Abstract
Background Fast treadmill training improves walking speed to a greater extent than training at a self-selected speed after stroke. It is unclear whether fast treadmill walking facilitates a more normal gait pattern after stroke, as has been suggested for treadmill training at self-selected speeds. Given the massed stepping practice that occurs during treadmill training, it is important for therapists to understand how the treadmill speed selected influences the gait pattern that is practiced on the treadmill.
Objective The purpose of this study was to characterize the effect of systematic increases in treadmill speed on common gait deviations observed after stroke.
Design A repeated-measures design was used.
Methods Twenty patients with stroke walked on a treadmill at their self-selected walking speed, their fastest speed, and 2 speeds in between. Using a motion capture system, spatiotemporal gait parameters and kinematic gait compensations were measured.
Results Significant improvements in paretic- and nonparetic-limb step length and in single- and double-limb support were found. Asymmetry of these measures improved only for step length. Significant improvements in paretic hip extension, trailing limb position, and knee flexion during swing also were found as speed increased. No increases in circumduction or hip hiking were found with increasing speed.
Limitations Caution should be used when generalizing these results to survivors of a stroke with a self-selected walking speed of less than 0.4 m/s. This study did not address changes with speed during overground walking.
Conclusions Faster treadmill walking facilitates a more normal walking pattern after stroke, without concomitant increases in common gait compensations, such as circumduction. The improvements in gait deviations were observed with small increases in walking speed.
Footnotes
All authors provided concept/idea/research design and data analysis. Dr Tyrell, Dr Roos, and Dr Reisman provided writing and data collection. Dr Tyrell and Dr Reisman provided project management and clerical support. Dr Reisman provided fund procurement. Dr Rudolph and Dr Reisman provided facilities/equipment. Dr Tyrell, Dr Rudolph, and Dr Reisman provided consultation (including review of manuscript before submission).
The study protocol was approved by the University of Delaware Human Subjects Review Board.
Platform presentations of this research were given at the Combined Sections Meetings of the American Physical Therapy Association; February 6–9, 2008; Nashville, Tennessee, and February 6–9, 2009; Las Vegas, Nevada. This research also was presented at the 18th International Society for Posture and Gait Research Conference; July 14–18, 2007; Burlington, Vermont.
This work was supported by grant 0765314U from the American Heart Association for expenses related to data collection, analysis, and dissemination of results. In addition, instrumentation grants NIH S10 RR022396-01 (National Center for Research Resources) and DOD W911NF-05-1-0097 supported the purchase of the motion capture system and instrumented treadmill, and grant NIH K01 HD050582 provided partial support of the authors' time (D.S.R., C.M.M.).
- Received December 22, 2009.
- Accepted November 10, 2010.