Split-belt treadmill training improves gait symmetry and lower limb function in patients with stroke

Split-belt treadmill training (SBTT) enhances gait symmetry in patients with stroke (PwS) by improving sensorimotor adaptation, However, it remains unclear whether repeated SBTT leads to long-term acquisition of gait adaptation skills and whether it improves functional walking in PwS. This study aimed to investigate the effect of SBTT on gait symmetry and lower limb function in PwS. We designed a parallel-group randomized controlled experiment. PwS who have the ability to stand and walk unassisted for at least 30 min were included in this study. They were randomly assigned to either rehabilitation with SBTT or with tied-belt treadmill training (TBTT). The treatment was provided once per day, five times per week for four weeks(total of 20 treatments). Gait analysis including step length, gait speed, temporal and spatial asymmetry and clinical assessment of lower limb function using Fugl-Meyer Assessment - lower extremity (LEFM), the Berg Balance Scale (BBS), the Wisconsin Gait Scale(WGS), and the Timed Up and Go Test (TUGT) were measured at baseline, 2 weeks post intervention, 4 weeks post intervention, and at follow-up after 4 weeks finishing the exercise. Two-way repeated measures ANOVA was used for intergroup comparisons between the two groups at different time points. In addition, Pearson correlation analysis was used to test the relationship between the improvement of clinical assessment scales and changes in gait parameters. Results showed that SBTT could effectively and efficiently improve the spatial asymmetry and speed of gait, as well as lower limb balance and walking function in PwS. In addition, the improvement of functional walking was positively correlated with the decrease of spatial asymmetry, and the increase of step length of paretic leg. In Conclusion, a 4-week SBTT intervention could effectively improve gait asymmetry and, consequently, enhance walking and lower limb function in PwS with independent walking ability.