Abstract
Stroke remains one of the leading causes of disability in adults, and lower limb spasticity, affected stance, and balance impact everyday life and activities of such patients. Robotic therapy and assessment are becoming important tools to clinical evaluation for post-stroke rehabilitation. The aim of this study was to determine in a more objective manner the effects of visual feedback balance training through a balance trainer system and radial extracorporeal shock wave therapy (rESWT), along with conventional physiotherapy, on lower limb post-stroke spasticity, trunk control, and static and dynamic balance through clinical and stabilometric assessment. The study was designed as a randomized controlled trial. The experimental group underwent conventional physiotherapy, visual feedback balance training, and rESWT. The control group underwent conventional physiotherapy, visual feedback training and sham rESWT. The statistical analysis was performed using GraphPad Software and MATLAB. Primary clinical outcome measures were The Modified Ashworth Scale (MAS), passive range of motion (PROM), Visual Analogue Scale (VAS), and Clonus score. Secondary outcome measures were trunk performance, sensorimotor, and lower limb function. Stabilometric outcome measures were trunk control, static balance, and dynamic balance. Visual feedback training using the Prokin system and rESWT intervention, along with conventional physiotherapy, yielded statistically significant improvement both on clinical and stabilometric outcome measures, enhancing static and dynamic balance, trunk performance, sensorimotor outcome, and limb function and considerably diminishing lower limb spasticity, pain intensity, and clonus score in the experimental group.
Highlights
Stroke remains one of the leading causes of death and disability all over the world [1,2,3].Trunk control and sitting balance are commonly affected in post-stroke patients and are considered important features to predict functional outcome and hospital stay [4,5,6,7,8,9]
The trial aimed to determine whether conventional physical therapy in conjunction with visual feedback balance training and two radial extracorporeal shock wave therapy sessions might have a positive impact on stance, balance, and spasticity grade, and we assessed their relationship with trunk performance in post-stroke patients
One patient in the control group was discharged earlier due to personal matters and was excluded from the analysis
Summary
Stroke remains one of the leading causes of death and disability all over the world [1,2,3].Trunk control and sitting balance are commonly affected in post-stroke patients and are considered important features to predict functional outcome and hospital stay [4,5,6,7,8,9]. Trunk deviations may imply balance deficit, gait impairment, and diminished functional ability, but core stability exercises may provide more efficient use of the lower limbs for static and dynamic balance, as well as for gait [7,15,16,17,18]. The aim of our study was to assess, in a more objective, global manner, both clinically and through stabilometric system Prokin, the relationship between stance, balance, trunk deviations, and lower limb post-stroke spasticity. The trial aimed to determine whether conventional physical therapy in conjunction with visual feedback balance training and two radial extracorporeal shock wave therapy (rESWT) sessions might have a positive impact on stance, balance, and spasticity grade, and we assessed their relationship with trunk performance in post-stroke patients. It was used in various clinical trials as a training tool for promoting stance and balance improvement in several neurorehabilitation programs [10,23,24]
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