title: Body-weight-supported treadmill rehabilitation after stroke.
abstract: BACKGROUND
  Locomotor training, including the use of body-weight support in treadmill stepping, is a physical therapy intervention used to improve recovery of the ability to walk after stroke. The effectiveness and appropriate timing of this intervention have not been established.
  
  
  METHODS
  We stratified 408 participants who had had a stroke 2 months earlier according to the extent of walking impairment--moderate (able to walk 0.4 to <0.8 m per second) or severe (able to walk <0.4 m per second)--and randomly assigned them to one of three training groups. One group received training on a treadmill with the use of body-weight support 2 months after the stroke had occurred (early locomotor training), the second group received this training 6 months after the stroke had occurred (late locomotor training), and the third group participated in an exercise program at home managed by a physical therapist 2 months after the stroke (home-exercise program). Each intervention included 36 sessions of 90 minutes each for 12 to 16 weeks. The primary outcome was the proportion of participants in each group who had an improvement in functional walking ability 1 year after the stroke.
  
  
  RESULTS
  At 1 year, 52.0% of all participants had increased functional walking ability. No significant differences in improvement were found between early locomotor training and home exercise (adjusted odds ratio for the primary outcome, 0.83; 95% confidence interval [CI], 0.50 to 1.39) or between late locomotor training and home exercise (adjusted odds ratio, 1.19; 95% CI, 0.72 to 1.99). All groups had similar improvements in walking speed, motor recovery, balance, functional status, and quality of life. Neither the delay in initiating the late locomotor training nor the severity of the initial impairment affected the outcome at 1 year. Ten related serious adverse events were reported (occurring in 2.2% of participants undergoing early locomotor training, 3.5% of those undergoing late locomotor training, and 1.6% of those engaging in home exercise). As compared with the home-exercise group, each of the groups receiving locomotor training had a higher frequency of dizziness or faintness during treatment (P=0.008). Among patients with severe walking impairment, multiple falls were more common in the group receiving early locomotor training than in the other two groups (P=0.02).
  
  
  CONCLUSIONS
  Locomotor training, including the use of body-weight support in stepping on a treadmill, was not shown to be superior to progressive exercise at home managed by a physical therapist. (Funded by the National Institute of Neurological Disorders and Stroke and the National Center for Medical Rehabilitation Research; LEAPS ClinicalTrials.gov number, NCT00243919.).
authors: Department of Community and Family Medicine, Doctor of Physical Therapy Division, Duke University, Durham, NC 27705, USA. pamela.duke@duke.edu
authors: Pamela W
authors: PW
authors: Duncan
authors: Katherine J
authors: KJ
authors: Sullivan
authors: Andrea L
authors: AL
authors: Behrman
authors: Stanley P
authors: SP
authors: Azen
authors: Samuel S
authors: SS
authors: Wu
authors: Stephen E
authors: SE
authors: Nadeau
authors: Bruce H
authors: BH
authors: Dobkin
authors: Dorian K
authors: DK
authors: Rose
authors: Julie K
authors: JK
authors: Tilson
authors: Steven
authors: S
authors: Cen
authors: Sarah K
authors: SK
authors: Hayden
references: Stroke. 1994 Jun;25(6):1181-8
references: 8202977
references: Neurorehabil Neural Repair. 2010 Jun;24(5):486-92
references: 20053950
references: J Am Geriatr Soc. 2008 Dec;56(12):2234-43
references: 19093923
references: Arch Phys Med Rehabil. 2005 Aug;86(8):1552-6
references: 16084807
references: Stroke. 2010 Aug;41(8):1715-22
references: 20616328
references: Arch Gen Psychiatry. 1983 Jul;40(7):812
references: 6860082
references: Stroke. 2002 Mar;33(3):756-61
references: 11872900
references: Neurorehabil Neural Repair. 2004 Mar;18(1):12-28
references: 15035960
references: Stroke. 1995 Jun;26(6):976-81
references: 7762049
references: Clin Rehabil. 2004 Sep;18(6):640-51
references: 15473116
references: Arch Phys Med Rehabil. 2002 May;83(5):683-91
references: 11994808
references: NeuroRehabilitation. 2008;23(1):55-65
references: 18356589
references: Stroke. 1995 Jun;26(6):982-9
references: 7762050
references: Stroke. 2009 Oct;40(10):3281-5
references: 19661475
references: Stroke. 2003 Sep;34(9):2173-80
references: 12920254
references: J Nurs Meas. 2001 Winter;9(3):275-90
references: 11881269
references: Neurorehabil Neural Repair. 2002 Sep;16(3):232-40
references: 12234086
references: Arch Phys Med Rehabil. 2003 Jul;84(7):950-63
references: 12881816
references: Cochrane Database Syst Rev. 2005 Oct 19;(4):CD002840
references: 16235304
references: Arch Phys Med Rehabil. 1995 Jan;76(1):27-32
references: 7811170
references: Clin Rehabil. 2002 Jun;16(4):420-8
references: 12061477
references: Stroke. 2002 Feb;33(2):553-8
references: 11823669
references: Phys Ther. 2010 Feb;90(2):196-208
references: 20022995
references: J Am Geriatr Soc. 2001 May;49(5):664-72
references: 11380764
references: Arch Phys Med Rehabil. 2003 Oct;84(10):1458-65
references: 14586912
references: Can Med Assoc J. 1985 Apr 15;132(8):919-23
references: 3978515
references: Stroke. 2005 Oct;36(10):2206-11
references: 16151035
references: Physiother Theory Pract. 2008 May-Jun;24(3):195-204
references: 18569856
references: J Gerontol A Biol Sci Med Sci. 1995 Jan;50A(1):M28-34
references: 7814786
references: Phys Ther. 2007 Dec;87(12):1580-602
references: 17895349
references: J Aging Phys Act. 2004 Jan;12(1):64-74
references: 15211021
references: Scand J Rehabil Med. 1995 Mar;27(1):27-36
references: 7792547
references: J Rehabil Res Dev. 2008;45(8):1195-213
references: 19235120
references: Neurorehabil Neural Repair. 2009 Jan;23(1):5-13
references: 19109447
references: Stroke. 2005 Mar;36(3):635-8
references: 15677576
references: Stroke. 2007 Jul;38(7):2096-100
references: 17510461
references: BMC Neurol. 2007 Nov 08;7:39
references: 17996052
references: Stroke. 1998 Jun;29(6):1122-8
references: 9626282