Comparison of Gait Training Methods in Sub-acute Stroke and Spinal Cord Injury

NCT ID: NCT06169657

Last Updated: 2025-05-25

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

WITHDRAWN

Study Classification

OBSERVATIONAL

Study Start Date

2024-09-01

Study Completion Date

2025-12-31

Brief Summary

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The purpose of the project is to compare intensity (minutes in target heart rate zone) and steps per session across three gait training modalities, including body-weight supported treadmill training (BWSTT), overground gait training with body weight-support (BWS), and overground gait training utilizing a lower extremity exoskeleton, between patients presenting with varying functional ambulation capacities in the inpatient setting. Additionally, the researchers will compare physical therapist (PT) burden across these modalities and patient functional presentation levels.

Detailed Description

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Aim 1 of this study is to measure stepping repetition and intensity via heart rate of three gait-training modalities utilized with patients in the subacute phase of stroke and iSCI during inpatient rehabilitation in order to guide therapists through clinical decision-making of selecting the optimal intervention for patients based on functional presentation. Aim 2 of this study is to measure therapist burden across each gait training modalities, as this is an additional factor that contributes to the number of steps taken and intensity experienced by the patient.

The gait training modalities assessed will include BWSTT, overground gait training with a lower extremity exoskeleton, and overground gait training with BWS. The participants' functional level will be classified by gait speed obtained via the 10 meter walk test (10MWT), a standardized assessment commonly used in rehabilitation. These functional classification categories include household ambulator (low level) and limited community ambulator (high level), determined by Fritz et al. 2009.

The researchers hypothesize that low functioning/household ambulators will achieve more minutes in high-intensity training zones utilizing the exoskeleton due to the enhanced participation and increased weight-bearing the device supports compared to the other modalities. In addition, a greater number steps will be achieved in this mode due to the exoskeleton's ability to decrease overall therapist burden compared to BWSTT and overground with BWS. In contrast, the researchers anticipate that steps per session and overall intensity will be decreased in high functioning/limited community ambulators due the unnecessary support the exoskeleton provides at this functional level. The researchers believe that high functioning/ limited community ambulators will achieve the highest number of steps and intensity during BWSTT due to the ability to increase challenges via treadmill parameters such as speed and incline while utilizing a harness for safety and bodyweight support only as necessary. In contrast, the researchers believe the amount of BWS and assistance a PT must provide relative to the patient's contribution to practice successful stepping during BWSTT will result in a lower intensity and number of steps achieved in low functioning/household ambulators.

Conditions

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Stroke Incomplete Spinal Cord Injury

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Inpatients Post-stroke, low level ambulators

Individuals post acute or subacute stroke that that are inpatients at the Shirley Ryan AbilityLab ages 18-75 with initial gait speed 0.0-0.39 m/s

Body-weight-supported treadmill training (BWSTT)

Intervention Type DEVICE

Walking on a treadmill in a harness with body weight support as needed

EksoNR exoskeleton gait training

Intervention Type DEVICE

Walking in the EksoNR exoskeleton

Overground gait training

Intervention Type DEVICE

Walking overground in a harness with body weight support as needed

Inpatients Post-stroke, high level ambulators

Individuals post acute or subacute stroke that that are inpatients at the Shirley Ryan AbilityLab ages 18-75 with initial gait speed 0.4-0.79 m/s

Body-weight-supported treadmill training (BWSTT)

Intervention Type DEVICE

Walking on a treadmill in a harness with body weight support as needed

EksoNR exoskeleton gait training

Intervention Type DEVICE

Walking in the EksoNR exoskeleton

Overground gait training

Intervention Type DEVICE

Walking overground in a harness with body weight support as needed

Inpatients with iSCI, low level ambulators

Individuals post-SCI or subacute that that are inpatients at the Shirley Ryan AbilityLab ages 18-75 with initial gait speed 0.0-0.39 m/s

Body-weight-supported treadmill training (BWSTT)

Intervention Type DEVICE

Walking on a treadmill in a harness with body weight support as needed

EksoNR exoskeleton gait training

Intervention Type DEVICE

Walking in the EksoNR exoskeleton

Overground gait training

Intervention Type DEVICE

Walking overground in a harness with body weight support as needed

Inpatients with iSCI, high level ambulators

Individuals post-SCI or subacute that that are inpatients at the Shirley Ryan AbilityLab ages 18-75 with initial gait speed 0.4-0.79 m/s

Body-weight-supported treadmill training (BWSTT)

Intervention Type DEVICE

Walking on a treadmill in a harness with body weight support as needed

EksoNR exoskeleton gait training

Intervention Type DEVICE

Walking in the EksoNR exoskeleton

Overground gait training

Intervention Type DEVICE

Walking overground in a harness with body weight support as needed

Interventions

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Body-weight-supported treadmill training (BWSTT)

Walking on a treadmill in a harness with body weight support as needed

Intervention Type DEVICE

EksoNR exoskeleton gait training

Walking in the EksoNR exoskeleton

Intervention Type DEVICE

Overground gait training

Walking overground in a harness with body weight support as needed

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* Age 18-75 years old, inclusive
* Medical clearance from primary medical team (signed Medical Clearance form)
* Adequate cognitive function as determined by the NIH scale: score ≤1 on question 1b and score =0 on question 1c
* Gait speed between 0-0.79 m/s
* Informed consent provided by participant or POA
* English speaking


* First stroke, ischemic or hemorrhagic, within the past six months
* Unilateral, supratentorial stroke


* ASIA C or D
* Traumatic iSCI, within past six months

Exclusion Criteria

* Severe aphasia limiting ability to express needs or discomfort verbally or nonverbally
* History of or concurrent neurologic condition (i.e., stroke, SCI, PD, TBI, MS, etc.)
* History of peripheral nerve injury
* Severe knee, hip, or ankle osteoarthritis
* Severe osteoporosis as indicated by physician medical clearance
* Open wounds on skin surfaces in contact with exoskeleton or harness
* Unstable spine or unhealed fractures
* Weight bearing precautions
* Unresolved deep vein thrombosis (DVT)
* Pregnancy
* Prisoners


* Weight \>220 lbs (100 kg)
* Height below 60 inches or above 76 inches
* Standing hip width of approximately 18 inches or more
* Joint contractures or range of motion deficits that limit normal range of motion during ambulation:

* Knee flexion contracture greater than 12°
* Hip flexion contracture greater than 17°
* Inability to achieve 0° neutral ankle dorsiflexion with knee flexion up to 12°
* Bilateral hip flexion less than 110°
* Significant spasticity in the lower limbs (Modified Ashworth Scale ≥3)
* Leg length discrepancy:

* Greater than 0.5 in. (1.27 cm) for upper legs
* Greater than 0.75 in. (1.91 cm) for lower legs
* Active heterotopic ossification
* Significant spasticity in the lower limbs (Modified Ashworth Scale ≥3)
* High anxiety or claustrophobia
* Clostridium difficile or other gastrointestinal isolation precautions
* Colostomy
* Uncontrolled autonomic dysreflexia
* Lower limb prosthesis
Minimum Eligible Age

18 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Shirley Ryan AbilityLab

OTHER

Sponsor Role lead

Responsible Party

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Jose Pons

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Jose L Pons, PhD

Role: PRINCIPAL_INVESTIGATOR

Shirley Ryan AbilityLab

Locations

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Shirley Ryan AbilityLab

Chicago, Illinois, United States

Site Status

Countries

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United States

Other Identifiers

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STU00219486

Identifier Type: -

Identifier Source: org_study_id

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