Verbal feedback enhances motor learning during post-stroke gait retraining

• 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
• Journal Title: TOPICS IN STROKE REHABILITATION
• Volume: Volume 28, Number 5
• Publisher: TAYLOR & FRANCIS LTD | 2020-09-19, Pages 362-377
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1080/10749357.2020.1818480
• Subjects: Health Sciences, Rehabilitation and Therapy
• Keywords: Science & Technology; Life Sciences & Biomedicine; Rehabilitation; Verbal instructions; walking; rehabilitation; variable practice; cerebrovascular accident; gait propulsion; SPINAL-CORD-INJURY; REDUCED-FREQUENCY; VARIABLE PRACTICE; WALKING FUNCTION; STROKE; INDIVIDUALS; INTENSITY; KNOWLEDGE; RECOVERY; MUSCLE

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.