Immediate Effect on Ground Reaction Forces Induced by Step Training Based on Discrete Skill during Gait in Poststroke Individuals: A Pilot Study

Improving walking ability, especially the step-to-step transition control, is important in individuals after stroke.Although walking is a continuous skill, the discrete skills of gait, defined as movements with a clear beginning and end, mayeffectively modify walking performance. This pilot study shows the immediate effects of a discrete skill-based step training onground reaction forces (GRFs) during gait in individuals with chronic hemiplegia following stroke.Methods. Twenty-twocommunity-dwelling patients with chronic hemiplegia participated in this study. Eight participants performed only discrete-skillstep training during the loading response phase, focusing on paretic hip extension movement (LR group). Another eightperformed only discrete-skill step training during the preswing phase, focusing on paretic swing movement (PSw group). Theremaining six were trained using both training methods, with at least 6 months in each group to washout the influence of previoustraining. Therefore, thefinal number of participants in each group was 14. The braking and propulsive forces of GRFs weremeasured during gait before and after 30 repetitions of the discrete-skill step training.Results. Although both groups showed asignificant increase in stride length, walking speed was increased only in the LR group. The PSw group showed an increase inbraking forces of both sides without any change in propulsion. In the LR group, paretic braking impulse did not change, whilenonparetic propulsion increased.Conclusion. The discrete-skill step training during loading response phase induced an increase innonparetic propulsion, resulting in increased walking speed. This study provides a clear understanding of immediate effects of thediscrete-skill step training in patients with chronic stroke and helps improve interventions in long-term rehabilitation.