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| Name | Class |
|---|---|
| Manitoba Medical Service Foundation | OTHER |
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Stroke patients clearly benefit from intensive and coordinated inpatient care. While inpatient rehabilitation care is the preferred form for many patients post-stroke, due to access and financial barriers, many patients do not have this option. Community, outpatient rehabilitation programs will allow the patients with moderately disabling strokes the opportunity to maintain or augment gains achieved during inpatient stroke rehabilitation , while allowing some patients with mild disability to avoid inpatient rehabilitation completely.
Objective: Phase 1 randomized control trial to test the efficiency and effectiveness of treating adults who have suffered a single stroke using the following essential treatment components; a) community setting, b) group activity program, c) flexible, task-specific, computer-based exercise regime This program is designed to allow an extension of the in-patient rehabilitation experience to a community-based setting, in a cost-effective manner using paraprofessional staff and rehabilitation specialists, to provide a challenging, functional program to promote recovery and independence from physical impairments affecting balance and walking.
The specific objectives are to:
Hypothesis: Intense training targeting standing balance, and walking will significantly improve stroke clients' functional mobility. Training in a group setting and incorporating interactive and engaging computer gaming further provides the benefits of motivation and peer support while providing treatment in a cost effective manner.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| conventional physical Therapy | Active Comparator | will receive a conventional out-patient program which will include: lower extremity stretching and strengthening exercise; fitness using cycle ergometer; balance exercises in standing; over ground walking and stair exercises |
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| community-based group rehabilitation | Experimental | Group training will include different workstations to target dynamic standing balance and walking. The key features includes facilitate repetition of task-related movements, tailored to the patient and patient's goals, in a meaningful context. Specifically:
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| conventional physical therapy | Behavioral | will receive a conventional out-patient program which will include: lower extremity stretching and strengthening exercise; fitness using cycle ergometer; balance exercises in standing; over ground walking and stair exercises |
| Measure | Description | Time Frame |
|---|---|---|
| Gait speed | Proportion of participants with an improved functional level of walking As per LEAPS multi-centre RCT.47 Improved functional level was defined as; (a) the ability to walk independently at a speed of 0.8 m per second or faster for persons with initially moderate gait impairment , or (b) ability to walk independently at a speed of 0.4 m per second or faster for persons with initially severe gait impairment. These transitions are associated with improvements in home or community ambulation, functional status, and quality of life.50 | pre and post intervention of 8 weeks |
| Stroke Impact Scale | This scale is a self reported, stroke specific, valid, reliable, and responsive measure that includes 59 items and assesses eight domains related to activities and participation. | Pre and post intervention of 8 weeks |
| Measure | Description | Time Frame |
|---|---|---|
| Berg Balance Scale | pre and post intervention of 8 weeks | |
| Timed Up and Go Test | Pre and Post intervention of 8 weeks |
| Measure | Description | Time Frame |
|---|---|---|
| 6-minute wlak test | Pre and Post intervention of 8 weeks | |
| Spatial-Temporal gait variables | . Spatial-Temporal gait parameters using instrumented walkway.56 Average walking speed (in 4 meters) mean and variance measurement (over 20 steps) will be obtained for the following parameters: swing and stance duration, single support |
Inclusion Criteria:
Exclusion Criteria:
Any medical condition or disability that prevents participation in an exercise program. For example, a reported medical history of current treatment for cancer, kidney disease, recent fracture, uncontrolled diabetes or seizure disorder, uncontrolled cardiovascular-related problems .
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| Name | Affiliation | Role |
|---|---|---|
| Tony Szturm Szturm, PT, PhD | Faculty of Medicine University of Manitoba | Principal Investigator |
| Sepideh Pooyania, MD | Faculty of Medicine University of Manitoba | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| School of Medical Rehabilitation , University of Mantioba | Winnipeg | Manitoba | R3e 0T6 | Canada | ||
| Riverview Health Centre |
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| community-based group rehabilitation | Behavioral | Group training will include different workstations to target dynamic standing balance and walking. The key features includes facilitate repetition of task-related movements, tailored to the patient and patient's goals, in a meaningful context. Specifically:
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| pre and post intervention of 8 weeks |
| Winnipeg |
| Manitoba |
| R3T 1a3 |
| Canada |