Training propulsion: Locomotor adaptation to accelerations of the trailing limb

Many stroke survivors suffer from hemiparesis, a condition that results in impaired walking ability. Walking ability is commonly assessed by walking speed, which is dependent on propulsive force generation both in healthy and stroke populations. Propulsive force generation is determined by two factors: ankle moment and the posture of the trailing limb during push-off. Recent work has used robotic assistance strategies to modulate propulsive force with some success. However, robotic strategies are limited by their high cost and the technical difficulty of fitting and operating robotic devices in a clinical setting. Here we present a new paradigm for goal-oriented gait training that utilizes a split belt treadmill to train both components of propulsive force generation, achieved by accelerating the treadmill belt of the trailing limb during push off. Belt accelerations require subjects to produce greater propulsive force to maintain their position on the treadmill and increase trailing limb angle through increased velocity of the accelerated limb. We hypothesized that locomotor adaptation to belt accelerations would result in measurable after effects in the form of increased propulsive force generation. We tested our protocol on healthy subjects at two acceleration magnitudes. Our results show that 79% of subjects significantly increased propulsive force generation following training, and that larger accelerations translated to larger, more persistent behavioral gains.