http://nnr.sagepub.com/content/27/5/460.abstract?etoc
Abstract
Background and objective. Previous studies
suggest that error augmentation may be used as a strategy to achieve
longer-term changes in gait deficits
after stroke. The purpose of this study was to
determine whether longer-term improvements in step length asymmetry
could be
achieved with repeated split-belt treadmill walking
practice using an error augmentation strategy. Methods. 13
persons with chronic stroke (> 6 months) participated in testing: (1)
prior to 12 sessions of split-belt treadmill training,
(2) after the training, and (3) in follow-up
testing at 1 and 3 months. Step length asymmetry was the target of
training,
so belt speeds were set to augment step length
asymmetry such that aftereffects resulted in reduced step length
asymmetry
during overground walking practice. Each individual
was classified as a “responder” or “nonresponder” based on whether
their
reduction in step length asymmetry exceeded
day-to-day variability. Results. For the group and for the responders (7 individuals), step length asymmetry improved from baseline to posttesting (P < .05) through an increased step length on both legs but a relatively larger change on the shorter step side (P < .05). Other parameters that were not targeted (eg, stance time asymmetry) did not change over the intervention. Conclusions.
This study demonstrates that short-term adaptations can be capitalized
on through repetitive practice and can lead to longer-term
improvements in gait deficits poststroke. The error
augmentation strategy, which promotes stride-by-stride adjustment to
reduce
asymmetry and results in improved asymmetry during
overground walking practice, appears to be critical for obtaining the
improvements
observed.
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