Balance and walking after three different models of stroke rehabilitation: early supported discharge in a day unit or at home, and traditional treatment (control) (original) (raw)
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The effects of a task-oriented walking interventions on balance in chronic stroke patients
Journal of Experimental Stroke & Translational Medicine, 2021
Stroke is a neurological insufficiency which causes major motor deficits particularly in lower limbs. Task oriented walking intervention is a novel approach used for stroke rehabilitation. The purpose of this research study was to compare the effects of the task oriented walking interventions with the conservative rehabilitation for improvement of balance in the chronic stroke patients. The study was a randomized control trial, conducted in hospital settings. 48 patients with predefined inclusion and Exclusion criteria were selected. Subjects were randomly allocated into 2 groups. After obtaining consent, data was collected via self-structured questionnaire, 06 minutes-walk test, Timed "Up and Go" test, and Berg Balance Scale. Group one received Task-Oriented Walking Intervention interventions and conventional treatment while control group received conventional interventions only. Data was analyzed by SPSS version 24. The results showed that, there were 54% males and 46% females. After 6 weeks of intervention experimental group receiving task oriented training along with conventional interventions showed significant improvement in balance with P-value <0.005 for all the three scales TUG, BBS and 6MWT as compared to the control group receiving only conventional interventions. Our respective study concluded that patients who were receiving task oriented walking interventions had considerable improvement in balance.
Archives of Physical Medicine and Rehabilitation, 2012
Blennerhassett JM, Dite W, Ramage ER, Richmond ME. Changes in balance and walking from stroke rehabilitation to the community: a follow-up observational study. Arch Phys Med Rehabil 2012;93:1782-7. Objectives: To investigate (1) whether clinical test scores at discharge predict falls or limited community mobility after discharge from inpatient stroke rehabilitation; and (2) how walking and dynamic standing balance change after discharge. Design: Follow-up observational study between 6 and 36 months after discharge. Setting: Rehabilitation setting. Participants: Community-dwelling stroke survivors (Nϭ30) who could walk unassisted when discharged from inpatient rehabilitation. Interventions: Not applicable. Main Outcome Measures: Six-minute walk test (6MWT), Four Square Step Test (FSST), Step Test (ST), Environmental Analysis of Mobility Questionnaire (EAMQ), Falls Efficacy Scale-International (FES-I), and self-reported falls. Results: Follow-up occurred at a median of 14.5 months postdischarge. Significant improvements occurred between discharge and follow-up for the 6MWT (mean difference [MD]ϭ110.1m; 95% confidence interval [CI], 70.8 -149.4; PϽ.001), ST (MDϭ1.8 steps; 95% CI, 0.3-3.4; Pϭ.03), and FSST (MDϭ4.3s; 95% CI, Ϫ10.3 to 1.6; Pϭ.05). Despite this, 40% of participants reported falling. The group who fell had lower clinical test scores at discharge and follow-up than nonfallers. Specific cutoff scores for the clinical tests accurately classified falls history in 70% to 78% of participants. The cutoff scores were Ͻ250m for the 6MWT, Ͻ10 steps on the ST, and a failure or Ն15 seconds to complete the FSST. Participants performing under the cutoff scores reported lower levels of community mobility (EAMQ, PϽ.04). Concern about falling was only higher for those classified at risk by the FSST (FES-I, Pϭ.008).
Stroke, 2005
Background and Purpose-The optimal organization of rehabilitation services after discharge from a stroke unit has not been determined. This study sought to evaluate the effect of early supported discharge and continued rehabilitation at home (ESD), in terms of patient outcome 5 years after stroke and changes in selected data over time. Methods-Eighty-three patients from Southwest Stockholm, mildly or moderately impaired 5 to 7 days after acute stroke, were enrolled in a randomized controlled trial. The core components of the ESD service were initial treatment in a stroke unit and the involvement of an outreach team to deliver and coordinate home-based rehabilitation in partnership with the patient. At the 5-year follow-up, measures used to assess patient outcome included survival, motor capacity, dysphasia, activities of daily living (ADL), social activities, subjective dysfunction, and self-reported falls. Results-Fifty-four patients (30 in the intervention group and 24 in the control group) were evaluated 5 years after stroke, at which time a significantly larger proportion of patients in the intervention group were independent in extended ADL and active in household activities. Conclusions-This ESD service has a beneficial effect on extended ADL 5 years after stroke for mildly to moderately impaired patients. (Stroke. 2005;36:297-302.
Scandinavian Journal of Rehabilitation Medicine, 2000
A 6-month follow-up of a single-blind, randomized, controlled trial in Southwest Stockholm was performed in order to evaluate the effect of early supported discharge and continued rehabilitation at home after stroke. Eighty-three stroke patients with moderate neurological impairments, continent, independent in feeding, and mental function within normal limits one week after onset were included in the study. The patients were allocated 1:1 to early supported discharge and continued rehabilitation at home by a specialized team, versus routine rehabilitation. Patient outcomes measured were motor capacity, dysphasia, activities of daily living, social activities, perceived dysfunction, mortality and reported falls. Data on length of stay in hospital; initial and recurrent during 6 months were compared. The 6-month follow-up of 78 patients showed no statistically significant differences in patient outcome. The results of multivariate logistic regression analysis suggest a positive effect of home rehabilitation on activities of daily living. At 3-6 months the frequency of significant improvements was higher in the intervention group. Death or dependency in activities of daily living was 24% in the intervention group compared with 44% in the control group. The mean initial hospitalization was 29 days in routine rehabilitation group versus 14 days in the home rehabilitation group. We conclude that for moderately disabled stroke patients with mental function within normal limits, early supported discharge and continued rehabilitation at home had no less a beneficial effect on patient outcome than routine rehabilitation, reduced initial hospitalization significantly and had no adverse effects on mortality and number of falls.
Advances in Physiotherapy, 2006
The main purpose of this study was to investigate relationships between gait velocity, static and dynamic balance in patients with first time ever stroke in the acute rehabilitation period. Patients with first ever stroke (n 0/57) were consecutively included during 2003 Á04. Mean age was 74 years (range 38 Á98) and mean time at the stroke unit was 18 days (range 5 Á47). The 6-minute walk test (6MWT) was the main outcome measure in addition Motor Assessment Scale (MAS) items 3 and 5, Berg's Balance Scale (BBS) items 6 and 8 and Timed Up-and-Go (TUG) was measured on admission to and at discharge from the stroke unit. 6MWT correlated highly to balance measures MAS items 3 and 5, BBS items 6 and 8 and the TUG (r s between 0.53 and 0.82) on admission and at discharge (r s between 0.47 Á 0.67). Stepwise regression analysis on admission showed the TUG (p B/0.001), MAS item 3 (p B/0.01) and BBS item 8 (p B/0.03) to be explanatory factors for gait velocity, with an adjusted R 2 0.83. At discharge, the TUG (p B/0.02), MAS item 3 (p B/0.001) and BBS item 8 (p B/0.001), with an adjusted R 2 of 0.73, were the main explanatory factors for gait velocity. The strong relationships between 6MWT and static balance, measures (MAS item 3 (sitting) and BBS item 6 (standing blindfolded), on admission indicate enhancement of stability at this early stage in stroke patients. The relationships between gait velocity and dynamic balance, MAS item 5 (walking), BBS item 8 (reaching), indicate that dynamic balance, also, is related to gait velocity at this stage. The clinical implication being that balance, both static and dynamic needs to be addressed equally in the early rehabilitation of stroke patients, and is closely related to task, e.g. walking, getting up from a chair, turning and reaching, and cannot be regarded as separate from the task.
The importance of balance and postural control in the recovery of stroke patients
Balneo Research Journal, 2020
Introduction.According to the criteria of WHO, stroke is a health condition that causes focal or global brain disorders (1), but without an apparent nonvascular cause. Stroke is considered the third leading cause of death in industrialized countries and accounts for 9% of all deaths, being considered one of the largest cases of disability in the world. Due to the medical, social and economic consequences that it causes, stroke is considered a public health issue. Purpose of research. The study starts from the idea that in the recovery of stroke patients it is important to have an individualized physiotherapy program adapted to the functional parts of each patient, having the role of improving the static and dynamic balance, of achieving postural control and finally functional independence. Material and method. The study included a number of 22 patients with sequelae stroke. They made physiotherapy, occupational therapy and occupational therapy sessions in the ambulatory, with the le...
Biomedical Human Kinetics, 2022
Study aim: To check if the short rehabilitation treatment (3 weeks) complemented by complex rehabilitation on advanced equipment improves the functional status of chronic stroke patients; and which clinical and objective parameters can be used to assess the efficacy of such treatment. Material and methods: 28 patients 3 to 6 months after the stroke. They participated in 3 weeks rehabilitation program in Rehabilitation Hospital. This program was supplemented by rehabilitation on: Zebris treadmill, ALFA and GAMMA platform, Biodex Balance System SD, the Balance Tutor treadmill. Their functional status was assessed by: Scandinavian Stroke Scale (SSS), Timed-Up-And-Go test (TUG), balance tests on Zebris, instrumented gait analysis on BTS system. Results: The positive changes of the patients' functional status were found in time of TUG test, in case of balance test for 95% of the ellipsoid area, lengths of major and minor axes of the ellipsoid, average sway speed, sway path length, total ground reaction force for left and right leg, and Gillette Gait Index in case of the gait analysis. Conclusions: The improvement of the functional status of chronic stroke patients after relatively short rehabilitation treatment was achieved, due to the addition to the standard rehabilitation treatment the program on the advanced technologically equipment.
Polish Hyperbaric Research, 2015
Cerebral stroke is one of the most important issues for modern medicine. Despite the fact that numerous activities have been undertaken for the purpose of raising awareness and significance of prevention, this condition still remains one of the main reasons behind disability. The objective of the work was to assess the effects of the type of therapy, age and period from the incident occurrence, on the progress of rehabilitation of imbalance and body stability observed in a group of researched patients, on the basis of results obtained according to the Berg Balance Scale, tandem balance test, Kwolek’s loading symmetry index and Timed Up and Go test. The test group comprised of 55 post-stroke patients. The group consisted of 29 women (52.73%) and 26 men (47.27%). The average age of the subjects was 61.02 years (age range between 33-85 years). A number of the patients were subjected to rehabilitation with the use of classic kinesitherapy, whereas the remaining group underwent rehabilit...
Arch Phys Med Rehabil, 2004
de Haart M, Geurts AC, Huidekoper SC, Fasotti L, van Limbeek J. Recovery of standing balance in postacute stroke patients: a rehabilitation cohort study. Arch Phys Med Rehabil 2004;85:886–95.To identify and interrelate static and dynamic characteristics of the restoration of quiet standing balance in a representative sample of stroke survivors in the Netherlands during their inpatient rehabilitation.Exploratory study using an inception cohort with findings related to reference values from healthy elderly persons.Rehabilitation center.Thirty-seven inpatients (mean age, 61.6y; mean time poststroke, 10.0wk) with a first hemispheric intracerebral infarction or hematoma who were admitted to retrain standing balance and walking.Individualized therapy.Center of pressure fluctuations were registered under each foot and in the sagittal and frontal planes separately by using a dual-plate force platform. The first balance measurements took place as soon as patients were able to stand unassisted for at least 30 seconds as well as 2, 4, 8, and, 12 weeks later. Quiet standing was assessed under 4 conditions: with and without a visual midline reference, with the eyes closed, and while performing a concurrent arithmetic task.The stroke patients showed excessive postural sway and instability, particularly in the frontal plane, compared with reference values. Frontal plane balance was, however, also most responsive to the effects of balance training and recovery (P<.001). The degree of visual dependency for frontal plane balance control showed a significant reduction in time (P<.02). Weight-bearing asymmetry, which was most pronounced in patients with disturbed sensibility or ankle clonus, diminished considerably during the first 4 weeks of the follow-up period (P<.02). Yet, a substantial degree of weight-bearing asymmetry persisted during the 8 weeks thereafter, and it continued to be aggravated by attentional distraction (P<.001). During the same period, static asymmetry (ie, the degree of pes equinovarus loading at the paretic side) and dynamic asymmetry (ie, the extent to which compensatory ankle moments are applied at the nonparetic side) did not show normalization at all, although motor selectivity of the paretic leg improved by 1 stage on the 6-stage Brunnstrom scale (P<.001) and the independency level of balance and walking skills improved by 2 points on the 6-point Functional Ambulation Categories (P<.001).Balance recovery in postacute stroke inpatients is characterized by a reduction in postural sway and instability as well as by a reduction in visual dependency, particularly with regard to frontal plane balance. These restoration characteristics may be important factors underlying the relearning of independent standing and walking abilities. The clear lack of normalization for measures reflecting static and dynamic aspects of postural asymmetry suggests that the functional improvements in balance and gait must be more related to other mechanisms than to the restoration of support functions and equilibrium reactions of the paretic leg.