Fast Muscle Activation and Stepping Training (FAST) Post-stroke (FAST)

Effectiveness of Fast Muscle Activation and Stepping Training (FAST) on Balance and Mobility Post-stroke

The purpose of this study is to determine whether FAST (Fast muscle Activation and Stepping Training) exercises will improve walking balance in individuals after stroke to a greater extent than usual care. Hypothesis: The primary hypothesis is that improvements in walking balance will be larger following 12 sessions of FAST exercise retraining compared to usual care in persons in the sub-acute phase after stroke.

It is estimated that 75-80% of individuals who have had a stroke will survive the acute event and be left with residual disability. Regaining independence in standing and walking is of utmost importance for patients recovering from stroke. Walking balance requires muscles in the legs and trunk to contract quickly if people lose their balance. Physical therapy plays a key role in the rehabilitation of walking balance in individuals after stroke. Given that maintaining one's balance requires fast muscle activity, rehabilitation post-stroke should focus on speed of movement. Thus we are proposing to compare a program that emphasizes speed of movement, Fast muscle Activation and Stepping Training versus an active control (usual care).

The usual care will consist of strength training, endurance, range of motion, patient education, weight shifting in standing and gait re-training.

The Fast muscle activation and stepping training will be the Experimental arm of this trial. This program will be exercises emphasizing speed of movement.

The Fast muscle activation and Stepping Training (FAST protocol) will be exercises emphasizing speed, small squats and protective steps, that will be progressed. This program will be 2 sessions a week for 45 minutes for 6 weeks in duration.

Study population: Subjects with a diagnosis of stroke Inclusion Criteria: first stroke (<6 months ago) presence of hemiparesis in the lower extremity minimum Berg Balance Score (BBS) of 30/56 cognitive ability to give informed consent Exclusion Criteria: bilateral stroke, or a previous stroke in the other hemisphere severe co-morbidity that is likely to dominate the pattern of care co-existing peripheral neuropathies or disorders of the vestibular apparatus musculoskeletal problems global aphasia or receptive aphasia

Miller KJ, Hunt MA, Pollock CL, Bryant D, Garland SJ. Protocol for a randomized controlled clinical trial investigating the effectiveness of Fast muscle Activation and Stepping Training (FAST) for improving balance and mobility in sub-acute stroke. BMC Neurol. 2014 Oct 10;14:187. doi: 10.1186/s12883-014-0187-y.

Peters S, Ivanova TD, Lakhani B, Boyd LA, Garland SJ. Neuroplasticity of Cortical Planning for Initiating Stepping Poststroke: A Case Series. J Neurol Phys Ther. 2020 Apr;44(2):164-172. doi: 10.1097/NPT.0000000000000311.