Study looks at getting stroke patients back on their feet

Feb 11, 2011

Home-based physical therapy to improve the strength and balance of stroke survivors works about as well to get them walking again as treadmill training done in a physical therapy lab, according to the results of a study presented today by a Duke researcher at the American Stroke Association's International Stroke Conference.

"We have been working for years in rehabilitation to develop the most effective interventions for walking recovery," said Pamela Woods Duncan, Ph.D., PT, professor in the Doctor of Division at Duke University and principal investigator of the trial. "Until now, there has not been a major, phase III trial to systematically evaluate different interventions."

The NIH-funded study, Locomotor Experience Applied Post-Stroke (LEAPS), was completed over five years at multiple sites to compare a specialized locomotor training program, which includes body-weight supported treadmill training with multiple physical therapists, to an in-home progressive strength and balance program with a single therapist.

"The results of this study show that the more expensive "high tech" therapy was not superior to home strength and balance training," said Walter Koroshetz, M.D., deputy director of NIH's National Institute of Neurological Disorders and .

"This is important, because the home-based intervention is more accessible, more feasible and it was also associated with fewer risks in our study," Duncan said.

More than four million stroke survivors have difficulty walking, which often contributes to subsequent falls, and an overall decline in health.

Locomotor training relies in part on body-weight supported treadmill training, in which patients are suspended over a treadmill in a harness and walk with help of multiple physical therapists, working their way up to walking without assistance on ground.

"There has been an emerging use of locomotor-style training in clinical practice, with some preliminary data in small trials that suggests that this is an effective intervention," Duncan said.

The LEAPS trial included 408 stroke survivors from six inpatient rehabilitation facilities in Florida and California. Each group received either the locomotor training (at two months or six months post-stroke) or home exercise for 1.5 hours, three times a week for 12 weeks. The locomotor group focused on progressive body-weight supported treadmill training followed by translation of skills to over-ground walking. Two to three physical therapists worked with each patient.

The home exercise program consisted of structured and progressive strength and balance exercises completed in the patient's home with the assistance of one physical therapist. The patients were also encouraged to walk daily.

Each patient's improvement in walking was evaluated one year after their stroke and 52 percent of patients in all the groups made significant improvement.

Duncan and her team found the body-weight supported treadmill training was not superior to the home-based intervention. All groups did equally well, achieving similar gains in walking speed, motor recovery, balance, social participation and quality of life.

A secondary analysis at six months demonstrated that both of the interventions are more effective than the physical therapy patients routinely receive two months post-stroke. "At six months, the improvement from either one of these interventions is twice what you see when patients get usual care," Duncan said.

The trial showed, that when the locomotor training was used early, patients were at a higher risk for multiple and injurious falls.

"This suggests that as we move forward in clinical practice with programs to improve mobility, we also have to partner with more aggressive falls prevention strategies," Duncan said. "These programs need to improve balance and mobility, but also include risk assessment and management for falls prevention. For example we should assess the patient's environment, their vision and their medications."

Explore further: With kids in school, parents can work out

add to favorites email to friend print save as pdf

Related Stories

Study yields promising results for patients with stroke

Feb 11, 2011

One year after having a stroke, 52% of people who participate in either a physical therapy program that includes a walking program using a body-weight supported treadmill or a home-based program focused on progressive strength ...

Stroke survivors walk better after human-assisted rehab

May 08, 2008

Walking therapy for stroke survivors is significantly more effective when conducted by a physical therapist instead of a robot, according a small study reported in Stroke: Journal of the American Heart Association.

People with type 2 diabetes improved muscular strength

Sep 22, 2009

Physical therapist-directed exercise counseling combined with fitness center-based exercise training can improve muscular strength and exercise capacity in people with type 2 diabetes, with outcomes similar to those of supervised ...

Stroke survivors improve balance with tai chi

Mar 23, 2009

Stroke can impair balance, heightening the risk of a debilitating fall. But a University of Illinois at Chicago researcher has found that stroke survivors can improve their balance by practicing the Chinese martial art of ...

Recommended for you

With kids in school, parents can work out

18 hours ago

(HealthDay)—Back-to-school time provides an opportunity for parents to develop an exercise plan that fits into the family schedules, an expert suggests.

Obama offers new accommodations on birth control

22 hours ago

The Obama administration will offer a new accommodation to religious nonprofits that object to covering birth control for their employees. The measure allows those groups to notify the government, rather than their insurance ...

Use a rule of thumb to control how much you drink

22 hours ago

Sticking to a general rule of pouring just a half glass of wine limits the likelihood of overconsumption, even for men with a higher body mass index. That's the finding of a new Iowa State and Cornell University ...

User comments : 0