Article

Although task-related walking training has been recommended after
stroke, the theoretical basis, content, and impact of interventions vary across
the literature. There is a need for a comparison of different approaches to
task-related walking training after stroke. OBJECTIVE:
To compare the impact of a
motor-learning-science-based overground walking training program with
body-weight-supported treadmill training (BWSTT) in ambulatory,
community-dwelling adults within 1 year of stroke onset. METHODS: In this rater-blinded, 1:1 parallel, randomized controlled trial, participants were
stratified by baseline gait speed. Participants assigned to the Motor Learning
Walking Program (MLWP) practiced various overground walking tasks under the
supervision of 1 physiotherapist. Cognitive effort was encouraged through random
practice and limited provision of feedback and guidance.
The BWSTT program
emphasized repetition of the normal gait cycle while supported on a treadmill and
assisted by 1 to 3 therapy staff. The primary outcome was comfortable gait speed
at postintervention assessment (T2). RESULTS: In total, 71 individuals (mean age
= 67.3; standard deviation = 11.6 years) with stroke (mean onset = 20.9 [14.1]
weeks) were randomized (MLWP, n = 35; BWSTT, n = 36).
There was no significant
between-group difference in gait speed at T2 (0.002 m/s; 95% confidence interval
[CI] = -0.11, 0.12; P > .05). The MLWP group improved by 0.14 m/s (95% CI = 0.09,
0.19), and the BWSTT group improved by 0.14 m/s
(95% CI = 0.08, 0.20).
CONCLUSIONS: In this sample of community-dwelling adults within 1 year of stroke,
a 15-session program of varied overground walking-focused training was not
superior to a BWSTT program of equal frequency, duration, and in-session step activity.
CI - (c) The Author(s) 2014.

Langue : ANGLAIS