Image_1_Feasibility of challenging treadmill speed-dependent gait and perturbation-induced balance training in chronic stroke patients with low ambulation ability: a randomized controlled trial.pdf

BackgroundTreadmill training shows advantages in the specificity, amount, and intensity of gait and balance practice for the rehabilitation of stroke patients.ObjectiveTo investigate the feasibility and effectiveness of challenging treadmill speed-dependent gait and perturbation-induced balance training in chronic stroke patients with low ambulation ability.MethodsFor this randomized controlled trial (Chinese Clinical Trials.gov registration number ChiCTR-IOR-16009536) with blinded testers, we recruited 33 ambulatory stroke participants with restricted community ambulation capacity and randomly assigned them into two groups: the experimental group with 2 week treadmill speed-dependent gait training combined with 2 week treadmill perturbation-induced balance training (EXP) or the control group with traditional gait and balance training (CON). Various variables were recorded during EXP training, including the rating of perceived exertion, heart rate, causes of pauses, treadmill speed, and perturbation intensity. Outcome measures were examined before training and at 2 and 4 weeks after training. They included gait velocity during five-meter walk test at comfortable and fast speed and reactive balance ability in the compensatory stepping test as primary outcome measures, as well as dynamic balance ability (timed up-and-go test and 5 times sit-to-stand test) and balance confidence as secondary outcome measures.ResultsAll participants completed the study. The treadmill speed and perturbation intensity significantly increased across training sessions in the EXP group, and no adverse effects occurred. The normal and fast gait velocities showed significant time and group interaction effects. They significantly increased after 2 and 4 weeks of training in the EXP group (p  0.05). Likewise, dynamic balance ability measured using the timed up-and-go test at a fast speed significantly improved after 2 and 4 weeks of training in the EXP group (p  0.05), although without a significant time and group interaction effect. Surprisingly, the reactive balance ability did not show improvement after treatment in the EXP group (p > 0.05).ConclusionChallenging treadmill speed-dependent gait and treadmill perturbation-induced balance training is feasible and effective to improve ambulation function in chronic stroke patients with low ambulation ability.</p

Epidermal cells of leaves and floral parts of <i>Cercidiphyllum japonicum</i>.

<p>Since male and female flowers are the same besides floral organs, so just female ones were displayed. (A) Abaxial (bar = 50 μm) and amplified (inset; bar = 10 μm) epidermal cells of a outer scale at mature stage. (B) Adaxial (bar = 30 μm) epidermal cells of a outer a scale at mature stage. (C) Abaxial (bar = 25 μm) and adaxial (inset; bar = 20 μm) epidermal cells of a inner scale at mature stage, showing irregular striation. (D) Abaxial (bar = 30 μm) and adaxial (inset; bar = 10 μm) epidermal cells of a inner scale at mature stage. (E) Carpels from a mature flower (bar = 200 μm). (F) Epidermal cells of a stigma (left; bar = 15 μm) and back (right; bar = 5 μm) of carpel. (G) A stamen from a mature flower (bar = 200 μm). (H) Surface of anther (left; bar = 10 μm) and filament (right; bar = 20 μm). (I) Juvenile leaves (bar = 200 μm) and the abaxial and amplified epidermal cells (inset; bar = 15 μm). (J) Epidermal cells of glands (bar = 30 μm). (K) Surface of a stipule (bar = 500 μm), showing relatively regular sculpturing (insert; bar = 30 μm). (L) Bracts (bar = 300 μm), showing middle slotted or tee or cross grooves (bar = 20 μm).</p

Phylogenetic analysis of <i>AGL6</i> lineages.

<p>A phylogenetic tree was built using the maximum-parsimony method through the program MEGA 7.0 based on the protein sequences of different species. <i>DGL14</i> and <i>GGM11</i> are used as outgroups. The percentage bootstrap values are indicated by numbers at the branch points.</p

Expression patterns of floral organ identity genes.

<p>Real time qPCR was performed showing expression in different organs. The <i>CejaActin</i> was used as an internal reference. Values represent the means ± standard error of triplicates.</p

A list of all primers used for gene cloning and qRT-PCR in this study.

<p>A list of all primers used for gene cloning and qRT-PCR in this study.</p

All the MADS-box proteins in protein sequence comparisons and phylogenetic analysis.

<p>All the MADS-box proteins in protein sequence comparisons and phylogenetic analysis.</p

Phylogenetic analysis of A-class genes.

<p>A phylogenetic tree was built using the maximum-parsimony method through the program MEGA 7.0 based on the protein sequences of different species. <i>GGM1</i> and <i>DAL1</i> are used as outgroups. The percentage bootstrap values are indicated by numbers at the branch points.</p

Phylogenetic analysis of B-class genes.

<p>A phylogenetic tree was built using the maximum-parsimony method through the program MEGA 7.0 based on the protein sequences of different species. PrDGL and GGM2 are used as outgroups. The percentage bootstrap values are indicated by numbers at the branch points.</p

Sequence information of the primers listed in Table 1.

<p>Sequence information of the primers listed in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0178382#pone.0178382.t001" target="_blank">Table 1</a>.</p

Representative predicted amino acid sequences of ABCD genes from <i>Cercidiphyllum japonicum</i> and selected taxa.

<p>Representative predicted amino acid sequences of ABCD genes from <i>Cercidiphyllum japonicum</i> and selected taxa.</p