2011 Annual Conference

Daniel Perry Wingard

Stroke is the leading cause of adult disability. Of the 730,000 survivors of stroke (SSs) each year, 73% will have residual disability. Of the SSs who achieve independent ambulation, 60-80% walk at speeds less than 0.8 m/s, placing them below an effective community ambulation speed. The purpose of this project was to assess the effects of locomotor robotic-assisted body weight supported (BWS) treadmill, Lokomat®, training (LT) and conventional gait training (CGT) on gait speed, endurance, and function in SSs.

20 subjects (11 LT & 9 CGT)

SSs were randomly assigned into either the LT or CGT group. Both groups participated in five one-hour sessions per week for a total of 40 sessions. If randomized to the LT group 40% of BWS was provided initially and gait speed was progressed to 2 mph. Initially time duration and guidance force were progressed, then BWS was decreased as tolerated. If randomized to the CGT group, SSs worked on gait training on level and unlevel surfaces, and exercises to develop strength, balance, endurance, flexibility, and motor control needed for gait activities. The primary outcome measures used were the 10 meter walk test (10mWT), 6 minute walk test (6MWT), and the Functional Independence Measure (FIM). Outcome measures were assessed at baseline, post intervention, and at three month follow up by assessors blinded to group assignment.

There were no significant differences in the 10mWT, 6MWT, and FIM scores over time or between groups across time points using the repeated measures analysis of variance (ANOVA) Greenhouse-Geisser F test (p > 0.0167). The minimally clinically important difference (MCID) and minimal detectable change (MDC) for the 10mWT and 6MWT was significant in one subject in CGT group from baseline to post intervention.

This study recruited low functioning assisted ambulating chronic SSs, as this population of SSs has not been studied much. For this population, the outcome measures selected may not have been sensitive enough to detect subtle changes that may have occurred. A strength of this study included that each SS participated in a fairly standardized treatment protocol, modified to address individual needs dependent on the group assignment. The limitations of this study include the small sample size with a diverse amount of functional and cognitive ability to participate.

Although no differences were detectable in the current study, further study is warranted in combining LT with CGT for people with chronic stroke. One hour sessions were selected due to typical sessions provided in an out-patient environment. Due to the low ambulation status required for inclusion in this study, these deconditioned SSs may have needed more time per session to get enough practice in order to show significant improvement.