Functional brain reorganization enhanced by a novel gait training – evidenced by brain connectivity during treadmill walking in chronic stroke

Subjects in the experimental group received 30 minutes of turning-based treadmill training for 12 sessions in 4 weeks. a) A rotational treadmill was designed to provide turning-based treadmill training. This treadmill is similar to a regular treadmill except for its circular running motor belt (0.8-m radius), which forces patients to continually turn rather than walk straight. Safety features included front and side handrails around the walking area, a harness connected to an overhead suspension system, and an emergency stop button located on the side handrail. Participants were trained in both directions, with the affected leg as the inner limb for 15 minutes and then as the outer limb for 15 minutes with a 5-minute break in between. After completing the turning-based treadmill training, a 10-minute ambulation training was followed. b) The training session was performed as individual one-on-one sessions at the study site. c) During each training session, an experienced physical therapist stood bedside and encouraged participants to walk with large strides and upright posture. d) As progressively faster speeds are needed to continue challenging the locomotor abilities of individuals with hemiparesis, the treadmill speed, which began as each individual’s comfortable turning speed on level ground, was increased by increments of 0.05 m/s every 5 minutes as tolerated. The criteria for increasing speed was determined by the ability to remain an upright posture and a perceived exertion of “somewhat hard” or lower (ie, a Borg rating of perceived exertion <13). e) The register of attendance at sessions was checked by physical therapist.