Balance Retraining In Post Stroke Patients Using A Simple, Effective And Affordable Technique

Abstract

Purpose Balance impairment is important sequel of stroke that is of primary concern in physiotherapy intervention. This quasi-experimental study evaluated the efficacy of stepper in training balance in post stroke patients; and the effects of change in balance performance on motor function. Subjects Eight individuals (6 males and 2 females) presenting with hemiparesis resulting from first incidence hemispheric cerebrovascular disease (age=61.38 ± 6.04 years) who were receiving physiotherapy on out-patient basis at a tertiary health facility in Nigeria participated in this study. All subjects had attained independent walking status without the use of any assistive device. Methods Subjects performed 60 repetitions stepping exercise on a stepper at own self-determined pace, twice a week for 6 consecutive weeks. Progression of the exercise was by increasing the repetition by 10 every week. Baseline and post-training balance and motor function were assessed using Berg Balance Scale (BBS) and Motor Assessment Scale (MAS) respectively. Results Analyses using the Wilcoxon signed rank test showed significant improvement in some of the BBS activities viz. the tandem standing (z = - 2.42; p=0.01); standing on one leg (z=-2.59; p=0.00); turning trunk with feet fixed (z= -2.07; p=0.03); turning 3600 (z = -2.12;p=0.03); stool stepping (z =-1.89; p=0.05) and reaching forward in standing (z= -2.56; p= 0.01). Significant improvement were also recorded in the moving from supine to side lying (z = -2.06; p=0.03); sitting to standing (z = -2.33; p=0.02); walking (z=-2.40; p=0.01); hand movements (z = -2.44; p=0.01); and advanced hand movements (z = -2.00; p=0.04) on the MAS. Conclusion The outcomes suggest that both balance and motor function could be improved in individuals who have suffered a stroke using the stepper as a training tool. Further studies involving large sampling size is however needed to make a conclusive inference Objectifs Les troubles de l\'equilibre sont des sequelles importantes des accidents vasculaires cerebraux (AVC). Cette etude se propose d\'evaluer l\'efficacite de « stepper » dans la reeducation des troubles de l\'equilibre chez des patients apres un AVC et les repercussions sur la fonction motrice. Methodes Huit patients - 6 hommes et 2 femmes - presentant une hemiparesie en rapport avec un AVC ( âge = 61,38+/- 6,04 ans) ont beneficie d\'une physiotherapie en ambulatoire dans un centre hospitalier tertiaire au Nigeria. Tous les patients ont eu une marche autonome sans l\'aide d\'une quelconque assistance. Les patients ont effectue 60 seances repetitives de stepping sur un mode auto-adapte, deux fois par semaine et ce durant 6 semaines consecutives. La progression des exercices a ete augmentee toutes les dix semaines. L\'evaluation a ete realisee a l\'aide de la Berg Balance Scale (BBS) et la Motor Assessment Scale (MAS) Resultats Les analyses utilisant le test de Wilcoxon ont note une amelioration significative sur les activites BBS vs la station bipodale (z = - 2.42; p=0.01) station unipodale (z=-2.59; p=0.00); rotation du tronc avec un pied fixe (z = -2.12;p=0.03) ; retournement 3600 (z = -2.12;p=0.03); stool stepping (z =-1.89; p=0.05) et reaching forward in standing (z= -2.56; p= 0.01). Une amelioration significative a ete relevee lors du passage de la position couchee en decubitus lateral (z = -2.06; p=0.03);de la station assise a la station debout (z = -2.33; p=0.02); a la marche (z=-2.40; p=0.01); la des mains (z = -2.44; p=0.01); et l\'avancee des mains (z = -2.00; p=0.04) sur le MAS Conclusion L\'evolution atteste que l\'equilibre et la fonction motrice pourraient etre ameliorees chez les patients ayant eu un AVC en utilisant la methode du stepper. Toutefois des etudes plus larges sont necessaires pour valider cette technique. Keywords : Stroke, Balance, Training, Exercise, Stepper. African Journal of Neurological Sciences Vol. 26 (2) 2007: pp. 39-47