The Effects of Plantar Flexion Training in People With Chronic Stroke
Status
Completed
Conditions
Stroke
Hemiplegic Gait
Treatments
Other: Skateboard exercise at an incline angle of 0 degrees and 50% body weight
Other: Skateboard exercise at an incline angle determined to be optimal in phase 1 (either 0 or 5 degrees) and 90% body weight
Other: Skateboard exercise at an incline angle of 5 degrees and 50% body weight
Other: Experimental 4-week exercise intervention
Other: Over-ground multi-directional gait training
Other: Skateboard exercise at an incline angle determined to be optimal in phase 1 (either 0 or 5 degrees) and 75% body weight
Other: Control 4-week exercise intervention
Other: Home exercise
Details and patient eligibility
About
This study consists of three phases that aim to develop an exercise intervention to promote maximal activation of ankle plantar flexors in the paretic lower extrimty (LE) in order to restore a more normalized gait pattern in chronic stroke survivors.
The aim of the first phase is to determine if there are differences between standing on different levels of inclination on plantar flexion activation during forward movement of the contralateral LE in adults with chronic with stroke.
The aim of second phase is to determine if there are differences between different percentages of weight bearing on the paretic LE on plantar flexion activation during forward movement of the contralateral LE in adults with chronic stroke.
The aim of the third phase is to determine if there are differences between a 4-week plantar flexion training intervention and conventional physical therapy.
Full description
Description of Arms:
This study has three phases. The first phase is performed in a cross-over fashion. Participants will stand on two different incline angles on the paretic LE and simultaneously move a small skateboard forward with the non-paretic LE. The testing order for the two different incline angles will be randomized, and all participants will be required to complete both incline angle conditions within a single test session.
The second phase will also be performed in a cross-over fashion. Participants will stand with three different percentages of body weight on their paretic LE while moving the skateboard forward with the non-paretic LE. The testing order for the three body weight percentages will be randomized. All participants will be required to complete all three body weight conditions within a single test session.
In the third phase, participants will be randomized to either a control 4-week exercise intervention (conventional physical therapy) or a 4-week experimental exercise intervention (plantar flexion training). Both the control and exerimental arms will complete over-ground multi-directional gait training and home exercise.
Enrollment
15 patients
Sex
All
Ages
18+ years old
Volunteers
No Healthy Volunteers
Inclusion criteria
- Must be able to perform five times sit to stand test without the use of upper extremities
- Must have 10 degrees of passive ankle dorsiflexion measured in standing
- Must be able to walk with supervision level assistance with no assistive device
Exclusion criteria
- Currently receiving physical therapy
- History of orthopedic ankle instability
- Lacking knee extension to neutral
- Unable to understand English
- Unable to follow multi-step commands
- History of orthopedic pathology that prevents completion of experimental condition
- Pain with weight bearing on paretic LE
- Received Botox to the plantar flexors within the last three months or phenol injections within the last six months
- Walk with a longer nonparetic step length than paretic step length
Trial design
Primary purpose
Treatment
Allocation
Randomized
Interventional model
Crossover Assignment
Masking
Single Blind
15 participants in 24 patient groups
1
Experimental group
Description:
Phase 1 (skateboard exercise at 50% body weight and an incline level of 0 degrees, then 5 degrees), Phase 2 (skateboard exercise with incline level determined to be optimal in phase 1 and body weight at 50%, then 75%, then 90%), Phase 3 (control 4-week exercise intervention)
Treatment:
Other: Skateboard exercise at an incline angle of 0 degrees and 50% body weight
Other: Over-ground multi-directional gait training
Other: Skateboard exercise at an incline angle determined to be optimal in phase 1 (either 0 or 5 degrees) and 90% body weight
Other: Skateboard exercise at an incline angle determined to be optimal in phase 1 (either 0 or 5 degrees) and 75% body weight
Other: Home exercise
Other: Control 4-week exercise intervention
Other: Skateboard exercise at an incline angle of 5 degrees and 50% body weight
2
Experimental group
Description:
Phase 1 (skateboard exercise at 50% body weight and an incline level of 0 degrees, then 5 degrees), Phase 2 (skateboard exercise with incline level determined to be optimal in phase 1 and body weight at 50%, then 90%, then 75%), Phase 3 (control 4-week exercise intervention)
Treatment:
Other: Skateboard exercise at an incline angle of 0 degrees and 50% body weight
Other: Over-ground multi-directional gait training
Other: Skateboard exercise at an incline angle determined to be optimal in phase 1 (either 0 or 5 degrees) and 90% body weight
Other: Skateboard exercise at an incline angle determined to be optimal in phase 1 (either 0 or 5 degrees) and 75% body weight
Other: Home exercise
Other: Control 4-week exercise intervention
Other: Skateboard exercise at an incline angle of 5 degrees and 50% body weight
3
Experimental group
Description:
Phase 1 (skateboard exercise at 50% body weight and an incline level of 0 degrees, then 5 degrees), Phase 2 (skateboard exercise with incline level determined to be optimal in phase 1 and body weight at 75%, then 50%, then 90%), Phase 3 (control 4-week exercise intervention)
Treatment:
Other: Skateboard exercise at an incline angle of 0 degrees and 50% body weight
Other: Over-ground multi-directional gait training
Other: Skateboard exercise at an incline angle determined to be optimal in phase 1 (either 0 or 5 degrees) and 90% body weight
Other: Skateboard exercise at an incline angle determined to be optimal in phase 1 (either 0 or 5 degrees) and 75% body weight
Other: Home exercise
Other: Control 4-week exercise intervention
Other: Skateboard exercise at an incline angle of 5 degrees and 50% body weight
4
Experimental group
Description:
Phase 1 (skateboard exercise at 50% body weight and an incline level of 0 degrees, then 5 degrees), Phase 2 (skateboard exercise with incline level determined to be optimal in phase 1 and body weight at 75%, then 90%, then 50%), Phase 3 (control 4-week exercise intervention)
Treatment:
Other: Skateboard exercise at an incline angle of 0 degrees and 50% body weight
Other: Over-ground multi-directional gait training
Other: Skateboard exercise at an incline angle determined to be optimal in phase 1 (either 0 or 5 degrees) and 90% body weight
Other: Skateboard exercise at an incline angle determined to be optimal in phase 1 (either 0 or 5 degrees) and 75% body weight
Other: Home exercise
Other: Control 4-week exercise intervention
Other: Skateboard exercise at an incline angle of 5 degrees and 50% body weight
5
Experimental group
Description:
Phase 1 (skateboard exercise at 50% body weight and an incline level of 0 degrees, then 5 degrees), Phase 2 (skateboard exercise with incline level determined to be optimal in phase 1 and body weight at 90%, then 50%, then 75%), Phase 3 (control 4-week exercise intervention)
Treatment:
Other: Skateboard exercise at an incline angle of 0 degrees and 50% body weight
Other: Over-ground multi-directional gait training
Other: Skateboard exercise at an incline angle determined to be optimal in phase 1 (either 0 or 5 degrees) and 90% body weight
Other: Skateboard exercise at an incline angle determined to be optimal in phase 1 (either 0 or 5 degrees) and 75% body weight
Other: Home exercise
Other: Control 4-week exercise intervention
Other: Skateboard exercise at an incline angle of 5 degrees and 50% body weight
6
Experimental group
Description:
Phase 1 (skateboard exercise at 50% body weight and an incline level of 0 degrees, then 5 degrees), Phase 2 (skateboard exercise with incline level determined to be optimal in phase 1 and body weight at 90%, then 75%, then 50%), Phase 3 (control 4-week exercise intervention)
Treatment:
Other: Skateboard exercise at an incline angle of 0 degrees and 50% body weight
Other: Over-ground multi-directional gait training
Other: Skateboard exercise at an incline angle determined to be optimal in phase 1 (either 0 or 5 degrees) and 90% body weight
Other: Skateboard exercise at an incline angle determined to be optimal in phase 1 (either 0 or 5 degrees) and 75% body weight
Other: Home exercise
Other: Control 4-week exercise intervention
Other: Skateboard exercise at an incline angle of 5 degrees and 50% body weight
7
Experimental group
Description:
Phase 1 (skateboard exercise at 50% body weight and an incline level of 5 degrees, then 0 degrees), Phase 2 (skateboard exercise with incline level determined to be optimal in phase 1 and body weight at 50%, then 75%, then 90%), Phase 3 (control 4-week exercise intervention)
Treatment:
Other: Skateboard exercise at an incline angle of 0 degrees and 50% body weight
Other: Over-ground multi-directional gait training
Other: Skateboard exercise at an incline angle determined to be optimal in phase 1 (either 0 or 5 degrees) and 90% body weight
Other: Skateboard exercise at an incline angle determined to be optimal in phase 1 (either 0 or 5 degrees) and 75% body weight
Other: Home exercise
Other: Control 4-week exercise intervention
Other: Skateboard exercise at an incline angle of 5 degrees and 50% body weight
8
Experimental group
Description:
Phase 1 (skateboard exercise at 50% body weight and an incline level of 5 degrees, then 0 degrees), Phase 2 (skateboard exercise with incline level determined to be optimal in phase 1 and body weight at 50%, then 90%, then 75%), Phase 3 (control 4-week exercise intervention)
Treatment:
Other: Skateboard exercise at an incline angle of 0 degrees and 50% body weight
Other: Over-ground multi-directional gait training
Other: Skateboard exercise at an incline angle determined to be optimal in phase 1 (either 0 or 5 degrees) and 90% body weight
Other: Skateboard exercise at an incline angle determined to be optimal in phase 1 (either 0 or 5 degrees) and 75% body weight
Other: Home exercise
Other: Control 4-week exercise intervention
Other: Skateboard exercise at an incline angle of 5 degrees and 50% body weight
9
Experimental group
Description:
Phase 1 (skateboard exercise at 50% body weight and an incline level of 5 degrees, then 0 degrees), Phase 2 (skateboard exercise with incline level determined to be optimal in phase 1 and body weight at 75%, then 50%, then 90%), Phase 3 (control 4-week exercise intervention)
Treatment:
Other: Skateboard exercise at an incline angle of 0 degrees and 50% body weight
Other: Over-ground multi-directional gait training
Other: Skateboard exercise at an incline angle determined to be optimal in phase 1 (either 0 or 5 degrees) and 90% body weight
Other: Skateboard exercise at an incline angle determined to be optimal in phase 1 (either 0 or 5 degrees) and 75% body weight
Other: Home exercise
Other: Control 4-week exercise intervention
Other: Skateboard exercise at an incline angle of 5 degrees and 50% body weight
10
Experimental group
Description:
Phase 1 (skateboard exercise at 50% body weight and an incline level of 5 degrees, then 0 degrees), Phase 2 (skateboard exercise with incline level determined to be optimal in phase 1 and body weight at 75%, then 90%, then 50%), Phase 3 (control 4-week exercise intervention)
Treatment:
Other: Skateboard exercise at an incline angle of 0 degrees and 50% body weight
Other: Over-ground multi-directional gait training
Other: Skateboard exercise at an incline angle determined to be optimal in phase 1 (either 0 or 5 degrees) and 90% body weight
Other: Skateboard exercise at an incline angle determined to be optimal in phase 1 (either 0 or 5 degrees) and 75% body weight
Other: Home exercise
Other: Control 4-week exercise intervention
Other: Skateboard exercise at an incline angle of 5 degrees and 50% body weight
11
Experimental group
Description:
Phase 1 (skateboard exercise at 50% body weight and an incline level of 5 degrees, then 0 degrees), Phase 2 (skateboard exercise with incline level determined to be optimal in phase 1 and body weight at 90%, then 50%, then 75%), Phase 3 (control 4-week exercise intervention)
Treatment:
Other: Skateboard exercise at an incline angle of 0 degrees and 50% body weight
Other: Over-ground multi-directional gait training
Other: Skateboard exercise at an incline angle determined to be optimal in phase 1 (either 0 or 5 degrees) and 90% body weight
Other: Skateboard exercise at an incline angle determined to be optimal in phase 1 (either 0 or 5 degrees) and 75% body weight
Other: Home exercise
Other: Control 4-week exercise intervention
Other: Skateboard exercise at an incline angle of 5 degrees and 50% body weight
12
Experimental group
Description:
Phase 1 (skateboard exercise at 50% body weight and an incline level of 5 degrees, then 0 degrees), Phase 2 (skateboard exercise with incline level determined to be optimal in phase 1 and body weight at 90%, then 75%, then 50%), Phase 3 (control 4-week exercise intervention)
Treatment:
Other: Skateboard exercise at an incline angle of 0 degrees and 50% body weight
Other: Over-ground multi-directional gait training
Other: Skateboard exercise at an incline angle determined to be optimal in phase 1 (either 0 or 5 degrees) and 90% body weight
Other: Skateboard exercise at an incline angle determined to be optimal in phase 1 (either 0 or 5 degrees) and 75% body weight
Other: Home exercise
Other: Control 4-week exercise intervention
Other: Skateboard exercise at an incline angle of 5 degrees and 50% body weight
13
Experimental group
Description:
Phase 1 (skateboard exercise at 50% body weight and an incline level of 0 degrees, then 5 degrees), Phase 2 (skateboard exercise with incline level determined to be optimal in phase 1 and body weight at 50%, then 75%, then 90%), Phase 3 (experimental 4-week exercise intervention)
Treatment:
Other: Skateboard exercise at an incline angle of 0 degrees and 50% body weight
Other: Over-ground multi-directional gait training
Other: Skateboard exercise at an incline angle determined to be optimal in phase 1 (either 0 or 5 degrees) and 90% body weight
Other: Skateboard exercise at an incline angle determined to be optimal in phase 1 (either 0 or 5 degrees) and 75% body weight
Other: Home exercise
Other: Skateboard exercise at an incline angle of 5 degrees and 50% body weight
Other: Experimental 4-week exercise intervention
14
Experimental group
Description:
Phase 1 (skateboard exercise at 50% body weight and an incline level of 0 degrees, then 5 degrees), Phase 2 (skateboard exercise with incline level determined to be optimal in phase 1 and body weight at 50%, then 90%, then 75%), Phase 3 (experimental 4-week exercise intervention)
Treatment:
Other: Skateboard exercise at an incline angle of 0 degrees and 50% body weight
Other: Over-ground multi-directional gait training
Other: Skateboard exercise at an incline angle determined to be optimal in phase 1 (either 0 or 5 degrees) and 90% body weight
Other: Skateboard exercise at an incline angle determined to be optimal in phase 1 (either 0 or 5 degrees) and 75% body weight
Other: Home exercise
Other: Skateboard exercise at an incline angle of 5 degrees and 50% body weight
Other: Experimental 4-week exercise intervention
15
Experimental group
Description:
Phase 1 (skateboard exercise at 50% body weight and an incline level of 0 degrees, then 5 degrees), Phase 2 (skateboard exercise with incline level determined to be optimal in phase 1 and body weight at 75%, then 50%, then 90%), Phase 3 (experimental 4-week exercise intervention)
Treatment:
Other: Skateboard exercise at an incline angle of 0 degrees and 50% body weight
Other: Over-ground multi-directional gait training
Other: Skateboard exercise at an incline angle determined to be optimal in phase 1 (either 0 or 5 degrees) and 90% body weight
Other: Skateboard exercise at an incline angle determined to be optimal in phase 1 (either 0 or 5 degrees) and 75% body weight
Other: Home exercise
Other: Skateboard exercise at an incline angle of 5 degrees and 50% body weight
Other: Experimental 4-week exercise intervention
16
Experimental group
Description:
Phase 1 (skateboard exercise at 50% body weight and an incline level of 0 degrees, then 5 degrees), Phase 2 (skateboard exercise with incline level determined to be optimal in phase 1 and body weight at 75%, then 90%, then 50%), Phase 3 (experimental 4-week exercise intervention)
Treatment:
Other: Skateboard exercise at an incline angle of 0 degrees and 50% body weight
Other: Over-ground multi-directional gait training
Other: Skateboard exercise at an incline angle determined to be optimal in phase 1 (either 0 or 5 degrees) and 90% body weight
Other: Skateboard exercise at an incline angle determined to be optimal in phase 1 (either 0 or 5 degrees) and 75% body weight
Other: Home exercise
Other: Skateboard exercise at an incline angle of 5 degrees and 50% body weight
Other: Experimental 4-week exercise intervention
17
Experimental group
Description:
Phase 1 (skateboard exercise at 50% body weight and an incline level of 0 degrees, then 5 degrees), Phase 2 (skateboard exercise with incline level determined to be optimal in phase 1 and body weight at 90%, then 50%, then 75%), Phase 3 (experimental 4-week exercise intervention)
Treatment:
Other: Skateboard exercise at an incline angle of 0 degrees and 50% body weight
Other: Over-ground multi-directional gait training
Other: Skateboard exercise at an incline angle determined to be optimal in phase 1 (either 0 or 5 degrees) and 90% body weight
Other: Skateboard exercise at an incline angle determined to be optimal in phase 1 (either 0 or 5 degrees) and 75% body weight
Other: Home exercise
Other: Skateboard exercise at an incline angle of 5 degrees and 50% body weight
Other: Experimental 4-week exercise intervention
18
Experimental group
Description:
Phase 1 (skateboard exercise at 50% body weight and an incline level of 0 degrees, then 5 degrees), Phase 2 (skateboard exercise with incline level determined to be optimal in phase 1 and body weight at 90%, then 75%, then 50%), Phase 3 (experimental 4-week exercise intervention)
Treatment:
Other: Skateboard exercise at an incline angle of 0 degrees and 50% body weight
Other: Over-ground multi-directional gait training
Other: Skateboard exercise at an incline angle determined to be optimal in phase 1 (either 0 or 5 degrees) and 90% body weight
Other: Skateboard exercise at an incline angle determined to be optimal in phase 1 (either 0 or 5 degrees) and 75% body weight
Other: Home exercise
Other: Skateboard exercise at an incline angle of 5 degrees and 50% body weight
Other: Experimental 4-week exercise intervention
19
Experimental group
Description:
Phase 1 (skateboard exercise at 50% body weight and an incline level of 5 degrees, then 0 degrees), Phase 2 (skateboard exercise with incline level determined to be optimal in phase 1 and body weight at 50%, then 75%, then 90%), Phase 3 (experimental 4-week exercise intervention)
Treatment:
Other: Skateboard exercise at an incline angle of 0 degrees and 50% body weight
Other: Over-ground multi-directional gait training
Other: Skateboard exercise at an incline angle determined to be optimal in phase 1 (either 0 or 5 degrees) and 90% body weight
Other: Skateboard exercise at an incline angle determined to be optimal in phase 1 (either 0 or 5 degrees) and 75% body weight
Other: Home exercise
Other: Skateboard exercise at an incline angle of 5 degrees and 50% body weight
Other: Experimental 4-week exercise intervention
20
Experimental group
Description:
Phase 1 (skateboard exercise at 50% body weight and an incline level of 5 degrees, then 0 degrees), Phase 2 (skateboard exercise with incline level determined to be optimal in phase 1 and body weight at 50%, then 90%, then 75%), Phase 3 (experimental 4-week exercise intervention)
Treatment:
Other: Skateboard exercise at an incline angle of 0 degrees and 50% body weight
Other: Over-ground multi-directional gait training
Other: Skateboard exercise at an incline angle determined to be optimal in phase 1 (either 0 or 5 degrees) and 90% body weight
Other: Skateboard exercise at an incline angle determined to be optimal in phase 1 (either 0 or 5 degrees) and 75% body weight
Other: Home exercise
Other: Skateboard exercise at an incline angle of 5 degrees and 50% body weight
Other: Experimental 4-week exercise intervention
21
Experimental group
Description:
Phase 1 (skateboard exercise at 50% body weight and an incline level of 5 degrees, then 0 degrees), Phase 2 (skateboard exercise with incline level determined to be optimal in phase 1 and body weight at 75%, then 50%, then 90%), Phase 3 (experimental 4-week exercise intervention)
Treatment:
Other: Skateboard exercise at an incline angle of 0 degrees and 50% body weight
Other: Over-ground multi-directional gait training
Other: Skateboard exercise at an incline angle determined to be optimal in phase 1 (either 0 or 5 degrees) and 90% body weight
Other: Skateboard exercise at an incline angle determined to be optimal in phase 1 (either 0 or 5 degrees) and 75% body weight
Other: Home exercise
Other: Skateboard exercise at an incline angle of 5 degrees and 50% body weight
Other: Experimental 4-week exercise intervention
22
Experimental group
Description:
Phase 1 (skateboard exercise at 50% body weight and an incline level of 5 degrees, then 0 degrees), Phase 2 (skateboard exercise with incline level determined to be optimal in phase 1 and body weight at 75%, then 90%, then 50%), Phase 3 (experimental 4-week exercise intervention)
Treatment:
Other: Skateboard exercise at an incline angle of 0 degrees and 50% body weight
Other: Over-ground multi-directional gait training
Other: Skateboard exercise at an incline angle determined to be optimal in phase 1 (either 0 or 5 degrees) and 90% body weight
Other: Skateboard exercise at an incline angle determined to be optimal in phase 1 (either 0 or 5 degrees) and 75% body weight
Other: Home exercise
Other: Skateboard exercise at an incline angle of 5 degrees and 50% body weight
Other: Experimental 4-week exercise intervention
23
Experimental group
Description:
Phase 1 (skateboard exercise at 50% body weight and an incline level of 5 degrees, then 0 degrees), Phase 2 (skateboard exercise with incline level determined to be optimal in phase 1 and body weight at 90%, then 50%, then 75%), Phase 3 (experimental 4-week exercise intervention)
Treatment:
Other: Skateboard exercise at an incline angle of 0 degrees and 50% body weight
Other: Over-ground multi-directional gait training
Other: Skateboard exercise at an incline angle determined to be optimal in phase 1 (either 0 or 5 degrees) and 90% body weight
Other: Skateboard exercise at an incline angle determined to be optimal in phase 1 (either 0 or 5 degrees) and 75% body weight
Other: Home exercise
Other: Skateboard exercise at an incline angle of 5 degrees and 50% body weight
Other: Experimental 4-week exercise intervention
24
Experimental group
Description:
Phase 1 (skateboard exercise at 50% body weight and an incline level of 5 degrees, then 0 degrees), Phase 2 (skateboard exercise with incline level determined to be optimal in phase 1 and body weight at 90%, then 75%, then 50%), Phase 3 (experimental 4-week exercise intervention)
Treatment:
Other: Skateboard exercise at an incline angle of 0 degrees and 50% body weight
Other: Over-ground multi-directional gait training
Other: Skateboard exercise at an incline angle determined to be optimal in phase 1 (either 0 or 5 degrees) and 90% body weight
Other: Skateboard exercise at an incline angle determined to be optimal in phase 1 (either 0 or 5 degrees) and 75% body weight
Other: Home exercise
Other: Skateboard exercise at an incline angle of 5 degrees and 50% body weight
Other: Experimental 4-week exercise intervention
Trial contacts and locations
1
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