Treadmill System Research Articles

Miniature linear and split-belt treadmills reveal mechanisms of adaptive motor control in walking Drosophila

To navigate complex environments, walking animals must detect and overcome unexpected perturbations. One technical challenge when investigating adaptive locomotion is measuring behavioral responses to precise perturbations during naturalistic walking; another is that manipulating neural activity in sensorimotor circuits often reduces spontaneous locomotion. To overcome these obstacles, we introduce miniature treadmill systems for coercing locomotion and tracking 3D kinematics of walking Drosophila. By systematically comparing walking in three experimental setups, we show that flies compelled to walk on the linear treadmill have similar stepping kinematics to freely walking flies, while kinematics of tethered walking flies are subtly different. Genetically silencing mechanosensory neurons altered step kinematics of flies walking on the linear treadmill across all speeds. We also discovered that flies can maintain a forward heading on a split-belt treadmill by specifically adapting the step distance of their middle legs. These findings suggest that proprioceptive feedback contributes to leg motor control irrespective of walking speed and that the fly's middle legs play a specialized role in stabilizing locomotion.

Development and Evaluation of a Treadmill-based Video-see-through and Optical-see-through Mixed Reality Systems for Obstacle Negotiation Training.

Mixed reality (MR) technologies have a high potential to enhance obstacle negotiation training beyond the capabilities of existing physical systems. Despite such potential, the feasibility of using MR for obstacle negotiation on typical training treadmill systems and its effects on obstacle negotiation performance remains largely unknown. This research bridges this gap by developing an MR obstacle negotiation training system deployed on a treadmill, and implementing two MR systems with a video see-through (VST) and an optical see-through (OST) Head Mounted Displays (HMDs). We investigated the obstacle negotiation performance with virtual and real obstacles. The main outcomes show that the VST MR system significantly changed the parameters of the leading foot in cases of Box obstacle (approximately 22 cm to 30 cm for stepping over 7cm-box), which we believe was mainly attributed to the latency difference between the HMDs. In the condition of OST MR HMD, users tended to not lift their trailing foot for virtual obstacles (approximately 30 cm to 25 cm for stepping over 7cm-box). Our findings indicate that the low-latency visual contact with the world and the user's body is a critical factor for visuo-motor integration to elicit obstacle negotiation.

Strolling in Room-Scale VR: Hex-Core-MK1 Omnidirectional Treadmill.

The natural locomotion interface is critical to the development of many VR applications. For household VR applications, there are two basic requirements: natural immersive experience and minimized space occupation. The existing locomotion strategies generally do not simultaneously satisfy these two requirements well. This article presents a novel omnidirectional treadmill (ODT) system named Hex-Core-MK1 (HCMK1). By implementing two kinds of mirror-symmetrical spiral rollers to generate the omnidirectional velocity field, this proposed system is capable of providing real walking experiences with a full-degree of freedom in an area as small as 1.76 m 2, while delivering great advantages over several existing ODT systems in terms of weight, volume, latency and dynamic performance. Compared with the sizes of Infinadeck and HCP, the two best motor-driven ODTs so far, the 8 cm height of HCMK1 is only 20% of Infinadeck and 50% of HCP. In addition, HCMK1 is a lightweight device weighing only 110 kg, which provides possibilities for further expanding VR scenarios, such as terrain simulation. The system latency of HCMK1 is only 9ms. The experiments show that HCMK1 can deliver a starting acceleration of 16.00 m/s 2 and a braking acceleration of 30.00 m/s 2.

Staff perceptions towards virtual reality-motivated treadmill exercise for care home residents: a qualitative feedback study with key stakeholders and follow-up interview with technology developer

ObjectivesHealth and care resources are under increasing pressure, partly due to the ageing population. Physical activity supports healthy ageing, but motivating exercise is challenging. We aimed to explore staff perceptions...

Quantification of spinal ataxia in dogs with thoracolumbar spinal cord injury.

The clinical sign of ataxia is related to several neurological diseases and is seen in conjunction with paresis in dogs with spinal cord injury (SCI). Endeavours to objectify canine spinal ataxia in SCI remain limited. The aim of this clinical study was to determine and quantify differences between gait characteristics of ataxic dogs with thoracolumbar myelopathy and healthy control dogs using a computer-and treadmill-based gait analysis system. Five dogs with spinal ataxia and six healthy dogs underwent video-and computer-assisted gait analysis while walking on a four-ground reaction force plate treadmill system (maximum speed of 0.7 m/s). Spatio-temporal and kinetic gait characteristics regarding the dogs' locomotion were analysed with a focus on the individual coefficient of variation (CV), as a potential measure for quantification of the level of ataxia. Ataxic dogs with thoracolumbar SCI showed no effect on symmetry indices but higher variability in spatio-temporal and kinetic gait parameters mainly in the pelvic, but also in the thoracic limbs. Double support phase of the individual limb was prolonged in SCI dogs at the cost of the single support and swing phase. Reduced peaks of ground reaction forces (GRF) could potentially be explained by reduction of muscle strength, as a strategy of avoiding falling by taking enthusiastic steps, or by alteration of the rhythmogenic spinal circuits between the pelvic and thoracic limb pattern generators.

Is Morton's neuroma in a pes planus or pes cavus foot lead to differences in pressure distribution and gait parameters?

Morton's neuroma (MN) is a compressive neuropathy of the common digital plantar nerve causing forefoot pain. Foot posture and altered plantar pressure distribution have been identified as predispoing factors, however no studies have compared individuls with different foot postures with MN. Thus, we aimed to compare the effect of MN on spatiotemporal gait parameters and foot-pressure distribution in individuals with pes planus and pes cavus. Thirty-eight patients with unilateral MN were evaluated between June and August 2021. Nineteen patients with bilateral pes planus and 19 age and gender-matched patients with pes cavus who had no prior surgery were recruited. A Zebris FDM–THM–S treadmill system (Zebris Medical GmbH, Germany) was used to evaluate step length, stride length, step width, step time, stride time, cadence, velocity, foot-pressure distribution, force and whole stance phase, loading response, mid stance, pre-swing and swing phase percentages. There were no significant differences between the groups in spatiotemporal gait parameters (p > 0.05). Patients with pes planus displayed the following results for step length (49.36 ± 8.38), step width (9.05 ± 2.12), stance phase percentage (65.92 ± 2.11), swing phase percentage (34.08 ± 2.12), gait speed (2.96 ± 0.55), and cadence (100.57 ± 8.84). In contrast, patients with pes cavus displayed the following results for step length (49.06 ± 8.37), step width (8.10 ± 2.46), stance phase percentage (64.96 ± 1.61), swing phase percentage (34.79 ± 1.60), gait speed (2.95 ± 0.65), and cadence (99.73 ± 13.81). Foot-pressure distribution values showed no differences were detected in force, forefoot, and rearfoot pressure distribution, except for midfoot force (p < 0.05). The forefoot, midfoot, and rearfoot pressure values for the pronated group were 32.14 ± 10.90, 13.80 ± 3.03, and 22.78 ± 5.10, and for the supinated group were 33.50 ± 11.49, 14.23 ± 3.11 and 24.93 ± 6.52. MN does not significantly affect spatiotemporal gait parameters or foot-pressure distribution in patients with pes cavus or pes planus.

Motor state changes escape behavior of crickets

Animals change their behavior depending on external circumstances, internal factors, and their interactions. Locomotion state is a crucial internal factor that profoundly affects sensory perception and behavior. However, studying the behavioral impacts of locomotion state in free-moving animals has been challenging due to difficulty in reproducing quantitatively identical stimuli in freely moving animals. We utilized a closed-loop controlled servosphere treadmill system, enabling unrestricted confinement and orientation of small animals, and investigated wind-induced escape behavior in freely moving crickets. When stimulated during locomotion, the crickets quickly stopped before initiating escape behavior. Moving crickets exhibited a higher probability of escape response compared to stationary crickets. The threshold for pausing response in moving crickets was also much lower than the escape response threshold. Moving crickets had delayed reaction times for escape and greater variance in movement direction compared to stationary crickets. The locomotion-related response delay may be compensated by an elevated sensitivity to airflow.

A robotic treadmill system to mimic overground walking training with body weight support.

Body weight support overground walking training (BWSOWT) is widely used in gait rehabilitation. However, existing systems require large workspace, complex structure, and substantial installation cost for the actuator, which make those systems inappropriate for the clinical environment. For wide clinical use, the proposed system is based on a self-paced treadmill, and uses an optimized body weight support with frame-based two-wire mechanism. The Interactive treadmill was used to mimic overground walking. We opted the conventional DC motors to partially unload the body weight and modified pelvic type harness to allow natural pelvic motion. The performance of the proposed system on the measurement of anterior/posterior position, force control, and pelvic motion was evaluated with 8 healthy subjects during walking training. We verified that the proposed system was the cost/space-effective and showed the more accurate anterior/posterior position than motion sensor, comparable force control performance, and natural pelvic motion. The proposed system is cost/space effective, and able to mimic overground walking training with body weight support. In future work, we will improve the force control performance and optimize the training protocol for wide clinical use.

Baseline Gait and Motor Function Predict Long-Term Severity of Neurological Outcomes of Viral Infection.

Neurological dysfunction following viral infection varies among individuals, largely due to differences in their genetic backgrounds. Gait patterns, which can be evaluated using measures of coordination, balance, posture, muscle function, step-to-step variability, and other factors, are also influenced by genetic background. Accordingly, to some extent gait can be characteristic of an individual, even prior to changes in neurological function. Because neuromuscular aspects of gait are under a certain degree of genetic control, the hypothesis tested was that gait parameters could be predictive of neuromuscular dysfunction following viral infection. The Collaborative Cross (CC) mouse resource was utilized to model genetically diverse populations and the DigiGait treadmill system used to provide quantitative and objective measurements of 131 gait parameters in 142 mice from 23 CC and SJL/J strains. DigiGait measurements were taken prior to infection with the neurotropic virus Theiler's Murine Encephalomyelitis Virus (TMEV). Neurological phenotypes were recorded over 90 days post-infection (d.p.i.), and the cumulative frequency of the observation of these phenotypes was statistically associated with discrete baseline DigiGait measurements. These associations represented spatial and postural aspects of gait influenced by the 90 d.p.i. phenotype score. Furthermore, associations were found between these gait parameters with sex and outcomes considered to show resistance, resilience, or susceptibility to severe neurological symptoms after long-term infection. For example, higher pre-infection measurement values for the Paw Drag parameter corresponded with greater disease severity at 90 d.p.i. Quantitative trait loci significantly associated with these DigiGait parameters revealed potential relationships between 28 differentially expressed genes (DEGs) and different aspects of gait influenced by viral infection. Thus, these potential candidate genes and genetic variations may be predictive of long-term neurological dysfunction. Overall, these findings demonstrate the predictive/prognostic value of quantitative and objective pre-infection DigiGait measurements for viral-induced neuromuscular dysfunction.

Heel‐Strike and Toe‐Off Detection Algorithm Based on Deep Neural Networks Using Shank‐Worn Inertial Sensors for Clinical Purpose

A foot placement of inertial sensors is commonly used for heel‐strike (HS) and toe‐off (TO) event detection. However, in clinical practice, such sensor placement may be difficult or even impossible due to the deformity of patients’ feet. The first contribution of this paper is a new algorithm for HS and TO event detection for cases when the sensors are placed on the lateral malleolus. Such sensor placement allows gait analysis in patients with foot deformities. In addition, the placement of the sensor directly on the wide bone surface of the lateral malleolus ensures secure fixation of the sensor during walking. The proposed algorithm is based on deep neural networks, which can be easily adapted (by retraining the neural networks) for analysis of various pathological gait patterns. It is especially important in clinical practice when the number of possible pathological gait patterns is very large. The algorithm proposed in this paper was implemented in a new wearable system for the clinical gait analysis. The second contribution is a validation of this new wearable system. The performance of both proposed algorithm and gait analysis system was evaluated against a reference treadmill system where a capacitance–based pressure platform was used. A total of 117 healthy volunteers participated in the comparison (62 males and 55 females, age 24–55 years, height 162–183 cm). They were asked to perform 2 min walking trials with different speed. Mean accuracy ± precision was –0.021 ± 0.091 s for gait cycle, 0.589 ± 1.144 steps/min for cadence, –0.051 ± 0.544% for stance phase, –0.37 ± 0.649% for single support, 0.296 ± 0.711% for double support, 0.132 ± 0.561% for load response, and 0.106 ± 0.661% for preswing. Limitations of the proposed algorithm and its compassion with state‐of‐the‐art algorithms were discussed.

Novel Robotics-Treadmill-Platform Application To Improve Walking In A Person With Parkinson's Disease: A Case Report

<h3>Research Objectives</h3> Illustrate the potential benefits of a 6-week novel Robotic treadmill system training protocol, focused on implicit learning of challenging tasks, on walking performance in an older adult with Parkinson's Disease. <h3>Design</h3> A single-subject case report. <h3>Setting</h3> Outpatient rehabilitation clinic in the southwestern U.S. <h3>Participants</h3> An 82-year-old-female with a 3-year history of Parkinson's disease (PD) on carbidopa/levodopa (Hoehn and Yahr stage 1) was referred to physical therapy (PT) to improve performance and safety of walking. <h3>Interventions</h3> Twelve twice-weekly PT sessions on the walking robotics platform (KineAssist). The platform allows "self-driven"/intentional movement on the treadmill with body weight support, catching after loss of balance, and including full freedom of movement. The protocol emphasized progressive Endurance, Strength, Speed, and Perturbation exercises individualized to her abilities. <h3>Main Outcome Measures</h3> . The primary outcomes were the overground 6-Min-Walk Test (6MWT), TUG, TUG Carry, TUG Cognitive, and Mini-Best test. Secondary outcomes included 10-Meter-Walk-Test (10MWT) self-selected and max walking speeds assessed via the Robotic treadmill system. <h3>Results</h3> The 6MWT improved 51% (318-481m); the TUG score improved 53% (10.3-5.5 sec); the TUG Carry, 50% faster (13.7- 6.8 sec); the TUG Cognitive, 50% faster (13.2- 6.5 sec), the Mini-Best Test improved 8 points (18/28-26/28). The self-selected 10MWT speed improved 196% (0.27- 0.8 m/s) and max gait speed by 120% (1.0-2.2 m/s). <h3>Conclusions</h3> An individualized robotic treadmill gait training protocol was used successfully with an older patient with PD, with marked improvement in her walking, exceeding available minimal clinically important distances for all outcome measures. An implicit learning approach, combined with a robotic treadmill, may enable individuals to perform challenging tasks without fear of physical harm and to develop strategies for safe mobility in their environment. <h3>Author(s) Disclosures</h3> The authors declare that they have no relevant or material financial interests related to the research described in this abstract. Dr. Brown is a Co-inventor of a device described in the presentation, but he currently DOES NOT receive any royalties.

Balance Stability and Cervical Spine Range of Motion While Wearing a Custom-Made Mandibular Splint with Special Consideration of the Sex

Introduction: An altered dental occlusion can also affect balance stability or mobility. Thus, the aim of this study was to examine whether wearing a mandibular splint, which retains the occlusion close to the centric occlusion, can increase or decrease balance stability and the range of motion (ROM) of the cervical spine as opposed to the habitual occlusion, and if there is a difference between men and women. Material and methods: In this study, 41 male (34.7 ± 11.4 years) and 50 female subjects (29.3 ± 12.7 years) participated. Cervical spine ROM was recorded using the Zebris CMS 70P system. For balance stability, a pressure measuring platform integrated into the treadmill system (FDM-T) of the company Zebris® Medical GmbH was used. Here, the area of the ellipse and the length of the Center of Pressure (CoP) was recorded whilst in the bipedal and unipedal stance. Results: The sex comparison showed significant differences for the area of the ellipse of the right leg and ROM extension in the habitual occlusion: females showed a better balance stability and a larger ROM extension. When wearing the splint, only the CoP of the left leg was significant with a better balance stability in female subjects. Within the male subjects, the ellipse area in the bipedal and unipedal (left/right) stance showed mostly significant reductions, while the rotation left and right as well as the lateral flexion (left/right) improved when wearing the splint. Female subjects, when wearing the splint, showed a significant decrease of the ellipse area and the CoP length when standing on either leg. Flexion, rotation to the right and lateral flexion to the left/right, all increased significantly. Conclusion: Wearing a splint that keeps the jaw close to the centric relation improved balance stability and increased the ROM of the cervical spine for both male and female subjects. Women may have marginally different basic balance stability strategies than men, with regard to bipedal and unipedal standing. Nevertheless, there are scarcely any differences between the two sexes in the adaptation when wearing a splint. Changing the jaw relation in healthy adults can possibly support the release of movement potentials that simplify the performance of everyday activities or sports movements.

Real-time feedback control of split-belt ratio to induce targeted step length asymmetry

IntroductionSplit-belt treadmill training has been used to assist with gait rehabilitation following stroke. This method modifies a patient’s step length asymmetry by adjusting left and right tread speeds individually during training. However, current split-belt training approaches pay little attention to the individuality of patients by applying set tread speed ratios (e.g., 2:1 or 3:1). This generalization results in unpredictable step length adjustments between the legs. To customize the training, this study explores the capabilities of a live feedback system that modulates split-belt tread speeds based on real-time step length asymmetry.Materials and methodsFourteen healthy individuals participated in two 1.5-h gait training sessions scheduled 1 week apart. They were asked to walk on the Computer Assisted Rehabilitation Environment (CAREN) split-belt treadmill system with a boot on one foot to impose asymmetrical gait patterns. Each training session consisted of a 3-min baseline, 10-min baseline with boot, 10-min feedback with boot (6% asymmetry exaggeration in the first session and personalized in the second), 5-min post feedback with boot, and 3-min post feedback without boot. A proportional-integral (PI) controller was used to maintain a specified step-length asymmetry by changing the tread speed ratios during the 10-min feedback period. After the first session, a linear model between baseline asymmetry exaggeration and post-intervention asymmetry improvement was utilized to develop a relationship between target exaggeration and target post-intervention asymmetry. In the second session, this model predicted a necessary target asymmetry exaggeration to replace the original 6%. This prediction was intended to result in a highly symmetric post-intervention step length.Results and discussionEleven out of 14 participants (78.6%) developed a successful relationship between asymmetry exaggeration and decreased asymmetry in the post-intervention period of the first session. Seven out of the 11 participants (63.6%) in this successful correlation group had second session post-intervention asymmetries of < 3.5%.ConclusionsThe use of a PI controller to modulate split-belt tread speeds demonstrated itself to be a viable method for individualizing split-belt treadmill training.

Biomechanical running gait assessments across prevalent adolescent musculoskeletal injuries

BackgroundWhile there is substantial information available regarding expected biomechanical adaptations associated with adult running-related injuries, less is known about adolescent gait profiles that may influence injury development. Research questionsWhich biomechanical profiles are associated with prevalent musculoskeletal lower extremity injuries among adolescent runners, and how do these profiles compare across injury types and body regions? MethodsWe conducted a cross-sectional study of 149 injured adolescents (110 F; 39 M) seen at a hospital-affiliated injured runner’s clinic between the years 2016–2021. Biomechanical data were obtained from 2-dimensional video analyses and an instrumented treadmill system. Multivariate analyses of variance covarying for gender and body mass index were used to compare continuous biomechanical measures, and Chi-square analyses were used to compare categorical biomechanical variables across injury types and body regions. Spearman’s rho correlation analyses were conducted to assess the relationship of significant outcomes. ResultsPatients with bony injuries had significantly higher maximum vertical ground reaction forces (bony: 1.87 body weight [BW] vs. soft tissue: 1.79BW, p = 0.05), and a higher proportion of runners with contralateral pelvic drop at midstance (χ2 =5.3, p = 0.02). Maximum vertical ground reaction forces and pelvic drop were significantly yet weakly correlated (ρ = 0.20, p = 0.01). Foot strike patterns differed across injured body regions, with a higher proportion of hip and knee injury patients presenting with forefoot strike patterns (χ2 =22.0, p = 0.01). SignificanceThese biomechanical factors may represent risk factors for injuries sustained by young runners. Clinicians may consider assessing these gait adaptations when treating injured adolescent patients.

Status of exercise duration and metabolic equivalents in interpretation of exercise electrocardiography testing

Both exercise duration and metabolic equivalent give an idea about the effort tolerance of the patient. Effort tolerance depends on several factors e.g. cardiac status, pulmonary status, neuromuscular status, psychological status, physical conditioning, age, sex, haemoglobin concentration etc. Therefore, diminished effort tolerance alone, in absence of other evidence, can not be taken as an indication of the presence or severity of coronary artery disease or left ventricular dysfunction. Regression equations used for calculation of metabolic equivalent (MET) include speed and inclination of the treadmill (stage of particular protocol) in addition to the duration of exercise. MET, therefore, gives a more correct impression about the workload achieved by a given patient. For the same reason, MET is useful for comparing the reports of different treadmill tests performed by different protocols at different times. It helps in assessing the progression of the disease. Regression equations used by most of the conventional treadmill systems do not include other factors that affect effort tolerance. These include the age, sex, and weight of the patient. This is an important limitation. Keywords: Coronary Artery Disease; Exercise Electrocardiography; Left Ventricular Function; Myocardial Ischemia; Metabolic Equivalent; Treadmill Test

Fuzzy control decision-making framework adapted to the uncertainty environment of complex software system

As the system becomes more intelligent and embedded, the operating environment is gradually changed from closed, static, and controllable to more open, dynamic, and difficult to control. As a result, the design of complex software systems is faced with many challenges arising from the uncertainty of the environment (UoE). On the one hand, ignoring the UoE to manually describe requirements is not only a tough job, but it can also hinder the discovery of potential requirements; on the other hand, it is a challenge to integrate the representation of and reasoning of UoE into the process of modeling complex systems. Based on the analysis of the characteristics of complex systems engineering, this paper takes solving the UoE caused by stakeholders preferences and complex environment context as the entry point and designs a fuzzy control decision-making framework. Specifically, the framework contributes to the spiral of complex systems while solving the UoE by constructing a closed-loop intelligent system based on automatic data flow between information space and physical space for environment sensing, uncertainty analysis, requirements mining, fuzzy reasoning, decision execution as well as feedback optimization. Finally, the framework is validated with a concrete example of an adaptive treadmill system based on the support tools developed.

Spinopelvic Alignment as a Risk Factor for Poor Balance Function in Low Back Pain Patients.

Retrospective, observational study. This study aimed to examine the association between spinopelvic parameters and balance function in low back pain (LBP). Among patients in the rehabilitation medicine department, the data of 182 patients (mean age, 47.8years; M/F = 64/118) was obtained retrospectively. Spinopelvic parameters were measured through a whole-body low-dose biplanar radiography using the EOS imaging system, and balance function was evaluated by the center of pressure (COP) movement using the Zebris treadmill system. Pearson correlations were used to determine the relationship between radiographic and balance function. Stepwise multiple linear regression analyses were conducted with the balance function as a dependent variable and age and spinopelvic parameters as independent variables. Increased age, knee flexion (KF), pelvic tilt (PT), C7-central sacral line (C7-CSL) and C7 sagittal vertical axis (SVA), and decreased spino-sacral angle (SSA) were associated with both poor static and dynamic balance. Moreover, increased Cobb's angle and decreased thoracic kyphosis (TK) and lumbar lordosis (LL) was associated with poor static balance. Increased pelvic incidence (PI) was related to poor dynamic balance. Increased age, Cobb's angle, SVA, and decreased TK were risk factors for poor static balance. For dynamic balance, increased age, C7-CSL, and PT were risk factors for poor sagittal balance, whereas increased CAM-plumb line and PT were risk factors for poor coronal balance. Balance function was associated with spinopelvic parameters in patients with LBP. Increased SVA, followed by increased PT, was the strongest independent factor associated with poor static and dynamic balance.

Development of Rehabilitation Treadmill System for Walk with a Rotatable Chest Pad

Development of Rehabilitation Treadmill System for Walk with a Rotatable Chest Pad

Treadmill System for Providing Sensation of Overground Walking

Treadmill System for Providing Sensation of Overground Walking

Effects of virtual reality-based treadmill training on the balance and gait ability in patients after stroke

Gait and balance impairments contribute significantly to long-term disability after stroke. Modern concepts of stroke rehabilitation recommend a task-specific repetitive approach, such as using treadmill training. The purpose of this study was to investigate the effectiveness of using virtual reality-based treadmill training to improve balance and gait in subacute stroke patients. Twenty-two stroke patients were randomly stratified into two groups: the experimental (n = 11) and the control group (n = 11). Parameters associated with balance and gait were measured using the 6-minute walk test, the 10-meter walk test, the timed “up and go” test, the functional gait assessment, and the four square step test. Gait analysis using the zebris Rehawalk® treadmill system was also performed. Patients in the experimental group received virtual reality-based treadmill training five times a week for a period of four weeks, while those in the control group received treadmill training at the same frequency, duration, intensity, and structure, along with a progressively more difficult task demands. Significant improvements were observed in selected outcome measures in both groups after training. Patients in the experimental group experienced improvements in all of the spatiotemporal gait parameters, but there was a significant difference before and after training in duration of double support and lateral asymmetry. The findings of this pilot randomized controlled trial support the benefits of using a virtual reality-based treadmill training program to improve gait and balance in subacute stroke patients.