Different Error Size During Locomotor Adaptation Affects Transfer to Overground Walking Poststroke.
Carolina C Alcântara, Charalambos C Charalambous, Susanne M Morton and 2 others
PMID 30409103WHAT IT FOUND
Raising one treadmill belt speed gradually, rather than suddenly, produced greater transfer to overground walking in people after stroke.
Treadmill learning was similar, and the overground change was small and variable.
Key findings
01Transfer to overground walking was greater after gradual split-belt adaptation than after abrupt split-belt adaptation.
02Learning on the treadmill, measured as the aftereffect, did not differ between gradual and abrupt adaptation.
03Transfer to overground walking did not correlate with lower-limb Fugl-Meyer scores, Functional Gait Assessment scores, or comfortable overground walking speed.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Small sample: 13 participants were analysed in each group, and 2 of 28 allocated participants were excluded. Single-centre study in chronic post-stroke hemiparesis, limited to people who could already walk without another person's assistance, so it may not apply to more dependent walkers. Overground walking was tested as several 5-m trials, not a long-distance walk. All subjects held a handrail on the treadmill, which may have acted as a contextual cue and limited transfer. Transfer was small and variable; for many participants, the overground change did not exceed their own baseline walking variability. No correlation was found between transfer and clinical impairment, but the authors noted the clinical tools may not have been sensitive enough.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not conclude that gradual split-belt treadmill training will improve a patient's everyday walking. The study measured step length asymmetry during a laboratory adaptation task, not clinical walking function, and the transfer to overground walking was small and variable.