Verbal feedback enhances motor learning during post-stroke gait retraining

• Type of Material: Article
• Authors: Nicole Rendos, Emory University; Laura Zajac-Cox, Emory University; Raul Thomas, Emory University; Sumire Sato, University of Massachusetts Amherst; Steven Eicholtz, Emory University; Trisha Kesar, Emory University
• Language: English
• Date: 2020-09-19
• Publisher: TAYLOR & FRANCIS LTD
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: Rights managed by Taylor & Francis
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1080/10749357.2020.1818480
• Title of Journal or Parent Work: TOPICS IN STROKE REHABILITATION
• Volume: 28
• Issue: 5
• Start Page: 362
• End Page: 377
• Grant/Funding Information: This work was supported by the NIH NICHD under grant numbers R01 HD095975 and K01 HD079584; and the American Heart Association (AHA) under Scientist Development Grant number 13SDG13320000.
• Keywords: gait propulsion; KNOWLEDGE; Verbal instructions; SPINAL-CORD-INJURY; Life Sciences & Biomedicine; STROKE; Rehabilitation; cerebrovascular accident; REDUCED-FREQUENCY; RECOVERY; Science & Technology; INTENSITY; variable practice; MUSCLE; rehabilitation; WALKING FUNCTION; INDIVIDUALS; walking; VARIABLE PRACTICE

Abstract

Background: Fast treadmill walking combined with functional electrical stimulation to ankle muscles (FastFES) is a well-studied gait intervention that improves post-stroke walking function. Although individualized verbal feedback is commonly incorporated during clinical gait training, and a variable practice structure is posited to enhance learning, the influence of these two factors on motor learning during locomotor interventions such as FastFES is poorly understood. Objectives: To determine if the addition of individualized verbal feedback or variable practice to a FastFES training session enhances motor learning of targeted gait patterns. Methods: Nine individuals with post-stroke hemiparesis completed a crossover study comprising exposure to 3 dose-matched types of gait training: (1) FastFES (FF), comprising five 6-minute bouts of training with intermittent FES, (2) FF with addition of individualized verbal instructions and faded feedback delivered by a physical therapist (FF+PT), (3) FF with variable gait speed and FES timing (FF+Var). Gait biomechanics data were collected before (Pre), immediately after (Post), and 24-h following (Retention) each training type. Within-session and retention change scores of 3 targeted gait variables were calculated to assess locomotor learning. Results: FF+PT resulted in larger improvements within-session and at retention in trailing limb angle, and a trend for larger improvements in paretic pushoff compared to FF. FF+Var failed to show greater learning of biomechanical variables compared to FF. Conclusions: Addition of individualized verbal feedback (FF+PT) to a single session of gait training may enhance within- and across-session learning of targeted gait variables in people post-stroke, and merits more investigation.