Immediate Effect of Ankle Mobilization on Active Range of Motion and Gait in Subacute Stroke

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Loma Linda University (LLU)






Other: Joint mobilization

Study type


Funder types




Details and patient eligibility


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.

Full 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.


20 estimated patients




21 to 86 years old


No Healthy Volunteers

Inclusion and exclusion criteria

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

Trial design

Primary purpose




Interventional model

Single Group Assignment


None (Open label)

20 participants in 1 patient group

Experimental group
Pre-assessment of active and passive range of motion in the paretic ankle, and five strides of gait assessment on a pressure-sensitive mat. Intervention will be moderate grade III anterior-to-posterior directed ankle mobilization for 2 minutes while supine, ankle muscle stretch for 75 seconds in standing, ankle muscle training for 3 minutes while seated. Post-assessment is repeated in the same sequence and content as pre-assessment.
Other: Joint mobilization

Trial contacts and locations



Central trial contact

Eric G Johnson, PT, DSc; Dan G Wilson, DPT

Data sourced from

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