Task-oriented treadmill training with versus without posterior elastic resistance in chronic stroke survivors with limited walking function: a randomised controlled trial with exploratory strength-GRF-speed associations

 With NO protocol created and NO objective starting point this research is nonrepeatable, totally fucking useless!

Task-oriented treadmill training with versus without posterior elastic resistance in chronic stroke survivors with limited walking function: a randomised controlled trial with exploratory strength-GRF-speed associations

• Fang-Yu Cheng,
• Yan-Ting Chen,
• Sang-I Lin,
• Hui-Yu Tseng &
• Pei-Yun Lee 

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Abstract

Background

Reduced gait speed, impaired ground reaction force (GRF) generation, and lower-limb weakness are common in chronic stroke survivors and contribute to limited functional mobility. Although treadmill training can improve walking capacity, it remains unclear whether adding posterior elastic resistance provides incremental benefits in propulsion-related kinetics and in the functional linkage among strength, GRF, and walking performance, particularly in individuals with limited walking function. This study compared intensity-matched task-oriented treadmill training with versus without posterior resistance and secondarily explored changes in strength-GRF-speed relationships.

Methods

Forty chronic stroke participants were randomly assigned to conventional treadmill training (CON) or treadmill training with posterior resistance (EXP). Both groups received training for 30 min/session, twice weekly for eight weeks. Primary outcomes included preferred and maximum gait speed, bilateral vertical and anterior-posterior GRFs during walking, and lower-limb muscle strength. Secondary outcomes included walking energy expenditure (V̇O₂). Multivariate repeated-measures ANOVA was used to assess training effects. Pre-post associations among gait speed, GRFs, and strength were evaluated as secondary exploratory analyses.

Results

In the primary unadjusted analyses, both groups demonstrated significant time effects for preferred and maximum gait speed, walking energy expenditure, and affected-side knee flexor, knee extensor, and ankle plantarflexor strength (all p < 0.05). However, sensitivity analyses adjusted for stroke onset duration showed that several time effects were attenuated. A significant between-group difference was observed only for the second vertical GRF peak on the affected side at maximum speed, which was higher in EXP than CON and remained significant after adjustment (p = 0.049). No broad group × time interaction effects were observed. Exploratory analyses showed that post-training associations among gait speed, affected-side strength, and anterior-posterior GRF appeared more consistent.

Conclusions

In chronic stroke survivors with limited walking function, intensity-matched treadmill-based gait training improved walking speed, oxygen uptake, and lower-limb strength, although several time effects were attenuated after adjusting for stroke onset duration. Adding posterior resistance showed a condition-specific between-group difference in paretic late-stance vertical loading at maximum speed but did not result in broad superiority in functional outcomes. Posterior elastic resistance may serve as a feasible adjunct to augment paretic-limb loading during high-demand walking.

Trial registration ClinicalTrials.gov Protocol Registration: trial number NCT04974840

Rehabilitation of motor impairments in patients after cerebral stroke in the early recovery period using a treadmill with biofeedback

 Send your competent? doctor after the EXACT PROTOCOL! Inability to do that IS PURE INCOMPETENCE!

Rehabilitation of motor impairments in patients after cerebral stroke in the early recovery period using a treadmill with biofeedback

• Authors: Akhmadeeva L.R.¹, Goldyrev E.O.¹, Bagautdinov K.F.¹, Blinova N.M.¹
• Affiliations:
  1. Bashkir State Medical University
• Issue: Vol 11, No 2 (2026)
• Pages: 111-116
• Section: Neurology
• Published: 28.03.2026
• URL: https://innoscience.ru/2500-1388/article/view/704173
• DOI: https://doi.org/10.35693/SIM704173
• ID: 704173

Abstract

Aim: to evaluate the clinical effectiveness of integrating treadmill training with a biofeedback (BFB) system into an early post-stroke rehabilitation program for managing motor disorders and improving functional outcomes.

Material and methods. The study involved 60 patients during the first 6 months after ischemic stroke. Participants were randomized into two groups: the main (experimental) group and the control group. Both groups received standard comprehensive therapy, including physiotherapy, mechanotherapy, and occupational therapy. The main group additionally underwent a course of treatment on a treadmill with BFB (Walker View), which provided feedback on parameters of the support reaction and step symmetry. For an objective assessment of dynamics, a set of clinical scales (Timed Up and Go test, 10-meter walk test, Berg Balance Scale) and instrumental analysis of gait parameters (walking speed, step length) were used. The assessment was conducted before and after a 14-day rehabilitation course.

Results. The conducted study demonstrated a statistically significant improvement in all assessed parameters in both groups, confirming the effectiveness of standard rehabilitation. However, in the main group where BFB was applied, the dynamics of improvement were better. A comparative analysis showed that these patients achieved a more pronounced reduction in the time taken to complete the “Timed Up and Go” (20% vs. 17%) and 10-meter walk tests (23.3% vs. 23.1%), a substantial increase in scores on the Berg Balance Scale (27.4% vs. 15.1%), as well as a significant increase in step length (41.2% vs. 27.3%) and no difference in walking speed.

Conclusion. The integrating treadmill training with biofeedback into an early post-stroke rehabilitation program increases the effectiveness of walking recovery compared to standard therapy. The method promotes improved gait symmetry, balance, increased speed and step length, ultimately leading to enhanced functional independence of patients. Further research is required to determine the clinical effectiveness of treadmill gait training with BFB in a larger sample of patients and with a longer follow-up.

Dual-task improvement of older adults after treadmill walking combined with blood flow restriction of low occlusion pressure: the effect on the heart–brain axis

 Ask your competent? doctor if this is useful post stroke.

Dual-task improvement of older adults after treadmill walking combined with blood flow restriction of low occlusion pressure: the effect on the heart–brain axis

• Yi-Ching Chen,
• I-Ping Lo,
• Yi-Ying Tsai,
• Chen-Guang Zhao &
• Ing-Shiou Hwang 

Journal of NeuroEngineering and Rehabilitation volume 21, Article number: 116 (2024) Cite this article

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Abstract

Objective

This study explored the impact of one session of low-pressure leg blood flow restriction (BFR) during treadmill walking on dual-task performance in older adults using the neurovisceral integration model framework.

Methods

Twenty-seven older adults participated in 20-min treadmill sessions, either with BFR (100 mmHg cuff pressure on both thighs) or without it (NBFR). Dual-task performance, measured through light-pod tapping while standing on foam, and heart rate variability during treadmill walking were compared.

Results

Following BFR treadmill walking, the reaction time (p = 0.002) and sway area (p = 0.012) of the posture dual-task were significantly reduced. Participants exhibited a lower mean heart rate (p < 0.001) and higher heart rate variability (p = 0.038) during BFR treadmill walking. Notably, BFR also led to band-specific reductions in regional brain activities (theta, alpha, and beta bands, p < 0.05). The topology of the EEG network in the theta and alpha bands became more star-like in the post-test after BFR treadmill walking (p < 0.005).

Conclusion

BFR treadmill walking improves dual-task performance in older adults via vagally-mediated network integration with superior neural economy. This approach has the potential to prevent age-related falls by promoting cognitive reserves.

Introduction

Adults aged 65 and above are subject to fall accidents. In addition to a reduction in muscle strength, fall accidents is related to cognitive decline due to loss of frontal integrity with aging [4]. The 'frontal aging hypothesis' predicts age-related impairments in attentional resource allocation and information processing speed [50], which impact executive functions for multitasking [29]. Due to frontal degeneration, it becomes challenging for older adults to flexibly shift attention between two concurrent tasks [34]. The loss of cognitive resilience partly contributes to age-related falls, particularly when they occur during dual-task scenarios [2, 49].

Blood flow restriction (BFR) is a training method originally used to stimulate muscular development under local hypoxia. It involves applying pneumatic tourniquets to impede venous outflow in the working musculature. The strength gain associated with combined BFR and low-load exercise results from the activation of protein synthesis signaling for enhanced mechanical tension and metabolic stress [38]. Despite its minimal exercise intensity, walking with BFR can augment muscle strength in the elderly [1]. BFR can also affect metabolic cost and cardiovascular responses [31]. It can induce vasoconstriction in the restricted muscles while causing vasodilation in non-restricted areas due to parasympathetic system activation and endothelial nitric oxide (NO) release [21]. The overall impact of BFR on cardiovascular responses is interactively influenced by factors such as occlusion pressure, exercise protocol (resistance vs. aerobic), and application mode (continuous vs. intermittent) [6].

To date, only a few studies have focused on the improvement of frontal executive function by the application of BFR. One study observed that patients with dementia who underwent 6 months of bilateral upper limb compression followed by reperfusion showed improvements in tests of attention and executive function [22]. In healthy older adults, an 8-week dual-task walking program with BFR (occlusion pressure up to 200 mmHg, 20 min/session, 3 sessions/week) resulted in greater improvements in Mini-Mental State Examination scores and increased levels of brain-derived neurotrophic factor (BNDF), compared to those of a control group that did not receive such training [25]. Interestingly, Sugimoto et al. [48] even demonstrated an immediate effect of 15-min BFR treadmill walking (occlusion pressure: 200 mmHg) on the color-word Stroop task, independent of the effect of BFR alone or walking alone. However, it remains uncertain whether a single bout of combined BFR with relatively low occlusion pressure and aerobic exercise can enhance the posture dual-task of older adults with superior neural efficiency. Answering this question is of clinical significance. Lower occlusion pressure (40% systolic artery pressure) has been shown to increase muscle strength without causing elevated blood pressure. Therefore, combining BFR of lower occlusion pressure with aerobic exercise may contribute to fall prevention in older adults by jointly addressing both age-related declines in cognitive function and muscle strength while minimizing the cardiac cost and sympathetic activity.

Supporting the neural connections between the prefrontal cortex, the central autonomic network, and the vagus nerve system [26], higher cardiac vagal activity is linked to superior executive functioning [45]. Within the context of the heart–brain axis, it is possible that dual-task performance can be improved through BFR-related regulation of the autonomic nervous system, which contributes to enhanced executive function and cognitive flexibility. The aim of this study was to compare the acute effects of treadmill walking with and without BFR of low occlusion pressure on posture dual-task performance in older adults, with a special focus on variations in heart rate and EEG characteristics. For older adults, we hypothesized the following: (1) treadmill walking with leg BFR of low occlusion pressure would lead to better performance on a posture dual-task compared to treadmill walking without leg BFR; and (2) the BFR-related organization of the HR kinetics, power spectra of local EEG, inter-regional EEG connectivity, and network topology in various sub-bands would differ from those observed during non-BFR treadmill walking. Scalp EEG of the theta (4–7 Hz), alpha (8–12 Hz), and beta (13–35 Hz) bands were targeted, as they link characteristically to cognitive workload during a posture dual-task in older adults [36].

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IMproving Physical ACtivity after stroke via Treadmill training (IMPACT) and self-management: A randomized trial

You wouldn't have to cajole patients like this if you gave them EXACT 100% RECOVERY PROTOCOLS. They'd be too busy doing the reps because they would know at the end lies recovery.  Solve the correct problem; creation of recovery protocols.

IMproving Physical ACtivity after stroke via Treadmill training (IMPACT) and self-management: A randomized trial

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Sandra G Brauer, Suzanne S Kuys, Louise Ada, ...

First Published March 2, 2022 Research Article Find in PubMed 

https://doi.org/10.1177/17474930221078121

Article information

Abstract

Aim:

To determine if treadmill training embedded in self-management education commencing during stroke inpatient rehabilitation results in more physical activity than usual gait training.

Method:

A prospective, parallel-group, randomized trial with concealed allocation, blinded measurement, and intention-to-treat analysis involving 119 stroke survivors undergoing rehabilitation who were able to walk independently was undertaken. The experimental group undertook treadmill training (40–60% heart rate reserve) and self-management education for 30 min, three times a week for 8 weeks, and the control group undertook the same amount of usual gait training. Outcomes were measured at baseline (Week 0), on completion of the intervention (Week 8), and beyond the intervention (Week 26). The primary outcome was physical activity measured as steps/day using an activity monitor. Secondary outcomes were walking ability, cardiorespiratory fitness, cardiovascular risk, depression, self-efficacy, perception of physical activity, participation, and quality of life.

Results:

After 8 weeks, the experimental group took 1436 more steps/day (95% confidence interval (CI) = 229 to 2643) than the control group. By 6 months, they took 871 more steps/day (95% CI −385 to 2129) than the control group. There was no difference between groups in any other outcome.

Conclusion:

In individuals undergoing rehabilitation after stroke, 8 weeks of treadmill training embedded in self-management resulted in more physical activity than usual gait training and this was largely maintained at 6 months, despite little effect on walking or cardiorespiratory fitness, suggesting the self-management was responsible.

Keywords

Stroke, physical activity, randomized controlled trial, treadmill, walking

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Exploiting telerobotics for sensorimotor rehabilitation: a locomotor embodiment

I don't understand, but then the only thing that will make my gait better is curing my spasticity.  You could put a gun to my head and tell me to straighten my foot while walking and you'd have to kill me since I don't have control of that.  I'm hoping that I never am pulled over by cops where they tell me to put both hands on the roof and spread your legs. I'd fail just like having to alternately touch your nose with the index finger of each hand as a sobriety test.

Exploiting telerobotics for sensorimotor rehabilitation: a locomotor embodiment

• Min Hyong Koh,
• Sheng-Che Yen,
• Lester Y. Leung,
• Sarah Gans,
• Keri Sullivan,
• Yasaman Adibnia,
• Misha Pavel &
• Christopher J. Hasson 

Journal of NeuroEngineering and Rehabilitation volume 18, Article number: 66 (2021) Cite this article

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Abstract

Background

Manual treadmill training is used for rehabilitating locomotor impairments but can be physically demanding for trainers. This has been addressed by enlisting robots, but in doing so, the ability of trainers to use their experience and judgment to modulate locomotor assistance on the fly has been lost. This paper explores the feasibility of a telerobotics approach for locomotor training that allows patients to receive remote physical assistance from trainers.

Methods

In the approach, a trainer holds a small robotic manipulandum that shadows the motion of a large robotic arm magnetically attached to a locomoting patient's leg. When the trainer deflects the manipulandum, the robotic arm applies a proportional force to the patient. An initial evaluation of the telerobotic system’s transparency (ability to follow the leg during unassisted locomotion) was performed with two unimpaired participants. Transparency was quantified by the magnitude of unwanted robot interaction forces. In a small six-session feasibility study, six individuals who had prior strokes telerobotically interacted with two trainers (separately), who assisted in altering a targeted gait feature: an increase in the affected leg’s swing length.

Results

During unassisted walking, unwanted robot interaction forces averaged 3−4 N (swing–stance) for unimpaired individuals and 2−3 N for the patients who survived strokes. Transients averaging about 10 N were sometimes present at heel-strike/toe-off. For five of six patients, these forces increased with treadmill speed during stance (R² = .99; p < 0.001) and increased with patient height during swing (R² = .71; p = 0.073). During assisted walking, the trainers applied 3.0 ± 2.8 N (mean ± standard deviation across patients) and 14.1 ± 3.4 N of force anteriorly and upwards, respectively. The patients exhibited a 20 ± 21% increase in unassisted swing length between Days 1−6 (p = 0.058).

Conclusions

The results support the feasibility of locomotor assistance with a telerobotics approach. Simultaneous measurement of trainer manipulative actions, patient motor responses, and the forces associated with these interactions may prove useful for testing sensorimotor rehabilitation hypotheses. Further research with clinicians as operators and randomized controlled trials are needed before conclusions regarding efficacy can be made.

Background

Locomotor impairments can arise from injuries or disease processes that disrupt sensorimotor operations, such as spinal cord injuries and stroke. Locomotor training may be incorporated into a rehabilitation program. One approach uses a treadmill because it allows tight control over walking speed and terrain and facilitates the use of a body-weight support system [1, 2]. During treadmill training, human trainers can provide physical assistance to facilitate limb movement and support trunk stabilization [3]. High-volumes of task-orientated practice can promote neuroplasticity [4]. Although treadmill training has shown positive results for patient populations, including individuals who have had strokes [5, 6] or incomplete spinal cord injuries [7, 8], the overall efficacy is not unambiguously superior to other methods such as over-ground training or general exercise regimens [2, 9,10,11,12,13]. Explaining the inability of manual treadmill training to consistently meet expectations presents a grand challenge due to high investigational variability (e.g., eligibility criteria and intervention parameters [14]).

When providing physical assistance to elicit targeted modifications of a patient’s locomotor pattern, human trainers must contend with relatively complex patient dynamics. This includes the gravitational and inertial forces associated with the large wobbling mass [15] of a patient’s upper body, which is alternately supported by multi-link segmental chains (the legs) during locomotion. Further, the joints spanning these segments are actuated by a redundant set of viscoelastic muscles [16] controlled by a possibly impaired nervous system. Trainers also face significant sensorimotor constraints. They often need to produce large forces while kneeling or sitting with a limited view of a patient’s body and need to keep up with rapidly swinging patient limbs to prevent unintended interaction forces, which demands predictive control processes due to sensorimotor delays [17]. The combination of complex interactive dynamics, high forces, and rapid movements creates a challenging task that may limit trainer effectiveness.

One way to address the physical limitations of human trainers is to enlist the help of robots [18,19,20]. However, in doing so, human trainers have been relegated to a supervisory role. At the same time, robotic gait training outcomes have not proven dependably better than conventional rehabilitation approaches for spinal cord injury [21, 22] or stroke [23,24,25,26,27]. Giving trainers more online control of the robotic system (trainer-in-the-loop) could improve rehabilitation outcomes. The rationale is that trainers can use their experience and judgment to customize locomotor assistance on the fly, and their relatively high degree of motor execution variability could be a feature instead of a bug. Self-generated (intrinsic) variability can promote the exploration of novel motor actions that drive learning [28, 29]. Could this also hold for variability injected from an external source, i.e., from a trainer to a patient? If so, these advantages could be masked by trainer fatigue or other sensorimotor encumbrances. These points lead to the principal question: Would treadmill training outcomes improve if trainers remained in control, were relieved of high physical demands, and received augmented feedback about their patient interactions? Telerobotics, or robotics with a human operator in the control loop [30], may provide a viable approach to answering this question.

Although telerobotics has been broadly researched, for example, in areas related to telesurgery (see [30] for a review), rehabilitation applications with continuous physical interaction between clinicians and patients are more limited. Most existing telehealth approaches only permit visual and auditory communication [31,32,33,34]. One study investigated the feasibility of remote haptic communication using an exoskeleton to record the movements of patients who have had strokes; these movements were subsequently played back using an exoskeleton worn by therapists [35]. By feeling the patients' movements through the exoskeleton, the therapists were able to identify abnormal movement patterns. Although the results are promising, the therapists did not command the robotic system to apply forces to patients. Others have recently explored impedance-based telerobotics approaches for upper-extremity rehabilitation [36, 37], but such techniques have yet to be tested in clinical populations. In general, there is a significant need for telerobotics approaches that allow real-time bidirectional physical interaction between trainers and patients [38], which, in addition to benefits associated with human–human interaction (see previous paragraph) may be useful with heightened disease transmission risks.

 

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