Efficacy of anterioposterior weight-shift training with visual biofeedback for step length asymmetry and functional mobility in chronic stroke: a randomized controlled trial

 Have your competent? doctor set this up as a protocol to be used while still in the hospital! AND JUST WHY CAN'T YOUR DOCTOR DO THAT?

Do you prefer your doctor, hospital and board of director's incompetence NOT KNOWING? OR NOT DOING? Your choice; let them be incompetent or demand action!

Efficacy of anterioposterior weight-shift training with visual biofeedback for step length asymmetry and functional mobility in chronic stroke: a randomized controlled trial

• Jong Weon Lee,
• Yea Jin Jo,
• Yoon Su Baek,
• Seeun Kim,
• Jung Hoon Kim,
• Dae Hyun Kim,
• Jong Hyun Choi,
• Jong Bum Park &
• Deog Young Kim 

We are providing an unedited version of this manuscript to give early access to its findings. Before final publication, the manuscript will undergo further editing. Please note there may be errors present which affect the content, and all legal disclaimers apply.

Abstract

Background

Step length asymmetry is a specific and persistent characteristic of hemiparetic gait in patients with chronic stroke, typically resulting from impaired weight bearing and reduced propulsive force on the paretic side. This asymmetry leads to reduced walking efficiency and an increased risk of musculoskeletal complications. This study investigated the efficacy of an anterioposterior weight-shift training (AP training) system utilizing visual biofeedback to improve gait asymmetry in patients with chronic stroke.

Methods

This randomized controlled trial enrolled 34 patients with chronic hemiplegic stroke who exhibited step-length asymmetry (step-length ratio > 1.1). Participants were randomized into an AP training group or a control group. Both groups received conventional gait training for 6 weeks, and the experimental group received additional AP training sessions (30 min, 3 times/week). The AP training system provided real-time visual biofeedback on the Center of Pressure trajectory and weight distribution. The primary outcome was the Step Length Asymmetry Index (SLAI). The secondary outcomes included plantar pressure distribution, temporospatial parameters, 3D kinematic/kinetic gait analysis, and energy consumption.

Results

The AP training group demonstrated significant improvements in the SLAI compared with the control group (p < 0.05). Significant between-group differences favoring the intervention were also observed for swing time asymmetry, forefoot contact area, and pressure (p < 0.05). Three-dimensional gait analysis revealed an increased ankle dorsiflexion angle and hip extension moment on the affected side in the training group. While the self-selected walking speed showed no significant difference, the maximum safe walking speed significantly improved in the training group (p < 0.05). No significant between-group differences were observed in energy consumption (oxygen cost or oxygen rate).

Conclusion

AP training may effectively improve step length asymmetry and paretic limb mechanics in patients with chronic stroke. By enhancing the anterior weight transfer and propulsive force, this intervention offers a targeted strategy for addressing established asymmetric gait patterns in the chronic phase of recovery.

Trial details ClinicalTrial.gov Identifier NCT02207933.