Walking function, which is critical to performing many activities of daily living, is commonly assessed by walking speed. Walking speed is dependent on propulsion, which is governed by ankle moment and the posture of the trailing limb during push-off. Here, we present a new gait training paradigm that utilizes a dual belt treadmill to train both components of propulsion by accelerating the belt of the trailing limb during push off. Accelerations require subjects to produce greater propulsive force to counteract inertial effects, and increase trailing limb angle through increased belt velocity.We hypothesized that exposure to our training p rogram would produce after effects in propulsion mechanics and, consequently, walking speed. We tested our protocol on healthy subjects at two acceleration magnitudes-Perceptible (PE), and Imperceptible, (IM)-and compared their results to a third control group (VC) that walked at a higher velocity during training.Results show that the PE group significantly increased walking speed following training (mean ± s.e.m: 0.073 ± 0.013 m/s, p < 0.001). The change in walking speed in the IM and VC groups was not significant at the group level (IM: 0.032 ± 0.013 m/s; VC: -0.003 ± 0.013 m/s). Responder analysis showed that changes in push-off posture and in neuro-motor control of ankle plantar-flexor muscles contributed to the larger increases in gait speed measured in the PE group compared to the IM and VC groups. Analysis of the effects during and after training suggest that changes in neuromotor coordination are consistent with usedependent learning.
Many stroke survivors suffer from hemiparesis, a condition that results in impaired walking ability. Walking ability is commonly assessed by walking speed, which is dependent on propulsive force both in healthy and stroke populations. Propulsive force is determined by two factors: ankle moment and the posture of the trailing limb during push-off. Recent work has used robotic assistance strategies to modulate propulsive force with some success. However, robotic strategies are limited by their high cost and the technical difficulty of fitting and operating robotic devices with stroke survivors in a clinical setting.We present a new paradigm for goal-oriented gait training that utilizes a split belt treadmill to train both components of propulsive force generation, achieved by accelerating the treadmill belt of the trailing limb during push off. Belt accelerations require subjects to produce greater propulsive force to maintain their position on the treadmill and increases trailing limb angle through increased velocity of the accelerated limb.We hypothesized that accelerations would cause locomotor adaptation that would result in measurable after effects in the form of increased propulsive force generation. We tested our protocol on healthy subjects at two levels of belt accelerations. Our results show that 79% of subjects significantly increased propulsive force generation, and that larger accelerations translated to larger, more persistent behavioral gains.
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