Split-belt Treadmill Training for ACL Injury

(Mi-SPA Trial)

Overseen By Riann M Palmieri-Smith, PhD, ATC

Age: < 65

Sex: Any

Trial Phase: Academic

Sponsor: University of Michigan

Disqualifiers: Previous ACL injury, Knee surgery, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 2

30 Participants Needed

Trial Summary

Do I need to stop my current medications for the trial?

The trial information does not specify whether you need to stop taking your current medications.

How does split-belt treadmill training differ from other treatments for ACL injury?

Split-belt treadmill training is unique because it uses two belts moving at different speeds to help retrain walking patterns, which can be particularly useful for addressing asymmetries in gait. This approach allows for targeted rehabilitation of specific unilateral (one-sided) locomotor deficits, which is different from standard treadmill training where both belts move at the same speed. ^{1 2 3 4 5}

What is the purpose of this trial?

The goal of this study is to determine short-term adaptations (aftereffects) in knee loading after a 20-minute split-belt treadmill training session in patients with ACL reconstruction. Our main question for this aim are: 1. Are training-mediated aftereffects in the knee joint moment greater for tied-belt walking or split-belt walking? 2. Are training-mediated aftereffects in the knee joint moment different between subjects who train early stance knee loading versus subjects who train mid-stance knee loading?

Research Team

Chandramouli Krishnan, PhD

Principal Investigator

University of Michigan

Riann M Palmieri-Smith, PhD, ATC

Principal Investigator

University of Michigan

Eligibility Criteria

This trial is for English-speaking individuals aged 14-45 who have had an ACL reconstruction with autograft within the last 10 months due to a complete rupture confirmed by MRI and physical exam. Participants must be willing to follow the study's procedures.

Inclusion Criteria

I am between 14 and 45 years old.

I have a completely torn ACL confirmed by MRI and physical exam.

I had ACL surgery using my own tissue within the last 10 months.

Exclusion Criteria

I am not pregnant and do not plan to become pregnant.

Previous ACL injury

I have had surgery on one or both of my knees.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Training

Participants undergo a 20-minute split-belt treadmill training session to assess knee loading adaptations

1 day

1 visit (in-person)

Follow-up

Participants are monitored for short-term adaptations in knee loading after training

1 day

1 visit (in-person)

Treatment Details

Interventions

• Split-belt Training
• Tied-Belt Training

Trial Overview The study tests how effective two types of treadmill training, tied-belt and split-belt, are at improving knee joint loading after ACL reconstruction. It looks at changes in knee biomechanics following a single 20-minute training session.

Participant Groups

Group I: Mid-Stance Training Experimental Treatment 2 Interventions

This study arm will complete both a 20-minute split-belt \& tied-belt session. During the split-belt session, the ACL limb will walk at a slower speed (30-50% of 1.1 m/s) than the non-ACL limb (1.1 m/s). During the tied-belt session both limbs will walk at the same speed which will be set to match the slower speed of the ACL leg from the split-belt training day.

Group II: Early Stance Training Experimental Treatment 2 Interventions

This study arm will complete both a 20-minute split-belt \& tied-belt session. During the split-belt session, the ACL limb will walk at a faster speed (150-170% of 1.1 m/s) than the non-ACL limb (1.1 m/s). During the tied-belt session both limbs will walk at the same speed which will be set to match the faster speed of the ACL leg from the split-belt training day.

Who Is Running the Clinical Trial?

University of Michigan

Lead Sponsor

Trials

1,891

Recruited

6,458,000+

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)

Collaborator

Trials

508

Recruited

1,090,000+

Findings from Research

In a study with 13 healthy participants, walking on a split-belt treadmill (where each belt moves at different speeds) did not change the frontal plane mechanics of the ankle, knee, and hip joints compared to normal walking.

However, as participants adapted to the split-belt walking, there was an increase in medio-lateral ground reaction forces and hip moment impulse on the faster limb, suggesting that this type of walking could be beneficial for therapy in individuals with gait issues.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Split-Belt Treadmill Walking Alters Lower Extremity Frontal Plane Mechanics. Roper, JA., Roemmich, RT., Tillman, MD., et al.[2018]

Walking on a split-belt treadmill (SBT) reveals distinct joint moment patterns in the legs, with the faster limb showing greater ground reaction forces and ankle moments, which could be beneficial for rehabilitation of unilateral gait deficits.

The study suggests that the different mechanics produced by each belt on the SBT can be strategically used to target specific locomotor impairments, as the fast and slow limbs exhibit unique moment impulses during walking.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Lower extremity sagittal joint moment production during split-belt treadmill walking. Roemmich, RT., Stegemöller, EL., Hass, CJ.[2021]

The split-belt treadmill is an effective tool for studying locomotor learning, allowing researchers to investigate both immediate and long-term gait adaptations in a controlled environment, which is crucial for optimizing motor rehabilitation strategies.

This paper outlines a specific protocol for using the split-belt treadmill, emphasizing the importance of controlling variables such as belt speeds and participant experience to ensure reliable results in understanding locomotor learning.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Using a Split-belt Treadmill to Evaluate Generalization of Human Locomotor Adaptation. Vasudevan, EVL., Hamzey, RJ., Kirk, EM.[2019]

Asymmetric split-belt treadmill walking affects how much work is done at the hip and ankle joints, which is important for developing effective gait interventions.

Participants in the gradual training group showed increased hip work on the slower limb during training, suggesting that this area adapts to new walking patterns, but they reduced this work during retention tests, indicating a potential for learning and adaptation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Novel Kinetic Strategies Adopted in Asymmetric Split-Belt Treadmill Walking. Hinkel-Lipsker, JW., Hahn, ME.[2018]

In a study involving 10 participants who completed 14 tied-belt and 39 split-belt walking trials, it was found that walking on a split-belt treadmill was only slightly more energy-consuming (0.13 ± 0.32 W/kg) than walking on tied belts at the average speed, suggesting that split-belt walking is not as energy-efficient as previously thought.

The research revealed that contrary to expectations, greater differences in belt speeds led to higher energy costs, indicating that while split-belt walking offers potential therapeutic benefits, it also increases the energetic demands on the walker, which should be considered in rehabilitation protocols.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The energy cost of split-belt walking for a variety of belt speed combinations. Butterfield, JK., Collins, SH.[2022]

References

1. United States pubmed.ncbi.nlm.nih.gov

Split-Belt Treadmill Walking Alters Lower Extremity Frontal Plane Mechanics. [2018]

2. United States pubmed.ncbi.nlm.nih.gov

Lower extremity sagittal joint moment production during split-belt treadmill walking. [2021]

3. United States pubmed.ncbi.nlm.nih.gov

Using a Split-belt Treadmill to Evaluate Generalization of Human Locomotor Adaptation. [2019]

4. United States pubmed.ncbi.nlm.nih.gov

Novel Kinetic Strategies Adopted in Asymmetric Split-Belt Treadmill Walking. [2018]

5. United States pubmed.ncbi.nlm.nih.gov

The energy cost of split-belt walking for a variety of belt speed combinations. [2022]