Combined Cognitive and Gait Training Problem: Recent research in gait training for chronic stroke survivors showed that gait coordination can be best restored using the following interventions together: exercise, over ground gait training, and body weight supported treadmill training (BWSTT). These results are important because, to our knowledge, there have been no other reports of the restoration of gait coordination for those with persistent gait deficits (>6 months after stroke). However, a remaining problem was that the restored coordinated gait movements measured in the laboratory did not generalize for many subjects to the everyday environment. The known confluence of several factors can cause lack of generalization. First, it is known that dual task performance (walking and cognitive attention task) can degrade both gait speed and attention ability, even in healthy adults. Second, stroke can impair attention. Third, during walking in the everyday environment, attention is required in order to safely process normally occurring stimuli. Therefore, given the success of the new gait training protocol in the lab setting, it is important to address the problems remaining, for the generalization of recovered functional gait (gait speed) and gait coordination to the everyday environment. Purpose:
Aim 1 is to test an innovative combination of motor and cognitive training that is designed to restore functional gait (gait speed) and gait coordination to the everyday environment. Hypothesis I: Combined cognitive and motor training will produce greater gains in gait speed in the dual task test condition, versus motor training alone. Primary measure: gait speed, measured under the dual task conditions of walking and dealing with a visual distraction (obstacles) in the gait pathway. Secondary measures include: gait coordination, time spent walking in everyday environment, and life role participation (quality of life).
Aims 2 and 3 are t investigate the within-group, separate motor and cognitive changes in response to the respective treatments for each of the two study groups. Methods:
For Aim 1, Hyp I, thirty-eight subjects (>6 months post stroke) will be enrolled and randomized to either 1) Gait Training + Cognitive Training;or 2) Gait Training alone. Subjects in both groups will receive treatment 5 times/wk, 3hrs/session, for 12wks. The Gait Training Protocol will include: exercise;body weight supported treadmill training (BWSTT);and over ground gait training. For Group 1, the cognitive training will be phased into the daily sessions, by first emphasizing cognitive training alone, and subsequently dual training (cognitive and motor).
Aims 2 and 3 measures will include gait measures acquired both with and without a cognitive task, as well as cognitive measures acquired both with and without the gait task. Pre-/post-treatment comparisons will be made within each of the two treatment groups. Clinical Significance: The proposed intervention has the potential to restore safe, coordinated, functional walking in the every day environment.

Public Health Relevance

As the OIF, OEF, Korean Conflict, and Viet Nam veteran populations age, stroke and persistent gait deficits become an increasingly important problem for the Department of Veterans Affairs. More than 3 million Americans live with residual disabilities of stroke and over 750,000 acute strokes occur each year. Thirty to 60% of rehabilitated stroke patients have residual functional disability that interferes with independent mobility and self care, which in turn may require an attendant or institutionalization, costing in excess of $100,000/year/patient. The cost to society for medical care and days lost from work is more than $30 billion/year. It is important that the V.A. health care system develop and utilize state-of-the-art treatment to improve quality of life for its veterans. The proposed study has the potential to provide recovery of safe, coordinated gait in the everyday environment for many veterans who have had a stroke.

National Institute of Health (NIH)
Veterans Affairs (VA)
Non-HHS Research Projects (I01)
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Brain Injury: TBI &Stroke (RRD1)
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Louis Stokes Cleveland VA Medical Center
United States
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