The Effect of Gait Pattern in Hemiplegia Patients through ...

Journal of The Korean Society of Integrative Medicine 2014 2(1) 23~34httpdxdoiorg1015268ksim201421023

ISSN 2288-1174

985103 23 985103

The Effect of Gait Pattern in Hemiplegia Patients through

Progressive Speed Increase Treadmill Training

Lee Hyoungsoo RPT PhDǂ

Dept of Physical Therapy Gwangju Health University

점진적인 속도증진 트레드밀 훈련이 뇌졸중 환자의

보행패턴에 미치는 영향

이형수ǂ

광주보건대학교 물리치료과

Abstract

연구목적 본 연구의 목적은 8주간의 점진적인 속도증진 훈련이 뇌졸중환자의 족저압 보행주기 보행대칭성에 어떠

한 영향을 주는지 알아보는 것이다 연구방법 연구에 참여한 대상자들은 뇌졸중으로 진단 받고 N병원에 입원한 편마비환자 20명(실험군 10명 대조군

10명)을 대상으로 하였다 이들은 모두 물리치료와 작업치료를 받았고 실험군은 주3회 8주간의 트레드밀 보행훈련를

받았고 대조군은 받지 않았다 실험전 후에 F-scan을 이용하여 보행주기 보행대칭성을 검사하였다 연구결과 8주 후 보행주기는 실험군의 양하지지지기ⅠmiddotⅡ 단하지지지기에서 모두 유의하게 증가하였으나 대조군

에서는 양하지지지기 Ⅱ 단하지지지기에서 유의하게 증가하였다 유각기는 실험군과 대조군 모두 유의하지는 않았다 보행대칭성은 입각기 대칭성에서 대조군과 비교하여 실험군에서 유의하게 증가하였으나 유각기 대칭성은 실험군과 대

조군 모두 유의하지 않았다 결론 뇌졸중 환자에 있어 보행훈련은 보행주기과 보행대칭성과 를 개선시키며 특히 점진적인 속도 증진훈련은 양

하지지지기 단하지지지기 입각기 보행대칭성에 효과적인 방법으로 사용될 수 있을 것으로 보인다

Key Words 보행대칭성 보행주기 보행훈련 족저압 편마비

ǂCorresponding authorLee Hyoungsoo hsleeghuackr 010-5385-7420접수일 2013년 12월 28일 | 수정일 2014년 01월 24일 | 게재확정일 2014년 02월 14일

대한통합의학회지 제2권 제1호

985103 24 985103

Ⅰ Introduction

Restoration of gait is one of the goals in the

rehabilitation of hemiplegia patients To reach that

goal therapists apply either a traditional functional

approach with strengthening and practicing of single

movements or various neurofascilitation techniques

such as the Brunnstrom technique with synergistic

movements proprioceptive neuromuscular facilitation

with spiral and diagonal movements and neurodevelo-

pmental(Bobath) therapy with reflex inhibitory

movements(Dewald 1987) However these methods

are complex and do not stress gait practice perse

(Hesse 1995 Liston 2000)

The use of treadmill training with partial body

weight support has been a promising investigational

therapy in the rehabilitation of patients with

hemiparesis(Hesse et al 1994 Visintin et al 1998)

and impaired gait(Visintin amp Barbeau 1989 Wernig

amp Muller 1992 Dietz et al 1994) It is a task-

specific therapy enabling wheelchair-bound subjects

to practice complex gait cycles repeatedly The

theoretical background to this therapy involves

entrainment of spinal and supraspinal pattern

generators(Lovely et al 1986 Asanuma amp Keller

1991 Carr amp Shepherd 1998)

Since higher-level gait disorder is a type of motor

programming failure(Nutt et al 1993) it is

reasonable to anticipate that these damaged programs

might be re-activated by training especially since

there is now considerable evidence of plasticity in the

damaged adult nervous system which may be

influenced by sensory input particularly that from

normal activity(Kidd et al 1992) One way of

creating input for more normal walking is in the

forced of assisted walking situation of a treadmill

Animal studies have shown that the adult spinal

cord can recover a near-normal walking pattern after

a period of interactive locomotors training in which

weight support for the hindquarters is provided hence

facilitating stepping on a treadmill(Smith et al 1982

Rossignol et al 1986 Barbeau et al 1987) In

paraplegic patients Dietz et al(1994) observed that

coordinated stepping movements were induced by

standing on a moving treadmill and that with daily

training the amplitude of electromyographic activity

increased This strongly supports the idea of induced

plastic change normalizing neuronal activity as a

result of activation of spinal locomotors centers These

spinal locomotors centers or central pattern

generators(CPG) are closely involved in the regulation

of movement There is evidence that training can

modify the interaction between the central pattern

generator programs and peripheral reflex activity

(Armstrong 1988) Normally descending influences

from the motor cortex cerebellum and brainstem

activate these central pattern generators

In the patient with higher-level gait disorder who

has sustained extensive damage to supraspinal

control it may be assumed that descending drive is

attenuated to the point where the threshold of

activation is not exercised The rationale of treadmill

re-training is that inputs from the periphery would act

to reinforce or recalibrate existing but degraded

programs permitting them to be more easily

activated(Pohl 2002)

Smith et al(1999) reported that the progressive

treadmill aerobic exercise training improved volitional

torque and torquetime generation and reduced

The Effect of Gait Pattern in Hemiplegia Patients through Progressive Speed Increase Treadmill Training

985103 25 985103

reflexive torquetime production in the affected limb

Pohl et al(2002) demonstrated that gait therapy with

structured speed-dependent treadmill training(STT)

was and effective approach resulting in a superior

walking ability in ambulatory hemiplegia patients in

comparison with the Bobath or PNF and LTT

strategies

As a supplement to conventional therapies

treadmill training can significantly improve the results

of gait training(Dobkin 1999 Hesse 1999) Whether

treadmill training is actually superior to other gait

therapies is disputed(Hesse 1999 Davies 1999)

With seriously afflicted patients who cannot walk

under their own power treadmill training with body

weight support is recommended(Visintin et al 1998

Dobkin 1999) However the most effective combin-

ation of training parameters(eg amount and timing

of body weight support during the gait cycle belt

speed and acceleration) is still unknown

Drawing on principles of training we have

developed a gait training program(PSITT progressive

speed increase treadmill ambulation training) suitable

for ambulatory Hemiplegia patients

The purpose of the present study was to determine

if there was a difference in the gait cycle gait

symmetry and foot pressure of Hemiplegia patients

with and without 8 weeks PSITT(progressive speed

increase treadmill ambulation training) in order to

evaluate the effectiveness of the PSITT program

We hypothesized that there would be differences

between PSITT group and non-PSITT(CPT) group in

the gait cycle of single support phase in the gait

symmetry of single support(support phase in affected

sidesupport phase in non-affected side) and swing

phase(swing phase in affected sideswing phase in

non-affected side) and in the displacement of COP

after 8 weeks treadmill training

Ⅱ Methods

1 Subjects

We recruited 20 hemiparesis from the Korean

National Rehabilitation Center Hemiparesis was

caused by ischemic stroke or intracerebral

hemorrhage Eligible subjects had to be at least 12

weeks from their first supratentorial stroke Further

inclusion criteria included (1) ambulatory all of

them were able to walk without personal assistance

(functional ambulation categories=3) (2) no evidence

of heart failure absence of ischemia or during

exercise appropriate rise in systolic blood pressure

during exercise and the absence of non-sustained or

sustained ventricular tachycardia (3) no other

orthopedics or neurological diseases impairing

mobility and (4) able to understand at least simple

instructions and the meaning of the study The

average age of the group was 5535 years(range 40 -

73 years) and 45 were women

2 Experimental and Control Groups

The 20 subjects were randomized into one of two

groups the experimental group(PSITT n=10) and

the control group(non-PSITT n=10) by block

randomization on the basis of the initial time required

to walk 45 meters without assistance(Table 1) The

experimental group received gait training on a

treadmill while full weight bearing on their lower


985103 26 985103

extremities for 8 weeks at a frequency of three times

a week(20 minutes duration) and also received the

conventional physical therapy for 20 minutes three

times a week The conventional physical therapy

following the Neurodevelopmental or Bobath(NDT)

concept included gait-preparatory maneuverrsquos while

sitting and standing and the practice of gait itself

either on the floor or on the stairs The control group

only received the conventional physical therapy for

40 minutes three times a week

3 Training Programs and Strategies

The strategy focused on a straight trunk and limb

alignment with proper weight shift and weight

bearing onto the Hemiplegia limb during the loading

phases of gait as well as stepping to advance the

limb forward Training programs are shown in Table

2 The special training strategies are described below

4 PSITT (Progressive Speed Increase Treadmill

Ambulation Training)

All subjects wore a safety belt and assisted during

the treadmill training by a physical therapist The

therapist gave no assistance in the actual performance

of the movements The comfortable over ground

walking speed(Vi) was determined before the first

training phase In the first training phase(2 weeks)

treadmill speed set up at Vi and the treadmill speed

was increased by 25 at each training phase(2

weeks) passed The treadmills were run at 10

incline

5 CPT (Conventional Physical Therapy)

Physiotherapeutic gait therapy based on the latest

description of the principles of the proprioceptive

neuromuscular facilitation(PNF) and Bobath

concepts(Lennon 2001 Wang 1994) was performed

by experienced and skilled therapists with qualifi-

cation in the PNF and Bobath techniques Strategies

followed in these sessions emphasized general

bilateral and 3-dimensional movements required for

turning rolling kneeling sitting standing and so on

facilitation of selective movement on the paretic side

of the body integration of the selective movement in

functional activity exercise for improving balance

and so forth Overground walking was an integral

part of conventional therapy but with less emphasis

on distance walked than on gait quality(eg

equilibrium stability during stance phase foot

clearance during swing phase prepositioning of the

foot heel contact body weight transfer)(Mayr et al

2007)

6 Measurement Tools and Variables

All subjects were evaluated before commencement

of training and again at the completion of the 8-week

training period The outcome variables(gait cycle gait

symmetry and foot pressure) were measured using

the F-scan(Foot-scan ver 3623) during which

subjects walked at preferred and increasing velocities

The experimental group(PSITT) and the control group

(non-PSITT CPT) were compared in terms of gait

cycle gait symmetry and foot pressure


985103 27 985103

Total Experimental Group Control Group

No of subjects 20 10 10Age (y) Mean 5535 529 5780 SD 888 997 733Range 40-73 40-69 46-73Days poststroke (mo) Mean 1245 121 128 SD 1135 1083 1243Range 3-44 3-41 3-44Sex Male 11 6 5Female 9 4 5Side of hemiplegia Right 10 6 4Left 10 4 6Cause ischemic 10 5 5hemorrhage 10 5 5

Table 1 Demographic Data of Study Subjects

Group Program

Experimental(n=10)

CPT (30min 3 timesweek)gait-preparatory maneuvers (sitting and standing conditions)Practice of gait itself (one the floor or the stairs)PSITT (20min 3 timesweek)progressive speed increase treadmill ambulation training (increasing by 25 per 2 weeks)

Control(n=10)

CPT (30min 3 timesweek)gait-preparatory maneuvers (sitting and standing conditions)Practice of gait itself (one the floor or the stairs)

Table 2 Training Programs

7 Statistical Analysis

A paired t-test was used to determine differences

in the change of outcome variables(gait cycle gait

symmetry and foot pressure) within each group

during the training period An independent t-test was

used to determine differences of mean in the outcome

variables between two groups(experimental and

control group) For all tests and α-level of 5 was

assumed We used the standard software package

SPSS 100 for Windows


985103 28 985103

Fig 1 The cycle of double support Ⅰphase in gait cycle Fig 2 The cycle of single support phase in gait cycle

variables GroupPre-test

(Baseline)Post-test

(after 8weeks)Different within groups Different between groups

Mean SD Mean SD Mean SD p Value Mean SD p Value

Double support Ⅰphase( cycle)

EG 2280 341 1658 279 622 334 0001393 452 023

CG 2222 416 1993 300 229 245 016

Single support phase( cycle)

EG 2257 249 3412 272 -1155 265 0001-605 464 003

CG 2263 473 2753 375 -490 194 0001

Double support Ⅱphase( cycle)

EG 2231 289 1474 285 757 389 0001482 379 003

CG 2244 416 2009 276 235 223 009

Swing phase( cycle)

EG 3252 319 3456 254 -204 341 091-246 370 065

CG 3267 421 3245 348 22 191 724

EG Experimental Group(PSITT+CPT) CG Control Group(CPT) NS Non-significant

Table 3 Change of gait cycle in affected side(Unit cycle)

Ⅲ Results

The 10 subjects were randomized into the PSITT

group and the other 10 subjects were randomized into

the non-PSITT(CPT) group All completed the entire

study protocol

Table 3 shows the gait cycle of each phase(double

support Ⅰ single support double support Ⅱ and

swing phase) The gait cycle values of double support

Ⅰ phase and double support Ⅱ phase decreased

significantly single support phase at affected side

increased significantly in the both group An

independent t-test revealed significant differences

between the PSITT and non-PSITT(CPT) groups on the

mean difference of double support Ⅰ phase(622plusmn334

versus 229plusmn245 plt05) single support phase (-1155

plusmn265 versus -490plusmn194 p〈01) and double support

Ⅱ phase(757plusmn389 versus 235plusmn 223 plt01)

However there were no significant differences between

the two groups for the swing phase


985103 29 985103

Fig 3 The cycle of double support Ⅱ phase in gait cycle Fig 4 The cycle of swing phase in gait cycle

Fig 5 Change of gait cycle symmetry in support phase Fig 6 Change of gait cycle symmetry in swing phase


(Baseline)Post-test



Single support phase symmetry

EG 70 11 99 01 -29 10 0001-13 15 003

CG 71 19 86 17 -15 06 0001

Swing phase symmetry

EG 146 25 101 02 45 24 000115 36 15

CG 150 38 120 29 30 19 001

Single support phase symmetry support phase in affected side support phase in non-affected side Swing phase symmetry swing phase in affected side swing phase in non-affected side

Table 4 Change of gait cycle symmetry

Table 4 shows the gait symmetry in single support

phase(support phase in affected sidesupport phase in

non-affected side) and swing phase(swing phase in

affected sideswing phase in non-affected side) The

gait symmetry in single support phase and swing

phase increased significantly in the both group

(plt01) An independent t-test revealed non-significant

differences between the PSITT and non-PSITT(CPT)

groups on the mean difference in the single support

phase(-29plusmn10 versus -15plusmn06 plt01) However

there were no significant differences between the two

groups for the swing phase symmetry


985103 30 985103

Fig 7 Change of displacement of COP in affected side Fig 8 Change of displacement of COP in non-affected side


(Baseline)Post-test



Affected sideEG 1829 402 2326 305 497 136 0001

181 207 005CG 1845 597 2161 601 316 118 0001

Non-affected sideEG 2961 464 2439 450 -522 195 0001

235 186 004CG 2983 372 2696 370 -287 53 0001

Table 5 Change of displacement of COP(anterior - posterior direction)

Table 5 shows the displacement of COP(anterior -

posterior direction) in affected and non-affected side of

each group The displacement of COP(anterior -

posterior direction) in affected side of the PSITT

group and CPT group increased significantly after 8

weeks of training(plt001) However in the non-

affected side of the PSITT group and CPT group the

displacement of COP decreased significantly(plt0001)

An independent t-test revealed significant differences

between the PSITT and non-PSITT(CPT) groups on

the mean difference in all of two sides(plt01)

Ⅳ Discussion

The locomotor training was based on neuromuscular

principles of locomotion from animal and human

research studies(Lovely et al 1986 Harkema et al 1997

de Leon et al 1998 Patel et al 1998) Given the

response of the cases reported here there appear to be

several factors that are key to maximizing the locomotor

capacity of individuals after a stroke First maximum

weight bearing of the lower limbs is important during

stance Second when the speed of locomotion replicated

normal walking speeds(Craik and Dutterer 1995) less

manual assistance and greater independence while

stepping were observed Third by ensuring sufficient

hip extension and unloading of the limb at the end of

stance the swing phase of the step cycle was facilitated


985103 31 985103

Fourth weight bearing on the arms appeared to inhibit

rhythmic stepping with the lower extremities but a

reciprocating arm swing in a natural coordinated form

facilitated stepping(Werner 2002)

Traditionally the physical rehabilitation of

individuals typically ended within several months

after stroke because it was believed that most if not

all recovery of motor function occurred during this

interval Nevertheless recent research studies have

shown that aggressive rehabilitation beyond this time

period including treadmill exercise with or without

body weight support increases aerobic capacity and

sensorimotor function(Hesse et al 1994 Smith et al

1999 Macko et al 1997)

Kwakkel et al(1999) reported that greater intensity

of leg rehabilitation improved gait ability and

activities of daily living in acute stroke victims

Further Richards et al(1993) had shown that an

additionally applied task-specific program including

treadmill training without body weight support

resulted in a larger gait velocity in acute stroke

victims 6 weeks after study onset as compared with a

conventionally treated group who received less

therapy Conventional gait rehabilitation following

stroke usually is designed to emphasize facilitation of

recovery through strengthening and endurance

training of the unaffected muscles and compensation

for nonremediable deficits by using braces and

assistive devices for support(Somers 1992 Atrice et

al 1995) Together these therapeutic strategies are

designed to promote maximum functional capacity of

muscles and to compensate for the absence of

volitional lower limb muscle contractions or for

weakness Given the generally accepted assumption

that repair and recovery of the damaged brain is not

possible(Basso 1998) successful mobility is

dependent on learning new behavioral strategies

(Finger 1988) requiring either a wheelchair andof

bracing with assistive devices

One of the important goals in the rehabilitation of

hemiplegia patients is to improve the gait symmetry

To achieve this goal we have developed a gait

training program(PSITT progressive speed increase

treadmill ambulation training) suitable for ambulatory

Hemiplegia patients To evaluate the effects of 8

weeks of task-oriented treadmill exercise we

measured outcome variables(gait cycle gait symmetry

and displacement of COP)

We found support for 3 of our 3 hypotheses The

three hypotheses that were supported were that there

would be differences between PSITT group and

non-PSITT(CPT) group in the gait cycle of double

support Ⅰ phase and double support Ⅱ phase single

support phase and the gait symmetry in single

support phase that there would be differences


the displacement of COP after 8 weeks of treadmill

training The hypothesis that was not supported was

that there would be differences between PSITT group

and non-PSITT(CPT) group in the gait symmetry of

swing phase after 8 weeks treadmill training Instead

we found that the gait symmetry in swing phase

increased significantly but the fait symmetry in

swing phase decreased significantly in the PSITT

group(plt05)

In each gait cycle there were two periods of

double support and two periods of single support

The stance phase usually lasts about 60 of the

cycle the swing phase about 40 and each period

of double supports about 10 in a normal persons


985103 32 985103

gait(Michael 1996) However this varies with the

speed of walking the swing phase becoming

proprotionately longer and the stance phase and

double support phases shorter as the speed increases

(Murray 1967) We showed herein that the 8 weeks

PSITT(progressive speed increase treadmill

ambulation training) program decreased the cycle

values of double support Ⅰphase(EG 622plusmn334

versus CG 229plusmn245 plt05) double support Ⅱ phase(EG 757plusmn389 versus CG 235plusmn223 plt01)

of the PSITT group significantly(plt05) and the

cycle of single support phase at affected side

increased significantly in both groups(EG

-1155plusmn265 versus CG 490plusmn194 plt01) These

results indicated that the PSITT group resembled a

normal persons gait pattern than the non-PSITT(CPT)

group

The gait symmetry in single support phase(support

phase in affected sidesupport phase in non-affected

side) increased significantly in the both group(plt01)

However the gait symmetry in swing phase(swing

phase in affected sideswing phase in non-affected

side) decreased significantly in the both group(plt01)

An independent t-test revealed non-significant






The center of pressure is the point on the ground

through which a single resultant force appears to act

although in reality the total force is made up of

innumerable small force vectors spread over a finite

area on the surface In this study the displacement of

COP means the displacement from the position of

COP at initial contact(the beginning of the loading

response which is the first period of the stance

phase) to the position of COP at toe off(the point at

which the stance phase ends and the swing phase

begins)

The displacement of COP(anterior - posterior

direction) in affected side of the PSITT group

increased significantly after 8 weeks training(plt05)

The PSITT group revealed larger increasement than

non-PSITT(CPT) group in the displacement of COP

This would imply that the PSITT program result in a

larger supporting phase in affected side and enlarged

the step length

There were two main limitations of our research

design First only 20 hemiplegia patients in the Korean

National Rehabilitation Center were used in this study

Second because the investigators collecting the data

were aware of group membership of the participants

our expectations may have influenced their performance

Further research is needed to continue perfecting this

strategy It is important to investigate ldquoWhat is the most

effective timing intensity and duration of the PSITT

trainingrdquo and ldquoWhat is PSITT trainings long-term

effects on other areas of physical performance and

fitnessrdquo

Ⅴ Conclusion

This study demonstrates that gait therapy with the

PSITT is an effective approach because it results in

better gait ability(normal gait patten gait symmetry

larger supporting phase in affected side and

enlargement of step length) in ambulatory hemiplegia


985103 33 985103

patients in comparison with the CPT(Bobath of PNF)

However the timing intensity and duration of the

PSITT training as well as its long-term effects on

other areas of physical performance and fitness

require further investigation in more rigorous

randomized controlled studies

Acknowledgment

The Research has been conducted by the Research

Grant of Gwangju Health University in Gwangju

(3012014)

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Restoration of gait in nonambulatory hemiparetic

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Hesse S(1999) Treadmill training with partial body

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Human lumbosacral spinal cord interprets loading

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Intensity of leg and arm training after primary

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Conventional physiotherapy and treadmill

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Treadmill aerobic exercise training reduces the

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The response of neural locomotor circuits to

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Speed-dependent treadmill training in ambulatory

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Locomotion in exercised and nonexercised cats

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Smith GV Silver KH Goldberg AP et al(1999)

ldquoTask-orientedrdquo exercise improves hamstring

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Visintin M Barbeau H(1989) The effects of body

weight support on the locomotor pattern of spastic

paretic patients Can J Neurol Sci 16(3) 315-325

Visintin M Barbeau H Korner-Bitensky N et

al(1998) A new approach to retrain gait in stroke

patients through body weight support and

treadmill stimulation Stroke 29(6) 1122-1128

Werner C Bardeleben A Mauritz KH et al(2002)


support and physiotherapy in stroke patients a

preliminary comparison Eur J Neurol 9(6) 639-

644

Wernig A Muller S(1992) Laufband locomotion

with body weight support improved walking in

persons with severe spinal cord injuries

Paraplegia 30(4) 229-238


985103 24 985103

Ⅰ Introduction

Restoration of gait is one of the goals in the

rehabilitation of hemiplegia patients To reach that

goal therapists apply either a traditional functional

approach with strengthening and practicing of single

movements or various neurofascilitation techniques

such as the Brunnstrom technique with synergistic

movements proprioceptive neuromuscular facilitation

with spiral and diagonal movements and neurodevelo-

pmental(Bobath) therapy with reflex inhibitory

movements(Dewald 1987) However these methods

are complex and do not stress gait practice perse

(Hesse 1995 Liston 2000)

The use of treadmill training with partial body

weight support has been a promising investigational

therapy in the rehabilitation of patients with

hemiparesis(Hesse et al 1994 Visintin et al 1998)

and impaired gait(Visintin amp Barbeau 1989 Wernig

amp Muller 1992 Dietz et al 1994) It is a task-

specific therapy enabling wheelchair-bound subjects

to practice complex gait cycles repeatedly The

theoretical background to this therapy involves

entrainment of spinal and supraspinal pattern

generators(Lovely et al 1986 Asanuma amp Keller

1991 Carr amp Shepherd 1998)

Since higher-level gait disorder is a type of motor

programming failure(Nutt et al 1993) it is

reasonable to anticipate that these damaged programs

might be re-activated by training especially since

there is now considerable evidence of plasticity in the

damaged adult nervous system which may be

influenced by sensory input particularly that from

normal activity(Kidd et al 1992) One way of

creating input for more normal walking is in the

forced of assisted walking situation of a treadmill

Animal studies have shown that the adult spinal

cord can recover a near-normal walking pattern after

a period of interactive locomotors training in which

weight support for the hindquarters is provided hence

facilitating stepping on a treadmill(Smith et al 1982

Rossignol et al 1986 Barbeau et al 1987) In

paraplegic patients Dietz et al(1994) observed that

coordinated stepping movements were induced by

standing on a moving treadmill and that with daily

training the amplitude of electromyographic activity

increased This strongly supports the idea of induced

plastic change normalizing neuronal activity as a

result of activation of spinal locomotors centers These

spinal locomotors centers or central pattern

generators(CPG) are closely involved in the regulation

of movement There is evidence that training can

modify the interaction between the central pattern

generator programs and peripheral reflex activity

(Armstrong 1988) Normally descending influences

from the motor cortex cerebellum and brainstem

activate these central pattern generators

In the patient with higher-level gait disorder who

has sustained extensive damage to supraspinal

control it may be assumed that descending drive is

attenuated to the point where the threshold of

activation is not exercised The rationale of treadmill

re-training is that inputs from the periphery would act

to reinforce or recalibrate existing but degraded

programs permitting them to be more easily

activated(Pohl 2002)

Smith et al(1999) reported that the progressive

treadmill aerobic exercise training improved volitional

torque and torquetime generation and reduced


985103 25 985103







strategies































Ⅱ Methods

1 Subjects



























985103 26 985103





























incline




















2007)












985103 27 985103




Group Program

Experimental(n=10)


Control(n=10)














985103 28 985103



(Baseline)Post-test




EG 2280 341 1658 279 622 334 0001393 452 023

CG 2222 416 1993 300 229 245 016


EG 2257 249 3412 272 -1155 265 0001-605 464 003

CG 2263 473 2753 375 -490 194 0001


EG 2231 289 1474 285 757 389 0001482 379 003

CG 2244 416 2009 276 235 223 009

Swing phase( cycle)

EG 3252 319 3456 254 -204 341 091-246 370 065

CG 3267 421 3245 348 22 191 724



Ⅲ Results




study protocol
















985103 29 985103




(Baseline)Post-test




EG 70 11 99 01 -29 10 0001-13 15 003

CG 71 19 86 17 -15 06 0001


EG 146 25 101 02 45 24 000115 36 15

CG 150 38 120 29 30 19 001
















985103 30 985103



(Baseline)Post-test



Affected sideEG 1829 402 2326 305 497 136 0001

181 207 005CG 1845 597 2161 601 316 118 0001


235 186 004CG 2983 372 2696 370 -287 53 0001













Ⅳ Discussion
















985103 31 985103

































































group(plt05)







985103 32 985103
















group























begins)








the step length












fitnessrdquo

Ⅴ Conclusion







985103 33 985103







Acknowledgment



(3012014)

Refferences






2 1-30
















1263













Press





976-981





1087-1093




13(3) 179-182





985103 34 985103






Lancet 354(9174) 191-196








421-435










pair 21(4) 307-314







24 2104


















Exp Neurol 76(2) 393-413
















644






985103 25 985103







strategies































Ⅱ Methods

1 Subjects



























985103 26 985103





























incline




















2007)












985103 27 985103




Group Program

Experimental(n=10)


Control(n=10)














985103 28 985103



(Baseline)Post-test




EG 2280 341 1658 279 622 334 0001393 452 023

CG 2222 416 1993 300 229 245 016


EG 2257 249 3412 272 -1155 265 0001-605 464 003

CG 2263 473 2753 375 -490 194 0001


EG 2231 289 1474 285 757 389 0001482 379 003

CG 2244 416 2009 276 235 223 009

Swing phase( cycle)

EG 3252 319 3456 254 -204 341 091-246 370 065

CG 3267 421 3245 348 22 191 724



Ⅲ Results




study protocol
















985103 29 985103




(Baseline)Post-test




EG 70 11 99 01 -29 10 0001-13 15 003

CG 71 19 86 17 -15 06 0001


EG 146 25 101 02 45 24 000115 36 15

CG 150 38 120 29 30 19 001
















985103 30 985103



(Baseline)Post-test



Affected sideEG 1829 402 2326 305 497 136 0001

181 207 005CG 1845 597 2161 601 316 118 0001


235 186 004CG 2983 372 2696 370 -287 53 0001













Ⅳ Discussion
















985103 31 985103

































































group(plt05)







985103 32 985103
















group























begins)








the step length












fitnessrdquo

Ⅴ Conclusion







985103 33 985103







Acknowledgment



(3012014)

Refferences






2 1-30
















1263













Press





976-981





1087-1093




13(3) 179-182





985103 34 985103






Lancet 354(9174) 191-196








421-435










pair 21(4) 307-314







24 2104


















Exp Neurol 76(2) 393-413
















644






985103 26 985103





























incline




















2007)












985103 27 985103




Group Program

Experimental(n=10)


Control(n=10)














985103 28 985103



(Baseline)Post-test




EG 2280 341 1658 279 622 334 0001393 452 023

CG 2222 416 1993 300 229 245 016


EG 2257 249 3412 272 -1155 265 0001-605 464 003

CG 2263 473 2753 375 -490 194 0001


EG 2231 289 1474 285 757 389 0001482 379 003

CG 2244 416 2009 276 235 223 009

Swing phase( cycle)

EG 3252 319 3456 254 -204 341 091-246 370 065

CG 3267 421 3245 348 22 191 724



Ⅲ Results




study protocol
















985103 29 985103




(Baseline)Post-test




EG 70 11 99 01 -29 10 0001-13 15 003

CG 71 19 86 17 -15 06 0001


EG 146 25 101 02 45 24 000115 36 15

CG 150 38 120 29 30 19 001
















985103 30 985103



(Baseline)Post-test



Affected sideEG 1829 402 2326 305 497 136 0001

181 207 005CG 1845 597 2161 601 316 118 0001


235 186 004CG 2983 372 2696 370 -287 53 0001













Ⅳ Discussion
















985103 31 985103

































































group(plt05)







985103 32 985103
















group























begins)








the step length












fitnessrdquo

Ⅴ Conclusion







985103 33 985103







Acknowledgment



(3012014)

Refferences






2 1-30
















1263













Press





976-981





1087-1093




13(3) 179-182





985103 34 985103






Lancet 354(9174) 191-196








421-435










pair 21(4) 307-314







24 2104


















Exp Neurol 76(2) 393-413
















644






985103 27 985103




Group Program

Experimental(n=10)


Control(n=10)














985103 28 985103



(Baseline)Post-test




EG 2280 341 1658 279 622 334 0001393 452 023

CG 2222 416 1993 300 229 245 016


EG 2257 249 3412 272 -1155 265 0001-605 464 003

CG 2263 473 2753 375 -490 194 0001


EG 2231 289 1474 285 757 389 0001482 379 003

CG 2244 416 2009 276 235 223 009

Swing phase( cycle)

EG 3252 319 3456 254 -204 341 091-246 370 065

CG 3267 421 3245 348 22 191 724



Ⅲ Results




study protocol
















985103 29 985103




(Baseline)Post-test




EG 70 11 99 01 -29 10 0001-13 15 003

CG 71 19 86 17 -15 06 0001


EG 146 25 101 02 45 24 000115 36 15

CG 150 38 120 29 30 19 001
















985103 30 985103



(Baseline)Post-test



Affected sideEG 1829 402 2326 305 497 136 0001

181 207 005CG 1845 597 2161 601 316 118 0001


235 186 004CG 2983 372 2696 370 -287 53 0001













Ⅳ Discussion
















985103 31 985103

































































group(plt05)







985103 32 985103
















group























begins)








the step length












fitnessrdquo

Ⅴ Conclusion







985103 33 985103







Acknowledgment



(3012014)

Refferences






2 1-30
















1263













Press





976-981





1087-1093




13(3) 179-182





985103 34 985103






Lancet 354(9174) 191-196








421-435










pair 21(4) 307-314







24 2104


















Exp Neurol 76(2) 393-413
















644






985103 28 985103



(Baseline)Post-test




EG 2280 341 1658 279 622 334 0001393 452 023

CG 2222 416 1993 300 229 245 016


EG 2257 249 3412 272 -1155 265 0001-605 464 003

CG 2263 473 2753 375 -490 194 0001


EG 2231 289 1474 285 757 389 0001482 379 003

CG 2244 416 2009 276 235 223 009

Swing phase( cycle)

EG 3252 319 3456 254 -204 341 091-246 370 065

CG 3267 421 3245 348 22 191 724



Ⅲ Results




study protocol
















985103 29 985103




(Baseline)Post-test




EG 70 11 99 01 -29 10 0001-13 15 003

CG 71 19 86 17 -15 06 0001


EG 146 25 101 02 45 24 000115 36 15

CG 150 38 120 29 30 19 001
















985103 30 985103



(Baseline)Post-test



Affected sideEG 1829 402 2326 305 497 136 0001

181 207 005CG 1845 597 2161 601 316 118 0001


235 186 004CG 2983 372 2696 370 -287 53 0001













Ⅳ Discussion
















985103 31 985103

































































group(plt05)







985103 32 985103
















group























begins)








the step length












fitnessrdquo

Ⅴ Conclusion







985103 33 985103







Acknowledgment



(3012014)

Refferences






2 1-30
















1263













Press





976-981





1087-1093




13(3) 179-182





985103 34 985103






Lancet 354(9174) 191-196








421-435










pair 21(4) 307-314







24 2104


















Exp Neurol 76(2) 393-413
















644






985103 29 985103




(Baseline)Post-test




EG 70 11 99 01 -29 10 0001-13 15 003

CG 71 19 86 17 -15 06 0001


EG 146 25 101 02 45 24 000115 36 15

CG 150 38 120 29 30 19 001
















985103 30 985103



(Baseline)Post-test



Affected sideEG 1829 402 2326 305 497 136 0001

181 207 005CG 1845 597 2161 601 316 118 0001


235 186 004CG 2983 372 2696 370 -287 53 0001













Ⅳ Discussion
















985103 31 985103

































































group(plt05)







985103 32 985103
















group























begins)








the step length












fitnessrdquo

Ⅴ Conclusion







985103 33 985103







Acknowledgment



(3012014)

Refferences






2 1-30
















1263













Press





976-981





1087-1093




13(3) 179-182





985103 34 985103






Lancet 354(9174) 191-196








421-435










pair 21(4) 307-314







24 2104


















Exp Neurol 76(2) 393-413
















644






985103 30 985103



(Baseline)Post-test



Affected sideEG 1829 402 2326 305 497 136 0001

181 207 005CG 1845 597 2161 601 316 118 0001


235 186 004CG 2983 372 2696 370 -287 53 0001













Ⅳ Discussion
















985103 31 985103

































































group(plt05)







985103 32 985103
















group























begins)








the step length












fitnessrdquo

Ⅴ Conclusion







985103 33 985103







Acknowledgment



(3012014)

Refferences






2 1-30
















1263













Press





976-981





1087-1093




13(3) 179-182





985103 34 985103






Lancet 354(9174) 191-196








421-435










pair 21(4) 307-314







24 2104


















Exp Neurol 76(2) 393-413
















644






985103 31 985103

































































group(plt05)







985103 32 985103
















group























begins)








the step length












fitnessrdquo

Ⅴ Conclusion







985103 33 985103







Acknowledgment



(3012014)

Refferences






2 1-30
















1263













Press





976-981





1087-1093




13(3) 179-182





985103 34 985103






Lancet 354(9174) 191-196








421-435










pair 21(4) 307-314







24 2104


















Exp Neurol 76(2) 393-413
















644






985103 32 985103
















group























begins)








the step length












fitnessrdquo

Ⅴ Conclusion







985103 33 985103







Acknowledgment



(3012014)

Refferences






2 1-30
















1263













Press





976-981





1087-1093




13(3) 179-182





985103 34 985103






Lancet 354(9174) 191-196








421-435










pair 21(4) 307-314







24 2104


















Exp Neurol 76(2) 393-413
















644






985103 33 985103







Acknowledgment



(3012014)

Refferences






2 1-30
















1263













Press





976-981





1087-1093




13(3) 179-182





985103 34 985103






Lancet 354(9174) 191-196








421-435










pair 21(4) 307-314







24 2104


















Exp Neurol 76(2) 393-413
















644






985103 34 985103






Lancet 354(9174) 191-196








421-435










pair 21(4) 307-314







24 2104


















Exp Neurol 76(2) 393-413
















644





The Effect of Gait Pattern in Hemiplegia Patients through ...

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