Immediate effect of voluntary-induced stepping response training on protective stepping in persons with chronic stroke: a randomized controlled trial

Abstract

Purpose

To compare the immediate effects of voluntary-induced stepping response training (VSR) and DynSTABLE perturbation training (DST) on protective stepping in patients with stroke.

Methods

A randomized controlled trial (registration number: TCTR20170827001) was conducted in 34 patients with chronic stroke who were randomly allocated to the VSR (n = 17) or DST (n = 17) group. The VSR group was instructed to lean forward to induce protective stepping, while the DST group experienced support surface translation. All participants received one session of training (3 set, 10 min for each set with 10-minute rest in between). Step length, step width, number of steps and center of mass (CoM) position during protective stepping were assessed using a computer-assisted rehabilitation environment (CAREN) system prior to and immediately after training. Two-way ANOVA was used to compare between groups and times.

Results

Both types of training resulted in an increase in step width, but step length increased and there was a more positive COM position exhibited following DST (p < .05) than following VSR. Single-step incidence increased, whereas multiple-step incidence decreased significantly in both groups. Only participants in the VSR group generated protective stepping with the affected leg in a larger percentage of trials (27%) after training than before training.

Conclusion

Both DST and VSR led to changes in protective stepping parameters after a single session of training. VSR may be a feasible alternative to equipment-based training but requires further study.

Implication for Rehabilitation

• VSR and DST trainings improved protective stepping in stroke.

• Step length and CoM control at foot touchdown increased after DST training.

• VSR training for 50 minutes led to increase affected stepping and reduce grasping.

• Step width, affected step length, and single step increased after both trainings.

• Without instrument, VSR increased steps execution and performance similar to DST.

Keywords:

• Postural control
• balance
• rehabilitation
• cerebrovascular accident
• fall risk

Acknowledgements

The authors thank Brain and Spinal Injury Center for offering laboratory room and laboratory instruments for research activities from 2017 to 2018.

Disclosure statement

The authors report no conflicts of interest.

Additional information

Funding

This work was supported by the Thailand Research Fund through the Royal Golden Jubilee Ph.D. program [grant number PHD/0076/2558].