Effects of stroke severity and training duration on locomotor recovery after stroke: a pilot study

Document Type


Publication Date


Publication Title

Neural Rehabilitation and Neural Repair



Medical Subject Headings

Stroke, Locomotion, Rehabilitation, Recovery


Background. Locomotor training using partial body weight– supported treadmill (BWST) walking has been widely investigated for people after stroke, yet there remains a lack of evidence concerning the optimal training duration and the effect of locomotor impairment severity. Previous protocols have not emphasized the transfer of locomotor skills from the BWST environment to overground.

Objectives. To assess the feasibility of a program combining locomotor training using BWST with task-specific overground training and to obtain pilot data on the effects of severity and training duration on recovery of locomotion.

Methods. Seven adults with chronic poststroke hemiparesis and gait speed less than 0.8 m/s were recruited to participate in a 12-week (36 session) locomotor training program. Each session comprised 20 to 30 minutes of training using BWST with manual assistance, followed by 10 to 15 minutes of overground training to transfer the skills trained in the BWST environment. Gait speed was the primary outcome measure.

Results. Six out of the 7 enrolled individuals completed the intervention program; 1 was withdrawn due to transportation difficulties affecting compliance with the training schedule. Four of the 6 participants had a functionally significant improvement in walking speed after 36 sessions, defined as having achieved a 0.4 m/s gait speed or greater for those with initial severe gait speed impairment (

Conclusions. A locomotor training program combining walking using BWST and manual assistance with overground practice is feasible for people with chronic poststroke hemiparesis and moderate or severe gait speed impairment. This intervention shows promise for achieving functionally significant improvements in walking speed.





First Page


Last Page


PubMed ID



DOI: https://doi.org/10.1177/1545968306295559


1. Jorgensen HS, Nakayama H, Raddshou HO, et al. Recovery of walking function in stroke patients: the Copenhagen Stroke Study. Arch Phys Med Rehabil. 1995;76:27-32.

2. Dean CM, Mackey FH. Motor Assessment Scale scores as a measure of rehabilitation outcome following stroke. Aust J Physiother. 1992;38:31-35.

3. Hill K, Ellis P, Bernhardt J, et al. Balance and mobility outcomes for stroke patients: a comprehensive audit. Aust J Physiother. 1997;43:173-180.

4. Duncan P, Richards L, Wallace D, et al. A randomized, controlled pilot study of a home-based exercise program for individuals with mild and moderate stroke. Stroke. 1998;29:2055-2060.

5. Green J, Forster A, Bogle S, et al. Physiotherapy for patients with mobility problems more than 1 year after stroke: a randomised controlled trial. Lancet. 2002;359:199-203.

6. McGinley J. Criteria for Community Ambulation: Implications for Stroke Rehabilitation (Vol. 3). Melbourne: Australian Physiotherapy Association (Vic) Neurology Research Forum; 1992.

7. Perry J, Garrett M, Gronley JK, et al. Classification of walking handicap in the stroke population. Stroke. 1995;26:982-989.

8. Lennihan L, Wootten M, Wainwright M, et al. Treadmill with partial body weight support versus conventional gait training after stroke. Arch Phys Med Rehabil. 2003;84:A5.

9. Hesse S, Werner C, Seibel H, et al. Treadmill training with partialbody weight support after total hip arthroplasty: a randomized controlled trial. Arch Phys Med Rehabil. 2003;84:1767-1773.

10. Kosak MC, Reding MJ. Comparison of partial body weight-supported treadmill gait training versus aggressive bracing assisted walking post stroke. Neurorehabil Neural Repair. 2000;14:13-19.

11. Nilsson L, Carlsson J, Danielsson A, et al. Walking training of patients with hemiparesis at an early stage after stroke: a comparison of walking training on a treadmill with body weight support and walking training on the ground.Clin Rehabil. 2001;15:515-527.

12. Ada L, Dean CM, Hall JM, et al. A treadmill and overground walking program improves walking in persons residing in the community after stroke: a placebo-controlled, randomized trial. Arch Phys Med Rehabil. 2003;84:1486-1491.

13. Barbeau H, Visintin M. Optimal outcomes obtained with bodyweight support combined with treadmill training in stroke patients. Arch Phys Med Rehabil. 2003;84:1458-1465.

14. da Cunha IT, Lim PAC, Qureshy H, et al. A comparison of regular rehabilitation and regular rehabilitation with supported treadmill ambulation training for acute stroke patients. J Rehabil Res Dev. 2001;38:245-255.

15. da Cunha IT, Lim PA, Qureshy H, et al. Gait outcomes after acute stroke rehabilitation with supported treadmill ambulation training: a randomized controlled pilot study. Arch Phys Med Rehabil. 2002;83:1258-1265.

16. Hesse S, Bertelt C, Jahnke MT, et al. Treadmill training with partial body weight support compared with physiotherapy in nonambulatory hemiparetic patients. Stroke. 1995;26:976-981.

17. Hesse S, Malezic M, Schaffrin A, et al. Restoration of gait by combined treadmill training and multichannel electrical stimulation in non-ambulatory hemiparetic patients. Scand J Rehabil Med. 1995;27:199-204.

18. Hesse S, Konrad M, Uhlenbrock D. Treadmill walking with partial body weight support versus floor walking in hemiparetic subjects. Arch Phys Med Rehabil. 1999;80:421-427.

19. Pohl M, Mehrholz J, Ritschel C, et al. Speed-dependent treadmill training in ambulatory hemiparetic stroke patients: a randomized controlled trial. Stroke. 2002;33:553-558.

20. Sullivan KJ, Knowlton BJ, Dobkin BH. Step training with body weight support: effect of treadmill speed and practice paradigms on poststroke locomotor recovery. Arch Phys Med Rehabil. 2002;83:683-691.

21. Trueblood PR. Partial body weight treadmill training in persons with chronic stroke. Neurorehabilitation. 2001;16:141-153.

22. Visintin M, Barbeau H, Korner-Bitensky N, et al. A new approach to retrain gait in stroke patients through body weight support and treadmill stimulation. Stroke. 1998;29:1122-1128.

23. Werner C, Bardeleben A, Mauritz K-H, et al. Treadmill training with partial body weight support and physiotherapy in stroke patients: a preliminary comparison. Eur J Neurol. 2002;9:639-644.

24. Moseley AM, Stark A, Cameron ID, et al. Treadmill training and body weight support for walking after stroke [Cochrane Review]. The Cochrane Library. 2005;4.

25. Hesse S, Bertelt C, Schaffrin A, et al. Restoration of gait in nonambulatory hemiparetic patients by treadmill training with partial body-weight support. Arch Phys Med Rehabil. 1994;75:1087-1093.

26. Moseley AM, Stark A, Cameron ID, et al. Treadmill training and body weight support for walking after stroke [Cochrane Review]. The Cochrane Library. 2003;3.

27. Laufer Y, Dickstein R, Chefez Y, et al. The effect of treadmill training on the ambulation of stroke survivors in the early stages of rehabilitation: a randomized study. J Rehabil Res Dev. 2001;38: 69-78.

28. Forssberg H, Grillner S, Rossignol S. Phasic gain control of reflexes from the dorsum of the paw during spinal locomotion. Brain Res. 1977;132:121-139.

29. Forssberg H. Stumbling corrective reaction: a phase-dependent compensatory reaction during locomotion. J Neurophysiol. 1979; 42:936-953.

30. Forssberg H. On integrative motor functions in the cats spinal cord. Acta Physiol Scand Suppl. 1979;474:1-56.

31. Barbeau H. Locomotor training in neurorehabilitation: emerging rehabilitation concepts. Neurorehabil Neural Repair. 2003;17: 3-11.

32. World Health Organization. Stroke - 1989: recommendations on stroke prevention, diagnosis, and therapy. Report of the WHO Task Force on Stroke and Other Cerebrovascular Disorders. Stroke. 1989;20:1407-1431.

33. Folstein MF, Robins LN, Helzer JE. The Mini-Mental State Examination. Arch Gen Psychiatry. 1983;40:812.

34. Folstein MF, Folstein SE, McHugh PR. “Mini-Mental State.” A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189-198. Plummer et al 150 Neurorehabilitation and Neural Repair 21(2); 2007

35. Yesavage JA, Brink TL, Rose TL, et al. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res. 1982;17:37-49.

36. Craik R, Dutterer L. Spatial and temporal characteristics of foot fall patterns. In: Craik R, ed.Gait Analysis: Theory and Application. St. Louis, MO: Mosby-Year Book; 1995:143-158.

37. Behrman AL, Harkema SJ. Locomotor training after human spinal cord injury: a series of case studies. Phys Ther. 2000;80:688-700.

38. Mahler DA. The American College of Sports Medicine’s Guidelines for Exercise Testing and Prescription. 5th ed. Philadelphia, PA: Williams and Wilkins; 1995.

39. Rimmer JH, Riley B, Creviston T, et al. Exercise training in a predominantly African-American group of stroke survivors. Med Sci Sports Exercise. 2000;32:1990-1996.

40. Patla AE, Shumway-Cook A. Dimensions of mobility: defining the complexity and difficulty associated with community mobility. J Aging Phys Activity. 1998;7:7-19.

41. Shumway-Cook A, Patla AE, Stewart A, et al. Environmental demands associated with community mobility in older adults with and without mobility disabilities. Phys Ther. 2002;82:670-681.

42. Pohl M, Duncan PW, Perera S, et al. Influence of stroke-related impairments in performance in 6-minute walk test. J Rehabil Res Dev. 2002;39:439-444.

43. Bowden MG, Balasubramanian CK, Neptune RR, et al. Anteriorposterior ground reaction forces as a measure of paretic leg contribution in hemiparetic walking. Stroke. 2006;37:872-876.

44. Guyatt GH, Sullivan MJ, Thompson PJ, et al. The 6-minute walk: a new measure of exercise capacity in patients with chronic heart failure. Can Med Assoc J. 1985;132:919-923.

45. Macko R, Haeuber E, Shaughnessy M, et al. Portable ambulatory and activity monitoring in hemiparetic stroke patients. Presented at the 2nd National Department of Veterans Affairs Rehabilitation Research and Development Conference, Arlington, VA; 2000.

46. Haeuber E, Shaughnessy M, Forrester LW, et al. Accelerometer monitoring of home- and community-based ambulatory activity after stroke. Arch Phys Med Rehabil. 2004;85:1997-2001.

47. Macko RF, Haeuber E, Shaughnessy M, et al. Microprocessorbased ambulatory activity monitoring in stroke patients. Med Sci Sports Exercise. 2002;34:394-399.

48. Michael KM, Allen JK, Macko RF. Reduced ambulatory activity after stroke: the role of balance, gait, and cardiovascular fitness. Arch Phys Med Rehabil. 2005;86:1552-1556.

49. Shaughnessy M, Michael KM, Sorkin JD, et al. Steps after stroke: capturing ambulatory recovery. Stroke. 2005;36:1305-1307.

50. Bilney B, Morris M, Webster K. Concurrent related validity of the GAITRite® walkway system for quantification of the spatial and temporal parameters of gait. Gait Posture. 2003;17:68-74.

51. Gladstone DJ, Danells CJ, Black SE. The Fugl-Meyer assessment of motor recovery after stroke: a critical review of its measurement properties. Neurorehabil Neural Repair. 2002;16:232-240.

52. Fugl-Meyer A, Jaasko L, Leyman I, et al. The post-stroke hemiplegic patient. I. A method for evaluation of physical performance. Scand J Rehabil Med. 1975;7:13-31.

53. Berg K, Wood-Dauphinee S, Williams J. The Balance Scale: reliability assessment with elderly residents and patients with an acute stroke. Scand J Rehabil Med. 1995;27:27-36.

54. Powell LE, Myers AM. The Activities-specific Balance Confidence (ABC) Scale. J Gerontol - Series A Biol Sci Med Sci. 1995;50A.

55. Meyers AM, Fletcher PC, Myers AH, et al. Discriminative and evaluative properties of the Activities-specific Balance Confidence (ABC) scale. J Gerontol: Med Sci. 1998;53A:M287-M294.

56. Botner EM, Miller WC, Eng JJ. Measurement properties of the Activities-specific Balance Confidence Scale among individuals with stroke. Disabil Rehabil. 2005;27:156-163.

57. Duncan PW, Wallace D, Lai SM, et al. The Stroke Impact Scale Version 2.0: evaluation of reliability, validity, and sensitivity to change. Stroke. 1999;30:2131-2140.

58. Duncan PW, Bode RK, Lai SM, et al. Rasch analysis of a new stroke-specific outcome scale: the Stroke Impact Scale. Arch Phys Med Rehabil. 2003;84:950-963.

59. Schmid A, Duncan PW, Studenski S, et al. Meaningful Changes in Gait Velocity After Stroke. Gainesville: University of Florida; 2006.

60. Dean CM, Richards CL, Malouin F. Task-related circuit training improves performance of locomotor tasks in chronic stroke: a randomized, controlled pilot trial. Arch Phys Med Rehabil. 2000;81:409-417.

61. Belli A, Bui P, Berger A, et al. A treadmill ergometer for three-dimensional ground reaction forces measurement during walking. J Biomechanics. 2001;34:105-112.

62. Duncan PW. Stroke recovery and rehabilitation research.J Rehabil Res Dev. 2002;39:ix-xi.