A pilot clinical trial on a Variable Automated Speed and Sensing Treadmill (VASST) for hemiparetic gait rehabilitation in stroke patients

Abstract

Introduction: Impairments in walking speed and capacity are common problems after stroke which may benefit from treadmill training. However, standard treadmills, are unable to adapt to the slower walking speeds of stroke survivors and are unable to automate training progression. This study tests a Variable Automated Speed and Sensing Treadmill (VASST) using a standard clinical protocol. VASST is a semi-automated treadmill with multiple sensors and micro controllers, including wireless control to reposition a fall-prevention harness, variable pre-programmed exercise parameters and laser beam foot sensors positioned on the belt to detect subject's foot positions.Materials and Methods: An open-label study with assessor blinding was conducted in 10 community-dwelling chronic hemiplegic patients who could ambulate at least 0.1 m/s. Interventions included physiotherapist-supervised training on VASST for 60 min three times per week for 4 weeks (total 12 h). Outcome measures of gait speed, quantity, balance, and adverse events were assessed at baseline, 2, 4, and 8 weeks.Results: Ten subjects (8 males, mean age 55.5 years, 2.1 years post stroke) completed VASST training. Mean 10-m walk test speed was 0.69 m/s (SD = 0.29) and mean 6-min walk test distance was 178.3 m (84.0). After 4 weeks of training, 70% had significant positive gains in gait speed (0.06 m/s, SD = 0.08 m/s, P = 0.037); and 90% improved in walking distance. (54.3 m, SD = 30.9 m, P = 0.005). There were no adverse events.Discussion and Conclusion: This preliminary study demonstrates the initial feasibility and short-term efficacy of VASST for walking speed and distance for people with chronic post-stroke hemiplegia.

An Exploratory Clinical Study on an Automated, Speed-Sensing Treadmill Prototype With Partial Body Weight Support for Hemiparetic Gait Rehabilitation in Subacute and Chronic Stroke Patients

“…The positive outcomes of this study lend further support to the findings of a previous study based on an earlier iteration, the VASST I. VASST II permits a wider range of stroke walking abilities to be treated by safe supervised treadmill training safely (31). In spite of similar inclusion and exclusion criteria between VASST I and II devices, key differences between VASST I and VASST II study subjects were shown in their baseline walking abilities; VASST I study subjects had to be able to ambulate at least 150 m with contact guard or supervision (FAC score >4) on level ground at a self-selected walking speed of ≥0.1 m/s with or without walking aids or orthoses in order to be eligible for study participation.…”

“…After 12 sessions of treadmill training over 4 weeks, VASST I study subjects experienced significant 428 improvements in the 6 MWT (54.3 ± 30.9 m; P = 0.005), 10 MWT (0.06 ± 0.08 m/s; P = 0.037), and BBS score (2 ± 2; P = 0.005) ( 31 ). These motor gains were sustained up to 4 weeks post-cessation of training (Δ in 6 MWT: 55.9 ± 31.8 m, P = 0.005; Δ in 10 MWT: 0.12 ± 0.1 m/s, P = 0.013; and Δ in BBS score: 2 ± 2, P = 0.01).…”

“…Previously, Chua et al tested a novel treadmill prototype, the Variable Speed and Sensing Treadmill (VASST I), which incorporated automated speed-control to adapt to patients' gait speeds and patterns, among other key features (31). Results of a pilot study in chronic stroke patients to assess the feasibility, safety and user acceptability of VASST I were promising, with improvements seen in distance walked, gait speed and balance immediately post-training and at follow-up (4 and 8 weeks, respectively) (31).…”

“…Previously, Chua et al tested a novel treadmill prototype, the Variable Speed and Sensing Treadmill (VASST I), which incorporated automated speed-control to adapt to patients' gait speeds and patterns, among other key features (31). Results of a pilot study in chronic stroke patients to assess the feasibility, safety and user acceptability of VASST I were promising, with improvements seen in distance walked, gait speed and balance immediately post-training and at follow-up (4 and 8 weeks, respectively) (31). The need and importance of novel ways of treadmill training in clinical practice to improve safety and reduce task complexity by ameliorating fall risks through backward displacements during treadmill training and reduction of frequent manual adjustments of speed progression by the physiotherapist are proposed in this study.…”

Stroke Rehabilitation for Falls and Risk of Falls in Southeast Asia: A Scoping Review With Stakeholders' Consultation

“…The virtual therapy exergame study reported that both the intervention and control groups had significant improvements in functional mobility and lower limb strength after the intervention phase, indicating that substituting a portion of the standard physiotherapy time with virtual reality games was equally effective in maintaining physical function outcomes and activities of daily living among community-dwelling stroke survivors (61). The VASST showed significant improvement in walking distance, gait speed, and balance of the stroke survivors (63,65). Compliance with all 12 training sessions was 100% for all subjects, and there were no dropouts or serious adverse events when the VASST was used (65).…”