Long-Term Retention of Robotic Gait Training: Transference From The Laboratory To The Real-World

Abstract

<h3>Research Objectives</h3> Investigate the long-term retention of effects on gait and mobility after a robotic treadmill gait training protocol (TT) plus a transfer package (TP). <h3>Design</h3> Preliminary RCT findings of a six-week robotic treadmill training combined with behavioral strategies. Outcomes measured pre-, immediately after (post), and at 3-month follow-up (FU). <h3>Setting</h3> Clinical Research Unit. <h3>Participants</h3> 7 participants (>6 months poststroke); walking impairment, can walk ≤10 feet. Randomized to experimental (n=4) or control groups (n=3). <h3>Interventions</h3> All participants receive the same TT protocol. The experimental group (TT+TP) receives TT, and 30 minutes of behavioral strategies (TP) application to enhance motor skill transference outside clinical settings. Controls (TT) receive home exercise handouts plus TT. The 6-week intervention involves three 30-minute TT sessions a week targeting endurance, strength, and speed. <h3>Main Outcome Measures</h3> Lower Extremity Motor Activity Log (LE-MAL), Berg Balance Scale (BBS), 10MWT, 6MWT, Fear of Falling Avoidance Questionnaire (FFABQ). <h3>Results</h3> On average, all participants improved on all post-pre assessments. TT+TP participants showed continuous improvement at FU. LE-MAL (TT post-pre: 0.6 and: -0.6; TT+TP post-pre: 1.0 and FU: 0.2), BBS (TT post-pre: 1.3 and FU: -1.0; TT+TP post-pre: 1.5 and FU: 0.7), 10MWT self-selected speed: TT post-pre: 0.03m/s and FU: -0.15m/s; TT+TP post-pre: 0.01m/s and FU: 0.04 m/s, 10MWT fast speed: TT post-pre: 0.02 m/s and FU: 0.0.3 m/s; TT+TP post-pre: -0.01 m/s and FU: 0.08 m/s, 6MWT TT post-pre: 22.2 m and FU: 10.7 m/s; TT+TP post-pre: 13.8 m and FU: 17.4 m, and FFABQ (lower scores mean lower avoidance behavior), TT post-pre: -5 and FU: 0.7; TT+TP post-pre: -3.3 and FU: -3.25. <h3>Conclusions</h3> This preliminary analysis suggests the TT+TP group retains TT improvements. Adding behavioral strategies to robotic gait training may induce long-term retention of improvements in TT, endurance, balance, and confidence. <h3>Author(s) Disclosures</h3> DB has a potential conflict of interest, please refer to author disclosure of information for details. The other authors have no conflict of interest to declare.