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Article type: Research Article
Authors: Munari, Danielea | Serina, Annab | Disarò, Jacopob | Modenese, Angelaa | Filippetti, Mirkob | Gandolfi, Marialuisaa; b | Smania, Nicolaa; b; * | Picelli, Alessandroa; b
Affiliations: [a] Department of Neurosciences, Neurorehabilitation Unit, University Hospital of Verona, Verona, Italy | [b] Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy
Correspondence: [*] Address for correspondence: Nicola Smania, MD, Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, P. le L.A. Scuro, 10, 37134 Verona, Italy. Tel.: +39 0458124573; Fax: +39 0458124495; E-mail: [email protected].
Abstract: BACKGROUND:Backward walking is recommended to improve the components of physiological gait in neurological disease. Botulinum toxin type A is an effective safe first line-treatment for post-stroke spasticity. OBJECTIVE:To compare the effects of backward treadmill training (BTT) versus standard forward treadmill training (FTT) on motor impairment in patients with chronic stroke receiving botulinum toxin type A therapy. METHODS:Eighteen chronic stroke patients were randomly assigned to receive BTT (n = 7) or FTT (n = 11) as adjunct to botulinum toxin type A therapy. A total of twelve 40-minute sessions (3 sessions/week for 4 weeks) of either BTT or FTT were conducted. A blinded assessor evaluated the patients before and after treatment. The primary outcome was the 10-meter Walking Test (10 MWT). Secondary outcomes were the modified Ashworth Scale, gait analysis, and stabilometric assessment. RESULTS:Between-group comparison showed a significant change on the 10 MWT (P = 0.008) and on stabilometric assessment [length of centre of pressure CoP (P = 0.001) and sway area (P = 0.002) eyes open and length of CoP (P = 0.021) and sway area (P = 0.008) eyes closed] after treatment. CONCLUSIONS:Greater improvement in gait and balance was noted after BTT than after FTT as an adjunct to botulinum toxin therapy in patients with chronic stroke.
Keywords: Postural balance, locomotion, muscle spasticity, rehabilitation, stability, cerebral stroke
DOI: 10.3233/NRE-203067
Journal: NeuroRehabilitation, vol. 46, no. 4, pp. 519-528, 2020
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