Neurophysiologic and rehabilitation insights from the split-belt and other locomotor adaptation paradigms

Locomotion is incredibly flexible. Humans are able to stay upright and navigate long distances in the face of ever-changing environments and varied task demands, such as walking while carrying a heavy object or in thick mud. The focus of this review is a behavior that is critical for this flexibility: motor adaptation. Adaptation is defined here as the process of adjusting a movement to new demands through trial-and-error practice. A key feature of adaptation is that more practice without the new demand is required to return the movement to its original state. Thus, motor adaptation is a short-term motor learning process. Several studies have been undertaken to determine how humans adapt walking to novel circumstances. Many of these studies have examined locomotor adaptation using a split-belt treadmill. The results of these studies of people who were healthy and people with neurologic damage suggest that the cerebellum is required for normal adaptation of walking and that the role of cerebral structures may be less critical. They also suggest that intersegmental and interlimb coordination is critical but readily adaptable to accommodate changes in the environment. Locomotor adaptation also can be used to determine the walking potential of people with specific neurologic deficits. For instance, split-belt and limb-weighting locomotor adaptation studies show that adults with chronic stroke are capable of improving weight-bearing and spatiotemporal symmetry, at least temporarily. Our challenge as rehabilitation specialists is to intervene in ways that maximize this capacity.