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Gait Parameters Associated With Responsiveness to Treadmill Training With Body-Weight Support After Stroke: An Exploratory Study

S.J. Mulroy, PT, PhD, is Director, Pathokinesiology Laboratory, Rancho Los Amigos National Rehabilitation Center, 7601 E Imperial Hwy, Bldg 800, Room 33, Downey, CA 90242 (USA).
T. Klassen, MS, PT, NCS, is Clinical Instructor, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.
J.K. Gronley, PT, DPT, is Associate Director of Clinical Research, Pathokinesiology Laboratory, Rancho Los Amigos National Rehabilitation Center.
V.J. Eberly, PT, NCS, is Research Physical Therapist, Pathokinesiology Laboratory, Rancho Los Amigos National Rehabilitation Center.
D.A. Brown, PT, PhD, is Associate Professor and Associate Chair for Post-Professional Education, Department of Physical Therapy and Human Movement Sciences; Associate Professor, Department of Physical Medicine and Rehabilitation; and Adjunct Faculty, Department of Biomedical Engineering, Northwestern University, Chicago, Illinois.
K.J. Sullivan, PT, PhD, is Associate Chair and Associate Professor of Clinical Physical Therapy, Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California.

Address all correspondence to Dr Mulroy at: smulroy{at}dhs.lacounty.gov.

Background: Task-specific training programs after stroke improve walking function, but it is not clear which biomechanical parameters of gait are most associated with improved walking speed.

Objective: The purpose of this study was to identify gait parameters associated with improved walking speed after a locomotor training program that included body-weight–supported treadmill training (BWSTT).

Design: A prospective, between-subjects design was used.

Methods: Fifteen people, ranging from approximately 9 months to 5 years after stroke, completed 1 of 3 different 6-week training regimens. These regimens consisted of 12 sessions of BWSTT alternated with 12 sessions of: lower-extremity resistive cycling; lower-extremity progressive, resistive strengthening; or a sham condition of arm ergometry. Gait analysis was conducted before and after the 6-week intervention program. Kinematics, kinetics, and electromyographic (EMG) activity were recorded from the hemiparetic lower extremity while participants walked at a self-selected pace. Changes in gait parameters were compared in participants who showed an increase in self-selected walking speed of greater than 0.08 m/s (high-response group) and in those with less improvement (low-response group).

Results: Compared with participants in the low-response group, those in the high-response group displayed greater increases in terminal stance hip extension angle and hip flexion power (product of net joint moment and angular velocity) after the intervention. The intensity of soleus muscle EMG activity during walking also was significantly higher in participants in the high-response group after the intervention.

Limitations: Only sagittal-plane parameters were assessed, and the sample size was small.

Conclusions: Task-specific locomotor training alternated with strength training resulted in kinematic, kinetic, and muscle activation adaptations that were strongly associated with improved walking speed. Changes in both hip and ankle biomechanics during late stance were associated with greater increases in gait speed.

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