Automatized, Standardized, and Patient-Tailored Progressive Walking-Adaptability Training: A Proof-of-Concept Study

Abstract

Background: Treadmill training augmented with visual images projected on the belt's surface can help improve walking adaptability. Moreover, patient-tailored automatization and standardization can increase the feasibility of walking-adaptability therapy. We developed C-Gait, a treadmill protocol consisting of a baseline walking-adaptability assessment involving 7 putatively distinct walking-adaptability tasks and a decision algorithm, to automatically update training content and execution parameters to a patients' performance and perceived challenge.

Objectives: The main objective was to examine the feasibility, acceptability, and clinical potential of C-Gait training. The secondary objective was to evaluate the validity of the baseline assessment.

Design: This was a longitudinal proof-of-concept study with pretraining, posttraining, and retention tests encompassing baseline assessment and walking-related clinical measures.

Methods: Twenty-four healthy adults, 12 healthy older persons, and 28 patients with gait and/or balance deficits performed the baseline assessment; the gait deficit group received 10 C-Gait training sessions over a 5-week period. Baseline assessment scores and walking-related clinical measures served as outcome measures.

Results: C-Gait training exhibited significant progression in training content and execution, with considerable between-patient variation and minimal overruling by therapists. C-Gait training was well accepted and led to improvements in walking adaptability and general walking ability, which persisted after training cessation. Baseline assessment scores differed over groups and difficulty levels, had no-to-moderate correlations with walking-related clinical measures, and had limited correlations among walking-adaptability tasks.

Limitations: C-Gait was evaluated in a small yet diverse cohort. More encompassing studies are required to further establish its apparent merits. The validity of treadmill-based walking-adaptability assessment against an overground standard remains to be established.

Conclusions: C-Gait offers automatized, standardized, and patient-tailored walking-adaptability training that is feasible and well accepted, with good potential for improving task-specific and generic measures of walking.

Figure 1.

The C-Mill and the 7 C-Gait walking-adaptability tasks.

Figure 2.

Feasibility results: progress and between-patient variation in training content and execution parameters, performance, and perceived challenge over the 10 training sessions for the gait and/or balance deficits (GD) group (top 4 panels) and 2 representative cases (Participant A and Participant B) highlighted (lower 4 panels).

Figure 3.

Acceptability results: patients’ experience (n = 26) after C-Gait training assessed with a custom-made questionnaire, presented as the number of patients (n) per score for 7 items.

Figure 4.

Clinical potential: effect of C-Gait training on C-Gait baseline assessment scores (belt speed and composite score) and walking-related clinical measures—10-Meter Walking Test (10MWT), Timed “Up & Go” Test (TUG), Activities-specific Balance Confidence Scale (ABC), and Short Physical Performance Battery (SPPB). Error bars represent the standard error, and asterisks represent significant differences (P < .05) compared with the pretraining tests.