# Movement Amplification Gait Training to Enhance Walking Balance Post-Stroke

> **NIH VA I21** · EDWARD HINES JR VA HOSPITAL · 2024 · —

## Abstract

Background: There is a pressing need to develop effective methods to enhance walking balance in people with
chronic stroke (PwCS). Interventions that amplify self-generated movements may accelerate motor learning by
enhancing a person's perception of movement errors. This method could potentially be applied to help PwCS
improve walking balance. To this end, we have developed a cable-driven robot to create a Movement
Amplification Environment (MAE) during treadmill walking. The MAE challenges walking balance by applying
lateral forces to the pelvis that are proportional in magnitude to real-time lateral center of mass (COM) velocity.
Unlike a popular form of balance training that uses unpredictable perturbations to enhance reactive balance,
training in a MAE targets anticipatory balance by developing predictive control mechanisms that are likely to
persist when the training environment is removed (after-effects). We believe that supplementing high-intensity
gait training (the recommended practice to improve walking speed and distance) with a MAE will substantially
enhance walking balance. Thus, our purpose is to evaluate the unique effects of MAE training on walking balance
in PwCS and determine feasibility of conducting high-intensity gait training in a MAE.
Specific Aims: Aim 1: To evaluate gait patterns PwCS adapt during and immediately following walking practiced
in two balance-challenging training environments: MAE and unpredictable lateral perturbations. Aim 2: To
establish feasibility of high intensity gait training in MAE we will evaluate cardiovascular intensity during gait
training interventions performed in either a natural unmodified environment or a MAE.
Approach: Aims 1: 15 PwCS will participate in a single-day experiment evaluating gait biomechanics (COM
dynamics and stepping patterns) during and immediately following treadmill walking performed in a MAE or while
receiving frequent unpredictable lateral perturbations. Outcomes will assess if changes in gait patterns to
maintain stability persist immediately following exposure to either of the balance-challenging environments. Aim
2: 15 PwCS will participate in two high-intensity gait training sessions. One session will be performed in a natural
unmodified environment, the other in a MAE. We will quantify differences in mean heart rate (HR) between the
two sessions and whether mean HR is in the target high-intensity range of 70-85% of maximum HR.
Impact: This project will identify if and how PwCS uniquely adapt locomotor strategies following exposure to
balance challenging environments and evaluate feasibility of administering high-intensity gait training in a MAE.
Training walking balance of PwCS in a MAE by amplifying their own self-generated movements is a radical
departure from current practice and could substantially enhance walking balance. Successful outcomes will
motivate a future randomized controlled trial assessing the efficacy of MAE training to enhance walking balance
in...

## Key facts

- **NIH application ID:** 10915806
- **Project number:** 1I21RX004882-01A1
- **Recipient organization:** EDWARD HINES JR VA HOSPITAL
- **Principal Investigator:** Keith Edward Gordon
- **Activity code:** I21 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2024-07-01 → 2026-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10915806

## Citation

> US National Institutes of Health, RePORTER application 10915806, Movement Amplification Gait Training to Enhance Walking Balance Post-Stroke (1I21RX004882-01A1). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10915806. Licensed CC0.

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