Comparison of 6-Week Reactive Balance Training With and Without Electrical Stimulation for Stroke Recovery

What this Trial Is About

Researchers are evaluating reactive balance training combined with neuromuscular electrical stimulation NMES to improve balance control in people with chronic stroke who have moderate to severe motor impairment. This Phase I, double-blinded, randomized controlled trial compares the effects of 6 weeks of reactive balance training REACT alone versus REACT combined with NMES on biomechanical, clinical, neuromuscular, and neuroplastic outcomes related to reactive balance control. Participants will be randomly assigned to one of two groups the intervention group receives REACT with NMES applied to the paretic lower limb muscles, while the control group receives REACT with sham NMES. Both groups will complete 12 one-hour training sessions over 6 weeks 2 sessions per week. NMES synchronization is controlled by a footswitch on the paretic shoe and is delivered during perturbations mimicking slips. The control group receives low-intensity sham stimulation to prevent unblinding. Participants will undergo initial screening and pre-training assessments including walking tests and laboratory-induced slips or trips to measure balance responses. After the 6-week training, post-training assessments will repeat these tests to evaluate changes. Researchers will measure changes in falls, reactive and proactive stability, muscle activation patterns, neuroplastic brain activity, and clinical balance and gait outcomes. The study lasts approximately 9 weeks per participant and includes detailed monitoring to understand immediate therapeutic effects and underlying mechanisms.

The REACTplusNMES Trial: A Double-blinded RCT