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Han B, Lee J, Yim S, Kim D. Effects of rehabilitation exercise program types on dynamic balance in patients with stroke: a meta-analysis of randomized controlled trials. Top Stroke Rehabil 2024:1-11. [PMID: 38598557 DOI: 10.1080/10749357.2024.2329849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/29/2024] [Indexed: 04/12/2024]
Abstract
PURPOSE The purposes of meta-analysis are to evaluate evidence about the effects of Rehabilitation Exercise Program on the balance of post-stroke patients, evaluated by the Berg Balance Scale (BBS). METHODS The search was conducted 'stroke,' 'rehabilitation,' 'dynamic balance,' 'Berg Balance Scale,' 'exercise' and 'randomized controlled trial'using MEDLINE (accessed by PubMed), Web of Science (WoS), ProQuest, and Google Scholar for journal studies published from January 2018 to October 2022. Two independent reviewers performed the article selection, data extraction, and methodological quality assessment. The main outcome was dynamic balance assessed by the Berg Balance scale. RESULTS The review included 30 papers and a total of 540 patients. The overall effect size was 0.550, a medium effect size according to the Cohen's standard. It was observed that gender has moderate effect size in male (0.551), female (0.458) and higher in male. Exercise type results showed large effect sizes in balance training (0.966), and aquatic activities (0.830), moderate effect sizes in virtual reality (0.762), moderate effect sizes in physically active (0.581), gait training (0.541), dual-task (0.478), trunk control (0.284), and small effect sizes in resistance training (0.128). CONCLUSIONS Exercise programs are effective in improving dynamic balance in stroke patients. Especially, the meta-analysis showed higher Effect Size for balance training and virtual reality than for other programs making this relevant interventions for future head to head superiority studies that compare different balance interventions in stroke.
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Affiliation(s)
- Byumsuk Han
- Department of Sports Medicine, Kyunghee University, Yongin-si, South Korea
| | - Jaewon Lee
- Department of Special Physical Education, Yongin University, Yongin-si, South Korea
| | - Sanghun Yim
- Department of Special Physical Education, Yongin University, Yongin-si, South Korea
| | - Dongmin Kim
- Department of Special Physical Education, Yongin University, Yongin-si, South Korea
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Lee JH, Lee DH. A comparative study on the overlapping effects of clinically applicable therapeutic interventions in patients with central nervous system damage. Open Med (Wars) 2023; 18:20230828. [PMID: 37900962 PMCID: PMC10612527 DOI: 10.1515/med-2023-0828] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 08/04/2023] [Accepted: 10/04/2023] [Indexed: 10/31/2023] Open
Abstract
This study was conducted to investigate the effects of anti-gravity treadmill (AGT) training, which provides visual feedback and Biorescue training on proprioception, muscle strength, balance, and gait, in stroke patients. A total of 45 people diagnosed with post-stroke were included as study subjects; they were randomized to an AGT training group provided with visual feedback (Group A), a Biorescue training group provided with visual feedback (Group B), and an AGT/Biorescue group that subsequently received AGT training and Biorescue training (Group C). A muscle strength-measuring device was used to evaluate muscle strength. Timed Up and Go and Bug Balance Scale assessment sheets were used to evaluate balance ability. Dartfish software was used to evaluate gait ability. The results of the study showed that Groups A and C had a significant increase in muscle strength compared with Group B; in terms of balance and gait abilities, Group C showed a significant increase in balance ability and gait speed and a significant change in knee joint angle compared with Groups A and B. In conclusion, this study suggests that including a method that applies multiple therapeutic interventions is desirable in the rehabilitation of stroke patients to improve their independence.
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Affiliation(s)
- Jung-Ho Lee
- Physical therapy, Kyungdong University, Goseong-gun, Republic of Korea
| | - Dae-Hwan Lee
- Physical therapy, Kyungdong University, Goseong-gun, Republic of Korea
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Cao J, Chang J, Wu C, Zhang S, Wang B, Yang K, Cao X, Sui T. Extradural contralateral S1 nerve root transfer for spastic lower limb paralysis. J Biomed Res 2023; 37:394-400. [PMID: 37750309 PMCID: PMC10541774 DOI: 10.7555/jbr.37.20230068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 05/16/2023] [Accepted: 05/23/2023] [Indexed: 09/27/2023] Open
Abstract
The current study aims to ascertain the anatomical feasibility of transferring the contralateral S1 ventral root (VR) to the ipsilateral L5 VR for treating unilateral spastic lower limb paralysis. Six formalin-fixed (three males and three females) cadavers were used. The VR of the contralateral S1 was transferred to the VR of the ipsilateral L5. The sural nerve was selected as a bridge between the donor and recipient nerve. The number of axons, the cross-sectional areas and the pertinent distances between the donor and recipient nerves were measured. The extradural S1 VR and L5 VR could be separated based on anatomical markers of the dorsal root ganglion. The gross distance between the S1 nerve root and L5 nerve root was 31.31 (± 3.23) mm in the six cadavers, while that on the diffusion tensor imaging was 47.51 (± 3.23) mm in 60 patients without spinal diseases, and both distances were seperately greater than that between the outlet of S1 from the spinal cord and the ganglion. The numbers of axons in the S1 VRs and L5 VRs were 13414.20 (± 2890.30) and 10613.20 (± 2135.58), respectively. The cross-sectional areas of the S1 VR and L5 VR were 1.68 (± 0.26) mm 2 and 1.08 (± 0.26) mm 2, respectively. In conclusion, transfer of the contralateral S1 VR to the ipsilateral L5 VR may be an anatomically feasible treatment option for unilateral spastic lower limb paralysis.
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Affiliation(s)
- Jiang Cao
- Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Jie Chang
- Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Chaoqin Wu
- Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Sheng Zhang
- Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Binyu Wang
- Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Kaixiang Yang
- Department of Orthopedics, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Xiaojian Cao
- Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Tao Sui
- Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
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Zhang H, Li X, Gong Y, Wu J, Chen J, Chen W, Pei Z, Zhang W, Dai L, Shu X, Shen C. Three-Dimensional Gait Analysis and sEMG Measures for Robotic-Assisted Gait Training in Subacute Stroke: A Randomized Controlled Trial. BIOMED RESEARCH INTERNATIONAL 2023; 2023:7563802. [PMID: 37082189 PMCID: PMC10113045 DOI: 10.1155/2023/7563802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/01/2023] [Accepted: 03/11/2023] [Indexed: 04/22/2023]
Abstract
Background The efficacy of robotic-assisted gait training (RAGT) should be considered versatilely; among which, gait assessment is one of the most important measures; observational gait assessment is the most commonly used method in clinical practice, but it has certain limitations due to the deviation of subjectivity; instrumental assessments such as three-dimensional gait analysis (3DGA) and surface electromyography (sEMG) can be used to obtain gait data and muscle activation during walking in stroke patients with hemiplegia, so as to better evaluate the rehabilitation effect of RAGT. Objective This single-blind randomized controlled trial is aimed at analyzing the impact of RAGT on the 3DGA parameters and muscle activation in patients with subacute stroke and evaluating the clinical effect of improving walking function of RAGT. Methods This randomized controlled trial evaluated the improvement of 4-week RAGT on patients with subacute stroke by 3DGA and surface electromyography (sEMG), combined with clinical scales: experimental group (n = 18, 20 sessions of RAGT) or control group (n = 16, 20 sessions of conventional gait training). Gait performance was evaluated by the 3DGA, and clinical evaluations based on Fugl-Meyer assessment for lower extremity (FMA-LE), functional ambulation category (FAC), and 6-minute walk test (6MWT) were used. Of these patients, 30 patients underwent sEMG measurement synchronized with 3DGA; the cocontraction index in swing phase of the knee and ankle of the affected side was calculated. Results After 4 weeks of intervention, intragroup comparison showed that walking speed, temporal symmetry, bilateral stride length, range of motion (ROM) of the bilateral hip, flexion angle of the affected knee, ROM of the affected ankle, FMA-LE, FAC, and 6MWT in the experimental group were significantly improved (p < 0.05), and in the control group, significant improvements were observed in walking speed, temporal symmetry, stride length of the affected side, ROM of the affected hip, FMA-LE, FAC, and 6MWT (p < 0.05). Intergroup comparison showed that the experimental group significantly outperformed the control group in walking speed, temporal symmetry of the spatiotemporal parameters, ROM of the affected hip and peak flexion of the knee in the kinematic parameters, and the FMA-LE and FAC in the clinical scale (p < 0.05). In patients evaluated by sEMG, the experimental group showed a noticeable improvement in the cocontraction index of the knee (p = 0.042), while no significant improvement was observed in the control group (p = 0.196), and the experimental group was better than the control group (p = 0.020). No noticeable changes were observed in the cocontraction index of the ankle in both groups (p > 0.05). Conclusions Compared with conventional gait training, RAGT successfully improved part of the spatiotemporal parameters of patients and optimized the motion of the affected lower limb joints and muscle activation patterns during walking, which is crucial for further rehabilitation of walking ability in patients with subacute stroke. This trial is registered with ChiCTR2200066402.
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Affiliation(s)
- Huihuang Zhang
- The Third Clinical Medical College, Zhejiang Chinese Medical University, 310053 Hangzhou, Zhejiang, China
| | - Xiang Li
- The Third Clinical Medical College, Zhejiang Chinese Medical University, 310053 Hangzhou, Zhejiang, China
| | - Yichen Gong
- Department of Center for Rehabilitation Assessment and Therapy, Zhejiang Rehabilitation Medical Center, 310053 Hangzhou, Zhejiang, China
| | - Jianing Wu
- The Third Clinical Medical College, Zhejiang Chinese Medical University, 310053 Hangzhou, Zhejiang, China
| | - Jianer Chen
- The Third Clinical Medical College, Zhejiang Chinese Medical University, 310053 Hangzhou, Zhejiang, China
- The Third Affiliated Hospital of Zhejiang Chinese Medical University, 310013 Hangzhou, Zhejiang, China
- Neurorehabilitation Department, Zhejiang Rehabilitation Medical Center, 310053 Hangzhou, Zhejiang, China
| | - Weihai Chen
- Department of Hangzhou Innovation Institute, Beihang University, 310053 Hangzhou, Zhejiang, China
| | - Zhongcai Pei
- Department of Hangzhou Innovation Institute, Beihang University, 310053 Hangzhou, Zhejiang, China
| | - Wanying Zhang
- The Third Clinical Medical College, Zhejiang Chinese Medical University, 310053 Hangzhou, Zhejiang, China
| | - Lei Dai
- The Third Clinical Medical College, Zhejiang Chinese Medical University, 310053 Hangzhou, Zhejiang, China
| | - Xinxin Shu
- Department of Center for Rehabilitation Assessment and Therapy, Zhejiang Rehabilitation Medical Center, 310053 Hangzhou, Zhejiang, China
| | - Cheng Shen
- Department of Hangzhou Innovation Institute, Beihang University, 310053 Hangzhou, Zhejiang, China
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Meng G, Ma X, Chen P, Xu S, Li M, Zhao Y, Jin A, Liu X. Effect of early integrated robot-assisted gait training on motor and balance in patients with acute ischemic stroke: a single-blinded randomized controlled trial. Ther Adv Neurol Disord 2022; 15:17562864221123195. [PMID: 36147622 PMCID: PMC9486263 DOI: 10.1177/17562864221123195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/12/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Gait disruption is a common poststroke problem. Robot-assisted gait training
(RAGT) might improve motor function, balance, and activities of daily
living. Objective: We compared the clinical effectiveness of early integrated RAGT using the
Walkbot robotic gym with an intensity-matched enhanced lower limb therapy
(ELLT) program and with conventional rehabilitation therapy (CRT) in
patients with acute ischemic stroke. Methods: A total of 192 patients with acute ischemic stroke were randomly assigned
(1:1:1) to receive RAGT, ELLT, or CRT. All three groups received 45 min of
training daily, 3 days a week, for 4 weeks consecutively. Before and after
the 4-week treatment, the patients were assessed based on a 6-minute walking
test (6MWT), functional ambulation classification (FAC), timed up and go
(TUG) test, dual-task walking (DTW) test, Tinetti’s test, Barthel’s index
(BI), stroke-specific quality of life (SS-QOL) scale, and gait analysis
parameters. Results: After the 4-week intervention, the results of the 6MWT, FAC, TUG, DTW,
Tinetti’s test, BI, SS-QOL, and gait in the three groups significantly
improved. Compared with ELLT and CRT groups, participants in the RAGT group
had a better performance in 6MWT (199.11 ± 60.72 versus
182.47 ± 59.72 versus 173.69 ± 40.58,
p = 0.035), FAC (4.10 ± 0.91 versus
3.69 ± 0.88 versus 3.58 ± 0.81,
p = 0.044), DTW (10.29 ± 2.38 versus
12.92 ± 2.64 versus 13.89 ± 2.62,
p = 0.031), SS-QOL (184.46 ± 20.53 versus
165.39 ± 20.49 versus 150.72 ± 20.59,
p = 0.012), velocity (0.66 ± 0.22 versus
0.55 ± 0.23 versus 0.51 ± 0.20,
p = 0.008), cycle duration (1.38 ± 0.40
versus 1.50 ± 0.38 versus 1.61 ± 0.30,
p = 0.040), and swing phase symmetry ratio (SPSR,
1.10 ± 0.33 versus 1.21 ± 0.22 versus
1.48 ± 0.25, p = 0.021). The TUG, Tinetti’s test, BI, and
RMT results were similar, however. Conclusion: In the acute stroke phase, early integrated RAGT showed greater performance
in gait rehabilitation than CRT and ELLT. Registration: ChiCTR1900026225
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Affiliation(s)
- Guilin Meng
- Neurorehabilitation Center, Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaoye Ma
- Neurorehabilitation Center, Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Pengfei Chen
- Neurorehabilitation Center, Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shaofang Xu
- Neurorehabilitation Center, Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Mingliang Li
- Neurorehabilitation Center, Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yichen Zhao
- Neurorehabilitation Center, Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Aiping Jin
- Neurorehabilitation Center, Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301 Yanchang Road, Shanghai 200072, China
| | - Xueyuan Liu
- Neurorehabilitation Center, Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301 Yanchang Road, Shanghai 200072, China
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Cho JE, Kim H. Ankle Proprioception Deficit Is the Strongest Factor Predicting Balance Impairment in Patients With Chronic Stroke. Arch Rehabil Res Clin Transl 2021; 3:100165. [PMID: 34977547 PMCID: PMC8683870 DOI: 10.1016/j.arrct.2021.100165] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To determine the main factor that predicts balance impairment in patients with chronic stroke. DESIGN Cross-sectional study. SETTING Inpatient rehabilitation hospital and research laboratory. PARTICIPANTS A total of 57 patients (42 men, 15 women; mean age 55.7±12.2 years) with chronic symptoms after stroke. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Primary outcomes were ankle functions, including strength, range of motion, and proprioception, and balance, including Berg Balance Scale score and Timed Up and Go test values. Secondary outcomes included gait kinematics, Fugl-Meyer Scale score, and Fall Efficacy Scale score. RESULTS According to the cutoff score <46 on the Berg Balance Scale and the Timed Up and Go test ≥13.5 seconds, 21 patients were classified as having a balance impairment (36.8%). Multivariable logistic regressions showed that ankle proprioception (odds ratio = 3.49; 95% confidence interval, 1.17-10.42) was a significant predictor when coupled with step length (odds ratio = 0.00; 95% confidence interval, 0.00-0.22). A cutoff score of 2.59 for the ankle proprioception value predicts balance impairment in patients with stroke (area under the curve 0.784). CONCLUSION Ankle proprioception can be used to predict balance impairment in patients with stroke.
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Affiliation(s)
- Ji-Eun Cho
- Department of Rehabilitation & Assistive Technology, National Rehabilitation Center, Seoul, South Korea
| | - Hogene Kim
- Department of Clinical Rehabilitation Research, National Rehabilitation Center, Seoul, South Korea
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Necessity and Content of Swing Phase Gait Coordination Training Post Stroke; A Case Report. Brain Sci 2021; 11:brainsci11111498. [PMID: 34827497 PMCID: PMC8615654 DOI: 10.3390/brainsci11111498] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/28/2021] [Accepted: 11/05/2021] [Indexed: 11/17/2022] Open
Abstract
Background/Problem: Standard neurorehabilitation and gait training has not proved effective in restoring normal gait coordination for many stroke survivors. Rather, persistent gait dyscoordination occurs, with associated poor function, and progressively deteriorating quality of life. One difficulty is the array of symptoms exhibited by stroke survivors with gait deficits. Some researchers have addressed lower limb weakness following stroke with exercises designed to strengthen muscles, with the expectation of improving gait. However, gait dyscoordination in many stroke survivors appears to result from more than straightforward muscle weakness. PURPOSE Thus, the purpose of this case study is to report results of long-duration gait coordination training in an individual with initial good strength, but poor gait swing phase hip/knee and ankle coordination. METHODS Mr. X was enrolled at >6 months after a left hemisphere ischemic stroke. Gait deficits included a 'stiff-legged gait' characterized by the absence of hip and knee flexion during right mid-swing, despite the fact that he showed good initial strength in right lower limb quadriceps, hamstrings, and ankle dorsiflexors. Treatment was provided 4 times/week for 1.5 h, for 12 weeks. The combined treatment included the following: motor learning exercises designed for coordination training of the lower limb; functional electrical stimulation (FES) assisted practice; weight-supported coordination practice; and over-ground and treadmill walking. The FES was used as an adjunct to enhance muscle response during motor learning and prior to volitional recovery of motor control. Weight-supported treadmill training was administered to titrate weight and pressure applied at the joints and to the plantar foot surface during stance phase and pre-swing phase of the involved limb. Later in the protocol, treadmill training was administered to improve speed of movement during the gait cycle. Response to treatment was assessed through an array of impairment, functional mobility, and life role participation measures. RESULTS At post-treatment, Mr. X exhibited some recovery of hip, knee, and ankle coordination during swing phase according to kinematic measures, and the stiff-legged gait was resolved. Muscle strength measures remained essentially constant throughout the study. The modified Ashworth scale showed improved knee extensor tone from baseline of 1 to normal (0) at post-treatment. Gait coordination overall improved by 12 points according to the Gait Assessment and Intervention Tool, Six Minute Walk Test improved by 532', and the Stroke Impact Scale improved by 12 points, including changes in daily activities; mobility; and meaningful activities. DISCUSSION Through the combined use of motor learning exercises, FES, weight-support, and treadmill training, coordination of the right lower limb improved sufficiently to exhibit a more normal swing phase, reducing the probability of falls, and subsequent downwardly spiraling dysfunction. The recovery of lower limb coordination during swing phase illustrates what is possible when strength is sufficient and when coordination training is targeted in a carefully titrated, highly incrementalized manner. Conclusions/Contribution to the Field: This case study contributes to the literature in several ways: (1) illustrates combined interventions for gait training and response to treatment; (2) provides supporting case evidence of relationships among knee flexion coordination, swing phase coordination, functional mobility, and quality of life; (3) illustrates that strength is necessary, but not sufficient to restore coordinated gait swing phase after stroke in some stroke survivors; and (4) provides details regarding coordination training and progression of gait training treatment for stroke survivors.
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