Evidence - Principles of training - walking

Question 1

Sutherland et al, 1980

Answer 1

• performed unilateral tibial nerve block in healthy people
• decreased weight transfer to front of foot and single leg stance, increased DF and knee f in stance, increased quad activity, reduced step length, walking speed, exaggerated fall of COG resulting in excessive effort to lift with intact leg
• Clinical Implications: Train PF

Question 2

Preston et al, 2011

Answer 2

• review
• likelihood of patients who are non ambulatory in first month after stroke regaining indepenedent walking
• Rehab - 60% at 3 months, 65% at 6 months and 91% at 12 months
• Acute - 39% at 3 motns, 69% at 6 months and 74% at 12 months
• CLinical implications: promote rehab untis for regaining independent ambulation

Question 3

Hesse et al, 1997

Answer 3

• effects of body weight support on treadmill walking in stroke patients
• BWS increased single leg stance however > 30% support reduced muscle activation in major lower limb muscle groups
• Clinical implications: consider BWS on treadmill walking but don’t go greater than 30%

Question 4

Ada et al, 2010

Answer 4

• review looking at how well treadmill training improves walking in acute stroke patients
• they found more patients were walking independently at 4 weeks, 6 months, aso patients were walking faster at 6 months when using treadmill
• Clinical implications: use treadmill walking for intervention

Question 5

Ada et al, 2003

Answer 5

• One group treadmill training
• One group low intensity Ex program
• treadmill group had improvements in speed, step length and endurance. ALl maintained at follow up
• Clinical Implications: Treadmill training benefiticial. Use it!!

Question 6

Balmaseda et al, 1988

Answer 6

• effects of AFO in normal walking
• AFO resulted in decreased stance, increase vertical force at push off and later shift at centre of pressure
• Don’t consider AFO initially
• Only use if no improvement

Question 7

Stanton et al, 2011

Answer 7

• systematic review at effectiveness on biofeedback in improving LL activities after stroke
• improvement in walking performance when biofeedback used in addition to usual walking training
• post stroke patients
• Clinical Implications: Use Biofeedback

Question 8

Scrivener et al, 2012

Answer 8

• measured LL ex dose and walking speed at discharge - 200 patients
• for every 100 reps completed in a day, there was an increase in walking speed of 0.08m/s
• clinical implications: aim for at least 100 reps of LL ex/day

Question 9

Mahendran et al, 2016

Answer 9

• community ambulation ability in 24 stroke patients: 1, 3 and 6 months post
• AMount of walking did not change until 6 months
• still reduced compared to healthy
• Clinical implications: Ask about community ambulation goals and specifically train to that