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ORIGINAL RESEARCH
Effects of Gait Training With Body Weight Support
on a Treadmill Versus Overground in Individuals
With Stroke
Gabriela L. Gama, MSc,
a
Melissa L. Celestino, MSc,
a
Jose
´A. Barela, PhD,
a,b
Larry Forrester, PhD,
c
Jill Whitall, PhD,
d,e
Ana M. Barela, PhD
a
From the
a
Institute of Physical Activity and Sport Sciences, Cruzeiro do Sul University, Sa˜o Paulo, SP;
b
Department of Physical Education, Sa˜o
Paulo State University, Rio Claro, SP, Brazil;
c
Maryland Exercise & Robotics Center of Excellence, Veterans Administration Maryland Health Care
System, Baltimore, MD;
d
Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, Baltimore,
MD; and
e
Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom.
Abstract
Objective: To investigate the effects of gait training with body weight support (BWS) on a treadmill versus overground in individuals with
chronic stroke.
Design: Randomized controlled trial.
Setting: University research laboratory.
Participants: Individuals (NZ28) with chronic stroke (>6mo from the stroke event).
Interventions: Participants were randomly assigned to receive gait training with BWS on a treadmill (nZ14) or overground (nZ14) 3 times a
week for 6 weeks.
Main Outcome Measures: Gait speed measured using the 10-meter walk test, endurance measured using the 6-minute walk test, functional
independence measured using the motor domain of the FIM, lower limb recovery measured using the lower extremity domain of the Fugl-Meyer
assessment, step length, step length symmetry ratio, and single-limb support duration. Measurements were obtained at baseline, immediately after
the training session, and 6 weeks after the training session.
Results: At 1 week after the last training session, both groups improved in all outcome measures except paretic step length and step length
symmetry ratio, which were improved only in the overground group (PZ.01 and PZ.01, respectively). At 6 weeks after the last training session,
all improvements remained and the treadmill group also improved paretic step length (P<.001) but not step length symmetry ratio (P>.05).
Conclusions: Individuals with chronic stroke equally improve gait speed and other gait parameters after 18 sessions of BWS gait training on
either a treadmill or overground. Only the overground group improved step length symmetry ratio, suggesting a role of integrating overground
walking into BWS interventions poststroke.
Archives of Physical Medicine and Rehabilitation 2017;98:738-45
ª2016 by the American Congress of Rehabilitation Medicine
Partial body weight support (BWS) systems have been widely
used for gait rehabilitation poststroke.
1-7
In individuals with
stroke, these systems improved body weight distribution between
paretic and nonparetic limbs as erect posture is facilitated,
5
and
they promote improvement in spatial-temporal gait characteristics,
including interlimb symmetry of stance and swing phases, muscle
activity, and joint angle excursions of the lower limbs.
8
BWS used
with treadmills facilitates performance of a high number of
symmetrical and consistent steps,
9
as well as allowing control of
walking speed. In contrast, the requirements for walking on
treadmills are different from those for overground walking, mainly
in terms of propulsion and balance.
10,11
Treadmills may provide a degree of passive movement to the
lower limbs with little change in muscular activation,
8,9,12-14
limiting the extent of skill transfer to overground walking. This
Supported by the Sa
˜o Paulo Research Foundation eFAPESP and by fellowship from Coor-
denac¸a
˜o de Aperfeic¸oamento de Pessoal de Nı
´vel Superior eCAPES. All financial support had no
influence on analysis and interpretation of data or writing of manuscript.
Clinical Trial Registration No.: NCT02088255.
Disclosures: none.
0003-9993/17/$36 - see front matter ª2016 by the American Congress of Rehabilitation Medicine
http://dx.doi.org/10.1016/j.apmr.2016.11.022
Archives of Physical Medicine and Rehabilitation
journal homepage: www.archives-pmr.org
Archives of Physical Medicine and Rehabilitation 2017;98:738-45
raises a question whether BWS alone promotes improvement in
gait performance or whether this is due to the interaction between
BWS and treadmill. A related question is whether using gait
training with BWS on would yield any differences in gait
improvement compared with BWS on the treadmill.
Only 2 studies have used overground BWS training in in-
dividuals with stroke, including a case study
15
and a single-arm
study with a small sample.
16
Sousa et al
16
reported improve-
ments in walking speed and step length symmetry ratio as well as
increased stride lengths and segmental angle rotations
17
after
overground BWS gait training, but the study lacked a treadmill
comparison group. Comparing BWS gait training in a controlled
treadmill versus overground experiment may reveal differential
effects due to use of BWS on a moving versus stationary walking
surface. The purpose of this study was to investigate the effects of
moving versus stationary walking surfaces during BWS gait
training on measures of spatial-temporal gait parameters and
clinical function in individuals with chronic stroke. It was hy-
pothesized that overground BWS training would elicit a greater
improvement in walking performance than would treadmill BWS
training, because the former would reduce the need for skill
transfer from the externally driven treadmill to fully self-generated
control of overground mobility tasks.
Methods
A randomized controlled trial was conducted using Consolidated
Standards of Reporting Trials guidelines. The study was approved
by the research ethics committee of Cruzeiro do Sul University and
was registered at ClinicalTrials.gov (Clinical Trial Registration No.:
NCT02088255). All procedures were performed with adequate
understanding, and written, signed informed consent of the partic-
ipants was obtained before entry into the study.
Setting and participants
From April 1, 2014, to June 15, 2015, 114 individuals with stroke
were contacted and invited to join the study (fig 1). One physical
therapist researcher screened all potential participants. Inclusion
criteria were chronic hemiparetic gait after an ischemic or hemor-
rhagic stroke, >6 months from the stroke event, absence of cardiac
(or medical clearance for participation), orthopedic, or pulmonary
disease or other neurologic impairment that could compromise gait
or training, ability to follow 2-step verbal commands, and ability to
walk 10m with or without assistance. Individuals who presented
with uncontrolled blood pressure were excluded. All stages of the
study were conducted in the Movement Analysis Laboratory at
Cruzeiro do Sul University, Sa
˜o Paulo, Sa
˜o Paulo, Brazil.
Randomization and blinding
After baseline testing, and using a computer-based algorithm,
participants were randomly allocated to 2 BWS groups: treadmill
training group (TMG) or overground training group. The
researcher who did the randomization and data analyses was not
involved in any assessment or training session. Complete and
continuous blinding of researchers who performed the training
sessions and the assessments was not feasible because of
personnel constraints. Participants were not blinded to the training
conditions, but were unaware of the hypothesis of the study.
Intervention protocols
The BWS system used for the TMG consisted of a treadmill
(model TK35
a
) and a metal frame with an instrumented load cell
to register the amount of supported body weight. The BWS system
(fig 2) used for the overground training group consisted of a
suspended rail (7m) mounted on the ceiling (3m) and supported by
2 steel beams.
b
A moving cart was attached to the bottom of the
rail, allowing backward and forward movements and controlled by
a belt system linked to a servomotor. A customized program
(LabVIEW
c
) was developed to control displacement, velocity, and
acceleration of the moving cart. In addition, a second servomotor
controlled unloading of body weight through a harness and
instrumented load cell system.
Training sessions were conducted 3 times weekly, with at least
1 day between sessions, for 6 weeks, totaling 18 training sessions.
Each session lasted up to 45 minutes. Throughout the training
sessions, each participant’s heart rate was monitored and blood
pressure was measured at the beginning and end of each session.
Rest intervals were provided according to individual needs.
The amount of BWS during training sessions ranged from 30%
to 0% of body weight. The amount of BWS was based on the
individual alignment of trunk and limbs with proper weight shift
and bearing onto the hemiplegic limb during the loading phases of
gait. Walking speed was set to match participants’ comfortable
level on the treadmill or overground. The overground training
group walked back and forth along the walkway. Participants were
allowed to use the front handrail of the treadmill (TMG) or the
therapist’s hand (overground training group), but through training
sessions, all participants were encouraged to walk without any
external assistance other than the BWS system.
Progression of the training was achieved by reducing the
BWS, increasing the gait speed, and/or reducing the patient
support from the handrail for the TMG and the therapist’s hand
for the overground training group. The training parameter changes
to progress the training were implemented at the beginning of
each session. The progression was maintained as long as the
participants could maintain alignment of trunk and limbs with
proper weight shift and bearing onto the hemiplegic limb during
the loading phases of gait. If not, the parameter change was
decreased to the previous value. Two trained therapists conducted
all training sessions of both groups and provided similar verbal
and manual cues.
Outcome measures and follow-up
Participants were assessed 1 week before the first training session,
1 week after the last gait training session, and 6 weeks after the
last training session. One experienced researcher took the lead on
all assessments, and standardized instructions for each test were
given to ensure consistency in test administration. Participants
underwent the following evaluations: 10-meter walk test
(10MWT),
18-20
6-minute walk test (6MWT),
21
motor domain of
the FIM,
22,23
lower extremity domain of the Fugl-Meyer
List of abbreviations:
6MWT 6-minute walk test
10MWT 10-meter walk test
BWS body weight support
FM Fugl-Meyer assessment
TMG treadmill training group
Body weightesupported training after stroke 739
www.archives-pmr.org
assessment (FM),
24
and quantitative gait analyses (see below).
Rest intervals were provided between tests according to individual
needs, when necessary.
The primary outcome measure was gait speed measured using
the 10MWT. During this test, participants were required to walk
10m at a comfortable speed. Two photocells
a
measured the time
required to cover the intermediate 6m to exclude periods of ac-
celeration and deceleration. The average of 3 trials was calculated.
Secondary outcome measures included endurance measured
using the 6MWT, functional independence measured using the
motor domain of the FIM, lower limb recovery measured using the
lower extremity domain of the FM, which evaluated the subscales
of joint pain, passive joint motion, sensibility, voluntary move-
ment, reflex activity, and coordination. Finally, paretic and non-
paretic step length, step length symmetry ratio, and paretic and
nonparetic single-limb support were measured using a computer-
ized gait analysis system during walking at a comfortable speed.
For both 10MWT and 6MWT, participants were allowed to use
assistive devices, if necessary.
The gait analysis was performed on a 7m walkway equipped
with 2 embedded force platforms (model 9286BA
d
). A comput-
erized gait analysis system (VICON
e
) with 7 infrared cameras
(Bonita 10
e
) was used to acquire data from reflective markers that
were placed on the main body landmarks (Vicon Plug-In Gait
model
e
).
25
After a calibration trial, participants were asked to walk
at a comfortable self-selected speed. They were not allowed to use
any assistive devices, but, when necessary, a therapist offered her
Fig 1 Flow diagram of the study following Consolidated Standards of Reporting Trials guidelines.
Fig 2 Representation of the BWS system adopted by the overground
training group.
740 G.L. Gama et al
www.archives-pmr.org
hand to assist their balance without providing any meaningful
mechanical support (see Results).
Data processing of gait analysis
Two consecutive and steady-state strides (paretic and nonparetic)
(4 steps) per trial by each participant were analyzed for a total of 3
selected trials for each evaluation. A stride (walking cycle) was
defined by 2 consecutive initial contacts of the same limb with the
ground along the progression line. In addition, foot contacts and
toe-offs during a stride were identified for subsequent calculation
of the spatial-temporal organization of walking for both paretic
and nonparetic sides.
The gait outcome measures analyzed in this study were step
length, calculated as the distance between the initial contact of
each foot along the progression line (determined by the position of
the heel markers); step length symmetry ratio, calculated as the
ratio between the shorter step and the longer step (we were
interested in the magnitude of asymmetry rather than its direc-
tion)
26
; and single-limb support duration (determined by the time
interval the limb supports total body weight while the contralateral
limb swings). Data analysis was performed using a customized
routine written in MATLAB.
f
Data from 3 trials for each evalu-
ation were averaged for each participant and considered for
further analyses.
Statistical analysis
For all outcome measures, comparisons between the following
assessments were made: baseline test and 1 week after the last gait
training session and baseline test and 6 weeks after the last
training session. One participant from the overground training
group missed assessment at 6 weeks after the last training session,
and her scores from the 1 week after the last gait training session
assessment were used to replace missing data, a conservative
assumption.
27,28
We used a schematic box plot for the primary
outcome measurement to test for the existence of outliers, and we
did not find any outlier. Two-way analysis of variance and
multivariate analysis of variance were used using group (TMG and
overground training group) and time of assessment (baseline test
and 1 week after the last gait training session; baseline test and 6
weeks after the last training session) as factors. The dependent
variables for the analyses of variance were 10MWT, 6MWT, FIM,
FM, and step length symmetry ratio. The dependent variables for
the multivariate analyses of variance were step length and single-
limb support of paretic and nonparetic sides. When necessary,
Tukey post hoc tests were conducted. An alevel of .05 was
adopted for all statistical tests, which were conducted using SPSS
version 22.
g
Within-group effect sizes (baseline test and 1 week after the
last gait training session; baseline test and 6 weeks after the last
training session) were calculated as the difference in mean values
from each assessment divided by the pooled SD. Effect sizes were
defined using Cohen dclassifications (dZ0.2, small; dZ0.5,
medium; dZ0.8, large).
29
Results
Thirty-two individuals with a mean age of 58.29.1 years were
randomized into the study. Random assignment generated groups
that were comparable in terms of age and time poststroke.
Twenty-eight participants completed the training protocol in the
allocated group and were included in the final analyses (table 1).
During each set of assessments, 11 participants (5 from the
overground training group, 6 from the TMG) used assistive de-
vices to perform the 10MWT and 6MWT and 8 of these partici-
pants (4 from each group) used light hand assistance for balance
from the same therapist during their gait analyses. All individuals
were interested, motivated, and cooperative throughout the
training period and assessments, and none of them reported any
intervention-related adverse effects. All participants performed all
assessments, except the 6MWT, which 6 individuals did not
perform (3 from the overground training group, 3 from the TMG)
because this test was added to the study after they had begun
training and after these individuals had self-reported walking
longer distances.
Throughout the training period, no differences were observed
between the groups for the percentage of BWS (TMG: 16.81%
7.62%; overground training group: 14.89%6.59%) or for session
duration (TMG: 376min; overground training group: 365min).
However, the mean comfortable speed set for the treadmill and the
servomotor was different (TMG: .27.07m/s; overground training
group: .52.07m/s) despite the fact that the groups were equal
during baseline 10m walking.
Clinical evaluations
At 1 week after the last gait training session, both groups
demonstrated improvements in gait speed (TMG: dZ.14; over-
ground training group: dZ.16; PZ.049), 6MWT (TMG: dZ.35;
overground training group: dZ.30; P<.001), FIM (TMG: dZ.41;
overground training group: dZ.27; P<.001), and FM (TMG:
dZ.82; overground training group: dZ.55; P<.001). At 6 weeks
after the last training session, both groups maintained these im-
provements in gait speed (TMG: dZ.25; overground training
group: dZ.32; P<.001), 6MWT (TMG: dZ.36; overground
training group: dZ.33; PZ.001), FIM (TMG: dZ.59; overground
training group: dZ.63; P<.001), and FM (TMG: dZ.99; over-
ground training group: dZ.95; P<.001). However, there were no
Table 1 General baseline characteristics of individuals
Characteristic TMG OGG P
Sex: female/male 7/7 8/6 .71*
Age (y) 58.78.4 57.710.1 .78
Mass (kg) 66.711.1 66.012.4 .86
Height (m) 1.630.08 1.600.11 .43
Time poststroke (mo) 60.255.4 53.842.2 .73
Type of lesion: I/H 12/2 10/4 .37*
Hemiparesis side: R/L 5/9 8/6 .27*
Mini-Mental State
Examination score
24.433.98 21.856.87 .23*
Baseline 10MWT (m/s) 0.690.25 0.730.28 .81
Baseline 6MWT (m) 244119 240152 .94
Baseline FIM score
(maximum, 91)
80.67.31 83.07.1 .46
Baseline FM score
(maximum, 84)
69.26.7 70.98.6 .83
Abbreviations: H, hemorrhagic; I, ischemic; L, left; OGG, overground
training group; R, right.
*c
2
test.
Body weightesupported training after stroke 741
www.archives-pmr.org
differences in improvement between the groups for any of the
clinical outcome measures at either 1 week after the last gait
training session or 6 weeks after the last training session (table 2).
Gait analyses
At 1 week after the last gait training session, both groups
increased nonparetic step length (TMG: dZ.32; overground
training group: dZ.60; P<.001); however, only participants from
the overground training group increased paretic step length
(dZ.32; P<.001) and improved step length symmetry ratio
(dZ1.08; P<.001), and both groups increased single-limb support
duration for the paretic limb only (TMG: dZ.06; overground
training group: dZ.42; PZ.015). At 6 weeks after the last training
session, both groups increased step length of both paretic (TMG:
dZ.36; overground training group: dZ.44; P<.001) and non-
paretic (TMG: dZ.40; overground training group: dZ.56;
P<.001) sides; however, only participants from the overground
training group improved step length symmetry ratio (dZ1.08;
P<.01), and both groups increased single-limb support duration
for the paretic limb only (TMG: dZ.14; overground training
group: dZ.79; PZ.006) (table 3).
Discussion
This study is the first to investigate the effects of time-matched
overground versus treadmill gait training with BWS in individuals
with stroke. We found that both groups improved their gait speed,
endurance, recovery of lower limb motor function impairments,
functional independence, nonparetic step length, and single-limb
support duration for the paretic limb only immediately after the
completion of training and at follow-up. Gait training with over-
ground BWS had an additional benefit of improving step length
symmetry ratio compared with treadmill BWS training. In addi-
tion, overground BWS training promoted immediate and durable
improvement in paretic step length whereas treadmill BWS
training improved this outcome measure only at follow-up.
Therefore, our hypothesis that overground BWS training would
be superior to treadmill BWS training for improvement in walking
performance was supported only for step length symmetry ratio.
Gait speed is one of the most common and important measures
of functional walking ability in the clinical setting
30
and is closely
associated with functional independence.
31,32
Both our study
groups demonstrated improvements in gait speed immediately
after the intervention and at follow-up. The average improvement
in gait speed of .09m/s demonstrated by both training groups
would be considered a small to substantial meaningful change in
gait speed for individuals with chronic stroke, as defined by Perera
et al.
33
This improvement was similar to or greater than that re-
ported in 2 previous studies
5,34
of BWS treadmill training that also
included a follow-up but was less than that reported in 3 other
comparable studies.
3,35,36
However, all the 3 studies that reported
larger improvements used participants who had lower initial
walking speeds and therefore may have had the potential to
demonstrate greater gains than did our participants. In addition, 2
of these studies
35,36
used longer training periods. The only pre-
vious study
16
that investigated the use of overground BWS
training reported a similar change in gait speed immediately after
training but did not include follow-up testing. Based on the results
of the present study, it appears that improvements in gait speed are
similar between BWS treadmill training and overground training.
Therefore, if a primary goal is to improve gait speed, clinicians
should rely on clinical judgment to determine which training
method would be most appropriate for an individual patient on the
basis of factors such as patient preference, safety, comfort, and
other therapeutic goals.
Gains in other clinical measures suggest that our BWS para-
digm, in either condition, has benefits other than improving
walking speed. Participants in both groups demonstrated a 50-m
improvement in 6MWT distance immediately after training and at
follow-up. This exceeds the 34.4m that has been suggested as the
minimal clinically important difference for individuals with
stroke.
37
It is also greater than, or similar to, that reported in other
treadmill training studies with and without BWS. Lower extremity
impairment, as measured using the FM, also improved by >7
points and exceeded the threshold for a perceived meaningful
recovery (6 points) by individuals with chronic stroke
38
and was
greater than the 1.5-point improvement demonstrated in the only
other BWS training study
34
reporting FM scores. Finally, the
average improvement of 3.9 points in the motor domain of the
FIM for our participants was also greater than the 1.7-point
Table 2 Outcome measures of clinical assessments
Variable
t0 t1 t2
Mean SD 95% CI Mean SD 95% CI Mean SD 95% CI
10MWT (m/s)
TMG 0.660.29 0.50e0.82 0.700.30* 0.52e0.88 0.740.34*** 0.56e0.93
OGG 0.690.30 0.53e0.85 0.740.34* 0.56e0.92 0.790.33*** 0.60e0.97
6MWT (m)
TMG 244119 158e330 291148*** 201e382 294159** 199e389
OGG 240152 154e325 283139*** 193e373 289144** 193e384
FIM score (maximum, 91)
TMG 80.47.6 76.3e84.4 83.36.6*** 79.8e86.8 84.56.3*** 81.5e87.5
OGG 82.47.1 78.4e86.5 84.26.1*** 80.7e87.7 86.14.3*** 83.1e89.0
FM score (maximum, 84)
TMG 68.77.1 64.3e73.1 74.96.7*** 70.7e79.0 75.77.0*** 71.9e79.5
OGG 69.48.8 64.9e73.8 74.18.2*** 70.0e78.3 76.96.8 73.1e80.6
NOTE. Statistic effect for t0 t1 and t0 t2; *P<.05; **P<.01; ***P<.001.
Abbreviations: CI, confidence interval; OGG, overground training group; t0, baseline; t1, posttraining; t2, follow-up.
742 G.L. Gama et al
www.archives-pmr.org
change seen in a previous BWS treadmill training study.
39
In
summary, the meaningful improvements in each of the clinical
outcome measures support the use of BWS training either on
a treadmill or overground, with no differential benefits
being observed.
The only outcome measure that was different between the
overground training group and the TMG group at follow-up was
step length symmetry ratio. This is an important finding for
several reasons. First, reduced step length symmetry ratio has been
shown to be associated with an increase in fall risk.
40
Therefore,
an improvement in step length symmetry ratio may contribute to a
reduction in fall risk during walking. Second, individuals with
stroke often desire to look more “normal”
41,42
and having a more
symmetrical gait may contribute to that goal especially when
accompanied by an increase in speed and endurance. Third,
improved symmetry may reduce the energetic cost of walking to
increase the functional range or intensity in performance of ac-
tivities of daily living.
43,44
Therefore, if a BWS system is available
for overground walking, it may be more useful than a treadmill-
based system. Although walking on a treadmill by itself will in-
crease symmetry,
9
this does not appear to carry over well to
overground walking, as reported in several studies.
5,45
Indeed, the
overground requirement to intrinsically generate leg movements
without extrinsic forcing (eg, the moving treadmill surface) may
be an important factor for promoting spatial symmetry.
One caveat to our finding that overground training improved
step length symmetry ratio is that the TMG adopted a lower self-
selected walking speed for training in comparison to the over-
ground training group. It is typical for individuals to adopt a
slower speed on the treadmill than overground, partly because
they initially feel less stable on a treadmill, perhaps owing to the
lack of visual flow and moving floor surface.
8,46
Therefore, we
cannot be certain that the improvement in step length symmetry
ratio was a result of the interaction with a stationary floor surface
or from having more repetitions. Because all other variables,
including the 10MWT improved similarly across the 2 groups and
did not, therefore, show an effect of any increased repetition, we
believe that the effect of walking overground in this study is the
more likely explanation.
Study limitations
One limitation of the study was the lack of blinding to treatment
by the testers. This could certainly cause bias, although the testers
had no specific a priori expectation of which outcome measures
were expected to improve differentially between the groups. In
addition, the testers were effectively blinded during the gait
analysis and could not, therefore, influence these variables
including step length symmetry ratio. A second limitation was a
lack of a control group, which did not receive any gait training.
The main purpose of the present article was the use of partial
BWS during gait training either on a treadmill (which is the most
common use of BWS for gait interventions) or overground.
Because our participants were in the chronic stage, we made the
assumption that a control group with no training would be un-
likely to show any short-term or follow-up improvements. In
addition, most of our participants presented relatively high mental
and motor functions, but with some of them using assistive de-
vices or hand assistance for balance during the assessments. This
may limit the generalizability to the wider population with stroke.
For future studies, we suggest the addition of a control group and
inclusion of a greater range of deficit severity with randomization
stratified by motor function.
Conclusions
The use of BWS training either on a treadmill or overground
promoted meaningful and durable improvements in gait speed,
walking endurance, lower limb function, functional independence,
and nonparetic step length. However, only overground training led
Table 3 Parameters of gait analyses
Variable
t0 t1 t2
Mean SD 95% CI Mean SD 95% CI Mean SD 95% CI
Step length (m)
TMG
P 0.400.11 0.33e0.47 0.420.12 0.35e0.48 0.440.11*** 0.37e0.51
NP 0.350.11 0.28e0.42 0.390.14*** 0.32e0.45 0.400.14*** 0.32e0.47
OGG
P 0.390.14 0.32e0.46 0.460.11* 0.39e0.52 0.450.13*** 0.38e0.52
NP 0.370.13 0.31e0.44 0.440.10*** 0.37e0.51 0.440.12*** 0.37e0.51
Step length symmetry ratio
TMG 0.800.14 0.73e0.87 0.820.13 0.76e0.87 0.810.13 0.76e0.86
OGG 0.840.11 0.77e0.91 0.930.04* 0.87e0.98 0.930.04* 0.88e0.98
Single-limb support duration (%)
TMG
P 25.78.1 21.6e29.6 26.27.6* 22.7e29.8 26.87.2** 23.2e30.4
NP 36.14.6 32.9e39.3 36.04.9 33.0e38.9 36.43.3 33.8e39.0
OGG
P 26.06.33 22.0e30.0 28.44.9* 24.9e31.9 30.85.8** 27.2e34.5
NP 36.96.8 33.8e40.2 37.65.9 34.7e40.6 37.65.9 35.0e40.2
NOTE. Statistic effect for t0 t1 and t0 t2; *P<.05; **P<.01; ***P<.001.
Abbreviations: CI, confidence interval; NP, nonparetic side; OGG, overground training group; P, paretic side; t0, baseline; t1, posttraining; t2,
follow-up.
Body weightesupported training after stroke 743
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to significant improvements in step length symmetry ratio.
Therefore, if BWS gait training is utilized for poststroke gait
rehabilitation, it may be useful to include overground training if
one of the therapeutic goals is to improve step length symme-
try ratio.
Suppliers
a. Model TK35; CEFISE Biotecnologia Esportiva.
b. BWS system; FENIX Tecnologia.
c. LabVIEW; National Instruments Corp.
d. Model 9286BA; Kistler Instruments Corp.
e. VICON; Oxford Metrics Ltd.
f. MATLAB; The MathWorks Inc.
g. SPSS version 22; IBM Corporation.
Keywords
Assistive technology; Clinical protocols; Exercise therapy;
Rehabilitation
Corresponding author
Ana M. Barela, PhD, Institute of Physical Activity and Sport
Sciences, Cruzeiro do Sul University, Rua Galva
˜o Bueno, 868,
Sa
˜o Paulo, SP 01506-000, Brazil. E-mail address: ana.barela@
cruzeirodosul.edu.br.
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