Abstract
Introduction: Stroke is a leading cause of disability in the United States and it occurs when blood supply to part of the brain is interrupted or severely reduced, depriving brain tissue of oxygen and nutrients. Around 50-80% of people who have experienced a stroke typically recover their ability to walk, but still have many difficulties associated with their gait. This can negatively impact their body composition, physical fitness, and ability to interact in the community. Prior research has shown that using partial body weight support training, as well as visual biofeedback, has been helpful in improving gait and balance for people who have experienced a stroke. Therefore, the purpose of this research is to examine the use of underwater treadmill training with use of real-time visual feedback for improving ambulation in people who have experienced a stroke. Research Design: This research was a single subject design study examining outcomes of underwater treadmill training of a 58 year-old male who sustained a right cerebellar stroke 12 months ago. The participant underwent pre- and post intervention measures for balance and gait: GAITRite© system walking, Timed-Up-and-Go, and Dynamic Gait Index. The intervention of underwater treadmill training using real-time visual feedback was applied for 8 sessions of about 45 minutes each session, which included warm-up exercises and a cool-down period. Outcomes: The participant showed slight trends towards improved balance in his gait analysis and functional outcome measures. Specifically, his average time spent on each leg was closer to equal, average step length of each foot increased, the length of stride increased, and his overall step width decreased from pre-intervention to post-intervention. For the functional tests of balance, his Timed-Up-and-Go score improved (9.0 sec to 8.2 sec). Furthermore, the participant was able to improve his DGI score by 4 points from pre-test to post-test, which indicates a clinically important difference was made for his overall dynamic standing balance. Conclusion: The changes in outcome measures, in conjunction with subjective statements made by the participant, suggest that underwater treadmill training with real-time visual feedback may be beneficial for patients who have experienced a stroke up to a year ago. Further research should be conducted performing a longer randomized controlled study with more participants to determine if these results may be generalized. Furthermore, the participants of the study should demonstrate higher levels of impairments, as the participant in this study had minimal impairments. This would allow for potentially larger gains in outcomes.