The effect of progressive task-oriented training on a supplementary tilt table on lower extremity muscle strength and gait recovery in patients with hemiplegic stroke.

date: 2015 Feb;41(2):425-30. doi
author: Kim C-Y.
publication: Gait Posture
PubMed ID:25467171


The purpose of this study was to determine the influence of progressive taskoriented training on a supplementary tilt table on the lower extremity (LE) muscle strength and spatiotemporal parameters of gait in subjects with hemiplegic stroke. Thirty subjects between three and nine months post stroke were included in this study. Thirty subjects were randomly allocated to a control group (CG, n1=10), experimental group I (EG1, n2=10), and experimental group II (EG2, n3=10). All of the subjects received routine therapy for half an hour, five times a week for three weeks and additionally received training on the following three different tilt table applications for 20min a day: (1) both knee belts of the tilt table were fastened (CG), (2) only the affected side knee belt of the tilt table was fastened and one-leg standing training was performed using the less-affected LE (EG1), and (3) only the affected side knee belt of the tilt table was fastened and progressive taskoriented training was performed using the less-affected LE (EG2). The effect of tilt table applications was assessed using a hand-held dynamometer for LE muscle strength and GAITRite for spatiotemporal gait data. Our results showed that there was a significantly greater increase in the strength of all LE muscle groups, gait velocity, cadence, and stride length, a decrease in the double limb support period, and an improvement in gait asymmetry in subjects who underwent progressive taskoriented training on a supplementary tilt table compared to those in the other groups. These findings suggest that progressive taskoriented training on a supplementary tilt table can improve the LE muscle strength and spatiotemporal parameters of gait at an early stage of rehabilitation of subjects with hemiplegic stroke

Lower extremity muscle activation and function in progressive task-oriented training on the supplementary tilt table during stepping-like movements in patients with acute stroke hemiparesis.

date: 2015 Jun;25(3):522-30
author: Kim C-Y.
publication: J Electromyogr Kinesiol.
PubMed ID:25863464


An effective and standardized method for applying a tilt table as a supplementary treatment in the early rehabilitation of stroke patients is still missing. The aim of this study was to determine the influence of progressive task-oriented training on the tilt table on the improvement in lower extremity (LE) muscle activation and clinical function in subjects with hemiplegia due to stroke. Thirty-nine subjects with acute stroke were randomly allocated to three groups; control group, tilt table group, and task-oriented training group on the tilt table, with 13 patients, respectively. All of the subjects received the routine therapy for half an hour, and subjects in the experimental groups additionally received training on two different tilt table applications for 20min a day, five times a week for three weeks. The effect of tilt table applications was assessed using the surface electromyography (EMG) analysis during stepping-like movements on the tilt table for LE muscle activation and clinical scores for function. Our results showed that there was a significantly greater increase in the EMG patterns of the extensors and flexors of the affected leg muscles during flexion and extension movements of both legs and clinical scores in patients undergoing the progressive task-oriented training on the tilt table compared to the other groups. These findings suggest that progressive task-oriented training on the tilt table can improve LE muscle activation and clinical scores of functional performance for early rehabilitation of subjects with acute stroke.

Clinical evaluation of a new biofeedback standing balance training device.

date: 1996 Mar-Apr;20(2):60-6.
author: Lee M.
publication: J Med Eng.
PubMed ID:8836924


For patients with neurological damage of the central nervous system, such as that due to cerebrovascular accident (CVA), standing balance training is a critical therapeutic procedure to be undertaken before walking and self-care training. The identification and characterization of neurological disorder in postural steadiness will enhance our understanding of the postural control system, and help to identify patients at risk of falls in the CVA population. This paper discusses the design and clinical evaluation of a new biofeedback training device for static (postural steadiness) performance of the standing balance system. The device includes a height adjustable standing table, an instrumented force sensing platform, an on-line weight bearing audio/visual biofeedback system, a postural correction mirror, and a belt suspension system for the upper extremities. A quantitative evaluation protocol of bilateral asymmetries in weight distribution and postural sway to characterize standing balance with the force sensing platform is discussed. Finally, the clinical evaluation results of sixty patients with hemiplegia from acute stroke for a period of four weeks are discussed. With this economic standing training device, the static standing steadiness can be trained effectively through weight bearing biofeedback and a postural correction mirror in the clinical and home caring environments.

Early poststroke rehabilitation using a robotic tilt-table stepper and functional electrical stimulation

date: 2013;2013:946056
author: Kuznetsov AN,
publication: Stroke Res Treat.
PubMed ID:23691432


Background. Stroke frequently leaves survivors with hemiparesis. To prevent persistent deficits, rehabilitation may be more effective if started early. Early training is often limited because of orthostatic reactions. Tilt-table stepping robots and functional electrical stimulation (FES) may prevent these reactions. Objective. This controlled convenience sample study compares safety and feasibility of robotic tilt-table training plus FES (ROBO-FES) and robotic tilt-table training (ROBO) against tilt-table training alone (control). A preliminary assessment of efficacy is performed. Methods. Hemiparetic ischemic stroke survivors (age 58.3 ± 1.2 years, 4.6 ± 1.2 days after stroke) were assigned to 30 days of ROBO-FES (n = 38), ROBO (n = 35), or control (n = 31) in addition to conventional physical therapy. Impedance cardiography and transcranial doppler sonography were performed before, during, and after training. Hemiparesis was assessed using the British Medical Research Council (MRC) strength scale. Results. No serious adverse events occurred; 8 patients in the tilt-table group prematurely quit the study because of orthostatic reactions. Blood pressure and CBFV dipped <10% during robot training. In 52% of controls mean arterial pressure decreased by ≥20%. ROBO-FES increased leg strength by 1.97 ± 0.88 points, ROBO by 1.50 ± 0.85 more than control (1.03 ± 0.61, P < 0.05). CBFV increased in both robotic groups more than in controls (P < 0.05). Conclusions. Robotic tilt-table exercise with or without FES is safe and may be more effective in improving leg strength and cerebral blood flow than tilt table alone.

Pilot randomized controlled trial to assess the impact of additional supported standing practice on functional ability post stroke

date: 2007 Jul;21(7):614-9.
author: Allison R, Dennett R.
publication: Clin Rehabil.
PubMed ID:17702703



To investigate whether provision of additional standing practice increases motor recovery and mobility post stroke.


A pilot randomized controlled trial.


A stroke rehabilitation unit in the UK.


Seventeen participants, seven women and ten men, age range 51-92 admitted to the unit 6-58 days post stroke.


Each participant was randomly allocated into a control (conventional physiotherapy) or treatment (conventional therapy plus an additional session of standing practice) group. The period of intervention ranged from 14 to 28 days dependent upon length of stay on the unit.


The Gross Functional Tool Section of the Rivermead Motor Assessment, the Trunk Control Test and the Berg Balance Scale were used on admission to the study, at weekly intervals during the intervention, and at 12 weeks (after discharge).


Of the 17 participants recruited, three withdrew from the additional intervention group citing fatigue as a barrier and 15 completed the study. Participants completing additional standing practice demonstrated higher scores in all motor measures at week 12, but this difference was not statistically significant. There was a statistically significant difference (P < 0.05) in the changes in Berg Balance score when comparing week 1 with week 12, in support of the group receiving extra standing practice.


A larger study is required to establish the value of additional standing practice after stroke. This pilot demonstrates that the Gross Functional Tool Section of the Rivermead Motor Assessment and the Berg Balance Scale would be useful in such a study. Fatigue may be a significant barrier to ability to participate in more intensive programmes so screening participants for severe fatigue may be useful.

The prevalence of joint contractures, pressure sores, painful shoulder, other pain, falls, and depression in the year after a severely disabling stroke

date: 2008 Dec;39(12):3329-34
author: Sackley C1, Brittle N, Patel S, Ellins J, Scott M, Wright C, Dewey ME.
publication: Stroke




Complications after stroke have been shown to impede rehabilitation, lead to poor functional outcome, and increase cost of care. This inception cohort study sought to investigate the prevalence of immobility-related complications during the first year after severely disabling stroke in relation to functional independence and place of residence.


Over a 7-month period, 600 stroke survivors were identified in the hospital through the Nottingham Stroke Register. Those who had a Barthel Index score <or=10 3 months poststroke and did not have a primary diagnosis of dementia were eligible to participate in the study. Assessments of complications were carried out at 3, 6, and 12 months poststroke.


Complications were recorded for 122 stroke survivors (mean age, 76 years; 57% male). Sixty-three (52%) had significant language impairment and of the remaining 59 who were able to complete an assessment of cognitive function, 10 (8%) were cognitively impaired. The numbers of reported complications over 12 months, in rank order, were falls, 89 (73%); contracture, 73 (60%); pain, 67 (55%); shoulder pain, 64 (52%); depression, 61 (50%); and pressure sores, 26 (22%). A negative correlation was found between Barthel Index score and the number of complications experienced (low scores on the Barthel Index correlate with a high number of complications). The highest relative percentages of complications were experienced by patients who were living in a nursing home at the time of their last completed assessment.


Immobility-related complications are very common in the first year after a severely disabling stroke. Patients who are more functionally dependent in self-care are likely to experience a greater number of complications than those who are less dependent. Trials of techniques to limit and prevent complication are required.

One session of whole body vibration increases voluntary muscle strength transiently in patients with stroke.

date: 09/01/2007
author: Tihanyi TK, Horváth M, Fazekas G, Hortobágyi T, Tihanyi J.
publication: Clin Rehabil. 2007 Sep;21(9):782-93.
pubmed_ID: 17875558
OBJECTIVE: To determine the effect of whole body vibration on isometric and eccentric torque and electromyography (EMG) variables of knee extensors on the affected side of stroke patients. DESIGN: A randomized controlled study. SETTING: A rehabilitation centre. SUBJECTS: Sixteen patients (age 58.2+/-9.4 years) were enrolled in an inpatient rehabilitation programme 27.2+/-10.4 days after a stroke. INTERVENTIONS: Eight patients were randomly assigned to the vibration group and received 20 Hz vibration (5 mm amplitude) while standing on a vibration platform for 1 minute six times in one session. Patients in the control group also stood on the platform but did not receive vibration. MAIN MEASURES: Maximum isometric and eccentric torque, rate of torque development, root-mean-squared EMG, median frequency of vastus lateralis, and co-activation of knee flexors. RESULTS: Isometric and eccentric knee extension torque increased 36.6% and 22.2%, respectively, after vibration (P<0.05) and 8.4% and 5.3% in the control group. Vibration increased EMG amplitude 44.9% and the median frequency in the vastus lateralis by 13.1% (all P<0.05) without changes in the control group (10.6% and 3.9%). Vibration improved the ability to generate mechanical work during eccentric contraction (17.5%). Vibration reduced biceps femoris co-activation during isometric (8.4%, ns) and eccentric (22.5%, P<0.05) contraction. CONCLUSION: These results suggest that one bout of whole body vibration can transiently increase voluntary force and muscle activation of the quadriceps muscle affected by a stroke.

Passive ankle dorsiflexion increases in patients after a regimen of tilt table-wedge board standing. A clinical report.

date: 11/01/1985
author: Bohannon RW, Larkin PA.
publication: Phys Ther. 1985 Nov;65(11):1676-8.
pubmed_ID: 4059330

We monitored the result of a tilt table-wedge board routine on the passive ankle dorsiflexion of 20 patients consecutively to determine the effectiveness of the treatment. The calculated frequency of the treatment, which was applied for 30 minutes on each of 5 to 22 treatment days, ranged from 2.3 to 6.4 treatments a week. All patients demonstrated increased passive ankle dorsiflexion. The increases ranged from 3 to 17 degrees and occurred at a calculated rate of 0.11 to 1.0 degrees a day. We believe the treatment is an effective clinical method for increasing passive ankle dorsiflexion in neurologically involved patients.

Cerebrovascular and cardiovascular responses to graded tilt in patients with autonomic failure.

date: 09/28/1997
author: Bondar RL, Dunphy PT, Moradshahi P, Kassam MS, Blaber AP, Stein F, Freeman R.
publication: Stroke. 1997 Sep;28(9):1677-85.
pubmed_ID: 9303009
BACKGROUND AND PURPOSE: Patients with autonomic nervous system failure often experience symptoms of orthostatic intolerance while standing. It is not known whether these episodes are caused primarily by a reduced ability to regulate arterial blood pressure or whether changes in cerebral autoregulation may also be implicated. METHODS: Eleven patients and eight healthy age- and sex-matched control subjects were studied during a graded-tilt protocol. Changes in their steady state middle cerebral artery mean flow velocities (MFV), measured by transcranial Doppler, brain-level mean arterial blood pressures (MABPbrain), and the relationship between the two were assessed. RESULTS: Significant differences between patients and control subjects (P < .05) were found in both their MFV and MABPbrain responses to tilt. Patients’ MFV dropped from 60 +/- 10.2 cm/s in the supine position to 44 +/- 14.0 cm/s at 60 degrees head-up tilt, whereas MABPbrain fell from 109 +/- 11.7 to 42 +/- 16.9 mm Hg. By comparison, controls’ MFV dropped from 54 +/- 7.8 cm/s supine to 51 +/- 8.8 cm/s at 60 degrees, whereas MABPbrain went from 90 +/- 11.2 to 67 +/- 8.2 mm Hg. Linear regression showed no significant difference in the MFV-MABPbrain relationship between patients and control subjects, with slopes of 0.228 +/- 0.09 Hg-1 for patients and 0.136 +/- 0.16 Hg-1 for control subjects. CONCLUSIONS: The present study found significant differences between patients and control subjects in their MFV and MABPbrain responses to tilt but no difference in the autoregulatory MFV-MABPbrain relationship. These results suggest that patients’ decreased orthostatic tolerance may primarily be the result of impaired blood pressure regulation rather than a deficiency in cerebral autoregulation.

Reliability and comparison of weight-bearing ability during standing tasks for individuals with chronic stroke.

date: 08/01/2002
author: Eng JJ, Chu KS.
publication: Arch Phys Med Rehabilitation. 2002 Aug;83(8):1138-44.
pubmed_ID: 12161837

OBJECTIVES: To determine the test-retest reliability over 2 separate days for weight-bearing ability during standing tasks in individuals with chronic stroke and to compare the weight-bearing ability among 5 standing tasks for the paretic and nonparetic limbs. DESIGN: Prospective study using a convenient sample. SETTING: Free-standing tertiary rehabilitation center. PARTICIPANTS: Fifteen community-dwelling stroke individuals with moderate motor deficits; volunteer sample. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Weight-bearing ability as measured by the vertical ground reaction force during 5 standing tasks (rising from a chair, quiet standing, weight-shifting forward, backward, laterally). RESULTS: The weight-bearing ability was less for the paretic limb compared with the nonparetic limb, but the intraclass correlation coefficients were high (.95-.99) for both limbs between the 2 sessions for all 5 tasks. The forward weight-shifting ability was particularly low in magnitude on the paretic side compared with the other weight-shifting tasks. In addition, the forward weight-shift ability of the nonparetic limb was also impaired but to a lesser extent. Large asymmetry was evident when rising from a chair, with the paretic limb bearing a mean 296N and the nonparetic side bearing a mean 458N. The weight-bearing ability during all 5 tasks correlated with one another (r range,.56-.94). CONCLUSIONS: Weight-bearing ability can be reliably measured and may serve as a useful outcome measure in individuals with stroke. We suggest that impairments of the hemiparetic side during forward weight shifting and sit-to-stand tasks presents a challenge to the motor systems of individuals with stroke, which may account for the poor balance that is often observed in these individuals. Copyright 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.