Effectiveness of body weight-supported treadmill training compared to overground training on functional outcomes in patients with hemiparesis.

Abstract Background: Cerebral Vascular Accident (CVA) or stroke, is among the most common diagnoses seen in an inpatient rehabilitation facility as more than 790,000 Americans suffer new or recurrent strokes each year. Of these, approximately two thirds of survivors experience significant limitations in walking leading to increased risk for falls and fractures, decreased mobility, limited community access, depression and decreased quality of life. For this reason, gait training becomes a major focus of a rehabilitation program. Several common gait training methods may be implemented which have proven to be effective for improving gait speed and walking endurance in patients with hemiparesis (weakness on one side of the body). These may include overground training, treadmill training with or without body weight support, robotic-assisted locomotor training and functional electrical stimulation. Of these methods, overground gait training and treadmill training are among the most commonly used. Purpose: The purpose of this literature review is to examine overground training and body weight supported treadmill training and evaluate which method of gait training is more effective in improving functional outcomes in individuals following stroke. Case Description: This patient is a 35 year old male who suffered a right hemorrhagic cerebral vascular accident and seizures for which he underwent a right craniotomy. Patient presents with left hemiparesis, flaccid left upper and lower extremities, right lateral gaze and dysphagia. Upon initial evaluation, the patient required maximal two person assistance for bed positioning and mobility and maximal two person assistance for all transfers. Patient was only able to walk approximately 25 feet using an Arjo® Walker (hydraulic lift) at maximal assist with a dorsiflexion Ace wrap applied to the left lower extremity and assistance with foot clearance and limb advancement during ambulation. Outcomes: Over an eight week period the patient made significant gains. Patient required moderate assistance with all bed mobility skills and basic transfers. Both gait training methods were utilized in the rehabilitation program with an improvement demonstrated in ambulation with the patient able to ambulate 150 feet using a narrow based quad cane with moderate assistance and a dorsiflexion wrap to the left lower extremity. Neither method of gait training was proven to be superior to the other in improving walking speed and endurance. Discussion: Evidence shows that both overground gait training and body weight supported gait training are effective methods for increasing walking capacity, speed and endurance. No conclusive evidence exists that suggests that either method is more effective in promoting functional outcomes. Therefore, selection of intervention must be determined by the physical therapist based on functional status and limitations, along with the patient's values, goals, and expectations.Advised by: James Dexter, P.T., M.A