Update in physical medicine and rehabilitation: new technologies and robots versus classical training in gait rehabilitation after stroke.

Stroke is the leading disability-causing disease all over the world. Two thirds of the survivors have significant limitations in walking and everyday living activities. These determine further limitations of mobility, high risk of falling, lifethreatening complications by prolonged immobilization. An impaired ability to walk is common after stroke. Gait recovery is the most important purpose in rehabilitation treatment after a stroke; we can measure the amount of recovery using the gait parameters. Waking speed is one of the indicators to measure and predict disability. At a walking speed of more than 0.8 m per second, full mobility in the community is possible; if the walking speed is less than 0.4 m per second, the mobility is limited to the home; at a speed between these values, mobility is limited to short supervised walks outside the house (1). There are a lot of physical therapy interventions for rehabilitation; but we still have to assess the effectiveness of these interventions and to establish optimal methodology: timing, intensity and duration for every post-stroke rehabilitation intervention. A lot of methods emphasizing different therapeutic exercises programs provided by physical therapists were developed during the last 50-60 years in order to improve the ability to walk. Since the end of the last century, new technologies are rapidly adopted: walking on a treadmill, possibly with some body weight supported, or robot-assisted stepping on a treadmill can be used for gait training. There are many studies that demonstrated the treadmill training was effective for restoration of gait ability and walking velocity. Other motor functions improved steadily during these studies. Treadmill training offers the advantages of task-oriented training with numerous repetitions of a supervised gait pattern. It proved efficiency in gait rehabilitation for patients with chronic hemiparesis. Treadmill training could therefore become an adjunctive tool in regaining walking ability for a shorter period of time (2). For example, S. Hesse and his colleagues studied treadmill training with partial body weight support compared with physiotherapy in nonambulatory hemiparetic patients; they concluded that treadmill training offers the advantages of task-oriented training with numer-