Abstract
Background: Stroke subjects presented with greater postural instability which lead to challenge their balance control in sensory conflict conditions. Studies have shown that deficits of sensorimotor integration and an inability to select the appropriate sensory input are associated with balance measures following stroke.However, limited studies have been focused to sensorimotor integration in balance rehabilitation.Objective: Our study aimed to evaluate the Task Oriented Training (TOT) with sensory manipulation to enhance balance and functional mobility in chronic stroke subjects.Design: Randomized controlled pilot study.Setting: Department of Physiotherapy in a Tertiary care Hospital.Subjects: A convenience sample consisting of 26 hemi paretic subjects at least 6 months post stroke duration with Brunnstroms recovery stage ?5 for the lower limb and Berg Balance Score of 40 or above were randomly assigned control group (n=13) and in experimental group (n=13).Interventions: Control group received the conventional physical therapy and in the Experimental group received TOT with manipulations of sensory inputs and provision of sensory conflict for the trunk and lower limb focusing on balance and mobility were implemented for 15 sessions, 5 days a week for 3 weeks with each session of 45-60 mints duration.Outcome measures: Dynamic Gait Index (DGI), Timed Up and Go Test (TUGT) and Fall Efficacy Scale (FES) were analyzed before and after the training.Results: Post training there was a significant improvement in all the outcome measurements for both the groups. However components 3, 4 and 5 of DGI, TUGT and FES of experimental group had a highly significant statistical difference between-group analysis with p<.05.Conclusion:Task oriented exercises with altered sensory input was found to be effective in improving functional mobility in terms of dynamic balance and reduction in their fear of fall levels after a 3 week training program.Bangladesh Journal of Medical Science Vol.16(2) 2017 p.307-313
Highlights
Stroke is the leading cause of high levels of morbidity and long-term functional disability in adults.1When balance impairment is affected early after stroke, performance of simple as well as complex tasks become difficult which results in their functional mobility.[2]
A significant difference within-group total score of Dynamic Gait Index (DGI) suggests a greater improvement in the experimental group
Known to be very effective in rehabilitation of stroke patients, when incorporated with altered sensory input are challenging in nature and progressively induce the patients to use lower limb somatosensory inputs to maintain balance.18.19 Challenging various sensory systems in the exercises forces the stroke patients to improve the process of sensory reweighting.[5]
Summary
Stroke is the leading cause of high levels of morbidity and long-term functional disability in adults.1When balance impairment is affected early after stroke, performance of simple as well as complex tasks become difficult which results in their functional mobility.[2] Impaired balance has been identified as the strongest predictor of falling, which in turn is related with fear of falling, limited activity and quality of life. This vicious cycle of balance disability is continued, resulting in delaying the recovery process of stroke rehabilitation.3,4Balance. Conclusion:Task oriented exercises with altered sensory input was found to be effective in improving functional mobility in terms of dynamic balance and reduction in their fear of fall levels after a 3 week training program
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