Should you hold onto the treadmill handrails or not? Cortical evidence at different walking speeds.

The sample was 24 healthy young adults with no neurological or orthopedic conditions, so the findings may not transfer to the older or neurological populations who typically receive treadmill rehabilitation. The study measured cortical activation and connectivity only. It collected no behavioral gait data, no clinical outcomes and no measure of muscular workload, so it cannot show that any pattern of activation leads to better walking or recovery. The authors state that no significant differences were found when comparing holding versus not holding at the same speed, so the paper does not establish that handrails themselves reduce activation relative to unsupported walking. The speeds used were 3 and 5 km/h, which the authors describe as not demanding for healthy subjects; the effect of handrails at the slower, more typical speeds used in neurological rehabilitation is unknown. The study was small and exploratory, and the authors themselves call for further work in patients with neurological disease.

Funded by the Italian Multiple Sclerosis Foundation (FISM Grant). No other conflicts of interest are reported in the supplied text.

Do not read the increased cortical activity at faster unsupported speeds as proof that dropping the handrails will improve a patient's gait or recovery. The study measured brain activation in 24 healthy adults, collected no behavioral or clinical outcomes, and found no significant difference in activation between holding and not holding at the same speed.