The role of movement errors in modifying spatiotemporal gait asymmetry post stroke: a randomized controlled trial.
Michael D Lewek, Carty H Braun, Clint Wutzke and 1 others
PMID 28750549WHAT IT FOUND
No gait training strategy beat the others.
Augmenting errors, minimizing errors, and control treadmill walking produced similar step length asymmetry changes. Step length asymmetry improved over time in all groups, while stance time asymmetry did not.
Key findings
01No training group was better than another for step length asymmetry or stance time asymmetry.
02Step length asymmetry improved over time across all step length groups, while stance time asymmetry did not.
03Comfortable gait speed increased from 0.41 m/s before training to 0.53 m/s after training, and to 0.56 m/s at follow-up.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
11 participants dropped out, and transportation issues were reported for 6. The paper planned a sample size of 45, and 37 completed. This left small cell counts within each stratification. The final 4 participants were assessed by an unblinded assessor. All groups received treadmill walking, verbal cues, and overground gait training, so it is not possible to tell whether the treadmill algorithm, the attention to asymmetry, the verbal feedback, or the overground practice produced the step length changes. Participants had to walk more than 10 meters without physical help and walk below 1.0 m/s, so the findings may not apply to people with more severe walking difficulty or faster baseline walking.
The easy way to misread this
Do not conclude that augmenting movement errors is the necessary treatment. The augmentation group did not outperform minimization or control, and step length asymmetry improved across all three groups.