Effects of Visual Feedback During Recumbent Stepping in Individuals With Chronic Stroke

OBJECTIVE: To investigate the effects of intermittent visual feedback (using the Balanced Power program on the NuStep Transitt) during recumbent stepping on strength, balance, and functional mobility in individuals with chronic stroke. DESIGN: Quasi-experimental 1-group pretest-posttest study. SETTING: Human performance research laboratory. PARTICIPANTS: Adults (N=11; 7 female; mean age, 58.7±13.6y), >6 months post stroke. INTERVENTIONS: Eight 45-minute training sessions on the NuStep Transitt (visits 2-9) twice a week (5-minute warm-up and cooldown with 35 minutes of training [5min with and then without visual feedback regarding left/right lower extremity percentage effort]). Visits 1 and 10: pre- and post assessment. MAIN OUTCOME MEASURES: Self-selected and fast gait speeds; maximum voluntary contractions (MVCs) of knee extension and flexion and ankle dorsiflexion and plantarflexion; and 5 times sit-to-stand (5TSTS). RESULTS: Significant improvements in 5TSTS (14.2s, P=.007) and fast gait (hemi: 4.9 cm [P=.024], nonhemi: 4.5cm (P=.019) stride length; nonhemi step length 2.3 cm (P=.024]). MVC and self-selected gait parameters showed no significant changes. CONCLUSIONS: The NuStep Transitt is a valuable tool that provides real-time feedback about percentage of use of the hemiparetic leg. This intervention study has demonstrated that the addition of visual feedback about left/right percentage effort while exercising on the Transitt has significant and clinically relevant effects on the functional mobility of individuals with chronic stroke.