Grant: Doctoral Award - Frederick Banting and Charles Best Canada Graduate Scholarships

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. Even though exercise is the main form of treatment used by physiotherapists in stroke rehabilitation, the ability of exercise to promote recovery of muscles after stroke is not known. This study will examine the effects of a novel retraining protocol that focusses on speed of muscle contraction to develop the fast bursts of muscle activation necessary for normal walking and standing balance. Given that keeping one's balance requires fast muscle activity, rehabilitation after stroke should focus on speed of movement. The purpose of this study is to determine whether Fast muscle Activation and Stepping Training, or FAST, exercises will improve walking balance in individuals after stroke more than usual care. Sixty patients who have been recently discharged from in-patient stroke rehabilitation will be randomly assigned to one of two groups: FAST exercises or usual care. Both groups will receive two treatments per week for six weeks with a physiotherapist at the out-patient physical therapy department of one of two local hospitals. The FAST exercises will include fast squats and stepping in standing. The usual care group will include strengthening and range of motion exercises, but no speed work. Walking balance and cortical excitability will be tested before, immediately after, and one month after therapy using clinical and laboratory measurements including assessment of walking, balance confidence, brain activation, muscle electrical activity, and the amount of body sway during standing. If FAST exercises are effective, walking balance will be better than in the usual care group. This study will examine whether these specific exercises could be used by physiotherapists to improve walking balance after stroke.