Effect of Structured Progressive Task-Oriented Circuit Class Training With Motor Imagery on Gait in Stroke
Condition: Stroke; Gait, Hemiplegic
MeSH terms: Stroke; Gait Disorders, Neurologic
Study type: Interventional

Summary: 
      The objectives of the study will be General Objective is to investigate the effect of TOCCT
      with MI on gait performance in patients with stroke. Speific Objevtives.

      Specific Objectives are to compare the effect of TOCCT with MI and TOCCT with education on
      the spatio-temporal and functional gait variables in patients with stroke, to investigate the
      spatio-temporal and functional gait variables in patients with stroke after receiving TOCCT
      with MI and to investigate the spatio-temporal and functional gait variables in patients with
      stroke after receiving TOCCT with education.
    

Detailed description: 
      This study will use a sample of convenience between the ages of 18-75 years. Forty patients
      with stroke from the departments of physical medicine and rehabilitation, North Okkalapa
      General Hospital, East General Hospital and National Rehabilitation Hospital, Yangon, Myanmar
      will participate in this study. The sample size was calculated using the mean value of gait
      speed from the previous study. Probability of type I error, apha value at 0.05 and power of
      0.80 were set.

      All participants will be explained about details of the study and the interventions. After
      that, they will be asked to sign on the written consent approving by the committee of the
      institution prior to participate in study. All participants will be randomly allocated the
      participants into the experimental (TOCCT with MI) or the control (TOCCT with health
      education) groups. All participants will be screened following the criteria and will be
      collected the demographic data.

      All outcome measures will be assessed by the therapist who have been trained the outcome
      measures of the study. As the primary outcome measurements, spatio-temporal variables will be
      measured by using two dimensional motion analysis method. The protocol of this method was
      proved to be valid and reliability from previous pilot study. For functional gait variables,
      six-minute walk test will be assessed for determining walking endurance, step test will be
      assessed for dynamic balance, and Timed Up and Go (TUG) test will be assessed for mobility
      function.

      As the secondary outcome measure, the strength of hip flexor, hip extensor, knee flexor, knee
      extensor, ankle dorsiflexor, and ankle plantarflexor muscles will be assessed by using
      hand-held dynamometer. Muscle spasticity will be assessed by using the Modified Ashworth
      Scale (MAS). The outcome measures will be assessed at the baseline, after 2 weeks and 4 weeks
      intervention. For the safety, the therapist will measure blood pressure, pulse rate and
      fatigue level in the assessments, just before the training, and rest period during the
      training program.

      Both groups will receive the same 65 minutes structured progressive TOCCT and will receive 25
      minutes of MI training for the experimental group and 25 minutes of health education for the
      control group. So, total training duration will be 90 minutes. Intervention program will
      provide 3 times a week over a period of 4 weeks.

      Descriptive statistic will be used for analyze the demographic and baseline characteristics
      of the participants. To clarify whether the data are normally distributed, the Kolmogorov
      Smirnov Goodness of Fit test will be used. If data are normally distributed, two-way mixed
      repeated measure ANOVA will be used. If the data are not normally distributed, Friedman test
      will be used to compare the mean differences of the spatio-temporal measures, 6 minutes walk
      test, step test, TUG test, muscle strength test and muscle spasticity test. The significant
      level is set at p < 0.05.
    

Intervention name(s): Motor imagery; Health education; Task-Oriented Circuit Class Training
Intervention type(s): Procedure; Procedure; Procedure
Intervention description(s): Motor imagery (MI) will be trained for the individuals by imagination of the movement. Program of MI includes 1) body relaxation and awareness 2) visual imagery 3) kinesthetic imagery and 4) refocusing of body and environment.; Topic of Health education (HE) consists of 1) Changes caused by stroke 2) Complications after stroke 3) Emotional changes after stroke 4) Living at home after stroke 5) High blood pressure and stroke and 6) Preventing recurrent stroke.; Program of Task-Oriented Circuit Class Training (TOCCT) consists of warm up and perform tasks 1) Stepping forward-backward onto block 2) Stepping sideway onto block 3) Heel lifts in standing to strengthen affected planter-flexor muscles 4) Standing with a decreased base and reach for object 5) Standing up from chair, walking a short distance, and returning to chair 6) Symmetrical walking and 7) Walking at fast speed.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Motor Imagery; Task-Oriented Circuit Class Training; Health Education