Treadmill-Based Locomotor Training With Robotic Pelvic Assist and Visual Feedback: A Feasibility Study.

BACKGROUND AND PURPOSE: Gait asymmetries are common after stroke, and often persist despite conventional rehabilitation. Robots provide training at a greater practice frequency than conventional approaches. However, prior studies of have found the transfer of learned skills outside of the device to be inadequate. The tethered pelvic assist device (TPAD) promotes weight shifting, yet allows users to independently navigate spatiotemporal aspects of gait. The purpose of this study was to evaluate feasibility and preliminary efficacy of a 5-day intervention combining TPAD training with visual feedback and task-specific overground training to promote improved force and stance symmetry in individuals after stroke. METHODS: After baseline assessments, 11 participants chronically after stroke received 1 hour of practice for 5 consecutive days. Training sessions included visual feedback during TPAD treadmill training followed by overground gait training. Safety, perceived exertion, and adherence were recorded as measures of feasibility. Load and stance symmetry were reassessed after the intervention (posttraining) and again 1 week later. RESULTS: No adverse events were reported. Mean (SD) perceived exertion (3.61 (0.23)) was low and did not significantly change throughout the intervention. Overall adherence was 96.4%. Load asymmetry was not significantly reduced on the treadmill from baseline to posttraining (P = 0.075). Overground stance symmetry significantly improved on posttraining (F = 8.498, P = 0.002), but was not sustained at follow-up. (See the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A311, which summarizes the study background, methods, and results.) DISCUSSION AND CONCLUSIONS:: Results demonstrate this combined interventional approach was feasible and improved stance symmetry overground, yet further work should consider increasing training intensity and/or duration to induce gains lasting through follow-up.