Learning to walk again: Use of motor learning principles as a theoretical framework for walking-skill training in community-dwelling individuals following stroke

Abstract

<p><strong>Background: </strong>Walking dysfunction is one of the most disabling and persistent of stroke-related sequela. Theory- and research-derived motor learning principles (MLPs) offer an ideal theoretical framework for the development and evaluation of walking-skill focused interventions.</p> <p><strong>Purpose: </strong>To: 1) appraise the degree of adherence to motor learning principles (MLPs) in current post-stroke walking-skill training research; 2) describe the Motor Learning Walking Program (MLWP), a novel, MLPs-framed walking training program; and 3) compare the MLWP to an alternate theory-framed walking-focused intervention in community-dwelling individuals within one year of stroke.</p> <p><strong>Methods: </strong>A scoping review methodology was used to identify the prevalent theoretical frameworks in current post-stroke walking training literature, and to appraise the adherence to selected MLPs in walking-focused interventions. A randomized controlled trial (n=71) was conducted to compare the MLWP to a body-weight-supported treadmill training (BWSTT) intervention.</p> <p><strong>Results: </strong>In the scoping review of 27 walking-focused studies, a minority of investigators explicitly stated a theoretical-framework. Application of MLPs was inconsistent across interventions. In the randomized controlled trial, both intervention groups improved walking function after 5 weeks of training however, there were no significant between-group differences in the primary and secondary outcomes.</p> <p><strong>Conclusions:</strong> To date, there has been limited integration of MLPs into post-stroke walking-skill training literature. This randomized controlled trial is unique in its comparison of two theoretically divergent, yet equally intense, walking-training interventions. While the results were equivocal, future research should continue to explore the impact of application of MLPs on walking-skill recovery after stroke.</p>