Turning-Based Treadmill Training Improves Turning Performance and Gait Symmetry After Stroke

Background. Turning is a challenging task for stroke patients. Programs that effectively target turning, however, have not been established. Objective. This study examined the effects of a novel turning-based treadmill training on turning performance, gait symmetry, balance, and muscle strength in patients with chronic stroke. Methods. Thirty participants were randomly assigned to the experimental group that received 30 minutes of turning-based treadmill training or to the control group that received 30 minutes of regular treadmill training, followed by a 10-minute general exercise program for 12 sessions over 4 weeks. Primary outcomes (overground turning speed and temporal-spatial characteristics of straight walking) and secondary outcomes (balance and muscle strength) were assessed at baseline, after training, and at 1-month follow-up. Results. Fifteen participants per group were 54.2 +/- 9.6 years old, poststroke 2.6 +/- 1.9 years, and walked overground at 0.59 +/- 0.28 m/s. Sixteen had an ischemic and 14 a hemorrhagic stroke. There were significant interaction effects between groups and time on turning speed regardless of turning direction, straight-walking performance (speed and temporal symmetry), strength of hip muscles and ankle dorsiflexors, and balance control (Berg Balance Scale, weight shifting in the forward direction and vestibular function). Compared with the control group, the experimental group showed greater improvements in these measures following training. These improvements persisted at the 1-month follow-up evaluation. Conclusions. Turning-based treadmill training may be a feasible and effective strategy to improve turning ability, gait symmetry, muscle strength, and balance control for individuals with chronic stroke.