Optimizing Gait Symmetry After Stroke Using Mechanical Constraints and Sensory Feedback

The University of Texas Medical Branch, Galveston30 enrolled

Overview

This single-session study aims to evaluate a novel gait training protocol that integrates mechanical constraints and sensory feedback to enhance paretic leg propulsion in individuals post-stroke. The study will include 15 individuals who have experienced a stroke and 15 healthy adults, each aged 20 years or older. Participants will walk on both tied-belt and split-belt treadmills under various training conditions, including backward-directed resistance (applied at the pelvis, ankle, or both) and real-time sensory feedback (visual, auditory, or combined). These interventions will be applied individually and in combination to identify the most effective environment for promoting symmetrical gait patterns. Each session will last approximately two hours. The equipment used is non-invasive, and the risk to participants is minimal.

The purpose of this study is to assess the effectiveness of an integrated gait training paradigm that combines mechanical task constraints and sensory feedback during split-belt treadmill walking to enhance paretic leg propulsion and improve propulsion symmetry in individuals post-stroke. The risks associated with this study are lower than those encountered during daily walking in the community and in typical physical therapy clinics, where patients with physical impairments routinely engage in challenging exercises to improve their abilities. There is a slight possibility of local skin irritation or rash resulting from the non-allergenic adhesive tape or sensor gel used to attach the EMG sensors. This is a rare occurrence and typically resolves within one to two days without medical intervention. This study will last approximately one to two hours, depending on your condition, and involves a one-time visit. If you choose to participate in this study, the participant will be asked to: 1. Sign a consent form approved by the University of Texas Medical Branch IRB, outlining the study's purpose, procedures, benefits, risks, and policies. 2. Share medical history and well-being, and have weight, height, and heart rate (via smartwatch) monitored. 3. Assess your walking capacity. 4. Assess the Optimal Gait Training Protocol using Treadmill, Sensory Feedback, and Mechanical task constraints.

Study Type

INTERVENTIONAL

Allocation

Purpose

Interventions

Treadmill Walking with Split-Belt and/or Tied-Belt ConditionsBEHAVIORAL

Participants will walk on an instrumented treadmill under split-belt and/or tied-belt conditions depending on their walking capacity. The belt speeds will be adjusted to facilitate locomotor adaptation and evaluate propulsion symmetry.

Mechanical Resistance (Pelvis and/or Ankle) depending on participant's walking capacityBEHAVIORAL

Participants will walk on a treadmill (Split-belt and/or Tied-belt) with backward-directed resistance applied at the pelvis, ankle, or both. The resistance is used to challenge paretic leg propulsion and assess adaptive gait responses.

Sensory Feedback TrainingBEHAVIORAL

Real-time feedback-visual, auditory, or combined-will be provided based on the propulsive force generated during split-belt and/or tied-belt treadmill walking, with or without mechanical resistance.

Eligibility

Sex: ALLMin age: 20 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: Aged 20 years or older For stroke group: clinical diagnosis of stroke at least 1 month prior to participation Ability to walk at least 10 meters with or without assistive devices For healthy group: able to walk independently without assistive devices Exclusion Criteria: Life expectancy less than one year Comatose or unable to follow three-step commands Amputation of any lower limb Poorly controlled diabetes (e.g., foot ulceration) Blindness Progressive neurological disease Medically unstable condition Significant musculoskeletal impairments affecting gait Congestive heart failure or unstable angina Peripheral vascular disease Severe neuropsychiatric conditions (e.g., dementia, cognitive deficits, severe depression)

Outcomes

Primary Outcomes

Change in Paretic Leg Propulsive Force

Peak anterior ground reaction force of the paretic leg will be measured using an instrumented split-belt treadmill . Changes in propulsive force under different treadmill and resistance/feedback conditions will be analyzed to evaluate improvements in gait symmetry.

Time frame: Within a single session (approximately 2 hours)

Secondary Outcomes

Muscle Activity of Lower Extremity During Treadmill and overgrouun Walking

Surface EMG (Delsys Inc.) will be used to measure activity of major lower limb muscles (e.g., Tibialis anterior and soleus) during treadmill walking under different resistance and feedback conditions.

Time frame: Day 1 (during treadmill and overground walking trials)

Step Length (m) During Overground Walking Using Zeno Walkway

Step length (in meters) will be measured using the Zeno Walkway Gait Analysis System during overground walking trials on Day 1. The average step length for each participant will be reported.