title: Repeated split-belt treadmill training improves poststroke step length asymmetry.
abstract: OBJECTIVE
  Previous studies suggest that error augmentation may be used as a strategy to achieve longer-term changes in gait deficits after stroke. The purpose of this study was to determine whether longer-term improvements in step length asymmetry could be achieved with repeated split-belt treadmill walking practice using an error augmentation strategy.
  
  
  METHODS
  13 persons with chronic stroke (>6 months) participated in testing: (1) prior to 12 sessions of split-belt treadmill training, (2) after the training, and (3) in follow-up testing at 1 and 3 months. Step length asymmetry was the target of training, so belt speeds were set to augment step length asymmetry such that aftereffects resulted in reduced step length asymmetry during overground walking practice. Each individual was classified as a "responder" or "nonresponder" based on whether their reduction in step length asymmetry exceeded day-to-day variability.
  
  
  RESULTS
  For the group and for the responders (7 individuals), step length asymmetry improved from baseline to posttesting (P < .05) through an increased step length on both legs but a relatively larger change on the shorter step side (P < .05). Other parameters that were not targeted (e.g., stance time asymmetry) did not change over the intervention.
  
  
  CONCLUSIONS
  This study demonstrates that short-term adaptations can be capitalized on through repetitive practice and can lead to longer-term improvements in gait deficits poststroke. The error augmentation strategy, which promotes stride-by-stride adjustment to reduce asymmetry and results in improved asymmetry during overground walking practice, appears to be critical for obtaining the improvements observed.
authors: University of Delaware, Newark, DE 19716, USA. dreisman@udel.edu
authors: Darcy S
authors: DS
authors: Reisman
authors: Heather
authors: H
authors: McLean
authors: Jennifer
authors: J
authors: Keller
authors: Kelly A
authors: KA
authors: Danks
authors: Amy J
authors: AJ
authors: Bastian
mesh_terms: D000222:Adaptation, Physiological; D000328:Adult; D000368:Aged; D005080:Exercise Test; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality / Q000502:physiology*; D020233:Gait Disorders, Neurologic / Q000209:etiology* / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D020521:Stroke / Q000150:complications*; D000071939:Stroke Rehabilitation; D013997:Time Factors; D016138:Walking
keywords: gait; motor learning; stroke
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