Physical Therapy Korea (한국전문물리치료학회지)

Korean Research Society of Physical Therapy (한국전문물리치료학회)
권호 표지
DOI QR코드

DOI QR Code

Comparison of the Effect of Treadmill Walking Combined With Obstacles-Crossing on Walking Function in Stroke Patients

장애물 통과 트레드밀 보행훈련이 뇌졸중 환자의 보행기능에 미치는 효과

  • Jeong, Yeon-Gyu (Dept. of Physical Therapy, Dongguk University Ilsan Medical Center) ;
  • Jeong, Yeon-Jae (Dept. of Physical Therapy, Hanyang University Medical Center) ;
  • Kim, Hyun-Sook (Dept. of Physical Therapy, Yeoju Institute of Technology)
  • 정연규 (동국대학교일산병원 물리치료실) ;
  • 정연재 (서울한양대학교병원 물리치료실) ;
  • 김현숙 (여주대학교 물리치료학과)
  • Received : 2013.06.17
  • Accepted : 2013.07.05
  • Published : 2013.09.17
Download PDF
⟨ Previous Next ⟩

Abstract

The study aimed to compare the effect of the treadmill walking training combined with obstacle-crossing (TWT-OC) and treadmill walking training (TWT) on the walking function of patients with chronic stroke. 29 subjects volunteered to participate in this study; they were randomly assigned to either TWT-OC group (15 subjects) or TWT group (14 subjects). Subjects from the TWT-OC group underwent a treadmill walking combined with obstacles-crossing for 30 minutes daily, three days a week for four weeks, whereas subjects from the TWT group received only a treadmill walking. The 10 m walk test (10MWT), 6-min walk test (6MWT), berg balance scale (BBS), timed up and go test (TUG), activities-specific balance confidence-Korean version (ABC-K), and walking ability questionnaire (WAQ) were measured before and after the 4-week training. The TWT-OC group showed significantly better functional mobility of walking and balance measured by 6MWT (p<.01), BBS (p<.01), and TUG scores (p<.05) when compared with those of the TWT group. Further, within-group comparison showed significant improvement in all variables (p<.01) except for 10MWT. These findings suggest that the TWT-OC and TWT may be helpful for improving the walking function of patients with chronic stroke, and the TWT-OC has probably more favorable outcomes for chronic stroke, however, further trials with wider range of subjects are warranted for generalization and clinical relevance.

Keywords

References

  1. Amatachaya S, Thaweewannakij T, Adirek-udomrat J, et al. Factors related to obstacle crossing in independent ambulatory patients with spinal cord injury. J Spinal Cord Med. 2010;33(2):144-149. https://doi.org/10.1080/10790268.2010.11689689
  2. Berg K, Wood-Dauphinee S, Williams JI. The balance scale: Reliability assessment with elderly residents and patients with an acute stroke. Scand J Rehabil Med. 1995;27(1):27-36.
  3. Bogey R, Hornby GT. Gait training strategies utilized in poststroke rehabilitation: Are we really making a difference? Top Stroke Rehabil. 2007;14(6): 1-8.
  4. Cahalin LP, Mathier MA, Semigran MJ, et al. The six-minute walk test predicts peak oxygen uptake and survival in patients with advanced heart failure. Chest. 1996;110(2):325-332. https://doi.org/10.1378/chest.110.2.325
  5. Chen G, Patten C. Treadmill training with harness support: Selection of parameters for individuals with poststroke hemiparesis. J Rehabil Res Dev. 2006;43(4):485-498. https://doi.org/10.1682/JRRD.2005.04.0063
  6. Chou LS, Kaufman KR, Brey RH, et al. Motion of the whole body's center of mass when stepping over obstacles of different heights. Gait Posture. 2001;13(1):17-26. https://doi.org/10.1016/S0966-6362(00)00087-4
  7. DePaul VG, Wishart LR, Richardson J, et al. Varied overground walking-task practice versus body-weight-supported treadmill training in ambulatory adults within one year of stroke: A randomized controlled trial protocol. BMC Neurol. 2011;11:129. doi:10.1186/1471-2377-11-129.
  8. Dietz V. Body weight supported gait training: From laboratory to clinical setting. Brain Res Bull. 2009;78(1):I-VI. https://doi.org/10.1016/S0361-9230(08)00410-3
  9. Duncan PW, Sullivan KJ, Behrman AL, et al. Body-weight-supported treadmill rehabilitation after stroke. N Engl J Med. 2011;364(21): 2026-2036. https://doi.org/10.1056/NEJMoa1010790
  10. Duncan PW. Stroke disability. Phys Ther. 1994;74(5): 399-407. https://doi.org/10.1093/ptj/74.5.399
  11. Fisher BE, Sullivan KJ. Activity-dependent factors affecting poststroke functional outcomes. Top Stroke Rehabil. 2001;8(3):31-44. https://doi.org/10.1310/B3JD-NML4-V1FB-5YHG
  12. Forrester LW, Wheaton LA, Luft AR. Exercisemediated locomotor recovery and lower-limb neuroplasticity after stroke. J Rehabil Res Dev. 2008;45(2):205-220. https://doi.org/10.1682/JRRD.2007.02.0034
  13. Goldie PA, Matyas TA, Evans OM. Deficit and change in gait velocity during rehabilitation after stroke. Arch Phys Med Rehabil 1996;77(10): 1074-1082. https://doi.org/10.1016/S0003-9993(96)90072-6
  14. Green J, Forster A, Young J. Reliability of gait speed measured by a timed walking test in patients one year after stroke. Clin Rehabil. 2002;16(3):306-314. https://doi.org/10.1191/0269215502cr495oa
  15. Hesse S, Bertelt C, Jahnke MT, et al. Treadmill training with partial body weight support compared with physiotherapy in nonambulatory hemiparetic patients. Stroke. 1995;26(6):976-981. https://doi.org/10.1161/01.STR.26.6.976
  16. Holsbeeke L, Ketelaar M, Schoemaker MM, et al. Capacity, capability, and performance: Different constructs or three of a kind? Arch Phys Med Rehabil. 2009;90(5):849-855. https://doi.org/10.1016/j.apmr.2008.11.015
  17. Hwang EO, Oh DW, Kim SY. Community ambulation in patients with chronic post-stroke hemiparesis: Comparison of walking variables in five different community situations. Korean Acad Phys Ther Sci. 2009;16(1):31-39.
  18. Hwang SJ, Yi CH, Park SY. Application of rasch analysis to the activities-specific balance confidence (ABC) scale. Phys Ther Kor. 2007;14(1): 37-45.
  19. Jones AM, Doust JH. A 1% treadmill grade most accurately reflects the energetic cost of outdoor running. J Sports Sci. 1996;14(4):321-327. https://doi.org/10.1080/02640419608727717
  20. Kelley RE, Borazanci AP. Stroke rehabilitation. Neurol Res. 2009;31(8):832-840. https://doi.org/10.1179/016164109X12445505689689
  21. Kelly-Hayes M, Beiser A, Kase CS, et al. The influence of gender and age on disability following ischemic stroke: The framingham study. J Stroke Cerebrovasc Dis. 2003;12(3):119-126. https://doi.org/10.1016/S1052-3057(03)00042-9
  22. Kim JM, Ann DH. Movement dysfunction in spastic hemiparesis: A problem of spasticity or muscular weakness? Phys Ther Kor. 2002;9(3):125-135.
  23. Langhorne P, Stott DJ, Robertson L, et al. Medical complications after stroke: A multicenter study. Stroke. 2000;31(6):1223-1229. https://doi.org/10.1161/01.STR.31.6.1223
  24. Lindsay P, Bayley M, McDonald A, et al. Toward a more effective approach to stroke: Canadian best practice recommendations for stroke care. CMAJ. 2008;178(11):1418-1425. https://doi.org/10.1503/cmaj.071253
  25. Macko RF, Ivey FM, Forrester LW, et al. Treadmill exercise rehabilitation improves ambulatory function and cardiovascular fitness in patients with chronic stroke: A randomized, controlled trial. Stroke. 2005;36(10):2206-2211. https://doi.org/10.1161/01.STR.0000181076.91805.89
  26. Mayo NE, Wood-Dauphinee S, Ahmed S, et al. Disablement following stroke. Disabil Rehabil. 1999;21(5-6):258-268. https://doi.org/10.1080/096382899297684
  27. Miller EW, Quinn ME, Seddon PG. Body weight support treadmill and overground ambulation training for two patients with chronic disability secondary to stroke. Phys Ther. 2002;82(1): 53-61. https://doi.org/10.1093/ptj/82.1.53
  28. Moreland JD, Depaul VG, Dehueck AL, et al. Needs assessment of individuals with stroke after discharge from hospital stratified by acute functional independence measure score. Disabil Rehabil. 2009;31(26):2185-2195. https://doi.org/10.3109/09638280902951846
  29. Morris S, Morris ME, Iansek R. Reliability of measurements obtained with the timed "up & go" test in people with parkinson disease. Phys Ther. 2001;81(2):810-818. https://doi.org/10.1093/ptj/81.2.810
  30. Moseley AM, Stark A, Cameron ID, et al. Treadmill training and body weight support for walking after stroke. Cochrane Database Syst Rev. 2005;(4):CD002840.
  31. Mossberg KA. Reliability of a timed walk test in persons with acquired brain injury. Am J Phys Med Rehabil. 2003;82(5):385-390.
  32. Park HJ, Oh DW, Kim SY, et al. Effectiveness of community-based ambulation training for walking function of post-stroke hemiparesis: A randomized controlled pilot trial. Clin Rehabil. 2011;25(5):451-459. https://doi.org/10.1177/0269215510389200
  33. Park JH, Kwon YC. Standardization of korean version of the mini-mental state examination (mmse-k) for use in the elderly. Part II. Diagnostic validity. Psychiatry Investig. 1989; 28(3):508-513.
  34. Patla AE, Prentice SD, Robinson C, et al. Visual control of locomotion: Strategies for changing direction and for going over obstacles. J Exp Psychol Hum Percept Perform. 1991;17(3): 603-634. https://doi.org/10.1037/0096-1523.17.3.603
  35. Perry J, Garrett M, Gronley JK, et al. Classification of walking handicap in the stroke population. Stroke. 1995;26(6):982-989. https://doi.org/10.1161/01.STR.26.6.982
  36. Podsiadlo D, Richardson S. The timed "up & go": A test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39(2):142-148. https://doi.org/10.1111/j.1532-5415.1991.tb01616.x
  37. Pohl M, Mehrholz J, Ritschel C, et al. Speed-dependent treadmill training in ambulatory hemiparetic stroke patients: A randomized controlled trial. Stroke. 2002;33(2):553-558. https://doi.org/10.1161/hs0202.102365
  38. Pound P, Gompertz P, Ebrahim S. A patient-centred study of the consequences of stroke. Clin Rehabil. 1998;12(4):338-347. https://doi.org/10.1191/026921598677661555
  39. Powell LE, Myers AM. The activities-specific balance confidence (ABC) scale. J Gerontol A Biol Sci Med Sci. 1995;50A(1):M28-M34. https://doi.org/10.1093/gerona/50A.1.M28
  40. Rantakokko M, Manty M, Iwarsson S, et al. Fear of moving outdoors and development of outdoor walking difficulty in older people. J Am Geriatr Soc. 2009;57(4):634-640. https://doi.org/10.1111/j.1532-5415.2009.02180.x
  41. Said CM, Goldie PA, Culham E, et al. Control of lead and trail limbs during obstacle crossing following stroke. Phys Ther. 2005;85(5):413-427.
  42. Said CM, Goldie PA, Patla AE, et al. Effect of stroke on step characteristics of obstacle crossing. Arch Phys Med Rehabil. 2001;82(12): 1712-1719. https://doi.org/10.1053/apmr.2001.26247
  43. Salbach NM, Mayo NE, Robichaud-Ekstrand S, et al. Balance self-efficacy and its relevance to physical function and perceived health status after stroke. Arch Phys Med Rehabil. 2006;87(3): 364-370. https://doi.org/10.1016/j.apmr.2005.11.017
  44. Salbach NM, Mayo NE, Wood-Dauphinee S, et al. A task-orientated intervention enhances walking distance and speed in the first year post stroke: A randomized controlled trial. Clin Rehabil. 2004;18(5):509-519. https://doi.org/10.1191/0269215504cr763oa
  45. Salminen AL, Brandt A, Samuelsson K, et al. Mobility devices to promote activity and participation: A systematic review. J Rehabil Med. 2009;41(9):697-706. https://doi.org/10.2340/16501977-0427
  46. Shumway-Cook A, Patla AE, Stewart A, et al. Environmental demands associated with community mobility in older adults with and without mobility disabilities. Phys Ther. 2002;82(7): 670-681.
  47. Sohn RH, Choi HS, Son JS, et al. The comparison of overground walking and treadmill walking according to the walking speed: Motion analysis and energy consumption. J Biomed Eng Res. 2009;30(3):226-232.
  48. Solway S, Brooks D, Lacasse Y, et al. A qualitative systematic overview of the measurement properties of functional walk tests used in the cardiorespiratory domain. Chest. 2001;119(1):256-270. https://doi.org/10.1378/chest.119.1.256
  49. Sullivan KJ, Knowlton BJ, Dobkin BH. Step training with body weight support: Effect of treadmill speed and practice paradigms on poststroke locomotor recovery. Arch Phys Med Rehabil. 2002;83(5):683-691. https://doi.org/10.1053/apmr.2002.32488
  50. Waagfjord J, Levangie PK, Certo CM. Effects of treadmill training on gait in a hemiparetic patient. Phys Ther. 1990;70(9):549-558. https://doi.org/10.1093/ptj/70.9.549
  51. Werner C, Bardeleben A, Mauritz KH, et al. Treadmill training with partial body weight support and physiotherapy in stroke patients: A preliminary comparison. Eur J Neurol. 2002;9(6): 639-644. https://doi.org/10.1046/j.1468-1331.2002.00492.x
  52. Wevers L, van de Port I, Vermue M, et al. Effects of task-oriented circuit class training on walking competency after stroke: A systematic review. Stroke. 2009;40(7):2450-2459. https://doi.org/10.1161/STROKEAHA.108.541946
  53. Yang YR, Tsai MP, Chuang TY, et al. Virtual reality-based training improves community ambulation in individuals with stroke: A randomized controlled trial. Gait Posture. 2008;28(2):201-206. https://doi.org/10.1016/j.gaitpost.2007.11.007

Cited by

  1. The Effects of Treadmill Obstacle-Stepping on Physical Activity in Ambulatory Patients After Stroke vol.22, pp.4, 2013, https://doi.org/10.12674/ptk.2015.22.4.071
  2. 장애물 보행훈련이 뇌졸중 환자의 균형, 보행 및 일상생활활동에 미치는 영향 - 예비연구 vol.27, pp.2, 2013, https://doi.org/10.26862/jkpts.2020.09.27.2.1
  3. 뇌졸중환자에게 적용된 트레드밀훈련의 효과 및 방법에 대한 체계적 고찰 vol.27, pp.2, 2013, https://doi.org/10.26862/jkpts.2020.09.27.2.63