scholarly journals The role of movement errors in modifying spatiotemporal gait asymmetry post stroke: a randomized controlled trial

2017 ◽  
Vol 32 (2) ◽  
pp. 161-172 ◽  
Author(s):  
Michael D Lewek ◽  
Carty H Braun ◽  
Clint Wutzke ◽  
Carol Giuliani
Keyword(s):  
Randomized Controlled Trial ◽  
Motor Learning ◽  
Learning Strategies ◽  
Gait Speed ◽  
Controlled Trial ◽  
Step Length ◽  
Verbal Feedback ◽  
Gait Symmetry ◽  
Randomized Controlled ◽  
Stance Time

Objective: Current rehabilitation to improve gait symmetry following stroke is based on one of two competing motor learning strategies: minimizing or augmenting symmetry errors. We sought to determine which of those motor learning strategies best improves overground spatiotemporal gait symmetry. Design: Randomized controlled trial. Setting: Rehabilitation research lab. Subjects: In all, 47 participants (59 ± 12 years old) with chronic hemiparesis post stroke and spatiotemporal gait asymmetry were randomized to error augmentation, error minimization, or conventional treadmill training (control) groups. Interventions: To augment or minimize asymmetry on a step-by-step basis, we developed a responsive, “closed-loop” control system, using a split-belt instrumented treadmill that continuously adjusted the difference in belt speeds to be proportional to the patient’s current asymmetry. Main measures: Overground spatiotemporal asymmetries and gait speeds were collected prior to and following 18 training sessions. Results: Step length asymmetry reduced after training, but stance time did not. There was no group × time interaction. Gait speed improved after training, but was not affected by type of asymmetry, or group. Of those who trained to modify step length asymmetry, there was a moderately strong linear relationship between the change in step length asymmetry and the change in gait speed. Conclusion: Augmenting errors was not superior to minimizing errors or providing only verbal feedback during conventional treadmill walking. Therefore, the use of verbal feedback to target spatiotemporal asymmetry, which was common to all participants, appears to be sufficient to reduce step length asymmetry. Alterations in stance time asymmetry were not elicited in any group.

scholarly journals Cerebellar Transcranial Direct Current Stimulation for Motor Learning in People with Chronic Stroke: A Pilot Randomized Controlled Trial

2020 ◽  
Vol 10 (12) ◽  
pp. 982
Author(s):  
Nitika Kumari ◽  
Denise Taylor ◽  
Sharon Olsen ◽  
Usman Rashid ◽  
Nada Signal
Keyword(s):  
Randomized Controlled Trial ◽  
Motor Learning ◽  
Direct Current ◽  
Transcranial Direct Current Stimulation ◽  
Walking Speed ◽  
Controlled Trial ◽  
Step Length ◽  
Chronic Stroke ◽  
Randomized Controlled ◽  
Over Ground Walking

Cerebellar transcranial direct current stimulation (ctDCS) is a non-invasive brain stimulation technique that alters neural plasticity through weak, continuous, direct currents delivered to the cerebellum. This study aimed to evaluate the feasibility of conducting a randomized controlled trial (RCT) delivering three consecutive days of ctDCS during split-belt treadmill training (SBTT) in people with chronic stroke. Using a double-blinded, parallel-group RCT design, eligible participants were randomly allocated to receive either active anodal ctDCS or sham ctDCS combined with SBTT on three consecutive days. Outcomes were assessed at one-week follow-up, using step length symmetry as a measure of motor learning and comfortable over-ground walking speed as a measure of walking capacity. The feasibility of the RCT protocol was evaluated based on recruitment, retention, protocol deviations and data completeness. The feasibility of the intervention was assessed based on safety, adherence and intervention fidelity. Of the 26 potential participants identified over four months, only four were enrolled in the study (active anodal ctDCS n = 1, sham ctDCS n = 3). Both the inclusion criteria and the fidelity of the SBTT relied upon the accurate estimation of step length asymmetry. The method used to determine the side of the step length asymmetry was unreliable and led to deviations in the protocol. The ctDCS intervention was well adhered to, safe, and delivered as per the planned protocol. Motor learning outcomes for individual participants revealed that treadmill step length symmetry remained unchanged for three participants but improved for one participant (sham ctDCS). Comfortable over-ground walking speed improved for two participants (sham ctDCS). The feasibility of the planned protocol and intervention was limited by intra-individual variability in the magnitude and side of the step length asymmetry. This limited the sample and compromised the fidelity of the SBTT intervention. To feasibly conduct a full RCT investigating the effect of ctDCS on locomotor adaptation, a reliable method of identifying and defining step length asymmetry in people with stroke is required. Future ctDCS research should either optimize the methods for SBTT delivery or utilize an alternative motor adaptation task.

scholarly journals A Randomized Controlled Trial to Compare e-Feedback Versus “Standard” Face-to-Face Verbal Feedback to Improve the Acquisition of Procedural Skill

2017 ◽  
Vol 74 (3) ◽  
pp. 390-397 ◽  
Author(s):  
Wissam Al-Jundi ◽  
Mohamed Elsharif ◽  
Melanie Anderson ◽  
Phillip Chan ◽  
Jonathan Beard ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Procedural Skill ◽  
Verbal Feedback ◽  
Face To Face ◽  
Randomized Controlled

scholarly journals The role of vaginal palpation in motor learning of the pelvic floor muscles for women with stress urinary incontinence: study protocol for a randomized controlled trial

Trials ◽  
2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Letícia de Azevedo Ferreira ◽  
Fátima Faní Fitz ◽  
Márcia Maria Gimenez ◽  
Mayanni Magda Pereira Matias ◽  
Maria Augusta Tezelli Bortolini ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Urinary Incontinence ◽  
Stress Urinary Incontinence ◽  
Motor Learning ◽  
Pelvic Floor ◽  
Study Protocol ◽  
Controlled Trial ◽  
Pelvic Floor Muscles ◽  
Randomized Controlled

Does focus of attention alter craniocervical flexion test motor learning? A randomized controlled trial

2020 ◽  
Vol 74 ◽  
pp. 102709
Author(s):  
Maurício Scholl Schell ◽  
Francisco Xavier de Araujo ◽  
Rosicler da Rosa Almeida ◽  
Ian Sulzbacher Peroni ◽  
Carolina Gomes Rosa ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Motor Learning ◽  
Controlled Trial ◽  
Focus Of Attention ◽  
Randomized Controlled ◽  
Flexion Test

scholarly journals A Randomized Controlled Trial of a Passive Accessory Joint Mobilization on Acute Ankle Inversion Sprains

2001 ◽  
Vol 81 (4) ◽  
pp. 984-994 ◽  
Author(s):  
Toni Green ◽  
Kathryn Refshauge ◽  
Jack Crosbie ◽  
Roger Adams
Keyword(s):  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Step Length ◽  
Control Group ◽  
Joint Mobilization ◽  
Randomized Controlled ◽  
Ankle Inversion ◽  
Before And After ◽  
Experimental Group ◽  
Support Time

Abstract Background and Purpose. Passive joint mobilization is commonly used by physical therapists as an intervention for acute ankle inversion sprains. A randomized controlled trial with blinded assessors was conducted to investigate the effect of a specific joint mobilization, the anteroposterior glide on the talus, on increasing pain-free dorsiflexion and 3 gait variables: stride speed (gait speed), step length, and single support time. Subjects. Forty-one subjects with acute ankle inversion sprains (<72 hours) and no other injury to the lower limb entered the trial. Methods. Subjects were randomly assigned to 1 of 2 treatment groups. The control group received a protocol of rest, ice, compression, and elevation (RICE). The experimental group received the anteroposterior mobilization, using a force that avoided incurring any increase in pain, in addition to the RICE protocol. Subjects in both groups were treated every second day for a maximum of 2 weeks or until the discharge criteria were met, and all subjects were given a home program of continued RICE application. Outcomes were measured before and after each treatment. Results. The results showed that the experimental group required fewer treatment sessions than the control group to achieve full pain-free dorsiflexion. The experimental group had greater improvement in range of movement before and after each of the first 3 treatment sessions. The experimental group also had greater increases in stride speed during the first and third treatment sessions. Discussion and Conclusion. Addition of a talocrural mobilization to the RICE protocol in the management of ankle inversion injuries necessitated fewer treatments to achieve pain-free dorsiflexion and to improve stride speed more than RICE alone. Improvement in step length symmetry and single support time was similar in both groups.

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