None listed
Conditions
Brief summary
Evidence suggests that muscle strengthening after stroke can improve strength and activity. The improved lower limb muscle strength is related to improvement of walking speed. Additionally, task related practice performed at a high intensity may enhance walking competency in people with stroke. However, there is insufficient evidence to conclude that any one physiotherapy approach is more effective than any other. This clinical trial investigates if 10 weeks of progressive muscle strengthening of lower extremities in addition to a task-specific walking therapy in acute stroke patients results in better strength, motor coordination, walking ability and quality of life in comparison to task-specific walking training alone.
Interventions
The experimental group will undertake task-specific walking training plus targeted strength training 3 times per week over 10 weeks. The overall duration of the section will be approximately 60 minutes (30 minutes of task-specific walking training and 30 minutes of strength training). Task-specific walking training plus targeted strength training: The 30-minute sessions of task-specific walking training will include practising part of the task (= 20 min) where muscles are working in a similar ma
The experimental group will undertake task-specific walking training plus targeted strength training 3 times per week over 10 weeks. The overall duration of the section will be approximately 60 minutes (30 minutes of task-specific walking training and 30 minutes of strength training). Task-specific walking training plus targeted strength training: The 30-minute sessions of task-specific walking training will include practising part of the task (= 20 min) where muscles are working in a similar manner to full task performance and practising the whole task (= 10 min). Additionally, of the12 lower limb muscle groups (hip flexors, extensors, abductors, adductors, internal and external rotators; knee flexors and extensors, and ankle dorsiflexors, plantarflexors, invertors and evertors), all those Grade 4 or less on Manual Muscle Test (MMT) will undergo training. For very weak muscles (Grade 1 on Manual Muscle Test), strengthening exercises will be set up so that minimal muscle activity will result in movement. This will be achieved by focusing on the mid-range of muscle length; decreasing the effect of gravity; decreasing friction and decreasing the lever arm of the limb. Progression of exercises (Grade 2 on Manual Muscle Test), will focus on range of motion; sustaining contractions; increasing speed; beginning to add resistance to mid-range and resisted exercises. Once resistance can be introduced (Grade =3 on Manual Muscle Test), it will be implemented using weight machines, free weights and body weight. Programs will be individually-tailored and 50% of 1 Repetition Maximum (the maximum weight that can be lifted on a single occasion) will be used to set the initial load. Participants will be instructed to perform three sets of 10 repetitions for each exercise with a 1–2 minute rest period between sets. Then, the load will be increased to 80% of 1 repetition maximum (RM) and the training stimulus will be adjusted to stay at this load every two weeks.
Sponsors
Universidade Federal de Minas Gerais
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used)
Eligibility
Sex/Gender
All
Age
20 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Stroke patients will be eligible if they had clinical diagnosis of a first stroke resulting walking deficit; they are living at home for less than 6 months having been discharged from hospital post stroke; they are older than 20 years of age; they are diagnosed clinically with hemiparesis or hemiplegia; they can walk 10 metres independently using aids or orthoses, with or without supervision, their walking velocity is within 0.4 to 0.8 m/s (limited community)
Exclusion criteria
They will be excluded if they have severe cognitive deficits assessed by the Mini-Mental State Exam and/or language problems (comprehensive aphasia), evaluated by simple motor commands, which could prevent them from following instructions during measurement and/or intervention; they have adverse health conditions, which could affect balance and mobility, such as vestibular disturbances, severe arthritis or other neurological disorders.
Outcome results
None listed