A simple, clinically applicable motor learning protocol to increase push-off during gait: A proof-of-concept

Objective Task-specific training is often used in functional rehabilitation for its potential to improve performance at locomotor tasks in neurological populations. As push-off impairment are often seen with these patients, this functional approach shows potential to retrain gait overground to normalize the gait pattern and retrain the ability to improve gait speed. The main objective of this project was to validate, in healthy participants, a simple, low-cost push-off retraining protocol based on task-specific training that could be implemented during overground walking in the clinic. Methods 30 healthy participants walked in an 80-meter long corridor before, during, and after the application of an elastic resistance to the right ankle. Elastic tubing attached to the front of a modified ankle-foot orthosis delivered the resistance during push-off. Relative ankle joint angular displacements were recorded bilaterally and continuously during each walking condition. Results On the resisted side, participants presented aftereffects (increased peak plantarflexion angle from 13.4 +/- 4.2 degrees to 20.0 +/- 6.4 degrees, p<0.0001 and increased peak plantarflexion angular velocity from 145.8 +/- 22.7 degrees/s to 174.4 +/- 37.4 degrees/s, p<0.0001). On the non-resisted side, aftereffects were much smaller than on the resisted side suggesting that the motor learning process was mainly specific to the trained leg. Conclusion This study shows the feasibility of modifying push-off kinematics using an elastic resistance applied at the ankle while walking overground. This approach represents an interesting venue for future gait rehabilitation.