Impact of Training on Gait and Strength in Stroke Survivors

Study Overview
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Brief Summary
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Background: A discrepancy between strength gain and gait changes following various training programs aimed at improving gait function after stroke has been noted. A mismatch between the training program and gait parameters could explain this finding. Objective: To evaluate the impact of an isokinetic-strengthening program, matching the requirements of the affected lower-limb muscle groups involved in the energy generation of gait, to a control intervention, on gait performance and muscle strength. Hypothesis: The isokinetic training program of the affected lower-limb muscles would produce greater changes in gait performance and strength than a control intervention not aiming at training these muscle groups. Design: Single-blinded randomized controlled trial. Participants: A convenient sample of 30 individuals with chronic hemiparesis. Interventions: Participants were randomly assigned into two groups (n=15), each training three times/week for six weeks. The experimental group trained the affected plantarflexors, hip flexors and extensors concentrically, while the control group trained the affected upper-limb muscles. Main outcome measures: Baseline values and post-training values, taken at the end of the training program, of maximal voluntary concentric strength, gait speed and peak positive power.

Official Title
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Gait Performance and Lower-limb Muscle Strength Improved in Both Upper-limb and Lower-limb Isokinetic Training Programs in Individuals With Chronic Stroke

Conditions
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Stroke

Intervention / Treatment
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* Other: isokinetic lower-limb training
* Other: isokinetic upper-limb training


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: have a chronic (six months or more) unilateral stroke be able to walk 10 meters independently with or without a cane present residual weakness at the affected lower limb have an activity tolerance of at least two hours with a rest period Exclusion Criteria: receptive aphasia incontinence unstable medical condition history of injury anesthesia at the lower limbs

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: isokinetic lower-limb training<br>3 times/week for 6 weeks | Other: isokinetic lower-limb training<br>* concentric training of the affected plantarflexors, hip flexors and hip extensors<br>|
| Placebo Comparator: isokinetic uppe-limb training<br>3 times/week for 6 weeks | Other: isokinetic upper-limb training<br>* concentric training of the affected wrist extensors, elbow flexors and shoulder flexors<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| change in gait speed | change in gait speed, in meter/second, was assessed as the difference between the baseline and week #7 values. | gait speed was assessed at baseline and at the completion of the 6-week training (i.e. week #7) | 
| change in peak positive power | peak positive power was evaluated at the affected plantarflexors, hip flexors and hip extensors. Also, change in peak positive power, in weight/kilogram, was assessed as the difference between the baseline and week #7 values. | peak positive power was assessed at baseline and at the completion of the 6-week training (i.e. week #7) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| change in maximal voluntary concentric strength | maximal voluntary concentric strength was evaluated at the affected plantarflexors, hip flexors and hip extensors. Also, change in maximal voluntary concentric strength, in Newton-metre, was assessed as the difference between the baseline and week #7 values. | maximal voluntary concentric strength was assessed at baseline and at the completion of the 6-week training (i.e. week #7) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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exercise, muscle strength, gait, rehabilitation, stroke