Improved gait adjustments after gait adaptability training are associated with reduced attentional demands in persons with stroke
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After stroke, the ability to make step adjustments during walking is reduced and requires more attention, which may cause problems during community walking. The C-Mill is an innovative treadmill augmented with visual context (e.g., obstacles and stepping targets), which was designed specifically to practice gait adaptability. The objective of this study was to determine whether C-Mill gait adaptability training can help to improve gait adjustments and associated attentional demands. Sixteen community-ambulating persons in the chronic stage of stroke (age: 54.8 ± 10.8 years) received ten sessions of C-Mill training within 5–6 weeks. Prior to and after the intervention period, participants performed an obstacle-avoidance task with and without a secondary attention-demanding auditory Stroop task to assess their ability to make gait adjustments (i.e., obstacle-avoidance success rates) as well as the associated attentional demands (i.e., Stroop success rates, stratified for pre-crossing, crossing, and post-crossing strides). Obstacle-avoidance success rates improved after C-Mill training from 52.4 ± 16.3 % at pretest to 77.0 ± 16.4 % at posttest (p < 0.001). This improvement was accompanied by greater Stroop success rates during the obstacle-crossing stride only (pretest: 62.9 ± 24.9 %, posttest: 77.5 ± 20.4 %, p = 0.006). The observed improvements in obstacle-avoidance success rates and Stroop success rates were strongly correlated (r = 0.68, p = 0.015). The ability to make gait adjustments and the associated attentional demands can be successfully targeted in persons with stroke using C-Mill training, which suggests that its underlying assumptions regarding motor control are appropriate. This study lends support and guidance for designing a randomized controlled trial to further examine the potential of C-Mill training for improving safe community ambulation after stroke.
KeywordsStroke Exercise therapy Rehabilitation Gait Attention Dual task
The authors thank Judith Vloothuis, rehabilitation physician at Reade, Centre for Rehabilitation and Rheumatology, for conducting the intake visits. The authors also thank the physical therapists Peter Elich, Sifra Broeder, Sjoerd Heubers, and Jasper den Boer for their feedback on the training intervention. From the department of Rehabilitation at the Radboud University, the authors thank Coen Bongers, Digna de Kam, and Jorik Nonnekes for supporting data collection and Roland Loeffen and Roos van Swigchem for their technical support. This study was funded by the Dutch Brain Foundation (‘Hersenstichting Nederland’), Grant 2010(1)-25. The contributions of Melvyn Roerdink and Vivian Weerdesteyn were supported by Veni Grants 451-09-024 and 916-10-106, respectively, of The Netherlands Organization for Scientific Research (NWO).
Conflict of interest
ForceLink (producer of the C-Mill) was not financially involved in this study and had no influence on the interpretation of data and the final conclusions.
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- Field A (2009) Discovering statistics using SPSS, 3rd edn. Sage, New YorkGoogle Scholar
- Mirelman A, Maidan I, Herman T, Deutsch JE, Giladi N, Hausdorff JM (2011) Virtual reality for gait training: can it induce motor learning to enhance complex walking and reduce fall risk in patients with parkinson’s disease? J Gerontol A Biol Sci Med Sci 66:234–240. doi: 10.1093/gerona/glq201 PubMedCrossRefGoogle Scholar
- Pichierri G, Coppe A, Lorenzetti S, Murer K, de Bruin ED (2012) The effect of a cognitive-motor intervention on voluntary step execution under single and dual task conditions in older adults: a randomized controlled pilot study. Clin Interv Aging 7:175–184. doi: 10.2147/CIA.S32558 PubMedCentralPubMedCrossRefGoogle Scholar
- Roerdink M, Beek PJ (2009) Device for displaying target indications for foot movements to persons with a walking disorder. US patent 2009246746-A1 (October 1, 2009), European patent 2106779-A1 (October 7, 2009), Japanese patent 2009240775-A (October 22, 2009), and Dutch patent 1035236-C2 (October 1, 2009)Google Scholar
- Smulders E, van Lankveld W, Laan R, Duysens J, Weerdesteyn V (2011) Can improved obstacle avoidance performance explain the effectiveness of a multimodal falls prevention program for persons with osteoporosis? J Am Geriatr Soc 59:368–369. doi: 10.1111/j.1532-5415.2011.03254.x PubMedCrossRefGoogle Scholar
- van Ooijen MW, Roerdink M, Trekop M, Visschedijk J, Janssen TW, Beek PJ (2013) Functional gait rehabilitation in elderly people following a fall-related hip fracture using a treadmill with visual context: design of a randomized controlled trial. BMC Geriatr 13:34. doi: 10.1186/1471-2318-13-34 PubMedCentralPubMedCrossRefGoogle Scholar
- Yamada M, Aoyama T, Arai H, Nagai K, Tanaka B, Uemura K, Mori S, Ichihashi N (2012) Complex obstacle negotiation exercise can prevent falls in community-dwelling elderly Japanese aged 75 years and older. Geriatr Gerontol Int 12:461–467. doi: 10.1111/j.1447-0594.2011.00794.x PubMedCrossRefGoogle Scholar