Repeated Split-Belt Treadmill Training Improves Poststroke Step Length Asymmetry

1University of Delaware, Newark, DE, USA.
Neurorehabilitation and neural repair (Impact Factor: 3.98). 02/2013; 27(5). DOI: 10.1177/1545968312474118
Source: PubMed

ABSTRACT Background and objective:
Previous studies suggest that error augmentation may be used as a strategy to achieve longer-term changes in gait deficits after stroke. The purpose of this study was to determine whether longer-term improvements in step length asymmetry could be achieved with repeated split-belt treadmill walking practice using an error augmentation strategy.

13 persons with chronic stroke (>6 months) participated in testing: (1) prior to 12 sessions of split-belt treadmill training, (2) after the training, and (3) in follow-up testing at 1 and 3 months. Step length asymmetry was the target of training, so belt speeds were set to augment step length asymmetry such that aftereffects resulted in reduced step length asymmetry during overground walking practice. Each individual was classified as a "responder" or "nonresponder" based on whether their reduction in step length asymmetry exceeded day-to-day variability.

For the group and for the responders (7 individuals), step length asymmetry improved from baseline to posttesting (P < .05) through an increased step length on both legs but a relatively larger change on the shorter step side (P < .05). Other parameters that were not targeted (e.g., stance time asymmetry) did not change over the intervention.

This study demonstrates that short-term adaptations can be capitalized on through repetitive practice and can lead to longer-term improvements in gait deficits poststroke. The error augmentation strategy, which promotes stride-by-stride adjustment to reduce asymmetry and results in improved asymmetry during overground walking practice, appears to be critical for obtaining the improvements observed.

25 Reads
  • Source
    • "The asymmetrical gait features that have been studied can be divided into two categories: (1) discrete parameters, such as swing time [7] and stride length [8], and (2) continuous signals, such as joint displacement [9], GRF [10] and electromyography [11] signals. Compared with the discrete parameters, a distinct advantage of the continuous signals is that they can be analyzed by both time and frequency domain methods. "
    [Show abstract] [Hide abstract]
    ABSTRACT: This study introduces gait asymmetry measures by comparing the ground reaction force (GRF) features of the left and right limbs. The proposed features were obtained by decomposing the GRF into components of different frequency sub-bands via the wavelet transform. The correlation coefficients between the right and left limb GRF components of the same frequency sub-band were used to characterize the degree of bilateral symmetry. The asymmetry measures were then obtained by subtracting these coefficients from one. To demonstrate the effectiveness of these asymmetry measures, the proposed measures were applied to differentiate the walking patterns of Parkinson's patients and healthy subjects. The results of the statistical analyses found that the patient group has a higher degree of gait asymmetry. By comparing these results with those obtained by conventional asymmetry measures, it was found that the proposed approach can more effectively distinguish the differences between the tested Parkinson's disease patients and the healthy control subjects.
    Biomedical Signal Processing and Control 04/2015; 18. DOI:10.1016/j.bspc.2014.11.008 · 1.42 Impact Factor
  • Source
    • "Errors attributed to oneself are more likely to be generalized to other movements. These differences in generalization suggest that the neural substrates for motor adaptation to small vs large errors may be different [31], and is worth pursuing in the future, particularly with respect to training of walking after injury, when transfer to other related walking environments is highly desirable [32]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Children can modify learned motor skills, such as walking, to adapt to new environments. Movement errors in these new situations drive the learning. We used split-belt walking to determine whether size of the error affects the degree of learning. Twenty-two children (aged 2-5 y) walked on the split-belt treadmill on two separate days spaced 1 week apart. Twenty-eight adults served as controls. On Day 1, children experienced an abrupt change in belt speeds (from 1∶1 to 2∶1 differential) resulting in large errors, or a gradual change (same change in speed over 12-15 min), resulting in small errors. Learning was measured by the size of the aftereffect upon return to a 1∶1 differential. On Day 2 (1 week later), the leg on the fast belt was reversed, as was the method of introducing the speed differential. We found that the error size did not affect learning. Unexpectedly, learning was greater on Day 2 compared to Day 1, especially for children under 4 y of age, despite the fact that the task was opposite to that of Day 1, and did not influence learning in adults. Hence, 11 additional children under 4 y of age were tested with belts running at the same speed on Day 1, and with a 2∶1 speed differential (abrupt introduction) on Day 2. Surprisingly, learning was again greater on Day 2. We conclude that size of error during split-belt walking does not affect learning, but experience on a treadmill does, especially for younger children.
    PLoS ONE 03/2014; 9(3):e93349. DOI:10.1371/journal.pone.0093349 · 3.23 Impact Factor
  • Source
    • "These differential findings in clinical populations suggest that the cerebellum may be more important than the cerebral cortex in perturbation adaptation in the lower limb. Lasting improvement remains to be demonstrated in large clinical studies but the first trials suggest that gait asymmetry in chronic stroke can be ameliorated by split-belt walking training (81). However the long-term neuroplastic changes underlying the adapted behavior in both healthy subjects and clinical groups are unknown, but deserve future investigation. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The recovery of functional movements following injury to the central nervous system (CNS) is multifaceted and is accompanied by processes occurring in the injured and non-injured hemispheres of the brain or above/below a spinal cord lesion. The changes in the CNS are the consequence of functional and structural processes collectively termed neuroplasticity and these may occur spontaneously and/or be induced by movement practice. The neurophysiological mechanisms underlying such brain plasticity may take different forms in different types of injury, for example stroke vs. spinal cord injury (SCI). Recovery of movement can be enhanced by intensive, repetitive, variable, and rewarding motor practice. To this end, robots that enable or facilitate repetitive movements have been developed to assist recovery and rehabilitation. Here, we suggest that some elements of robot-mediated training such as assistance and perturbation may have the potential to enhance neuroplasticity. Together the elemental components for developing integrated robot-mediated training protocols may form part of a neurorehabilitation framework alongside those methods already employed by therapists. Robots could thus open up a wider choice of options for delivering movement rehabilitation grounded on the principles underpinning neuroplasticity in the human CNS.
    Frontiers in Neurology 11/2013; 4:184. DOI:10.3389/fneur.2013.00184
Show more