title: Meaningful Gait Speed Improvement During the First 60 Days Poststroke: Minimal Clinically Important Difference Repetitive locomotor training and physiotherapy improve walking and basic activities of daily living after stroke: a single-blind, randomized multicentre trial (DEutsche GAngtrainerStudie, DEGAS) Effects of Locomotion Training With Assistance of a Robot-Driven Gait Orthosis in Hemiparetic Patients After Stroke: A Randomized Controlled Pilot Study Multicenter Randomized Clinical Trial Evaluating the Effectiveness of the Lokomat in Subacute Stroke Randomized Trial of Treadmill Walking With Body Weight Support to Establish Walking in Subacute Stroke: The MOBILISE Trial Gait rehabilitation machines based on programmable footplates Effects of intensive therapy using gait trainer or floor walking exercises early after stroke. An evaluation of two different exercise regimes during the first year following stroke: A randomised controlled trial Effect of encouragement on walking test performance. A Pilot Study of Randomized Clinical Controlled Trial of Gait Training in Subacute Stroke Patients With Partial Body-Weight Support Electromechanical Gait Trainer and Functional Electrical Stimulation: Six-Month Follow-Up Comparison of Partial Body Weight-Supported Treadmill Gait Training Versus Aggressive Bracing Assisted Walking Post Stroke The effectiveness of body weight-supported gait training and floor walking in patients with chronic stroke. How feasible is the attainment of community ambulation after stroke? A pilot randomized controlled trial to evaluate community-based physiotherapy in subacute stroke The effectiveness of locomotor therapy using robotic-assisted gait training in subacute stroke patients: a randomized controlled trial. Prospective, Blinded, Randomized Crossover Study of Gait Rehabilitation in Stroke Patients Using the Lokomat Gait Orthosis Walking training of patients with hemiparesis at an early stage after stroke: a comparison of walking training on a treadmill with body weight support and walking training on the ground Gait outcomes after acute stroke rehabilitation with supported treadmill ambulation training: a randomized controlled pilot study. Task-specific physical therapy for optimization of gait recovery in acute stroke patients. Effectiveness of gait training using an electromechanical gait trainer, with and without functional electric stimulation, in subacute stroke: a randomized controlled trial.
abstract: Background When people with stroke recover gait speed , they report improved function and reduced disability . However , the minimal amount of change in gait speed that is clinical ly meaningful and associated with an important difference in function for people poststroke has not been determined . Objective The purpose of this study was to determine the minimal clinical ly important difference ( MCID ) for comfortable gait speed ( CGS ) associated with an improvement in the modified Rankin Scale ( mRS ) score for people between 20 to 60 days poststroke . Design This was a prospect i ve , longitudinal , cohort study . Methods The participants in this study were 283 people with first-time stroke prospect ively enrolled in the ongoing Locomotor Experience Applied Post Stroke ( LEAPS ) multi-site r and omized clinical trial . Comfortable gait speed was measured and mRS scores were obtained at 20 and 60 days poststroke . Improvement of ≥1 on the mRS was used to detect meaningful change in disability level . Results Mean ( SD ) CGS was 0.18 ( 0.16 ) m/s at 20 days and 0.39 ( 0.22 ) m/s at 60 days poststroke . Among all participants , 47.3 % experienced an improvement in disability level ≥1 . The MCID was estimated as an improvement in CGS of 0.16 m/s anchored to the mRS . Limitations Because the mRS is not a gait-specific measure of disability , the estimated MCID for CGS was only 73.9 % sensitive and 57.0 % specific for detecting improvement in mRS scores . Conclusions We estimate that the MCID for gait speed among patients with subacute stroke and severe gait speed impairments is 0.16 m/s . Patients with subacute stroke who increase gait speed ≥0.16 m/s are more likely to experience a meaningful improvement in disability level than those who do not . Clinicians can use this reference value to develop goals and interpret progress in patients with subacute stroke 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 — The success of gait rehabilitation after stroke depends on active walking exercises . However , the disabling after-effects of stroke often make such exercises impossible at the onset of therapy . To facilitate treadmill training of paraparetic patients , a robot-driven gait orthosis ( Lokomat ) was developed . We investigated the effects of the Lokomat when used with hemiparetic patients . Methods — The authors conducted a r and omized , controlled pilot study of 30 acute stroke survivors . The treatment group received 30 minutes of robotic training daily and the control group 30 minutes of conventional physiotherapy daily in addition to 30 minutes of conventional physiotherapy for each group . Outcome measures were independence of gait , gait speed , gait parameters , and body tissue composition . Results — After 4 weeks of therapy , the walking ability of the Lokomat group and the control group expressed as the functional ambulation classification was significantly improved . The functional ambulation category ( median± interquartile range ) was at baseline 0±0 in control and 0±1 in the therapy group and increased after therapy to 1±3 in both groups significantly ( P=0.01 ) . There was no significant difference in gain of these parameters between the groups . The Lokomat group had a significantly longer single stance phase ( sec ; mean±SEM ) on the paretic leg when walking on the floor . At baseline , it was 0.19±0.17 and after therapy 0.49±0.07 ( P=0.014 ) . The control group had increased their body weight approximately 1.33±1.40 kg ( mean±SEM ; P=0.046 ) , mostly as fat mass , whereas the Lokomat group had lost fat mass approximately −2.9±1.0 kg ( mean±SEM ; P=0.016 ) and increased their muscle mass approximately 3.36±1.4 kg ( mean± SEM ; P=0.031 ) . Conclusions — This pilot study indicates that Lokomat therapy is a promising intervention for gait rehabilitation . Although there was no difference between groups in gain of functional scores , the Lokomat group showed an advantage of robotic training over conventional physiotherapy in improvement of gait abnormality and body tissue composition Objective . To compare the efficacy of robotic-assisted gait training with the Lokomat to conventional gait training in individuals with subacute stroke . Methods . A total of 63 participants < 6 months poststroke with an initial walking speed between 0.1 to 0.6 m/s completed the multicenter , r and omized clinical trial . All participants received twenty-four 1-hour sessions of either Lokomat or conventional gait training . Outcome measures were evaluated prior to training , after 12 and 24 sessions , and at a 3-month follow-up exam . Self-selected overground walking speed and distance walked in 6 minutes were the primary outcome measures , whereas secondary outcome measures included balance , mobility and function , cadence and symmetry , level of disability , and quality of life measures . Results . Participants who received conventional gait training experienced significantly greater gains in walking speed ( P = .002 ) and distance ( P = .03 ) than those trained on the Lokomat . These differences were maintained at the 3-month follow-up evaluation . Secondary measures were not different between the 2 groups , although a 2-fold greater improvement in cadence was observed in the conventional versus Lokomat group . Conclusions . For subacute stroke participants with moderate to severe gait impairments , the diversity of conventional gait training interventions appears to be more effective than robotic-assisted gait training for facilitating returns in walking ability Background and Purpose — The main objective of this r and omized trial was to determine whether treadmill walking with body weight support was effective at establishing independent walking more often and earlier than current physiotherapy intervention for nonambulatory stroke patients . Methods — A r and omized trial with concealed allocation , blinded assessment , and intention-to-treat analysis was conducted . One hundred twenty-six stroke patients who were unable to walk were recruited and r and omly allocated to an experimental or a control group within 4 weeks of stroke . The experimental group undertook up to 30 minutes per day of treadmill walking with body weight support via an overhead harness whereas the control group undertook up to 30 minutes of overground walking . The primary outcome was the proportion of participants achieving independent walking within 6 months . Results — Kaplan – Meier estimates of the proportion of experimental participants who achieved independent walking were 37 % compared with 26 % of the control group at 1 month , 66 % compared with 55 % at 2 months , and 71 % compared with 60 % at 6 months ( P=0.13 ) . The experimental group walked 2 weeks earlier , with a median time to independent walking of 5 weeks compared to 7 weeks for the control group . In addition , 14 % ( 95 % CI , −1–28 ) more of the experimental group were discharged home . Conclusions — Treadmill walking with body weight support is feasible , safe , and tends to result in more people walking independently and earlier after stroke . Trial Registration — NN Clinical Trial.gov ( NCT00167531 ) Background Gait restoration is an integral part of rehabilitation of brain lesioned patients . Modern concepts favour a task-specific repetitive approach , i.e. who wants to regain walking has to walk , while tone-inhibiting and gait preparatory manoeuvres had dominated therapy before . Following the first mobilization out of the bed , the wheelchair-bound patient should have the possibility to practise complex gait cycles as soon as possible . Steps in this direction were treadmill training with partial body weight support and most recently gait machines enabling the repetitive training of even surface gait and even of stair climbing . Results With treadmill training harness-secured and partially relieved wheelchair-mobilised patients could practise up to 1000 steps per session for the first time . Controlled trials in stroke and SCI patients , however , failed to show a superior result when compared to walking exercise on the floor . Most likely explanation was the effort for the therapists , e.g. manually setting the paretic limbs during the swing phase result ing in a too little gait intensity . The next steps were gait machines , either consisting of a powered exoskeleton and a treadmill ( Lokomat , AutoAmbulator ) or an electromechanical solution with the harness secured patient placed on movable foot plates ( Gait Trainer GT I ) . For the latter , a large multi-centre trial with 155 non-ambulatory stroke patients ( DEGAS ) revealed a superior gait ability and competence in basic activities of living in the experimental group . The HapticWalker continued the end effector concept of movable foot plates , now fully programmable and equipped with 6 DOF force sensors . This device for the first time enables training of arbitrary walking situations , hence not only the simulation of floor walking but also for example of stair climbing and perturbations . Conclusion Locomotor therapy is a fascinating new tool in rehabilitation , which is in line with modern principles of motor relearning promoting a task-specific repetitive approach . Sophisticated technical developments and positive r and omized controlled trials form the basis of a growing acceptance worldwide to the benefits or our patients OBJECTIVE To analyse the effects of gait therapy for patients after acute stroke in a r and omized controlled trial . METHODS Fifty-six patients with a mean of 8 days post-stroke participated in : ( i ) gait trainer exercise ; ( ii ) walking training over ground ; or ( iii ) conventional treatment . Patients in the gait trainer exercise and walking groups practice d gait for 15 sessions over 3 weeks and received additional physiotherapy .  Functional Ambulatory Category and several secondary outcome measures assessing gait and mobility were administered before and after rehabilitation and at 6-month follow-up . Patients also evaluated their own effort . RESULTS Walking ability improved more with intensive walk training compared with conventional treatment ; median Functional Ambulatory Category was zero in all patients at the start of the study , but it was 3 in both walk-training groups and 0.5 in the conventional treatment group at the end of the therapy . Median Functional Ambulatory Category was 4 in both walk-training groups and 2.5 in conventional treatment group at 6-month follow-up . Mean accomplished walking distance was not different between the gait trainer exercise and over ground walking groups . Borg scale indicated more effort in over ground walking . Secondary outcomes also indicated improvements . CONCLUSION Exercise therapy with walking training improved gait function irrespective of the method used , but the time and effort required to achieve the results favour the gait trainer exercise . Early intensive gait training result ed in better walking ability than did conventional treatment The purpose of this r and omised controlled trial was to evaluate the effects of two different exercise approaches during the first 12 months post stroke on Instrumental Activities of Daily Living ( IADL ) , motor function , gait performance , balance , grip strength , and muscle tone . This study is a double-blind longitudinal r and omised trial of first-time-ever stroke patients . Seventy-five patients were included : 35 in an intervention group and 40 in a self-initiated exercise group .  After discharge from acute rehabilitation , patients assigned in the intervention group had physiotherapy for a minimum amount of 80 hours during the first year . Patients in the self-initiated exercise group were not recommended any specific therapy besides treatment when needed . Main outcome measures were Instrumental Activities of Daily Living according to Fillenbaum , Motor Assessment Scale , 6-Minute Walk Test , Berg Balance Scale , Timed Up- and -Go Test , grip strength , Modified Ashworth Scale , and pulse monitoring . The patients were tested on admission , at discharge , and after 3 , 6 , and 12 months post stroke by an experienced investigator , blinded to group assignment . Twelve months post stroke showed higher levels of independence in all items of the Instrumental Activities of Daily Living Test and improvements in the results of Motor Assessment Scale , 6-Minute Walk Test , Berg Balance Scale , Timed Up- and -Go , and grip strength in both groups . Only a few significant differences were seen between groups , and they were in favour of the self-initiated exercise group ( e.g. , ability to use the telephone independently ) . Attending examination sessions following each intervention phase appeared to be strong motivators for training , irrespective of group allocation Walking tests , frequently used to document effects of treatment on exercise capacity , have never been st and ardised . We studied the effects of encouragement on walking test performance in a r and omised study that controlled for the nature of the underlying disease , time of day , and order effects . We r and omised 43 patients with chronic airflow limitation or chronic heart failure or both to receive or not receive encouragement as they performed serial two and six minute walks every fortnight for 10 weeks . Simple encouragement improved performance ( p less than 0.02 for the six minute walk ) , and the magnitude of the effect was similar to that reported for patients in studies purporting to show beneficial effects of therapeutic manoeuvres . Age and test repetition also affected performance . These results demonstrate the need for careful st and ardisation of the performance of walking tests , and suggest caution in interpreting studies in which st and ardisation is not a major feature of the study design Background and Purpose — This study aim ed to assess the effectiveness of gait training using an electromechanical gait trainer with or without functional electrical stimulation for people with subacute stroke . Methods — This was a nonblinded r and omized controlled trial with a 6-month follow-up . Fifty-four subjects were recruited within 6 weeks after stroke onset and were r and omly assigned to 1 of 3 gait intervention groups : conventional overground gait training treatment ( CT , n=21 ) , electromechanical gait trainer ( GT , n=17 ) and , electromechanical gait trainer with functional electrical stimulation ( GT-FES , n=16 ) . All subjects were to undergo an assigned intervention program comprising a 20-minute session every weekday for 4 weeks . The outcome measures were Functional Independence Measure , Barthel Index , Motricity Index leg subscale , Elderly Mobility Scale ( EMS ) , Berg Balance Scale , Functional Ambulatory Category ( FAC ) , and 5-meter walking speed test . Assessment s were made at baseline , at the end of the 4-week intervention program , and 6 months after the program ended . Results — By intention-to-treat and multivariate analysis , statistically significant differences showed up in EMS ( Wilks ' & lgr;=0.743 , P=0.005 ) , FAC ( Wilks ' & lgr;=0.744 , P=0.005 ) and gait speed ( Wilks ' & lgr;=0.658 , P<0.0001 ) . Post hoc analysis ( univariate 2-way ANCOVA ) revealed that the GT and GT-FES groups showed significantly better improvement in comparison with the CT group at the end of the 4 weeks of training and in the 6-month follow-up . Conclusions — For the early stage after stroke , this study indicated a higher effectiveness in poststroke gait training that used an electromechanical gait trainer compared with conventional overground gait training . The training effect was sustained through to the 6-month follow-up after the intervention Purpose : To test the hypothesis that partial body weight-supportcd treadmill training ( PBWSTT ) provides more effective gait training than an equally supportive but less physiologic aggressive bracing assisted walking ( ABAW ) program . Methods : Following informed consent , patients participating in an inpatient re habilitation program with significant leg weakness and need for at least moderate as sistance for walking , without orthostatic hypotension , symptomatic dyspnea , or angina pectoris were r and omized to receive PBWSTT vs. ABAW . PBWSTT was provided by a commercially available , overhead motorized hoist attached to a parachute-type body harness , which provided partial support of the patient 's weight over a treadmill . Ther apists assisted with weight shifting , leg advancement , and foot placement as needed . ABAW included aggressive early therapist-assisted ambulation using knee-ankle com bination bracing and hemi-bar if needed . Treatment sessions of up to 45 minutes per day , five days per week were given as tolerated for the duration of the inpatient stay or until patients could walk over-ground unassisted . All patients had an additional 45- minute session of functionally oriented physical therapy each day with or without brac ing as judged appropriate by the patient 's individual therapist . Results : Fifty-six patients a mean age of 71 ±1 SEM were enrolled 40 ± 3 days post stroke . Although die outcome of the two groups as a whole did not differ , a subgroup with major hemispheric stroke defined by the presence of hemiparesis , hemianopic vi sual deficit , and hemihypesthesia who received more than 12 treatment sessions showed significantly better over-ground endurance ( 90 ± 34 vs. 44 ± 10 meters ) and speed scores ( 12 ± 4 vs. 8 ± 2 meters/minute ) for PBWSTT vs. ABAW , respectively . Conclusions : PBWSTT and ABAW are equally effective gait training techniques except for a subset of patients with major hemispheric stroke who are difficult to mo bilize using ABAW alone OBJECTIVE To compare body weight-supported exercise on a gait trainer with walking exercise overground . DESIGN R and omized controlled trial . SETTING Rehabilitation hospital . PARTICIPANTS Forty-five ambulatory patients with chronic stroke . INTERVENTIONS Patients were r and omized to 3 groups : ( 1 ) gait trainer exercise with functional electric stimulation ( GTstim ) , ( 2 ) gait trainer exercise without stimulation ( GT ) , and ( 3 ) walking overground ( WALK ) . All patients practice d gait for 15 sessions during 3 weeks ( each session , 20 min ) , and they received additional physiotherapy 55 minutes daily . MAIN OUTCOME MEASURES Ten-meter walk test ( 10MWT ) , six-minute walk test ( 6MWT ) , lower-limb spasticity and muscle force , postural sway tests , Modified Motor Assessment Scale ( MMAS ) , and FIM instrument scores were recorded before , during , and after the rehabilitation and at 6 months follow-up . RESULTS The mean walking distance using the gait trainer was 6900+/-1200 m in the GTstim group and 6500+/-1700 m in GT group . In the WALK group , the distance was 4800+/-2800 m , which was less than the walking distance obtained in the GTstim group ( P=.027 ) . The body-weight support was individually reduced from 30 % to 9 % of the body weight over the course of the program . In the pooled 45 patients , the 10MWT ( P<.001 ) , 6MWT ( P<.001 ) , MMAS ( P<.001 ) , dynamic balance test time ( P<.001 ) , and test trip ( P=.005 ) scores improved ; however , no differences were found between the groups . CONCLUSIONS Both the body weight-supported training and walking exercise training programs result ed in faster gait after the intensive rehabilitation program . Patients ' motor performance remained improved at the follow-up Objective : This pilot r and omized controlled trial evaluated an assistant-led , community-based intervention to improve community mobility and participation after stroke , and examined the potential for independent community ambulation in people with subacute stroke who present with moderate gait deficit . Design : A multicentre , pilot r and omized controlled trial . Setting : Three hospitals and three community setting s in New Zeal and . Subjects : Thirty post-acute , home-dwelling stroke survivors were r and omly allocated to receive intervention in the community ( n = 14 ) or as hospital out patients ( n = 16 ) twice a week for seven weeks . Interventions : The community intervention involved practice of functional gait activities in community environments relevant to each participant . Hospital-based physiotherapy was based upon a Motor Relearning approach . Main measures : The primary outcome measure was gait speed ( m/min ) . Secondary outcomes included endurance ( six-minute walk time ) , Activities-specific Confidence Balance Scale , and the Subjective Index of Physical and Social Outcomes measured at baseline , post intervention and six months . Results : Large gains in gait speed were obtained for participants in both groups : community group mean ( SD ) 16 ( 16.1 ) m/min ; physiotherapy group mean ( SD ) 15.9 ( 16.1 ) m/min , maintained at six months . There were no significant differences between groups for primary and secondary outcomes after treatment ( P = 0.86 ANOVA ) or at six months ( P = 0.83 ANOVA ) . Only 11 participants reported independent community ambulation . Levels of social integration were low to moderate . Conclusions : A community-based gait recovery programme appears a practicable alternative to routine physiotherapy , however independent community ambulation is a challenging rehabilitation goal OBJECTIVE To evaluate the effectiveness of early and prolonged locomotor treatment with the use of a robotic-assisted gait training ( RAGT ) device ( Lokomat ; Hocoma Inc. , Zurich , Switzerl and ) on the functional outcomes of patients after subacute stroke . DESIGN A nonblinded prospect i ve , r and omized , controlled study . SETTING Rehabilitation department in tertiary university medical center . PATIENTS Sixty-seven patients in the first 3 months after subacute stroke were r and omized into 2 groups as follows . Thirty-seven patients were treated with RAGT , and 30 were treated with regular physiotherapy . Inclusion criteria were first stroke , independent ambulation before the stroke , and neurological severity between 6 and 20 according to the National Institutes of Health Stroke Scale ( NIHSS ) . INTERVENTION RAGT treatment was administered 3 times a week for 30 minutes , combined with regular physiotherapy for 6 weeks . Control patients received the equivalent additional time of regular physiotherapy . MAIN OUTCOME MEASUREMENTS The primary outcome was the ability to walk independently , as assessed by use of the functional ambulatory capacity scale . The secondary outcomes included the neurological status according to the NIHSS ; functional motor assessment ( determined by use of the stroke activity scale ) ; and gait parameters , including gait velocity , endurance , and number of climbed stairs . RESULTS In the intention-to-treat analysis , subjects in the RAGT group exhibited greater gains than the control group in their ability to walk independently , as expressed by a greater functional ambulatory capacity score ( P < .01 ) , and in their neurological status according to NIHSS ( P < .01 ) . Among those who achieved independent walking , nonsignificant differences between groups were noted according to secondary outcome measures of gait parameters except from step climbing . CONCLUSION This controlled study showed , at the end of a 6-week trial , that locomotor therapy with the use of RAGT combined with regular physiotherapy produced promising effects on functional and motor outcomes in patients after subacute stroke as compared with regular physiotherapy alone Objective . Treadmill training with partial body weight support has been suggested as a useful strategy for gait rehabilitation after stroke . This prospect i ve , blinded , r and omized controlled study of gait retraining tested the feasibility and potential efficacy of using an electromechanical-driven gait orthosis ( Lokomat ) for treadmill training . Methods . Sixteen stroke patients , mostly within 3 months after onset , were r and omized into 2 treatment groups , ABA or BAB ( A = 3 weeks of Lokomat training , B = 3 weeks of conventional physical therapy ) for 9 weeks of treatment . The outcome measures were the EU-Walking Scale , Rivermead Motor Assessment Scale , 10-m timed walking speed , 6-minute timed walking distance , Motricity Index , Medical Research Council Scale of strength , and Ashworth Scale of tone . Results . The EU-Walking Scale , Rivermead Motor Assessment Scale , 6-minute timed walking distance , Medical Research Council Scale , and Ashworth Scale demonstrated significantly more improvement during the Lokomat training phase than during the conventional physical therapy phase within each 3-week interval . Conclusions . Despite the small number of patients , the present data suggest that the Lokomat robotic assistive device provides innovative possibilities for gait training in stroke rehabilitation while eliminating prolonged repetitive movements in a nonergonomic position on the part of the physical therapist Objective : To compare the effect of walking training on a treadmill with body weight support ( BWS ) and walking training on the ground at an early stage of rehabilitation in patients with hemiparesis after stroke . Design : R and omized controlled experimental study . Setting : Multicentre design ; three departments of rehabilitation medicine . Subjects : Seventy-three consecutive first stroke patients admitted to a rehabilitation clinic were r and omized into a treatment group and a control group . Interventions : The treatment group received walking training on a treadmill with BWS for 30 minutes , 5 days a week . The control group received walking training according to the Motor Relearning Programme ( MRP ) on the ground for 30 minutes 5 days a week , not including treadmill training . During the time in the rehabilitation department ( about two months ) , all patients in the study also received professional stroke rehabilitation besides the walking training in the two groups . Main outcome measures : Functional Independence Measure ( FIM ) , walking velocity for 10 m , Functional Ambulation Classification ( FAC ) , Fugl-Meyer Stroke Assessment and Berg 's Balance Scale . The assessment s were performed at admission , at discharge and at 10-month follow-up . Results : There were no statistically significant differences between the groups at discharge or at the 10-month follow-up with regard to FIM , walking velocity , FAC , Fugl-Meyer Stroke Assessment , and Berg 's Balance Scale . Patients in both groups improved in these variables from admission to the 10-month follow-up . Conclusions : Treadmill training with BWS at an early stage of rehabilitation after stroke is a comparable choice to walking training on the ground OBJECTIVE To investigate gait outcomes with supported treadmill ambulation training ( STAT ) associated with regular rehabilitation in acute stroke survivors . DESIGN R and omized controlled trial , pilot study . SETTING Rehabilitation medicine service at a Veterans Affairs medical center . PARTICIPANTS Seven acute stroke survivors assigned to regular intervention group and 6 patients assigned to STAT intervention .  INTERVENTIONS Regular intervention consisted of 3 hours daily of physical therapy , kinesiotherapy , and occupational therapy . STAT group received regular rehabilitation with STAT substituted for usual gait training . Participants were tested at baseline , treated for an average of 3 weeks , and retested on discharge . The analysis of covariance procedure was used to test for differences between the 2 approaches . MAIN OUTCOME MEASURES Functional Ambulation Category Scale , gait speed , walking distance , gait energy expenditure , and gait energy cost . RESULTS The small sample size did not generate enough power to detect significant differences in any variable . However , medium to large effect sizes of 0.7 and 1.16 st and ard deviation units were observed for gait energy cost and walk distance , respectively . CONCLUSIONS This pilot study indicated that STAT is a safe , feasible , and promising intervention for acute stroke survivors . A larger trial is warranted for statistical relevance 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 OBJECTIVE To compare the therapeutic effects of conventional gait training ( CGT ) , gait training using an electromechanical gait trainer ( EGT ) , and gait training using an electromechanical gait trainer with functional electric stimulation ( EGT-FES ) in people with subacute stroke . DESIGN Nonblinded r and omized controlled trial . SETTING Rehabilitation hospital for adults . PARTICIPANTS Fifty patients were recruited within 6 weeks after stroke onset ; 46 of these completed the 4-week training period . INTERVENTION Participants were r and omly assigned to 1 of 3 gait intervention groups : CGT , EGT , or EGT-FES . The experimental intervention was a 20-minute session per day , 5 days a week ( weekdays ) for 4 weeks . In addition , all participants received their 40-minute sessions of regular physical therapy every weekday as part of their treatment by the hospital . MAIN OUTCOME MEASURES Five-meter walking speed test , Elderly Mobility Scale ( EMS ) , Berg Balance Scale , Functional Ambulatory Category ( FAC ) , Motricity Index leg subscale , FIM instrument score , and Barthel Index . RESULTS The EGT and EGT-FES groups had statistically significantly more improvement than the CGT group in the 5-m walking speed test ( CGT vs EGT , P=.011 ; CGT vs EGT-FES , P=.001 ) , Motricity Index ( CGT vs EGT-FES , P=.011 ) , EMS ( CGT vs EGT , P=.006 ; CGT vs EGT-FES , P=.009 ) , and FAC ( CGT vs EGT , P=.005 ; CGT vs EGT-FES , P=.002 ) after the 4 weeks of training . No statistically significant differences were found between the EGT and EGT-FES groups in all outcome measures . CONCLUSIONS In this sample with subacute stroke , participants who trained on the electromechanical gait trainer with body-weight support , with or without FES , had a faster gait , better mobility , and improvement in functional ambulation than participants who underwent conventional gait training . Future studies with assessor blinding and larger sample sizes are warranted
target: Mechanically assisted walking with body weight support is more effective than overground walking at increasing independent walking in non-ambulatory patients early after stroke .
background: QUESTION Does mechanically assisted walking with body weight support result in more independent walking and is it detrimental to walking speed or capacity in non-ambulatory patients early after stroke ?