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Augmenting propulsion demands during split-belt walking increases locomotor adaptation of asymmetric step lengths.

ABSTRACT: BACKGROUND:Promising studies have shown that the gait symmetry of individuals with hemiparesis due to brain lesions, such as stroke, can improve through motor adaptation protocols forcing patients to use their affected limb more. However, little is known about how to facilitate this process. Here we asked if increasing propulsion demands during split-belt walking (i.e., legs moving at different speeds) leads to more motor adaptation and more symmetric gait in survivors of a stroke, as we previously observed in subjects without neurological disorders. METHODS:We investigated the effect of propulsion forces on locomotor adaptation during and after split-belt walking in the asymmetric motor system post-stroke. To test this, 12 subjects in the chronic phase post-stroke experienced a split-belt protocol in a flat and incline session so as to contrast the effects of two different propulsion demands. Step length asymmetry and propulsion forces were used to compare the motor behavior between the two sessions because these are clinically relevant measures that are altered by split-belt walking. RESULTS:The incline session resulted in more symmetric step lengths during late split-belt walking and larger after-effects following split-belt walking. In both testing sessions, subjects who have had a stroke adapted to regain speed and slope-specific leg orientations similarly to young, intact adults. Importantly, leg orientations, which were set by kinetic demands, during baseline walking were predictive of those achieved during split-belt walking, which in turn predicted each individual's post-adaptation behavior. These results are relevant because they provide evidence that survivors of a stroke can generate the leg-specific forces to walk more symmetrically, but also because we provide insight into factors underlying the therapeutic effect of split-belt walking. CONCLUSIONS:Individuals post-stroke at a chronic stage can adapt more during split-belt walking and have greater after-effects when propulsion demands are augmented by inclining the treadmill surface. Our results are promising since they suggest that increasing propulsion demands during paradigms that force patients to use their paretic side more could correct gait asymmetries post-stroke more effectively.

SUBMITTER: Sombric CJ

PROVIDER: S-EPMC7268294 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

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Augmenting propulsion demands during split-belt walking increases locomotor adaptation of asymmetric step lengths.

Sombric Carly J CJ Torres-Oviedo Gelsy G

Journal of neuroengineering and rehabilitation 20200603 1

<h4>Background</h4>Promising studies have shown that the gait symmetry of individuals with hemiparesis due to brain lesions, such as stroke, can improve through motor adaptation protocols forcing patients to use their affected limb more. However, little is known about how to facilitate this process. Here we asked if increasing propulsion demands during split-belt walking (i.e., legs moving at different speeds) leads to more motor adaptation and more symmetric gait in survivors of a stroke, as we ...[more]

PMID: 32493440

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Project description:Locomotor adaptation is crucial for daily gait adjustments to changing environmental demands and obstacle avoidance. Mobile brain imaging with high-density electroencephalography (EEG) now permits quantification of electrocortical dynamics during human locomotion. To determine the brain areas involved in human locomotor adaptation, we recorded high-density EEG from healthy, young adults during split-belt treadmill walking. We incorporated a dual-electrode EEG system and neck electromyography to decrease motion and muscle artefacts. Voluntary movement preparation and execution have been linked to alpha (8-13 Hz) and beta band (13-30 Hz) desynchronizations in the sensorimotor and posterior parietal cortices, whereas theta band (4-7 Hz) modulations in the anterior cingulate have been correlated with movement error monitoring. We hypothesized that relative to normal walking, split-belt walking would elicit: (1) decreases in alpha and beta band power in sensorimotor and posterior parietal cortices, reflecting enhanced motor flexibility; and (2) increases in theta band power in anterior cingulate cortex, reflecting instability and balance errors that will diminish with practice. We found electrocortical activity in multiple regions that was associated with stages of gait adaptation. Data indicated that sensorimotor and posterior parietal cortices had decreased alpha and beta band spectral power during early adaptation to split-belt treadmill walking that gradually returned to pre-adaptation levels by the end of the adaptation period. Our findings emphasize that multiple brain areas are involved in adjusting gait under changing environmental demands during human walking. Future studies could use these findings on healthy, young participants to identify dysfunctional supraspinal mechanisms that may be impairing gait adaptation. KEY POINTS: Identifying the location and time course of electrical changes in the brain correlating with gait adaptation increases our understanding of brain function and provides targets for brain stimulation interventions. Using high-density EEG in combination with 3D biomechanics, we found changes in neural oscillations localized near the sensorimotor, posterior parietal and cingulate cortices during split-belt treadmill adaptation. These findings suggest that multiple cortical mechanisms may be associated with locomotor adaptation, and their temporal dynamics can be quantified using mobile EEG. Results from this study can serve as a reference model to examine brain dynamics in individuals with movement disorders that cause gait asymmetry and reduced gait adaptation.

Project description:IntroductionBackward-directed resistance is the resistance applied in the opposite direction of the individual's walking motion. Progressive application of backward-directed resistance during walking at a target speed engages adaptive motor control to maintain that speed. During split-belt walking, a motor control strategy must be applied that allows the person to keep up with the two belts to maintain their position on the treadmill. This situation becomes more challenging when progressive resistance is applied since each limb needs to adapt to the greater resistance to maintain the position. We propose that strategies aimed at changing relative propulsion forces with each limb may explain the motor control strategy used. This study aimed to identify the changes in propulsive force dynamics that allow individuals to maintain their position while walking on an instrumented split-belt treadmill with progressively increasing backward-directed resistance.MethodsWe utilized an instrumented split-belt treadmill while users had to overcome a set of increasing backward-directed resistance through the center of mass. Eighteen non-impaired participants (mean age = 25.2 ± 2.51) walked against five levels of backward resistance (0, 5, 10, 15, and 20% of participant's body weight) in two different modalities: single-belt vs. split-belt treadmill. On the single-belt mode, the treadmill's pace was the participant's comfortable walking speed (CWS). In split-belt mode, the dominant limb's belt pace was half of the CWS, and the non-dominant limb's belt speed was at the CWS.ResultsWe assessed differences between single-belt vs. split-belt conditions in the slope of the linear relationship between change in propulsive impulse relative to change of backward resistance amount. In split-belt conditions, the slower limb showed a significantly steeper increase in propulsion generation compared to the fast limb across resistance levels.DiscussionAs a possible explanation, the slow limb also exhibited a significantly increased slope of the change in trailing limb angle (TLA), which was strongly correlated to the propulsive impulse slope values. We conclude that the motor control strategy used to maintain position on a split-belt treadmill when challenged with backward-directed resistance is to increase the propulsive forces of the slow limb relative to the fast limb by progressively increasing the TLA.Clinical trial registrationClinicalTrials.gov, identifier NCT04877249.

Project description:Interlimb coordination plays an important role in adaptive locomotion of humans and animals. This has been investigated using a split-belt treadmill, which imposes different speeds on the two sides of the body. Two types of adaptation have been identified, namely fast and slow adaptations. Fast adaptation induces asymmetric interlimb coordination soon after a change of the treadmill speed condition from same speed for both belts to different speeds. In contrast, slow adaptation slowly reduces the asymmetry after fast adaptation. It has been suggested that these adaptations are primarily achieved by the spinal reflex and cerebellar learning. However, these adaptation mechanisms remain unclear due to the complicated dynamics of locomotion. In our previous work, we developed a locomotion control system for a biped robot based on the spinal reflex and cerebellar learning. We reproduced the fast and slow adaptations observed in humans during split-belt treadmill walking of the biped robot and clarified the adaptation mechanisms from a dynamic viewpoint by focusing on the changes in the relative positions between the center of mass and foot stance induced by reflex and learning. In this study, we modified the control system for application to a quadruped robot. We demonstrate that even though the basic gait pattern of our robot is different from that of general quadrupeds (due to limitations of the robot experiment), fast and slow adaptations that are similar to those of quadrupeds appear during split-belt treadmill walking of the quadruped robot. Furthermore, we clarify these adaptation mechanisms from a dynamic viewpoint, as done in our previous work. These results will increase the understanding of how fast and slow adaptations are generated in quadrupedal locomotion on a split-belt treadmill through body dynamics and sensorimotor integration via the spinal reflex and cerebellar learning and help the development of control strategies for adaptive locomotion of quadruped robots.

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Augmenting propulsion demands during split-belt walking increases locomotor adaptation of asymmetric step lengths.

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Augmenting propulsion demands during split-belt walking increases locomotor adaptation of asymmetric step lengths.

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