Impact of Training on Gait and Strength in Stroke Survivors

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

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.

Study Overview

• Status: Completed
• Conditions: Stroke
• Intervention / Treatment: Other: isokinetic lower-limb training; Other: isokinetic upper-limb training

• Study Type: Interventional
• Enrollment (Actual): 30
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Canada
  • Quebec
    • Montréal, Quebec, Canada, H3S 1M9
      • Institut de réadaptation Gingras-Lindsay

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

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

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

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

What is the study measuring?

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)

Collaborators and Investigators

• Sponsor: Université de Montréal
• Collaborators: Canadian Institutes of Health Research (CIHR)
• Investigators: Principal Investigator: Sylvie Nadeau, PhD, Université de Montréal

Study record dates

Study Major Dates

• Study Start: March 1, 2002
• Primary Completion (Actual): December 1, 2005
• Study Completion (Actual): December 1, 2007

Study Registration Dates

• First Submitted: March 15, 2013
• First Submitted That Met QC Criteria: March 21, 2013
• First Posted (Estimate): March 26, 2013

Study Record Updates

• Last Update Posted (Estimate): March 26, 2013
• Last Update Submitted That Met QC Criteria: March 21, 2013
• Last Verified: March 1, 2013

More Information

Terms related to this study

• Keywords: exercise; stroke; gait; rehabilitation; muscle strength
• Additional Relevant MeSH Terms: Cardiovascular Diseases; Vascular Diseases; Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Stroke
• Other Study ID Numbers: IRSC-44059