The efficacy of gait training using a body weight support treadmill and visual biofeedback in patients with subacute stroke: a randomized controlled trial

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Brain strokes are one of the main causes of permanent impairment. The main symptoms of stroke are hemiparesis, muscle tension disorders, balance and coordination impairment, cognitive functions and communicative disorders. Restoration of patient’s gait is one of the primary targets of rehabilitation after stroke. Although 80% of stroke survivors regain the ability of independent walking, their gait is often impaired and limited. Disorders mainly lower the gait speed and the covered distance, they also affect the stability of gait. Among many patients the asymmetrical walking pattern is observed among time and space-related parameters. In rehabilitation of stroke patients many different techniques and devices are used, treadmills, partial body weight support systems and robots are commonly used. The efficacy of gait training is increased in systems providing real time feedback (gait parameters), the method using acoustic and visual feedback is very efficient and important. The use of treadmill and PBWS facilitates patient’s moves, it also facilitates to perform a full gait cycle (similar pattern to the natural one) by patient, it allows to increase the gait speed, covered distance, what increases the efficacy of motoric training. The real time, visual feedback about the symmetry and the length of patient’s step allows him to adjust his gate properly and learn the symmetrical walking pattern. The aim of this study is to asses the gait training with PBWS treadmill and visual feedback among patients during subacute period after stroke. The assumed hypothesis is that gait training on a treadmill with PBWS and visual feedback facilitates the reconstruction of the symmetrical gait in comparison to patients training on a treadmill with PBWS, but without visual feedback. The study will be conducted on the clinical rehabilitation ward of the Clinical Provincial Hospital in Rzeszów, Poland. Patients recruited for the study will be stroke survivors, that had suffered from brain stroke three weeks before they were recruited for the study. Gait training will be performed using the Gait Trainer 3 treadmill with partial body weight support system (provided by Biodex). The treadmill software enables a real time feedback, informing the patient about the placement of his feet and the correct area they should be placed in order to make the patient’s step length symmetrical. Patients qualified for the study will be randomly divided into two groups. The study group will be training on a treadmill with real time visual feedback and the control group will use the same treadmill, but without visual feedback provided. Each patient is going to undergo the training every day (from Monday to Friday) for three weeks. One training session will last for 30 minutes. Qualifications for the study will be performed by experienced physiotherapists. Initial and control examinations will be performed by the team member, who is not participating in patient’s training. Along the treadmill gait training, patients will be undergoing the rehabilitation program, set by the physiotherapeutic team.