Authors (including presenting author) :
Mok YT(1), Chui KW(1),Leung YYC(1), Wong TWL(2)(3)
Affiliation :
(1) Physiotherapy Department, Princess Margaret Hospital (2) Department of Rehabilitation Sciences, Faculty of Health and Social Sciences,The Hong Kong Polytechnic University (3) School of Public Health, LKS Faculty of Medicine, The University of Hong Kong
Introduction :
Balance impairment and walking instability were commonly manifested among stroke survivors, which could lead to functional decline and falls. Backward and lateral walking training have been shown to promote gait function and balance in stroke patients. Therefore, a multi-directional treadmill walking training, with the interventional characteristics of task-oriented and repetitive-practice, was designed for sub-acute stroke patients in the Geriatric Day Hospital (GDH) of Princess Margaret Hospital (PMH).
Objectives :
To examine the effect of multi-directional treadmill walking training on gait parameters and standing balance for subacute stroke patients.
Methodology :
This study was a randomized, controlled (active control), two-armed trial. Patients attended the GDH of PMH, with diagnosis of stroke within 3 months and the Modified Functional Ambulation Classification (MFAC) of level IV or V, were recruited. Eligible participants were randomly allocated to either a Multi-Directional Walking Training Group (MDWTG) or a Forward Walking Training Group (FWTW). Participants in both groups received 15-minute treadmill walking training for 12 sessions, together with the conventional physiotherapy. Participants in the MDWTG conducted treadmill walking training in forward, backward and lateral directions while participants in the FWTG were trained with forward walking only. Two main groups of outcome measurements included gait parameters and standing balance.
Result & Outcome :
Twenty-four eligible participants (mean age = 71.7 ± 8.07 years; 14 female) completed their training sessions from March 2017 to July 2019. 83% of them sustained ischemic stroke with the mean weeks post stroke of 7.54 ± 3.50. Paired samples t-tests revealed a significant improvement (t(22) = -2.25, p = 0.035, mean difference = -9.23) in cadence of gait parameters after treadmill walking training for all participants. Besides, standing balance was also significantly improved in terms of the composite score in Sensory Organization Test (SOT) (t(20) = -4.39, p ＜ 0.001, mean difference = -8.90). In the Limits of Stability (LOS), significant improvement was demonstrated in both the movement velocity (t(18) = -3.33, p = 0.004, mean difference = -0.61) and maximum excursion (t(18) = -2.16, p = 0.045, mean difference = -9.42). However, no significant interaction effect and/or group difference could be discovered for these outcome measurements in the follow-up analysis using a series of ANOVA with repeated measures. In conclusion, treadmill walking training is a feasible addition to stroke rehabilitation in enhancing gait parameters and standing balance. Further studies employing larger sample size and a long-term follow-up session are warranted to further examine and re-confirm the effectiveness of the multi-directional walking training and its long-term effect.
