Recovering walking ability is a primary goal for those who have survived a stroke, yet many do not regain the ability to walk at a community-based level or reduce their dysfunctional asymmetry. We propose to combine two intervention methods, treadmill training (TT) and rhythmic auditory cueing (RAC) into a novel paradigm (TREADTRAC) that will have three potential advantages over either approach alone. First, combining two successful approaches may have an additive/multiplicative effect. Second, by manipulating RAC and treadmill speed independently, it is possible to target the improvement of specific temporal-spatial characteristics, that is, stride length or cadence depending on the preferred therapeutic goal. Third, preliminary evidence suggests that using RAC during overground (OG) walking, after the combined TREADTRAC, may provide a mechanism whereby the benefits of TT can be translated to overground walking in the community. We will target 24 older adults with chronic stroke who are ambulatory and conduct a pilot randomized controlled trial with primary goals of increasing walking velocity and gait symmetry.
Specific Aims will determine: #1: the effect of 6 weeks TREADTRAC followed by 6 weeks RAC+OG walking compared to 6 weeks dose-equivalent TT followed by 6 weeks OG walking #2: retention effect of the 12 week TREADTRAC/RAC+OG program compared with the dose- equivalent TT/OG program measured 12 weeks after all training has ceased. The training protocol will be individualized for each subject dependent on initial evaluation over the first week of training. We hypothesize that TREADTRAC is a powerful intervention for increasing walking speed and gait symmetry that can be individualized for spatial or temporal parameters and, potentially, translated into community living. Accomplishing our aims will demonstrate the feasibility of TREADTRAC, its relative advantage over TT alone for 6 weeks and implicate RAC+OG overground as a transitional training tool between laboratory/clinic and the community. It will also highlight the role of attentional and entrainment mechanisms engaged through RAC. This intervention could have future application to different populations.
This project is designed to test a new combined intervention for those with hemiparesis of the leg. It combines treadmill training with the use of rhythmic auditory cueing where individuals time their steps to an auditory beat. One potential benefit from this approach is that it may produce increased recovery of function over the single approaches alone.
| Eikema, D J A; Forrester, L W; Whitall, J (2014) Manipulating the stride length/stride velocity relationship of walking using a treadmill and rhythmic auditory cueing in non-disabled older individuals. A short-term feasibility study. Gait Posture 40:712-4 |
