Key words: Antigravity treadmill, Gait, Falls, Stroke, Balance
Research Purpose: To investigate the effect of antigravity treadmill gait training (AGT) on gait function, balance, and fall risk in stroke patients.
Research Methods:This study included 30 patients with stroke (mean age, 73 years). All subjects were randomly divided into two groups. The intervention group (n=15) performed AGT for 20 minutes, five times per week for 4 weeks. The control group (n=15) received conventional gait training for the same duration. To assess fall risk, the Tinetti Performance-Oriented Mobility Assessment (POMA) was measured. The Berg Balance Scale (BBS), Timed Up and Go test (TUG), and 10-m walk test (10mWT) were measured to assess dynamic balance. All scales were measured before intervention (T0) and at 4 weeks (T1) and 12 weeks (T2) after intervention.
Research Resul<ts:Results showed that the total POMA score, BBS, and 10mWT scores improved significantly (p<0.05) at T1 and T2 in both groups. The POMA gait score (4.20±1.37 at T1, 4.87±1.36 at T2) and TUG (4.52±4.30 at T1, 5.73±4.97 at T2) significantly improved (p<0.05) only in the intervention group. The changes in total P<OMA score and BBS of the intervention group (7.20±2<.37, 7.47±3.07) improved more significantly (p<0.05) between T0 and T2 than the control group (2.53±2.10, 2.87±2.53).
Conclusion:Our study showed that AGT enhances dynamic balance and gait speed and effectively lowers fall risk in stroke patients. Compared to conventional gait therapy, AGT would improve gait function and balance in stroke patients more effectively.
Article citation copyright：© 2022 by Korean Academy of Rehabilitation Medicine
Article link：Effect of Antigravity Treadmill Gait Training on Gait Function and Fall Risk in Stroke Patients
After a stroke, patients occasionally experience reduced balance and asymmetry in weight support, leading to subsequent problems such as loss of functional gait, limited movement, and falls. Among these problems, falls are a very common and serious problem, affecting approximately 12%-47% of hospitalized stroke patients. Falls in stroke patients are significantly associated with disease-specific physical deficits, such as lower extremity weakness, loss of balance, and reduced gait speed. Falls can cause fractures, depression, and other problems in stroke patients, thereby hindering rapid recovery, causing functional sequelae, delaying return to normal life, and thus prolonging hospitalization and increasing medical expenses. Therefore, improving gait function and reducing fall risk in stroke patients is an important issue. A variety of treatment methods are used in rehabilitation treatment to improve patients’ dynamic balance and reduce the risk of falls; in recent years, Microgravity treadmill training has been actively studied as a gait training method.
Research Object：This study was a single-blinded controlled trial conducted on 30 stroke patients hospitalized in the outpatient clinic of our hospital.
The inclusion criteria are as follows： (1) patients aged ≥20 years, (2) at least 6 months since the diagnosis of stroke, (3) ability to walk for at least 10 min with or without assistance, (4) impaired balance (Berg Balance Scale [BBS] score ≤45), (5) had undergone the conventional therapy but not AGT, (6) medically stable and lack of major cardiovascular or other medical conditions. Patients with serious cognitive impairment (Mini-Mental State Examination score ≤20), those with a history of orthopedic surgery in the past 6 months, and those with a neurological diagnosis other than stroke were excluded.
This study was approved by the Institutional Review Board of Gwangju Veteran Hospital (IRB No. 2021-9-2). Each participant signed the IRB approved informed consent form, and the participants’ rights were protected in accordance with the ethical principles of the Declaration of Helsinki.
Experimental Method：30 patients were randomly divided into two groups, including 15 patients in the intervention group and 15 patients in the control group.
The intervention group underwent AGT for 20 minutes a day, five times a week for 4 weeks. AGT was designed as a progressive resistance training focused on improving dynamic balance control and stability, where the initial overload was set to 30% of the body weight and then increased gradually. All patients started treatment at 30% load, and if they adapted to training for 5 minutes (confirming no adverse events such as discomfort or blood pressure increase), AGT was gradually increased to 80% of the patient’s body weight. If there was an adverse event, the training was terminated.
The control group underwent rehabilitation therapy involving conventional gait training with a therapist with more than 5 years of clinical experience. The control group also underwent training 20 minutes a day, five times a week for 4 weeks.
The measurement results of participants in the intervention group and control group are as follows:
（Values are presented as mean±standard deviation. POMA, Tinetti Performance Oriented Mobility Assessment; BBS, Berg Balance Scale; TUG, Timed Up and Go test; 10mWT, 10-m walk test; T0, before the intervention; T1, 4 weeks after training;< T2, 12 weeks after training. a)p0.05, comparison between T0 and T1 by repeated-measures ANOVA. b)p0.05, comparison between T0 and T2 by repeated-measures ANOVA.<）
The changes in measurement values of participants in the intervention group and control group are as follows:
（Values are presented as mean±standard deviation. POMA, Tinetti Performance Oriented Mobility Assessment; BBS, Berg Balance Scale; TUG, Timed Up and Go test; 10MWT, 10-m walk test; T0, before the intervention; T1, 4 weeks after training; T2, 12 weeks after training. *p0.05, comparison between the intervention group and the control group by repeated-measures ANOVA (contrast).<）
In summary, this study shows that Microgravity treadmill gait training can improve the dynamic balance and gait speed of stroke patients and effectively reduce the risk of falls. Therefore, Microgravity treadmill gait training can be a useful alternative to traditional gait therapy to improve gait function and balance in stroke patients. However, in the future, studies should conduct follow-up tests and observations and include more participants to better examine the long-term effects of the treatment.