Split-Belt Treadmill Training Poststroke

Abstract

Background/Purpose Even after rehabilitation, many individuals with stroke have residual gait deviations and limitations in functional walking. Applying the principles of motor adaptation through a split-belt treadmill walking paradigm can lead to short-term improvements in step length asymmetry after stroke. The focus of this case study was to determine whether it is possible to capitalize on these improvements for long-term gain. Case Description The participant was a 36-year-old female who was 1.6 years post-stroke. She had a slow walking speed and multiple specific gait deviations, including step length asymmetry. Intervention The participant walked on the split-belt treadmill 3 days/week for four weeks, with the paretic leg on slow belt. The goal was 30 minutes of split-belt treadmill walking each day, followed by overground walking practice to reinforce improvements in step length symmetry. Outcome With training, step length asymmetry decreased from 21% to 9%, and decreased further to 7% asymmetry 1 month after training. Self-selected walking speed increased from 0.71 m/s to 0.81 m/s after training and 0.86 m/s 1 month later. Percent recovery, measured by the Stroke Impact Scale, increased from 40% to 50% post-training and to 60% 1 month later. Discussion Improvements in step length symmetry were observed following training and these improvements were maintained 1 month later. Concomitant changes in clinical measures were also observed, although these were relatively modest. The outcomes for this participant are encouraging given the relatively small dose of training. They suggest that short-term adaptation can be capitalized on through repetitive practice and can lead to longer-term improvements after stroke.

Learning the spatial features of a locomotor task is slowed after stroke

“…These responses, of changing interlimb dynamics over a series of steps during one practice period on the rotating or split-belt treadmill, are a form of motor adaptation; participants are adjusting an already well-learned motor skill over a period of trial-and-error practice, as they are exposed to a novel and perturbing environment (Martin et al 1996b). This adaptation has been extensively studied (Earhart et al 2001;Malone and Bastian 2010;Reisman et al 2005Reisman et al , 2007Reisman et al , 2009Reisman et al , 2010Torres-Oviedo and Bastian 2010;Vasudevan and Bastian 2010) and is thought to be a necessary component of longer-term motor learning (Bastian 2008).…”

Effects on Ankle Dorsiflexor Activity to Active and Passive Perturbation Condition in Patients With Stroke

“…According to the results, 50 or more steps were sufficient to maintain a modified muscle activity pattern; thus, the researchers suggested that movement errors would decrease for 24 hours after initial exposure to a novel environment. In addition, short-term modified low extremity movement patterns obtained in perturbation environments can lead to long-term improvement of the CNS (Lam et al, 2011;Reisman et al, 2010). Through these studies, external stimulations such as perturbations were found to change muscle activity patterns and the altered muscle activity patterns were found to remain for a certain amount of time.…”

“…In many previous studies, increases in ankle dorsiflexion angles and improvement in gait speed and balance ability could be found when ankle dorsiflexor muscle activity increased during ambulation (Blanchette et al, 2011;Kesar et al, 2010;Lam et al, 2011;Reisman et al, 2010;Richards et al, 1993;Rose et al, 2010;van Swigchem et al, 2011). In addition, the strength and the coordination of ankle muscles such as tibialis anterior and gastrocneminus are important factors to maintain balance (Kaminski and Hartsell;.…”

“…In addition, according to an experimental study on body weight-supported treadmill training in patients with stroke or spinal cord injury, short-term low extremity movement modification during gait training against the resistance of perturbation can lead to longer term improvements (Lam et al, 2011;Reisman et al 2010).…”

Rehabilitation of Walking After Stroke

“…Several studies have been conducted by this team and found promising, short term after effects of improved gait symmetry in patients post-stroke. Recently, Reisman produced a case study investing long-term effects using 1-month follow-up data and found asymmetry to continually decrease from baseline to post testing and 1 month follow-up [12].…”