RESEARCH REPORT PLATFORM PRESENTATION

STRUCTURED TREADMILL WALKING FOR STROKE PATIENTS: THE IMPACT OF WALKING SURFACE AND CARDIOVASCULAR DEMAND ON GAIT QUALITY. Kuys S^1,2, Brauer S³, Ada L⁴; ¹Griffith University, Gold Coast, Australia. ²Princess Alexandra Hospital, Brisbane, Australia. ³University of Queensland, Brisbane, Australia. ⁴University of Sydney, Sydney, Australia

PURPOSE: The purpose of this study was to determine if walking quality in stroke patients was different: when walking overground compared with walking on a treadmill; and when cardiovascular demand was increased during treadmill walking. RELEVANCE: Following stroke, most survivors are able to walk but few manage this easily in the community significantly contributing to the ongoing disability associated with stroke. While treadmill training is increasing in popularity as a mode of retraining walking, the impact of this type of training on gait quality has not been investigated. Results of this project will be directly applicable to physiotherapists rehabilitating walking in stroke survivors and should improve knowledge of the impact of treadmill training on stroke survivors. PARTICIPANTS: 20 stroke survivors currently undergoing inpatient rehabilitation were recruited to these studies. Gender was evenly distributed with 45% being male. Average age of participants was 55.9 (±12) years with a range of 38-78 years. Participants were medically stable, referred for physiotherapy, demonstrated walking deficits, provided informed consent and scored at least 3 on Motor Assessment Scale, Item 5, Walking. Equivalence analyses indicated that 15-20 participants would be required to determine minimum clinical differences. Ethical approval for study was granted by institutional Medical Research Ethics Committees. METHODS: Two counterbalanced descriptive studies were conducted. In the first study, participants underwent a ten minute overground walking intervention and a ten minute treadmill walking intervention (in different sessions on different days) where heart rates during each intervention were matched. In the second study, performed on another day, participants walked at predetermined heart rates equivalent to 40, 50 and 60% heart rate reserve, the minimum intensity capable of improving cardiorespiratory fitness. For both studies, spatial and temporal gait measures were taken pre and post each intervention when walking over an 8m Gaitrite mat. Hip, knee and ankle joint measures were taken at stance and swing phases of gait via 2D posterior and lateral webcam footage during overground and treadmill walking. Reliability of using the webcam for angle measures has previously been published, and will be confirmed for this population in this study. ANALYSIS: In the first study repeated measures (RM) analysis of variances (ANOVAs) were used to determine any task effect (overground vs. treadmill) and time effect (pre vs post) in gait parameters. RMANOVAs were also used to determine any effect of increased cardiovascular demand on gait parameters. RESULTS: No differences were found between an overground walking and treadmill walking intervention on spatio-temporal gait parameters. No differences were found in spatio-temporal gait parameters following treadmill walking at increasing cardiovascular demand. There were no differences in joint kinematics at hip, knee or ankle movement during stance and swing phases of gait at increasing treadmill speeds. CONCLUSIONS: Treadmill walking does not negatively impact on gait spatial temporal parameters, joint kinematics or walking pattern compared to overground walking or when walking at increasing cardiovascular demands. IMPLICATIONS: It is feasible to use treadmill walking during inpatient rehabilitation to retrain walking capacity in stroke patients able to walk without compromising gait quality. KEYWORDS: Professional Practice – Exercise. FUNDING ACKNOWLEDGEMENTS: Australian Physiotherapy Association Queensland Branch Dorothy Hopkins Award for Clinical Study, Queensland Health Allied Health Research Grant. CONTACT: s.kuys@griffith.edu.au

ETHICS COMMITTEE: Princess Alexandra Hospital Research and Ethics Committee; University of Queensland Medical Research Ethics Committee