Intense and unpredictable perturbations during gait training improve dynamic balance abilities in chronic hemiparetic individuals: a randomized controlled pilot trial.
Study Goal
The researchers aimed to determine whether treadmill training with intense, unpredictable perturbations improves dynamic balance and gait post-stroke more effectively than treadmill walking-only training.
Results Summary
Perturbation training led to significant improvements in balance, gait, balance confidence, and community integration, while walking-only training had minimal effects except on balance confidence. The benefits persisted at follow-up, and satisfaction with perturbation training was high.
Population
Individuals post-stroke with reduced dynamic balance abilities, able to walk on a treadmill without support for at least 1 minute.
Effective Dosage
Nine training sessions over 3 weeks (frequency not specified).
Duration
3 weeks
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
treadmill training with intense and unpredictable perturbations | increase | most variables | individuals post-stroke with reduced dynamic balance abilities (Perturb group) | Effect Size: ES > .46 | yielded large improvements | #1 |
treadmill training with intense and unpredictable perturbations | increase | most variables | individuals post-stroke with reduced dynamic balance abilities (NonPerturb group post-crossing) | Effect Size: ES > .45 | yielded large improvements | #2 |
walking-only training | no change | most variables | individuals post-stroke with reduced dynamic balance abilities (NonPerturb group pre-crossing) | Effect Size: ES < .26 | mostly had no effect | #3 |
walking-only training | increase | balance confidence | individuals post-stroke with reduced dynamic balance abilities (NonPerturb group pre-crossing) | Effect Size: ES = .46 | had effect | #4 |
gait training | increase | balance confidence | individuals post-stroke with reduced dynamic balance abilities | - | effects were still present | #5 |
gait training | increase | community integration | individuals post-stroke with reduced dynamic balance abilities | - | effects were still present | #6 |
intense and unpredictable gait perturbations | increase | balance abilities | individuals with chronic stroke | - | have the potential to be an efficient component of training to improve | #7 |
intense and unpredictable gait perturbations | increase | community integration | individuals with chronic stroke | - | have the potential to be an efficient component of training to improve | #8 |
BACKGROUND: Previous studies have assessed the effects of perturbation training on balance after stroke. However, the perturbations were either applied while standing or were small in amplitude during gait, which is not representative of the most common fall conditions. The perturbations were also combined with other challenges such as progressive increases in treadmill speed. OBJECTIVE: To determine the benefit of treadmill training with intense and unpredictable perturbations compared to treadmill walking-only training for dynamic balance and gait post-stroke. METHODS: Twenty-one individuals post-stroke with reduced dynamic balance abilities, with or without a history of fall and ability to walk on a treadmill without external support or a walking aid for at least 1 min were allocated to either an unpredictable gait perturbation (Perturb) group or a walking-only (NonPerturb) group through covariate adaptive randomization. Nine training sessions were conducted over 3 weeks. NonPerturb participants only walked on the treadmill but were offered perturbation training after the control intervention. Pre- and post-training evaluations included balance and gait abilities, maximal knee strength, balance confidence and community integration. Six-week phone follow-ups were conducted for balance confidence and community integration. Satisfaction with perturbation training was also assessed. RESULTS: With no baseline differences between groups (p > 0.075), perturbation training yielded large improvements in most variables in the Perturb (p < 0.05, Effect Size: ES > .46) group (n = 10) and the NonPerturb (p ≤ .089, ES > .45) group (n = 7 post-crossing), except for maximal strength (p > .23) in the NonPerturb group. Walking-only training in the NonPerturb group (n = 8, pre-crossing) mostly had no effect (p > .292, ES < .26), except on balance confidence (p = .063, ES = .46). The effects of the gait training were still present on balance confidence and community integration at follow-up. Satisfaction with the training program was high. CONCLUSION: Intense and unpredictable gait perturbations have the potential to be an efficient component of training to improve balance abilities and community integration in individuals with chronic stroke. Retrospective registration: ClinicalTrials.gov. March 18th, 2020. Identifier: NCT04314830.