Abstract
BackgroundThe ability to adapt walking to environmental properties and hazards, a prerequisite for safe ambulation, is often impaired in persons after stroke. Research questionThe aim of this study was to compare the efficacy of two walking-adaptability interventions: treadmill-based C-Mill therapy (using gait-dependent augmented reality) and the overground FALLS program (using physical context). We hypothesized better outcomes for C-Mill therapy than the FALLS program due to its expected greater amount of walking practice. MethodsIn this randomized controlled trial, forty persons after stroke (≥3 months ago) with walking and/or balance deficits were randomly allocated to either 5 weeks of C-Mill therapy or the FALLS program. The primary outcome measure was the standard walking speed as determined with the 10 Meter Walking Test (10MWT). Additionally, context-specific walking speed was assessed in environments enriched with either stationary physical context (10MWT context) or suddenly appearing visual images (Interactive Walkway). The walking-adaptability scores of those enriched walking tests served as secondary outcome measures. Furthermore, a cognitive task was added to all three assessments to evaluate dual-task performance. Finally, the participants’ experience and amount of walking practice were scored.Results While both interventions did not show significant improvements in the standard walking speed, they did show significant improvements in context-specific walking speed, walking adaptability and cognitive dual-task performance. C-Mill therapy led to a greater improvement in context-specific walking speed with stationary physical context compared to the FALLS program; however, this improvement was no longer significant at retention. Both interventions were well received, but C-Mill therapy scored better on perceived increased fitness than the FALLS program. Moreover, C-Mill therapy resulted in twice as many steps per session of equal duration than the FALLS program.SignificanceBoth interventions led to long term context-specific improvements in walking speed, walking adaptability and dual-tasking.Trial registration: The Netherlands Trial Register (NTR4030). Registered 11-June 2013, https://www.trialregister.nl/trial/3842
The effect of cognitive-motor dual task training with the biorescue force platform on cognition, balance and dual task performance in institutionalized older adults: a randomized controlled trial
