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Chronic StrokeNCT07804342

Ankle Robotics for Error Augmentation After Stroke

A study testing AMBLE in people with Chronic Stroke, run by University of Maryland, Baltimore at 2 sites in United States.

Enrolling by invitation

Enrolling by invitation. The study team selects and invites participants, usually from an existing group of patients.

Sites and contacts
Official record
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Trial summary

The goal of this pilot clinical trial is to test whether training with a portable ankle robot improves ankle push-off and walking speed in adults with chronic stroke who have ankle weakness. The study will also evaluate whether the device is safe and practical to use during walking rehabilitation. Read more about this study

Who is it for?
Ages 18 to 88 years
Conditions the study is for
Chronic Stroke
What is being tested?
AMBLE
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
10 participants
Where
2 sitesUnited States
Study dates
16 Jun 2025to Dec 2027
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 88 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Chronic stroke, more than 6 months post-stroke
  • Clinical evidence of hemiparetic gait
  • Ankle dorsiflexion and plantarflexion strength on the affected side graded 1/5 (trace contraction) to 4/5 (reduced strength) on manual muscle testing
  • Able to independently complete the 10-Meter Walk Test at a walking speed less than 1.0 m/s, with or without an assistive device

Who cannot join

  • Self-reported unstable angina, myocardial infarction within the past 3 months, congestive heart failure (NYHA Class II), or hemodynamically significant valvular disease
  • Self-reported hypertension that is a contraindication to routine physical therapy (greater than 160/100 mmHg on two assessments)
  • Self-reported hospitalization within the past 3 months for severe medical illness
  • Self-reported symptomatic peripheral arterial occlusive disease
  • Self-reported orthopedic conditions or chronic pain that significantly alter gait function
  • Self-reported pulmonary or renal failure
Show all 11Show fewer
  • Self-reported active cancer
  • Self-reported history of a non-stroke neuromuscular disorder restricting gait
  • Aphasia or cognitive functioning that confounds participation, defined as unable to follow two-step commands or by judgment of the evaluating therapist
  • Self-reported history of cerebellar stroke or observable cerebellar signs
  • Self-reported botulinum toxin prescribed for the lower extremities within the previous 3 months

Trial locations and contacts

2 sites in 1 country. Contact the study team or a site near you to ask about taking part.

United States2 sites
  • Allied Health Research Building

    Baltimore, Maryland, 21042

  • Allied Health Research Building

    Baltimore, Maryland, 21201

Other trials in United States

About this study

The goal of this pilot clinical trial is to test whether training with a portable ankle robot improves ankle push-off and walking speed in adults with chronic stroke who have ankle weakness. The study will also evaluate whether the device is safe and practical to use during walking rehabilitation.

The main questions it aims to answer are:

Read more

Does training with the portable ankle robot improve paretic ankle propulsion during walking? Does training with the portable ankle robot improve walking speed at self-selected and fast walking speeds?

Participants will:

Complete 30 training sessions of treadmill and overground walking while wearing the portable ankle robot, 3 to 4 times per week over 8 to 9 weeks Complete walking and movement assessments before training, after 15 sessions, and after 30 sessions Walk at self-selected and fast speeds while researchers measure ankle propulsion, gait symmetry, and walking speed

Read the detailed description

This is a single-arm pilot study evaluating robotic error augmentation of paretic ankle propulsion during gait training in adults with chronic stroke. Ten participants with chronic (>6 months) stroke and residual ankle weakness will complete 30 training sessions using the AMBLE portable ankle exoskeleton. Assessments are conducted at baseline, after 15 sessions, and after 30 sessions. The hypothesis is that 30 sessions of robot-assisted treadmill gait training enhances paretic ankle plantarflexion propulsive torque and gait symmetry.

Approximately half of stroke survivors are left with chronic mobility disability, typically involving ankle weakness that impairs walking and increases fall risk. Current care relies on ankle-foot orthoses, functional electrical stimulation, canes, and walkers, none of which address the underlying deficit in ankle motor control. Weakness of the paretic plantarflexors limits push-off during late stance, reducing forward propulsion and contributing to reduced walking speed and gait asymmetry.

The investigators previously developed the AMBLE, a lightweight portable ankle exoskeleton that uses impedance-based control with real-time gait event detection to deliver torque synchronized to specific phases of the gait cycle. Prior work by this group using laboratory-based and portable ankle robotics targeted dorsiflexion, demonstrating reduced foot drop and improved overground walking in both early and chronic stroke, and the present study extends an ongoing investigation of the device (NCT04594837). Paretic plantarflexion propulsion has not previously been targeted with the AMBLE. Recent engineering modifications enable graded resistance during the push-off phase of gait, permitting investigation of whether error augmentation applied to paretic ankle propulsion can enhance forward propulsion during walking.

Training sessions consists of two 10-minute bouts of treadmill walking at progressively increasing speed and one 10-minute bout of overground walking as able, with the robot donned on the paretic leg. Plantarflexion resistance is delivered through the ankle robot and calibrated individually, increased as tolerated up to the level just below the point at which hip circumduction or instability emerges. Resistance is applied after attainment of steady-state walking speed and intermittently removed at predetermined intervals to sample voluntary paretic ankle power. Treadmill speed is then progressed toward a target of 70-85% heart rate reserve and RPE 15-18, recorded every 3-5 minutes. Seated rest of 2-3 minutes is provided between bouts.

Visual feedback of ankle propulsion power is delivered through a tablet-based application on a faded schedule: continuously during weeks 1-2, for 1 minute every 5 minutes during weeks 3-4, for 1 minute at the end of each 10-minute bout during weeks 5-6, and as terminal summary feedback during seated rest in weeks 7-9.

Assessments include the 10-meter walk test at self-selected and fastest comfortable speeds; overground gait biomechanics using an instrumented walkway for spatiotemporal parameters and gait symmetry and two force plates for propulsive torque during push-off; and paretic and non-paretic ankle power normalized to body mass with kinetic symmetry, collected during unassisted walking with the device in evaluation mode. The Fugl-Meyer Assessment for the Lower Extremity is administered at baseline. Baseline and post-training measures will be compared using paired t-tests or nonparametric equivalents. Findings will provide preliminary effect estimates to inform the design of a larger trial.

Conditions
Chronic Stroke
Being tested
AMBLE
Keywords
error augmentation, robotics, device, walking

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • AMBLEDevice

    The AMBLE is a portable robotic ankle exoskeleton designed to provide individualized assistance and/or resistance during gait training. The device uses adaptive impedance-based control and real-time gait detection to provide dorsiflexion assistance during swing and plantarflexion assistance or resistance during push-off based on participant performance. It is used during treadmill and overground walking to promote recovery of ankle motor control and walking function.

Study groups in NCT07804342
Study groupRoleWhat they receive
AMBLE Robotic Gait TrainingExperimentalParticipants with chronic stroke will receive a 30-session gait training program using the AMBLE portable robotic ankle exoskeleton. Training will include treadmill and overground walking with individualized robotic resistance to improve ankle plantarflexion during push-off. Robotic assistance will be adjusted throughout the intervention based on participant performance and tolerance to promote active motor recovery and improve walking function.
Receives: Device: AMBLE

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Peak ankle plantarflexion propulsive torque during walking

    Peak ankle plantarflexion propulsive torque will be measured using force plates during overground walking to quantify propulsion generated by the paretic limb during the push-off phase of gait.

    Measured: Baseline (prior to intervention), 5 weeks after intervention initiation (following approximately 15 sessions), and 10 weeks after intervention initiation (following approximately 30 sessions)

Secondary outcomes (3)
  1. Self-selected walking speed

    Self-selected walking speed will be assessed using the 10-Meter Walk Test and reported in meters per second.

    Measured: Baseline (prior to intervention), 5 weeks after intervention initiation (following approximately 15 training sessions), and 10 weeks after intervention initiation (following approximately 30 training sessions)

  2. Fast walking speed

    Maximum comfortable walking speed will be assessed using the 10-Meter Walk Test and reported in meters per second.

    Measured: Baseline (prior to intervention), 5 weeks after intervention initiation (following approximately 15 training sessions), and 10 weeks after intervention initiation (following approximately 30 training sessions)

  3. Step Length Symmetry Ratio During Overground Walking Measured by Instrumented Walkway

    Step length symmetry ratio computed as paretic step length divided by non-paretic step length from spatiotemporal data collected during overground walking on a GAITRite instrumented walkway. A ratio of 1.0 indicates perfect symmetry between limbs; values below 1.0 indicate shorter paretic steps and values above 1.0 indicate longer paretic steps. Values are averaged across [N] walkway passes at self-selected walking speed at each assessment timepoint. Unit of Measure: ratio

    Measured: Baseline (prior to intervention), 5 weeks after intervention initiation (following approximately 15 training sessions), and 10 weeks after intervention initiation (following approximately 30 training sessions)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted4 Sep 2026
  2. Study start16 Jun 2025
  3. Primary completionJul 2027 (estimated)
  4. Study completionDec 2027 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Model description
All enrolled participants will be assigned to a single intervention arm and receive the AMBLE robotic gait training intervention. Outcomes will be evaluated longitudinally using repeated assessments performed before, during, and after completion of the 30-session training program
Masking
None (open label)
Enrolment
10 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07804342
Sponsor's protocol ID
HP-00108406
Status last verified
Aug 2026
First submitted
17 Aug 2026
Last updated
4 Sep 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
Yes
Individual data sharing
No

Publications

  • Forrester LW, Roy A, Krebs HI, Macko RF. Ankle training with a robotic device improves hemiparetic gait after a stroke. Neurorehabil Neural Repair. 2011 May;25(4):369-77. doi: 10.1177/1545968310388291. Epub 2010 Nov 29.

    PubMed 21115945
  • Forrester LW, Roy A, Krywonis A, Kehs G, Krebs HI, Macko RF. Modular ankle robotics training in early subacute stroke: a randomized controlled pilot study. Neurorehabil Neural Repair. 2014 Sep;28(7):678-87. doi: 10.1177/1545968314521004. Epub 2014 Feb 10.

    PubMed 24515923
  • Macko RF, Ivey FM, Forrester LW, Hanley D, Sorkin JD, Katzel LI, Silver KH, Goldberg AP. Treadmill exercise rehabilitation improves ambulatory function and cardiovascular fitness in patients with chronic stroke: a randomized, controlled trial. Stroke. 2005 Oct;36(10):2206-11. doi: 10.1161/01.STR.0000181076.91805.89. Epub 2005 Sep 8.

    PubMed 16151035
  • Macko RF, Ivey FM, Forrester LW. Task-oriented aerobic exercise in chronic hemiparetic stroke: training protocols and treatment effects. Top Stroke Rehabil. 2005 Winter;12(1):45-57. doi: 10.1310/PJQN-KAN9-TTVY-HYQH.

    PubMed 15736000
  • Westlake KP, Dudek K, Roy A, Henderson CE, Hornby TG. The Concept of Shaping Applied to Locomotor Interventions: Clinical and Robotic Strategies to Facilitate and Progress Variable Stepping Training at Higher Intensities. Neurorehabil Neural Repair. 2026 Jun 15:15459683261454948. doi: 10.1177/15459683261454948. Online ahead of print.

    PubMed 42290198

Questions about this trial

What is this clinical trial studying?

A study testing AMBLE in people with Chronic Stroke, run by University of Maryland, Baltimore at 2 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 11 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: enrolling by invitation, as of the sponsor's last update on 4 Sep 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Peak ankle plantarflexion propulsive torque during walking (time frame: Baseline (prior to intervention), 5 weeks after intervention initiation (following approximately 15 sessions), and 10 weeks after intervention initiation (following approximately 30 sessions)). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT07804342, which also lists 5 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 4 Sep 2026.

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