Post-Stroke Optimization of Walking Using Explosive Resistance

Depression is the most common neuropsychiatric manifestation following stroke and current
treatments are largely ineffective. Depression has both direct and indirect effects on
response to rehabilitation, thus subjects with post-stroke depression (PSD) are routinely
excluded from clinical trials and treatment options are extremely limited. The investigators
propose to determine the impact of a novel, high-intensity resistance training program,
Post-stroke Optimization of Walking using Explosive Resistance (POWER) training, on
post-stroke depressive symptoms. Further, the investiators will determine if depression
limits training-induced improvements in muscular and locomotor function. This project is
based on the premise that depression negatively affects the potential for neuroplastic
changes to occur in response to treatment such that rehabilitation may not produce the same
adaptations that it does in non-depressed individuals. The investigators propose that
effective treatment for PSD would result in a virtuous cycle where reducing depression
enhances neuroplastic changes, thereby facilitating functional gains. That is, effectively
treating depression will make the individual better able to recover from stroke. Furthermore,
in addition to its beneficial effects on depression, POWER training is known to improve
post-stroke walking, thus providing an attractive option for treating depression as well as
an established vehicle to study the effects of PSD on response to rehabilitation. The
experiments proposed as part of this project are designed to address critical questions
related to 1) the effects of POWER training on depressive symptoms; 2) the potential for PSD
to limit improvements following training; and 3) the interaction between improvements in
depression and increases in walking function. Successful completion of this project will
provide a foundation for larger scale trials to determine dosing parameters as well as
establish therapeutic effectiveness of POWER training on post-stroke depression as well as
identify the mechanisms that may be responsible for the changes that occur in response to
treatment.

Inclusion Criteria:

- age 50-70

- stroke within the past 6 to 60 months

- residual paresis in the lower extremity (Fugl-Meyer LE motor score <34)

- ability to walk without assistance and without an AFO during testing and training at
speeds ranging from 0.2-0.8 m/s

- no antidepressant medications or no change in doses of psychotropic medication for at
least 4 weeks prior to the study (6 weeks if newly initiated medication)

- HRSD question #9 regarding suicide <2; and 7) provision of informed consent.

Exclusion Criteria:

- Unable to ambulate at least 150 feet prior to stroke, or experienced intermittent
claudication while walking

- history of congestive heart failure, unstable cardiac arrhythmias, hypertrophic
cardiomyopathy, severe aortic stenosis, angina or dyspnea at rest or during ADL's

- History of COPD or oxygen dependence

- Preexisting neurological disorders, dementia or previous stroke

- History of major head trauma

- Legal blindness or severe visual impairment

- history of psychosis or other Axis I disorder that is primary

- Life expectancy <1 yr.

- Severe arthritis or other problems that limit passive ROM

- History of DVT or pulmonary embolism within 6 months

- Uncontrolled diabetes with recent weight loss, diabetic coma, or frequent insulin
reactions

- Severe hypertension with systolic >200 mmHg and diastolic >110 mmHg at rest

- attempt of suicide in the last 2 years or at suicidal risk assessed by SCID interview

- History of seizures or currently prescribed anti-seizure medications

- Current enrollment in a clinical trial to enhance motor recovery

- Pregnancy