Physical Interventions Used to Improve Gait Adaptability for Individuals with Non-progressive Neurological Impairments: A Scoping Review

Objective(s): To synthesize quantitative studies that examined the effects of gait adaptability interventions (i.e., interventions designed to prompt one to modify their walking pattern in response to the environment/task) for individuals with non-progressive neurological impairments.

Data Sources: A comprehensive search was conducted in six databases: CINAHL Complete, Embase, Emcare Nursing, Medline ALL, PEDro, and Web of Science Core Collection, from inception to March 22, 2024. No language or date limits were applied.

Study Selection: Five researchers were involved in title and abstract screening to identify articles of interest. Subsequently, three researchers independently reviewed full texts to identify articles for inclusion. Conflicts were resolved through discussion. Studies were included if: a) participants were adults with a non-progressive neurological injury/disease, b) walking was involved in the training intervention, c) the environment/task changed during the intervention, d) gait/walking adaptability was a target of the intervention, and e) participants completed more than two training sessions.

Data Extraction: Data regarding study and participant characteristics, details of gait interventions, and outcomes were extracted. Methodological quality was evaluated using the Modified Downs and Black checklist.

Data Synthesis: From the 28 included studies, 687 adults (567 stroke, 97 motor incomplete spinal cord injury, 23 acquired brain injury of non-vascular origin) participated in various gait adaptability interventions. The most prevalent interventions were: combined treadmill and overground walking with an additional adaptability task (n=8 studies), treadmill training with virtual/augmented reality (n=7), skilled overground or community walking with real-world obstacles (n=5), and treadmill training with an additional adaptability task (n=3). Sixteen studies employed randomized control trials. Common outcome measures included the 10-meter walk test, 6-minute walk test, and Berg Balance Scale. Most assessment measures focused on the evaluation of spatiotemporal metrics of level-ground walking and standing balance, rather than evaluating gait adaptability. Results showed improvements in walking speed, endurance, and balance control, with varying efficacy compared to control groups.

Conclusions: Gait adaptability interventions improved walking-related outcomes in individuals with non-progressive neurological impairments; however, conclusive evidence regarding their superiority over alternative training methods is lacking.

Author(s) Disclosures: Funded by Canadian Institutes of Health Research.