Sideways Treadmill Training to Improve Paretic Leg Stepping in Persons Post-Stroke
| Status: | Completed |
|---|---|
| Conditions: | Neurology |
| Therapuetic Areas: | Neurology |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 3/15/2019 |
| Start Date: | February 2015 |
| End Date: | March 2019 |
The Feasibility and Efficacy of Induced Lateral Step Treadmill Training to Improve Paretic Limb Stepping Post-Stroke
People who are living in the community following a stroke fall frequently. The ability to
take a step in response to a balance disturbance helps to prevent falls but stroke survivors
tend not to step with their paretic leg in these circumstances. This leaves them vulnerable
to falls towards their paretic side. The purpose of this study is to train paretic limb
stepping by having individuals stand sideways on a treadmill and respond to sudden
accelerations of the treadmill.
take a step in response to a balance disturbance helps to prevent falls but stroke survivors
tend not to step with their paretic leg in these circumstances. This leaves them vulnerable
to falls towards their paretic side. The purpose of this study is to train paretic limb
stepping by having individuals stand sideways on a treadmill and respond to sudden
accelerations of the treadmill.
Stroke survivors living in the community are at high risk for falling. Falls are considered
to be one of the most prevalent post-stroke complications. Fall history in this population
has been associated with developing activity limitation, decreased independence and increased
fear of falling.
The ability to step in response to an equilibrium disturbance is considered to be critical to
prevent a fall. Stroke survivors tend not to step with their paretic limb when their standing
equilibrium is perturbed. Training the paretic limb to step in response to perturbations has
had limited success in stroke survivors. In response to sagittal plane perturbation training,
stroke survivors continued tend to step with their non-paretic leg even when cued or induced
to step with paretic leg. This tendency decreases their flexibility to respond to
perturbations and also makes it difficult to train the paretic limb.
In contrast, coronal plane perturbations may be a useful way to induce paretic limb stepping.
Acceleration and deceleration of a treadmill has been used to train reactive stepping in all
directions persons with Parkinson's Disease. Coronal plane perturbations may elicit greater
responses from the paretic limb but this has never been investigated in the stroke
population.
In this study participants will engage in 6 training sessions over 2-3 weeks. They will stand
sideways on the treadmill with their paretic leg towards the front of the treadmill belt,
which will be suddenly accelerated for 3 seconds to a predetermined velocity. Participants
will perform 80 trials each session under one or more of the following four training
conditions.
NON-ENCOURAGED TREADMILL ONLY: These trials are defined as trials when the subject is
instructed to respond as necessary to remain on the front half of the treadmill while
maintaining their balance without using external supports, but are not given any specific
instructions about which limb to use to initiate stepping when the treadmill begins to move.
NON-ENCOURAGED USE TREADMILL PLUS SECONDARY TASK: All the same procedures for non-encouraged
use treadmill only trials will be used with the following addition. Just after the subject
attains equal weight bearing, the subject will be engaged in a cognitive task to name as many
items in a category as they are able. During this time period, the treadmill will be started
randomly.
ENCOURAGED USE TREADMILL ONLY TRIALS: These trials are defined as trials where subjects will
be instructed to respond as necessary to remain on the front half of the treadmill while
maintaining their balance without using external supports AND to initiate stepping with his
or her paretic leg when the treadmill begins to move.
ENCOURAGED USE TREADMILL PLUS SECONDARY TASK: All the same procedures for encouraged use
treadmill only trials will be used with the following addition. Just after the subject
attains equal weight bearing, the subject will be engaged in a cognitive task to name as many
items in a category as they are able. During this time period, the treadmill will be started
at randomly.
In pilot testing, this protocol has been tolerated by most community dwelling stroke
survivors and the encouraged use trials with feedback consistently elicited paretic leg
reactive steps.
to be one of the most prevalent post-stroke complications. Fall history in this population
has been associated with developing activity limitation, decreased independence and increased
fear of falling.
The ability to step in response to an equilibrium disturbance is considered to be critical to
prevent a fall. Stroke survivors tend not to step with their paretic limb when their standing
equilibrium is perturbed. Training the paretic limb to step in response to perturbations has
had limited success in stroke survivors. In response to sagittal plane perturbation training,
stroke survivors continued tend to step with their non-paretic leg even when cued or induced
to step with paretic leg. This tendency decreases their flexibility to respond to
perturbations and also makes it difficult to train the paretic limb.
In contrast, coronal plane perturbations may be a useful way to induce paretic limb stepping.
Acceleration and deceleration of a treadmill has been used to train reactive stepping in all
directions persons with Parkinson's Disease. Coronal plane perturbations may elicit greater
responses from the paretic limb but this has never been investigated in the stroke
population.
In this study participants will engage in 6 training sessions over 2-3 weeks. They will stand
sideways on the treadmill with their paretic leg towards the front of the treadmill belt,
which will be suddenly accelerated for 3 seconds to a predetermined velocity. Participants
will perform 80 trials each session under one or more of the following four training
conditions.
NON-ENCOURAGED TREADMILL ONLY: These trials are defined as trials when the subject is
instructed to respond as necessary to remain on the front half of the treadmill while
maintaining their balance without using external supports, but are not given any specific
instructions about which limb to use to initiate stepping when the treadmill begins to move.
NON-ENCOURAGED USE TREADMILL PLUS SECONDARY TASK: All the same procedures for non-encouraged
use treadmill only trials will be used with the following addition. Just after the subject
attains equal weight bearing, the subject will be engaged in a cognitive task to name as many
items in a category as they are able. During this time period, the treadmill will be started
randomly.
ENCOURAGED USE TREADMILL ONLY TRIALS: These trials are defined as trials where subjects will
be instructed to respond as necessary to remain on the front half of the treadmill while
maintaining their balance without using external supports AND to initiate stepping with his
or her paretic leg when the treadmill begins to move.
ENCOURAGED USE TREADMILL PLUS SECONDARY TASK: All the same procedures for encouraged use
treadmill only trials will be used with the following addition. Just after the subject
attains equal weight bearing, the subject will be engaged in a cognitive task to name as many
items in a category as they are able. During this time period, the treadmill will be started
at randomly.
In pilot testing, this protocol has been tolerated by most community dwelling stroke
survivors and the encouraged use trials with feedback consistently elicited paretic leg
reactive steps.
Inclusion Criteria for subjects who have had a stroke:
- at least 18 years old
- a stroke survivor for at least 3 months
- able to understand the testing instructions
- able to walk 10 steps independently without an assistive device
- living in the community (at home in an apartment, condo or house).
- may have a history of one or more strokes but must present with one-sided hemiparesis
Exclusion Criteria for subjects who have had a stroke:
- currently participating in physical therapy for balance and gait-training
- other major musculoskeletal or other neurological disorders
- residing in skilled nursing or assisted living facilities.
Exclusion criteria for subjects who have not had a stroke:
- other major musculoskeletal or neurological disorders
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