Effects of Reactive and Proactive Exercises on Ankle Spasticity in Patients with Chronic Stroke: A Randomized Clinical Trial

Abstract

Introduction: Stroke is a leading cause of adult disability. Spasticity is a neurological condition that occurs secondary to stroke and affects the patient’s quality of life. This study aimed to compare the effects of reactive and proactive exercises on spasticity in people with stroke. Materials and Methods: In this single-blind clinical trial, 30 individuals with stroke were randomly divided into three groups: Control, reactive, and proactive, of which 27 patients completed the study. These individuals were treated for 12 sessions for 4 weeks (three times a week). The control group received conventional exercises, the reactive group received conventional exercises plus reactive exercises, and the proactive group received conventional exercises plus proactive exercises. The outcomes were clinical measures of spasticity at baseline and neural properties, evaluated using the Modified Modified Ashworth Scale and H-reflex latency and Hmax/Mmax ratio. All statistical analyses were performed using SPSS software, version 20. Results: No significant differences were observed between the groups in H-reflex latency (F=0.404, P=0.672, ηp2=0.033) and Hmax/Mmax ratio (F=0.878, P=0.429, ηp2=0.071). Conclusion: Intergroup comparisons did not show a significant advantage of proactive and reactive exercises over conventional exercises alone in improving neural properties of spasticity. Copyright © 2026 Tehran University of Medical Sciences.