Since nothing was done with this from 6 years ago. Why don't you ask your board of directors why nothing was done and incompetence was allowed to fester and never will be fixed until survivors run things.
The latest here:
Turning-Based Treadmill Training Improves Turning Performance and Gait Symmetry After Stroke
2014, Neurorehabilitation and Neural Repair
I-Hsuan Chen, PhD 1,
I-Hsuan Chen, PhD 1,
Yea-Ru Yang, PhD 1,2,
Rai-Chi Chan, MD 3,
and Ray-Yau Wang, PhD 1
Abstract
Background
. Turning is a challenging task for stroke patients. Programs that effectively target turning, however, have not been established.
Objective
. This study examined the effects of a novel turning-based treadmill training on turning performance, gait symmetry, balance, and muscle strength in patients with chronic stroke.
Methods
. Thirty participants were randomly assigned to the experimental group that received 30 minutes of turning-based treadmill training or to the control group that received 30 minutes of regular treadmill training, followed by a 10-minute general exercise program for 12 sessions over 4 weeks. Primary outcomes (overground turning speed and temporal–spatial characteristics of straight walking) and secondary outcomes (balance and muscle strength) were assessed at baseline, after training, and at 1-month follow-up.
Results
. Fifteen participants per group were 54.2± 9.6 years old, poststroke 2.6± 1.9 years, and walked overground at 0.59± 0.28 m/s. Sixteen had an ischemic and 14 a hemorrhagic stroke. There were significant interaction effects between groups and time on turning speed regardless of turning direction, straight-walking performance (speed and temporal symmetry), strength of hip muscles and ankle dorsiflexors, and balance control (Berg Balance Scale, weight shifting in the forward direction and vestibular function). Compared with the control group, the experimental group showed greater improvements in these measures following training. These improvements persisted at the 1-month follow-up evaluation.
Conclusions
. Turning-based treadmill training may be a feasible and effective strategy to improve turning ability, gait symmetry, muscle strength, and balance control for individuals with chronic stroke.
Approximately two thirds of stroke patients eventually walk with or without assistance1.
However, many individuals still exhibit hemiplegic gait patterns and cannot achieve the walking dexterity required for all activities of daily living. Advanced gait training programs have there-fore been emphasized in recent years, including dual-task training2, obstacle crossing in a virtual reality environment3,4, and robotics-assisted practice of stair climbing5. Up to 40% of all steps taken in everyday walking are turns6. Turning requires the central nervous system to coordinate whole-body reorientation toward a new travel direc-tion7. Balance maintenance during turning involves complex integration of multiple sensory systems (vestibular, visual, somatosensory) and motor output8.
Moreover, there are increased medial–lateral impulses during turning as compared with straight walking9. The outer limb requires relatively greater activation of the ankle dorsiflexors during the swing phase and greater activation of the ankle plantar flexors during the stance phase to provide body propulsion. The inner limb requires increased extensor muscle activity to generate supportive action and to maintain whole-body stability in the stance phase10. Turning is often compromised in individuals with stroke and is one of the most frequent activities leading to falls within this population11. Following stroke, individuals demonstrate inadequate propulsion and weight shifting, along with insufficient extensor and ankle dorsiflexor strength12-14. Abnormally large and disrupted sequences of gaze, head, and body motion because of deficits in sensorimotor integration have also been observed during turning15.
Kobayashi et al16 reported that patients with hemiplegia had difficulty walking along curvilinear paths. Recent studies also suggest that these patients turn more slowly because of the absence of kinematic and muscular modulations in the affected leg17,18. Moreover, longer turn time were correlated with poor functional balance ability (indicated by Berg Balance Scale [BBS]) and temporal gait asymmetry17.As a result of these difficulties with turning, this activity has been indicated as a major target for gait rehabilitation19. Effective training programs specifically targeting turning characteristics, however, have not been established. Since motor learning involves repetition of desired movements (ie, specificity of training), “specific and repetitive” rehabilitation protocols that focus on turning may optimize turning-related outcomes20. We therefore hypothesized that a novel treatment turning based treadmill training would lead to greater improvement in turning performance as compared with regular treadmill training in subjects with chronic stroke. In addition, as turning requires side-specific muscle modulation of the lower limbs and medial–lateral balance control18,
we hypothesized that the turning-based treadmill training would improve gait symmetry during straight walking, muscle strength of the lower extremities and standing balance.
Actual description of treadmill at link.
. Turning is a challenging task for stroke patients. Programs that effectively target turning, however, have not been established.
Objective
. This study examined the effects of a novel turning-based treadmill training on turning performance, gait symmetry, balance, and muscle strength in patients with chronic stroke.
Methods
. Thirty participants were randomly assigned to the experimental group that received 30 minutes of turning-based treadmill training or to the control group that received 30 minutes of regular treadmill training, followed by a 10-minute general exercise program for 12 sessions over 4 weeks. Primary outcomes (overground turning speed and temporal–spatial characteristics of straight walking) and secondary outcomes (balance and muscle strength) were assessed at baseline, after training, and at 1-month follow-up.
Results
. Fifteen participants per group were 54.2± 9.6 years old, poststroke 2.6± 1.9 years, and walked overground at 0.59± 0.28 m/s. Sixteen had an ischemic and 14 a hemorrhagic stroke. There were significant interaction effects between groups and time on turning speed regardless of turning direction, straight-walking performance (speed and temporal symmetry), strength of hip muscles and ankle dorsiflexors, and balance control (Berg Balance Scale, weight shifting in the forward direction and vestibular function). Compared with the control group, the experimental group showed greater improvements in these measures following training. These improvements persisted at the 1-month follow-up evaluation.
Conclusions
. Turning-based treadmill training may be a feasible and effective strategy to improve turning ability, gait symmetry, muscle strength, and balance control for individuals with chronic stroke.
Introduction
Gait recovery is critical for individuals who have suffered a stroke.1Approximately two thirds of stroke patients eventually walk with or without assistance1.
However, many individuals still exhibit hemiplegic gait patterns and cannot achieve the walking dexterity required for all activities of daily living. Advanced gait training programs have there-fore been emphasized in recent years, including dual-task training2, obstacle crossing in a virtual reality environment3,4, and robotics-assisted practice of stair climbing5. Up to 40% of all steps taken in everyday walking are turns6. Turning requires the central nervous system to coordinate whole-body reorientation toward a new travel direc-tion7. Balance maintenance during turning involves complex integration of multiple sensory systems (vestibular, visual, somatosensory) and motor output8.
Moreover, there are increased medial–lateral impulses during turning as compared with straight walking9. The outer limb requires relatively greater activation of the ankle dorsiflexors during the swing phase and greater activation of the ankle plantar flexors during the stance phase to provide body propulsion. The inner limb requires increased extensor muscle activity to generate supportive action and to maintain whole-body stability in the stance phase10. Turning is often compromised in individuals with stroke and is one of the most frequent activities leading to falls within this population11. Following stroke, individuals demonstrate inadequate propulsion and weight shifting, along with insufficient extensor and ankle dorsiflexor strength12-14. Abnormally large and disrupted sequences of gaze, head, and body motion because of deficits in sensorimotor integration have also been observed during turning15.
Kobayashi et al16 reported that patients with hemiplegia had difficulty walking along curvilinear paths. Recent studies also suggest that these patients turn more slowly because of the absence of kinematic and muscular modulations in the affected leg17,18. Moreover, longer turn time were correlated with poor functional balance ability (indicated by Berg Balance Scale [BBS]) and temporal gait asymmetry17.As a result of these difficulties with turning, this activity has been indicated as a major target for gait rehabilitation19. Effective training programs specifically targeting turning characteristics, however, have not been established. Since motor learning involves repetition of desired movements (ie, specificity of training), “specific and repetitive” rehabilitation protocols that focus on turning may optimize turning-related outcomes20. We therefore hypothesized that a novel treatment turning based treadmill training would lead to greater improvement in turning performance as compared with regular treadmill training in subjects with chronic stroke. In addition, as turning requires side-specific muscle modulation of the lower limbs and medial–lateral balance control18,
we hypothesized that the turning-based treadmill training would improve gait symmetry during straight walking, muscle strength of the lower extremities and standing balance.
Actual description of treadmill at link.
