Combined effects of backward treadmill training and botulinum toxin type A therapy on gait and balance in patients with chronic stroke: A pilot, single-blind, randomized controlled trial

Article type: Research Article

Authors: Munari, Daniele^a | Serina, Anna^b | Disarò, Jacopo^b | Modenese, Angela^a | Filippetti, Mirko^b | Gandolfi, Marialuisa^{a; b} | Smania, Nicola^{a; b; *} | Picelli, Alessandro^{a; 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