The effect of elastic band assisted gait training to improve the gait kinematics in stroke survivors - a randomized control trial

Priya Sudarshan Visoi, P. Mohanty, M. Pattnaik
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Abstract

Introduction: Stroke is the leading cause of serious long-term disabilities, the restoration of walking plays a prime role in his rehabilitation. The reduction in gait performance may prevent the resumption of activities of daily living. Aim of the study: To compare the effectiveness of elastic band assisted gait training over the task-oriented circuit interval gait training in stroke survivors. Methodology: A total of 50 male stroke survivors with functional ambulatory category score ≥4, mini mental state 24-30, normal cardio-pulmonary status and age between 30-60 years were recruited and randomly distributed in two groups. Group 1 received conventional exercises (task-oriented approach in the form of circuit interval gait training) and Group 2 received elastic band assisted gait training with task-oriented approach in the form of circuit interval gait training. Outcome measures: Stride length (both side), cadence, walking speed and gait profile score (both side). Measurements were taken with gait laboratory before and at the end of 6 weeks of treatment, for 45 minutes divided into nine 5-minute blocks separated by 5-minute rest periods 5 days/week. Results: Overall result of this study showed that experiment group had significantly improved in terms of speed, cadence, stride length of paretic limb, gait profile score of non paretic limb from pre to post test measurements, but no significant improvement in conventional group. Gait profile score of paretic limbs had significantly improved. Both the groups had significantly improved in terms of stride length of non paretic limb from pre to post-test measurements; however, the experiment group showed more improvement than the conventional group. Conclusion: Elastic band assisted gait training over the task-oriented circuit interval gait training is found to be effective for the hemiplegic gait. *Correspondence to: Patitapaban Mohanty, PhD, Assoc. Prof. (PT), Swami Vivekanand National Institute of Rehabilitation Training and Research, Olatpur, Bairoi, Cuttack, India, E-mail: ppmphysio@rediffmail.com Received: May 13, 2019; Accepted: June 18, 2019; Published: June 21, 2019 Introduction Stroke is the leading cause of serious long-term disabilities, including loss of motor, sensory or cognitive function [1]. The restoration of walking plays a prime role in rehabilitation [2]. The reduction in gait performance may prevent the resumption of activities of daily living, which can have an adverse effect on perceived participation [3]. Hemiparetic gait pattern is characterized by being stereotyped with reduced weight bearing on the paretic lower limb. Over activity or shortening of plantar flexor muscles at swing phase giving the equinovarus foot placement [4]. Reduced knee flexion, exaggerated hip circumduction and hip hiking during the swing phase are a common disability in people with stroke [5]. Which movements are energetically demanding and may lead to chronic joint pain [6,7]. Manual assistance during gait training is necessary to properly align the trunk and guide the lower extremity through normal gait trajectory. It is difficult to consistently and adequately control the patient and manually assist dorsiflexion during the swing phase of gait; it can be exhausting and place the physical therapist in a nonergonomic position [8]. There exist devices like Hip flexion orthosis [9], Elastic band orthosis [10], Wearable tubing assistive walking device [11], AFO shaped band [12] and wearable tubing to address ankle dorsiflexion, hip and knee flexion with patient either in non-weight or weight bearing positions. Elastic resistance training has been reported to increase gait, mobility, balance and reduced pain [8-15]. Apart from its use in strengthening program, elastic band can also be used in assisted gait training [15].
弹性带辅助步态训练对改善中风幸存者步态运动学的影响-一项随机对照试验
中风是导致严重长期残疾的主要原因,恢复行走功能在其康复中起着首要作用。步态性能的降低可能会阻碍日常生活活动的恢复。研究目的:比较松紧带辅助步态训练与任务导向循环间歇步态训练对脑卒中幸存者的有效性。方法:招募功能动态分类评分≥4分、精神状态24 ~ 30分、心肺状态正常、年龄30 ~ 60岁的男性脑卒中幸存者50例,随机分为两组。第1组采用常规训练(任务导向的循环间歇步态训练形式),第2组采用任务导向的循环间歇步态训练形式进行松紧带辅助步态训练。结果测量:步幅(两侧),节奏,步行速度和步态特征评分(两侧)。在6周治疗前和治疗结束时通过步态实验室进行测量,45分钟分为9个5分钟的时段,中间间隔5分钟的休息时间,每周5天。结果:本研究的总体结果显示,实验组在缓瘫肢体的速度、节奏、步长、非缓瘫肢体的步态剖面评分等测试前后测量均有显著改善,而常规组无显著改善。麻痹肢体的步态特征评分明显改善。两组在测试前和测试后的非麻痹肢体跨步长度方面均有显著改善;然而,实验组比常规组有更大的改善。结论:松紧带辅助步态训练优于任务导向循环间歇步态训练,对偏瘫步态有较好的效果。*通讯:pattapaban Mohanty, PhD, associate。教授(PT), Swami Vivekanand国家康复训练与研究所,印度,Olatpur, Bairoi, Cuttack,印度,E-mail: ppmphysio@rediffmail.com收到:2019年5月13日;录用日期:2019年6月18日;中风是导致严重长期残疾的主要原因,包括运动、感觉或认知功能丧失[1]。行走功能的恢复在康复中起着首要作用[2]。步态性能的降低可能会阻止日常生活活动的恢复,这可能对感知的参与产生不利影响[3]。偏瘫步态的特点是偏瘫下肢负重减轻。在摆动阶段,跖屈肌过度活动或缩短,导致马蹄内翻足放置[4]。在摇摆阶段,膝关节屈曲减少、髋关节绕行夸张和髋关节徒步是卒中患者常见的残疾[5]。哪些运动需要消耗能量,并可能导致慢性关节疼痛[6,7]。在步态训练过程中,人工辅助是必要的,以使躯干正确对齐,引导下肢通过正常的步态轨迹。在步态摇摆阶段,很难持续和充分地控制患者并手动辅助背屈;这可能会让人筋疲力尽,并将物理治疗师置于一个不符合人体工程学的位置[8]。目前存在髋关节屈曲矫形器[9]、弹力带矫形器[10]、可穿戴管道辅助行走装置[11]、AFO形矫形器[12]和可穿戴管道等设备,用于解决患者在非负重或负重姿势下的踝关节背屈、髋关节和膝关节屈曲。据报道,弹性阻力训练可以增加步态、活动能力、平衡和减轻疼痛[8-15]。弹力带除了用于强化训练外,还可用于辅助步态训练[15]。
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