The role of movement errors in modifying spatiotemporal gait asymmetry post stroke: a randomized controlled trial

Lewek, Michael D.; H., Braun, Carty; Wutzke, Clint; Giuliani, Carol

doi:10.1177/0269215517723056

Cited by 67 publications

(100 citation statements)

References 36 publications

(77 reference statements)

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“…Moreover, we have shown that the extent to which movements are recalibrated varied greatly across post-stroke individuals. We speculate that individual differences in sensorimotor recalibration may explain why some stroke survivors improve their gait symmetry in response to repeated split-belt treadmill training while others do not (Reisman et al, 2013;Betschart et al, 2018;Lewek et al, 2018). If so, it may be possible to identify patients that will benefit from splitbelt training within just a single session.…”

Section: Discussionmentioning

confidence: 98%

Cerebral contribution to the execution, but not recalibration, of motor commands in a novel walking environment

Kam

Iturralde

Torres-Oviedo

2019

Preprint

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Human movements are flexible as they continuously adapt to changes in the environment by updating planned actions and generating corrective movements. Planned actions are updated upon repeated exposure to predictable changes in the environment, whereas corrective responses serve to overcome unexpected environmental transitions. It has been shown that corrective muscle responses are tuned through sensorimotor adaptation induced by persistent exposure to a novel situation. Here, we asked whether cerebral structures contribute to this recalibration using stroke as a disease model. To this end, we characterized changes in muscle activity in stroke survivors and unimpaired individuals before, during, and after walking on a split-belt treadmill moving the legs at different speeds, which has been shown to induce recalibration of corrective responses in walking in healthy individuals. We found that the recalibration of corrective muscle activity was comparable between stroke survivors and controls, which was surprising given then known deficits in feedback responses post-stroke. Also, the intact recalibration in the group of stroke survivors contrasted the patients' limited ability to adjust their muscle activity during steady state split-belt walking compared to controls. Our results suggest that the recalibration and execution of motor commands in new environments are partially dissociable: cerebral lesions interfere with the execution, but not the recalibration, of motor commands upon novel movement demands.

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Section: Discussionmentioning

confidence: 98%

Cerebral contribution to the execution, but not recalibration, of motor commands in a novel walking environment

Kam

Iturralde

Torres-Oviedo

2019

Preprint

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“…We do not intend for these findings to be interpreted as an indictment on step length asymmetry as a target of post-stroke gait rehabilitation. Interventions that target step length asymmetry have shown promise for improving gait speed 15 and decreasing cost of transport 19 .…”

Section: Discussionmentioning

confidence: 99%

“…Many rehabilitation approaches aim to restore step length symmetry [10][11][12][13][14][15][16] . The rationale for restoring step length symmetry is multifaceted: 1) asymmetric stepping increases the cost of transport in healthy adults 17 , 2) persons post-stroke who walk with more asymmetric step lengths also tend to exhibit poorer balance 18 and more effortful gait patterns 19 , 3) step length is easy to measure and manipulate in clinical settings (e.g., "step to the lines on the floor"), and 4) step length asymmetry is a simple, discrete metric that manifests from complex kinematic and kinetic asymmetries that can be difficult to treat in isolation.…”

Section: Introductionmentioning

confidence: 99%

“…The rationale for restoring step length symmetry is multifaceted: 1) asymmetric stepping increases the cost of transport in healthy adults 17 , 2) persons post-stroke who walk with more asymmetric step lengths also tend to exhibit poorer balance 18 and more effortful gait patterns 19 , 3) step length is easy to measure and manipulate in clinical settings (e.g., "step to the lines on the floor"), and 4) step length asymmetry is a simple, discrete metric that manifests from complex kinematic and kinetic asymmetries that can be difficult to treat in isolation. Consequently, there has been increasing interest in restoring step length symmetry after stroke, especially after recent intervention studies showed that improved step length symmetry coincided with improvements in gait speed 15 and cost of transport 19 .…”

Section: Introductionmentioning

confidence: 99%

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Persons post-stroke restore step length symmetry by walking asymmetrically

Padmanabhan

Rao

Gulhar

et al. 2019

Preprint

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word count: 238 Text word count: 4500 Number of figures: 6Symmetric stepping after stroke ABSTRACT Background: Restoration of step length symmetry is a common rehabilitation goal after stroke.Persons post-stroke often retain the capacity to walk with symmetric step lengths ("symmetric steps"); however, the resulting walking pattern remains effortful. Two key questions with direct implications for rehabilitation have emerged: 1) how do persons post-stroke generate symmetric steps, and 2) why do symmetric steps remain so effortful?Objective: To understand how persons post-stroke generate symmetric steps and how the resulting gait pattern relates to the metabolic cost of transport.Methods: Ten persons post-stroke walked on an instrumented treadmill under two conditions: preferred walking and symmetric stepping (using visual feedback). We recorded kinematic, kinetic, and metabolic data during both conditions. Results: Persons post-stroke restored step length symmetry using energetically expensive, asymmetric patterns. Impaired paretic propulsion and abnormal vertical movement of the center of mass were evident during both preferred walking and symmetric stepping. These deficits contributed to diminished positive work performed by the paretic limb on the center of mass in both conditions. Decreased positive paretic work correlated with increased metabolic cost of transport, decreased self-selected walking speed, and increased asymmetry in limb kinematics.

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“…462 463 Incline split-belt training may be a promising way to augment locomotor and adaptation 464 and recalibration in the lesioned motor system. Not everyone who has had a stroke re-learns to 465 walk symmetrically following several weeks of flat split-belt training 466 Betschart et al 2018;Lewek et al 2018). Thus, it is clinically relevant to explore alternative 467 strategies to augment adaptation in survivors of stroke other than increasing the speed difference 468 We investigated the influence of propulsion demands during walking on the locomotor 477 adaptation and recalibration in the asymmetric motor system.…”

Section: Larger After-effects Of Propulsion Forces Split-belt Inclinementioning

confidence: 99%

Augmenting propulsion demands during split-belt walking increases locomotor adaptation in the asymmetric motor system

Sombric

Torres-Oviedo

2019

Preprint

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15 16 Background: 17Promising studies have shown that the mobility of individuals with hemiparesis due to 18 brain lesions, such as stroke, can improve through motor adaptation protocols forcing patients to 19 use their affected limb more. However, little is known about how to facilitate this process. Here 20 we asked if increasing propulsion demands during split-belt walking (i.e., legs moving at 21 different speeds) leads to more motor adaptation and more symmetric gait in survivors of a 22 stroke, as we previously observed in subjects without neurological disorders. 23 24 Methods: 25We investigated the effect of propulsion forces on locomotor adaptation during and after 26 split-belt walking in the asymmetric motor system post-stroke. To test this, 12 subjects in the 27 chronic phase post-stroke experienced a split-belt protocol in a flat and incline session so as to 28 contrast the effects of two different propulsion demands.Step length asymmetry and propulsion 29 forces were used to compare the motor behavior between the two sessions because these are 30 clinically relevant measures that are altered by split-belt walking. 31 32 Results: 33The incline session resulted in more symmetric step lengths during late split-belt walking 34 and larger after-effects following split-belt walking. In both testing sessions, subjects who have 35 had a stroke adapted to regain speed and slope-specific leg orientations similarly to young, intact 36 adults. Importantly, leg orientations during baseline walking were predictive of those achieved 37 during split-belt walking, which in turn predicted each individual's post-adaptation behavior. 38 3 39 Conclusion: 40These results indicated that survivors of a stroke can adapt their movements to meet leg-41 specific kinetic demands. This promising finding suggests that augmenting propulsion demands 42 during split-belt walking could favor symmetric walking in individuals who had a stroke, 43 possibly making split-belt interventions a more effective gait rehabilitation strategy. 44 45 Key Words 46 47 Stroke, motor learning, hemiparesisOur previous work indicates that locomotor adaptation in young, unimpaired subjects 61 increases by augmenting propulsion demands during split-belt walking. More specifically, we 62 found that baseline kinetic demands were predictive of step lengths at steady state and after-63 effects, such that greater propulsion demands led to more adaptation and larger after-effects in 64 every individual (Sombric et al. 2019). It is unclear if the same could be observed post-stroke 65given their known propulsion deficits (Bowden et al. 2006; Balasubramanian et al. 2007). This 66 might be possible since there is evidence that survivors of a stroke can augment their propulsion 67 forces when required by the task (Kesar et al. 2011;Awad et al. 2014; Hsiao 68 et al. 2015 Hsiao 68 et al. , 2016b Hsiao 68 et al. , 2016a). Thus, we tested whether locomotor adaptation in survivors of a stroke 69 could be augmented by increasing propulsion demands with inclined ...

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The role of movement errors in modifying spatiotemporal gait asymmetry post stroke: a randomized controlled trial

Cited by 67 publications

References 36 publications

Cerebral contribution to the execution, but not recalibration, of motor commands in a novel walking environment

Cerebral contribution to the execution, but not recalibration, of motor commands in a novel walking environment

Persons post-stroke restore step length symmetry by walking asymmetrically

Augmenting propulsion demands during split-belt walking increases locomotor adaptation in the asymmetric motor system

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