Step by step: A proof of concept study of C-Mill gait adaptability training in the chronic phase after stroke

Heeren, Anita; Ooijen, Mariëlle W. van; Geurts, Alexander C. H.; Day, Brian L.; Janssen, Thomas W J; Beek, Peter J.; Roerdink, Melvyn; Weerdesteyn, Vivian

doi:10.2340/16501977-1180

Cited by 74 publications

(64 citation statements)

References 37 publications

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“…A second component of the typical stabilization strategy is the modulation of mediolateral FP through active control of the swing limb. While in its early stages, gait training that includes practice stepping to targets may improve mobility by allowing more accurate FP [55]. …”

Section: Discussionmentioning

confidence: 99%

Foot placement control and gait instability among people with stroke

Dean¹,

Kautz²

2015

J Rehabil Res Dev

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Gait instability is a common problem following stroke, as evidenced by increases in fall risk and fear of falling. However, the mechanism underlying gait instability is currently unclear. We recently found that young, healthy humans use a consistent gait stabilization strategy of actively controlling their mediolateral foot placement based on the concurrent mechanical state of the stance limb. In the present work, we tested whether people with stroke (n = 16) and age-matched controls (n = 19) used this neuromechanical strategy. Specifically, we used multiple linear regressions to test whether (1) swing phase gluteus medius (GM) activity was influenced by the simultaneous state of the stance limb and (2) mediolateral foot placement location was influenced by swing phase GM activity and the mechanical state of the swing limb at the start of the step. We found that both age-matched controls and people with stroke classified as having a low fall risk (Dynamic Gait Index [DGI] score >19) essentially used the stabilization strategy previously described in young controls. In contrast, this strategy was disrupted for people with stroke classified as higher fall risk (DGI

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Section: Discussionmentioning

confidence: 99%

Foot placement control and gait instability among people with stroke

Dean¹,

Kautz²

2015

J Rehabil Res Dev

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“…For example, walking adaptability is crucial when walking on uneven or cluttered terrains (unpredictable environment), to ensure safe and appropriate foot placement [64, 69]. Similarly, walking adaptability is essential when the task requires walking and turning to negotiate a curved path.…”

Section: Conceptual Challenges For the Measurement Of Walking Adapmentioning

confidence: 99%

Walking Adaptability after a Stroke and Its Assessment in Clinical Settings

Balasubramanian

Clark

Fox

2014

Stroke Research and Treatment

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Control of walking has been described by a tripartite model consisting of stepping, equilibrium, and adaptability. This review focuses on walking adaptability, which is defined as the ability to modify walking to meet task goals and environmental demands. Walking adaptability is crucial to safe ambulation in the home and community environments and is often severely compromised after a stroke. Yet quantification of walking adaptability after stroke has received relatively little attention in the clinical setting. The objectives of this review were to examine the conceptual challenges for clinical measurement of walking adaptability and summarize the current state of clinical assessment for walking adaptability. We created nine domains of walking adaptability from dimensions of community mobility to address the conceptual challenges in measurement and reviewed performance-based clinical assessments of walking to determine if the assessments measure walking adaptability in these domains. Our literature review suggests the lack of a comprehensive well-tested clinical assessment tool for measuring walking adaptability. Accordingly, recommendations for the development of a comprehensive clinical assessment of walking adaptability after stroke have been presented. Such a clinical assessment will be essential for gauging recovery of walking adaptability with rehabilitation and for motivating novel strategies to enhance recovery of walking adaptability after stroke.

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“…Although both C-Mill therapy and the FALLS program incorporate practice of walking adaptability and thereby aim at improving community ambulation, and first results are encouraging in this regard [9, 14, 15], it is hypothesized that C-Mill therapy will result in better outcomes than the FALLS program, as a result of the expected greater amount of walking practice owing to treadmill training [18, 20–22]. The results of the study of Moore et al [19] indeed showed significant gains in daily stepping and walking efficacy after treadmill training, compared with conventional physical therapy, which appears to be related to the number of steps taken per session.…”

Section: Discussionmentioning

confidence: 99%

“…The projected obstacles and stepping targets make C-Mill therapy well suited for task-specific and context-specific training because step adjustments are required to adapt to the projected context similar to the step adjustments required to adapt to environmental circumstances during community ambulation. A recent proof-of-concept study showed that C-Mill therapy in the chronic stage after stroke is not only well received by this population, but also beneficial [14]. C-Mill therapy resulted in training-related increments in walking speed and improvements in various other walking-related clinical scores.…”

Section: Introductionmentioning

confidence: 99%

“…The study’s aim is to compare the effects of two promising interventions for improving walking speed, walking adaptability, and commonly used clinical measures of walking and balance in persons after stroke: treadmill-based C-Mill therapy [14, 15] and the overground FALLS program [9]. We expect that C-Mill therapy will result in better outcomes than the FALLS program because of the expected greater amount of walking practice per session of equal duration.…”

Section: Introductionmentioning

confidence: 99%

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Walking adaptability therapy after stroke: study protocol for a randomized controlled trial

Timmermans

Roerdink

Ooijen

et al. 2016

Trials

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BackgroundWalking in everyday life requires the ability to adapt walking to the environment. This adaptability is often impaired after stroke, and this might contribute to the increased fall risk after stroke. To improve safe community ambulation, walking adaptability training might be beneficial after stroke. This study is designed to compare the effects of two interventions for improving walking speed and walking adaptability: treadmill-based C-Mill therapy (therapy with augmented reality) and the overground FALLS program (a conventional therapy program). We hypothesize that C-Mill therapy will result in better outcomes than the FALLS program, owing to its expected greater amount of walking practice.MethodsThis is a single-center parallel group randomized controlled trial with pre-intervention, post-intervention, retention, and follow-up tests. Forty persons after stroke (≥3 months) with deficits in walking or balance will be included. Participants will be randomly allocated to either C-Mill therapy or the overground FALLS program for 5 weeks. Both interventions will incorporate practice of walking adaptability and will be matched in terms of frequency, duration, and therapist attention. Walking speed, as determined by the 10 Meter Walking Test, will be the primary outcome measure. Secondary outcome measures will pertain to walking adaptability (10 Meter Walking Test with context or cognitive dual-task and Interactive Walkway assessments). Furthermore, commonly used clinical measures to determine walking ability (Timed Up-and-Go test), walking independence (Functional Ambulation Category), balance (Berg Balance Scale), and balance confidence (Activities-specific Balance Confidence scale) will be used, as well as a complementary set of walking-related assessments. The amount of walking practice (the number of steps taken per session) will be registered using the treadmill’s inbuilt step counter (C-Mill therapy) and video recordings (FALLS program). This process measure will be compared between the two interventions.DiscussionThis study will assess the effects of treadmill-based C-Mill therapy compared with the overground FALLS program and thereby the relative importance of the amount of walking practice as a key aspect of effective intervention programs directed at improving walking speed and walking adaptability after stroke.Trial registrationNetherlands Trial Register NTR4030. Registered on 11 June 2013, amendment filed on 17 June 2016.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1527-6) contains supplementary material, which is available to authorized users.

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Step by step: A proof of concept study of C-Mill gait adaptability training in the chronic phase after stroke

Abstract: The concept of C-Mill gait adaptability training in the chronic phase after stroke is promising and warrants future research involving a randomized controlled trial.

Cited by 74 publications

References 37 publications

Foot placement control and gait instability among people with stroke

Foot placement control and gait instability among people with stroke

Walking Adaptability after a Stroke and Its Assessment in Clinical Settings

Walking adaptability therapy after stroke: study protocol for a randomized controlled trial

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