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가설 설정
- This study was therefore undertaken to examine and propose a more effective treadmill speed control training protocol for improving the function of stroke patients, by comparing the effects of treadmill walking training with gradually increasing speed, and treadmill walking training with random changing of speed. We hypothesized that treadmill gait training with a gradual speed change would be more effective in improving gait and respiratory function, as compared to treadmill gait training with randomly changing speed.
제안 방법
- A treadmill (TRAK K-200T, Lift gear, Seoul, Korea) with easy speed control was used for gait training, with gradual speed increase or random speed change. All subjects underwent comprehensive rehabilitation which included joint range of motion exercise, muscle strength exercise, balance training, and gait training, 60 minutes, 5 times a week, for 6 weeks. In addition, gradual speed increasing treadmill walking training or random speed changing treadmill walking training was imparted for 20 minutes, 5 times a week, for a total of 6 weeks.
- The 10-m walking test is a measure used to evaluate gait performance [20]. Barring the initial acceleration section and the end deceleration section of 2 m each, the walking speed in the middle 10 m, in a total 14 m flat walking path, was measured using a stopwatch. No feedback, such as instructions or encouragement, was provided during the test.
- These results are unable to generalize and interpret the effect of the intervention since it is difficult to completely control psychological variables when measuring the heart rate. However, this study has promising clinical significance, in that it investigates the effects of treadmill gait training program conducted in a more difficult environment, by applying gradual increase in speed and randomly changing speed. Further studies that complement the limitations of this study need to be performed in future, and current study results can be used as basic data for application of an intervention method that can be generalized to improve gait and respiratory function in stroke patients.
- All subjects underwent comprehensive rehabilitation which included joint range of motion exercise, muscle strength exercise, balance training, and gait training, 60 minutes, 5 times a week, for 6 weeks. In addition, gradual speed increasing treadmill walking training or random speed changing treadmill walking training was imparted for 20 minutes, 5 times a week, for a total of 6 weeks. The treadmill walking training was supervised by a physical therapist having 7 years clinical experience, who was blinded to the study.
- In order to evaluate gait function, a 10-m walking test, a timed up and go test, and a 6-minute walking test were performed. The 10-m walking test is a measure used to evaluate gait performance [20].
- A spirometer (Spirometer HI-801, CHEST MI INC, Japan) was used to evaluate respiratory functions. In this study, we measured the forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and maximum voluntary ventilation (MVV). All measurements were performed three times in total, and the maximum value was used for analysis [23].
- Walking training was performed for 20 minutes, by changing the calculated four treadmill speeds in a random order every 5 minutes. The random sequence speed was changed by the physical therapist every 5 minutes, according to the order in which the subject drew lots before training. In case of difficulty in maintaining continuous walking due to sudden increase or decrease in speed, the speed was maintained at the previous stage.
- This study was conducted to compare the effects of gradual speed increasing treadmill gait training, and random speed changing treadmill gait training, on gait and respiratory function in stroke patients. Both groups showed effective improvements in the gait function and respiratory function of stroke patients, with the gradual speed increasing treadmill gait training group being more efficacious in improving the respiratory function.
- This study was therefore undertaken to examine and propose a more effective treadmill speed control training protocol for improving the function of stroke patients, by comparing the effects of treadmill walking training with gradually increasing speed, and treadmill walking training with random changing of speed. We hypothesized that treadmill gait training with a gradual speed change would be more effective in improving gait and respiratory function, as compared to treadmill gait training with randomly changing speed.
- This study was undertaken to compare the effects of treadmill gait training with gradually increasing speed, and gait training with randomly changing speeds, on the gait and respiratory function changes in stroke patients. Evaluation of gait function revealed significant improvement after intervention in both groups, when considering the 10-m walking test, timed up and go test, and 6-minute walking test; however, no significant intergroup difference was observed for the amount of change.
- When comparing the respiratory function, significant changes were determined for FVC, FEV1, and MVV after intervention in both groups. In the FVC, the group subjected to gradual speed increasing treadmill gait training showed a more significant increase of 2.
대상 데이터
- Totally, 86 patients with stroke were initially considered, and represented 70% of all patients with stroke admitted to our inpatient rehabilitation center; 65 patients were unable to participate in the study as they did not fulfill the inclusion criteria or met exclusion criteria. Finally, 21 patients who met the criteria for selection and exclusion in this study were enrolled. The 21 participants were assigned to either a gradual speed increase treadmill walking training group (GSI group, n = 10, mean age = 59.
- The participant of this study were patients diagnosed with hemiplegic stroke and receiving inpatient treatment at the Bonifacio Rehabilitation Hospital in Daejeon Metropolitan City. The inclusion criteria for the participants were: stroke of more than 6 months, score greater than 24 on the Korean Mini-Mental Status Examination (MMSE-K), and could walk for more than 20 minutes on a treadmill speed of 0.
데이터처리
- The demographic variables were analyzed at the baseline using appropriately an independent t-test or Chi-Square test. The Shapiro-Wilk test was used to assess the normality.
- To determine the source of significant differences between pre- and post-training, simple contrasts were conducted for each significant time for the main effects. Two-way repeated measures analysis of the variance (ANOVA) was applied to compare the mean differences between the two groups (GSI group and RSC group) as the first factor, and time (pre training and post training) as the second factor. SPSS ver.
이론/모형
- The demographic variables were analyzed at the baseline using appropriately an independent t-test or Chi-Square test. The Shapiro-Wilk test was used to assess the normality. To determine the source of significant differences between pre- and post-training, simple contrasts were conducted for each significant time for the main effects.
성능/효과
- This study was undertaken to compare the effects of treadmill gait training with gradually increasing speed, and gait training with randomly changing speeds, on the gait and respiratory function changes in stroke patients. Evaluation of gait function revealed significant improvement after intervention in both groups, when considering the 10-m walking test, timed up and go test, and 6-minute walking test; however, no significant intergroup difference was observed for the amount of change. Munari et al.
- For the application of random speed changing treadmill gait training, the treadmill speed corresponding to each participant's maximum heart rate reserve 40%, 50%, 60%, and 70% was calculated, similar to gradual speed increase treadmill gait training.
- Therefore, as determined in the current study, the result of increasing lung function in stroke patients subjected to changing treadmill speed, in either a gradual or random order, could be due to an increase in energy metabolism. In this study, the gradual speed increasing treadmill gait training showed a greater improvement in FVC than random speed changing treadmill gait training. These results are possibly because gait training, in which the treadmill speed is gradually increased, provides a more favorable environment for lung function adaptation, than training conditions in which the treadmill speed is randomly increased or decreased [29].
- 9 mL/kg/km. These results are similar to the results obtained in this study, which shows improved respiratory function at high speed of up to 70% of the maximum heart rate reserve in both training methods. Seethapathi et al.
후속연구
- However, this study has promising clinical significance, in that it investigates the effects of treadmill gait training program conducted in a more difficult environment, by applying gradual increase in speed and randomly changing speed. Further studies that complement the limitations of this study need to be performed in future, and current study results can be used as basic data for application of an intervention method that can be generalized to improve gait and respiratory function in stroke patients.
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