title: Walking adaptability therapy after stroke: study protocol for a randomized controlled trial.
abstract: Walking 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.
  
  
  
  This 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.
  
  
  
  This 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.
  
  
  
  Netherlands Trial Register NTR4030 . Registered on 11 June 2013, amendment filed on 17 June 2016.
authors: MOVE Research Institute Amsterdam, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 9, Amsterdam, 1081 BT, The Netherlands. c.timmermans@vu.nl.|Amsterdam Rehabilitation Research Center, Reade, Overtoom 283, Amsterdam, 1054 HW, The Netherlands. c.timmermans@vu.nl.
authors: Celine
authors: 0000-0001-8451-2326
authors: C
authors: Timmermans
authors: MOVE Research Institute Amsterdam, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 9, Amsterdam, 1081 BT, The Netherlands.
authors: Melvyn
authors: M
authors: Roerdink
authors: MOVE Research Institute Amsterdam, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 9, Amsterdam, 1081 BT, The Netherlands.|Amsterdam Rehabilitation Research Center, Reade, Overtoom 283, Amsterdam, 1054 HW, The Netherlands.
authors: Marielle W
authors: MW
authors: van Ooijen
authors: VU Medical Centre, Department of Rehabilitation Medicine, De Boelelaan 1118, Amsterdam, 1081 HZ, The Netherlands.
authors: Carel G
authors: CG
authors: Meskers
authors: MOVE Research Institute Amsterdam, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 9, Amsterdam, 1081 BT, The Netherlands.|Amsterdam Rehabilitation Research Center, Reade, Overtoom 283, Amsterdam, 1054 HW, The Netherlands.
authors: Thomas W
authors: TW
authors: Janssen
authors: MOVE Research Institute Amsterdam, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 9, Amsterdam, 1081 BT, The Netherlands.
authors: Peter J
authors: PJ
authors: Beek
mesh_terms: D000222:Adaptation, Physiological; D002985:Clinical Protocols; D004185:Disability Evaluation; D005080:Exercise Test; D005081:Exercise Therapy / Q000379:methods*; D005684:Gait; D006801:Humans; D009426:Netherlands; D004856:Postural Balance; D020127:Recovery of Function; D012107:Research Design; D020521:Stroke / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D000071939:Stroke Rehabilitation / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D016138:Walking
keywords: Exercise; Rehabilitation; Stroke; Therapy; Walking adaptability; Walking speed