Split Belt Research Articles

Pilot Study of Split Belt Treadmill Based Gait Rehabilitation System for Symmetric Stroke Gait

A split belt treadmill for gait rehabilitation was developed to improve the symmetry of the stance phase time of patients with stroke. The system, which increases the stance phase time of the affected leg and then realizes a well-balanced gait, is divided into two components. First, the stance phases of the sound and affected legs were measured and presented visually in real time to the patient and physical therapist as biofeedback. Second, using stance phase biofeedback, the physical therapist sets two different velocities of treadmill belts for sound and affected legs. In an experiment, 11 patients with chronic stroke participated in a short-term intervention trial (20 gait cycles) of the developed treadmill system. Three of the five subjects who had lost balance between the stance phase of the sound leg and that of the affected one improved their gait balance in the intervention trial. In addition, one subject kept the well-balanced gait after the intervention.

Split-second decisions on a split belt: does simulated limping affect obstacle avoidance?

During normal gait a suddenly appearing obstacle is avoided either by making a large crossing step (long-step strategy, LSS) or by interrupting the swing phase (short-step strategy, SSS) depending on the time of appearance of the obstacle in the step cycle. Limping changes the proportion of time spent in the swing phase and the question arises whether this could affect the ability to avoid obstacles. This was investigated using a split-belt treadmill that induces behavior that is similar to limping even in normal adults. Subjects walked on a split-belt treadmill with speed ratios between left and right of 2:2 up to 2:8km/h in combination with obstacle avoidance (OA) on the slow belt. The failure rate of obstacle avoidance increased markedly as speed differences between legs increased. This increment was paralleled by augmented use of the SSS, related to an increase in time pressure. In all split-belt walking conditions, the alternative strategy (LSS) yielded less OA failures but it required much longer preparation time than the SSS. In addition, the prolonged stance phases prior to crossing in the LSS required a concomitant prolongation of the contralateral swing phase. This was difficult to achieve at times and as a result the swing phase was sometimes interrupted, giving rise to a contralateral SSS (and a 2:1 coordination pattern). It is concluded that simulated limping greatly increases the risk of failing to avoid suddenly appearing obstacles.

Are stability issues a potential cause for adaptations in split belt walking?

Are stability issues a potential cause for adaptations in split belt walking?

Preliminary investigation of residual limb plantarflexion and dorsiflexion muscle activity during treadmill walking for trans-tibial amputees

Novel powered prosthetic ankles currently incorporate finite state control, using kinematic and kinetic sensors to differentiate stance and swing phases/sub-phases and control joint impedance and position or torque. For more intuitive control, myoelectric control of the ankle using the remnant residual limb dorsiflexors and plantarflexors, perhaps in concert with kinetic and kinematic sensors, may be possible. The specific research objective was to assess the feasibility of using myoelectric control of future active or powered prosthetic ankle joints for trans-tibial amputees. The project involved human subject trials to determine whether current techniques of myoelectric control of upper extremity prostheses might be readily adapted for lower extremity prosthetic control. Gait analysis was conducted for three unilateral trans-tibial amputee subjects during ambulation on an instrumented split belt treadmill. Data included ankle plantarflexor and dorsiflexor activity for the residual limb, as well as lower limb kinematics and ground reaction forces and moments of both the sound and prosthetic limbs. These data indicate that: 1) trans-tibial amputees retain some independent ankle plantarflexor and dorsiflexor muscle activity of their residual limb; 2) it is possible to position surface electromyographic electrodes within a trans-tibial socket that maintain contact during ambulation; 3) both the plantarflexors and dorsiflexors of the residual limb are active during gait; 4) plantarflexor and dorsiflexor activity is consistent during multiple gait cycles; and 5) with minimal training, trans-tibial amputees may be able to activate their plantarflexors during push-off. These observations demonstrate the potential for future myoelectric control of active prosthetic ankles. Clinical relevance This study demonstrated the feasibility of applying upper extremity prosthetic myoelectric signal acquisition, processing and control techniques to future myoelectric control of active prosthetic ankles for trans-tibial amputees.

Unique characteristics of motor adaptation during walking in young children

Children show precocious ability in the learning of languages; is this the case with motor learning? We used split-belt walking to probe motor adaptation (a form of motor learning) in children. Data from 27 children (ages 8-36 mo) were compared with those from 10 adults. Children walked with the treadmill belts at the same speed (tied belt), followed by walking with the belts moving at different speeds (split belt) for 8-10 min, followed again by tied-belt walking (postsplit). Initial asymmetries in temporal coordination (i.e., double support time) induced by split-belt walking were slowly reduced, with most children showing an aftereffect (i.e., asymmetry in the opposite direction to the initial) in the early postsplit period, indicative of learning. In contrast, asymmetries in spatial coordination (i.e., center of oscillation) persisted during split-belt walking and no aftereffect was seen. Step length, a measure of both spatial and temporal coordination, showed intermediate effects. The time course of learning in double support and step length was slower in children than in adults. Moreover, there was a significant negative correlation between the size of the initial asymmetry during early split-belt walking (called error) and the aftereffect for step length. Hence, children may have more difficulty learning when the errors are large. The findings further suggest that the mechanisms controlling temporal and spatial adaptation are different and mature at different times.

Younger Is Not Always Better: Development of Locomotor Adaptation from Childhood to Adulthood

New walking patterns can be learned over short timescales (i.e., adapted in minutes) using a split-belt treadmill that controls the speed of each leg independently. This leads to storage of a modified spatial and temporal motor pattern that is expressed as an aftereffect in regular walking conditions. Because split-belt walking is a novel task for adults and children alike, we used it to investigate how motor adaptation matures during human development. We also asked whether the immature pattern resembles that of people with cerebellar dysfunction, because we know that this adaptation depends on cerebellar integrity. Healthy children (3-18 years old) and adults, and individuals with cerebellar damage were adapted while walking on split belts (1:2 speed ratio). Adaptation and de-adaptation rates were quantified separately for temporal and spatial parameters. All healthy children and adults tested could learn the new timing at the same rate and showed significant aftereffects. However, children younger than 6 years old were unable to learn the new spatial coordination. Furthermore, children as old as age 11 years old showed slower rates of adaptation and de-adaptation of spatial parameters of walking. Young children showed patterns similar to cerebellar patients, with greater deficits in spatial versus temporal adaptation. Thus, although walking is a well-practiced, refined motor skill by late childhood (i.e., 11 years of age), the processes underlying learning new spatial relationships between the legs are still developing. The maturation of locomotor adaptation follows at least two time courses, which we propose is determined by the developmental state of the cerebellum.

Split-Belt Treadmill Adaptation Shows Different Functional Networks for Fast and Slow Human Walking

New walking patterns can be learned over short time scales (i.e., adapted in minutes) using a split-belt treadmill that controls the speed of each leg independently. This leads to storage of a modified motor pattern that is expressed as an aftereffect in regular walking conditions and must be de-adapted to return to normal. Here we asked whether the nervous system adapts a general walking pattern that is used across many speeds or a specific pattern affecting only the two speeds experienced during split-belt training. In experiment 1, we tested three groups of healthy adult subjects walking at different split-belt speed combinations and then assessed aftereffects at a range of speeds. We found that aftereffects were largest at the slower speed that was used in split-belt training in all three groups, and it decayed gradually for all other speeds. Thus adaptation appeared to be more strongly linked to the slow walking speed. This result suggests a separation in the functional networks used for fast and slow walking. We tested this in experiment 2 by adapting walking to split belts and then determining how much fast regular walking washed out the slow aftereffect and vice versa. We found that 23-38% of the aftereffect remained regardless of which speed was washed out first. This demonstrates that there is only partial overlap in the functional networks coordinating different walking speeds. Taken together, our results suggest that there are some neural networks for controlling locomotion that are recruited specifically for fast versus slow walking in humans, similar to recent findings in other vertebrates.

Gait acts as a gate for reflexes from the foot

During human gait, electrical stimulation of the foot elicits facilitatory P2 (medium latency) responses in TA (tibialis anterior) at the onset of the swing phase, while the same stimuli cause suppressive responses at the end of swing phase, along with facilitatory responses in antagonists. This phenomenon is called phase-dependent reflex reversal. The suppressive responses can be evoked from a variety of skin sites in the leg and from stimulation of some muscles such as rectus femoris (RF). This paper reviews the data on reflex reversal and adds new data on this topic, using a split-belt paradigm. So far, the reflex reversal in TA could only be studied for the onset and end phases of the step cycle, simply because suppression can only be demonstrated when there is background activity. Normally there are only 2 TA bursts in the step cycle, whereas TA is normally silent during most of the stance phase. To know what happens in the stance phase, one needs to have a means to evoke some background activity during the stance phase. For this purpose, new experiments were carried out in which subjects were asked to walk on a treadmill with a split-belt. When the subject was walking with unequal leg speeds, the walking pattern was adapted to a gait pattern resembling limping. The TA then remained active throughout most of the stance phase of the slow-moving leg, which was used as the primary support. This activity was a result of coactivation of agonistic and antagonistic leg muscles in the supporting leg, and represented one of the ways to stabilize the body. Electrical stimulation was given to a cutaneous nerve (sural) at the ankle at twice the perception threshold. Nine of the 12 subjects showed increased TA activity during stance phase while walking on split-belts, and 5 of them showed pronounced suppressions during the first part of stance when stimuli were given on the slow side. It was concluded that a TA suppressive pathway remains open throughout most of the stance phase in the majority of subjects. The suggestion was made that the TA suppression increases loading of the ankle plantar flexors during the loading phase of stance.

Leg muscle activation during gait in Parkinson's disease: adaptation and interlimb coordination

Adaptation in leg muscle activity and coordination between lower limbs were studied during walking on a treadmill with split belts in one group of parkinsonian patients and one of age-matched healthy subjects. Four different belt speeds (0.25/0.5/0.75/1.0 m/sec) were applied in selected combinations to the left and right leg. While these walking conditions were easily tolerated by the healthy subjects, the parkinsonian patients usually reached the limits of their walking capabilities. Both groups adapted automatically to a change in belt speed within approximately 20 stride cycles. Healthy subjects adapted by reorganizing their stride cycle with a relative shortening of duration of support and lengthening of the swing phase of the “fast” leg and vice versa on the “slow” leg. The patients showed a restricted range of stride frequencies for the. various belt speeds during normal and split-belt walking with consequent deviations in the reorganization of the stride cycle. In both healthy subjects and patients, ipsilateral gastrocnemius and contralateral tibialis anterior electromyographic (EMG) activity increased predominantly with an ipsilateral increase in belt speed. Two main differences were observed in the EMG patterns: (1) In the patients leg muscle EMG activity was less modulated and gastrocnemius EMG amplitude was small during normal and split-belt walking. However, there was no significant difference between the two groups in respect to the reorganization of the EMG pattern required for the various split-belt walking conditions. (2) The amount of co-activation of antagonistic leg muscles during the support phase of the stride cycle was greater in the patients compared to the healthy subjects during normal and split-belt walking. It is suggested that reduced EMG modulation and recruitment in the leg extensors may contribute to the impaired walking of the patients. This in turn is a result of an irepaired proprioceptive feedback from extensor load receptors. This defective control is partially compensated for in parkinsonian patients by a greater amount of leg flexor activation which leads to a higher degree of co-activation. Visual input plays a role in the control of this increased activation.

Split belt gait and limping: motor plasticity and phase-dependent modulation of cutaneous reflexes

Split belt gait and limping: motor plasticity and phase-dependent modulation of cutaneous reflexes

Interlimb coordination of stance in children: Divergent modulation of spinal reflex responses and cerebral evoked potentials in terms of age

EMG responses in the gastrocnemius (GM) and tibialis anterior muscles (TA) of both legs together with cerebral evoked potentials (CP), were recorded following perturbations of stance on a treadmill with split belts, in two age groups of children. Unilateral displacements were followed by ipsilateral short latency and bilateral long latency EMG responses. The CP was similar in both tasks. When displacements were simultaneously induced in opposite directions, a significant reduction in the long latency components of EMG responses occurred, while the amplitude of the CP was maximal in this condition. In the older children the CP and long latency EMG responses were larger and the short latency reflex potentials smaller in all conditions compared to the younger children. It is concluded that (1) CP and EMG responses reflect a divergent modulation of a given somatosensory input; (2) developmental changes are reflected in alterations in the amplitude of CP and EMG responses; (3) there is no evidence of transcortically mediated muscle responses.

Perturbations of human posture: influence of impulse modality on EMG responses and cerebral evoked potentials.

Leg muscle EMG responses and cerebral evoked potentials (CP), elicited by perturbations of stance while on a treadmill with split belts, were analyzed in order to study the relationship between compensatory leg muscle responses and afferent input to supraspinal centers. Various conditions of perturbation were used to establish the extent to which compensatory EMG responses and CPs show congruent behavior. Four different treadmill acceleration rates were applied in three different conditions (unilateral perturbation, directed forward or backward; bilateral perturbation, directed forward or backward; and opposing bilateral perturbation). EMG responses and CPs showed parallel increases in amplitude with increasing displacement velocity. The EMG responses showed distinct differences, predominantly in the response amplitude, between the different perturbation conditions, whereas the CPs were affected only to a minor degree. Tibialis anterior EMG responses were more closely related to the CP following forward perturbation than the corresponding gastrocnemius responses were to the CP following backward perturbation. We conclude that the EMG responses are more closely related than the CPs to displacement parameters and suggest that this is due to the further spinal processing of the afferent input needed to generate an appropriate EMG response. The closer relationship between the tibialis anterior response and CP may reflect a predominant central representation and control of tibialis anterior activation in the regulation of posture. The functional implications of these findings are discussed.

Spatial and temporal co-ordination during walking in crustacea

Crustacea provide models for the study of locomotor co-ordination because of thevariety of their behaviour patterns and the simplicity of their neuromuscular organization. A treadmill with a split belt is a useful device enabling the experimenter to recreate natural conditions in a controlled manner. During stereotypical walking, return stroke duration and stride length are invariable whatever the speed. As soon as the walking behaviour becomes more complex, for example, during turning, these two ‘constants’ are then varied to maintain co-ordination.