Feasibility and preliminary efficacy of visual cue training to improve adaptability of walking after stroke : multi-centre, single-blind randomised control pilot trial

Hollands, K; Pelton, TA; Wimperis, A; Whitham, D; Tan, W; Jowett, S; Sackley, CM; Wing, AM; Tyson, SF; Mathias, J; Hensman, M; van Vliet, PM

Abstract

Objectives:
Given the importance of vision in the control of walking and evidence indicating varied practice of walking improves mobility outcomes, this study sought to examine the feasibility and preliminary efficacy of varied walking practice in response to visual cues, for the rehabilitation
of walking following stroke.
Design:
This 3 arm parallel, multi-centre, assessor blind, randomised control trial was conducted within outpatient neurorehabilitation services Participants
Community dwelling stroke survivors with walking speed <0.8m/s, lower limb paresis and
no severe visual impairments.
Intervention:
Over-ground visual cue training (O-VCT), Treadmill based visual cue training (T-VCT), and
Usual care (UC) delivered by physiotherapists twice weekly for 8 weeks.

Main outcome measures: Participants were randomised using computer generated random
permutated balanced blocks of randomly varying size. Recruitment, retention, adherence,
adverse events and mobility and balance were measured before randomisation, postintervention
and at four weeks follow-up.
Results:
Fifty-six participants participated (18 T-VCT, 19 O-VCT, 19 UC). Thirty-four completed treatment
and follow-up assessments. Of the participants that completed, adherence was good
with 16 treatments provided over (median of) 8.4, 7.5 and 9 weeks for T-VCT, O-VCT and
UC respectively. No adverse events were reported. Post-treatment improvements in walking
speed, symmetry, balance and functional mobility were seen in all treatment arms.
Conclusions:
Outpatient based treadmill and over-ground walking adaptability practice using visual cues
are feasible and may improve mobility and balance. Future studies should continue a carefully
phased approach using identified methods to improve retention.
Trial Registration: Clinicaltrials.gov NCT01600391

Citation

Hollands, K., Pelton, T., Wimperis, A., Whitham, D., Tan, W., Jowett, S., …van Vliet, P. (2015). Feasibility and preliminary efficacy of visual cue training to improve adaptability of walking after stroke : multi-centre, single-blind randomised control pilot trial. PLoS ONE, 10(10), e0139261. https://doi.org/10.1371/journal.pone.0139261

• Journal Article Type: Article
• Acceptance Date: Sep 4, 2015
• Publication Date: Oct 7, 2015
• Deposit Date: Oct 19, 2015
• Publicly Available Date: Apr 5, 2016
• Journal: PLOS ONE
• Publisher: Public Library of Science
• Peer Reviewed: Peer Reviewed
• Volume: 10
• Issue: 10
• Pages: e0139261
• DOI: https://doi.org/10.1371/journal.pone.0139261
• Publisher URL: http://dx.doi.org/10.1371/journal.pone.0139261
• Related Public URLs: http://www.plosone.org/
• Additional Information: Projects : Visual Cue training to improve walking and turning after stroke: a pilot study