Resistance-based, reciprocal upper and lower limb locomotor training in chronic stroke: a randomized, controlled crossover study

Abstract

Objective: To determine efficacy of a bilateral reciprocal training regimen on affected leg impairment and dynamic balance. Design: Randomized, controlled, single-blinded crossover study. Setting: Outpatient rehabilitation hospital. Participants: Seven patients who experienced stroke >1 year prior to study entry exhibiting affected leg weakness. Intervention: Subjects were randomly assigned to receive both of the following in a randomized, sequential order: (a) a resistance-based, reciprocal, affected leg locomotor training protocol using the NuStep apparatus ( n = 4) and (b) a home exercise programme (HEP) consisting of self-supervised practice with fractionated joint movements of the lower limb. Each phase of the intervention was performed for 30 minutes each session, three days a week, and conducted over an eight-week period. Main outcome measures: Outcomes were evaluated by a blinded rater using the lower extremity scale of the Fugl-Meyer and the Berg Balance Scale. Results: After HEP participation, subjects showed nominal or no changes on any of the outcome measures. After NuStep participation, patients in both treatment groups showed impairment reductions as shown by the Fugl-Meyer (+4.3; +2.2), and increased balance as shown by the Berg Balance Scale (+4.0; +4.0). These trends were exhibited regardless of group assignment. Conclusion: Impairment reductions and balance gains may be achieved using a resistance-based, reciprocal upper and lower limb locomotor training protocol.