Positive Balance Recovery in Ischemic Post-Stroke Patients with Delayed Access to Physical Therapy

Anselmo De Athayde Costa E Silva,Alex Tadeu Viana Da Cruz Júnior,Ketlin Jaquelline Santana De Castro,Aline Do Socorro Soares Cardoso Almeida,Givago Da Silva Souza,Skarleth Raissa Andrade Candeira,Nathalya Ingrid Cardoso Do Nascimento,Bianca Callegari,Ramon Costa De Lima,Tatiana Generoso Campos Pinho Barroso

doi:10.1155/2020/9153174

Abstract

Background Since patient's prognosis after stroke depends on its severity, brain location, and type early intervention is strongly recommended. Objective We aimed to determine whether it is still possible to improve balance in chronic patients, who suffered Intracerebral Hemorrhagic Strokes (ICHS) or Ischemic Strokes (IS), after later intervention. Methods 34 patients who had unilateral ICHS or IS and involved the motor cortex or sub-cortical areas took part in the study. The patients underwent clinical balance evaluation (using the Berg Balance Scale) and posturographic assessment (with a capacitive pressure platform) at the time of admission to the physiotherapy and at the end of the study. The physiotherapy intervention consisted of 20 sessions of 60 minutes carried out 3 times per week, following standard protocols: stretching; passive range of motion (ROM); active assistive ROM; active ROM; resistance training; coordination and balance activities while sitting and standing, and Large-muscle activities such as walking, treadmill, stationary cycle, combined arm-leg ergometry, arm ergometry, seated stepper and circuit training. Results In the posturographic assessment, the IS group had significant lower amplitude of center of pressure (COP) anteroposterior displacement, after physical therapy intervention. Also, the 95% confidence ellipse area of the COP and the total COP displacement showed significant interaction between the subtype of stroke and the assessment period, meaning the IS group improved their balance after treatment on the contrary of ICHS. The structural analysis of the COP reinforced these results. On the other hand, no difference was observed in the clinical scale, between the assessment periods, for any subtype of stroke. Conclusion Only IS patients have shown balance improvements after conventional intervention. COP measurements are more sensible to assess balance in chronic patients than Berg Balance Scale.

Highlights

Since patient’s prognosis a er stroke depends on its severity, brain location, and type early intervention is strongly recommended
These events implicate the poor recovery of functional ability and an increased risk of falls [3]. e consequences of a stroke depend on its severity, brain location, and type
E cerebral accidents can be classified into Ischemic Strokes (IS), which comprises 87% of the cases and are caused by thrombotic occlusion of arteries and veins; or Intracerebral

Summary

Background

Stroke represents the fourth cause of death worldwide [1] and survivors present a combination of muscle weakness or imbalance, decreased postural control, muscle spasticity, poor voluntary control, and body misalignments [2] These events implicate the poor recovery of functional ability and an increased risk of falls [3]. Participants were excluded if they were unable to follow verbal requests, had other neurological, musculoskeletal, or orthopedic conditions, or were on antispastic medication at the time of the study (including botulinum toxin injection before physical therapy). All participants gave their written informed consent to participate in the study. All participants gave their written informed consent to participate in the study. is study has been approved by the internal ethics committee of the Federal University of Pará (report #141.605)

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