Power Training Post-stroke
Condition: Stroke
MeSH terms: Stroke
Intervention: POWER training
Intervention description: Individuals with chronic post-stroke hemiparesis will undergo training to improve muscle power generation for 24 sessions (3 times/week) that includes both resistive and task-specific elements. Session duration will be ~90 minutes/day (inclusive of rest intervals). Training will include five distinct resistance activities aimed at improving muscle power-- each previously reported to contribute to improved walking
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Intervention model: Single Group Assignment
Masking: Double (Participant, Outcomes Assessor)
Enrollment: 56.0
Sex: All
Minimum age: 50 Years
Maximum age: 70 Years
Healthy volunteers: Accepts Healthy Volunteers
Keywords: exercise; rehabilitation; walking

Summary:

      Hemiparesis, strictly defined as (muscular) weakness affecting one side of the body, is seen
      in three-quarters of individuals following stroke. Weakness in this population results from
      both neural and muscular factors which include, respectively, the ability to activate
      skeletal muscle as well as the force generating capacity of the muscle. The overall goal is
      to improve walking in persons post-stroke by training subjects with an intervention that
      specifically targets existing neural and muscular impairments, thereby facilitating locomotor
      recovery.
    

Eligibility criteria:

        Inclusion Criteria:

          -  age 50-70,

          -  stroke within the past 6 to 24 months,

          -  residual paresis in the lower extremity (Fugl-Meyer Lower Extremity motor score <34),

          -  ability to walk without assistance and without an ankle foot orthotic (AFO) on the
             treadmill 30 seconds at speeds ranging from 0.3 - 0.8 m/s, and

          -  provision of informed consent.

          -  In addition, all subjects who meet criteria for the training portion must complete an
             exercise tolerance test and be cleared for participation by the study cardiologist.

        Exclusion Criteria:

          -  Unable to ambulate at least 150 feet prior to stroke, or experienced intermittent
             claudication while walking;

          -  rating on Modified Ashworth Scale 3 at the knee or ankle;

          -  limited lower extremity range of motion of the knee (passive flexion Range of Motion
             [ROM] < 90); hip (inability to achieve neutral 0 hip extension); or ankle (inability
             to achieve 0 of active dorsiflexion);

          -  history of congestive heart failure, unstable cardiac arrhythmias, hypertrophic
             cardiomyopathy, severe aortic stenosis, angina or dyspnea at rest or during activities
             of daily living (ADLs);

          -  History of chronic obstructive pulmonary disease (COPD) or oxygen dependence;

          -  Preexisting neurological disorders, dementia or previous stroke;

          -  History of major head trauma;

          -  Legal blindness or severe visual impairment;

          -  history of significant psychiatric illness

          -  Life expectancy <1 yr.,

          -  Severe arthritis or other problems that limit passive ROM;

          -  post-stroke depression (PHQ-9 10),

          -  History of deep vein thrombosis (DVT) or pulmonary embolism within 6 months;

          -  Uncontrolled diabetes with recent diabetic coma, or frequent insulin reactions;

          -  Severe hypertension with systolic >200 mmHg and diastolic >110 mmHg at rest;

          -  Previous or current enrollment in a trial to enhance motor recovery;

          -  Presence of non-magnetic resonance (MR) compatible implants, pregnancy or severe
             claustrophobia.