Long-Term Effects of Task-Oriented Lower Extremity Strengthening Training
Condition: Ischemic Cerebrovascular Accident
MeSH terms: Stroke; Ischemic Stroke
Study type: Interventional

Summary: 
      Task-oriented exercises combined with strengthening have been shown effective in improving
      walking functions in patients with chronic stroke. However, similar approaches of therapeutic
      exercises have not been applied to subacute stroke with long-term follow-up, using outcome
      measures across the three levels of functioning (body functions/structure, activities, and
      participation) of the International Classification of Functioning, Disability, and

      Health (ICF) model. Therefore, this study will be conducted to fulfill three purposes:

        1. To investigate the long-term effects of a four-week task-oriented lower extremity
           strengthening training (TOLEST) program in patients with subacute stroke;

        2. To investigate the interrelationships among functional connectivity of the brain, lower
           extremity motor functions, physical activity level, and quality of life in patients with
           stroke who have received this four-week TOLEST program in the subacute phase of stroke;
           and

        3. To identify prognostic factors for recovery in functional connectivity of the brain,
           lower extremity motor functions, physical activity level, and quality of life in
           patients with stroke who have received this four-week TOLEST program in the subacute
           phase of stroke.
    

Detailed description: 
      We conducted a meta-analysis to examine the effects of task-oriented approach in patients
      with sub-acute stroke and a preliminary study of an assessor-blind randomized controlled
      trial with a total of 3 patients with sub-acute stroke (experimental group: E1; control
      group: C1 and C2). The participants were randomly assigned to the experimental group or the
      control group. All participants received 4 weeks of exercise training, which were 4 sessions
      per week and 60 minutes for each session. The experimental group received task-oriented
      circuit training to improve lower extremity motor functions. The control group received
      stretch exercises and upper extremity activities in sitting posture. Both groups received
      clinical asessments on lower extremity motor functions (primary outcomes), the structural
      integrity of the CST using diffusion spectrum imaging, and the cortical activation patterns
      of the SMC using functional magnetic resonance imaging(secondary outcomes) at baseline,
      post-training (week 4), and 1 month follow-up (week 8). Because of the small number of
      subjects, we also included one subject (E2) who received the same training programs as
      experimental group in our pilot study as one subject of the training group result. Training
      effects were descriptively analyzed for individual subjects.

      The meta-analysis results showed that task-oriented training led to significantly greater
      improvement than other training on 6-minute walking distance (mean difference = 82.49 meter;
      95% confidence interval: 27.59-137.38) and comfortable gait speed (standardized mean
      difference = 0.27; 95% confidence interval: 0.03-0.52) in patients with subacute stroke. Our
      preliminary results showed that the experimental group achieved meaningful improvements in
      most of the primary outcomes but not for the control group. In addition, different brain
      reorganization patterns were observed in the two groups.

      The results of meta-analysis provide relevant clinical evidence for the effects of
      task-oriented training on lower extremity motor functions, and this preliminary study
      provides the pilot result for the effects of task-oriented circuit training on lower
      extremity motor functions, brain structural and functional plasticity in patients with
      sub-acute stroke.
    

Intervention name(s): Task-Oriented Lower Extremity Strengthening Training
Intervention type(s): Behavioral
Intervention description(s): On the 30th day post stroke (D30), the experimental group will start to receive the TOLEST program for four weeks, one hour per session and three sessions per week. The TOLEST focuses on using task-specific circuit training combined with strengthening of bilateral lower limbs.
The control group will receive equal-dose exercises starting on D30, with the emphasis on stretching and non-functional movements of the affected lower extremity.
Allocation: Randomized
Intervention model: Single Group Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: task-oriented training, long-term effects, plasticity