Implicit motor learning in gait training after stroke

Objective: The objective of this study is twofold. The first objective is to study the effectiveness of implicit motor learning on walking speed in clients after stroke in daily practice. The second objective is to determine the technology acceptance, feasibility, and first effects on walking performance of the Stappy-system.

Study design: This research protocol involves two work packages A (objective 1) and B (objective 2). In work package A, a randomized, controlled, single-blinded study design will be adopted. Work package A will be followed by work package B in which a prospective process evaluation of a technology intervention will take place.

Study population: The same participants will take place in both work packages A and B. People will be eligible for participation if they have had a stroke (>6 months after stroke), would like to improve their walking performance, have a slower walking speed than (10 m/s), can communicate in Dutch language (enough to understand the instructions), and can follow a 3-stage command. People will be excluded for participation if they cannot walk a minimum of 10 meters, or have other additional impairments that may influence their gait.

Intervention: Work package A consists of a 3-week intervention period that includes 3 training sessions per week. The experimental group receives gait training based on implicit learning principles and the control group will receive gait training based on explicit learning principles. In work package B, the participants will receive an easy-to-use technology (Stappy-system) to support their gait exercises independently at home.

Main study parameters/endpoints
Demographic data: Age, gender, Length, time post stroke, side of stroke, walking aids, educational level, Montreal Cognitive Assessment, Berg Balance Scale, Rivermead Mobility Index, Fugl-Meyer Assessment, Movement Specific Reinvestment Scale

Work package A: The main outcome parameter is walking speed measured using the 10-Meter Walk Test. Secondary outcome measures include: quality of gait (modified Dynamic Gait Index), dual-task performance, the participants' satisfaction (Global Perceived Effect), the propensity for conscious processing (Movement Specific Reinvestment Scale) and quality of life (Stroke and Aphasia Quality of Life Scale-39).

Work package B: The main outcome parameter for work package B is the technology acceptance of the Stappy-system. Secondary outcomes are based on the feasibility and potential first effects on walking performance.

Work package A

The aim of work package A is to examine the effectiveness of analogy learning (based on implicit motor learning principles) compared to explicit motor learning on walking performance in people after stroke.



Work package B

The primary aim of work package B is to evaluate the acceptability of the Stappy-system for independent gait training in daily life in people after stroke. Secondary aims are to assess the feasibility and potential first effects on walking performance of the Stappy-system in people

T0: 0-weeks (baseline)

T1: 4-weeks

T2: 8-weeks

Depending on randomisation, participants will receive a gait training based on implicit motor learning principles (experimental group) or based on explicit motor learning principles (control group).