Biomechanical and neural correlates of FastFES versus Fast gait training in individuals post stroke: a randomized...

Fast gait training, individually and when combined with functional electrical stimulation (FastFES), has been shown to improve walking function in individuals post stroke. However, the neural mechanisms underlying the effects of these two gait training interventions are poorly understood. The purpose of this mechanism-focused gait rehabilitation randomized clinical trial is to assess the effects of Fast and FastFES gait training interventions on corticospinal neurophysiology, gait biomechanics, energy cost, and walking function in individuals with chronic post-stroke hemiparesis.

In this randomized clinical trial, participants with chronic stroke are recruited and randomized to receive one of two gait training interventions-FastFES or Fast. Participants in each intervention group receive 12 sessions of gait training, with each training session comprising 30 min of training. During FastFES training, electrical stimulation is delivered to ankle dorsi- and plantar-flexor muscles during paretic swing phase and late stance phase, respectively. Evaluations of clinical, gait biomechanics, neurophysiological, and energy cost outcomes are performed at baseline, after completion of 12 training session (post12), and at 3-weeks and 6-weeks after completion of training (3-week follow up, 6-week follow up), to measure longitudinal effects of gait training. Additional evaluations are performed at completion of 3 and 6 training sessions (post3 and post6) to measure the time course of change during gait training. Upon completion of the study, planned analyses will include between-group comparisons of FastFES versus Fast gait training on training-induced changes in corticomotor and spinal excitability, gait biomechanics outcomes such as peak anterior ground reaction force, as well as association of training-induced changes in corticospinal neurophysiology and gait biomechanics with clinical and energy cost measures.

By elucidating the biomechanical and neural correlates underlying gait training-induced changes in locomotor function, this study promises to build on existing evidence supporting the clinical effects of FastFES and Fast gait training. The long-term goal of this study is to inform the development of neurobiology-informed, personalized, and innovative strategies to enhance the effectiveness of stroke gait rehabilitation.

clinicaltrials.gov, identifier NCT04380454.