Bobath Research Articles

Modified tai chi movement training based on sEMG and movement analysis on improving upper extremities motor function: a protocol for a clinical randomised controlled trial

IntroductionStroke survivors often face motor dysfunction, increasing fall risk. Lower extremity muscle weakness is a key factor affecting walking ability. Tai chi (TC) has been shown to improve muscle strength...

Effectiveness of Bobath Technique on Walking Speed and Balance in Hemiplegic Patients: A Review

Worldwide, stroke is the largest cause of disability, affecting walking speed and balance, especially in hemiplegics. Bobath, or Neurodevelopmental Treatment (NDT), is a specialist physiotherapy method that improves motor control and movement patterns for motor deficits. Given the prevalence of stroke and the importance of rehabilitation in recovery, the Bobath technique's ability to improve walking speed and balance, which are crucial to stroke survivors' functional independence, must be assessed. Methods: This Review examined how the Bobath method affected walking speed and balance in hemiplegic individuals. A total of 15 studies were evaluated. Most of studies uses 2 groups The Bobath group received three-times-weekly motor function and balance training for 12 weeks Data was collected at Baseline, 6-week, and 12-week. Aim: This research focused on to review whether the Bobath approach improved walking speed and balance in hemiplegic patients. Results: The research revealed a substantial improvement in walking speed using the Bobath approach, with a mean increase of 0.25 meters per second compared to 0.10 meters per second in the control group (p < 0.05). Significant balance improvements were seen in the Bobath group, with a mean gain of 10 points on the Berg Balance Scale and 5 cm on the Functional Reach Test, compared to 4 points and 2 centimetres in the control group (p < 0.05). The Bobath approach improved walking speed and balance no more than traditional physiotherapy. Conclusion: This research found that Bobath improves walking speed and balance in hemiplegics no more than traditional physiotherapy. These findings suggest that stroke therapy programs using the Bobath technique may improve functional outcomes. To validate these results and investigate the Bobath technique's long-term stroke healing advantages, bigger sample sizes and longer follow-ups are needed. Keyword: - Bobath concept, stroke, hemiplegia, rehabilitation.

The effect of trunk exercises with hip strategy training to maximize independence level and balance for patient with stroke: Randomized controlled study.

Balance while seated and the capacity to conduct selective trunk movements are significant predictors of functional outcomes following stroke. Patients with inappropriate muscle activation and inadequate movement control in the trunk muscles cause mobility and daily function difficulties. Stroke patients have weak leg muscles and decreased balance, resulting in compensatory changes. Functional postural strategy training is necessary to restore balance in these patients. Few studies have examined the effect of physical therapy trunk exercises with hip strategy training on improving balance and increasing independence after stroke. This study aimed to explore the effect of selective trunk exercises (STE) with hip strategy training in improving balance in patients with stroke as well as independence levels. A multicenter inpatient stroke treatment randomized pre- and post-test control trial. Forty-six stroke survivors were randomly allocated to experimental or control groups (n=23 each). The experimental group received hip strategy training and trunk exercises. All groups received Neuro-Developmental Treatment (NDT)-based physical therapy four times a week for 6weeks. Trunk impairment scale, Berg Balance Scale (BBS), and functional independence measure (FIM) measured static and dynamic seated balance, functional balance, and trunk movement coordination pre- and post-therapy. The experimental group's post-therapeutic measures were substantially higher than the control group. The experimental group's TIS score, and subscale improved more than the control group. The experimental group considerably increased the BBS score. The experimental group also showed greater FIM gains. This study demonstrated that adding STE in conjunction with hip strategy training to patients after has a positive impact on trunk control while maintaining static and dynamic sitting balance, functional balance, and independence levels which are effective in stroke rehabilitation.

Effect of Virtual Reality on Trunk Control in Children with Developmental Delays

Background: Developmental delays affect motor function and trunk control in children, impacting their overall development and daily activities. Virtual reality (VR) interventions have the potential to enhance motor abilities through engaging, personalized therapies.Objective: This study aimed to determine the effectiveness of virtual reality-based neurodevelopmental treatment with trunk control exercises (VR-NDT-TCE) in improving trunk control and cognitive functions in children with developmental delays.Methods: A single-blinded randomized controlled trial was conducted with 22 children aged 2-8 years diagnosed with developmental delays. Participants were randomly assigned to Group A (NDT-TCE) or Group B (VR-NDT-TCE) for a six-week intervention, three times per week. Trunk control was measured using the Trunk Control Measurement Scale (TCMS), and cognition was assessed through the Hammersmith Infant Neurological Examination (HINE) Performa. Data analysis was performed using SPSS version 27 with paired t-tests and Mann-Whitney tests.Results: Significant improvements were observed in trunk control (TCMS score: 20.18 ± 2.40 in Group A vs. 24.18 ± 4.67 in Group B, p = 0.017). Group B showed notable gains in cognitive parameters, including conscious state (p < 0.001), emotional state (p = 0.012), and social orientation (p = 0.031).Conclusion: VR-NDT-TCE significantly improved trunk control and cognitive outcomes, offering an effective intervention for children with developmental delays.

Severe neurodevelopmental phenotype, diagnostic, and treatment challenges in patients with SECISBP2 deficiency

PurposeDefects in the gene encoding selenocysteine insertion sequence binding protein 2, SECISBP2, result in global impaired selenoprotein synthesis manifesting a complex syndrome with characteristic serum thyroid function tests due to impaired thyroid hormone metabolism. Knowledge about this multisystemic defect remains limited. MethodsGenetic and laboratory investigations were performed in affected members from 6 families presenting with short stature and failure to thrive. ResultsFour probands presented a complex neurodevelopmental profile, including absent speech, autistic features, and seizures. Pediatric neurological evaluation prompted genetic investigations leading to the identification of SECISBP2 variants before knowing the characteristic thyroid tests in 2 cases. Thyroid hormone treatment improved motor development, whereas speech and intellectual impairments persisted. This defect poses great diagnostic and treatment challenges for clinicians, as illustrated by a case that escaped detection for 20 years because SECISBP2 was not included in the neurodevelopmental genetic panel, and his complex thyroid status prompted antithyroid treatment instead. ConclusionThis syndrome uncovers the role of selenoproteins in humans. The severe neurodevelopmental disabilities manifested in 4 patients with SECISBP2 deficiency highlight an additional phenotype in this multisystem disorder. Early diagnosis and treatment are required, and long-term evaluation will determine the full spectrum of manifestations and the impact of therapy.

Pediatric Bobath Concept in management of children with cerebral palsy: view of Turkish Bobath therapists

Purpose: Pediatric Bobath Concept (PBC) is a family-child centered holistic concept applied interdisciplinary to support the functional skills of children with cerebral palsy. The aim of this study was to examine the effects of PBC on children, parents, and themselves from the perspective of Bobath therapists in Turkey. Methods: In this observational study, 104 (69.2% female) Bobath therapists with a mean age of 37.9+6.1 years participated. The Pediatric-Bobath Impact Questionnaire (P-BIQ) was developed by the Delphi method. Content validity (Lawshe's Content Validity Index-CVI) and test-retest reliability (Intraclass correlation coefficient -ICC) were examined. The relationships between the rates of change in children, parents, and therapists were analyzed using the Chi Square (χ2) test and the effect sizes of the relationships were analyzed according to Cramer's V values. Results: According to the P-BIQ (CVI=0.836, ICC >0.737), at least 74% of therapists reported that the PBC positively affected children (compliance with therapy and home program, body structure and function, activity and participation, environmental adaptations), parents (compliance with therapy and home program) and themselves (sense of professional competence and motivation). Compliance of the child, parent, and therapist was positively associated with the child's activity and participation levels and environmental adaptation (p

The effects of gaze stability exercises on balance, gait ability, and fall efficacy in patients with chronic stroke: A 2-week follow-up from a randomized controlled trial.

This study aimed to examine the effect of gaze stability exercises on balance, gait ability, and fall efficacy in patients with chronic stroke, as well as to investigate whether any observed effects were maintained 2 weeks later. In this experiment, 30 chronic stroke patients were selected. The patients were randomly divided into 3 groups (10 patients in each group). All patients in the 3 groups performed basic neurodevelopmental treatment. Group 1 performed balance exercises accompanied by gaze stability exercises. Group 2 performed gaze stability exercises, and group 3 performed balance exercises. Each exercise program for 40 minutes 3 times a week for 4 weeks. After the intervention period, the patient's balance, gait ability, and fall efficacy were measured again. In order to know whether the training effect is maintained, a 2-week follow-up test was conducted after the training. The results of this study showed that there was a significant improve in balance (overall stability index, limit of stability test, and Berg Balance Scale), gait ability (gait velocity, cadence, step time and step length, Timed Up and Go [TUG] test), and fall efficacy over the different time within the 3 groups. The effect was observed to be maintained in follow-up tests after 2 weeks. In the comparison among 3 groups, the overall stability index, limit of stability test in the balance test and the gait velocity, cadence, step time, step length and Timed Up and Go test in the gait test all showed statistically significant differences, and the other items did not have significant differences. In most of the assessments, group 1 that used balance exercise combined with gaze stability exercise showed a better improvement than the other 2 groups. As a result, for stroke patients, gaze stability exercise is an effective arbitration method to improve balance and gait ability and fall efficacy. With balance exercise combined with gaze stability exercise, a greater effect can be seen than with gaze stability exercise or balance exercise alone. Thus, this combination exercise program can be recommended as effective.

Exoskeleton-assisted upper limb rehabilitation after stroke: a randomized controlled trial

ABSTRACT Objectives The upper-limb exoskeleton training program which is repetetive and task-specific therapy can improve motor functions in patients with stroke. To compare the effect of an upper-limb exoskeleton training program with Bobath concept on upper limb motor functions in individuals with chronic stroke. Methods Participants were randomly assigned to exoskeleton group (EG, n = 12) or to Bobath group (BG, n = 12). Interventions were matched in terms of session duration and total number of sessions and performed 2 times per week for 6-weeks. Primary outcome was Fugl-Meyer- Upper Extremity (FMA-UE). Secondary outcomes were Modified Ashworth Scale (elbow and wrist flexor muscles), Motor Activity Log-30 which is consist of two parts as an amount of use (AOU) and quality of movement (QOM), and The Nottingham Extended Activities of Daily Living (NEADL) index. Results After 12-sessions of training, the mean (SD) FMA-UE score increased by 5.7 (2.9) in the EG, and 1.9 (1.5) points in the BG (p < .05). In total, 40% of participants (5/12) demonstrated a clinically meaningful improvement (≥5.25 points) in the FM-UE, while none of the participants reached MCID score in the bobath group. Changes in the AOU, QOM, and NEADL were significantly larger in the EG compared to BG (p < .05). 7/12 (58.33%) of participants for AOU and 5/12 (42%) of participants for QOM in the EG showed that clinically meaningful change. 5/12 of participants (42%) in the EG demonstrated ≥4.9-point increase in NEADL score. Discussion High-intensity repetitive arm and hand exercises with an exoskeleton device was safe and feasible. Exoskeleton-assisted training demonstrated significant benefits in improving upper limb functions and quality of life in individuals after stroke.

Early interventions with parental participation and their implications on the neurodevelopment of premature children: a systematic review and meta-analysis.

The occurrence of preterm birth is correlated with the potential emergence of disabilities in children. Early intervention programs are designed to promote better developmental outcomes. These interventions employ family-centered methodologies, wherein parents are instructed to facilitate neurodevelopment, thereby promoting heightened involvement of the child in their daily activities. The objective of this investigation was to evaluate the efficacy of early family-based interventions on motor, cognitive, and language development. A systematic review and meta-analysis was conducted utilizing the databases PubMed, Medline, PEDro, Scopus, CINAHL Complete, SciELO, and Open Grey. The search terms utilized included NDT (neuro-developmental treatment), Bobath, neurodevelopmental therapy, parents administered, family administered, physical therapy modalities, early intervention (educational), early intervention, premature infant, preterm, and premature. Randomized clinical trials and observational studies written in English or Spanish were taken into consideration. The initial search resulted in 420 articles. After removing duplicates and applying the selection criteria, 12 articles were selected for the systematic review and 5 articles were selected for the meta-analysis. The meta-analysis revealed a significant association between early intervention and enhanced cognitive function (p = 0.01) in this study. Additionally, the meta-analysis indicated improvements resulting from early family-based intervention (p = 0.02) in motor function. Early motor interventions that emphasize parent involvement and education in neurodevelopment show significant outcomes in motor and cognitive areas at 2 years of age in very premature or extremely premature infants. However, inconclusive effects have been found in the language area, which is the least studied domain. Due to the methodological heterogeneity observed, further research is needed to establish conclusive decisions regarding the administration of these interventions and the determination of key evaluation periods.

Effectiveness of Neurodevelopmental Therapy with Conventional Physiotherapy on Gross Motor Function and Spasticity in Spastic Diplegic Cerebral Palsy Children

Effectiveness of Neurodevelopmental Therapy with Conventional Physiotherapy on Gross Motor Function and Spasticity in Spastic Diplegic Cerebral Palsy Children

Explicit training through neurodevelopmental therapy improves tone and postural control in hemiplegic stroke-A Systematic review protocol

Introduction Hemiplegia is the common term used to describe a multitude of clinical problems associated with a stroke. Hemiplegic stroke accounts for 70-85% of all first strokes. Trunk stability is impaired due to hypertonia and weakness in hemiplegia. Impaired trunk control leads to gait and postural abnormalities which if left untreated causes permanent disability in hemiplegics. Objective To investigate the scope of research on the benefits of explicit training using Neurodevelopmental Therapy (NDT) for enhancing tone and postural control in subjects with hemiplegic stroke. Methods In order to adhere to established protocols of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework, the systematic review will be carried out to find pertinent studies published up to the search date, and a thorough search strategy will be applied across popular electronic databases including PubMed/Medline, Scopus, and Cochrane Library. This systematic review methodology has been registered in PROSPERO for rigorous and transparent dissemination of study search, synthesis, and analysis. Discussion As the motor impairments due to abnormal tone and postural impairment in hemiplegic stroke substantially impact a stroke survivor’s quality of life, this study will provide a thorough and methodical approach to synthesize and report the merits and demerits on the effectiveness of NDT in enhancing tone and postural control, considering the potential variability in interventions and outcomes, and the methodological rigor of particular studies. The review also intends to provide significant insights for clinicians, researchers, and policymakers by critically analysing and summarizing the present state of research in this domain. This will facilitate evidence-based decision-making in rehabilitation techniques for patients with hemiplegic stroke. Systematic Review Registration number CRD42023476137

The results of early intervention neurodevelopmental therapy in premature infants at the age of four, according to the Bayley's III assessment tool

Introduction: The main goal of modern Neonatology is the survival of premature infants with as few problems as possible. The purpose is to preserve and care for the brain potential of Brain Care (Als H. 2006). Neurodevelopmental Care is provided to infants from birth to the age of three. It concerns infants who have developmental deficits or are at risk of developing neurodevelopmental disorders. The goal of Early Intervention is to promote child health, enhance existing and emerging abilities, minimize developmental delay, address existing or emerging motor, cognitive, and emotional deficits, as well as prevent cognitive, functional, and limited parents and the entire family environment. Purpose: The purpose of this research is to study the necessity and possibilities of early intervention and physiotherapeutic rehabilitation of premature infants, according to the Bayley III assessment scale. A clinical trial demonstrating the effect of Neurodevelopmental Education on premature infants, according to the measurements of the Bayley Scale. Method: This study was designed as a clinical trial between September 2017 and August 2023. It included one hundred premature infants who were recorded and equally divided between premature infants who received simple counseling according to early intervention therapy and not any type of Neurodevelopmental Education (Group A, 25 boys, 25 girls aged 1 month and 15 days) and premature infants who received Neurodevelopmental Education therapy immediately after their discharge from the NICU (Group B, 25 boys, 25 girls aged 1 month and 15 days). Both groups received Early Intervention Neurodevelopmental Care during their stay in the NICU. Therapy will be administered by the researcher and the staff trained by the researcher himself for a period of the last 12 years. The groups were evaluated at the age of 4 years using the Bayley Scale for Infant and Toddler Development, Third Edition (BayleyIII). It should be noted that the Bayley Scales for infant and toddler development will be examined and will serve as the research instrument of the current project. Finally, conclusions will be drawn based on the statistical analysis of the results obtained from the evaluation and comparison of the two groups.

General Treatments Promoting Independent Living in Parkinson's Patients and Physical Therapy Approaches for Improving Gait-A Comprehensive Review.

This study delves into the multifaceted approaches to treating Parkinson's disease (PD), a neurodegenerative disorder primarily affecting motor function but also manifesting in a variety of symptoms that vary greatly among individuals. The complexity of PD symptoms necessitates a comprehensive treatment strategy that integrates surgical interventions, pharmacotherapy, and physical therapy to tailor to the unique needs of each patient. Surgical options, such as deep brain stimulation (DBS), have been pivotal for patients not responding adequately to medication, offering significant symptom relief. Pharmacotherapy remains a cornerstone of PD management, utilizing drugs like levodopa, dopamine agonists, and others to manage symptoms and, in some cases, slow down disease progression. However, these treatments often lead to complications over time, such as motor fluctuations and dyskinesias, highlighting the need for precise dosage adjustments and sometimes combination therapies to optimize patient outcomes. Physical therapy plays a critical role in addressing the motor symptoms of PD, including bradykinesia, muscle rigidity, tremors, postural instability, and akinesia. PT techniques are tailored to improve mobility, balance, strength, and overall quality of life. Strategies such as gait and balance training, strengthening exercises, stretching, and functional training are employed to mitigate symptoms and enhance functional independence. Specialized approaches like proprioceptive neuromuscular facilitation (PNF), the Bobath concept, and the use of assistive devices are also integral to the rehabilitation process, aimed at improving patients' ability to perform daily activities and reducing the risk of falls. Innovations in technology have introduced robotic-assisted gait training (RAGT) and other assistive devices, offering new possibilities for patient care. These tools provide targeted support and feedback, allowing for more intensive and personalized rehabilitation sessions. Despite these advancements, high costs and accessibility issues remain challenges that need addressing. The inclusion of exercise and activity beyond structured PT sessions is encouraged, with evidence suggesting that regular physical activity can have neuroprotective effects, potentially slowing disease progression. Activities such as treadmill walking, cycling, and aquatic exercises not only improve physical symptoms but also contribute to emotional well-being and social interactions. In conclusion, treating PD requires a holistic approach that combines medical, surgical, and therapeutic strategies. While there is no cure, the goal is to maximize patients' functional abilities and quality of life through personalized treatment plans. This integrated approach, along with ongoing research and development of new therapies, offers hope for improving the management of PD and the lives of those affected by this challenging disease.

The effect of proprioceptive neuromuscular facilitation on functional skills, muscle strength, and trunk control in children with cerebral palsy: A randomized controlled trial

BackgroundProprioceptive neuromuscular facilitation (PNF) is generally used for the lower limbs in children with Cerebral Palsy (CP). This study aimed to determine the effect of PNF and Neurodevelopmental Therapy (NDT) on functional abilities, muscle strength, and trunk control in children with CP. MethodsThirty spastic CP children classified as either level I–II in the Gross Motor Function Classification System (GMFCS) or level I–II in the Manual Ability Classification System (MACS) were included. The PNF (n = 15) and the NDT group (n = 15) had physiotherapy for six weeks. The ABILHAND-Kids scale, the Purdue Pegboard Test (PBPT), the Nine-Hole Peg Test (9-HPT), and the Jebson-Taylor Hand Function Test (JTHFT) were employed. Pinch meters, Jamar handheld dynamometers, and digital muscular strength assessments were used. ResultsThe PNF group increased shoulder flexion (p < 0.05), adduction (p < 0.05), elevation (p < 0.05), scapular abduction (p < 0.05), elbow extension (right) (p < 0.05), grip (p < 0.05), and pinch strengths (left p < 0.05, right p < 0.05). The PNF group had significantly lower 9-HPT (p < 0.05), JTHFT (card turning), JTHFT (simulated feeding), JTHFT (lifting light cans), and JTHFT (lifting weight cans) durations (p < 0.05), and significantly higher PBPT (right-left) PBPT (bimanual), PBPT (assembly).(p < 0.05), ABILHAND (p < 0.05), and TCMS total scores (p < 0.001). While JTHFT (simulated feeding-left), JTHFT (stacking checkers-left), JTHFT (lifting light cans-left), and JTHFT (lifting weight cans-right/left) (p < 0.05) durations decreased in the NDT group, PBPT (right) (p < 0.05) had an increase in duration. ConclusionPNF improves trunk control, upper extremity functional skills, selective proximal muscle strength, and distal upper extremity muscle and grip strength.

EFFECTIVENESS OF BOBATH TECHNIQUE IN TREATING CHILDREN WITH CEREBRAL PALSY: A SYSTEMATIC REVIEW

ABSTRACT: Aim: To assess how Bobath therapy affects motor function and functional independence. Method: This systematic review was conducted in accordance with PRISMA guidelines. All randomized trials that recruited cerebral palsy children and applied Bobath approach as intervention were collected through a comprehensive online database search. For quality assessment, the revised Cochrane risk-of-bias tool for randomized trial (RoB 2) was used. Results: Six eligible articles including five RCTs and one quasi-experimental study were retrieved from PEDro, MEDLINE, COCHRANE, EBSCO and PubMed since 2010, and all studies had low risk of bias. Bobath therapy had shown positive effects on gross motor function, balance, upper extremity function and functional independence but no significant effects on gait parameters and disability involvement. Conclusion: Bobath technique would not be effective on its own, instead might be effective as adjunct to other conventional physiotherapy treatments. Keywords: Neurodevelopmental therapy, Bobath, cerebral palsy, Randomized control trials

Correlation between Improved Balance and Decreased Limb Spasticity and Improved Muscle Strength in Post-Stroke Hemiparesis

Approximately 80% of stroke patients experience disability in the form of hemiparesis (weakness of half of the body). Physiotherapy problems that commonly occur in post-stroke hemiparesis include decreased muscle strength, spasticity, and balance disorders. This research is a correlation analysis study with one independent variable and 2 dependent variables, aiming to determine the correlation between balance improvement with decreased leg muscle spasticity and improved leg muscle strength in post-stroke hemiparesis patients, carried out at the Inggit Medical Center Clinic Makassar with a total sample of 12 people who met the inclusion criteria and were given intervention in the form of the bobath method for 10 treatments, the measuring instruments used were functional reach test (FRT) for balance, Asworth scale for spasticity, and chair stand for leg muscle strength. Spearman test between balance and muscle strength obtained a p value of 0.001 (p &lt;0.05) with a positive r of 0.822 which means there is a positive and significant correlation between increasing balance and increasing muscle strength. While between balance and spasticity obtained a p value of 0.04 (p &lt;0.05) with a negative r value of 0.584, which means there is a negative and significant correlation between increasing balance and decreasing spasticity. Improved balance has a significant relationship with increased muscle strength, and improved balance has a significant relationship with decreased spasticity in post-stroke hemiparesis patients.

Control Design for a Power-Assisted Mobile Trainer: Applied to Clinical Stroke Rehabilitation

This paper presents control design and implementation for a power-assisted mobile trainer that employs neuro-developmental treatment (NDT) principles. NDT is a gait rehabilitation technique for stroke patients that provides minimum intervention at critical gait events. Traditional NDT rehabilitation is an effective post-stroke treatment but is also time consuming and labor intensive for therapists. Therefore, we designed a mobile NDT trainer to automatically repeat therapists’ intervention patterns, allowing patients to receive sufficient training without increasing therapists’ workloads. Because the trainer was self-propelled, it could cause burdens to stroke patients with limited muscle strength, thereby potentially degrading the rehabilitation effects. Hence, this paper proposes a power-assisted device that can let the mobile trainer follow the user, allowing the subject to focus on the rehabilitation training. We conducted system identification and control design for the power-assisted NDT trainer. We then implemented the designed controllers and tested the trainer. Finally, we invited 10 healthy subjects and 12 stroke patients to conduct clinical experiments. After using the power-assisted NDT trainer, most participants exhibited improvements in swing-phase symmetry, pelvic rotation, and walking speed. Based on the results, the power-assisted device was deemed effective in facilitating stroke rehabilitation.

Neurodevelopmental Treatment (NDT) Approach for Improving Balance in the Hemiplegic Stroke Patient: A Comprehensive Case Study

Neurodevelopmental Treatment (NDT) Approach for Improving Balance in the Hemiplegic Stroke Patient: A Comprehensive Case Study

Effectiveness of mid thoracic spine mobilization on postural balance and gait ability in subacute stroke patients: A randomized clinical trial.

Although mulligan sustained natural apophyseal glides (SNAG) and maitland mobilization (MM) are common interventions for musculoskeletal disease, no study has directly compared the effectiveness of mid-thoracic spine mobilization in subacute stroke patients. To investigate the effects of mid-thoracic spine mobilization (SNAG vs. MM) on postural balance and gait ability in subacute stroke patients. Fifty subacute stroke patients were randomly allocated to the SNAG (n= 17), MM (n= 16), and control (n= 17) groups, each receiving a neuro-developmental therapy program for four successive weeks. The SNAG and MM groups additionally received mid-thoracic spine mobilization (T4∼8). The primary outcome measure was postural sway, and secondary outcome measures included the five times sit-to-stand test (FTSST), functional reach test (FRT), 10-m walk test (10MWT), 6-minute walk test (6MWT) and global rating of change (GRC). Participants reported no adverse events, and there was no loss to follow-up. The SNAG and MM group patients demonstrated significant improvements (p< 0.05) in postural sway, FTSST, FRT, 10MWT, and 6MWT compared with those in the control group, with no between-group differences. Mid-thoracic spine mobilization allows significant improvements in postural balance and gait ability in subacute stroke patients, with no differences between the SNAG and MM techniques.

Modified-constraint movement induced therapy versus neuro-developmental therapy on reaching capacity in children with hemiplegic cerebral palsy.

Upper extremity impairment is one of the complications in hemiplegic children. The purpose of modified constraint-induced movement therapy (mCIMT) is to improve the function of impaired arms and hands in these children. This study compared the efficacy of mCIMT and the approach of neurodevelopmental therapy (NDT) on reaching capacity in children with spastic hemiplegia. Fifty-two spastic hemiplegic children ranging in age from four to 6years were selected for this study from an outpatient clinic and biomechanical lab (Prince Sattam bin Abdulaziz University, KSA). They were randomly divided into two experimental groups: group I received NDT and group II received mCIMT for the involved upper limb and restriction of the uninvolved arm movements for 12weeks (three times per week). Both groups received a conventional exercise program in addition to experimental one. Active elbow extension range of motion and three-dimensional motion analysis of the reaching task were measured before and after 3months of treatment. Significant enhancement in all pre-treatment and post-treatment outcomes was observed in both groups by a two-way mixed MANOVA; furthermore, Group II (mCIMT) showed the most significant improvement (elbow extension, percentage of reach to peak velocity, movement time and movement units) when comparing the post-treatment outcomes between the two groups (p<0.001). Addition of mCIMT to a conventional exercise was superior to adding NDT exercise therapy in promoting the performance of reaching pattern in hemiplegic children.