# Incline Training to Personalize Motor Control Interventions after Stroke

> **NIH VA I01** · RALPH H JOHNSON VA MEDICAL CENTER · 2020 · —

## Abstract

The long term goal of this research is to advance personalization of walking rehabilitation for individuals post-
stroke by developing therapeutic strategies targeting an individual’s specific motor control deficit. Stroke is an
incredibly heterogeneous population, and while various therapeutic approaches have produced large effects in
some individuals, group effects are often minimized by those who fail to respond to the intervention, leading to
a paucity of efficacious randomized controlled trials. In addition, evidence supporting mechanisms by which
walking is improved is limited, and we currently lack models predicting which individuals are likely to respond to
an intervention and the mechanisms by which they improve. An urgent need exists to maximize treatment effect
by targeting specific motor control impairments and improve predictive capability by developing theory-based
clinical decision-making frameworks to translate interventions tailored to specific deficits for walking rehabilitation
after stroke. Our overall goal for this project is to test a motor control deficit-based treatment approach that we
developed, in order to provide information necessary for future translation of personalized interventions. We
previously published the existence of distinct post-stroke motor control deficits based on the percentage of
overall propulsive forces generated by the paretic leg termed paretic propulsion (Pp), a widely accepted
biomechanical outcome measure that we developed. 1) Low Pp is associated with large and early paretic flexor
EMG activity, lengthened paretic step length, and decreased paretic hip extension; and 2) High Pp pattern is
characterized by decreased knee flexion during paretic swing, shortened paretic step length, and prolonged
paretic hip extension. Our pilot data reveal that individuals with these walking patterns are most effectively
rehabilitated by unique treatment strategies: 1) Low Pp by walking on an inclined treadmill requiring increased
force production; and 2) High Pp by walking on a declined treadmill, promoting effective stance to swing
transitions through normalization of joint kinetics and kinematics. The hypothesized ideal training strategy
(INCLINE for low Pp and DECLINE for high Pp) is the personalized strategy and will be compared to non-
personalized strategies (DECLINE for low Pp and INCLINE for high Pp). Both personalized strategies will be
compared to a CONTROL group training on a flat treadmill at equivalent amounts of walking activity. Pilot training
data demonstrate that personalized strategies demonstrate a larger effect on self-selected walking speed
(SSWS) and symmetry of Pp. Thus, the purposes of this proposal are to compare clinical and biomechanical
outcomes from personalized strategies to both non-personalized strategies and control interventions and to
identify the variables that predict meaningful changes in SSWS. To accomplish these purposes, we will equally
randomize 60 individuals (30 with ...

## Key facts

- **NIH application ID:** 10011586
- **Project number:** 5I01RX002665-03
- **Recipient organization:** RALPH H JOHNSON VA MEDICAL CENTER
- **Principal Investigator:** Mark G. Bowden
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2018-07-01 → 2022-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10011586

## Citation

> US National Institutes of Health, RePORTER application 10011586, Incline Training to Personalize Motor Control Interventions after Stroke (5I01RX002665-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10011586. Licensed CC0.

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