Proprioceptive Training With or Without Strength Training on Tibialis Anterior in Chronic Stroke Patients

Stroke is a major cause of long-term disability worldwide and is frequently associated with persistent motor and sensory impairments. Individuals living with chronic stroke often experience reduced muscle strength, impaired proprioception, balance deficits, gait abnormalities, and decreased functional mobility. These impairments can limit participation in daily activities and reduce overall quality of life.

The tibialis anterior muscle is an important component of lower-limb function because it contributes to ankle dorsiflexion during gait and assists with postural control. Weakness of this muscle following stroke may contribute to foot drop, reduced walking efficiency, impaired balance, and an increased risk of falls. Rehabilitation strategies that target both sensory and motor impairments may support recovery of lower-extremity function.

Proprioception refers to the ability to perceive joint position and movement through sensory input from muscles, tendons, and joints. Following stroke, disruption of sensory pathways may impair proprioceptive function and negatively affect motor performance. Proprioceptive training is commonly used in rehabilitation programs to improve sensory awareness, postural control, coordination, and movement quality through structured balance and functional activities.

Strength training is another established rehabilitation intervention used to address muscle weakness after stroke. Targeted strengthening exercises may improve force generation, neuromuscular activation, and lower-extremity performance during functional tasks. Strengthening the tibialis anterior muscle may assist with ankle control and walking-related activities.

This study will use a randomized controlled trial design. Participants diagnosed with chronic stroke who meet the eligibility criteria will be recruited from the University of Lahore Teaching Hospital. Following informed consent and baseline assessment, participants will be randomly allocated to one of two groups:

Group A: Proprioceptive training combined with tibialis anterior strength training.

Group B: Proprioceptive training alone.

The intervention period will last six weeks. Assessments will be conducted at baseline, Week 3, and Week 6. Outcome measures will evaluate lower-limb muscle strength, balance performance, gait characteristics, and functional mobility.

The study is designed to examine rehabilitation approaches commonly used in neurological physical therapy and to provide information regarding their application in individuals with chronic stroke. The findings may help guide future rehabilitation programs aimed at improving lower-extremity function, mobility, and participation in daily activities among stroke survivors.

Inclusion criteria

• Residual paresis in the lower extremity (Shahid et al., 2013).
• Ability to sit unsupported for 30 seconds (Shahid et al., 2013).
• Ability to follow 3 steps command (Shahid et al., 2013).
• Least degree of the associated reaction (Shahid et al., 2013).
• Survivor with stable C.V.S system (Shahid et al., 2013).
• Survivor without fixed contracture of the lower extremity (Shahid et al., 2013).
• Participants having a history of stroke within the prior 6 months or more (S. H. Chae et al., 2017).
• Participants having ability to understand the directions from the researchers (those with a MMSE score of 24 or greater) (S. H. Chae et al., 2017).
• Patients with grade 1 on modified Ashworth scale (Jan et al., 2019).

Exclusion criteria

• Presence of acute musculoskeletal symptoms (S. H. Chae et al., 2017).
• Participants having inability to communicate, and those deemed unable to participate in the study by the researchers (S. H. Chae et al., 2017).
• Serious cardiac condition (history of the CHF, documented serious and unstable cardiac arrhythmias (Shahid et al., 2013).
• Hypertrophic cardiomyppathy, severe aortic stenosis, history of severe COPD.
• Angina and dyspnea at rest or during ADL (Shahid et al., 2013).