Should you hold onto the treadmill handrails or not? Cortical evidence at different walking speeds

 I always did, it allowed me to get to a higher speed, but then I haven't done treadmills in over a decade. I now consider them to be vastly inferior to overground walking. You get no perturbations from treadmills. Overground greatly increases your balance ability. And you want to walk in the real world, so have your therapist take you there! None of this treadmill crapola.

Should you hold onto the treadmill handrails or not? Cortical evidence at different walking speeds

• Monica Biggio,
• Costanza Iester,
• Davide Cattaneo,
• Simone Cutini,
• Ambra Bisio,
• Ludovico Pedullà,
• Alessandro Torchio,
• Marco Bove &
• Laura Bonzano 

Journal of NeuroEngineering and Rehabilitation volume 22, Article number: 5 (2025) Cite this article

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Abstract

Background

Treadmill-based gait training is part of rehabilitation programs focused on walking abilities. The use of handrails embedded in treadmill systems is debated, and current literature only explores the issue from a behavioral perspective.

Methods

We examined the cortical correlates of treadmill walking in healthy participants using functional near-infrared spectroscopy. We investigated whether the utilization of treadmill handrails at varying walking speeds could affect cortical activation associated with the task, and we evaluated potential differences in task-based functional connectivity across the various walking conditions.

Results

Significant differences in cortical activation were found between the two walking speeds (3 and 5 km/h) in the unsupported condition; these differences were reduced when using the handrails. Specifically, cortical activation was significantly higher when the participants swung their arms freely while walking at a speed of 5 compared to 3 km/h in several Brodmann’s Areas (BA): left BA10, BA3 and BA39, and right BA10, BA9, BA8, BA3, and BA40. No significant differences were found when participants were holding onto the handrails. A significant difference was found in the left BA40 between the two speeds, regardless of whether the participants were holding onto the handrails. Furthermore, at the higher speed and without the use of handrails, a wider pattern of task-based functional connectivity was observed, with significantly stronger connectivity between the left BA10 and BA40.

Conclusions

We suggest that speed and handrails use play a role in walking cortical activity patterns, therefore they are key ingredients to take into account when planning a rehabilitation program.

Background

Gait abnormalities during old age and as a result of neurological diseases are very debilitating and can increase the risk of falls [1], negatively affect independence and quality of life [2], and increase health care costs [3]. For this reason, walking abilities are often considered a primary focus for rehabilitation programs.

To create controlled setups in rehabilitation, several studies recommend treadmill-based gait training paradigms [4], and body weight support systems are allowed in order to minimize the delay in starting gait training for neurological patients and to increase safety without the use of walking aids [5]. The use of handrails embedded in treadmill systems helps to stabilize the body by increasing afferent somatosensory signals through haptic contact with the handrails [6,7,8].

Some controversial results have been reported in the literature on the use of treadmill handrails during rehabilitation. First of all, it should be considered that holding the hands onto the handrails of the treadmill might not imply a representative walking pattern, in terms of an ecological perspective, since it encourages bad posture and prevents the natural stride [9,10,11]. It has been reported that supporting on the handrails lightens the workload since it requires less muscular activation without resulting in substantial neuromuscular re-organization. In fact, it increases the base of support, resulting in greater stability, reduces uncertainty leading to a better balance, and improves ability to generate corrective forces to compensate for perturbations [12]. Also, handrail use during treadmill walking in a split-belt adaptation training reduced locomotor learning in healthy young subjects, suggesting that this balance support may ease, or alter the task demand [6].

It has been shown that the effect of gait rehabilitation can be improved by holding handrails [13], especially when participants used a firm rather than a light touch on the handrails [12]. It should be noted, however, that Bello and colleagues attributed the improvements seen during the rehabilitation of patients with Parkinson’s disease to the belts used in combination with the treadmill, instead of the handrails themselves [14].

Nevertheless, all these studies explored the issue from a behavioral perspective. To our knowledge, the effects of holding handrails during treadmill walking have never been investigated with neuroimaging techniques.

In general, in order to propose effective rehabilitation paradigms, it is necessary to reach a better understanding of the mechanisms underlying the gait under various conditions [15]. Walking has long been regarded as predominantly automatic process, however functional magnetic resonance imaging (fMRI) studies based on motor imagery of gait have demonstrated a cortical control even during simple walking processes in healthy elderly, pathological subjects, as well as healthy young individuals [16,17,18]. The areas mainly involved in gait are the prefrontal cortex, supplementary motor, premotor and primary motor areas, sensorimotor areas; their activity has been found to be modulated by task demand [17, 19]. Bakker and colleagues asked their participants to (visually) imagine a normal gait or a precision gait over a narrower path, finding an increased cortical activity in cortical structures outside primary motor regions during the harder task, thus emphasizing greater cortical activity when an increased postural control is required [16].

Portable neuroimaging techniques, such as functional near-infrared spectroscopy (fNIRS), led to identify cortical activation patterns and locomotor networks involved in walking, providing new insight into cortical control of actual human locomotion [20,21,22]. In fact, this technique made it possible to study walking during its actual performance and to modulate the difficulty of the task [19], the somatosensory feedback from different peripheral stimuli [23], or to assess the difference between walking and running [24].

In this vein, we investigated the cortical correlates of treadmill walking by means of fNIRS in a group of healthy participants. We were interested in understanding whether the use of treadmill handrails, at different walking speeds, could modulate cortical activation related to the task. Specifically, we carried on an fNIRS study while walking on a treadmill at two different speeds (3 and 5 km/h - lower or equal with respect to the spontaneous walking speed of young healthy subjects [25]), with or without holding onto the handrails. Furthermore, one published study based on fMRI showed that individuals with faster gait speed have stronger resting-state functional connectivity (FC) within the frontoparietal control network, and that gait variability is correlated with between-network functional connectivity [26]. As a step forward, here using fNIRS we were able to assess possible differences in task-based FC among the task conditions during walking to better understand how task performance modulated the connectivity between cortical regions, providing a more comprehensive view of cortical function beyond isolated regional activity.

It has been reported that, during comfortable walking, lower extremity muscle activity had a strong correlation with cortical activation [27]. Therefore, we expected to find differences in cortical activation between the two walking speeds in the unsupported condition. Given that walking with handrails can lighten the workload of walking requiring less muscular activation [12], we hypothesized that this condition would be associated with a reduced brain resource demand and that the use of the handrails could mitigate the differences in cortical activity due to the walking speed.

More at ink.

Feasibility of challenging treadmill speed-dependent gait and perturbation-induced balance training in chronic stroke patients with low ambulation ability: a randomized controlled trial

I absolutely hated treadmills.

Feasibility of challenging treadmill speed-dependent gait and perturbation-induced balance training in chronic stroke patients with low ambulation ability: a randomized controlled trial

Jia Hu¹, Lingjing Jin¹, Yubing Wang^2* and Xia Shen^2,3*

• ¹Medical Education Department, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
• ²Rehabilitation Medicine Research Center, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
• ³Department of Rehabilitation Sciences, Tongji University School of Medicine, Shanghai, China

Background: Treadmill training shows advantages in the specificity, amount, and intensity of gait and balance practice for the rehabilitation of stroke patients.

Objective: To investigate the feasibility and effectiveness of challenging treadmill speed-dependent gait and perturbation-induced balance training in chronic stroke patients with low ambulation ability.

Methods: For this randomized controlled trial (Chinese Clinical Trials.gov registration number ChiCTR-IOR-16009536) with blinded testers, we recruited 33 ambulatory stroke participants with restricted community ambulation capacity and randomly assigned them into two groups: the experimental group with 2 week treadmill speed-dependent gait training combined with 2 week treadmill perturbation-induced balance training (EXP) or the control group with traditional gait and balance training (CON). Various variables were recorded during EXP training, including the rating of perceived exertion, heart rate, causes of pauses, treadmill speed, and perturbation intensity. Outcome measures were examined before training and at 2 and 4 weeks after training. They included gait velocity during five-meter walk test at comfortable and fast speed and reactive balance ability in the compensatory stepping test as primary outcome measures, as well as dynamic balance ability (timed up-and-go test and 5 times sit-to-stand test) and balance confidence as secondary outcome measures.

Results: All participants completed the study. The treadmill speed and perturbation intensity significantly increased across training sessions in the EXP group, and no adverse effects occurred. The normal and fast gait velocities showed significant time and group interaction effects. They significantly increased after 2 and 4 weeks of training in the EXP group (p < 0.05) but not in the CON group (p > 0.05). Likewise, dynamic balance ability measured using the timed up-and-go test at a fast speed significantly improved after 2 and 4 weeks of training in the EXP group (p < 0.05) but not in the CON group (p > 0.05), although without a significant time and group interaction effect. Surprisingly, the reactive balance ability did not show improvement after treatment in the EXP group (p > 0.05).

Conclusion: Challenging treadmill speed-dependent gait and treadmill perturbation-induced balance training is feasible and effective to improve ambulation function in chronic stroke patients with low ambulation ability.

Which exercises might reduce pro-inflammatory and enhance anti-inflammatory cytokines in older people with mild cognitive impairment or Alzheimer's disease?

I hate treadmills, they do nothing for balance recovery and fall prevention, and are boring as hell. So it is your doctor's responsibility to give you EXACT EXERCISES TO DO!

Which exercises might reduce pro-inflammatory and enhance anti-inflammatory cytokines in older people with mild cognitive impairment or Alzheimer's disease?

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By Neha MathurMar 17 2023Reviewed by Danielle Ellis, B.Sc.

In a recent article published in Experimental Gerontology, researchers systematically reviewed English language publications from 13 electronic databases, such as PubMed/Medline, Google Scholar, and Web of Science.

Study: A systematic review of exercise modalities that reduce pro-inflammatory cytokines in humans and animals' models with mild cognitive impairment or dementia. Image Credit: StockLite/Shutterstock

They investigated which exercises might enhance anti-inflammatory cytokines and reduce pro-inflammatory cytokines in patients with dementia or mild cognitive impairment (MCI), as illustrated in studies using apt animal models and human participants.

Background

MCI is often considered the earliest symptomatic manifestation of Alzheimer's disease (AD), the most common cause of dementia. By 2050, AD might become so prevalent that one in 85 people will have AD worldwide. Cognitive deficits, neurodegeneration, b-amyloid (Aβ) deposition, neurofibrillary tangle (NFT) formation, and neuroinflammation are some of the characteristic manifestations of AD.

There is a need for biomarker panels to diagnose AD early. Their identification is also crucial because inflammatory mediators play an important role in disease pathogenesis and could inform the development of novel therapeutic strategies for AD.

About the study

In the present study, researchers performed a detailed systematic review to understand the effects of chronic physical activity on MCI or AD outcomes. They included studies using exercise, physical activity, or fitness training as an experimental intervention.

These articles had participants who either had AD, MCI, or dementia, examined cerebrospinal fluid (CSF), brain tissue, etc., and measured cytokines or other inflammatory or neuroinflammatory immune markers. The researchers also included all animal studies that responded to these criteria.

In the study assessments, the researchers examined the effect of physical activity, stratified based on its type, frequency, volume, intensity, and duration.

Results

The authors claim this is the first systematic study on physical exercise parameters in this context. Thus, the studies covered in this review showed inflammatory and anti-inflammatory cytokine levels after exercise in the intervention and control groups.

The included studies also combined results from 25, 11, and two articles exclusively related to animals, humans, and both humans and animals, respectively. They include 1249 animals and 789 human participants.

First, the researchers evaluated only animal model articles to find that physical exercise reduced pro-inflammatory markers in 70.8% of the models, especially tumor necrosis factor-alpha (TNF-α), interleukin (IL)-1β, and IL-6. In 26% of the animal model articles, the levels of the anti-inflammatory cytokines, viz., IL -4, IL -4β, IL -10β, IL -10, and TGF-β showed a marked increase.

In 40.8% of animal model studies, the effect on cytokine levels was positive post-treadmill and swimming exercises, whereas resistance exercise decreased pro-inflammatory cytokines. These three exercise types also promoted a marked reduction in Aβ amyloid plaques, pro-inflammatory cytokines, and microglial activation. Further, the researchers noted elevated levels of IL -4 after four weeks of exercise, through which the brain most likely compensated for Aß-induced upregulation of IL-6.

A low, moderate, or high treadmill exercise volume decreased IL -1β and a surge in anti-inflammatory cytokine IL -10 in blood serum. Furthermore, the study results showed that low-intensity endurance training reversed neuroinflammation.

Intriguingly, 73% of studies where authors induced AD in non-transgenic animals found a positive exercise effect on neuroinflammation. In 100% of articles, hippocampal Aβ injection was very effective concerning neuroinflammation.

Moving on to studies with human models, the researchers observed that chronic exercise was beneficial. In 53.9% and 23% of chronic exercise articles, they observed reduced pro-inflammatory and increased anti-inflammatory cytokines, respectively.

Accordingly, cycling, aerobic and multimodal exercises, and resistance training reduced several pro-inflammatory cytokines, e.g., IL -6, IL -15, IL -1β, and TNF-α. Even in older adults with MCI, three times per week of multimodal training for 16 weeks reduced blood serum levels of IL -6 and TNF-α.

Likewise, resistance training had multiple benefits. For instance, it improved their cognitive function by increasing insulin-like Growth Factor One (IGF-1) levels in the hippocampus. Similarly, aerobic and mind-plus-body exercises increased Brain-derived neurotrophic factor (BDNF), whereas cycling reduced small nucleolar RNA host gene 14 (SNHG14) expression to halt AD progression.

Conclusions

The authors emphasized that future studies elucidate the effect of exercise protocols on AD stages, from preclinical to severe. Similarly, understanding the correlation between cytokine levels and cognitive functions is crucial to managing neuroinflammation and cognitive decline.

Furthermore, future studies should have a larger sample size covering both genders where they compare groups doing two different types of exercise, rather than a sedentary group vs. an exercise group. It would enhance understanding of how forced physical activity accentuates dementia progression.

Nonetheless, this review remarkably showed the positive effects of chronic physical activity on the brain tissue of animals and humans with MCI or AD. Though the study results could help guide healthcare professionals, the authors cautioned that this efficacy was biological and not proven clinically.

Journal reference:

• Ayari, S. et al. (2023) "A systematic review of exercise modalities that reduce pro-inflammatory cytokines in humans and animals' models with mild cognitive impairment or dementia", Experimental Gerontology, 175, p. 112141. doi: 10.1016/j.exger.2023.112141. https://www.sciencedirect.com/science/article/pii/S0531556523000621

Treadmill Exercise Improves PINK1/Parkin-Mediated Mitophagy Activity Against Alzheimer’s Disease Pathologies by Upregulated SIRT1-FOXO1/3 Axis in APP/PS1 Mice

WHOM is going to do the human research on this? Or do we just have to guess on the time and vigorousness of this treadmill exercise and hope it works?

Treadmill Exercise Improves PINK1/Parkin-Mediated Mitophagy Activity Against Alzheimer’s Disease Pathologies by Upregulated SIRT1-FOXO1/3 Axis in APP/PS1 Mice

• Na Zhao,
• Xianliang Zhang,
• Baixia Li,
• Jing Wang,
• Chenfei Zhang &
• Bo Xu 

Molecular Neurobiology (2022)Cite this article

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Abstract

Although treadmill exercise is effective against Alzheimer’s disease (AD), the molecular mechanisms underlying these effects are not fully understood. Recent literature has linked the accumulation of damaged mitochondria and defective mitophagy to AD progression. Here, we determined that abnormally activated PINK1/Parkin pathway–mediated mitophagy plays an important role in AD progression and pathogenesis in 6-month-old APP/PS1 mice. We used the lysosomal inhibitor chloroquine and demonstrated that a 12-week treadmill exercise program improved mitochondrial function, decreased accumulation of β-amyloid plaques, and ameliorated loss of learning and memory ability by enhancing PINK1/Parkin-mediated mitophagy activity in the hippocampus of APP/PS1 mice. Moreover, using the SIRT1 inhibitor EX527, we found that 12 weeks of treadmill exercise rescued PINK1/Parkin-mediated mitophagy by activating the SIRT1-FOXO1/3 axis in the hippocampus of APP/PS1 mice. These findings reveal that activating PINK1/Parkin-mediated mitophagy is a promising strategy for AD treatment, and that the SIRT1-FOXO1/3 axis is a potential candidate for the development of mitophagy enhancers.

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The Integrated Virtual Environment Rehabilitation Treadmill System

 You'll be damned lucky if your hospital can afford this. 

But what about all these other treadmills? Don't you believe in testing the complete universe of treadmills? Or too lazy to do them all?  So once again we will need followup research to identify the best intervention via treadmill. What a fucking waste just because we have NO stroke leadership and NO stroke strategy. 

Stroke Rehabilitation and the AlterG - Anti-gravity treadmill

 

The treadmill bike!?

 

air pressure treadmill 

 

Turning-Based Treadmill 

 

Air pressure treadmill instantly sheds 80% of your weight

 

underwater treadmill

 

Split Belt Treadmill 

 

rotating treadmill

 The latest here:

From the pdf, notice split belts.

 

             

 

 

 

 

 

 

 

 The Integrated Virtual Environment Rehabilitation Treadmill System 

Abstract:

Slow gait speed and interlimb asymmetry are prevalent in a variety of disorders. Current approaches to locomotor retraining emphasize the need for appropriate feedback during intensive, task-specific practice. This paper describes the design and feasibility testing of the integrated virtual environment rehabilitation treadmill (IVERT) system intended to provide real-time, intuitive feedback regarding gait speed and asymmetry during training. The IVERT system integrates an instrumented, split-belt treadmill with a front-projection, immersive virtual environment. The novel adaptive control system uses only ground reaction force data from the treadmill to continuously update the speeds of the two treadmill belts independently, as well as to control the speed and heading in the virtual environment in real time. Feedback regarding gait asymmetry is presented 1) visually as walking a curved trajectory through the virtual environment and 2) proprioceptively in the form of different belt speeds on the split-belt treadmill. A feasibility study involving five individuals with asymmetric gait found that these individuals could effectively control the speed of locomotion and perceive gait asymmetry during the training session. Although minimal changes in overground gait symmetry were observed immediately following a single training session, further studies should be done to determine the IVERT's potential as a tool for rehabilitation of asymmetric gait by providing patients with congruent visual and proprioceptive feedback.

Published in: IEEE Transactions on Neural Systems and Rehabilitation Engineering ( Volume: 19, Issue: 3, June 2011)

Page(s): 290 - 297

Date of Publication: 07 June 2011

ISSN Information:

PubMed ID: 21652279

INSPEC Accession Number: 12036220

DOI: 10.1109/TNSRE.2011.2120623

Publisher: IEEE

 

Body Weight–Supported Treadmill Training Is No Better Than Overground Training for Individuals with Chronic Stroke: A Randomized Controlled Trial

In the six years since this came out has your stroke hospital gotten rid of these machines? I hated BWSTT since it did nothing to control my spasticity. But then since this is for chronic instead of acute your hospital ignored it. Chronic stroke survivors have no way to get therapy other than what they figure our for themselves.

Body Weight–Supported Treadmill Training Is No Better Than Overground Training for Individuals with Chronic Stroke: A Randomized Controlled Trial

 2014, Topics in Stroke Rehabilitation
  Addie Middleton, DPT, 1
 Angela Merlo-Rains, PhD, DPT, 2
 Denise M. Peters, DPT, 1
 Jennifaye V. Greene, PhD, MS, PT, NCS, 1
 Erika L. Blanck, DPT, ATC,  3
 Robert Moran, PhD, 4
 and Stacy L. Fritz, PhD, PT 1
 

1 Department of Exercise Science, Physical Therapy Program, University of South Carolina, Columbia, South Carolina;
 2 College of Health and Human Services, Physical Therapy Program, Northern Arizona University, Phoenix, Arizona;
3 Department of Cell Biology and  Anatomy, University of South Carolina, School of Medicine, Columbia, South Carolina;
4 Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina
Background:
Body weight–supported treadmill training (BWSTT) has produced mixed results compared with other therapeutic techniques.
Objective:
The purpose of this study was to determine whether an intensive intervention (intensive mobility training) including BWSTT provides superior gait, balance, and mobility outcomes compared with a similar intervention with overground gait training in place of BWSTT.
Methods:
 Forty-three individuals with chronic stroke (mean [SD] age, 61.5 [13.5] years; mean [SD] time since stroke, 3.3 [3.8] years), were randomized to a treatment (BWSTT,n = 23) or control (overground gait training,n = 20) group. Treatment consisted of 1 hour of gait training; 1 hour of balance activities; and 1 hour of strength, range of motion, and coordination for 10 consecutive weekdays (30 hours). Assessments (step length differential, self-selected and fast walking speed, 6-minute walk test, Berg Balance Scale [BBS], Dynamic Gait Index [DGI], Activities-specific Balance Confidence [ABC] scale, single limb stance, Timed Up and Go [TUG], Fugl-Meyer [FM], and perceived recovery [PR]) were conducted before, immediately after, and 3 months after intervention.
Results:
 No significant differences (α = 0.05) were found between groups after training or at follow-up; therefore, groups were combined for remaining analyses. Significant differences (α = 0.05) were found pretest to post test for fast walking speed, BBS, DGI, ABC, TUG, FM, and PR. DGI, ABC, TUG, and PR results remained significant at follow-up. Effect sizes were small to moderate in the direction of improvement.
Conclusions:
 Future studies should investigate the effectiveness of intensive interventions of durations greater than 10 days for improving gait, balance, and mobility in individuals with chronic stroke.
Key words:
balance, gait, mobility, rehabilitation, stroke, treadmill training

Effects of Backward Walking Training on Static Balance, Balance Confidence, and Walking Endurance of Patients with Chronic Stroke

Been done already.

If your doctor/hospital didn't do anything with this from 14 years ago or any of the following then s/he needs to be fired.  Why is your board of directors being so incompetent in not demanding new interventions from any stroke research?

Effectiveness of backward walking treadmill training in lower extremity function after stroke - Oct. 2006

“A Backward Walking Training Program to Improve Balance and Mobility in Acute Stroke: A Pilot Randomized Controlled Trial” Oct. 2017 

Walking backwards boosts creativity April 2015

 The latest here:

 

 Effects of Backward Walking Training on Static Balance, Balance Confidence, and Walking Endurance of Patients with Chronic Stroke

후방보행훈련이 만성기 뇌졸중 환자의 정적 균형, 균형 자신감과 보행지구력에 미치는 영향.  Journal of Special Education & Rehabilitation Science , Volume 57(3) , Pgs. 473-489.

NARIC Accession Number: I246477.  What's this?
Author(s): Park, Gi-Tae; Kim, Mi-Hyun; Ju, Sung-Kwang.
Publication Year: 2018.

Abstract: 

The objective of this study was to describe the effects of backward walking training (BWT) on static balance, balance confidence, and walking endurance in patients with chronic stroke. To this end, 35 patients with chronic stroke were randomly divided into experimental (BWT; n=17) and control (forward walking training [FWT]; n=18) groups. Both groups underwent a 30-minute session, three times per week for six weeks (18 sessions). Static balance (Balance System SD), Korean Activities-specific Balance Confidence scale (K-ABC), and Six-Minute Walk Test (6MWT) were assessed at baseline, after intervention, and 6 weeks after the cessation of intervention. Two-way repeated measures ANOVA was used to compare differences between and within the groups. Compared to the control group, significant improvement in static balance, balance confidence, and walking endurance was observed in the experimental group (p<.05), and the improvement was maintained at follow-ups. These results suggest that backward walking training may have a positive effect on the static balance, balance confidence, and walking capacity of patients with stroke.
Descriptor Terms: Ambulation, Balance, Stroke, Therapeutic training.
Language: Korean
Geographic Location(s): Republic of Korea, East & Southeast Asia.

Can this document be ordered through NARIC's document delivery service*?: Request Information.
Get this Document: https://www.kci.go.kr/kciportal/landing/journalArticleList.kci?vol_isse_id=VOL000102488&sere_id=001516.

Citation: Park, Gi-Tae, Kim, Mi-Hyun, Ju, Sung-Kwang. (2018). Effects of Backward Walking Training on Static Balance, Balance Confidence, and Walking Endurance of Patients with Chronic Stroke.  후방보행훈련이 만성기 뇌졸중 환자의 정적 균형, 균형 자신감과 보행지구력에 미치는 영향.  Journal of Special Education & Rehabilitation Science , 57(3), Pgs. 473-489. Retrieved 9/19/2020, from REHABDATA database.

Study: Walking backward to get ahead

Been done already.

If your doctor/hospital didn't do anything with this from 14 years ago or any of the following then s/he needs to be fired.  Why is your board of directors being so incompetent in not demanding new interventions from any stroke research?

Effectiveness of backward walking treadmill training in lower extremity function after stroke - Oct. 2006

“A Backward Walking Training Program to Improve Balance and Mobility in Acute Stroke: A Pilot Randomized Controlled Trial” Oct. 2017 

Walking backwards boosts creativity April 2015

 The latest here:

Study: Walking backward to get ahead

by Katie Pence, University of Cincinnati

Oluwole Awosika, MD, assistant professor in the department of neurology and rehabilitative medicine at the University of Cincinnati and a UC Health stroke expert. He is also a member of the UC Gardner Neuroscience Institute. Credit: Colleen Kelley/UC Creative + Brand

Walking backward may seem counterintuitive, but to athletes in training, doing so on a treadmill builds strength and agility.

Now, a researcher with the University of Cincinnati Gardner Neuroscience Institute thinks this practice could also help patients who have experienced stroke learn to walk again.
Oluwole Awosika, MD, assistant professor in the department of neurology and rehabilitative medicine at UC and a UC Health stroke expert, is leading research examining how walking backward on a treadmill might impact sensory signaling in the brain and body to improve walking in this group of patients.
He received funding from the American Academy of Neurology ($450,000 over three years) and the National Institutes of Health ($100,000 over two years) to help continue this study.
"Despite current walking rehabilitation strategies, the majority of stroke survivors are unable to walk independently and remain at an increased risk for falls," Awosika explains. "Backward treadmill training is a novel training approach used by elite athletes to enhance speed, agility and balance; however, it is currently unknown(How fucking out-of-date are you?) how this exercise interacts with the central nervous system or if it could benefit stroke survivors with remaining walking impairment.
"Knowledge gained from our study will likely lead to more effective walking rehabilitation strategies in stroke and related disorders."
In this study, researchers will use sensors to measure training-related changes to the sensory pathways in the brain and spinal cord that affect balance and position of the body, as well as walking symmetry. These changes will be compared to study participants who are assigned to walk forward on the treadmill.
"What is known is that backwards walking exercises additional groups of muscles which are underactivated and underutilized with traditional forward walking," he says. "The use of a treadmill produces a more challenging training, which may lead to faster results and greater cardiovascular conditioning.
"From a neuroscience perspective, we think that backward treadmill training requires continuous awareness of where the foot is in space to keep from falling during training. Therefore, it is possible that it may increase sensory responses, essential for signaling to brain regions controlling balance and walking symmetry, and may improve walking speed."
The basis for this project originated from a pilot study led by Awosika, and funded by the Neuroscience Institute, which tested and confirmed the safety and likelihood of this rehabilitation approach. This study was published in the journal Brain Communications.
"Walking impairment impacts nearly 66% of stroke survivors which often leads to falls and injuries. Newer and more comprehensive approaches are needed to improve walking recovery in these survivors. We hope our research reveals a more effective strategy to help this group improve their quality of life and achieve independence."

Treadmill walking with partial body weight support versus floor walking in hemiparetic subjects

It has only been 21 years, how fucking long will you allow your stroke doctors and hospital to stay incompetent by not having protocols on this? Is another 50 years good? So your grandchildren have the same incompetent and ineffective stroke rehab you had? It is up to you to change the trajectory of stoke rehab. Your stroke medical professionals have failed for decades. I suggest firings start at the top with the board of directors.

 

Treadmill walking with partial body weight support versus floor walking in hemiparetic subjects

 Stefan Hesse, MD, Matthias Konrad, MD, Dietmar Uhlenbrock, MPhil

ABSTRACT. 

Hesse S, Konrad M, Uhlenbrock D. Treadmill walking with partial body weight support versus floor walking in hemiparetic subjects. Arch Phys Med Rehabil 1999;80: 421-7. 

Objective: 

To compare the gait of hemiparetic subjects walking on a treadmill with various body weight supports and walking on the floor. Design: Hemiparetic subjects walked on a treadmill, secured in a harness, with no body weight support and with 15% and 30% body weight relief, and walked on a floor. 

Setting: 

Kinematic laboratory of a department of rehabilitation. 

Subjects: 

Eighteen hemiparetic stroke patients. 

Main Outcome Measures: 

Gait cycle parameters and kinesiologic electromyogram of six muscles of the affected side and of two muscles of the nonaffected side. 

Results: 

On the treadmill, patients walked more slowly because of a reduced cadence, with a longer single stance period of the paretic limb, more symmetrically, and with a larger hip extension (multivariate profile analysis, p < .05). The mean functional activities of the gastrocnemius muscle and of the first crest of the erector spinae of the paretic side were smaller on the treadmill (univariate test, p < .05). Further, the premature activity of the gastrocnemius muscle, indicating spasticity, was less on the treadmill (univariate test, p < .05); correspondingly the qualitative muscle pattern analysis re- vealed less co-contraction between the gastrocnemius and tibialis anterior muscles in 11 of the 18 subjects. 

Conclusions: 

Treadmill training with partial body weight support in hemiparetic subjects allows them to practice a favorable gait characterized by a greater stimulus for balance training because of the prolonged single stance period of the affected limb, a higher symmetry, less plantar flexor spasticity, and a more regular activation pattern of the shank muscles as compared with floor walking.

1999 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

The Effect of a Low-Cost Body Weight-Supported Treadmill Trainer on Walking Speed and Joint Motion

With not even a preliminary protocol on this, useless waste of time.  Survivors need EXACT DETAILED INSTRUCTIONS. Good luck getting PT for 40 weeks.

The Effect of a Low-Cost Body Weight-Supported Treadmill Trainer on Walking Speed and Joint Motion

Jessica D. Ventura
 1,
*, Ann L. Charrette
 2
and Katherine J. Roberts
 3
1
Kinesiology Department, Gordon College, Wenham, MA 01984, USA
2
School of Physical Therapy, MCPHS University, Worcester, MA 01608, USA
3
Teachers College, Columbia University, New York, NY 10027, USA
*
 Correspondence: jessica.d.ventura@outlook.com; Tel.:
+
1-978-867-4371Received: 6 June 2019; Accepted: 24 July 2019; Published: 30 July 2019

Abstract:

 Background and Objectives:
 Gait training with body weight-support has been shown to
improve the walking speed of individuals with movement disorders. The Acces Sport America Gait
Trainer is a low-cost, premarket gait rehabilitation device that alters the stride characteristics of participants walking on a standard treadmill. The purpose of this study was to examine the
 biomechanical outcomes that training on this device has for people with brain injuries that affect motor functioning. It was hypothesized that there would be an increase in walking speed post-intervention, and that there would be an increase in step length and joint range-of-motion.
 Materials and Methods:
An intervention study was conducted with 11 people with ambulatory difficulty caused by post stroke hemiparesis (n = 7), traumatic brain injury (n = 3), and cerebral palsy (n =1). The average time using
the AccesSportAmerica Gait Trainer was 34.5 (SD = 6.0) minutes per session for 36.9 (SD=21.8) sessions. Gait speed, step length and time, and joint flexion were measured during the 10 Meter Walk Test.
 Results:
 From pre- to post-intervention, there was a mean increase in walking speed of 0.19 m /s (SD=0.06, p=0.016, d=0.40) and a decrease in step time of both affected and unaffected legs (affected: p = 0.011, d = 0.37; unaffected: p = 0.004, d = 0.67). There was no significant change in stride length or joint angles. This line from the full article is most interesting.

No significant differences were found in joint angles after the training (Table 2), and no correlation was found between hours spent on the AccesSportAmerica Gait Trainer and the change in walking speed.  
This doesn't match with this line from the discussion:
 Study participants increased their walking speed by an average of 0.19m /s. An increase in speed of 0.10m/s is considered a substantial meaningful change in physical performance for community dwelling older people and subacute stroke survivors  
Conclusions: 
The AccesSportAmerica Gait Trainer has the potential(NOT GOOD ENOUGH. We need protocols that WILL DELIVER RESULTS.) to improve the walking speed of people with ambulatory difficulty.

I have no clue what was really found out.

High-tech C-Mill rehab treadmill at Northridge Hospital Medical Center is first in L.A. County

Do you really think your stroke hospital will buy this and your doctors prescribe it? My doctor pooh-poohed the usefulness of the Lokomat. I considered it the only thing that could suppress my spasticity and make walking almost normal. This wouldn't have been useful for me at all. 

Or maybe this might be better: Does your stroke hospital even know about this one, only 7 years old?

Smart Floor Hopes to Help Improve Walking Skills June 2013

 

 High-tech C-Mill rehab treadmill at Northridge Hospital Medical Center is first in L.A. County

Tina Orkin, a stroke survivor, utilizes the new C-Mill at Northridge Hospital Medical Center. The C-Mill provides safe therapy to improve balance by simulating real-life experiences.(photo by Andy Holzman).

 

 

 

The Motek C-Mill, a trend-setting motivational and therapeutic tool for patients, made its debut last week at the Center for Rehabilitative Medicine at Dignity Health-Northridge Hospital.
It’s the first of its kind in Los Angeles County, hospital officials said.

Physical Therapist Megan Grady helps stroke survivor Tina Orkin with safety equipment before she uses the the new C-Mill at Northridge Hospital Medical Center. The C-Mill provides safe therapy to improve balance by simulating real-life experiences. (Photo by Andy Holzman).

The high-tech treadmill helps patients train for everyday life’s shifting environments and changing circumstances, such as walking in a crowded room or avoiding obstacles on the sidewalk.
The C-Mill is for people who need to improve or regain balance, build a steadier gait or restore the ability to manage dual tasking — such as clearing dishes from a table and walking over to a kitchen counter at the same time.
The C-Mill, which uses a body-weight support system to keep patients from losing balance or falling, analyzes a person’s stride pattern as they walk and helps them adjust their gait.
It then uses virtual and augmented reality — adding digital images — to help the person adjust their walking to avoid obstacles in a fun and interactive rehabilitation exercise.

Patients who may benefit from the virtual treadmill include people who have:

• Suffered a brain injury
• Endured a spinal cord injury
• Been diagnosed with multiple sclerosis
• Faced orthopedic challenges
• Been diagnosed with Parkinson’s disease
• Experienced a stroke.

In the end, the most important goal of the treadmill and accompanying therapy is to help people regain the ability to live independently.
More information on the Center for Rehabilitative Medicine at Northridge Hospital is available at  dignityhlth.org/3a8ke32
 

Exercise-mediated locomotor recovery and lower-limb neuroplasticity after stroke

Maybe you can get a protocol out of this.  I don't do treadmills anymore, they don't readily transfer to the vagaries of walking over rocks, tree roots and through water.  Real life walking will train your balance much faster and you can get forest bathing out of it.

Exercise-mediated locomotor recovery and lower-limb neuroplasticity after stroke

 Larry W. Forrester, PhD;
1–2
*
 Lewis A. Wheaton, PhD;
3
 Andreas R. Luft, MD
4
1
 Department of Veterans Affairs (VA) Maryland Health Care System, Research Service, Baltimore, MD;
2
 Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD;
3
VA  Maryland Health Care System, Baltimore, MD;
4
 Hertie Brain Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany

Abstract—

Assumptions that motor recovery plateaus within months after stroke are being challenged by advances in novel motor-learning-based rehabilitation therapies. The use of lower-limb treadmill (TM) exercise has been effective in improving hemiparetic gait function. (Improving is NOT GOOD ENOUGH! We want full recovery. Damn it all, do the right thing. 100% recovery for all.)In this review, we provide a rationale for treadmill exercise as stimulus for locomotor relearning after stroke. Recent studies using neuroimaging and neurophysiological measures demonstrate central nervous system (CNS) influences on lower-limb motor control and gait. As with studies of upper limbs, evidence shows that rapid transient CNS plasticity can be elicited in the lower limb. Such effects observed after short-term paretic leg exercises suggest potential mechanisms for motor learning with TM exercise. Initial intervention studies provide evidence that long-term TM exercise can mediate CNS plasticity, which is associated with improved gait function. Critical needs are to determine the optimal timing and intensities of TM therapy to maximize plasticity and learning effects.

 

Feasibility of combining multi-channel functional neuromuscular stimulation with weight-supported treadmill training

The only way I can see the survivors being satisfied is if the tyranny of low expectations was used on them.  You don't specify that they got 100% recovered so they couldn't be satisfied unless YOU bamboozled them into thinking any recovery is a success.

Feasibility of combining multi-channel functional neuromuscular stimulation with weight-supported treadmill training

 Janis J. Daly*, Robert L. Ruff
 Department of Neurology, Case Western Reserve University School of Medicine, United States Louis Stokes Cleveland VA Medical Center, Research Service 151-W 10701 E. Blvd., Cleveland, OH 44106, United States
Received 13 April 2004; received in revised form 30 June 2004; accepted 2 July 2004Available online 27 August 2004

 

More than 3 million stroke survivors live with residual disabilities and mobility deficits even after rehabilitation. Therefore, it is important to develop new, more effective, gait training methods. The purpose of this study was twofold: (1) testing the feasibility of combining multi-channel functional neuromuscular stimulation (FNS) using intramuscular (IM) electrodes and body weight supported treadmill training(BWSTT) for gait training; and (2) documenting the potential gait practice advantages afforded by combining FNS-IM and BWSTT. Eight subjects with gait deficits in the chronic phase (
N
12 months) were enrolled. Intramuscular electrodes were placed in the paretic hip abductors,knee flexors and extensors, and ankle dorsiflexors, plantar flexors, and evertors. Subjects were treated with exercise and gait training using the combined technologies 1 1/2 h/week, four times/week, for 12 weeks. Feasibility was tested according to performance of the technologies,clinician skill factors, and subject satisfaction. Impairment, function, and quality of life were measured. Provision of practice for eight gait characteristics was catalogued. We found the following results for the combined technologies: (1) the combined technologies were safe and feasible; (2) clinicians required five training sessions to reach proficiency; (3) subjects were satisfied (4) there were significant gains in impairment and functional measures; (5) a greater number of gait practice characteristics were provided with the combined technologies than with either alone.

Effect of backward walking treadmill training on walking capacity after stroke: a randomized clinical trial

And your mentors and senior researchers incompetently didn't tell you that this research was already done?

Other research already out there: I bet your doctor and stroke hospital  are totally incompetent in not having this intervention already being used. My god, 13 and 14 years ago this research came out, bet your doctor doesn't even know about it.

Gait outcomes after additional backward walking training in patients with stroke: a randomized controlled trial - May 2005

Effectiveness of backward walking treadmill training in lower extremity function after stroke - Oct. 2006

“A Backward Walking Training Program to Improve Balance and Mobility in Acute Stroke: A Pilot Randomized Controlled Trial” Oct. 2017 

Walking backwards boosts creativity April 2015

The latest here:

Effect of backward walking treadmill training on walking capacity after stroke: a randomized clinical trial

Stella Maris Michaelsen1*, Angélica Cristiane Ovando2, Fernanda Romaguera1, and Louise Ada3
Rationale 
Residual walking deficits are common in people after stroke. Treadmill training can increase walking speed and walking distance. A new way to increase the challenge of walking is to walk backwards. Backward treadmill walking may provide advantages by promoting improvement in balance, walking spatiotemporal parameters and quality that may reflect in improving walking distance. 
Aim 
This study will test the hypothesis that backward treadmill walking is superior to forward treadmill walking in improving walking capacity, walking parameters, quality and balance in people with stroke. 
Design 
A prospective, single-blinded, randomized trial will randomly allocate 88 community-dwelling people after stroke into either an experimental or control group. The experimental group will undertake 30-min sessions of backward treadmill walking, three-days/week for six-weeks, while the control group will undertake the same dose of forward treadmill walking. Training will begin at the baseline overground walking speed and will increase each week by 10% of baseline speed. Study outcomes The primary outcome will be distance walked in the 6-min Walk Test. Secondary outcomes will be walking speed, step length, cadence, and one-leg stance time. Outcomes will be collected by a researcher blinded to group allocation at baseline (Week 0), at the end of training period (Week 6), and three-months after the cessation of intervention (Week 18). 
Discussion 
If backward treadmill walking can improve walking capacity more than forward treadmill training in stroke, it may have broader implications because walking capacity has been shown to predict physical activity level and community participation.

Rehabilitation of gait after stroke: A critical review of treadmill training with and without weight support

Hell, we don't need a review, we need the creation of protocols that directly lead to recovery. This is useless, but good conscience laundering

Rehabilitation of gait after stroke: A critical review of treadmill training with and without weight support

Step training with body weight support: Effect of treadmill speed and practice paradigms on poststroke locomotor recovery

With no controls you can't tell if this is the placebo effect, the Hawthorne effect, or the training. Bad research.

Step training with body weight support: Effect of treadmill speed and practice paradigms on poststroke locomotor recovery

Katherine J. Sullivan, PhD, PT, Barbara J. Knowlton, PhD, Bruce H. Dobkin, MD
ABSTRACT. Sullivan KJ, Knowlton BJ, Dobkin BH. Step training with body weight support: effect of treadmill speed and practice paradigms on post stroke locomotor recovery. Arch Phys Med Rehabil 2002;83:683-91.
Objective:
 To investigate the effect of practice paradigms that varied treadmill speed during step training with bodyweight support in subjects with chronic hemiparesis after stroke.
Design:
 Randomized, repeated-measures pilot study with 1-and 3-month follow-ups.
Setting:
 Outpatient locomotor laboratory.
Participants:
 Twenty-four individuals with hemiparetic gait deficits whose walking speeds were at least 50% below normal.
Intervention:
 Participants were stratified by locomotor se-verity based on initial walking velocity and randomly assigned to treadmill training at slow (0.5mph), fast (2.0mph), or variable (0.5, 1.0, 1.5, 2.0mph) speeds. Participants received 20minutes of training per session for 12 sessions over 4 weeks.
Main Outcome Measure:
 Self-selected overground walking velocity (SSV) was assessed at the onset, middle, and end of training, and 1 and 3 months later.
Results:
 SSV improved in all groups compared with base-line (P<.001). All groups increased SSV in the 1-month follow-up (P<.01) and maintained these gains at the 3-monthfollow-up (P.77). The greatest improvement in SSV across training occurred with fast training speeds compared with the slow and variable groups combined (P=.04). Effect size (ES)was large between fast compared with slow (ES=
.75) and variable groups (ES=.73).
Conclusions:
 Training at speeds comparable with normal walking velocity was more effective in improving SSV than training at speeds at or below the patient’s typical over ground walking velocity.
Key Words:
 Locomotion skills; Recovery of function; Re-habilitation.©
 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and  Rehabilitation