Error Based Learning for Restoring Gait Symmetry Post-Stroke
| Status: | Completed |
|---|---|
| Conditions: | Neurology |
| Therapuetic Areas: | Neurology |
| Healthy: | No |
| Age Range: | 21 - Any |
| Updated: | 2/17/2019 |
| Start Date: | January 2012 |
| End Date: | December 2015 |
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.
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.
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.
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.
Inclusion Criteria:
- ability to walk >10 m overground without physical assistance
- overground comfortable gait speed (CGS) < 1.0 m/s (using assistive devices and bracing
below the knee as needed)
- able to walk independently on the treadmill at >80% CGS
- exhibits stance time and/or step length asymmetry during CGS
Exclusion Criteria:
- cerebellar lesion
- uncontrolled cardiorespiratory/metabolic disease (cardiac arrhythmia, uncontrolled
hypertension or diabetes, orthostatic hypertension, chronic emphysema)or other
neurological or orthopedic disorders that may affect gait training
- botulinum toxin to the lower limb in the past 6 months
- a history of balance deficits or unexplained falls not related to the stroke
- uncontrolled seizures
- concurrent physical therapy
- Mini-Mental Status Exam (MMSE) < 24
- communication impairments which could impede understanding of the purpose or
procedures of the study or an inability to comply with experimental procedures
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