Comparison of Open Vs Closed Kinetic Chain Exercises in Genu Recurvatum Among Stroke Patients: A Randomized Controlled Trial
试验速览
- 阶段
- 不适用
- 状态
- Enrolling By Invitation
- 入组人数
- 60
- 试验地点
- 1
- 主要终点
- Knee hyperextension with Goniometer
研究概览
简要总结
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.
详细描述
Background and Rationale
Stroke remains a leading cause of long-term disability worldwide, ranking among the top causes of death and accounting for a substantial proportion of disability-adjusted life years globally. Post-stroke gait abnormalities are common and vary according to the severity of sensorimotor impairment. One of the most frequently observed deviations in the paretic limb during the stance phase of gait is knee hyperextension, also known as genu recurvatum, which has been reported to affect approximately 40% to 68% of individuals with chronic hemiparetic stroke.
Knee hyperextension compromises joint stability, disrupts normal gait mechanics, and is associated with reduced walking speed and efficiency, as well as pain and an increased risk of long-term musculoskeletal complications such as joint degeneration. The condition is thought to arise from a combination of factors, including quadriceps weakness, plantar flexor spasticity, weak gluteal and hamstring muscles, limited ankle dorsiflexion, hip flexion contracture, and proprioceptive deficits. Because the underlying causes vary across individuals, rehabilitation strategies that fail to address the specific contributing impairments may be less effective.
Several intervention approaches have been described for managing post-stroke knee hyperextension, including functional electrical stimulation, electrogoniometric biofeedback, orthotic management, and surgical intervention; however, no consistently established best-practice rehabilitation protocol currently exists. Progressive resistance training (PRT) is widely used in stroke rehabilitation to increase muscle strength and improve functional outcomes, and is broadly categorized into open kinetic chain (OKC) and closed kinetic chain (CKC) exercise approaches.
OKC exercises involve movement of the distal limb segment in a non-weight-bearing position (for example, seated knee extension or straight leg raise) and are typically used to isolate and strengthen specific muscle groups, though they provide comparatively less joint stability and proprioceptive input. CKC exercises involve movement with the distal segment fixed against a surface in a weight-bearing position (for example, squats, step-ups, or lunges); these exercises are considered more functional, as they more closely replicate movement patterns used in walking and other activities of daily living, and are thought to enhance proprioception, joint stability, and coordinated multi-joint muscle activation.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Double (Participant, Outcomes Assessor)
入排标准
- 年龄范围
- 30 Weeks 至 65 Weeks（Child）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Male and female participants
- •Age between 30 and 65 years
- •Referred by a neurologist
- •Diagnosed case of stroke with one-sided hemiparesis
- •Functional ambulatory capacity (Functional Ambulation Category ≥ 2)
- •Muscle strength of at least grade 3+ on the Manual Muscle Testing (MMT) scale in the affected lower limb
- •No participation in other rehabilitation programs during the study period
排除标准
- •Participants with any musculoskeletal condition such as osteoarthritis or ligament laxity
- •Significant cognitive, communicative, perceptual, or sensory problems that hinder understanding and/or following verbal commands
- •Pregnant individuals
研究组 & 干预措施
Open Kinetic Chain Exercises
- Straight leg raising in lying position
- Knee extension in sitting position
- Hip abduction in lying position
- Hip adduction in lying position
- Prone Hamstring Curl
干预措施: Open and closed kinetic chain exercises (Other)
Closed Kinetic Chain Exercises
- Lunges
- Semi Squat
- Forward step up and down
- Side step up and down
干预措施: Open and closed kinetic chain exercises (Other)
结局指标
主要结局
Knee hyperextension with Goniometer
时间窗: Assessment takes approximately 2-5 minutes per knee and may be performed at baseline and after the intervention period (e.g., 6-8 weeks) to evaluate changes in knee alignment and range of motion.
Knee hyperextension is measured using a universal goniometer to determine the degree to which the knee extends beyond the neutral anatomical position (0°). The patient lies in a supine position with the lower limb fully supported. The fulcrum of the goniometer is placed over the lateral epicondyle of the femur, the stationary arm is aligned with the greater trochanter of the femur, and the movable arm is aligned with the lateral malleolus of the fibula. The patient actively or passively extends the knee to its maximum range. Any extension beyond 0° is recorded as hyperextension (e.g., 5°, 10°, or 15° hyperextension).
Muscle Strength with dynamometer
时间窗: The assessment requires approximately 5-10 minutes to complete and can be performed at baseline and after the intervention period (e.g., 6-8 weeks) to evaluate changes in muscle strength.
The dynamometer is an objective and reliable tool used to measure muscle strength by quantifying the force generated during a muscle contraction. During testing, the participant performs a maximal voluntary isometric contraction against the dynamometer. Dynamometers are commonly used to assess the strength of various muscle groups, including the quadriceps, hamstrings, hip muscles, and upper limb muscles. Higher values indicate greater muscle strength. Dynamometry is widely used in clinical practice and research to evaluate baseline strength, monitor rehabilitation progress, and assess treatment outcomes.
次要结局
- Barthel Index (BI)(The Barthel Index will be assessed at baseline and after 4 weeks of intervention to measure changes in activities of daily living and functional independence)
- Gait Dynamic Index(The Dynamic Gait Index takes approximately 10-15 minutes to administer and can be assessed at baseline and after the intervention period (4 weeks) to evaluate changes in dynamic balance and gait performance.)
- Berg Balance Scale(he Berg Balance Scale takes approximately 15-20 minutes to administer and can be assessed at baseline and after the intervention period (4 weeks) to evaluate changes in balance performance)
研究者
Dr. Syeda Areeba Asif
P.G Trainee
Dow University of Health Sciences