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Effects of aquatic and land-based exercise on balance and gait in post stroke patient

Author: 
Dr. Ajeet Kumar Saharan, Dr. Manisha Saharan, Dr. Sunita Sharma, Dr. Virendra Singh Rajpurohit and Dr. Shalini
Subject Area: 
Health Sciences
Abstract: 

Background: Stroke is the second most common cause of death worldwide after ischemic heart disease and is a major health burden. It contributes to three percent of disability worldwide. In developing countries, two-thirds of deaths occur due to stroke (Warlow, Sudlow, Dennis, Wardlaw & Sandercock, 2003). Stroke survivors may suffer from cardiovascular deterioration, motor deficits, postural control issues, balance disturbances, muscular weakness, spasticity and a limited ability to walk. Physical activity is decreased in people post-stroke, contributing to depression (O’Sullivan & Schmitz, 2004). A main goal of rehabilitation for people post-stroke is to improve motor performance and functional abilities when performing ADLs (Carr & Shepherd, 2003). Rehabilitation allows them to walk independently with sufficient velocity and endurance (Yen, Wang, Liao, Huang & Yang, 2008). It has been reported that up to 80% of people post-stroke are able to recover their ability to walk short distances, whereas the other 20% are not able to achieve the locomotor capacity that is essential for ambulation (Ross Bogey, 2007). In addition, people post-stroke require 50% to 100% more energy to walk at a self-selected speed as compared to age matched individuals (Ross Bogey, 2007). Treadmill walking with partial weight bearing helped improve gait patterns by reinforcing normal movement patterns by decreasing muscle spasms due to body weight (Petrofsky, Petrofsky & Bweir, 2004). Methods: Two people (1 male and 1 female) participated in land-based exercise, two people (1 male and 1 female) participated in aquatic exercise, and one person (male) was in the home-based exercise group. One participant in land-based exercise was excluded from the study for not being able to in the training sessions. Only four participants completed the study. The participants were recruited from Jaipur Physiotherapy College, Dhand They were randomly assigned to three groups: aquatic, land-based or home- based training programs. Inclusion criteria: Age 45-65years, Ability to ambulate, No cardiac conditions, Ability to communicate, Bladder and bowel control, No surgery within last six months, Minimum 10 month - 1 year post stroke, Medical clearance from a primary physician , No other neurological and/or orthopedic conditions, No current participation in any aquatic or land intervention. Exclusion Criteria: Fear of water, Open wounds, Inability to ambulate, Acute medical conditions, Any neurological condition other than stroke. The study was conducted at Jaipur Physiotherapy College, Dhand. The aquatic-based exercise program was held in a main therapy pool (4 foot depth) where the water temperature was maintained between 92- 94 degrees Fahrenheit. The land-based exercise program was held in the expansion room. The home-based exercise program was carried out at the participant’s home with a family member. Initial instruction and a program card were provided to the home-based exercise participant and their family member. Instrumentation: The Biodex Gait Trainer was used to collect participants’ walking data and Biodex Balance Equipment was used to collect participants’ balance data. Procedures: Two variables were tested with each participant: gait and balance. A total of five data collection points were included in the study. Pre-data were collected before the beginning of the exercise programs and then every alternate week during the exercise program. It was followed by the post data by the end of 8th week. The data collection procedures were explained to each participant and an informed consent form was obtained. After receiving instructions the participants were escorted to the assessment room for data collection. The participants were given two practice trials to determine the level of instability and for familiarization on the Biodex Balance Equipment. The participants were then given a 2-minute rest period followed by the three data collection trials. After the balance data were collected the participants were again given a 2-minute rest period followed by the gait data collection. For the gait data collection the participants were given one practice trial (2-minute walk) on the Biodex Gait Trainer to determine their comfortable speed and for familiarization of the equipment. This was followed by a 2- minute rest period. After the 2-minute rest period the data were collected on the Biodex Gait Trainer using a 2-minute walk test. Independent variables in this study were the training modes: aquatic exercise, land- based exercise and home-based exercise. The dependent variables in this study were spatiotemporal gait variables (cadence (steps/minute), stride length (meters), stride time (%), coefficient of variation (%), walking speed, and ambulation index. For balance, the dependent variables were: overall scores anterior/posterior index and medio-lateral index. Results: The purpose of this study was to determine the influence of aquatic and land- based exercise on balance and gait outcomes in people post-stroke. A total of five people post-stroke participated in this study. Two people (1 male & 1 female) participated in land-based exercise, two people (1 male & 1 female) participated in aquatic exercise and one person (male) participated in the home-based exercise group. One participant from land-based exercise group was excluded and only four participants completed the study. All the profiles of the participants are listed in Table 4. Fatigue, lower extremity weakness, impaired walking and impaired balance were most common symptoms among all participants. One of the five participants had pain due to spasticity in addition to other symptoms. Participants were randomly divided into three groups: aquatic, land-based and home-based exercise groups. The aquatic and land-based group participated in an 8-week exercise program with the home-based group following a similar program at home. All of the groups were tested on balance and gait parameters before the exercise programs began. These data were collected bi-weekly during the 8-week exercise program followed by the post data at the end of the 8th week. There was a total of five data collection points. The Biodex Gait Trainer was used to collect data for the gait parameters while the Biodex Balance Equipment was used to collect data for balance variables. The outcome of the study was analyzed by performing a visual analysis of progress based on a time graph series. Copyright©2016, Dr. Ajeet Kumar Saharan et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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