title: Feasibility and Preliminary Efficacy of Visual Cue Training to Improve Adaptability of Walking after Stroke: Multi-Centre, Single-Blind Randomised Control Pilot Trial.
abstract: OBJECTIVE
  Given the importance of vision in the control of walking and evidence indicating varied practice of walking improves mobility outcomes, this study sought to examine the feasibility and preliminary efficacy of varied walking practice in response to visual cues, for the rehabilitation of walking following stroke.
  
  
  METHODS
  This 3 arm parallel, multi-centre, assessor blind, randomised control trial was conducted within outpatient neurorehabilitation services.
  
  
  METHODS
  Community dwelling stroke survivors with walking speed <0.8m/s, lower limb paresis and no severe visual impairments.
  
  
  METHODS
  Over-ground visual cue training (O-VCT), Treadmill based visual cue training (T-VCT), and Usual care (UC) delivered by physiotherapists twice weekly for 8 weeks.
  
  
  METHODS
  Participants were randomised using computer generated random permutated balanced blocks of randomly varying size. Recruitment, retention, adherence, adverse events and mobility and balance were measured before randomisation, post-intervention and at four weeks follow-up.
  
  
  RESULTS
  Fifty-six participants participated (18 T-VCT, 19 O-VCT, 19 UC). Thirty-four completed treatment and follow-up assessments. Of the participants that completed, adherence was good with 16 treatments provided over (median of) 8.4, 7.5 and 9 weeks for T-VCT, O-VCT and UC respectively. No adverse events were reported. Post-treatment improvements in walking speed, symmetry, balance and functional mobility were seen in all treatment arms.
  
  
  CONCLUSIONS
  Outpatient based treadmill and over-ground walking adaptability practice using visual cues are feasible and may improve mobility and balance. Future studies should continue a carefully phased approach using identified methods to improve retention.
  
  
  BACKGROUND
  Clinicaltrials.gov NCT01600391.
authors.affiliation: School of Health Sciences, University of Salford, Allerton Building, Salford, M6 6PU, United Kingdom.
authors.forename: Kristen L
authors.initials: KL
authors.lastname: Hollands
authors.affiliation: Colleges of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom.
authors.forename: Trudy A
authors.initials: TA
authors.lastname: Pelton
authors.affiliation: Birmingham Community Health Care NHS Trust, (BCHCT), Moseley Hall Hospital, Birmingham, B13 8JL, United Kingdom.
authors.forename: Andrew
authors.initials: A
authors.lastname: Wimperis
authors.affiliation: University of Nottingham, Nottingham Clinical Trials Unit, Nottingham Health Science Partners, C-floor, South Block, Queen's Medical Centre, Nottingham, NG7 2UH, United Kingdom.
authors.forename: Diane
authors.initials: D
authors.lastname: Whitham
authors.affiliation: University of Nottingham, Nottingham Clinical Trials Unit, Nottingham Health Science Partners, C-floor, South Block, Queen's Medical Centre, Nottingham, NG7 2UH, United Kingdom.
authors.forename: Wei
authors.initials: W
authors.lastname: Tan
authors.affiliation: College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom.
authors.forename: Sue
authors.initials: S
authors.lastname: Jowett
authors.affiliation: King's College London, Capital House, Guy's Campus, London, SE1 3QD, United Kingdom.
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Sackley
authors.affiliation: Colleges of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom.
authors.forename: Alan M
authors.initials: AM
authors.lastname: Wing
authors.affiliation: School of Nursing, Midwifery & Social Work, University of Manchester,Oxford Rd, Manchester, M13 9PL, United Kingdom.
authors.forename: Sarah F
authors.initials: SF
authors.lastname: Tyson
authors.affiliation: Colleges of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Mathias
authors.affiliation: Colleges of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom.
authors.forename: Marianne
authors.initials: M
authors.lastname: Hensman
authors.affiliation: School of Health Sciences, Hunter Building, University Drive, University of Newcastle, Callaghn, New South Wales, 2308, Australia.
authors.forename: Paulette M
authors.initials: PM
authors.lastname: van Vliet
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002985:Clinical Protocols; D003463:Cues; D004185:Disability Evaluation; D005080:Exercise Test / Q000379:methods; D005081:Exercise Therapy / Q000379:methods; D005260:Female; D005684:Gait / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010291:Paresis / Q000503:physiopathology; D026741:Physical Therapy Modalities; D010865:Pilot Projects; D020127:Recovery of Function / Q000502:physiology*; D016037:Single-Blind Method; D020521:Stroke / Q000503:physiopathology*; D016896:Treatment Outcome; D015354:Vision, Low / Q000503:physiopathology; D014785:Vision, Ocular / Q000502:physiology*; D016138:Walking / Q000502:physiology*; D055815:Young Adult