Individualized feedback to change multiple gait deficits in chronic stroke.
Kevin A Day, Kendra M Cherry-Allen, Amy J Bastian
PMID 31870390WHAT IT FOUND
Stroke survivors used visual feedback to increase paretic knee flexion and improve gait symmetry in one session.
Verbal instructions about specific joint movements hindered their progress, whereas the feedback alone allowed them to explore and achieve better walking patterns without explicit guidance.
Key findings
01Participants with chronic stroke significantly improved their gait pattern toward a healthy goal when using visual feedback, specifically by increasing paretic knee flexion.
02Explicit verbal instructions on how to alter joint kinematics did not improve performance in the stroke group, while healthy controls benefited from such instructions.
03Training with visual feedback led to an increase in vertical ankle clearance during late swing, which may reduce tripping risk.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Small sample size of ten participants in each group. The study focused only on sagittal plane kinematics, ignoring potential compensatory movements in other planes. The stroke group had lower cognitive scores than the control group, which may have influenced their ability to process verbal instructions. Performance gains were measured within a single session or two sessions, so long-term retention and functional carryover are unknown.
Declared interests
The study was funded by the National Institutes of Health.
The easy way to misread this
Do not assume that verbal cues to 'bend your knee more' are universally effective for gait retraining. In this study, adding specific joint instructions prevented the stroke group from improving, suggesting that exploratory learning via visual feedback may be more effective for some patients.