Introduction
Methods
Power calculations
Participants
Assessments
Randomization to study groups
Walking Behavior | Hand Free n = 15 | Hands Free + Challenge n = 14 | p value |
---|---|---|---|
Walking speed severity (severe < 0.5; moderate≥0.5) | 7 moderate 8 severe | 6 moderate 8 severe | 0.84 |
Community Walking Status | 8 HH; 2 LC; 5 C | 8 HH; 1 LC; 5 C | 0.86 |
Assistive Devices used for overground assessments | n = 6 none n = 2 single-point cane n = 5 quad cane n = 1 hemi walker n = 1 other | n = 5 none n = 5 single-point cane n = 2 quad cane n = 2 hemi walker | 0.41 |
Ankle-Foot Orthosis | n = 6 none n = 5 rigid plastic, no joint n = 3 rigid plastic, joint n = 1 external ankle support | n = 11 none n = 2 rigid plastic, joint n = 1 metal double upright with joint | 0.07 |
Functional Ambulation Classification | n = 3 Dependent, Level II n = 3 Independent, level surfaces only n = 9 Independent, level and non-level surfaces | n = 1, Dependent, supervision n = 1, Independent, level surfaces only n = 12, Independent, level and non-level surfaces | 0.14 |
Training environment
Intervention protocols
Task | Delivery mechanism | Mobility dimension |
---|---|---|
Hurdles | A pliable hurdle positioned in front of participant’s paretic & nonparetic limb for 5 min each; challenge increased through raising hurdle height | terrain characteristics |
Foam Shoes | 3- or 6-in. foam blocks strapped to the bottom of participants’ shoes; challenge increased by using thicker foam or walking faster | terrain characteristics |
Backward Walking | Participants walked backward; challenge increased by faster speeds | postural transitions |
Head Turns | Participants asked to look in 4 different directions (i.e., up, down, left, or right) for 10s each; increased challenge through nodding head up/down & left/right for 10s each | attentional demands |
Backward Perturbation | Participants exposed to sudden brief accelerations of the treadmill belt, of sufficient magnitude to disturb forward progression; challenge increased through larger accelerations | postural transitions; external physical loads |
Speed Up/ Slow Down | Participants walked at double their CWS for 10s & then recovered at their CWS for 20s; challenge increased if CWS increased | time constraints; postural transitions |
Variable Speeds | Participants walked at a variety of randomly selected speeds between 0.2 m/s < daily CWS and 0.2 m/s > daily CWS; challenge increased if CWS increased | postural transitions |
Narrow Stepping | Participants walked in ambient lighting conditions while keeping their feet within a narrow area of the treadmill belt designated by laser light beams; challenge increased through narrowing lights | terrain characteristics; ambient lighting |
Long Stepping | Participants walked in ambient lighting conditions while taking long steps with both feet over a laser beam placed in front of them; challenge increased by moving laser farther away | terrain characteristics; ambient lighting |
Statistical analyses
Results
Characterization of participants at baseline
Participant Characteristic | HF (n = 15) | HF + C (n = 14) | p value |
---|---|---|---|
Age (years), mean (SD) | 60.3 (12.8) | 48.9 (14.4) | 0.03* |
Gender, # males | 7 | 8 | 0.57 |
Time since stroke (months), mean (SD) | 47.7 (64.7) | 52 (71.4) | 0.87 |
Side of hemiparesis, # Left | 9 | 11 | 0.28 |
Fugl-Meyer, mean (SD) | 18.9 (5.1) | 18.9 (6.5) | 0.99 |
ABC (%), mean (SD) | 56 (30) | 73 (15) | 0.09 |
GDS, mean (SD) | 8.4 (6.7) | 3.9 (3.5) | 0.03* |
DGI, mean (SD) | 13.7 (6.0) | 16.6 (4.5) | 0.16 |
SIS mobility, mean (SD) | 35.8 (8.5) | 39.8 (4.4) | 0.13 |
SIS ADL, mean (SD) | 36.9 (10.3) | 40.3 (6.2) | 0.30 |
SIS participation, mean (SD) | 28.8 (8.0) | 30.4 (5.1) | 0.52 |
CWS, mean (SD) | 0.53 (0.38) | 0.52 (0.32) | 0.95 |
FWS, mean (SD) | 0.71 (0.46) | 0.77 (0.51) | 0.76 |
6-min distance, mean (SD) | 182.2 (131.9) | 193.9 (113.7) | 0.80 |
BBS, mean (SD) | 42.5 (10.7) | 45.9 (9.3) | 0.37 |
Measure | Group | Pre Mean (95% CI) | Post Mean (95% CI) | Effect size η2 | Sig. change pre to post |
---|---|---|---|---|---|
FWS (m/s) | HF (n = 15) | 0.68 (0.42 to 0.93) | 0.78 (0.49 to 1.07) | 0.46 | p ≤ 0.0001 |
HF + C(n = 14) | 0.77 (0.50 to 1.04) | 0.88 (0.58 to 1.19) | |||
6-min distance (m) | HF (n = 15) | 182.2 (116.8 to 247.6) | 221.1 (146.6 to 295.5) | 0.43 | p ≤ 0.0001 |
HF + C(n = 14) | 193.9 (126.2 to 261.6) | 225.6 (148.5 to 302.7) | |||
BBS (points) | HF (n = 15) | 42.5 (37.2 to 47.9) | 45.1 (39.6 to 50.6) | 0.21 | p = 0.01 |
HF + C(n = 14) | 45.9 (40.4 to 51.5) | 47.6 (41.9 to 53.3) | |||
ABC (%) | HF (n = 15) | 56 1 (43.7 to 68.6) | 61.8 (51.6 to 72.0) | 0.14 | p = 0.05 |
HF + C(n = 14) | 71.9 (59.0 to 84.7) | 74.3 (63.7 to 84.9) |