Investigators: David L. Jaffe, MS and David A. Brown, PhD, PT Project Staff: Cheryl D. Pierson-Carey, MS, PT; Ellie L. Buckley, MS PT; Ruth Yap, MS; Kyle A. Smith, MPT; Rajinder Chitkara, MD; and James Canfield, BS-CCPT Project Category: Stroke - 2000 Summary: The long term goal of this work is to apply and evaluate a system for individuals with stroke that trains, monitors, and improves their walking characteristics including stride length, walking speed, balance, ability to step over objects, and endurance. The proposed method is expected to be safer and physically more compact than conventional training techniques and to provide more rapid and precise feedback to both the patient and the clinician. Methodology: This project compared two training interventions: stepping over real foam objects (Overground) and stepping over computer-generated objects (Treadmill). The latter protocol consists of a computer-simulated environment: computer generated objects are presented in a head-mounted display, superimposed on a real-time side view of the subject walking on a treadmill. "Collisions" between the users' feet and the computer-generated obstacles are detected using a commercial computer imaging system with vibro-tactile feedback given to the "colliding foot". The combination of visual, audio, tactile feedback, and advice from a physical therapist promotes more effective walking strategies with stroke patients. Gait parameters are monitored before training, after training, and two-weeks post-training. Preliminary Results: Preliminary results demonstrated improvements for subjects in both training groups in walking speed, cadence, stride length, and ability to step over stationary objects. Treadmill intervention data from subjects with stroke in the study show significantly increased walking speed and stride length measures for both normal and fast walking evaluation tests. Eighty to 95% of these improvements are retained two weeks after the end of the training. The minimal changes in cadence are to be expected - subjects do not take more steps per unit time, they take longer steps, which results in a greater walking speed. Implicationss: This project has demonstrated that training individuals with stroke to step over objects improves their gait parameters which, in turn, leads to increased walking speed and confidence. The Treadmill training system would be a good candidate for commercialization. It could be used in rehabilitation clinics or community-based adaptive group exercise classes to improve the gait of individuals with stroke. Clinical Impact: The ability to walk is an essential component for enabling people to live and work independently and to function safely in their community. Individuals with walking disabilities have an increased risk for falls and subsequent injuries due to their inability to respond quickly and appropriately to challenges within their environment such as stairs, inclines / slopes, and uneven surfaces. This is a particularly serious problem for persons with stroke because this disorder is characterized by poor balance, shortened stride length, poor ability to step over objects, and reduced endurance. Improvements in these conditions should enhance the ability to walk, step over obstacles, and reduce injuries due to falls. Future Plans: Two VA proposals have been submitted to the Rehabilitation Research and Development Service, one for the "Targeted Solicitation for Proposals in Selected Areas of Emphasis in Rehabilitation Science and Technology" and the other for Merit Review. They would extend the current study to individuals with Traumatic Brain Injury, Parkinson's Disease, and Stroke. A four-week Treadmill training program with additional evaluations has been proposed. A Report of Invention has been submitted for this project. This will start the process of patenting the Treadmill training technique and possible commercialization. Stanford Office of Technology Licensing Abstract Funding Source: VA RR&D Merit Review |
