The Effect of Multi-Directional Walking Training with Treadmill on Gait Outcomes and Balance in Subacute Post-stroke Hemiplegic Patients: A Preliminary Analysis

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Authors (including presenting author) :
Mok YT (1), Chui KW (1), LEUNG YYC (1), Wong TWL (2)
Affiliation :
(1) Physiotherapy Department, Princess Margaret Hospital (2) School of Public Health,Li Ka Shing Faculty of Medicine, The University of Hong Kong
Introduction :
Walking disability and falls were often seen in stroke patients, which may be attributed to muscle weakness and lack of automaticity in postural control upon perturbations. Therefore, balance and gait training have been advocated in stroke rehabilitation, which aimed at promoting independent walking and community reintegration. Backward walking training and lateral walking applied in stroke patients were demonstrated improvement on gait velocity, stride length and gait asymmetry. Hence, a multi-directional walking training incorporated backward and lateral walking was designed with the use of treadmill, which was task-oriented with repetitive gait practice and contribute to strengthening of lower limbs and cardiovascular fitness.
Objectives :
To examine the effects of multi-directional walking training on gait outcomes and balance in hemiplegic patients with subacute stroke.
Methodology :
Participants receiving rehabilitation in the Geriatric Day Hospital (GDH) of Princess Margaret Hospital (PMH) with diagnosis of stroke within 3 months and with Modified Functional Ambulation Classification (MFAC) level IV or V (i.e., IV- assisted walking & V-supervised walker) were recruited. They were randomly allocated to either Multi-Directional Walking Training Group (MDW) or the Forward Training Group (FW). In the MDW, participants received forward, backward and lateral (right and left) walking training for 3.75 minutes in each direction. In the FW, participants received forward walking training only. All participants participated in their group’s walking training on treadmill for 12 sessions (15 minutes in each session). Conventional physiotherapy treatments were also provided to both groups. Gait outcomes were measured by the G-walk and the balance, including the Sensory Organization Test (SOT) and Limit of Stability (LOS), were assessed by the Balance Master.
Result & Outcome :
18 stroke patients (mean age = 71.7 ± SD 8.2) completed the treadmill training within March 2017 to December 2018 and 11 were female. The mean time post stroke were around 7.4 weeks. Among them, 83% were ischemic stroke. Preliminary analysis revealed significant improvement of the composite score of SOT after training using the paired t-test(p=0.01). The movement velocity, maximum excursion and the directional control in LOS were also improved. For the gait parameters, improvement on stride length, cadence and gait speed after training were demonstrated. However, there was no significant difference in LOS and gait parameters. Also, there was no significant difference shown between MDW and FW group. Further study and analysis on the effects of the walking direction for gait outcomes and balance of stroke patients will be carried out after completion of the study.

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