The Effect of Split-Belt Treadmill Interventions on Step Length Asymmetry in Individuals Poststroke: A Systematic Review With Meta-Analysis

Dzewaltowski, Alex; Hedrick, Erica A.; Leutzinger, Todd J.; Remski, Lindsey; Rosen, Adam B.

doi:10.1177/15459683211011226

Cited by 15 publications

(11 citation statements)

References 49 publications

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“…We also solicited articles from social media, tables of contents from relevant journals (e.g., NNR), and citations from related systematic reviews. 18,19 We included 20 datasets from 17 studies in our meta-analysis (Figure 1). We identified 8236 studies using the search terms in the above databases and sources.…”

Section: Methodsmentioning

confidence: 99%

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The detrimental effect of stroke on motor adaptation

Abram,

Tsay,

Yosef

et al. 2024

Preprint

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Background. While it is evident that stroke impairs motor control, it remains unclear whether stroke impacts motor adaptation, the ability to flexibly modify movements in response to changes in the body and the environment. The mixed results in the literature may be due to differences in participants' brain lesions, sensorimotor tasks, or a combination of both. Objective. We first sought to better understand the overall impact of stroke on motor adaptation and then delineated the impact of lesion hemisphere and sensorimotor task on adaptation poststroke. Methods. Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic review and meta-analysis of 17 studies comparing individuals poststroke to neurotypical controls, with each group consisting of over 200 participants. Results. We found that stroke impairs motor adaptation (d = -0.64; 95% CI [-1.06, -0.22]), and that the extent of this impairment did not differ across sensorimotor tasks but may vary with the lesioned hemisphere. Specifically, we observed greater evidence for impaired adaptation in individuals with left hemisphere lesions compared to those with right hemisphere lesions. Conclusions. This review not only clarifies the detrimental effect of stroke on motor adaptation but also underscores the need for finer-grained studies to determine precisely how various sensorimotor learning mechanisms are impacted. The current findings may guide future mechanistic and applied research at the intersection of motor learning and neurorehabilitation.

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Section: Methodsmentioning

confidence: 99%

“…We also solicited articles from social media, tables of contents from relevant journals (e.g., NNR), and citations from related systematic reviews. 18,19…”

Section: Methodsmentioning

confidence: 99%

The detrimental effect of stroke on motor adaptation

Abram,

Tsay,

Yosef

et al. 2024

Preprint

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“…This process, if repeated over several exposures, can lead to clinical improvements [213][214][215]. A recent meta-analysis of the literature on split-belt based interventions has revealed that this therapy, when implemented as a long-term training paradigm, has the potential to improve step-length symmetry, while also pointing out the necessity of randomized control trials to further confirm this result [216].…”

Section: Perspectives On the Study And Use Of Locomotor Adaptationsmentioning

confidence: 99%

Locomotor adaptations: paradigms, principles and perspectives

Severini

Zych

2022

Prog. Biomed. Eng.

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The term “locomotor adaptations” indicates the alteration in motor commands that is automatically or volitionally generated in response to a perturbation continuously altering the task demands of locomotion. Locomotor adaptations have been widely studied, using a variety of experimental paradigms and analysis techniques. The perturbation can be expected or unexpected and constituted by a change in the movement environment, by forces actively pushing the person’s body segments, by a modification in the sensory feedback associated with the task or by explicit task instructions. The study of locomotor adaptations has been key in widening our understanding of the principles regulating bipedal locomotion, from the overall strategies driving the short-term adjustments of motor commands, down to the different neural circuits involved in the different aspects of locomotion. In this paper we will provide an in-depth review of the research field of locomotor adaptations. We will start with an analysis of the principles driving the evolution of bipedal locomotion in humans. Then we will review the different experimental paradigms that have been used to trigger locomotor adaptations. We will analyze the evidence on the neurophysiological correlates of adaptation and the behavioral reasons behind it. We will then discuss the characteristics of locomotor adaptation such as transfer, generalization, and savings. This will be followed by a critical analysis of how different studies point to different task-goal related drivers of adaptation. Finally, we will conclude with a perspective on the research field of locomotor adaptations and on its ramifications in neuroscience and rehabilitation.

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“…The device was designed to reduce the spatial and temporal gait asymmetries experienced in hemiparetic gait patterns by modifying interlimb coordination during overground walking using a combination of therapeutic mechanisms [31]- [34]. The original design concept was based upon the therapeutic mechanism used in split-belt treadmill training for individuals with asymmetric gait patterns (i.e., augmenting asymmetry with the shorter step length on the faster belt to produce a more symmetrical aftereffect [35]) -but in an overground, portable fashion that would allow more frequent training in a variety of environments. The device was additionally designed to create a subtle destabilization of the non-paretic limb, therefore encouraging greater usage of the paretic limb during the user's gait cycle.…”

Section: Introductionmentioning

confidence: 99%

“…Over time and through repeated use of the device, these altered mechanics result in improved gait patterns, including symmetry and speed, when the device is removed, and the user returns to natural walking with a modi ed gait pattern [31]. The mechanism of this change is an aftereffect that has been well-documented in the literature [35], [37], [38]. The gait device and its associated motion can be seen in Fig.…”

Section: Introductionmentioning

confidence: 99%

One-Year Retention of Gait Speed Improvement in Stroke Survivors After Treatment with a Wearable Home-Use Gait Device

Darcy¹,

Rashford²,

Tsai³

et al. 2022

Preprint

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A majority of stroke survivors experience gait impairments, some of which persist into the chronic phase of stroke. Treatment with the iStrideTM gait device has been shown to improve symmetry, gait speed, and functional balance for chronic stroke survivors with hemiparetic gait impairments. In this study, we examine the long-term gait speed changes up to twelve months after treatment with the gait device. Eighteen individuals (mean 56.7 years, range 44-77 years) at least one-year post-stroke (mean 59.7 months, range 13-308 months) participated in this single group, before-after study with multiple follow-ups. Participants completed approximately 12, 30-minute treatment sessions with the gait device in their home environment. Gait speed was measured using the Ten-Meter Walk Test at a comfortable pace at baseline and five follow-up sessions after the treatment period: one week, one month, three months, six months, and twelve months. Gait speed changes were analyzed using repeated-measures ANOVA from baseline to each follow-up time frame, comparison to the minimal clinically important difference threshold, evaluation of gait speed classification changes, and subjective questionnaires. Results showed that participants retained more than a 0.21 m/s gait speed improvement compared to baseline at all post-treatment time frames, p<0.01. Additionally, 94% of participants improved their gait speed beyond the minimally clinically important difference during one or more post-treatment measurements, and 88% of participants subjectively reported a gait speed improvement. These study findings indicate that treatment with the gait device may result in meaningful, long-term gait speed improvement for chronic stroke survivors with hemiparetic gait impairments.

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The Effect of Split-Belt Treadmill Interventions on Step Length Asymmetry in Individuals Poststroke: A Systematic Review With Meta-Analysis

Cited by 15 publications

References 49 publications

The detrimental effect of stroke on motor adaptation

The detrimental effect of stroke on motor adaptation

Locomotor adaptations: paradigms, principles and perspectives

One-Year Retention of Gait Speed Improvement in Stroke Survivors After Treatment with a Wearable Home-Use Gait Device

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