Previous studies have investigated stepping over obstacles in treadmill walking training (TWT-OS) and treadmill walking training (TWT) alone for walking capacity not considering real physical activity. As such, we investigated the effects of TWT-OS on physical activity and changes in different level...
Previous studies have investigated stepping over obstacles in treadmill walking training (TWT-OS) and treadmill walking training (TWT) alone for walking capacity not considering real physical activity. As such, we investigated the effects of TWT-OS on physical activity and changes in different levels of physical activity based on community ambulation in stroke patients. Thirty subjects were randomly assigned to either the experimental group or the control group, with 15 and 15 subjects, respectively. However, one subject from the control group was excluded because of inadequate treatment sessions. All subjects underwent routine physical therapy in the form of treadmill walking. The subjects in the experimental group underwent simultaneous training in obstacle-stepping while walking on the treadmill for 30 min/day, five times/week, for four weeks. Subjects were given a three-axis accelerometer to wear at the hip on a belt for one-week pre- and post-training physical activity. Step counts for seven days, average daily step counts, and the average of minutes spent in sedentary, light, and above moderate activity were chosen as outcome measures of physical activity. No significant differences between the groups were found in terms of step counts for seven days, average daily activity, or daily activity spent at sedentary levels after four-week interventions. However, the average daily activity spent at light levels (-42.60 min vs. -6.71 min) was significantly lower in the experimental group than in the controls. Conversely, average daily activity spent at above moderate levels was higher (19.86 min vs. 11.07 min) (p<.05) after adjusting for each baseline value. Significant pre- and post-training differences were found in all variables of the experimental group (p<.05). Thus, TWT-OS could improve physical levels above moderate activity as a community-oriented task more than simple repetitive waking on a treadmill, and it could provide an opportunity for patients ambulatory after stroke to participate in the community again.
Previous studies have investigated stepping over obstacles in treadmill walking training (TWT-OS) and treadmill walking training (TWT) alone for walking capacity not considering real physical activity. As such, we investigated the effects of TWT-OS on physical activity and changes in different levels of physical activity based on community ambulation in stroke patients. Thirty subjects were randomly assigned to either the experimental group or the control group, with 15 and 15 subjects, respectively. However, one subject from the control group was excluded because of inadequate treatment sessions. All subjects underwent routine physical therapy in the form of treadmill walking. The subjects in the experimental group underwent simultaneous training in obstacle-stepping while walking on the treadmill for 30 min/day, five times/week, for four weeks. Subjects were given a three-axis accelerometer to wear at the hip on a belt for one-week pre- and post-training physical activity. Step counts for seven days, average daily step counts, and the average of minutes spent in sedentary, light, and above moderate activity were chosen as outcome measures of physical activity. No significant differences between the groups were found in terms of step counts for seven days, average daily activity, or daily activity spent at sedentary levels after four-week interventions. However, the average daily activity spent at light levels (-42.60 min vs. -6.71 min) was significantly lower in the experimental group than in the controls. Conversely, average daily activity spent at above moderate levels was higher (19.86 min vs. 11.07 min) (p<.05) after adjusting for each baseline value. Significant pre- and post-training differences were found in all variables of the experimental group (p<.05). Thus, TWT-OS could improve physical levels above moderate activity as a community-oriented task more than simple repetitive waking on a treadmill, and it could provide an opportunity for patients ambulatory after stroke to participate in the community again.
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제안 방법
04 ㎧ until the maximum speed the patient could tolerate was attained, while still requiring that the patient meet specific endurance and quality demands according to a standardized protocol for progression in inpatients with stroke (Combs et al, 2010). Each patient was checked for progression during every training session, and they were challenged to maximize their performance. Rest breaks were allowed if requested, but they were not included in the overall walking time.
Paired t-tests were used to compare differences within group means. For between-group comparison of outcomes, an analysis of covariance with the pre-test score as the covariate was used to determine differences in clinical outcomes. All statistical analyses were performed using the SPSS ver 18.
All subjects underwent routine physical therapy in the form of TWT. The subjects in the experimental group underwent simultaneous training in TWT-OS for 30 min/day, five times/week, for four weeks.
Physical activity was assessed using a three-axis accelerometer, which is a valid and reliable test in older adults (Davis and Fox, 2007; Esliger et al, 2007; Strycker et al, 2007). The subjects were given an accelerometer (GT1M, ActiGraph, FL, USA) to wear on a belt at the hip all day (from the time of waking) for seven days during pre- and post-intervention, removing it only for bathing or swimming. The subjects were asked to maintain their usual activities and record them in a log.
To conduct the TWT-OS, one therapist repeatedly placed the obstacles on approximately one-third of the treadmill belt with physical guidance provided by another therapist. The subjects were instructed to step over the lowest obstacle (1 ㎝); after adapting to the same treadmill speed as the control group, the 3 ㎝ and 8 ㎝ obstacles were used if the participant had no contact with the obstacle and felt comfortable. The speed was then increased in increments of .
대상 데이터
Although 30 subjects were enrolled in the study, one patient (from the TWT group) was excluded because he did not participate regularly in the treatment sessions. Therefore, data for 29 patients were used for the analysis.
Although 30 subjects were enrolled in the study, one patient (from the TWT group) was excluded because he did not participate regularly in the treatment sessions. Therefore, data for 29 patients were used for the analysis. Figure 1 shows a flowchart of the study.
Thirty subjects were randomly assigned to either the experimental (TWT-OS) group or the control (TWT) group, with 15 subjects in each group. All subjects underwent routine physical therapy in the form of TWT.
성능/효과
Both groups in the current study performed treadmill walking, with obstacle-crossing being the only difference between the groups. Although both groups improved significantly in the seven-day step count, the TWT-OS group ultimately showed significantly better physical activity above moderate levels. Neurorecovery and functional performance are enhanced when training incorporates motor tasks of greater complexity and higher-intensity demands than training conditions that do not (Hornby et al, 2011).
In this study, stepping over obstacles while walking at progressively higher speeds on a treadmill as community-oriented task improved physical levels above moderate activity better than simple repetitive waking on a treadmill. As such, it provided an opportunity for ambulatory patients after stroke to participate in the community, leading to alternatives to outdoor walking in a clinical or rehabilitation unit.
The TWT-OS protocol we used was a short-term, typical inpatient schedule (one hour five times per week for four weeks) that was easily understood task-specific training. The findings of this study indicate that integrating community-related tasks into treadmill walking is more advantageous for improving gait function than treadmill walking alone. These findings are in line with those of previous studies that reported that a community-based walking program comprising mobility and environmental options is a safe, practical, and effective alternative to routine rehabilitation therapy for stroke patients (Lord et al, 2008; Stuart et al, 2009).
While it has been shown that TWT is beneficial for patients with acute stroke (Moseley et al, 2005), it has not been clear whether these protocols have the same effect in chronic patients who are ambulatory after stroke. When applied in patients with chronic stroke in the current study, TWT-OS was more beneficial than TWT at reducing activity at light levels, and in increasing moderate or vigorous levels after four weeks of training. The TWT-OS protocol we used was a short-term, typical inpatient schedule (one hour five times per week for four weeks) that was easily understood task-specific training.
후속연구
Our study has several limitations. First, it was a pilot study; therefore, further study of adequate power and sample size is required to confirm the results, although they seemed to be statistically significant. Second, the TWT-OS used in this study performed in rehabilitation center, which might have a different effect on community ambulation.
As such, it provided an opportunity for ambulatory patients after stroke to participate in the community, leading to alternatives to outdoor walking in a clinical or rehabilitation unit. To clarify the effectiveness of TWT-OS for hemiplegic patients, further study considering these limitations will be needed.
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