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Practice Structure and Locomotor Learning After Stroke

Helm, Erin E., DPT, PhD; Pohlig, Ryan T., PhD; Kumar, Devina S., MS; Reisman, Darcy S., PT, PhD

Journal of Neurologic Physical Therapy: April 2019 - Volume 43 - Issue 2 - p 85–93
doi: 10.1097/NPT.0000000000000260
Research Articles

Background and Purpose: The optimal characteristics of learning to promote recovery of walking have yet to be defined for the poststroke population. We examined characteristics of task practice that limit or promote learning of a novel locomotor pattern.

Methods: Thirty-two persons with chronic hemiparesis were randomized to 2 conditions (constant and variable practice) and participated in two 15-minute sessions of split-belt treadmill walking. On day 1, subjects in the constant condition walked on the split-belt treadmill at a constant 2:1 speed ratio, while subjects in the variable condition walked on the split-belt treadmill at 3 different speed ratios. On day 2, both groups participated in 15 minutes of split-belt treadmill walking at the 2:1 speed ratio. Step length and limb phase symmetry metrics were measured to assess within-session learning (ie, adaptation) on day 1 and the ability to retain this new pattern of walking (ie, retention) on day 2.

Results: The amount of adaptation on day 1 did not differ depending upon practice structure (constant and variable) for step length or limb phase (a)symmetry. The magnitude of reduction in asymmetry from day 1 to day 2 did not differ between groups for step and limb phase (a)symmetry.

Discussion and Conclusions: The results suggest that variable practice utilizing alternating belt speed ratios does not influence the ability of those with chronic stroke to adapt and retain a novel locomotor pattern. The effects of other forms of variable practice within other locomotor learning paradigms should be explored in those with chronic hemiparesis after stroke.

Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at:

Department of Physical Therapy (D.S.R.), Biomechanics and Movement Science Program (E.E.H., D.S.K., D.S.R.), and Biostatistics Core Facility (R.T.P.), University of Delaware, Newark.

Correspondence: Darcy S. Reisman, PT, PhD, STAR Health Sciences Complex, 540 S. College Ave, Newark, DE 19713 (

Funding sources include the National Institutes of Health: NIHT32HD007490 and NIHR01HD078330.

The authors declare no conflict of interest.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (

© 2019 Academy of Neurologic Physical Therapy, APTA