Adaptability training for individuals after stroke

After stroke, a major impairment is a decreased ability to adapt gait to meet
environmental demands. Rehabilitation programs targeting gait adaptability have
gained interest in clinical practice, yet evidence for the efficacy of these
interventions is limited to small, pilot trials. Moreover, it is unclear if and
how the retention of beneficial effects of the intensive, but short-duration
training programs can be maintained in the long run through booster sessions
(single training sessions every 3 months) or an unsupervised home exercise
program. We hypothesize that treadmill-based training with virtual and
augmented reality will improve gait adaptability in post-stroke patients when
compared to the standard care provided during a waiting-list control period. We
also hypothesize that providing booster sessions and/or unsupervised home-based
practice will yield better retention of training effects at 1 year follow-up as
compared to the control arm.

1. To evaluate the efficacy of a gait training program using an instrumented
treadmill with virtual and augmented reality for improving gait adaptability in
people in the chronic phase after stroke in an RCT.
2. To identify patient characteristics that predict a favorable response to
training.
3. To evaluate if retention of training-induced gains in gait adaptability can
be fostered by providing booster sessions and/or by prescribing unsupervised
home-based training.

We will use a waitlist controlled trial in this study (Study 1), to evaluate
the short-term effect of gait adaptability training using augmented reality (on
the C-Mill) in individuals in the chronic phase after stroke. Following the
post-intervention assessment of Study 1 (S1-T1), all waitlist control
participants will enrol in the gait adaptability training. They will undergo an
additional assessment after completion of the training period (S1-T2). In the
second part of the study, to evaluate the long-term effects of gait
adaptability training, the patients who completed the gait adaptability
training will be randomized (1:1:1) to one of three arms: booster sessions,
home-based exercise program or a control arm. For the group randomized to gait
adaptability training in study 1, we will use the post-intervention assessment
of study 1 as baseline assessment for study 2 (S1-T1 = S2-T0) . For the
wait-list control group, the additional assessment after completion of the
training will be used as baseline assessment in study 2 (S1-T2 = S2-T0).
Follow-up assessment will be done at 6 (S2-T1) and 12 (S2-T2) months following
start of the intervention.

Gait adaptability training with instrumented treadmill with augmented reality
(C-Mill)

Health risks are minimal.
Burden will consist of the effort to do the assessments, training sessions and
travel to the Sint Maartenskliniek