Retraining the Walking Pattern After Stroke

Hugo W. Moser Research Institute at Kennedy Krieger, Inc.

Status: Completed

Conditions: Stroke; Hemiparesis

Treatments: Behavioral: Gait training with visual feedback of joint kinematics

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT03813342

IRB00097573

2R37NS090610 (U.S. NIH Grant/Contract)

Details and patient eligibility

About

The purpose of the study is to determine the effects of pairing gait training with different forms of visual feedback about leg movements in individual post-stroke to modify/normalize their gait pattern over time.

Full description

Stroke often results in functional gait deficits and abnormal gait patterns. Typically, several features of gait are altered (e.g. knee joint movement decreases and step lengths are asymmetric). Data show that walking patterns after neurologic injury can be changed through gait training, but traditional rehabilitation approaches typically focus on changing one feature of gait at a time. However, the investigators have recently shown that in a single session individuals post-stroke are able to learn to change multiple components of this impaired gait pattern at the same time.

To further leverage this ability to learn multiple things at once, the investigators have also studied how different forms of visual feedback about leg movements may best facilitate individuals to make meaningful changes to multiple features of the gait pattern. Specifically, they have studied two forms of visual feedback - 1) multidimensional, with multiple streams of information about leg movements, and 2) one-dimensional, which distills/summarizes multiple pieces of information about the gait pattern into a single source of feedback. They have shown that the one-dimensional summary feedback is more effective to help people learn a new gait pattern that requires changing multiple features of how they are walking. This work has focused on single training sessions in neurologically intact individuals, but the authors would like to study the effects of longer-term training with these different forms of feedback. Therefore, the purpose of this study is to gather preliminary data to inform the design of a clinical trial of gait training to treat walking deficits post-stroke. The investigators will gather data to determine whether training with different forms of visual feedback about leg movements are effective at improving gait patterns post-stroke - and which form of feedback may be more effective.

The investigators will study adults with cerebral damage due to stroke. Subjects with hemiparesis will undergo training 3 times a week for a total of 12 training session. These 12 sessions will be broken into 2 blocks of 6 sessions, with at least a 2 week break in between. In each block, training will occur with one form of visual (multi- or one-dimensional). Participants will complete training with both forms of feedback, the order of feedback forms will be randomly assigned. These studies will provide important new information about gait training with visual feedback in individuals post-stroke. This study is critical for developing procedural reliability processes, calculating effect sizes, and determining other salient clinical variables in preparation for a randomized clinical trial.

Enrollment: 8 patients

Sex: All

Ages: 20 to 80 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• stroke or hemiparesis (>6 months post stroke)
• able to walk but has a residual gait deficit (including those who walk with a cane or walker)
• Able to walk for 5 minutes at their self-paced speed
• Adults age 20-80

Exclusion criteria

• Cerebellar signs (e.g.ataxic hemiparesis)
• Any neurologic condition other than stroke
• Uncontrolled diabetes
• Congestive heart failure
• Peripheral artery disease with claudication
• Pulmonary or renal failure
• Unstable angina
• Uncontrolled hypertension (>190/110 mmHg)
• MoCA (Montreal Cognitive Assessment Test for Dementia) < 23
• Severe aphasia
• Orthopedic or pain conditions that limit walking
• Pregnancy

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Crossover Assignment

Masking: None (Open label)

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8 participants in 2 patient groups

Multichannel Visual Feedback

Experimental group

Description:

Gait training with visual feedback of joint kinematics. The visual feedback will contain information about the lower limb joint angles. We will instruct subjects to use the feedback to reach a target walking pattern. In this arm, subjects will receive 4 channels of visual information, each of which represents a joint angle (right and left hips, right and left knees).

Treatment:

Behavioral: Gait training with visual feedback of joint kinematics

Single Channel Visual Feedback

Experimental group

Description:

Gait training with visual feedback of joint kinematics. The visual feedback will contain information about the lower limb joint angles. We will instruct subjects to use the feedback to reach a target walking pattern. In this arm, subjects will receive 1 channel of visual information that encompasses information from 4 lower limb joint angles (right and left hips, right and left knees).

Treatment:

Behavioral: Gait training with visual feedback of joint kinematics