NeuroRehabilitation - Volume 43, issue 2

Authors: Moon, Hyun Im | Yoon, Seo Yeon | Jeong, Yoon Jeong | Cho, Tae Hwan

Article Type: Research Article

Abstract: BACKGROUND: Impaired gait function after stroke contributes strongly to overall patient disability. Recently, sleep disturbance was reported to negatively affect functional recovery after stroke. OBJECTIVE: The aim of this study was to identify the impact of sleep disturbance on balance and gait function in stroke patients. METHODS: We retrospectively reviewed 140 patients with first-ever stroke. The patients were divided into two groups according to the presence of sleep disturbances, and differences in characteristics, such as demographic information, lesion factors, initial balance, and gait function. Lesion volume was measured on magnetic resonance images. Linear regression analyses were …performed to examine predictors of balance and gait function after a 1-month rehabilitation program. RESULTS: Of the 140 patients, 35 had sleep disturbance (25%). The patients with sleep disturbance were older than those without. Patients who had sleep disturbance had worse balance and gait function. BBS and FAC were also predicted by the initial BBS and sleep disturbance. The 10-m velocity was strongly associated with initial BBS, onset duration, and the presence of sleep disturbance. CONCLUSIONS: Our study showed that sleep disturbances negatively affected functional outcomes, especially balance and gait function. Therefore, sleep problems should be controlled to improve outcomes in stroke patients. Show more

Keywords: Stroke, gait, balance, sleep, disturbance, insomnia

DOI: 10.3233/NRE-172351

Citation: NeuroRehabilitation, vol. 43, no. 2, pp. 211-218, 2018

Authors: Rand, Debbie

Article Type: Research Article

Abstract: BACKGROUND: Proprioception deficits are common post-stroke and may lead to impaired standing balance and restricted mobility. OBJECTIVES: To compare 1) mobility, balance, balance confidence (BC), independence in basic and instrumental activities of daily living (BADL and IADL) of individuals with and without mild proprioception deficits at the chronic stage post-stroke. In addition, 2) correlations between mobility, balance and BC to BADL and IADL will be assessed. METHODS: Sixty-four participants [mean(SD) age - 59.9(9.3), 61% men, 26.1(18.3) months post-stroke] underwent the Thumb Localization Test (TLT) to assess proprioception; 45 participants had intact proprioception and 19 participants had …mild proprioception deficits. The Timed Up and Go Test (TUG) and the Functional Reach Test (FRT) assessed mobility and balance (respectively). Activities-specific Balance Confidence (ABC) scale rated BC. BADL and IADL was also assessed. RESULTS: Significant differences in mobility, balance and BC, BADL, IADL were found between participants with and without mild proprioception deficits. Correlations between mobility, balance, and BC to BADL and IADL, were significant (p < 0.05) for all 64 participants, but not within groups. CONCLUSIONS: Mild proprioception deficits seem to be a confounding factor for explaining daily living at the chronic stage post-stroke. Proprioception screening is recommended for clinical practice and future research. Show more

Keywords: Balance confidence, stroke, cardiovascular accident, proprioception, mobility

DOI: 10.3233/NRE-172398

Citation: NeuroRehabilitation, vol. 43, no. 2, pp. 219-226, 2018

Authors: Park, Jaeho | Chung, Yijung

Article Type: Research Article

Abstract: BACKGROUND: Robot-assisted gait training provide a big therapeutic advantage in functional mobility for postural control. OBJECTIVES: The purpose of this study was investigate the effects of robot-assisted gait training using virtual reality and auditory stimulation on balance and gait abilities in stroke patients. METHODS: All subjects were randomly divided into three groups where twelve subjects were in the Virtual reality robot-assisted gait training group (VRGT), twelve subjects in the auditory stimulation robot-assisted gait training group (ARGT), and sixteen subjects in the control group. Subjects received virtual reality and auditory stimulation while undergoing robot-assisted gait training for …45 minutes, three times a week for 6 weeks, and all subjects had undergone general physical therapy for 30 minutes, five times a week for 6 weeks. All subjects were assessed with the Medical Research Council (MRC), Berg balance scale (BBS), timed up and go test (TUG), 10-meter walk test (10MWT), Fugl-Myer Assessment (FMA) and Modified Barthel Index (MBI) pre- and post-intervention. RESULTS: Results showed that BBS, TUG, and 10MWT scores significantly improved post-intervention (p < 0.05), and the control group also had significantly improved in all areas post-treatment (p < 0.05). In addition, it has been confirmed that VRGT had significantly improved in MRC and FMA scores compared with the auditory stimulation. Also, it has significantly improved in MRC, BBS, TUG, 10MWT and FMA compared with control group (p < 0.05). CONCLUSIONS: The results of this study showed improve balance and gait abilities after VRGT compared with general physical therapy and were found to be effective in enhancing the functional activity of persons with stroke. Show more

Keywords: Stroke, rehabilitation, gait, balance, muscular strength

DOI: 10.3233/NRE-172415

Citation: NeuroRehabilitation, vol. 43, no. 2, pp. 227-235, 2018

Authors: Eyvaz, Nuran | Dundar, Umit | Yesil, Hilal

Article Type: Research Article

Abstract: BACKGROUND: After the stroke, a number of changes occur in the neuromuscular system functions. OBJECTIVE: To determine whether the water based exercise (WBE) program applied in combination with the land-based exercises (LBE) compared to LBE alone contributes to the stroke patients’ motor functions, walking, balance functions and quality of life (QoL). METHODS: In total, 60 patients participated in this study. Patients were randomly divided into two groups. WBE therapy (3/week) + LBE (2/week) combination was applied to the patients in the study group (n = 30) for six weeks. LBE was applied to the control …group (n = 30) 5/week for six weeks. Patients were evaluated before and after the treatment. Functional independence measurement, Berg balance scale, timed up and go test, and short form (SF) -36 assessment questionnaire were performed. RESULTS: Posttreatment results showed significant improvements in all of the parameters (except SF - 36 pain parameter) in both groups. The improvement in the vitality parameter of SF-36 was higher in the study group (p < 0.05), and improvement in the BBS was significantly higher in the LBE group than the WBE group (p < 0.05). CONCLUSION: Applying WBE together with the LBE (except SF-36 vitality sub-parameter) in patients with hemiplegia did not make any additional contribution to the application of LBE alone. Show more

Keywords: Stroke, aquatic rehabilitation, balance, quality of life

DOI: 10.3233/NRE-182422

Citation: NeuroRehabilitation, vol. 43, no. 2, pp. 237-246, 2018

Authors: Tramontano, Marco | Bergamini, Elena | Iosa, Marco | Belluscio, Valeria | Vannozzi, Giuseppe | Morone, Giovanni

Article Type: Research Article

Abstract: BACKGROUND: Vestibular rehabilitation (VR) consists in a customized exercise program patient-centred that includes a combination of different exercise components with the aim to promote gaze stability, improve balance and gait, and facilitate somatosensory integration. OBJECTIVE: The aim of this study was to investigate the effect of customized vestibular rehabilitation training on gait stability of patients with subacute stroke. METHODS: Twenty-five inpatients (12 M, age: 64.1±12.1 years) with diagnosis of subacute stroke were enrolled and randomized in two groups. All patients were evaluated before and after 4 weeks of training sessions. An instrumented 10-Meter Walk Test together …with traditional clinical scales were used to assess VR effects. To investigate if any fall event occurred after patients’ dismissal, they were followed-up at three and twelve months after dismissal. RESULTS: Higher values of walking speed and stride length were observed in the VR group. Conversely, no significant difference was found in terms of trunk stability. The results of between-group comparison highlight significant differences between the two groups for different clinical scale scores. CONCLUSION: VR could be included into a rehabilitation program for patients with stroke for improving their gait and dynamic balance acting on their vestibular system as facilitator of recovery. Show more

Keywords: Vestibular rehabilitation, stroke, instrumented assessment, dynamic balance and gait

DOI: 10.3233/NRE-182427

Citation: NeuroRehabilitation, vol. 43, no. 2, pp. 247-254, 2018