Practice Structure and Locomotor Learning After Stroke.
Erin E Helm, Ryan T Pohlig, Devina S Kumar and 1 others
PMID 30883495WHAT IT FOUND
Variable speed-ratio walking did not improve locomotor learning over constant practice after chronic stroke.
Both groups adapted on the first day and showed reduced initial asymmetry on the second day, but retention and adaptation rates did not differ between groups.
Key findings
01Variable practice did not produce more adaptation or return to baseline on Day 1 than constant practice for step length or limb phase.
02Both groups showed less initial asymmetry on Day 2, but the magnitude of retention did not differ between variable and constant practice.
03Adaptation and re-adaptation rates were similar between groups, and the Day 2 step-length interaction explained very little additional variance.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Participants had to walk independently for at least 4 minutes without another person, so the results may not apply to patients who need more support. The study tested only 15 minutes of treadmill practice on two consecutive days, so it does not show what happens with longer training. Learning was assessed as adaptation on the split-belt treadmill, not transfer to overground walking or carryover to tied-belt walking. The variable condition used one specific set of ratios, 2:1, 1.5:1 and 2.5:1, changed every 2.5 minutes, and the authors note other variable protocols may differ. Many subjects had lesions involving M1, which the authors suggest may limit benefit from variable practice. Only thirty two subjects participated.
Declared interests
The supplied text does not include a conflicts of interest or funding declaration. The publication types note NIH extramural research support.
The easy way to misread this
Do not conclude that variable practice improves locomotor learning after stroke. The between-group differences in adaptation, return to baseline, retention and rate of re-adaptation were not significant, although both groups did show reduced initial asymmetry on the second day.