Step by step: A proof of concept study of C-Mill gait adaptability training in the chronic phase after stroke

OBJECTIVE: To evaluate the concept of C-Mill gait adaptability training. DESIGN: Pre- and post-intervention assessments. SUBJECTS: Sixteen community-dwelling persons in the chronic phase after stroke (mean age 54.8 years). METHODS: Participants received 10 sessions (1 h per session, for 5-6 weeks) of gait adaptability training on an instrumented treadmill augmented with visual targets and obstacles (C-Mill). Pre- and post-intervention assessments included: (i) clinical assessments of balance and gait: 10-m walking test, Timed Up-and-Go test, Berg Balance Scale, obstacle sub-task of the Emory Functional Ambulation Profile, and the Trunk Impairment Scale; (ii) physical activity level, assessed with a pedometer; (iii) success rate of accurate step adjustments towards a displacing target, assessed with an instrumented Target-Stepping Task; (iv) participant's experience with the training. RESULTS: All clinical assessments improved significantly after training (all p < 0.05), except for the Trunk Impairment Scale (p = 0.584). Physical activity increased by 19.6% (p < 0.05). Improvements in Target-Stepping Task success rates depended on the specific testing condition (time × body support × step direction, χ2(1) = 3.884, p < 0.05). All participants appreciated the training. CONCLUSION: The concept of C-Mill gait adaptability training in the chronic phase after stroke is promising and warrants future research involving a randomized controlled trial.