A Challenge-Based Approach to Body Weight–Supported Treadmill Training Poststroke: Protocol for a Randomized Controlled Trial

Abstract

BackgroundBody weight support treadmill training protocols in conjunction with other modalities are commonly used to improve poststroke balance and walking function. However, typical body weight support paradigms tend to use consistently stable balance conditions, often with handrail support and or manual assistance.ObjectiveIn this paper, we describe our study protocol, which involved 2 unique body weight support treadmill training paradigms of similar training intensity that integrated dynamic balance challenges to help improve ambulatory function post stroke. The first paradigm emphasized walking without any handrails or manual assistance, that is, hands-free walking, and served as the control group, whereas the second paradigm incorporated practicing 9 essential challenging mobility skills, akin to environmental barriers encountered during community ambulation along with hands-free walking (ie hands-free + challenge walking).MethodsWe recruited individuals with chronic poststroke hemiparesis and randomized them to either group. Participants trained for 6 weeks on a self-driven, robotic treadmill interface that provided body weight support and a safe gait-training environment. We assessed participants at pre-, mid- and post 6 weeks of intervention-training, with a 6-month follow-up. We hypothesized greater walking improvements in the hands-free + challenge walking group following training because of increased practice opportunity of essential mobility skills along with hands-free walking.ResultsWe assessed 77 individuals with chronic hemiparesis, and enrolled and randomized 30 individuals poststroke for our study (hands-free group=19 and hands-free + challenge walking group=20) from June 2012 to January 2015. Data collection along with 6-month follow-up continued until January 2016. Our primary outcome measure is change in comfortable walking speed from pre to post intervention for each group. We will also assess feasibility, adherence, postintervention efficacy, and changes in various exploratory secondary outcome measures. Additionally, we will also assess participant responses to a study survey, conducted at the end of training week, to gauge each group's training experiences.ConclusionsOur treadmill training paradigms, and study protocol represent advances in standardized approaches to selecting body weight support levels without the necessity for using handrails or manual assistance, while progressively providing dynamic challenges for improving poststroke ambulatory function during rehabilitation.Trial RegistrationClinicalTrials.gov NCT02787759; https://clinicaltrials.gov/ct2/show/NCT02787759 (Archived by Webcite at http://www.webcitation.org/6yJZCrIea)

Simulation study on assist-as-needed control of a rehabilitation robotic walker

“…In order to encourage the stroke survivors for their active involvement, Olenšek et al proposed a balance assessment robot (BAR) that has three passive degrees of freedom (DoF) and three actuated DoF to control the pelvis, and an admittance-controlled system is developed, in such a way that the natural movement of pelvis is not significantly affected [ 13 ]. Besides, the KineAssist robot [ 14 ], the Robot assisted gait training (RAGT) [ 15 ], the assist robotic walker (JARoW-II) [ 16 ], the NaTUre-gaits robot [ 17 ] and the AssistOn-Gait system [ 18 ] are developed to study the pelvic control.…”