Article

OBJECTIVE: Current rehabilitation to improve gait symmetry following stroke is
based on one of two competing motor learning strategies: minimizing or augmenting
symmetry errors. We sought to determine which of those motor learning strategies
best improves overground spatiotemporal gait symmetry. DESIGN: Randomized
controlled trial. SETTING: Rehabilitation research lab. SUBJECTS: In all, 47
participants (59 +/- 12 years old) with chronic hemiparesis post stroke and
spatiotemporal gait asymmetry were randomized to error augmentation, error
minimization, or conventional treadmill training (control) groups. INTERVENTIONS:
To augment or minimize asymmetry on a step-by-step basis, we developed a
responsive, "closed-loop" control system, using a split-belt instrumented
treadmill that continuously adjusted the difference in belt speeds to be
proportional to the patient's current asymmetry. MAIN MEASURES: Overground
spatiotemporal asymmetries and gait speeds were collected prior to and following
18 training sessions. RESULTS: Step length asymmetry reduced after training, but
stance time did not. There was no group x time interaction. Gait speed improved
after training, but was not affected by type of asymmetry, or group. Of those who
trained to modify step length asymmetry, there was a moderately strong linear
relationship between the change in step length asymmetry and the change in gait
speed. CONCLUSION: Augmenting errors was not superior to minimizing errors or
providing only verbal feedback during conventional treadmill walking. Therefore,
the use of verbal feedback to target spatiotemporal asymmetry, which was common
to all participants, appears to be sufficient to reduce step length asymmetry.
Alterations in stance time asymmetry were not elicited in any group.

Langue : ANGLAIS