scholarly journals Highly challenging balance and gait training for individuals with Parkinson’s disease improves pace, rhythm and variability domains of gait – A secondary analysis from a randomized controlled trial

2020 ◽  
pp. 026921552095650
Author(s):  
Linda Rennie ◽  
Arve Opheim ◽  
Espen Dietrichs ◽  
Niklas Löfgren ◽  
Erika Franzén
Keyword(s):  
Controlled Trial ◽  
Secondary Analysis ◽  
Gait Training ◽  
Time Variability ◽  
Training Effects ◽  
Fast Speed ◽  
Randomized Controlled ◽  
Normal Speed ◽  
Stance Time

Objective: Evaluate immediate and long-term effects of highly challenging balance and gait training on pace-, rhythm-, variability-, asymmetry-, and postural control domains of gait for individuals with Parkinson’s disease (PD). Design: Randomized controlled trial - a secondary analysis. Setting: University hospital setting. Participants: One-hundred older adults with mild to moderate PD (Hoehn & Yahr 2 and 3). Intervention: Training group ( n = 51): 10 weeks (3 times/week) of intensive balance and gait training, incorporating dual tasks. Control group ( n = 49): care as usual. Main outcome measures: Spatiotemporal gait variables collected during normal and fast walking on a pressure-sensitive mat. A linear mixed model was used to evaluate training effects post intervention and at the 6 and 12 month follow-up. Results: Immediate training effects in the pace domain of gait were increased step velocity (normal speed: 8.2 cm/s, P = 0.04; fast: 10.8 cm/s, P < 0.01), increased step length (normal speed: 3 cm, P = 0.05; fast: 2.3 cm, P = 0.05) and reduced swing time variability (fast speed: –2.5 ms, P = 0.02). In the rhythm domain reduced step time (fast speed: –19.3 ms, P = 0.02), stance time (normal: –24.3 ms, P = 0.01; fast: –29.6 ms, P = 0.02) and swing time (fast speed: –8.7 ms, P = 0.04) was seen. Relative to the variability domain, the training decreased step time variability (fast: –2.8 ms, P = 0.02) and stance time variability (fast: –3.9 ms, P = 0.02). No training effects were retained at 6 months. Conclusions: Highly challenging balance and gait training improved pace, rhythm and variability aspects of PD gait in the short-term, but effects are not retained long-term. Trial registration number: NCT01417598.

scholarly journals Impact of Intensive Gait Training With and Without Electromechanical Assistance in the Chronic Phase After Stroke–A Multi-Arm Randomized Controlled Trial With a 6 and 12 Months Follow Up

2021 ◽  
Vol 15 ◽  
Author(s):  
Susanne Palmcrantz ◽  
Anneli Wall ◽  
Katarina Skough Vreede ◽  
Påvel Lindberg ◽  
Anna Danielsson ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Gait Training ◽  
Conventional Group ◽  
Control Group ◽  
Walk Test ◽  
Post Intervention ◽  
Randomized Controlled

Introduction: Movement related impairments and limitations in walking are common long-term after stroke. This multi-arm randomized controlled trial explored the impact of training with an electromechanically assisted gait training (EAGT) system, i.e., the Hybrid Assistive Limb® (HAL), when integrated with conventional rehabilitation focused on gait and mobility.Material and Methods: Participants, aged 18–70 years with lower extremity paresis but able to walk with manual support or supervision 1–10 years after stroke, were randomized to (A) HAL-training on a treadmill, combined with conventional rehabilitation interventions (HAL-group), or (B) conventional rehabilitation interventions only (Conventional group), 3 days/week for 6 weeks, or (C) no intervention (Control group). Participants in the Control group were interviewed weekly regarding their scheduled training. Primary outcome was endurance in walking quantified by the 6 Minute Walk Test (6MWT). A rater blinded to treatment allocation performed assessments pre- and post-intervention and at follow-ups at 6 and 12 months. Baseline assessment included the National Institute of Health Stroke Scale (NIHSS) and the Modified Ranking Scale (MRS). Secondary outcomes included the Fugl Meyer Assessment- Lower Extremity, 10 Meter Walk Test, Berg Balance Scale (BBS), Barthel Index (BI) and perceived mobility with the Stroke Impact Scale.Results: A total of 48 participants completed the intervention period. The HAL-group walked twice as far as the Conventional group during the intervention. Post-intervention, both groups exhibited improved 6 MWT results, while the Control group had declined. A significant improvement was only found in the Conventional group and when compared to the Control group (Tukey HSD p = 0.022), and not between the HAL group and Conventional group (Tukey HSD p = 0.258) or the HAL- group and the Control group (Tukey HSD p = 0.447). There was also a significant decline in the Conventional group from post-intervention to 6 months follow up (p = 0.043). The best fitting model to predict outcome included initial balance (BBS), followed by stroke severity (NIHSS), and dependence in activity and participation (BI and MRS).Conclusion: Intensive conventional gait training induced significant improvements long-term after stroke while integrating treadmill based EAGT had no additional value in this study sample. The results may support cost effective evidence-based interventions for gait training long-term after stroke and further development of EAGT.Trial registration: Published on clinicaltrials.gov (NCT02545088) August 24, 2015.

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