Targeted Ankle Proprioceptive Training Improves Balance, Gait, and Functional Mobility in Chronic Stroke Survivors

Targeted Ankle Proprioceptive Training Improves Balance, Gait, and Functional Mobility in Chronic Stroke Survivors: A Multicenter Randomized Controlled Trial With Longitudinal Follow Up

Stroke is a leading cause of long-term disability, with balance and gait deficits affecting >80% of survivors and increasing fall risk. Emerging evidence links ankle proprioceptive impairment-particularly inversion/eversion acuity-to these deficits, often bilateral and central in origin. Cross-sectional studies show strong associations, but causality, temporal progression, and intervention efficacy (especially in severe/non-ambulatory cases) remain unproven. This trial tests a targeted proprioceptive protocol against standard care.

Objectives: Primary: To evaluate the causal effect of 12-week targeted ankle proprioceptive training on weight-bearing ankle proprioception (AMEDA) in chronic stroke survivors.

Secondary: To assess effects on balance (Berg Balance Scale), gait speed (10m walk test), mobility (Timed Up and Go, Functional Ambulation Category), lower extremity motor function (Fugl-Meyer), and sustainability at 6-month follow-up. To describe longitudinal proprioceptive changes in a subsample from acute to chronic stages.

Inclusion Criteria:

• Clinical diagnosis of chronic ischemic/hemorrhagic stroke (≥12 months post-stroke)
• Moderate-to-severe lower extremity impairment (Fugl-Meyer LE ≤28 or NIHSS motor leg ≥2)
• Documented ankle proprioceptive deficit (AMEDA AUC <0.7)

Exclusion Criteria:

• Acute medical issues (e.g., uncontrolled hypertension)
• Severe cognitive impairment (MMSE <24)
• Exercise contraindications
• Concurrent conflicting trials