Rehabilitation with accurate adaptability walking tasks or steady state walking: A randomized clinical trial in adults post-stroke.
Study Goal
To compare the effects of two post-stroke walking rehabilitation interventions (ACC and SS) on walking function and prefrontal cortical activity.
Results Summary
Both ACC and SS interventions improved preferred walking speed similarly, with no significant difference between groups. fNIRS data suggested ACC training may reduce prefrontal executive demands during walking.
Population
Adults with chronic post-stroke hemiparesis and walking deficits.
Effective Dosage
36 sessions led by a physical therapist.
Duration
3 months (post-intervention assessment), with follow-up at 6 months.
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
accurate adaptability (ACC) walking intervention | increase | preferred walking speed | Adults with chronic post-stroke hemiparesis and walking deficits | 0.13 ± 0.11 m/s | increased | #1 |
steady state (SS) walking intervention | increase | preferred walking speed | Adults with chronic post-stroke hemiparesis and walking deficits | 0.14 ± 0.13 m/s | increased | #2 |
accurate adaptability (ACC) walking intervention | decrease | prefrontal (executive) resources during walking | Adults with chronic post-stroke hemiparesis and walking deficits | - | suggested a potential benefit for reducing demand | #3 |
accurate adaptability (ACC) walking intervention | increase | corticospinal tract activation | - | - | recruit cortical regions that increase | #4 |
steady state (SS) walking intervention | decrease | corticospinal tract activation | - | - | activates the corticospinal tract less intensely | #5 |
OBJECTIVE: To assess changes in walking function and walking-related prefrontal cortical activity following two post-stroke rehabilitation interventions: an accurate adaptability (ACC) walking intervention and a steady state (SS) walking intervention. DESIGN: Randomized, single blind, parallel group clinical trial. SETTING: Hospital research setting. SUBJECTS: Adults with chronic post-stroke hemiparesis and walking deficits. INTERVENTIONS: ACC emphasized stepping accuracy and walking adaptability, while SS emphasized steady state, symmetrical stepping. Both included 36 sessions led by a licensed physical therapist. ACC walking tasks recruit cortical regions that increase corticospinal tract activation, while SS walking activates the corticospinal tract less intensely. MAIN MEASURES: The primary functional outcome measure was preferred steady state walking speed. Prefrontal brain activity during walking was measured with functional near infrared spectroscopy to assess executive control demands. Assessments were conducted at baseline, post-intervention (three months), and follow-up (six months). RESULTS: Thirty-eight participants were randomized to the study interventions (mean age 59.6 ± 9.1 years; mean months post-stroke 18.0 ± 10.5). Preferred walking speed increased from baseline to post-intervention by 0.13 ± 0.11 m/s in the ACC group and by 0.14 ± 0.13 m/s in the SS group. The Time × Group interaction was not statistically significant ( CONCLUSIONS: The ACC and SS interventions produced similar changes in walking function. fNIRS suggested a potential benefit of ACC training for reducing demand on prefrontal (executive) resources during walking.