In the light of these findings, the primary objective of this review is to examine 5 RCTs, to investigate various interventions that target postural imbalance programs can be applied to a clinical setting. Search Strategy and Inclusion/Exclusion Criteria A systematic search was performed using 3 electronic databases: PubMed, ClinicalKey, and Embase. The following MeSH headings were used to conduct this search: Stroke AND Proprioception (OR Balance) AND Exercise. In Embase and ClinicalKey, a simple search was performed using combinations of the following key words: 1) Interventions (rehabilitation, exercises), 2) Stroke (cerebral vascular accident), 3) Balance (postural control). References of identified studies were manually searched. To be
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).
Strokes are not isolated to the United States. It is reported that worldwide nearly 15 million people suffer from a stroke every year (“Stoke,” n.d.). The idea of home therapy for stroke rehabilitation has appeared in other countries as well. A group of researchers in Spain looked into the effectiveness of occupational therapy for individuals affected by a stroke. They focused specifically on home based therapy. The researchers sought out occupational therapy programs which “aimed to improve the participation of the individual in significant functions, activities, and tasks” and how that translated into a home program (Ávila et al., 2014). The study included twenty-three participants who had suffered a stroke. The Barthel Index (Fig.3) was
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
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
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.
There are many ways to treat Postural Orthostatic Tachycardia Syndrome or POTS for short. Certain medicines, such as midodrine, propranolol, or antidepressants, can help, but another way to treat POTS is to undertake a lifestyle change. Although it is the opposite of what they might want to do, exercise is a key factor in helping a POTS patient. How do we know exercise is important when it comes to POTS? The American Heart Association published an article on June 20th, 2011 about the effects of exercise treatment for POTS patients. This research was done by Qi Fu, Tiffany B. VanGundy, Shigeki Shibata, Richard J. Auchus, Gordon H. Williams, and Benjamin D. Levine at the Institute for Exercise and Environmental Medicine in Texas. These researchers
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.
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
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).
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
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
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
Physical therapists can give patients exercises to help with balance and strength dysfunctions. This trial showed that if early identification of mild balance dysfunction is noticed early enough, it may have a range of benefits in older people (Yang, 2012 ). A lot of times people wait until it is too late and they have already had falls or functional losses before they seek medical treatment. If they were to be proactive and could seek help when they notice mild balance dysfunction they could avoid falls and more severe balance dysfunctions. For the idea of treating patients with mild balance dysfunctions to work and be used there needs to be more research done to help back this control trial up that home exercise programs are helpful and can prevent falls before they start
Individuals worldwide are affected by Parkinson’s disease. Parkinson’s is a chronic disorder with onset of symptoms occurring at a mean age of 60 years. The prevalence of Parkinson’s increases with age and may affect up to 5% of individuals over 79 years old. (Tosin, Campos, Andrade, Oliveira, & Santana, 2015). Those affected by the disease, experience impairments in movement, balance, and have difficulty performing everyday life tasks. Due to posture deficits and gait dysfunction, patients with Parkinson’s have an increased risk of falling which may lead to secondary health problems. Although exercise programs have been implemented to decrease falls, few programs are proven successful. (Li, Harmer, Fitzgerald, Eckstrom, Stock, Galver, Maddalozzo, & Batya, 2012). In order to find an effective program in decreasing falls, nurses are performing various rehabilitation interventions that focus on improving postural stability. Two examples of interventions include Qi Gong and Tai Chi. Qi Gong is a mindful exercise that effects neuroplasticity in the brain and can have an effect on the postural instability that Parkinson’s patients experience (Loftus, 2014). Tai Chi is a balance-based exercise that may have an effect on muscle strength and stability for those living with Parkinson’s (Li, et al., 2012). Qi Gong and Tai Chi are two rehabilitation interventions that nurses are implementing to prove whether or not complementary exercise programs improve posture enough to