Effects of therapeutic gait training using a prosthesis and a treadmill for ambulatory patients with hemiparesis.

Abstract

To examine the short-term effects of a newly developed hemiparetic gait training in which patients walk with a prosthesis applied to the nonparetic leg in the flexed knee position. Pre-post nonrandomized controlled trial. Rehabilitation center and gait laboratory of a university hospital. Community-dwelling ambulatory volunteers (N=22) with chronic hemiparesis caused by a unilateral stroke. Study subjects participated in a gait training program using either a below-knee prosthesis or a treadmill. Treadmill gait training was performed at a speed approximating the maximum gait velocity for each patient. The 3-week program consisted of a 5-minute gait training session 2 to 3 times a day. The ground reaction forces, stance time, step length and cadence during walking at a comfortable speed, and maximum gait speed, as well as the Berg Balance Score, were estimated before and after each training program. In comparison with changes after the treadmill gait training, analyses of covariance demonstrated a significant increase of the fore-aft ground reaction forces during the paretic propulsion phase and a significant increase in the relative durations of the paretic and nonparetic single stance involved in a gait cycle after the prosthetic gait training (P<.05). Prosthetic gait training would have different effects on a hemiparetic gait than treadmill gait training. The gait-related task inducing the dominant use of the paretic leg to support the body may be useful as a rehabilitative treatment to improve the kinetic abilities in the paretic stance period.