Error Based Learning for Restoring Gait Symmetry Post-Stroke

Completed

Phase 1 Results N/A

Trial Description

Many of the 780,000 people affected by stroke each year are left with slow, asymmetric walking patterns. The proposed project will evaluate the effectiveness of two competing motor learning approaches to restore symmetric gait for faster, more efficient, and safer walking.

Detailed Description

Walking after stroke is characterized by reduced gait speed and the presence of interlimb spatiotemporal asymmetry. These step length and stance time asymmetries can be energy inefficient, challenge balance control, increase the risk of falls and injury, and limit functional mobility. Current rehabilitation to improve gait is based on one of two competing motor learning strategies: minimizing or augmenting symmetry errors during training. Conventional rehabilitation often involves walking on a treadmill while therapists attempt to minimize symmetry errors during training. Although this approach can successfully improve gait speed, it does not produce long-term changes in symmetry. Conversely, augmenting or amplifying symmetry errors has been produced by walking on a split belt treadmill with the belts set at different fixed speeds. While this approach produced an 'after-effect' resulting in step length symmetry for short periods of time, with some evidence of long term learning in people with stroke, it had no influence on stance time asymmetry. The investigators propose that patients need real-time proprioceptive feedback of symmetry errors so that they are actively engaged in the learning process. For this project, the investigators developed and validated a novel, responsive, 'closed loop' control system, using a split-belt instrumented treadmill that continuously adjusts the difference in belt speeds to be proportional to the patient's current asymmetry. Using this system, the investigators can either augment or minimize asymmetry on a step-by-step basis to determine which motor learning strategy produces the largest improvement in overground spatiotemporal symmetry.

Conditions

Interventions

  • Treadmill belts of dual-belt treadmill respond to encourage symmetric gait Other
    Intervention Desc: 18 sessions of training (3X/week). 20 minutes/session on treadmill; 10 minutes/session overground 70-75%HRmax
    ARM 1: Kind: Experimental
    Label: Error Minimization
    Description: Belts of a dual belt treadmill may move at different speeds to encourage spatiotemporal gait symmetry during training
  • Treadmill belts of dual-belt treadmill respond to amplify asymmetric gait Other
    Intervention Desc: 18 sessions of training (3X/week). 20 minutes/session on treadmill; 10 minutes/session overground 70-75%HRmax
    ARM 1: Kind: Experimental
    Label: Error Augmentation
    Description: Belts of a dual belt treadmill may move at different speeds to amplify spatiotemporal gait asymmetry during training
  • No difference in treadmill belt speeds Other
    Intervention Desc: 18 sessions of training (3X/week). 20 minutes/session on treadmill; 10 minutes/session overground 70-75%HRmax
    ARM 1: Kind: Experimental
    Label: Control
    Description: Belts of a dual belt treadmill will move at the same speed during training
  • Same Belt Speeds Other
    Intervention Desc: 18 sessions of training (3X/week). 20 minutes/session on treadmill; 10 minutes/session overground 70-75%HRmax. Control-Dual-belted treadmill belts respond to encourage symmetric gait
    ARM 1: Kind: Experimental
    Label: Control
    Description: Symmetric Gait. Dual-belted treadmill belts moving at the same belt speeds during training
  • Different Belt Speeds Other
    Intervention Desc: 18 sessions of training (3X/week). 20 minutes/session on treadmill; 10 minutes/session overground 70-75%HRmax. Treadmill belts of dual-belted treadmill respond either to amplify asymmetric gait or encourage symmetric gait.
    ARM 1: Kind: Experimental
    Label: Gait Asymmetry
    Description: Error Augmentation. Belts of a dual-belted treadmill may move at different belt speeds to amplify spatiotemporal gait asymmetry during training
    ARM 2: Kind: Experimental
    Label: Gait Symmetry
    Description: Error Minimization. Belts of a dual-belted treadmill may move at different belt speeds to encourage spatiotemporal gait symmetry during training

Trial Design

  • Allocation: Randomized
  • Masking: Single Blind (Outcomes Assessor)
  • Purpose: Treatment
  • Endpoint: Efficacy Study
  • Intervention: Parallel Assignment

Outcomes

Type Measure Time Frame Safety Issue
Primary Change from baseline in spatiotemporal gait symmetry after 6 weeks of training participants will be followed for the duration of their training, expected to be about 6 weeks No
Secondary Change from baseline in gait speed after 6 weeks of training participants will be followed for the duration of their training, expected to be about 6 weeks No
Secondary Change from baseline in balance after 6 weeks of training participants will be followed for the duration of their training, expected to be about 6 weeks No
Secondary Change from baseline in endurance after 6 weeks of training participants will be followed for the duration of their training, expected to be about 6 weeks No
Secondary Change from baseline in quality of life after 6 weeks of training participants will be followed for the duration of their training, expected to be about 6 weeks No
Secondary Change from baseline in metabolic efficiency after 6 weeks of training participants will be followed for the duration of their training, expected to be about 6 weeks No
Secondary Change from baseline in community ambulation after 6 weeks of training participants will be followed for the duration of their training, expected to be about 6 weeks No
Secondary Change from baseline in gait speed at 1 month follow-up participants will be followed for one month following the duration of their training (expected to be about 6 weeks) for a total of 10 weeks No
Secondary Change from baseline in balance at 1 month follow up participants will be followed for one month following the duration of their training (expected to be about 6 weeks) for a total of 10 weeks No
Secondary Change from baseline in endurance at 1 month follow up participants will be followed for one month following the duration of their training (expected to be about 6 weeks) for a total of 10 weeks No
Secondary Change from baseline in quality of life at 1 month follow up participants will be followed for one month following the duration of their training (expected to be about 6 weeks) for a total of 10 weeks No
Secondary Change from baseline in metabolic efficiency at 1 month follow up participants will be followed for one month following the duration of their training (expected to be about 6 weeks) for a total of 10 weeks No
Secondary Change from baseline in community ambulation at 1 month follow up participants will be followed for one month following the duration of their training (expected to be about 6 weeks) for a total of 10 weeks No
Secondary Change from baseline in spatiotemporal gait asymmetry at 1 month follow up participants will be followed for one month following the duration of their training (expected to be about 6 weeks) for a total of 10 weeks No

Sponsors