Stroke Walking Explained After Trunk Training
Condition: Stroke
MeSH terms: Stroke
Study type: Interventional

Summary: 
      The aim of SWEAT² study is to further explore the effects of additional customized trunk
      exercises on clinical and biomechanical gait performance. Despite of the evidence
      demonstrating the importance of trunk control after stroke, studies about the effects of
      trunk rehabilitation on gait performance are inconsistent. The findings of this study might
      lead to new scientific insights in the importance of the trunk during gait rehabilitation in
      people suffering from stroke submitted to a rehabilitation hospital.
    

Detailed description: 
      Objective: To examine the effects of additional trunk exercises on gait performance via
      clinical and biomechanical assessments in patients receiving inpatient rehabilitation after
      stroke.

      Design: The design of this study is an assessor-blinded randomized controlled trial. Prior to
      evaluation, participants will be randomly allocated to either the experimental or control
      group by means of concealed envelopes. The number of patients required for this study was
      calculated a priori to ensure sufficient statistical power. Analysis showed that a sample
      size of 30 patients in each group was necessary to detect a difference (ES1) with 80 % using
      a two-tailed hypothesis (with significance of p=0.05).

      Intervention: All patients will receive a multidisciplinary conventional stroke
      rehabilitation program provided by the rehabilitation staff. The control group will receive a
      series of cognitive exercises focusing on aspects of memory (visual, auditory, and working
      memory), attention (sustained attention and selective attention), and executive functioning
      (planning and problem-solving). The additional training of the trunk training group focuses
      on trunk muscle strength, coordination and selective movements. The training program will
      consist of task-specific movements of the upper and lower part of the trunk both in supine
      and sitting position on stable and unstable surfaces (physio balls). The following trunk
      exercises will be performed: bridging, reaching, lower/upper trunk rotations, lower/upper
      trunk lateral flexion, upper/lower trunk flexion, ...

      Outcome measures:

        1. Tinetti Test

        2. Gait parameters recorded during 3D-Full body gait analysis:

           Gait analysis was performed at the M²OCEAN movement analysis laboratory
           (Multidisciplinary Motor Centre Antwerp, University of Antwerp, Antwerp, Edegem). VICON
           analysis system (©Vicon Motion Systems Ltd., London, UK) which is the golden standard
           for 3D motion analysis. Eight infrared automated cameras (Vicon T10 cameras, 100 fps, 1
           Megapixel) measured the 3D coordinates of reflective motion trackers. Two video cameras
           recorded the walking pattern of the participants in the sagittal and frontal plane. In
           addition, initial contact and toe off were measured based on the ankle trajectories of
           the reflective markers together with 3 AMTI type OR 6-7 force plates (1000 fps, 46x50x8
           cm) and 1 AccuGait® (1000 fps) force plate recordings. Subsequently, the movement
           analysis lab is equipped with a 16 channel telemetric wireless electromyographic (EMG)
           system (Arion Zerowire) which measures muscle activity. Recordings where analysed using
           the Vicon Nexus 1.8.5. software. Step time parameters and gait kinematics were filtered
           (Butterworth filter) and further processed in Matlab® (The MathWorks, Inc., Natick,
           Massachusetts, U.S.A.).

        3. Trunk Impairment Scale, Barthel Index

      Follow-up. One month post intervention patients will be again subjected to clinical and
      biomechanical assessment to measure the sustainability of trunk exercises over time.
    

Intervention name(s): Trunk training; Cognitive exercises
Intervention type(s): Other; Other
Intervention description(s): The experimental group receives 16 hours of additional trunk training (4 days/week, 4 weeks) focusing on trunk muscle strength, coordination and selective movements executed on stable and unstable surfaces.; The control group will be receiving the same amount of repetitive cognitive exercises within arm's range to ensure no anticipatory postural adjustments of the trunk.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Trunk; Biomechanical Phenomena; Gait; Electromyography; Rehabilitation; Balance