Targeted Ankle Proprioceptive Training Improves Balance, Gait, and Functional Mobility in Chronic Stroke Survivors

February 11, 2026 updated by: Muslim khan, Iqra National University

Targeted Ankle Proprioceptive Training Improves Balance, Gait, and Functional Mobility in Chronic Stroke Survivors: A Multicenter Randomized Controlled Trial With Longitudinal Follow Up

Stroke is a leading cause of long-term disability, with balance and gait deficits affecting >80% of survivors and increasing fall risk. Emerging evidence links ankle proprioceptive impairment-particularly inversion/eversion acuity-to these deficits, often bilateral and central in origin. Cross-sectional studies show strong associations, but causality, temporal progression, and intervention efficacy (especially in severe/non-ambulatory cases) remain unproven. This trial tests a targeted proprioceptive protocol against standard care.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Objectives: Primary: To evaluate the causal effect of 12-week targeted ankle proprioceptive training on weight-bearing ankle proprioception (AMEDA) in chronic stroke survivors.

Secondary: To assess effects on balance (Berg Balance Scale), gait speed (10m walk test), mobility (Timed Up and Go, Functional Ambulation Category), lower extremity motor function (Fugl-Meyer), and sustainability at 6-month follow-up. To describe longitudinal proprioceptive changes in a subsample from acute to chronic stages.

Study Type

Interventional

Enrollment (Actual)

140

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Pakistan
    • Peshawar
      • Swāt, Peshawar, Pakistan
        • Iqra National University

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Clinical diagnosis of chronic ischemic/hemorrhagic stroke (≥12 months post-stroke)
  • Moderate-to-severe lower extremity impairment (Fugl-Meyer LE ≤28 or NIHSS motor leg ≥2)
  • Documented ankle proprioceptive deficit (AMEDA AUC <0.7)

Exclusion Criteria:

  • Acute medical issues (e.g., uncontrolled hypertension)
  • Severe cognitive impairment (MMSE <24)
  • Exercise contraindications
  • Concurrent conflicting trials

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

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

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: Phase 1 (Weeks 1-4)
Robotic-assisted sensory discrimination (inversion/eversion, plantar/dorsiflexion; reduce angles, remove visual feedback).
Other: Gait training
Both groups: 12 weeks, 3 sessions/week × 60 min, supervised. Intervention Group (n=70): Progressive targeted ankle proprioceptive training
Active Comparator: Phase 2 (Weeks 5-8)
Functional weight-bearing challenges (e.g., balance boards, textured surfaces, dynamic tasks).
Other: Gait training
Both groups: 12 weeks, 3 sessions/week × 60 min, supervised. Intervention Group (n=70): Progressive targeted ankle proprioceptive training
Active Comparator: Phase 3 (Weeks 9-12)
Advanced integration (e.g., gait with proprioceptive cues, dual task)
Other: Gait training
Both groups: 12 weeks, 3 sessions/week × 60 min, supervised. Intervention Group (n=70): Progressive targeted ankle proprioceptive training

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Primary outcome
Time Frame: post-12 weeks, 6-month follow-up. Longitudinal subsample assessed from acute (<1 month) to chronic.
Active Movement Extent Discrimination Apparatus for measuring propioceptive acuity
post-12 weeks, 6-month follow-up. Longitudinal subsample assessed from acute (<1 month) to chronic.

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Secondary outcome
Time Frame: post-12 weeks, 6-month follow-up. Longitudinal subsample assessed from acute (<1 month) to chronic.
Berg Balance Scale for assessment of static balance and fall risk.
post-12 weeks, 6-month follow-up. Longitudinal subsample assessed from acute (<1 month) to chronic.

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Iqra National University

Investigators

  • Study Director: Ayman Abdullah Alhammad, Taibah University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

Helpful Links

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

January 1, 2023

Primary Completion (Actual)

December 31, 2024

Study Completion (Actual)

December 31, 2025

Study Registration Dates

First Submitted

February 4, 2026

First Submitted That Met QC Criteria

February 11, 2026

First Posted (Actual)

February 19, 2026

Study Record Updates

Last Update Posted (Actual)

February 19, 2026

Last Update Submitted That Met QC Criteria

February 11, 2026

Last Verified

February 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • Ref#: INU/REHAB/XC94

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

Ethical concerns underlying data sharing will be adhered too

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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