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Locomotor Training for Stroke Rehab Offers No Advantage

Locomotor training on a treadmill and home-based physical therapy produce similar results

WEDNESDAY, May 25 (HealthDay News) -- There is no significant difference between locomotor training and home exercise for rehabilitation after a stroke, according to a study published in the May 26 issue of the New England Journal of Medicine.

Pamela W. Duncan, P.T., Ph.D., from Duke University in Durham, N.C., and colleagues investigated the use of locomotor training for rehabilitation after a stroke. A total of 408 stroke patients aged 18 years or older with varying levels of walking impairment two months after a stroke were randomly assigned to one of three groups: 139 to early locomotor training on a treadmill with use of body-weight support starting after two months, 143 to late locomotor training starting after six months, and 126 to home-exercise training starting after two months. Each group underwent 36 sessions of 90 minutes each for 12 to 16 weeks. All of the patients were evaluated after one year for an improvement in functional walking ability.

The investigators found that 52 percent of all participants had increased functional walking ability at one year. There were no significant differences in improvement between early locomotor training and home exercise or between late locomotor training and home exercise. Similar improvements were seen for all groups in walking speed, motor recovery, balance, functional status, and quality of life. The one-year outcome was not affected by the time of onset of locomotor training, or the severity of the initial impairment.

"Our findings did not establish the superiority of locomotor training on a treadmill that included body-weight support over home-based physical therapy that emphasized strength and balance," the authors write.

One author disclosed financial relationships with pharmaceutical companies, including Allergan, GlaxoSmithKline, and Wyeth.

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