Abstract
BackgroundThe risk of falling is significantly higher in people with chronic stroke and it is, therefore, important to design interventions to improve mobility and decrease falls risk. Minimum toe clearance (MTC) is the key gait cycle event for predicting tripping-falls because it occurs mid-swing during the walking cycle where forward velocity of the foot is maximum.High forward velocity coupled with low MTC increases the probability of unanticipated foot-ground contacts. Training procedures to increase toe-ground clearance (MTC) have potential, therefore, as a falls-prevention intervention. The aim of this project is to determine whether augmented sensory information via real-time visual biofeedback during gait training can increase MTC.MethodsParticipants will be aged > 18 years, have sustained a single stroke (ischemic or hemorrhagic) at least six months previously, able to walk 50 m independently, and capable of informed consent. Using a secure web-based application (REDCap), 150 participants will be randomly assigned to either no-feedback (Control) or feedback (Experimental) groups; all will receive 10 sessions of treadmill training for up to 10 min at a self-selected speed over 5–6 weeks. The intervention group will receive real-time, visual biofeedback of MTC during training and will be asked to modify their gait pattern to match a required “target” criterion. Biofeedback is continuous for the first six sessions then progressively reduced (faded) across the remaining four sessions. Control participants will walk on the treadmill without biofeedback. Gait assessments are conducted at baseline, immediately following the final training session and then during follow-up, at one, three, and six months. The primary outcome measure is MTC. Monthly falls calendars will also be collected for 12 months from enrolment.DiscussionThe project will contribute to understanding how stroke-related changes to sensory and motor processes influence gait biomechanics and associated tripping risk. The research findings will guide our work in gait rehabilitation following stroke and may reduce falls rates. Treadmill training procedures incorporating continuous real-time feedback may need to be modified to accommodate stroke patients who have greater difficulties with treadmill walking.Trial registrationAustralia New Zealand Clinical Trials Registry, ACTRN12617000250336. Registered on 17 February 2017.
Highlights
The risk of falling is significantly higher in people with chronic stroke and it is, important to design interventions to improve mobility and decrease falls risk
Falls risk is significantly higher in people with chronic stroke [4] and approximately 50% of people living at home after a stroke will fall within 12 months [9], with up to half sustaining multiple falls
3) Minimum toe clearance (MTC) data collected during overground walking during retention conditions will determine whether any changes in MTC are translated to overground walking. This innovative study will evaluate the impact of augmented sensory information for improving gait function, foot-ground clearance, via visually presented biofeedback
Summary
The risk of falling is significantly higher in people with chronic stroke and it is, important to design interventions to improve mobility and decrease falls risk. Minimum toe clearance (MTC) is the key gait cycle event for predicting tripping-falls because it occurs mid-swing during the walking cycle where forward velocity of the foot is maximum. Training procedures to increase toe-ground clearance (MTC) have potential, as a falls-prevention intervention. Batchelor et al found that a multifactorial intervention including a home-based balance and strength program did not reduce falls in people with stroke [10]. Another study confirmed that a groupand home-based exercise program incorporating balance and strength training did not reduce falls [11]. This suggests that alternative, targeted treatments to reduce falls risk in people with stroke are urgently needed
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