Rehabilitation with accurate adaptability walking tasks or steady state walking: A randomized clinical trial in adults post-stroke.
David J Clark, Dorian K Rose, Katie A Butera and 9 others
PMID 33722075WHAT IT FOUND
Both accuracy-based adaptability tasks and steady-state walking improved walking speed similarly in adults post-stroke.
Neither training style was superior for functional recovery. However, the adaptability group showed a larger reduction in prefrontal brain activity during dual-task walking, suggesting improved automaticity despite identical functional gains.
Key findings
01There was no significant difference between the accurate adaptability group and the steady state group for any functional outcome measure, including the primary outcome of preferred walking speed.
02The accurate adaptability intervention group exhibited a larger reduction in prefrontal activity from baseline to post-intervention during dual-task walking compared to the steady state group.
03Although the adaptability group showed a nearly two-fold larger improvement in balance confidence at follow-up, the study was underpowered to confirm this difference.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The sample size was relatively small (38 participants), which the authors acknowledge may have underpowered the detection of differences in secondary outcomes like balance confidence. The study stopped enrollment when funding expired, which may have limited the final sample size and generalizability. The lack of difference in functional outcomes might be due to the comparable intensity and duration of training between the two groups, masking potential benefits of one approach over the other if dosing had been different. The reduction in prefrontal activity observed in the adaptability group did not correlate with improved dual-task performance (walking speed or subtraction accuracy), leaving the clinical meaning of this neural change unclear.
Declared interests
Funding was provided by the US Department of Veterans Affairs Rehabilitation Research and Development Service.
The easy way to misread this
Do not assume that the observed reduction in brain activity during dual-task walking translates to better real-world walking performance or dual-task ability. The study found that despite this neural efficiency, the adaptability group did not perform better than the steady state group on dual-task walking measures.