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

Abstract

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.

The efficacy of treadmill training with and without projected visual context for improving walking ability and reducing fall incidence and fear of falling in older adults with fall-related hip fracture: a randomized controlled trial

“…Walking adaptability is a complex and multifaceted construct that involves more than simple obstacle avoidance [47]. A gold standard clinical assessment that covers all aspects of walking adaptability seems necessary and should, if feasible, be included as outcome measure in future research on walking adaptability [47, 48]. …”

Walking behaviors for stroke survivors: comparison between straight line and curved path

“…When humans walk, if the external environment is changed, human walking is characterized by changing the number of steps or the step or stride lengths in order to maintain walking speed. This ability is namely gait adaptability or walking adaptability [23,24]. The results of this study suggest that one of reason why there was no significant difference in walking speed between straight walking and curved walking was walking adaptability.…”

Usability Assessments for Augmented Reality Motor Rehabilitation Solutions: A Systematic Review

“…Of the 32 articles, 14 did not report the participants' ages, 2 reported within an age range (20-30 years and 27-35 years) [26,37], and 3 articles reported the mean ages per group [22,28,29]. From the included papers, 3 presented study protocols [38][39][40] to be completed during the research.…”

“…Hands were the second highest occurrence in studies, accounting for 31% (11 studies) of these, 3 contemplated hands and upper limbs [36,46,47]. The lower limbs accounted for 14% of studies (5), 4 of these concerned with walking [38][39][40]44], the other focusing on the lateral movement of the legs for patients with Parkinson's disease [41]. Studies that proposed to investigate both upper and lower limbs numbered 3 (9%) [22,26,48].…”