Ada et al. [9
], Kang et al. [22
] and Mackay-Lyons et al. [34
] had better outcomes on treadmill interventions compared with training on the ground. However, Franceschini et al. [21
] and Dean et al. [10
] carried out a comparative study of gait treadmill training and walking on the floor. Franceschini et al. [21
] indicated improvements in both groups. Although, no differences were observed between the two groups before, during and after treatment and follow. In spite of that, Dean et al. [10
] showed that in patients, who could walk independently, there wasn’t any difference between both groups in stride length and speed. However, Duncan et al. [14
] they had a higher sample than the rest of the studies which treadmill training was used. Treadmill training with body weight support was compared with an exercise program at home managed by a physical therapist
in patients who have suffered a CVA in the last two and six month. All groups had similar improvements in walking speed, motor recovery, balance, functional state and quality of life [14
Regarding intensity on treadmill training, Kuys et al. [4
] applied high intensive to training treadmill in individuals with acute phase after stroke and they had good results in walking speed. Also, Globas et al. [5
] implemented treadmill training in a high intensive, although patients had suffered a CVA more than six month ago and they had a light chronic disability. However, Franceschini et al. [21
] indicated in 2009 that there wasn´t any agreement on the intensity, frequency and duration of gait training on treadmill.
With regard to neuronal plasticity, Hollands et al. [17
] indicated that in some studies there were quantified neuroplastic changes, which were associated with physiotherapy interventions in treadmill training to reeducate gait. Also, Luft et al. [23
] declared that exercise on treadmill recruited circuits in the cerebellum
; this reflected the plasticity of the neural network. This neuronal recruitment was associated to improvements in gait. No author indicated adverse effects of treadmill.
These authors [10
] had similar results when they compared the effects of treadmill training with training on the floor or training at home. Also, they had higher sample than other authors [9
] which results on treadmill training were better than the control group. This seems to show that treadmill is beneficial to reeducate gait in a high intensive [5
Relative to functional electrical stimulation as Physiotherapy intervention method, some authors [7
] obtained beneficial results.
The author [24
] had good results with ankle foot orthosis. Erel et al. [24
] and Carda et al. [35
] indicated better improvements in studies with Ankle Foot Orthosis than studies without ankle foot orthosis in the physical therapist intervention. Hollands et al. [17
] in their review recommend the use of ankle foot
orthosis as the use of functional electrical stimulation. In spite of that, Seze et al. [25
] recommend Hip Flexion Orthosis to improve hip flexion during walking.
Chan et al. [33
] compared the effects of vibration on the whole body in an experimental group and in a control group which follow the same process but the vibratory machine was turned off. The sample which the vibratory session was applied was very small, only there were 15 patients. Also, authors compared the effects of only one session. So, we could indicate that bigger samples are needed and a large application of this therapy to have results more completed. However, Paoloni et al. [18
] applied 12 sessions of segmental vibration therapy
. This sample was higher than the sample of Chan et al. [33
] and a major number of sessions was applied. In spite of that, authors showed different effects respect to vibration therapy. On the one hand, Chan et al. [33
] explicated that when vibration therapy was applied in whole the body, the spasticity was smaller in plantar flexors. On the other hand, Paoloni et al. [18
] indicated that when vibration therapy was applied in a segmentary way on the dorsiflexor muscles in the ankle, dorsal flexion was increased, but also the plantar flexion was increased during the swing phase of gait. So, we could suggest in the future major number of studies of this kind of therapy with larger samples, more number of sessions and these sessions can be applied by a segmental or global way to have more enlightening results.
With regard to the use of canes, Polese et al. [26
] had improvements on the gait and they didn’t indicated adverse effects. Also, Guillebastre et al. [29
] recommend the use of cane on patients who didn´t load more than 40% of their body weight in the hemiplegic lower limb. However, Polese et al. [26
] applied their study to patients who the majority of them had a satisfactory walking speed. So, in this case, the improvement that they had when the patients used the cane couldn´t be enough clear because there were patients in the sample who had few problems to walk and perhaps their body weight support could be higher to 40% in the hemiplegic lower limb.
Robotic devices to assisted walking are becoming on a popular alternative to gait reeducation [36
]. The authors Hesse et al. [31
] Koopman et al. [15
] Schwartz et al. [16
] realized an assisted gait training with robot followed by a physical therapy reeducation walking program by a manual way. The authors had better results in the experimental group than the control group who hadn’t been intervened with robotic devices. That suggests us that the addiction of the robot to the Physical Therapy
program had beneficial effects. Koopman et al. [15
] used an exoskeleton in healthy patients and in patients who had suffered a CVA. There were [12
] healthy patients compared with 6 patients with CVA. So, the sample of patients with CVA was smaller, also this sample didn´t follow a proportion respect the number of healthy patients. Furthermore, Mehrholz et al. [11
] had better results with an end effector than results with exoskeletons.
Relative to bodyweight support systems with electromechanical devices Iosa et al. [27
] used a suspended harness system bigger than Carr and Shepherd 2 used which had to be minor than 30% body weight support.
Referring to auditory stimuli, Muto et al. [32
] had beneficial effects in an experimental group with a feedback device to the lower limbs with auditory stimuli when the experimental group was compared with a control group. Also, Sungkarat et al. [20
] realized that their results showed beneficial effects in the application of auditory feedback during gait reeducation. Tanaka et al. [30
] indicated that an uniform repetitive movement could be useful to patients with chronic CVA. Also, Hollands et al. [17
] said that repetitive intervention which was implemented in the specific practice of a task seemed to have promising approaches to restore coordination of gait.
Bayon et al. [13
] indicated on their review that immersive systems were the best indicated to reeducate gait after a CVA. Also, Cho KH et al. [8
] used an immersive virtual reality system for gait training after CVA and patients had significant improvements p<0. 05.