Rhythmic auditory stimulation combined with split-belt treadmill training improves spatiotemporal gait parameters in hemiparetic stroke patients: a randomized controlled trial

Abstract

Split-belt walking training (SWT) primarily ameliorates spatial gait asymmetry after stroke, yet its effect on temporal gait parameters remains limited. Rhythmic auditory stimulation (RAS) enhances cadence and rhythmicity via auditory–motor coupling. This study examined whether combining RAS with SWT yields greater walking benefits than SWT alone or conventional rehabilitation. Thirty patients with post-stroke hemiparesis were randomized to RAS+SWT ( n  = 11), SWT alone ( n  = 8), or conventional rehabilitation (control, n  = 11). Interventions were delivered for three weeks (five sessions/week). Primary outcomes were spatiotemporal gait parameters: walking speed, cadence, step length, and limping index. Linear mixed-effects models were used, with Hedges’ g for effect sizes. No dropouts occurred. Significant time-group interactions were found for walking speed ( F  = 10.68, p  < 0.001), cadence ( F  = 5.01, p  = 0.014), and affected-side step length ( F  = 6.21, p  = 0.006). The RAS+SWT group showed greater improvements than controls in walking speed (mean difference = 0.167, 95% CI [0.090, 0.245]), cadence (mean difference = 9.340, 95% CI [4.456, 14.223]), and step length (unaffected: mean difference = 0.077, 95% CI [0.039, 0.116]; affected: mean difference = 0.081, 95% CI [0.035, 0.127]), and greater walking speed improvements than the SWT group (mean difference = 0.110, 95% CI [0.022, 0.197]). For the limping index, a significant main effect of group was observed ( F  = 5.41, p  = 0.011); however, the time-by-group interaction was not significant ( F  = 0.430, p  = 0.655). RAS combined with SWT is more effective than conventional rehabilitation in improving multidimensional spatiotemporal gait parameters—including walking speed, cadence, and affected-side step length—in patients with post-stroke hemiparesis. Compared with SWT alone, the combined intervention yielded greater improvements in walking speed, while no significant between-group differences were observed for cadence or step length. The combined protocol is feasible and safe. ChiCTR2600121963.