , and timed up and go test . Results : Muscle strength significantly improved in the experimental group for strong side muscle groups ( ranged from 23.9 % to 36.5 % ) and paretic side muscle groups ( ranged from 10.1 % to 77.9 % ) . In the control group muscle strength changes ranged from 6.7 % gain to 11.2 % decline . The experimental group showed significant improvement in all selected measures of functional performance except for the step test . In the control group , the number of repetitions of the step test significantly decreased ( -20.3 % ) with no change in other functional tests . There was a significant difference between groups for muscle strength and all functional measures . The strength gain was significantly associated with gain in the functional tests . Conclusions : The task-oriented progressive resistance strength training programme could improve lower extremity muscle strength in individuals with chronic stroke and could carry over into improvement in functional abilities BACKGROUND AND PURPOSE In hemiparetic individuals , low endurance to exercise may compound the increased energy cost of movement and contribute to poor rehabilitation outcomes . The purpose of this investigation was to describe how hemiparetic stroke patients responded to intense exercise and aerobic training . METHODS Forty-two subjects were r and omly assigned to an exercise training group or to a control group . Treatments were given three times per week for 10 weeks in similar laboratory setting s. Baseline and posttest measurements were made of maximal oxygen consumption , heart rate , workload , exercise time , resting and submaximal blood pressures , and sensorimotor function . RESULTS Only experimental subjects showed significant improvement in maximal oxygen consumption , workload , and exercise time . Improvement in sensorimotor function was significantly related to the improvement in aerobic capacity . After treatment , experimental subjects showed significantly lower systolic blood pressure at submaximal workloads during the grade d exercise test . CONCLUSIONS We conclude that hemiparetic stroke patients may improve their aerobic capacity and submaximal exercise systolic blood pressure response with training . Sensorimotor improvement is related to the improvement in aerobic capacity
target: Nonsignificant summary effect sizes in favor of task-oriented circuit class training were found for the step test and balance control .
  This meta- analysis supports the use of task-oriented circuit class training to improve gait and gait-related activities in patients with chronic stroke .
background: BACKGROUND AND PURPOSE There is increasing interest in the potential benefits of circuit class training after stroke , but its effectiveness is uncertain .
  Our aim was to systematic ally review r and omized , controlled trials of task-oriented circuit class training on gait and gait-related activities in patients with stroke .