An interventional study of Gait training and cognitive training in Stroke, sponsored by VA Office of Research and Development. Terminated at 1 site in United States. Open to participants aged 21 Years and older, including healthy volunteers. Per ClinicalTrials.gov, last updated 2019-02-11.
Sponsored by VA Office of Research and Development · Not applicable, Interventional, and Treatment
Recent research in gait training for stroke survivors showed that coordinated gait components can be best restored using the following interventions together: coordination exercises, over ground gait training, and body weight supported treadmill training (BWSTT). These results are important because, to the investigators' knowledge, there have been no other reports of the restoration of coordinated gait components for those with persistent gait deficits (> 6 months after stroke). However, a remaining problem was that the restored coordinated gait movements measured in the laboratory did not generalize for many subjects to the everyday environment. The confluence of several factors can cause lack of generalization. First, dual task performance (gait and cognitive attention task) can degrade both gait and attention ability, even in healthy adults. Second, stroke can impair attention. Third, during walking in the everyday environment, attention is required in order to safely process normally occurring stimuli. Therefore, given the success of the new gait training protocol in the lab setting, it is important to address the problems remaining for generalization of the recovered coordinated gait pattern to the everyday environment. The primary hypothesis of this study is that greater gains in gait speed will be produced by combined motor and cognitive training versus motor training alone.
Aim 1, Hypothesis Ia: Comparison of combined motor and cognitive training vs motor training alone. For Aim 1, Hypothesis Ia, this will be a randomized, controlled study. For the two groups, 38 subjects will be enrolled and randomized to either: A) Motor + Cognitive Training; or B) Motor Training alone. Subjects will first be stratified according to coordination and gait deficit severity, as described below. After stratification, the subject will be randomized to one of the two intervention groups for Hypothesis Ia. All the subjects will receive treatment 5 times/week, 3hrs/session, for 12 weeks or for a total of 60 treatment sessions. Group A will receive combined motor and cognitive training; Table 2 (below) shows the graduated approach to providing combined gait and cognitive training. Data collection will be at weeks 1, 6, 12, and 24 (i.e., before, mid-treatment and after treatment, and then 3 months after the end of the treatment protocol. Comparison will be made between the two groups to determine whether there was any additive effectiveness of the cognitive training.
Aim 2, Hypotheses IIa-d: Pre/post-treatment comparisons within Group A, receiving combined motor and cognitive training. For Aim 2, Hypotheses IIa-d, this will be a single cohort pre/post-treatment comparison within Group A receiving combined motor and cognitive training.
Aim 3, Hypotheses IIIa-d: Pre/post-treatment comparisons within Group B, receiving motor training alone. For Aim 3, Hypotheses IIIa-d, this will be a single cohort pre/post-treatment comparison within Group B, receiving motor training alone.
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Inclusion Criteria:
Stroke Survivor inclusion/exclusion criteria Inclusion Criteria
Able-bodied Inclusion criteria
Exclusion Criteria:
Exclusion Criteria
Rehabilitation of walking/gait, combined with rehabilitation of cognitive function
Behavioral: Gait training · Behavioral: cognitive training
Rehabilitation of walking/gait, combined with rehabilitation of arm function
Behavioral: Gait training · Behavioral: Arm training
Treatment will include coordination exercises and over ground gait training for impaired muscle groups and related gait deficits. The therapy will be provided by a clinical physical therapist specializing in rehabilitation for stroke patients, according to established, conventional guidelines. The protocol was used in the investigators' prior studies, and is designed to restore voluntary control of ankle dorsiflexion during swing phase; hip flexion during swing phase, knee flexion at toe-off, knee flexion during swing phase; knee extension before heel strike; knee control during stance phase; pelvic control during stance phase; and whole body balance control during weight shifting. Newly-learned coordinated movements will be integrated into practice of coordinated gait components. Cognitive rehabilitation will begin with the least difficult aspects of attention control, and progress to the more difficult. Home practice and generalization exercises will be assigned.
Cognitive training is designed to enhance attention, intention, executive function, decision making and reaction time. Commercially available computer software will be used, as well as custom cognitive training.
Treatment will include coordination exercises for reaching and grasping. Activities will include movement of shoulder, elbow, wrist and fingers.
Change in the Gait Assessment and Intervention (G.A.I.T.) Score
Coordination of walking, scored using the investigators' novel G.A.I.T. measure. This measure evaluated limb and joint movements while participants walk overground at preferred speed. Range of scale: 0 (normal) to 64 (extremely discoordinated gait).
Time frame: pre-training (0 weeks), post training (about 12 weeks)
| Milestone | Gait and Cognitive Training | Gait and Arm Training |
|---|---|---|
| Started | 5 | 7 |
| Completed | 4 | 7 |
| Not completed | 1 | 0 |
| Withdrew: Withdrawal by subject | 1 | 0 |
Coordination of walking, scored using the investigators' novel G.A.I.T. measure. This measure evaluated limb and joint movements while participants walk overground at preferred speed. Range of scale: 0 (normal) to 64 (extremely discoordinated gait).
| units on a scale | Gait and Cognitive Training | Gait and Arm Training |
|---|---|---|
| pre treatment mean | 28.8 ± 6.9 | 29.5 ± 3.8 |
| post treatment mean | 29.9 ± 5.9 | 28.7 ± 7.7 |
Non-serious events are listed at a 0% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Gait and Cognitive Training | 0/4 (0%) | 0/4 (0%) | 1/4 (25%) |
| Gait and Arm Training | 0/7 (0%) | 0/7 (0%) | 0/7 (0%) |
| Event | Gait and Cognitive Training | Gait and Arm Training |
|---|---|---|
| back painMusculoskeletal and connective tissue disorders | 1/4 | 0/7 |
| Age, Categorical(Participants) | Gait and Cognitive Training | Gait and Arm Training | Total |
|---|---|---|---|
| <=18 years | 0 | 0 | 0 |
| Between 18 and 65 years | 4 | 5 | 9 |
| >=65 years | 1 | 2 | 3 |
| Sex: Female, Male(Participants) | Gait and Cognitive Training | Gait and Arm Training | Total |
|---|---|---|---|
| Female | 3 | 3 | 6 |
| Male | 2 | 4 | 6 |
| Race (NIH/OMB)(Participants) | Gait and Cognitive Training | Gait and Arm Training | Total |
|---|---|---|---|
| American Indian or Alaska Native | 0 | 0 | 0 |
| Asian | 0 | 0 | 0 |
| Native Hawaiian or Other Pacific Islander | 0 | 0 | 0 |
| Black or African American | 2 | 2 | 4 |
| White | 3 | 5 | 8 |
| More than one race | 0 | 0 | 0 |
| Unknown or Not Reported | 0 | 0 | 0 |
| Region of Enrollment(Participants) | Gait and Cognitive Training | Gait and Arm Training | Total |
|---|---|---|---|
| United States | 5 | 7 | 12 |
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