Exploring the Impact of Backward and Forward Locomotor Treadmill Training in Chronic Stroke Survivors with Severe Post-Stroke Walking Impairment: A Single-Center Pilot Randomized Controlled Trial
Background: Defined as a self-selected speed of <0.4 m/s, chronic stroke survivors falling in this category are classified as “severe”, usually homebound and sedentary, and they experience worse outcomes. Limited rehabilitation strategies are available to improve walking speed and related outcome...
Saved in:
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2025-04-01
|
| Series: | Brain Sciences |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2076-3425/15/5/437 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849327486779785216 |
|---|---|
| author | Saiprasad Naidu Khwahish Singh Tamiel Murray Colin Drury Erin Palermo Heidi J. Sucharew Changchun Xie Pierce Boyne Kari Dunning Oluwole O. Awosika |
| author_facet | Saiprasad Naidu Khwahish Singh Tamiel Murray Colin Drury Erin Palermo Heidi J. Sucharew Changchun Xie Pierce Boyne Kari Dunning Oluwole O. Awosika |
| author_sort | Saiprasad Naidu |
| collection | DOAJ |
| description | Background: Defined as a self-selected speed of <0.4 m/s, chronic stroke survivors falling in this category are classified as “severe”, usually homebound and sedentary, and they experience worse outcomes. Limited rehabilitation strategies are available to improve walking speed and related outcomes in this subgroup, and questions regarding effective rehabilitation options remain. The objective of this study was to determine the effects of backward (BLTT) and forward (FLTT) locomotor treadmill training on overground walking speed, spatiotemporal symmetry, and dynamic postural stability. Methods: In this single-center, assessor-blinded, randomized controlled pilot trial, 14 stroke survivors with severe waking impairment underwent 12 sessions of BLTT (<i>n</i> = 7) or FLTT (<i>n</i> = 7). The primary outcome was the proportion of participants reaching clinically meaningful important difference (MCID) on the 10-meter walk test following training completion. Secondary outcomes were between-group differences in walking speed, spatiotemporal symmetry, and completion time on the 3-meter timed up and go (3M TUG) at 24 h, 30 days, and 90 days POST. Results: Two subjects in the BLTT group (28.6%) and one (14.3%) in FLTT achieved MCID following training; however, most subjects did not, with significant variability in response. At 24 h POST, the median (IQR) percent change in walking speed was 28.9 (9.01–36.7) and 17.4 (12.6–39.7) with BLTT and FLTT, respectively; however, no between-group differences were seen (<i>p</i> = 0.80) at this time point or at 30 (<i>p</i> > 0.99) and 90 (<i>p</i> > 0.99) days follow up. Likewise, there were no significant between-group differences in spatiotemporal symmetry and the 3M TUG across time points. Conclusions: While preliminary, this study found that 12 training sessions did not lead to group-level achievement of MCID for walking speed in our cohort and found no significant between-group differences in walking capacity or dynamic postural stability. Future well-powered dosing trials and mechanistically driven studies are needed to optimize and identify predictors of training response. |
| format | Article |
| id | doaj-art-4c3ebff650a74a1fb5cc013eb4eeda98 |
| institution | Kabale University |
| issn | 2076-3425 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Brain Sciences |
| spelling | doaj-art-4c3ebff650a74a1fb5cc013eb4eeda982025-08-20T03:47:52ZengMDPI AGBrain Sciences2076-34252025-04-0115543710.3390/brainsci15050437Exploring the Impact of Backward and Forward Locomotor Treadmill Training in Chronic Stroke Survivors with Severe Post-Stroke Walking Impairment: A Single-Center Pilot Randomized Controlled TrialSaiprasad Naidu0Khwahish Singh1Tamiel Murray2Colin Drury3Erin Palermo4Heidi J. Sucharew5Changchun Xie6Pierce Boyne7Kari Dunning8Oluwole O. Awosika9Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45267, USADepartment of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45267, USADepartment of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45267, USADepartment of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45267, USADepartment of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45267, USADepartment of Emergency Medicine, University of Cincinnati, Cincinnati, OH 45267, USADepartment of Biostatistics, Health Informatics and Data Sciences, University of Cincinnati, Cincinnati, OH 45267, USADepartment of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH 45267, USADepartment of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH 45267, USADepartment of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45267, USABackground: Defined as a self-selected speed of <0.4 m/s, chronic stroke survivors falling in this category are classified as “severe”, usually homebound and sedentary, and they experience worse outcomes. Limited rehabilitation strategies are available to improve walking speed and related outcomes in this subgroup, and questions regarding effective rehabilitation options remain. The objective of this study was to determine the effects of backward (BLTT) and forward (FLTT) locomotor treadmill training on overground walking speed, spatiotemporal symmetry, and dynamic postural stability. Methods: In this single-center, assessor-blinded, randomized controlled pilot trial, 14 stroke survivors with severe waking impairment underwent 12 sessions of BLTT (<i>n</i> = 7) or FLTT (<i>n</i> = 7). The primary outcome was the proportion of participants reaching clinically meaningful important difference (MCID) on the 10-meter walk test following training completion. Secondary outcomes were between-group differences in walking speed, spatiotemporal symmetry, and completion time on the 3-meter timed up and go (3M TUG) at 24 h, 30 days, and 90 days POST. Results: Two subjects in the BLTT group (28.6%) and one (14.3%) in FLTT achieved MCID following training; however, most subjects did not, with significant variability in response. At 24 h POST, the median (IQR) percent change in walking speed was 28.9 (9.01–36.7) and 17.4 (12.6–39.7) with BLTT and FLTT, respectively; however, no between-group differences were seen (<i>p</i> = 0.80) at this time point or at 30 (<i>p</i> > 0.99) and 90 (<i>p</i> > 0.99) days follow up. Likewise, there were no significant between-group differences in spatiotemporal symmetry and the 3M TUG across time points. Conclusions: While preliminary, this study found that 12 training sessions did not lead to group-level achievement of MCID for walking speed in our cohort and found no significant between-group differences in walking capacity or dynamic postural stability. Future well-powered dosing trials and mechanistically driven studies are needed to optimize and identify predictors of training response.https://www.mdpi.com/2076-3425/15/5/437severe walking impairmentsevere strokesensorineural integrationgaitoutcome measuresstroke recovery |
| spellingShingle | Saiprasad Naidu Khwahish Singh Tamiel Murray Colin Drury Erin Palermo Heidi J. Sucharew Changchun Xie Pierce Boyne Kari Dunning Oluwole O. Awosika Exploring the Impact of Backward and Forward Locomotor Treadmill Training in Chronic Stroke Survivors with Severe Post-Stroke Walking Impairment: A Single-Center Pilot Randomized Controlled Trial Brain Sciences severe walking impairment severe stroke sensorineural integration gait outcome measures stroke recovery |
| title | Exploring the Impact of Backward and Forward Locomotor Treadmill Training in Chronic Stroke Survivors with Severe Post-Stroke Walking Impairment: A Single-Center Pilot Randomized Controlled Trial |
| title_full | Exploring the Impact of Backward and Forward Locomotor Treadmill Training in Chronic Stroke Survivors with Severe Post-Stroke Walking Impairment: A Single-Center Pilot Randomized Controlled Trial |
| title_fullStr | Exploring the Impact of Backward and Forward Locomotor Treadmill Training in Chronic Stroke Survivors with Severe Post-Stroke Walking Impairment: A Single-Center Pilot Randomized Controlled Trial |
| title_full_unstemmed | Exploring the Impact of Backward and Forward Locomotor Treadmill Training in Chronic Stroke Survivors with Severe Post-Stroke Walking Impairment: A Single-Center Pilot Randomized Controlled Trial |
| title_short | Exploring the Impact of Backward and Forward Locomotor Treadmill Training in Chronic Stroke Survivors with Severe Post-Stroke Walking Impairment: A Single-Center Pilot Randomized Controlled Trial |
| title_sort | exploring the impact of backward and forward locomotor treadmill training in chronic stroke survivors with severe post stroke walking impairment a single center pilot randomized controlled trial |
| topic | severe walking impairment severe stroke sensorineural integration gait outcome measures stroke recovery |
| url | https://www.mdpi.com/2076-3425/15/5/437 |
| work_keys_str_mv | AT saiprasadnaidu exploringtheimpactofbackwardandforwardlocomotortreadmilltraininginchronicstrokesurvivorswithseverepoststrokewalkingimpairmentasinglecenterpilotrandomizedcontrolledtrial AT khwahishsingh exploringtheimpactofbackwardandforwardlocomotortreadmilltraininginchronicstrokesurvivorswithseverepoststrokewalkingimpairmentasinglecenterpilotrandomizedcontrolledtrial AT tamielmurray exploringtheimpactofbackwardandforwardlocomotortreadmilltraininginchronicstrokesurvivorswithseverepoststrokewalkingimpairmentasinglecenterpilotrandomizedcontrolledtrial AT colindrury exploringtheimpactofbackwardandforwardlocomotortreadmilltraininginchronicstrokesurvivorswithseverepoststrokewalkingimpairmentasinglecenterpilotrandomizedcontrolledtrial AT erinpalermo exploringtheimpactofbackwardandforwardlocomotortreadmilltraininginchronicstrokesurvivorswithseverepoststrokewalkingimpairmentasinglecenterpilotrandomizedcontrolledtrial AT heidijsucharew exploringtheimpactofbackwardandforwardlocomotortreadmilltraininginchronicstrokesurvivorswithseverepoststrokewalkingimpairmentasinglecenterpilotrandomizedcontrolledtrial AT changchunxie exploringtheimpactofbackwardandforwardlocomotortreadmilltraininginchronicstrokesurvivorswithseverepoststrokewalkingimpairmentasinglecenterpilotrandomizedcontrolledtrial AT pierceboyne exploringtheimpactofbackwardandforwardlocomotortreadmilltraininginchronicstrokesurvivorswithseverepoststrokewalkingimpairmentasinglecenterpilotrandomizedcontrolledtrial AT karidunning exploringtheimpactofbackwardandforwardlocomotortreadmilltraininginchronicstrokesurvivorswithseverepoststrokewalkingimpairmentasinglecenterpilotrandomizedcontrolledtrial AT oluwoleoawosika exploringtheimpactofbackwardandforwardlocomotortreadmilltraininginchronicstrokesurvivorswithseverepoststrokewalkingimpairmentasinglecenterpilotrandomizedcontrolledtrial |