Biofeedback gait training in stroke patients.

Eligible participants who have given informed consent will be randomly assigned to one of two gait training groups: no-feedback (control), and feedback (experimental group). Clinical and Demographic Assessment (all participants): Demographic and anthropometric data will be collected at initial assessment; including age, gender, body mass, standing height, lesion site, date of stroke and medical history. Clinical tests will be conducted at initial assessment and the 4 post training retention tests to provide information about specific impairments, and level of function. Clinical tests will be conducted by an experienced physiotherapist who is blind to group allocation: Baseline gait assessment (all participants) - Conducted at Victoria University biomechanics laboratory and at Austin Repatriation Hospital within the physiotherapy department. Gait assessments will include both treadmill walking and overground walking to establish pre-training (Baseline) performance and determine the Minimum Toe Clearance (MTC) feedback criterion for the experimental group. Training and testing will be undertaken in comfortable walking shoes. Participants will wear the same shoes throughout. Participants will also wear a safety harness and will walk at their preferred walking speed (calculated during treadmill familiarisation during visit 1 (session 1). Markers will be placed on the shoe, lower limb and the trunk. Optotrak 3D motion capture system will be used to determine the trajectory of the markers and Visual 3D software will be used to determine Minimum Toe Clearance event for each walking stride and calculate the vertical displacement between the ground (treadmill belt) and the forefoot at this event (MTC). The mean and standard deviation of MTC will be calculated. Once baseline assessment has been completed, all participants will complete 10 gait training sessions of treadmill walking over 5-6 weeks, with MTC target information presented in real-time for the experimental group. Participants will walk for up to 10 minutes during gait training. A single marker will be placed on the forefoot area of the affected limb to calculate toe clearance in real-time. Participants will be asked to modify their gait pattern to match a required “target” criterion (increased MTC). Baseline MTC data from the affected limb will be used to set the training target at mean baseline MTC plus one standard deviation. The training target MTC will be projected on a screen in front of the participant with parallel lines above and below indicating a target band. Participants will view their toe movement and minimum clearance in real-time and will be required to modify their affected limb motion to match the “target” toe clearance. Borg rating of perceived exertion will be recorded after each session. . The first 6 sessions will involve continuous visual biofeedback. Duration of biofeedback will then be progressively reduced (faded) across the remaining four sessions. Gait assessment will again be conducted after the final training session, one at 1-month post training and two relatively longer-term (3 months and 6 months). In retention conditions, participants will be asked to reproduce the movement criterion presented during the gait training sessions but no feedback will be provided.