Please select the eligibility criteria that correspond to the clinical trial below.
Title: A Motor Learning Based Walking Program Versus Body Weight Supported Treadmill Training in Community Dwelling Adults Within One Year of Stroke Onset: A Randomized Controlled Trial
Brief Summary: Stroke is a major cause of disability in Canadian adults. Following a stroke, many people have difficulty walking in their home and in the community. The purpose of this study is to compare the effect of two different approaches to walking retraining in people who have had a stroke.

Individuals living in the community who have had recently had a stroke will be asked to participate in this study. Participants will be randomly assigned to one of two five week walking training programs. In one program, individuals will re-learn to walk in a variety of real-life situations. Practice sessions will encourage active problem solving by the participants. The other program will have participants practice walking on a treadmill while some of their body weight is supported by a special harness system. Participants will also be assisted by a physiotherapist to walk in a more normal manner.

Participants' will be assessed at the beginning of the study, after the 5 week training program and again, eight weeks later. The research assistant will assess their ability to walk, their confidence level and the average daily walking activity.

Primary Hypothesis: Individuals assigned to the Motor Learning Walking Program will improve their walking ability from baseline to follow up assessment significantly more than individuals assigned to the Treadmill Training Program.

The results of this study will help physiotherapists plan effective treatment programs for individuals with walking difficulties following stroke. It will also give researchers direction for future studies in the areas of walking retraining and motor skill development post-stroke.


Options:
A: Inclusion Criteria:

* Age \>/=18
* Stroke within 45-days
* Residual paresis in the lower extremity (fugl-meyer le motor score \< 34)
* Ability to sit unsupported for 30 seconds
* Ability to walk at least 10 feet with maximum 1 person assist
* Ability to follow a three step command
* Provision of informed consent
* A self-selected 10 meter gait speed less than 0.8 m/s at the 2-month post-stroke assessment
* Successful completion of an exercise tolerance test

Exclusion Criteria:

* Lived in nursing home prior to stroke
* Unable to ambulate at least 150 feet prior to stroke, or experienced intermittent claudication while walking less than 200 meters
* Serious cardiac conditions (history of congestive heart failure, documented serious and unstable cardiac arrhythmias, hypertrophic cardiomyopathy, severe aortic stenosis, angina or dyspnea at rest or during activities of daily living). Anyone meeting New York Heart Association criteria for Class 3 or Class 4 heart disease will be excluded
* History of serious chronic obstructive pulmonary disease or oxygen dependence
* Severe weight bearing pain
* Preexisting neurological disorders such as Parkinson's disease, Amyotrophic Lateral Sclerosis (ALS), Multiple Sclerosis (MS), dementia, or previous stroke with residual neurological deficits
* History of major head trauma
* Lower extremity amputation
* Non-healing ulcers on the lower extremity
* Renal dialysis or end stage liver disease
* Legal blindness or severe visual impairment
* A history of significant psychiatric illness defined by diagnosis of bipolar affective disorder, psychosis, schizophrenia or medication refractory depression
* Life expectancy less than one year
* Severe arthritis or orthopedic problems that limit passive ranges of motion of lower extremity (knee flexion contracture of -10°, knee flexion Range of Motion (ROM) \< 90°, hip flexion contracture \> 25°, and ankle plantar flexion contracture \> 15°
* History of sustained alcoholism or drug abuse in the last six months
* Major post-stroke depression as measured by the Patient Health Questionnaire(PHQ-9 \>/= 10) that is not medically managed with antidepressant medication and/or psychotherapy
* History of pulmonary embolism within 6 months
* Uncontrollable diabetes with recent weight loss, diabetic coma, or frequent insulin reactions
* Severe hypertension with systolic greater than 200 mmHg and diastolic greater than 110 mmHg at rest,
* Previous or current enrollment in a clinical trial to enhance stroke motor recovery
* Lives more than 50 miles from the training sites
* Unable to travel 3 times per week for outpatient training programs
* Intracranial hemorrhage related to aneurysmal rupture or an arteriovenous malformation (hemorrhagic infarctions will not be excluded)

Inclusion and exclusion criteria will be determined by a chart review, depression screen and subject interview by study physician or study coordinator. After initial chart and subject interview, each subject's treating physician will be asked to review inclusion and exclusion criteria and provide a letter supporting inclusion in the study. All subjects who meet selection criteria must successfully complete an exercise tolerance test
B: Inclusion Criteria:

* Stroke onset within previous 12 months
* Age 40 or older
* Able to follow 2 step verbal command (English),
* Able to walk 10 metres without human assistance (may use walking aid)
* Independent community ambulatory prior to stroke
* Community dwelling
* Approval from physician for participation in study

Exclusion Criteria:

* Walking speed greater than 1.0 m/s without walking aid
* Within normal limits on Modified Mini Mental Status test (age and education adjusted)
* Documented global aphasia
* Legal blindness
* Unable to exercise due to the any of the following conditions
* A recent significant change in resting ECG suggesting ischemia
* Recent Myocardial infarction (within 3 months) or other acute cardiac event
* Unstable angina
* Severe SOB at rest or with activities of daily living
* Uncontrolled cardiac arrhythmias causing symptoms
* Severe symptomatic aortic stenosis
* Uncontrolled symptomatic heart failure
* Acute pulmonary embolus or pulmonary infarction
* Acute myocarditis or pericarditis
* Suspected or known dissecting aneurysm
* Acute systemic infection, accompanied by fever, body ache or swollen lymph glands
* Uncontrolled hypertension (systolic \> 200 mmHg, diastolic \> 110 mmHg )
* Severe peripheral vascular disease with sustained claudication (resulting in limited walking tolerance)
* Severe lower extremity orthopedic problems with severe pain on weight bearing
* Lower extremity amputation that requires prosthesis
C: Inclusion Criteria:

* First stroke
* Within 28 days post stroke
* Aged between 50 and 85 years of age
* Unilateral hemiplegia/hemiparesis and
* Score for Item 5 of the Motor Assessment Scale for Stroke \< 2

Exclusion Criteria:

* Any barriers to taking part in a physical rehabilitation program
* Insufficient cognition/language
* Unstable cardiac status
* Neuro-surgery
* Any pre-morbid history of orthopaedic conditions or any other problems that would preclude patient from relearning to walk.
D: Inclusion Criteria:

* age 18 years or older
* 4 months to 5 years after first-time onset of a ischemic or hemorrhagic cerebrovascular accident (CVA) confirmed by CT, MRI, or clinical criteria
* able to ambulate at least 14 meters with assistive and/or orthotic device and one person assist (minimum Functional Ambulation Classification Level II
* self-selected walking velocity of ≤1.0 meters/second
* approval of primary care physician to participate.

Exclusion Criteria:

* resting systolic blood pressure greater than 180mmHg and/or diastolic blood pressure greater than 110mmHg and/or resting heart rate greater than 100 beats/minute;
* lower limb orthopedic conditions such as prior joint replacement or range of motion limitations;
* spasticity management that included Botox injection (\< 4 months earlier) or phenol block injection (\< 12 months earlier) to affected lower extremity and intrathecal Baclofen or oral Baclofen (within past 30 days);
* Mini-Mental State Exam score \< 24;
* currently receiving lower extremity strengthening exercises or gait training,
* past participation in any study examining the effects of long term (\>4 weeks training) body weight support treadmill training; limb loaded pedaling, or lower extremity strengthening;
* plans to move out of the area in the next year,
* no transportation to the study site for all evaluations and intervention sessions.

Answer: B