Tele-based ischemic conditioning for chronic stroke: Safety, feasibility, and preliminary neurophysiological and motor effects

To examine the safety and feasibility of a two-week (seven-session) tele-based ischemic conditioning (tele-IC) intervention in individuals with chronic stroke and to explore secondary neurophysiological and motor outcomes. METHODS: Ten individuals with chronic stroke (8 males; age 61.7 ± 7.3 years; time since stroke 11.5 ± 7.5 years; Fugl-Meyer Lower Extremity score 20.5 ± 6.6) completed tele-IC. The primary outcomes were safety and feasibility. Safety was assessed through monitoring of IC-related adverse events and side effects across sessions; feasibility was evaluated through screening-to-enrollment, retention, intervention adherence, tolerability, and acceptability. Secondary exploratory outcomes included corticomotor excitability, transcallosal inhibition, lower-limb strength, paretic ankle motor control, and gait speed. Outcomes were assessed before and 24 h after the intervention. RESULTS: Across 70 tele-IC sessions, no serious adverse events occurred, and all 10 participants completed all seven sessions. Acceptability was high, including ratings for safety (4.9/5), remote assistance (4.8/5), and overall satisfaction (4.8/5). Exploratory analyses showed increased transcallosal inhibition (d_z = 0.929, p = 0.017), changes in bilateral lower-limb strength (d_z = 0.873-1.756), and shorter paretic ankle reaction time (d_z = 0.844, p = 0.049). Corticomotor excitability and gait speed did not significantly change. CONCLUSIONS: In this small, uncontrolled pilot study, synchronously supervised tele-IC was delivered with complete intervention adherence, no serious adverse events, and high participant acceptability. Exploratory secondary neurophysiological and motor findings require confirmation in larger controlled trials.