Postural Imbalance Studies

Stroke is a leading cause of adult disability and patients face multiple challenges, such as weakness/paralysis on one side of the body, social disability, inability to walk and self-care, the decline in community participation, and the decline in cognitive and emotional functioning. These challenges impede them from independently performing their daily activities related to work, school, parenting, or leisure. Evidence Based Practice shows that the best way to treat individuals with stroke is through the use of the mental practice. Mental practice is a training method during which a person cognitively rehearses a physical skill in the absence of overt, physical movements for the purpose of enhancing motor skill performance. It is a practice

Strokes are known as the leading cause of acquired disability in adults where between 20-30% are left unable to walk, and leaving those who are able to walk, with a moderate to severe walking disability (Maguire et al., 2012). This disability results in a huge socioeconomic impact on the patients and their families lives. In order to improve their quality of life, an improvement in balance is the important first step in which is crucial to enable more independent movement, for example walking.

A clinician, respectively, should produce the patient’s clinical history and results, as well as the measurement properties of the index, this well better format and put in place short- and long-term goals based on an individual-report functional scale like the LEFS (1). The intention of this research was to assess the reliability, construct validity, and sensitivity to change the Lower Extremity Functional Scale. This test was given to 107 patients with lower-extremity musculoskeletal dysfunction referred to twelve outpatient PT clinics. This index was dispensed during the patient’s initial assessment, 24 to 48 hours following the initial assessment, and then at weekly intervals for four weeks (1). A patient with an initial LEFS score of 56/80, an example of lower extremity functional scale is to create functional level, set goals, and track progress and outcome, based on the error at any specific position in time for the LEFS of five points, the therapist can be highly confident that the actual scale score is between 51 and 61 (1). The leeway, or error, associated with an assumed measure on the LEFS is about plus or minus five scale points (90% confident intervals). A clinician, ergo, can be moderately confident that an observed score within the parameter of five points of the patient’s “true” outcome (1). The short-form 36-health survey (SF-36) is a 36-item, patient-delivered

In the article, “In-Hospital Predictors of Falls in Community-Dwelling Individuals After Stroke in the First 6 Months After a Baseline Evaluation: A Prospective Cohort Study” we identified were that twenty-four (36%) patients fell within the 6-month period whether they were at home or in a rehab facility. Unfortunately, there is nothing physically medical staff can do to change to condition one suffers from a stroke but with strength training, physical therapy, proper lifting equipment and assistance, along with close monitoring falls can be decreased.

The participants were 106 with chronic stroke: 25 with a history of falling in the last year and 81 without a history of falling. To assess validity, participants in the stroke group and 48 healthy subjects performed the Mini-BESTest as well as four balance measures (BBS, One Leg Stand, Functional Reach Test and Timed Up and Go Test). The Mini-BESTest was repeated again for the 30 participants after 10 days in order to determine its reliability. The results showed a close relationship between scores on the Mini-BESTest and the other outcome measures. The Mini-BESTest was able to detect the difference between the fallers and non-fallers groups. More importantly the Mini-BESTest showed less floor and ceiling effect than the BBS (Tsang et al.,

Five participants with acute stroke and unilateral hemiparesis (Age 51 ± 17 years; Height 1.7 ± 0.1m; Weight 81.6 ± 3.6kg; LOS 36 ± 24.6 days; 3 males, 2 females; 2 with right hemiplegia) were recruited for RE gait training during inpatient rehabilitation in conjunction with traditional therapy. Participant inclusion requirements: have a medical clearance, upright standing tolerance (≥30 min), intact skin, physically fit into the device, have joint range of motion within normal functional limits for ambulation, have had stroke with its onset >1 week and 0.05). This may suggest that the RE was limited to rehabilitate muscles during the IDS and swing phases as seen in figures (6-8).

Constraint-Induced Physical Therapy is a specialized rehabilition approach used to improve motor ability and the functional use of a limb affected by brain injury or a stroke. After suffering a stroke, a person can lose the function of one of their limbs. These stroke survivors can get frustrated and learn to stop using affected limb and start relying on the unaffected limb. Constraint-Induced Physical Therapy tries to decrease the effects of learned non-use by forcing patients to use the affected side. CIMT uses techniques like placing a mitt on the patient’s unaffected functional hand and forcing them to perform tasks with their stroke-affected limb for a majority of the day. This therapy also has the patient perform repetitive movements to repair the brains pathways. CIMT is a deliberate practice that focuses on relearning previously acquired motor skills. Relearning motor skills is measured by acquisition, retention, and transfer of skills. Acquisition is the performance of a previously learned motor skill. To relearn a motor skill, the skill must be rehearsed repeatedly. The more time a patient devotes to a task the more opportunity they have to improve their movement

The study by Lee, Kim, and Na (2014) compared HT and a horseback riding simulator concerning their effects on static and dynamic balance in children with CP. This study consisted of 26 children ages 8-12 randomly divided into a HT group and a horseback riding simulator group. Both groups completed one hour of exercise, three days a week, for 12 weeks. The intervention consisted of anterior-sitting, posterior-sitting, and side-sitting exercises for ten minutes each. Both groups also received 20 minutes of physical therapy per session. This study used BPM software to measure static balance and the Pediatric Balance Scale (PBS) to measure dynamic balance, pre and post intervention. Data showed significantly decreased sway lengths in static balance

Physical therapists working at these large hospitals throughout the Midwest where recruitment will occur will be formally trained how on how to perform MT so that therapists will be consistent within and between patients. Both groups will receive 1 hour of MT of the upper extremity 5 days a week for 4 weeks. In addition to this treatment, the physical therapist will also work with patients in both groups on limb activation for 1 hour 5 days a week for 4 weeks and provide the more traditional physical therapy given to stroke patients, such as doing exercises to improve strength in the upper and lower extremity on the affected side involving neuromuscular re-education, pre-walking functional activities, weight shifts in sitting or standing, or the maintenance of unassisted

support early intervention of cognitive rehabilitation of having a great effect on improving ADL participation in stroke patient. The first article from Cochrane library titled “Cognitive rehabilitation for executive dysfunction in adults with stroke or other adult non-progressive acquired brain damage” by Charlie et al discuss which adaptive technique was used to assist stroke survivors who have cognitive impairment, but intact motor function to became independent in the ADL. The research was completed on “19 studies of 907 randomized participants, 496 TBI, 344 strokes, 67 other acquired brain injury. Data were available to potentially include 13 of the studies within meta-analyses (770 participants, 417 TBI, 304 stroke, 49 other acquired brain injury), with 660 participants who are related to the research were included in the treatment groups to be studied in the review. Studies performed during the research were related to (1) cognitive rehabilitation versus sensorimotor meta-analyses (one study, 86 participants), (2) cognitive rehabilitation versus no intervention or placebo meta-analyses (four studies, 184 participants) and (3) experimental cognitive rehabilitation versus standard cognitive rehabilitation meta-analyses (eight studies, 404 participants)”

Postural stability is the capacity to maintain the body in a state of equilibrium in static and dynamic situations. This postural stability is regularly impaired poststroke(Yanohara et al., 2014).In hemiplegic patients, postural instabilityresulted by agreater postural sway and asymmetrical weight bearingthrough displacing the body's center of mass towards the unaffected side (Peppen, 2008).Some patients may have altered sense of midline and motor control deficits. Maintaining a postural stability is an essential prerequisite for the more advanced stages of motor control, including controlled mobility and skilled activity (Martin & Kessler, 2007).

Impairments can contribute to an increased risk of falls at all stages following a stroke.2,5 As a result of these impairments, stroke has been classified as the most disabling chronic disease, with about 80% of individuals falling within the first three months from loss of balance when walking.2,5 In addition, approximately 70% of individuals who have had a stroke experience ongoing difficulty with ambulation within the first year.2 One research study revealed that patients post stroke have fall rates that range from 3.8 to 22%, and the incidence of falls range from 1.3 to 6.5 times in the year after the stroke.1 Furthermore, stroke has been identified as the primary cause of disability in the United States and the third leading cause of death in people over the age of

Five databases (CINAHL, PubMed, Embase, MEDLINE, and PsycINFO), were examined and the review included fourteen cross-sectional and longitudinal studies that revealed some important limitation in the method used during the study. Participants included in the thirty-two (32) evaluation of executive function or cognitive function after stroke were people who had stroke, diagnosed of stroke, and had been cognitively impaired by the World Health Organization definition. Proofs from Physical therapy practitioners show that despite their significant roles in restoring the post stroke patients’ movement and function through intensive exercise, there are still some cognitive issues that impede patients’ participation during therapy session in the areas of initiation and completion of the exercise due to the cognitive impairment. The article was a Randomized Controlled by PEDro scale and different assessments were used to test the patients. The tests used during this research were Trail Making Test (n56), Stroop Task (n56), Digit Span Test (n54), Wisconsin Card Sorting Test (n54), Verbal Fluency Test (n54), and MMSE which was used on patients to test their

Background. The majority of people after stroke demonstrate mobility limitations, which may reduce their physical activity levels. Task-specific training has been shown to be an effective intervention to improve mobility in individuals with stroke, however, little is known about the impact of this intervention on levels of physical activity. Objectives. The main objective is to investigate the efficacy of task-specific training, focused on both upper and lower limbs, in improving physical activity levels and mobility in individuals with stroke. The secondary objective is to investigate the effects of the training on muscle strength, exercise capacity, and quality of life. Design. This is a randomized controlled trial. Setting. The setting is

Occupational therapists working with the stroke population use activity analysis and observation skills to identify and analyze the functional impairments that result in activity limitations (McHugh Pendleton & Schultz-Krohn, 2011). Established and effective OT interventions, such as repetitive task training (RTP) and constraint-induced movement therapy (CIMT), are used to address functional impairments in the stroke population (Nilsen, Gillen, Arbesman, & Lieberman, 2015; Wolf et al., 2006). According to the National Board for Certification in Occupational Therapy (2012), 60.7% of registered OTs provide rehabilitation services to individuals who had been diagnosed with a Cerebral Vascular Accident (CVA). A systematic review (Nilsen et al., 2015) found that the responsibilities of an occupational therapist include administering a variety of assessments to create an occupational profile when treating an individual following a stroke. One example of an OT assessment that measures participation, one’s involvement in a life situation (WHO, 2001), is the Canadian Occupational Performance Measure (COPM), which asks the client to identify up to five occupations he or she would like improve performance for, and rate his or her perceived performance and satisfaction of these occupations (Law et al., 2014). Performance skills and client factors are often evaluated with Fugl-Meyer Assessment and the Action Research Arm Test to further assess functionality of the upper extremity with respect to neuromusculoskeletal functions, sensory functions, and motor skills (Fugl-Meyer, Jaasko, Leyman, Olsson, & Steglind, 1975; Lyle, 1981; Nilsen et al.,