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RECRUITINGINTERVENTIONAL

Ischemic Conditioning Improves Walking Function Post Stroke

Important: This information is not medical advice. Talk to your doctor about whether a clinical trial is right for you.

About This Trial

This innovative study will address scientific and clinical areas relatively unexplored in chronic stroke that could lead to greater recovery of walking. Ischemic Conditioning (IC) is a non-invasive, simple procedure that improves motor function, exercise performance and cardiovascular function in healthy controls, but it has never been applied to the stroke population. We postulate that IC enhances the recruitment of motoneurons and results in positive neural adaptations, improves vascular endothelial function and peripheral blood flow, and together these improvements result in an increased capacity to exercise and faster walking speed. Future studies will examine the effects of IC and traditional therapy at different time points of recovery post stroke, durability of IC, molecular mechanisms of neural and cardiovascular adaptation and the efficacy compared with other adjuncts.

Who May Be Eligible (Plain English)

Inclusion Criteria (Stroke Survivors): 1. be ≥ 1 year post diagnosis of a unilateral, cortical stroke and have residual lower extremity paresis 2. be between the ages of 18-85 3. be able to give willing to sign a consent form 4. walk slower than normative values based on age and sex Exclusion Criteria (Stroke Survivors): 1. history of deep vein thrombosis or any condition in which transient ischemia to the lower extremity is contraindicated 2. inability to follow 2 step commands 3. chronic low back or hip pain 4. history of substance abuse 5. history of head trauma 6. comorbid neurological disorder 7. any uncontrolled medical condition 8. pacemaker 9. any condition where fatiguing contractions or resisted leg contractions are contraindicated 10. inability to walk for 5 minute bouts on a treadmill with a harness supporting up to 50% of the body weight at 80% of over-ground self-selected walking speed. Inclusion Criteria (Healthy Control Subjects): 1. be between ages of 18-85 2. be able to give willing to sign a consent form Exclusion Criteria (Healthy Control Subjects): 1. Those listed above for stroke survivors 2. History of Stroke Always talk to your doctor about whether this trial is right for you.

Original Eligibility Criteria

View original clinical language
Inclusion Criteria (Stroke Survivors): 1. be ≥ 1 year post diagnosis of a unilateral, cortical stroke and have residual lower extremity paresis 2. be between the ages of 18-85 3. be able to give informed consent 4. walk slower than normative values based on age and sex Exclusion Criteria (Stroke Survivors): 1. history of deep vein thrombosis or any condition in which transient ischemia to the lower extremity is contraindicated 2. inability to follow 2 step commands 3. chronic low back or hip pain 4. history of substance abuse 5. history of head trauma 6. comorbid neurological disorder 7. any uncontrolled medical condition 8. pacemaker 9. any condition where fatiguing contractions or resisted leg contractions are contraindicated 10. inability to walk for 5 minute bouts on a treadmill with a harness supporting up to 50% of the body weight at 80% of over-ground self-selected walking speed. Inclusion Criteria (Healthy Control Subjects): 1. be between ages of 18-85 2. be able to give informed consent Exclusion Criteria (Healthy Control Subjects): 1. Those listed above for stroke survivors 2. History of Stroke

Treatments Being Tested

PROCEDURE

Ischemic Conditioning

Ischemic conditioning is a well-defined, non-invasive procedure which consists of inflating a blood pressure cuff around a limb (in our study, the paretic leg), inflating the cuff to 225 mmHg to occlude blood flow to the limb for 5 minutes, releasing the cuff for 5 minutes, and repeating 5 times. In our study, participants assigned to the IC Only and IC + Treadmill Training groups will undergo twelve sessions of ischemic conditioning over a four-week period.

PROCEDURE

Ischemic Conditioning Sham

Ischemic conditioning sham consists of the same setup as ischemic conditioning, which consists of inflating a blood pressure cuff around a limb (in our study, the paretic leg), inflating the cuff to 10 mmHg for 5 minutes, releasing the cuff for 5 minutes, and repeating 5 times. 10 mmHg is a sufficient inflation pressure for study participants to perceive some cuff tightness, but is not high enough to occlude blood flow. In our study, participants assigned to the IC Sham + Treadmill Training groups will undergo twelve sessions of ischemic conditioning sham over a four-week period.

PROCEDURE

Treadmill Training

Participants will perform 3 treadmill training sessions/week for a 4 week period (12 sessions total). Treadmill training will immediately follow IC or IC Sham. Personnel performing the treadmill training will be blinded to the IC treatment group. Subjects will walk on a treadmill for six, 5-minute intervals. Walking speed will be continuously adjusted to maintain heart rate between 50% and 60% of age-adjusted heart rate reserve to minimize the confounder of intensity. If individuals cannot walk at 80% of their overground self-selected walking speed, for 5 minutes, they will be assisted into a body weight support harness. Body weight support will be adjusted (up to 50%) such that individuals can walk at 80% of their over ground walking speed for five minutes and adjusted accordingly throughout the session. Participants assigned to the Treadmill + IC and Treadmill + IC Sham groups will receive Treadmill Training.

Locations (2)

Medical College of Wisconsin
Milwaukee, Wisconsin, United States
Marquette University
Milwaukee, Wisconsin, United States