Hemiparesis;Poststroke/CVA
Conditions
Keywords
subacute stroke, gait, dorsiflexion, joint mobilization
Brief summary
The goal of this observational study is to determine the effect of ankle joint mobilization on active range of motion and gait in subacute first-time stroke. The main questions it aims to answer are: * What is the effect of ankle joint mobilization on active range of motion in the ankle and gait qualities? * What is the effect of ankle joint mobilization on self-perceived gait ability? Participants will receive physical therapy interventions of: * Grade III ankle joint mobilization * stretching of ankle plantarflexor muscles * ankle muscle activation training * assisted gait as part of assessment Study design is to measure conditions before and after the intervention to determine effect(s) of one treatment dose, completed within one session of 90 minutes.
Detailed description
Initial passive and active ankle range of motion measured by goniometer. Initial gait quality will be measured by walking with splinting for frontal plane ankle stability if indicated, assistive device for body weight support if needed, and manual assistance from an experienced physical therapist, on a Zeno Walkway pressure-sensitive mat for five complete stride cycles, taking 3 to 5 minutes. Data collected from the mat will be electronically captured using ProtoKinetics software. Participant initial self-rated perception of ability to walk will be marked on a 0-10 scale, on paper. Treatment intervention follows. With participant lying on the back, paretic ankle moderate-force grade III anterior to posterior-directed manual joint mobilizations will be performed by therapist; three sets of fifteen oscillations. Ankle plantarflexor muscles will be stretched for 75 seconds in supported standing. Ankle dorsiflexion muscle activation training will be performed for three minutes while in a seated position. Post-intervention measurements will proceed in the same sequence as initial measurements listed above: Ankle passive and active range of motion and walking ability will be reassessed, and self-perceived ability to walk will be rated again.
Interventions
OTHERJoint mobilization
Grade III manual joint mobilization as standard-of-care physical therapy intervention
Sponsors
Loma Linda University
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Masking description
No masking to occur
Intervention model description
pre-test, intervention, post-test
Eligibility
Sex/Gender
ALL
Age
21 Years to 86 Years
Healthy volunteers
No
Inclusion criteria
* First stroke * subacute phase after stroke * able to follow one-step commands * paretic passive ankle dorsiflexion less than 5 degrees
Exclusion criteria
referring to paretic ankle; * ankle pain of undetermined cause at rest * fracture in paretic lower extremity * muscle or ligament tear * recent ankle sprain * skin tear or wound * joint fusion or implanted hardware
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Gait characteristic of: stride length | Change between baseline assessment and post-intervention assessment, immediately following intervention | distance from foot contact to same foot contact measurement in meters captured as participant walks over a pressure-sensing mat. Data is processed with ProtoKinetics software. Findings will be compared to normative values for non-stroke males (1.51m) and females (1.32 m). Distance is hypothesized to increase post-intervention, but not approximate normal distance. |
| Active range of motion of the paretic ankle | Change between baseline assessment and post-intervention assessment, immediately following intervention | ankle (talocrural) joint dorsiflexion movement of the foot away from plantarflexion end-range, measured by goniometry in seated position, by a physical therapist with 25 years' experience. Normal ankle ranges are 0 to 45 degrees from neutral for plantarflexion and 0-25 degrees from neutral for dorsiflexion. 0 to 15 degrees of dorsiflexion is needed for functionally efficient gait. Both passive and active ankle dorsiflexion range of motion are expected to increase, but be less than normal. |
| Gait characteristic of: velocity | Change between baseline assessment and post-intervention assessment, immediately following intervention | distance and time measurement captured as participant walks over a pressure-sensing mat. Data is processed with ProtoKinetics software. Velocity in meters per second is determined, and compared to normative values for non-stroke males (1.37 m/sec) and females (1.30 m/sec), and in relation to meaningful change in walking speed in in-patient stroke (0.13 m/sec). Velocity is anticipated to increase from pre- to post-intervention, but still be less than normal. |
| Gait characteristic of: second double limb stance symmetry | Change between baseline assessment and post-intervention assessment, immediately following intervention | Time measurement of the second occurrence when both feet are in contact with the ground. Times with reference to left and right lower extremity will be compared for symmetry. It is hypothesized that second double limb stance time will improve toward symmetry from pre- to post-intervention measurement. |
| Gait characteristic of: second double-limb stance time | Change between baseline assessment and post-intervention assessment, immediately following intervention | Time measurement of the second occurrence when both feet are in contact with the ground, with reference to the paretic lower extremity. This will be compared to the normative value in adults of 0.12 second, and is hypothesized to be of lower duration post-intervention compared to pre-intervention, but still longer than normal. |
| Gait characteristic of: stride length symmetry | Change between baseline assessment and post-intervention assessment, immediately following intervention | distance from foot contact to same foot contact measurement in meters captured for each foot as participant walks over a pressure-sensing mat. Data is processed with ProtoKinetics software. Normal gait stride length is symmetrical for adults, and is hypothesized to improve from pre- to post-intervention measurement. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Subjective rating of perceived ability to walk | Change between baseline assessment and post-intervention assessment, immediately following intervention | Participant marks on paper self-perception of walking ability, responding to the instruction: 'please circle a point on the scale that shows level of confidence in walking a few steps unassisted on any household surface at this time. Where 0 = not at all confident and 10 = very confident' |
Countries
United States
Outcome results
None listed