Physical therapy at home is as effective as body-weight support locomotor training

This trial examined the benefit of locomotor training with body-weight support in the recovery of walking ability after a stroke. The optimal time to begin locomotor training after the stroke was also examined.

Many stroke survivors suffer from limitations in walking that restrict their mobility within the community, or within the home. Therefore, physical therapy, often at home, is used to improve the ability to walk after strokes. Physical therapy focuses on progressive restoration of muscle strength, flexibility, and balance in order to improve quality of life.

Recent trials have suggested that body-weight support locomotor training (stepping on a treadmill with a mechanical arm supporting part of the body-weight) might improve walking recovery. However, compared to home exercise, body-weight support locomotor training requires expensive equipment and a larger support staff with more training. Patients may also be less likely to comply with the treatment regimen.

408 patients recovering from a stroke and suffering from a walking limitation were included in this trial. 139 patients were assigned to early locomotor training (beginning 2 months after the stroke) and 143 patients received late locomotor training (beginning 6 months after the stroke). As a control group, researchers assigned 126 patients to receive home exercise sessions with a physical therapist. The functional level of walking 1 year after the stroke was compared between patients receiving early locomotor training, late locomotor training, or home physical therapy.

52.0% of all patients experienced an increase in their functional level of walking. No significant difference was found among the three groups. Body-weight support locomotor training was not better in improving recovery compared to home-administered physical therapy. The timing of locomotor training did not affect the outcome. In addition, locomotor training was associated with a higher rate of minor adverse events (such as falls), and a higher percent of patient drop-out, compared to home exercise.

This study concluded that home physical therapy is a more pragmatic form of rehabilitation, with similar benefit and fewer risks compared to body-weight support locomotor training.

Consult with your physician regarding physical therapy and exercises that may benefit walking recovery.