The development and feasibility of treadmill-induced fall recovery training applied to individuals with chronic stroke

Abstract

Background Exercise has failed to reduce falls in those with chronic stroke. A limitation of traditional exercise is that the motor responses needed to prevent a fall are not elicited (i.e. they lack processing specificity ). Balance reactions often require compensatory steps. Therefore, interventions that target such steps have the potential to reduce falls. Computerized treadmills can deliver precise, repeatable, and challenging perturbations as part of a training protocol. The objective of this study was to develop and determine the feasibility of such training applied to those with chronic stroke. We developed the training to address specificity, appropriate duration and repetition, and progressive overloading and individualization. We hypothesized that our intervention would be acceptable, practical, safe, and demonstrate initial signs of efficacy. Methods In this single-arm study, thirteen individuals with chronic stroke (29–77 years old, 2–15 years post stroke) performed up to six training sessions using a computer-controlled treadmill. Each session had separate progressions focused on initial steps with the non-paretic or paretic limbs in response to anterior or posterior falls. Perturbation magnitudes were altered based on performance and tolerance. Acceptability was determined by adherence, or the number of sessions completed. Practicality was documented by the equipment, space, time, and personnel. Adverse events were documented to reflect safety . In order to determine the potential-efficacy of this training, we compared the proportion of successful recoveries and the highest perturbation magnitude achieved on the first and last sessions. Results The training was acceptable , as evident by 12/13 participants completing all 6 sessions. The protocol was practical , requiring one administrator, the treadmill, and a harness. The protocol was safe , as evident by no serious or unanticipated adverse events. The protocol demonstrated promising signs of efficacy . From the first to last sessions, participants had a higher proportion of successful recoveries and progressed to larger disturbances. Conclusions Using a computerized treadmill, we developed an approach to fall-recovery training in individuals with chronic stroke that was specific, considered duration and repetition, and incorporated progressive overloading and individualization. We demonstrated that this training was acceptable, practical, safe, and potentially beneficial for high-functioning individuals with chronic stroke. Trial registration Retrospectively registered at clinicaltrials.gov ( NCT03638089 ) August 20, 2018.

Perturbation-based balance training: Principles, mechanisms and implementation in clinical practice

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Age differences in adaptation of medial-lateral gait parameters during split-belt treadmill walking

“…The ability to dynamically adapt locomotion is critical for maintaining balance. In the event that one slips or trips, a quick adjustment must be made in order to maintain balance 1 , 2 . New locomotor patterns must also be adopted to safely navigate along a narrow path 3 or on uneven terrain 4 .…”

Anteroposterior balance reactions in children with spastic cerebral palsy

“…Importantly, feet-in-place balance reactions can be improved over the course of five practice sessions in children with CP. 7 Other forms of perturbation-based training can be translated from previous applications in stroke rehabilitation, including large treadmill-induced perturbations from our own studies, 38 as well as more clinically feasible versions involving lean-releases and therapist-induced perturbations. 39 In the context of interventions, the capabilities that we have quantified in the present study can serve as a modifiable target for interventions to improve that skill and, potentially, alter the risk of falling.…”