Rehabilitation Methods for Stroke Recovery

Not yet recruiting at 5 trial locations

Overseen By Joyce L Chen, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Toronto

Disqualifiers: Neurological disorders, Cognitive deficits, Apraxia, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 13

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial compares two rehabilitation methods, Goal Training and Quality Training, to help stroke survivors improve finger movements. It examines whether achieving movement goals using any strategy or focusing on refining movement technique without shortcuts is more effective. Researchers will also use MRI scans to observe brain changes with each method. Ideal candidates for this trial are those who have experienced a stroke within the last two years and can still move their fingers. As an unphased trial, this study allows participants to contribute to innovative research that could enhance stroke rehabilitation techniques.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What prior data suggests that these rehabilitation methods are safe for stroke recovery?

Research has shown that both rehabilitation methods under study are safe and effective. For the Goal Training method, one study found that setting specific goals helped patients practice exercises more frequently without major safety concerns. Another study suggested that goal-setting boosted motivation and improved movement accuracy during tasks, again with no significant safety issues.

For the Quality Training method, over 90% of interventions aimed at improving quality in stroke rehabilitation led to better outcomes without notable side effects. Additionally, resistance training, a component of quality training, safely increased muscle strength and reduced stiffness in stroke patients.

Both methods appear well-tolerated, with previous research supporting their safety and effectiveness in improving movement after a stroke. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about these rehabilitation methods for stroke recovery because they focus on enhancing specific aspects of recovery through tailored training. Goal Training emphasizes setting and achieving personal recovery milestones, which can motivate patients and provide clear progress markers. On the other hand, Quality Training is all about refining movement and improving motor skills, aiming for smoother and more controlled physical actions. Unlike standard rehabilitation methods that may not offer a personalized focus, these approaches are designed to address individual patient needs, potentially leading to more effective and satisfying recovery outcomes.

What evidence suggests that this trial's rehabilitation methods could be effective for stroke recovery?

This trial will compare two rehabilitation methods for stroke recovery: Goal Training and Quality Training. Studies have shown that setting goals during stroke recovery helps patients move more accurately and practice more intensely. Patients often try harder and perform more repetitions with clear goals. Meanwhile, focusing on quality training has been linked to significant improvements in the quality of life for stroke patients, especially with intensive therapy. Research indicates that these different training methods can greatly impact recovery, including physical abilities and overall well-being. Both approaches offer promising ways to improve finger movements after a stroke. ^{2 3 5 6 7}

Who Is on the Research Team?

Joyce L Chen, PhD

Principal Investigator

University of Toronto: Faculty of Kinesiology & Physical Education

Are You a Good Fit for This Trial?

This trial is for individuals who have experienced a stroke and are working on improving hand and finger movements. Participants will need to commit to multiple lab visits, piano training sessions, and MRI scans. Specific details about inclusion or exclusion criteria were not provided.

Inclusion Criteria

I had a stroke for the first time between 6 months and 2 years ago.

I am over 18 years old.

I can move my fingers actively.

Exclusion Criteria

History of developmental, neurological, or major psychiatric disorders

I have had a stroke in the cerebellum.

Contraindications to MRI

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Baseline Assessment

Participants undergo initial clinical and research assessments, including MRI scans

1 week

1 visit (in-person)

Piano Training

Participants complete 10 days of piano training, focusing on either quality of movement or achieving movement goals

2 weeks

10 visits (in-person)

Post-training Assessment

Participants undergo post-training assessments, including MRI scans and clinical evaluations

1 week

1 visit (in-person)

Follow-up

Participants are monitored for safety and effectiveness after training, with assessments at 3 months

3 months

1 visit (in-person)

What Are the Treatments Tested in This Trial?

Interventions

• Goal Training
• Quality Training

Trial Overview The study compares two rehabilitation methods: Goal Training, which allows any strategy to reach movement goals, and Quality Training, which focuses on technique improvement without compensatory strategies. It also examines brain changes through MRI imaging.

How Is the Trial Designed?

Group I: Goal Training Group Active Control 1 Intervention

Group II: Quality Training Group Active Control 1 Intervention

Who Is Running the Clinical Trial?

University of Toronto

Lead Sponsor

Trials

739

Recruited

1,125,000+

Heart and Stroke Foundation of Canada

Collaborator

Trials

131

Recruited

72,600+

McGill University

Collaborator

Trials

421

Recruited

1,017,000+

Published Research Related to This Trial

A systematic review of 37 randomized controlled trials (RCTs) found that while most studies reported the principle of specificity in exercise training for stroke survivors, only 13.5% included all key training principles, which limits the effectiveness of exercise interventions.

Patient adherence to prescribed exercise regimens was poorly reported, with only 8.1% of studies accounting for it, highlighting a significant gap in ensuring that stroke survivors follow through with their exercise programs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Application of principles of exercise training in sub-acute and chronic stroke survivors: a systematic review. Ammann, BC., Knols, RH., Baschung, P., et al.[2022]

A randomized controlled trial with 33 chronic stroke patients showed that a 4-week treadmill training program significantly improved gait velocity and dynamic balance ability compared to traditional training, indicating its effectiveness for rehabilitation.

The study found no adverse effects from the training, suggesting that challenging treadmill speed-dependent gait and balance training is a safe and feasible option for stroke patients with low ambulation ability.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Feasibility of challenging treadmill speed-dependent gait and perturbation-induced balance training in chronic stroke patients with low ambulation ability: a randomized controlled trial. Hu, J., Jin, L., Wang, Y., et al.[2023]

This review provides evidence-based guidelines for safely implementing aerobic exercise in the early phases post-stroke, emphasizing the importance of pre-participation screening and monitoring for potential complications like blood pressure dysregulation and cerebral hypoperfusion.

Countermeasures such as avoiding prolonged standing and incorporating lower limb movements are recommended to prevent blood pooling and minimize risks during exercise, ensuring a safer rehabilitation process for stroke patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Aerobic Training and Mobilization Early Post-stroke: Cautions and Considerations. Marzolini, S., Robertson, AD., Oh, P., et al.[2020]

In a study of 200 patients with moderate to severe subacute stroke, those who underwent aerobic training experienced a higher rate of serious adverse events compared to those in the relaxation control group, with an incident rate ratio of 1.70.

The occurrence of serious adverse events in the aerobic training group was significantly influenced by pre-existing conditions such as diabetes mellitus and atrial fibrillation, indicating that these factors may increase risk and warrant further investigation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Physical Fitness Training in Patients with Subacute Stroke (PHYS-STROKE): Safety analyses of a randomized clinical trial. Rackoll, T., Nave, AH., Ebinger, M., et al.[2022]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10189784/

Increasing the Amount and Intensity of Stepping Training ... Increasing the amount and cardiovascular intensity of gait training during inpatient stroke rehabilitation was feasible and led to significant improvements in ...

2. nature.com nature.com/articles/s41598-025-17709-4

Goal-setting improves movement accuracy during ... In stroke rehabilitation, several studies and systematic reviews have suggested the positive effects of goal setting on patients' psychological ...

3. ahajournals.org ahajournals.org/doi/10.1161/STROKEAHA.122.038956

Current Evidence for Walking Recovery After Stroke, Future ... Gait speed, lower extremity strength, and self-efficacy at 1- to 3-months poststroke are predictive of self-reported walking performance at >6- ...

4. sciencedirect.com sciencedirect.com/science/article/pii/S1836955319300207

Goal-oriented instructions increase the intensity of practice ... Goal-oriented instructions can result in significant increases in the rate of repetitions of exercise in stroke rehabilitation.

5. tandfonline.com tandfonline.com/doi/full/10.1080/09638288.2025.2499578

How do stroke survivors experience rehabilitation goal ... This study aimed to explore stroke survivors' experiences with their rehabilitation plan across hospital-to-municipality transition.

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12494762/

Goal-setting improves movement accuracy during ... This pilot study investigated whether goal-setting leads to good behavioral performance and high motivation during an unsupervised reaching task ...

7. obrienphysicaltherapy.net obrienphysicaltherapy.net/blog/post-stroke-rehabilitation-outcomes-statistics-on-physical-therapy-effectiveness

Post-Stroke Rehabilitation Outcomes: Statistics on Physical ... Patients receiving higher doses of rehabilitation—ranging from 20 to 300 hours—experience significant improvements in motor impairment and ...