Novel treadmill system to help with poststroke rehab

A novel, automated, speed-sensing treadmill is an effective and safe option for patient rehabilitation after stroke, according to a new Singapore study.

The Variable Automated Speed and Sensing Treadmill II (VASST II) is “a hybrid automated speed-sensing treadmill system with partial [body weight support (BWS)] mechanism,” researchers said. Patients “experienced significant improvements in walking capacity, gait speed, and overall balance ability at the end of training.”

Eleven ambulant, stroke patients (median age, 53.0 years; 63.6 percent male) were enrolled and underwent VASST II training for 60 minutes each day, three times per week, over five weeks. Most (54.5 percent) were in the chronic phase of stroke, while the rest were still in the subacute phase. More than half were able to ambulate independently on level ground at baseline. [Front Neurol 2020;11:747]

Distance walked and gait speed showed improvements by the 6th week. Results of the 6-minute walk test (6MWT) increased by 44.9±49.2 m, representing a significant 39.4-percent improvement from baseline. The change was statistically significant (p=0.003).

This persisted until week 12 (change, 56.18±63.84 m; p=0.007) and week 24 (change, 58.82±80.37 m; p=0.013), at which time points researchers logged a significant 49.3-percent and 51.6-percent improvement in 6MWT relative to baseline. No statistical improvements were reported, however, when week 6 was used as reference.

The VASST II system likewise yielded improvements in gait speed, as measured by the 10-metre walk test (10MWT). By week 6, speed had increased by 0.12±0.15 m/s relative to baseline, corresponding to a 33.7-percent improvement (p=0.016). This persisted until week 12, during which a speed jump of 0.17±0.21 m/s was recorded, representing a 45.9-percent increase from baseline (p=0.018).

The novel device was also deemed to be safe, with no cases of VASST II training-associated serious adverse events or falls over the five training weeks. Three participants (27.3 percent) reported transient muscle and joint aches which spontaneously resolved within 24 hours of the training session.

During the follow-up period, there was one report of stroke, one case of a minor fall, one incident of epileptic seizure, and one knee injury. None were attributable to the VASST II training. There were no dropouts recorded.

Importantly, all enrolled participants found the VASST II training system to be valuable in improving their walking ability and were open to undergoing further training session. Nine participants said their training experience was good or excellent.

“A randomized, controlled trial with a larger sample size of adequate statistical power and longer training period to compare VASST II against standard treadmill or overground training techniques would be necessary to establish the superiority and usability of VASST II over conventional strategies in improving locomotor abilities after stroke,” the researchers said.

“Insights from this pilot study will facilitate further enhancements and technical iterations to allow it to be used in the future by rehabilitation clinics to train hemiplegic gait,” they added.