RehabMove 2018: WALKING ADAPTABILITY TRAINING IN PEOPLE AFTER STROKE: A RANDOMIZED CONTROLLED TRIAL

PURPOSE: The ability to adapt walking to environmental properties and hazards, a prerequisite for safe
walking, is often impaired in persons after stroke. This study aimed to compare the efficacy of two walking adaptability
interventions: treadmill-based C-Mill therapy (therapy with augmented reality) and the
overground FALLS program (conventional therapy program using physical context). We hypothesized that,
besides the difference in type of environmental context, C-Mill therapy would result in better outcomes
than the FALLS program, owing to its expected greater amount of walking practice operationalized by the
number of steps taken per session.
METHODS: Within a randomized controlled trial with pre-intervention, post-intervention, retention and
follow-up tests, 30 persons after stroke (≥3 months) with walking and/or balance deficits were randomly
allocated to either 5 weeks of C-Mill therapy or the FALLS program. Outcome measures were walking
speed and walking adaptability, using 10MWTs with or without physical context and a novel Interactive
Walkway assessment with augmented context. A cognitive task was added to assess dual-task
performance. The amount of walking practice was scored using the treadmill’s inbuilt step counter (C-Mill
therapy) and video recordings (FALLS program).
RESULTS: Both interventions showed significant improvements in walking speed, walking adaptability
and cognitive dual-task performance when walking in enriched environments. Furthermore, C-Mill therapy
showed a greater improvement in walking speed at the 10MWT with physical context compared to the
FALLS program; however, this was no longer significant at retention. C-Mill therapy encompassed twice
as many steps per session compared to a FALLS program session.
CONCLUSIONS: Both C-Mill and FALLS training led to task-specific improvements in walking adaptability;
the greater improvement in walking speed might be explained by the greater amount of walking practice
during C-Mill therapy.