Innovative Gait Biofeedback Strategies for Stroke Rehabilitation
Condition: Stroke, Cardiovascular; Gait, Hemiplegic
MeSH terms: Gait Disorders, Neurologic; Myocardial Infarction
Study type: Interventional

Summary: 
      The long-term study goal is to develop a more engaging, motivating gait biofeedback
      methodologies specifically designed for post-stroke gait training. The current project aims
      to address fundamental questions regarding the optimal methodology to deliver AGRF
      biofeedback during gait, and the feasibility and preliminary efficacy of AGRF progression
      protocols for improved gait patterns and gait function. The study objectives are to (1)
      evaluate the immediate effects of biofeedback training methodology on gait biomechanics; and
      (2) evaluate the feasibility and short-term effects on gait performance of a real-time
      biofeedback protocol incorporating progression criteria (similar to those employed during
      clinical rehabilitative training).
    

Detailed description: 
      Even after discharge from rehabilitation, residual gait deficits are prevalent in stroke
      survivors, leading to decreased walking speed and endurance. Because gait dysfunctions limit
      community mobility, stroke survivors and rehabilitation clinicians consider restoration of
      walking a major goal of rehabilitation. Biomechanical impairments, such as reduced knee and
      ankle flexion during swing phase negatively affect gait function and increase the risk for
      falls. During the stance phase, decreased contribution of the paretic leg to forward
      propulsion during paretic terminal stance is a critical post-stroke gait deficit shown to be
      correlated with hemiparetic severity, walking speed, and gait asymmetry. These gait deficits
      can lead to falls, increased energy cost of gait, and decreased endurance. Also, a slowed
      self-selected walking speed is one of the hallmarks of post-stroke gait, and greatly limits
      community participation in individuals post-stroke. Very few interventions provide targeted
      practice of biomechanically appropriate movement patterns exclusively or preferentially to
      the paretic leg. Biofeedback can enhance an individual's awareness of the impairment targeted
      during gait training, enabling self-correction of aberrant gait patterns. Real-time
      biofeedback gait training has been used for modulating step length asymmetry in people
      post-stroke. A recent study developed a protocol combining treadmill training with visual and
      auditory real-time biofeedback to increase anterior ground reaction force (AGRF). AGRF
      biofeedback may be a beneficial strategy to target unilateral propulsion deficits in people
      post-stroke. The goal of this study is to develop improved methodologies for AGRF gait
      biofeedback and to evaluate the feasibility and short-term effects of gait biofeedback. To
      achieve this goal, experiments will be performed on young able-bodied individuals as well as
      stroke survivors.
    

Intervention name(s): biofeedback
Intervention type(s): Behavioral
Intervention description(s): treadmill walking with biofeedback regarding propulsion and other gait parameters
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Other
Keywords: gait biofeedback; gait rehabilitation; paretic propulsion; gait motor learning