Locomotor Training for Neurological Disease
Condition: Stroke; Hemiparesis
MeSH terms: Paresis; Nervous System Diseases
Study type: Interventional
Phase: Phase 1

Summary: 
      The purpose of this study is to determine whether split belt training can be used to treat
      walking pattern deficits from stroke and to determine whether different schedules and types
      of long term training on a custom split belt treadmill are likely to change/improve walking
      symmetry.
    

Detailed description: 
      Coordination between the legs during walking is often disrupted after neurological injury,
      resulting in asymmetric gait patterns. Recent data shows that walking patterns can be altered
      through treadmill training, even after central nervous system damage. The investigators have
      studied short-term adaptation of inter-limb coordination during walking using a split-belt
      treadmill to control speed of the two legs independently. Our findings demonstrate that
      walking patterns are adaptable, and that this process is dependent on cerebellar integrity.
      The investigators have also shown that people with cerebral damage from stroke can benefit in
      the short-term to correct asymmetric walking patterns. Since all of our previous work has
      focused on single training sessions, the investigators would like to study long-term effects
      of split belt treadmill training. Therefore, the purpose of this study is to prepare for a
      clinical trial of split-belt treadmill training to treat walking pattern deficits from
      cerebral damage. The investigators will gather data to determine whether different schedules
      and types of long-term training on a custom split-belt treadmill are likely to change/improve
      walking symmetry.

      The investigators will study subjects with and without cerebral damage. Subjects without
      hemiparesis will simply be trained daily for 2 weeks to understand how they learn a new
      pattern on the treadmill for comparison with patients. Subjects with hemiparesis will undergo
      training daily for 2 weeks or the same dose of training, spread over 4 weeks. Training for
      the subjects with hemiparesis will either be conventional treadmill walking or split-belt
      treadmill walking with one leg moving faster than the other. The investigators will study
      children and adults with hemiparesis. These studies will provide important new information
      about normal mechanisms of locomotor adaptation, as well as providing a new rehabilitation
      tool for people with asymmetric gait patterns. Note that this study is not an aerobic
      conditioning program since subjects will work well below their age-adjusted target heart
      rate; it is instead a retraining program aimed at teaching people a new inter-limb
      coordination pattern. This study is also critical for developing procedural reliability
      processes, calculating effect sizes, training clinical staff, and determining other salient
      clinical variables in preparation for a randomized clinical trial.
    

Intervention name(s): Split Belt treadmill
Intervention type(s): Behavioral
Intervention description(s): A split belt treadmill is like a typical treadmill that is seen in the gym, except that this treadmill has two belts that move instead of just one. One leg goes on one belt and the other leg uses the other belt. The belt speeds can be set to get at the same speed, making this treadmill similar to any regular treadmill, but, belt speeds can also be set so that one belt moves a little faster than the other. The belts are never set at a running or jogging speed, only a self-paced walking speed regardless of whether the belts are both going the same speed or both going slightly different speeds.
Other intervention name(s): Woodway Split Belt Treadmill; Company: Woodway USA, Inc
Allocation: Randomized
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: stroke; treadmill; walking; hemiparesis; training