Clinical Research Directory

Effects of Task-Oriented Sit-to-Stand Training Using Immersive VR and PNF on Quality of Life in Chronic Stroke: Trial Protocol

The purpose of this study is to evaluate the effects of two interventions based on different neurophysiological approaches on quality of life in individuals with chronic stroke. The interventions include Immersive Virtual Reality (IVR) and Proprioceptive Neuromuscular Facilitation (PNF), both focused on improving task-oriented sit-to-stand (STS) performance. A control group receiving conventional therapy will also be included. Participants in all three groups will receive 12 treatment sessions delivered three times per week over a 4-week period. The PNF group and the control group will receive 50-minute sessions. The IVR group will receive 10-20 minutes of IVR-based STS training combined with 30-40 minutes of conventional therapy, for a total session duration of 50 minutes. The primary outcome will be quality of life, assessed using the Newcastle Stroke-Specific Quality of Life Measure (NEWSQOL). Secondary outcomes will include STS kinematic parameters (hip, knee, and ankle angular velocity, center of mass displacement, and STS duration), reaction time to gait iniciation (RTGI) measures, fall risk, lower-limb functional strength and endurance, and user satisfaction with the IVR intervention. The study will be conducted in two phases. The first phase will consist of a pilot study to assess the feasibility of the protocol and identify any necessary adjustments to the experimental procedures. The second phase will involve the implementation of the full randomized controlled trial to evaluate the effectiveness of the interventions. This study aims to address the following research questions: (1) Does task-oriented STS training using IVR or PNF improve quality of life in individuals with chronic stroke to a greater extent than conventional therapy? (2) Do IVR- and PNF-based interventions lead to greater improvements in STS kinematics, reaction time and gait initiation, balance, and lower-limb functional strength and endurance compared with conventional therapy? (3) Is there an association between changes in STS kinematic parameters and improvements in stroke-specific quality of life following the intervention?

Comparison of Open Vs Closed Kinetic Chain Exercises in Genu Recurvatum Among Stroke Patients

Brief Summary The goal of this clinical trial is to learn which type of exercise is more effective for reducing knee hyperextension in people who have had a stroke. Knee hyperextension, also called genu recurvatum, occurs when the knee bends too far backward while standing or walking. This problem is common after a stroke and can make walking difficult, reduce balance, increase the risk of falls, and place extra stress on the knee joint. Over time, it may also lead to pain, joint damage, and reduced independence in daily activities. Stroke is one of the leading causes of long-term disability. Many people who survive a stroke experience weakness, muscle stiffness, balance problems, and difficulty controlling movement on one side of the body. These changes can affect the way a person walks. One common walking problem after stroke is knee hyperextension during the part of walking when the foot is on the ground. This may happen because of muscle weakness, poor balance, reduced body awareness, or difficulty controlling movement. As a result, people may walk more slowly, feel less confident when moving, and have difficulty performing everyday tasks. Physical therapy plays an important role in helping people recover after a stroke. Exercise programs are commonly used to improve strength, balance, walking ability, and overall function. Two types of exercises frequently used in rehabilitation are Open Kinetic Chain (OKC) exercises and Closed Kinetic Chain (CKC) exercises. However, there is limited research directly comparing these exercise approaches for treating knee hyperextension after stroke. Open Kinetic Chain exercises involve moving the leg freely while the foot is not fixed to the ground. Examples include straight leg raises, knee extensions while sitting, hip abduction, hip adduction, and hamstring curls. These exercises are often used to strengthen specific muscles and improve movement control. Closed Kinetic Chain exercises involve movements performed with the foot fixed on the ground or another stable surface. Examples include squats, lunges, step-ups, and side step exercises. These exercises require several joints and muscle groups to work together and may better reflect movements used in everyday activities such as standing, walking, and climbing stairs. They may also improve balance and body awareness. The main questions this study aims to answer are: * Does Closed Kinetic Chain exercise reduce knee hyperextension more effectively than Open Kinetic Chain exercise? * Does Open Kinetic Chain exercise improve knee control and walking ability after stroke? * Which exercise program leads to greater improvements in muscle strength, balance, mobility, and independence in daily activities? * Can these exercise programs be safely used as part of stroke rehabilitation? Researchers will compare the effects of these two exercise programs in adults who have experienced a stroke and have weakness on one side of the body. Participants must be able to walk with at least minimal assistance and meet other study requirements. People with certain musculoskeletal conditions, severe communication or cognitive difficulties, or other conditions that may interfere with participation will not be eligible to take part. A total of 60 participants will be enrolled in the study. Participants will be assigned by chance, similar to flipping a coin, to one of two treatment groups. Thirty participants will receive Closed Kinetic Chain exercises, and thirty participants will receive Open Kinetic Chain exercises. Neither participants nor researchers can choose which group a participant joins. Both groups will continue to receive standard rehabilitation care throughout the study. Participants will: * Attend supervised physical therapy sessions three times per week for four weeks. * Complete a total of 12 treatment sessions. * Perform exercises designed to improve lower limb strength and movement control. * Receive either Open Kinetic Chain or Closed Kinetic Chain exercises based on random assignment. * Continue their routine rehabilitation program alongside the study exercises. * Complete assessments before starting treatment and again after completing the intervention period. Participants assigned to the Open Kinetic Chain exercise group may perform activities such as: * Straight leg raises while lying down. * Knee extensions while sitting. * Hip abduction exercises. * Hip adduction exercises. * Hamstring curl exercises. Participants assigned to the Closed Kinetic Chain exercise group may perform activities such as: * Lunges. * Semi-squats. * Forward step-up and step-down exercises. * Side step-up and step-down exercises. Researchers will measure several outcomes before and after the treatment period. These measurements will help determine whether either exercise program improves movement and function.

Minocycline in Stroke Study at Maimonides

The goal of this study is to determine if Minocycline, when added to standard care, can improve survival and functional outcomes in patients with moderate acute stroke (ischemic or hemorrhagic) aged 18 years and older. The main questions it aims to answer are: 1. Does Minocycline improve \*National Institutes of Health Stroke Scale\* (NIHSS) scores at hospital discharge and 90 days post-stroke? 2. Does Minocycline reduce stroke-related disability, all-cause in hospital mortality (mRS -\*Modified Rankin Scale\* = 6) and at 90 days besides reducing brain bleeding complications compared to standard care? Researchers will compare patients receiving oral Minocycline plus standard care to those receiving standard care only to see if Minocycline leads to better neurological outcomes and lower mortality. Participants will: 1. Be randomly assigned by block to receive either: Minocycline 200 mg orally once daily for five days within 24 hours from symptoms onset + Standard Care, or Standard Care only 2. Undergo neurological assessments using NIHSS \*National Institutes of Health Stroke Scale\* and Modified Rankin Scale (mRS) at admission, discharge, 30 days post-stroke, 90 days post-stroke 3. Be monitored for: a) hemorrhagic transformation of ischemic strokes; b) Adverse events and mortality outcomes; c) Safety and efficacy signals through interim analyses NIHSS: \*National Institutes of Health Stroke Scale\*, which is stroke severity scale, mRS: \*Modified Rankin Scale\*, which is stroke disability scale