title: Effect of balance support on the energy cost of walking after stroke.
abstract: OBJECTIVE
  To examine the influence of balance support on the energy cost of treadmill and overground walking in ambulatory patients with stroke.
  
  
  METHODS
  Cross-sectional.
  
  
  METHODS
  Research laboratory at a rehabilitation center.
  
  
  METHODS
  Patients with stroke depending on a walking aid in daily life (n=12; walking aid dependent ambulators) and walking aid independent ambulators (n=12), all able to walk for at least 5 minutes.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Energy cost (J·kg(-1)·m(-1)) and temporal gait parameters (walking speed, mean and coefficient of variation of stride time, and symmetry index) were obtained during 4 walking trials at preferred walking speed: overground with and without a cane and on a treadmill with and without handrail support.
  
  
  RESULTS
  On the treadmill, handrail support resulted in a significant decrease in energy cost of 16%, independent of the group. Although walking aid dependent ambulators had on average a larger reduction in energy cost than walking aid independent ambulators (19% vs 14%), this interaction did not reach statistical significance (P=.11). Interestingly, overground walking with support resulted in an 8% reduction in energy cost for walking aid dependent ambulators, but a 6% increase for walking aid independent ambulators. The reduction in energy cost with support was accompanied by changes in temporal gait parameters, most notably an increase in stride time and symmetry and a decrease in stride time variability.
  
  
  CONCLUSIONS
  Balance support can result in a significant reduction in the energy cost of walking in stroke patients, the magnitude of which depends on walking ability and the walking task. Impaired balance control should not be overlooked as a contributing factor to the increased energy cost of walking in patients with stroke, and improving or assisting balance control should be considered to reduce the energy cost of hemiplegic gait.
authors.affiliation: MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands; Heliomare Research and Development, Wijk aan Zee, The Netherlands. Electronic address: t.ijmker@vu.nl.
authors.forename: Trienke
authors.initials: T
authors.lastname: Ijmker
authors.forename: Han
authors.initials: H
authors.lastname: Houdijk
authors.forename: Claudine J
authors.initials: CJ
authors.lastname: Lamoth
authors.forename: Ameerani V
authors.initials: AV
authors.lastname: Jarbandhan
authors.forename: Daniëlle
authors.initials: D
authors.lastname: Rijntjes
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Beek
authors.forename: Lucas H
authors.initials: LH
authors.lastname: van der Woude
mesh_terms: D002183:Canes; D003430:Cross-Sectional Studies; D004734:Energy Metabolism / Q000502:physiology*; D006801:Humans; D009983:Orthopedic Equipment; D010101:Oxygen Consumption / Q000502:physiology; D004856:Postural Balance; D011434:Proprioception / Q000502:physiology; D020521:Stroke / Q000503:physiopathology*; D000071939:Stroke Rehabilitation; D016138:Walking / Q000502:physiology*
keywords: BBS; Berg Balance Scale; CV; E(gross); Energy metabolism; FAC; Functional Ambulatory Category; Gait; Postural balance; RER; Rehabilitation; SI; Stroke; TMWT; Vo(2); coefficient of variation; gross metabolic energy expenditure; oxygen consumption; respiratory exchange ratio; symmetry index; ten-meter walk test