Water-based exercise for cardiovascular fitness in people with chronic stroke: a randomized controlled trial

Effect of Programed Walking Exercise Using Bot Fit in Younger Adults

INTRODUCTION

Physical inactivity and sedentary behavior both increase the risk of chronic disease and mortality. Regular participation in physical activity and reducing sedentary behavior play important roles in maintaining physical health and disease prevention.

OBJECTIVE

The purpose of this study was to investigate the effect of programed walking exercise using a wearable hip exoskeleton, Bot Fit on muscle strength, muscle effort, and the kinematics of the pelvis in younger adults.

METHODS

We designed three parallel experimental conditions and randomly assigned participants to one of three groups: those assigned to exercise using an interval program of Bot Fit (interval group), those who used a power program of Bot Fit (power group), and a control group who exercised without Bot Fit. A total of 45 young adults participated in 18 exercise-intervention sessions over six weeks, and all participants were assessed at two time points: before and after the 18 exercise sessions. Each assessment evaluated muscle strength, muscle effort, and the kinematics of the pelvis during walking. In addition, the number of steps, distance, energy expenditure, and heart rate for 30 min during the exercise sessions were recorded.

RESULTS

A significant increase in the maximum voluntary contraction (MVC) of the left biceps femoris (BF) was evident in the interval group, while significant changes in the MVC of the bilateral BF were seen in the power group after Bot Fit exercise. A significant decrease of muscle effort in the right BF in the interval group and right lumbar erector spinae and bilateral BF in the power group were also observed. In addition, the symmetry index of pelvic tilt significantly improved in the interval group, and greater exercise volume and intensity in both the interval and power groups compared with the control group were confirmed as measured by the number of steps, distance, energy expenditure, and heart rate.

CONCLUSIONS

The results of this study confirmed the beneficial effect of programed walking exercise using the Bot Fit on muscle strength of trunk and lower extremities, muscle effort, and pelvic movement symmetry in younger adults. Personalized exercise programs can be provided for younger adults using various resistance or assistance modes of robotic device with the Bot Fit.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT05862077. Registered 22 March 2022, https://register.

CLINICALTRIALS

gov/ .

Aquatic high-intensity interval training (HIIT) may be similarly effective to land-based HIIT in improving exercise capacity in people with chronic conditions: a systematic review and meta-analysis

Objective

To investigate the effect of aquatic high-intensity interval training (AHIIT) on exercise capacity in people with chronic conditions.

Design

Systematic review and meta-analysis.

Participants

Adults (age ≥18 years) with any chronic conditions (long duration, continuing health problems).

Data sources

The databases Medline, EMBASE, CINAHL, SPORTSDiscus, PEDro and The Cochrane Library were searched from inception to 11 August 2023.

Eligibility criteria

Randomised or non-randomised controlled trials of adults reporting one or more chronic conditions were included, comparing the effect of AHIIT with a non-exercising control group, land-based high-intensity interval training (LBHIIT) or aquatic moderate-intensity continuous training (AMICT).

Results

Eighteen trials with 868 participants with chronic musculoskeletal, respiratory, cardiovascular, metabolic or neurological conditions were included. Adherence to AHIIT was high, ranging from 84% to 100%. There was moderate certainty in evidence according to the Grading of Recommendations Assessment, Development and Evaluation system for a moderate beneficial effect on exercise capacity standardised mean differences (SMD) 0.78 (95% CI 0.48 to 1.08), p<0.00001) of AHIIT compared with a non-exercising control group. There was moderate certainty in evidence for no difference of effects on exercise capacity (SMD 0.28 (95% CI -0.04 to 0.60), p=0.08) of AHIIT compared with LBHIIT. There was moderate certainty in evidence for small effect on exercise capacity (SMD 0.45 (95% CI 0.10 to 0.80), p=0.01) of AHIIT compared with AMICT.

Conclusion

There are beneficial effects of AHIIT on exercise capacity in people with a range of chronic conditions. AHIIT has similar effects on exercise capacity as LBHIIT and may represent an alternative for people unable to perform LBHIIT.

PROSPERO registration number

CRD42022289001.

Ankle-targeted exosuit resistance increases paretic propulsion in people post-stroke

BACKGROUND

Individualized, targeted, and intense training is the hallmark of successful gait rehabilitation in people post-stroke. Specifically, increasing use of the impaired ankle to increase propulsion during the stance phase of gait has been linked to higher walking speeds and symmetry. Conventional progressive resistance training is one method used for individualized and intense rehabilitation, but often fails to target paretic ankle plantarflexion during walking. Wearable assistive robots have successfully assisted ankle-specific mechanisms to increase paretic propulsion in people post-stroke, suggesting their potential to provide targeted resistance to increase propulsion, but this application remains underexamined in this population. This work investigates the effects of targeted stance-phase plantarflexion resistance training with a soft ankle exosuit on propulsion mechanics in people post-stroke.

METHODS

We conducted this study in nine individuals with chronic stroke and tested the effects of three resistive force magnitudes on peak paretic propulsion, ankle torque, and ankle power while participants walked on a treadmill at their comfortable walking speeds. For each force magnitude, participants walked for 1 min while the exosuit was inactive, 2 min with active resistance, and 1 min with the exosuit inactive, in sequence. We evaluated changes in gait biomechanics during the active resistance and post-resistance sections relative to the initial inactive section.

RESULTS

Walking with active resistance increased paretic propulsion by more than the minimal detectable change of 0.8 %body weight at all tested force magnitudes, with an average increase of 1.29 ± 0.37 %body weight at the highest force magnitude. This improvement corresponded to changes of 0.13 ± 0.03 N m kg- 1 in peak biological ankle torque and 0.26 ± 0.04 W kg- 1 in peak biological ankle power. Upon removal of resistance, propulsion changes persisted for 30 seconds with an improvement of 1.49 ± 0.58 %body weight after the highest resistance level and without compensatory involvement of the unresisted joints or limb.

CONCLUSIONS

Targeted exosuit-applied functional resistance of paretic ankle plantarflexors can elicit the latent propulsion reserve in people post-stroke. After-effects observed in propulsion highlight the potential for learning and restoration of propulsion mechanics. Thus, this exosuit-based resistive approach may offer new opportunities for individualized and progressive gait rehabilitation.

Tides of Change-Barriers and Facilitators to Beach Accessibility for Older People and People with Disability: An Australian Community Survey

The beach is Australia's most popular recreational destination with participation in beach-based activities associated with a wide range of health and wellbeing benefits. Unfortunately, access to beach environments is not possible for many older people and people with a disability. The purpose of this study was to investigate the barriers and facilitators of beach accessibility using a framework that recognises the complex interconnections between blue space, accessibility, physical activity, and health and wellbeing. A 39-item anonymous online cross-sectional survey was developed and administered to explore the perspectives of older people and people with a disability regarding beach accessibility. In total, 350 people completed the survey (69% female, age range 2-90 years (mean = 52)). Disability was reported by 88% of respondents, with 77% requiring a community mobility aid. Two-thirds (68%) of respondents were unable to visit the beach as often as they wanted, with 45% unable to visit at all. The most frequently reported barriers to beach access included difficulty moving on soft sand (87%), no specialised mobility equipment (75%), and inaccessible lead-up pathways (81%). If beach access was improved, respondents reported they would visit the beach more often (85%), for longer (83%), and have an improved experience (91%). The most frequently reported facilitators to beach access were the presence of accessible lead-up pathways (90%), sand walkways (89%), and parking (87%). Older people and people with disability have limited beach access, primarily due to a lack of accessible equipment, excluding them from the wide range of health benefits associated with visiting the beach.

Effects of Exercise Programs on Functional Capacity and Quality of Life in People With Acquired Brain Injury: A Systematic Review and Meta-Analysis

OBJECTIVE

The aims of this systematic review and meta-analyses were to evaluate the effects of exercise on the functional capacity and quality of life (QoL) of people with acquired brain injury (ABI) and to analyze the influence of training variables.

METHODS

Five electronic databases (MEDLINE, Cochrane Library, CINAHL, SportDiscus, and Web of Science) were searched until October 2021 for clinical trials or experimental studies examining the effects of exercise on the functional capacity and QoL in adults with ABI and comparing exercise interventions with non-exercise (usual care).

RESULTS

Thirty-eight studies were evaluated. A total sample of 2219 people with ABI (exercise, n = 1572; control, n = 647) were included in the quantitative analysis. A greater improvement was observed in walking endurance (z score = 2.84), gait speed (z score = 2.01), QoL physical subscale (z score = 3.42), and QoL mental subscale (z score = 3.00) was observed in the experimental group than in the control group. In addition, an improvement was also observed in the experimental group in the "Timed Up and Go" Test scores and balance without differences from the control group. Significant interactions were also observed between the rehabilitation phases, type, frequency and volume of training, and overall effects.

CONCLUSION

The results suggest that exercise improves functional capacity and QoL regardless of model training, highlighting the effectiveness of long-term exercise that includes short sessions with components such as strength, balance, and aerobic exercise.

IMPACT

The results shown in this systematic review with meta-analysis will allow physical therapists to better understand the effects of training on people with ABI.

Water-based therapeutic exercise in stroke: a scoping review

PURPOSE

To (1) describe the state of the literature on water-based therapeutic exercise (WBTE) for people living with stroke, (2) describe the content and structure of interventions, (3) summarize the effects of interventions described in the literature, and (4) identify gaps in the literature limiting application and implementation.

MATERIALS AND METHODS

Scoping review methodology described by Arksey and O'Malley (2005) and Levac et al. (2010). Electronic databases were searched for articles with eligibility criteria including: (1) adult stroke survivors (18 years or older) of any type (ischemic/hemorrhagic) or stage (acute/chronic) in any setting, and (2) the study intervention involved WBTE to address a post-stroke deficit.

RESULTS

40 articles were included in this review. Five trials had a treatment control, 20 had an active comparison. Calculated intervention effect sizes demonstrated a strong effect of WBTE on balance and gait related outcomes in 80% of controlled and comparison trials.

CONCLUSIONS

This scoping review highlights common parameters of WBTE interventions and provides an inventory of the differences in the treatment approaches utilized in this population. Opportunities for future work include the development of a standardized treatment protocol, qualitative or mixed methodology research, and greater inclusion of more individuals with more severe stroke-related impairments. IMPLICATIONS FOR REHABILITATIONWater-based therapeutic exercise is an approach that may allow stroke survivors to carry out challenging activities in a safe and accessible environment.Water-based interventions for stroke survivors appear to have a beneficial impact on walking and balance.Given that an aquatic environment offers an opportunity for individuals with more significant physical impairments to carry out early practice of walking and balance related tasks, clinicians should explore the feasibility and effectiveness for this subset of stroke survivors.

Ankle resistance with a unilateral soft exosuit increases plantarflexor effort during pushoff in unimpaired individuals

BACKGROUND

Ankle-targeting resistance training for improving plantarflexion function during walking increases rehabilitation intensity, an important factor for motor recovery after stroke. However, understanding of the effects of resisting plantarflexion during stance on joint kinetics and muscle activity-key outcomes in evaluating its potential value in rehabilitation-remains limited. This initial study uses a unilateral exosuit that resists plantarflexion during mid-late stance in unimpaired individuals to test the hypotheses that when plantarflexion is resisted, individuals would (1) increase plantarflexor ankle torque and muscle activity locally at the resisted ipsilateral ankle, but (2) at higher forces, exhibit a generalized response that also uses the unresisted joints and limb. Further, we expected (3) short-term retention into gait immediately after removal of resistance.

METHODS

Ten healthy young adults walked at 1.25 m s-1 for four 10-min discrete bouts, each comprising baseline, exposure to active exosuit-applied resistance, and post-active sections. In each bout, a different force magnitude was applied based on individual baseline ankle torques. The peak resistance torque applied by the exosuit was 0.13 ± 0.01, 0.19 ± 0.01, 0.26 ± 0.02, and 0.32 ± 0.02 N m kg-1, in the LOW, MED, HIGH, and MAX bouts, respectively.

RESULTS

(1) Across all bouts, participants increased peak ipsilateral biological ankle torque by 0.13-0.25 N m kg-1 (p < 0.001) during exosuit-applied resistance compared to corresponding baselines. Additionally, ipsilateral soleus activity during stance increased by 5.4-11.3% (p < 0.05) in all but the LOW bout. (2) In the HIGH and MAX bouts, vertical ground reaction force decreased on the ipsilateral limb while increasing on the contralateral limb (p < 0.01). Secondary analysis found that the force magnitude that maximized increases in biological ankle torque without significant changes in limb loading varied by subject. (3) Finally, peak ipsilateral plantarflexion angle increased significantly during post-exposure in the intermediate HIGH resistance bout (p < 0.05), which corresponded to the greatest average increase in soleus activity (p > 0.10).

CONCLUSIONS

Targeted resistance of ankle plantarflexion during stance by an exosuit consistently increased local ipsilateral plantarflexor effort during active resistance, but force magnitude will be an important parameter to tune for minimizing the involvement of the unresisted joints and limb during training.

Associations Between Time After Stroke and Exercise Training Outcomes: A Meta-Regression Analysis

Background Knowledge gaps exist regarding the effect of time elapsed after stroke on the effectiveness of exercise training interventions, offering incomplete guidance to clinicians. Methods and Results To determine the associations between time after stroke and 6-minute walk distance, 10-meter walk time, cardiorespiratory fitness and balance (Berg Balance Scale score [BBS]) in exercise training interventions, relevant studies in post-stroke populations were identified by systematic review. Time after stroke as continuous or dichotomized (≤3 months versus >3 months, and ≤6 months versus >6 months) variables and weighted mean differences in postintervention outcomes were examined in meta-regression analyses adjusted for study baseline mean values (pre-post comparisons) or baseline mean values and baseline control-intervention differences (controlled comparisons). Secondary models were adjusted additionally for mean age, sex, and aerobic exercise intensity, dose, and modality. We included 148 studies. Earlier exercise training initiation was associated with larger pre-post differences in mobility; studies initiated ≤3 months versus >3 months after stroke were associated with larger differences (weighted mean differences [95% confidence interval]) in 6-minute walk distance (36.3 meters; 95% CI, 14.2-58.5), comfortable 10-meter walk time (0.13 m/s; 95% CI, 0.06-0.19) and fast 10-meter walk time (0.16 m/s; 95% CI, 0.03-0.3), in fully adjusted models. Initiation ≤3 months versus >3 months was not associated with cardiorespiratory fitness but was associated with a higher but not clinically important Berg Balance Scale score difference (2.9 points; 95% CI, 0.41-5.5). In exercise training versus control studies, initiation ≤3 months was associated with a greater difference in only postintervention 6-minute walk distance (baseline-adjusted 27.3 meters; 95% CI, 6.1-48.5; fully adjusted, 24.9 meters; 95% CI, 0.82-49.1; a similar association was seen for ≤6 months versus >6 months after stroke (fully adjusted, 26.6 meters; 95% CI, 2.6-50.6). Conclusions There may be a clinically meaningful benefit to mobility outcomes when exercise is initiated within 3 months and up to 6 months after stroke.

The effect of aquatic training on static and semi-dynamic balance of patients with chronic ischemic stroke: A randomized clinical trial

Objectives

This study aims to investigate the effect of six-week aquatic exercise on the static and semi-dynamic balance of male patients with chronic ischemic stroke (CIS).

Patients and methods

This randomized clinical trial (RCT) included a total of 36 male CIS patients (mean age 60.2±6.7 years; range, 40 to 70 years) between January 2015 and January 2017. The patients were randomly divided into three groups consisting of 12 patients in each group: (i) exercising in shallow water, (ii) exercising in deep water, and (iii) control group. Training sessions were held three days a week for six weeks, and the control group did not participate in these sessions. The balance of the patients was checked using the Biodex balance system in two stages.

Results

There was no significant difference between the two intervention groups (shallow and deep) in terms of the balance assessment post-test (p>0.05), yet there was a statistically significant difference between the two intervention groups (shallow and deep) with the control group in terms of the semi-dynamic balance (total) score, (p<0.05); the semi-dynamic balance (total) of the two intervention groups (shallow and deep) was higher than that of the control group (p<0.05).

Conclusion

Our study results indicate that exercise in both depths is a suitable solution to improve balance, particularly semi-dynamic balance (total) in male CIS patients. Accordingly, aquatic training has a positive effect on balance in male stroke patients and we can prescribe this protocol as a useful remedy for these patients.

The Feasibility of Tai Chi Exercise as a Beneficial Mind-Body Intervention in a Group of Community-Dwelling Stroke Survivors with Symptoms of Depression

Depression is prevalent among one-third to two-thirds of acute and chronic stroke survivors. Despite the availability of pharmacotherapies and/or psychotherapies, depression persists, even for 5–10 years after stroke, reflecting limited treatment responses and/or adherence to this conventional care. Mind-body interventions are commonly used among adults to ameliorate depressive symptoms. Thus, the feasibility of Tai Chi, alongside conventional care, to manage poststroke depression was investigated using a single-group pre-post intervention design. Recruitment and retention, intervention adherence, safety, acceptability, and fidelity were assessed. Symptoms of depression, anxiety, and stress were assessed using standardized questionnaires, objective sleep was assessed via a research-grade triaxial accelerometer, and blood samples were taken to measure oxidative stress, inflammatory markers, and a neurotrophic growth factor using commercially available kits per manufacturer's protocol. Pre-post intervention changes were assessed using paired t-tests. We enrolled stroke survivors (N = 11, mean age = 69.7 ± 9.3) reporting depression symptoms. After the intervention, we observed significant reductions in symptoms of depression (−5.3 ± 5.9, p=0.01), anxiety (−2.2 ± 2.4, p=0.01), and stress (−4.6 ± 4.8, p=0.01), along with better sleep efficiency (+1.8 ± 1.8, p=0.01), less wakefulness after sleep onset (−9.3 ± 11.6, p=0.04), and less time awake (−9.3 ± 11.6, p=0.04). There was a 36% decrease in oxidative stress (p=0.02), though no significant changes in the other biomarkers were found (all p values >0.05). Tai Chi exercise is a feasible intervention that can be used alongside conventional care to manage poststroke depression, aid in reducing symptoms of anxiety and stress, and improve sleep.

Effects of Aquatic Exercise and Land-Based Exercise on Cardiorespiratory Fitness, Motor Function, Balance, and Functional Independence in Stroke Patients-A Meta-Analysis of Randomized Controlled Trials

The aim of this study was to evaluate the efficacy of aquatic exercise (AE) and land-based exercise (LE) on cardiorespiratory fitness, motor function, balance, and functional independence in stroke patients. Design: Through searching PubMed, Embase, Cochrane Library, Web of Science, CNKI, VIP and Wanfang Database, only randomized controlled trials (RCTs) were collected to study the effects of AE and LE on cardiorespiratory fitness, motor function, balance, and functional independence in patients with stroke. The included studies were evaluated for methodological quality by the Cochrane bias risk assessment tool, and statistical analysis was carried out by the Review Manage 5.3 and Stata 15.1 software. Results: The RCTs were collected between the earliest available date and April 2021. Eleven RCTs were included, including five studies with low risk and six studies with moderate risk. The total sample size used in the study was 369, which included 187 patients undertaking AE and 182 patients undertaking LE. The results of the meta-analysis showed that AE can significantly improve patients’ Berg Balance Scale (BBS) (MD = 5.19, 95% CI: 2.66 to 7.71, p < 0.0001), peak oxygen uptake (VO₂peak) (MD = 3.49, 95% CI: 0.17 to 6.8, p = 0.04), Fugl–Meyer Assessment (FMA) (MD = 3.84, 95% CI: 1.64 to 6.04, p = 0.0006), and Functional Independence Measure (FIM) (MD = 6.1, 95% CI: 4.05 to 8.15, p < 0.00001). However, there was no statistically significant difference between the two exercise modes in the Timed Up and Go Test (TUGT) (MD = −2.52, 95% CI: −5.95 to 0.91, p = 0.15) or the Functional Ambulation Category scale (FAC) (MD = 0.28, 95% CI: −0.21 to 0.76, p = 0.26). Conclusion: Based on the improvement in the Berg Balance Scale, peak oxygen uptake, Fugl–Meyer Assessment, and Functional Independence Measure, we can state that aquatic exercise offers better advantages than land-based exercise for patients’ balance, motor function, cardiorespiratory fitness, and functional independence.

The Effect of Water-Based Therapy Compared to Land-Based Therapy on Balance and Gait Parameters of Patients with Stroke: A Systematic Review

INTRODUCTION

Stroke is defined as the lack of blood supply to the brain, leading to rapid loss of brain function presenting with impairments such as muscle weakness, spasticity, lack of coordination, and proprioception loss. Both hydrotherapy and land-based therapy aim to target these aspects in the process of rehabilitation. The study aims to determine the effectiveness of water-based therapy on balance and gait of patients with stroke compared to land-based therapy.

METHODS

Data for this review were extracted from databases such as CINAHL, OTseeker, Ovid, PEDro, and PubMed (MEDLINE) and other sources such as Google Scholar. PRISMA guidelines were followed to exclude irrelevant studies. Only randomized controlled trials (RCTs) were included, and methodological quality was assessed using the PEDro scale. A meta-analysis of extracted data was conducted.

RESULTS

A total of 16 relevant RCTs were included for the review (n = 412 participants). All RCTs investigated the effect of water-based therapy compared to land-based therapy on balance and gait of patients with stroke. Meta-analysis of studies that used the Berg Balance Scale (BBS) as a primary outcome measure favored land-based therapy. Studies that used the Good Balance System (GBS) and the Biodex Balance System (BioBS) to measure the changes in anteroposterior sway and mediolateral sway favored water-based therapy. The overall pooled effect favored land-based therapy in improving gait parameters.

CONCLUSION

Findings from meta-analysis support the effectiveness of land-based therapy in the improvement of balance and gait parameters of patients with stroke. However, the evidence for water-based therapy continues to be limited, and higher quality studies are required to determine the effectiveness of water-based therapy on patients with stroke, particularly on balance and gait.

Aquatic therapy in stroke rehabilitation: systematic review and meta-analysis

The main object of this systematic review and meta-analysis is to collect the available evidence of aquatic therapy in stroke rehabilitation and to investigate the effect of this intervention in supporting stroke recovery. The PubMed, the Cochrane Central Register of Controlled Trials and the PEDro databases were searched from their inception through to 31/05/2020 on randomized controlled trials evaluating the effect of aquatic therapy on stroke recovery. Subjects´ characteristics, methodological aspects, intervention description, and outcomes were extracted. Effect sizes were calculated for each study and outcome. Overall, 28 appropriate studies (N = 961) have been identified. A comparison with no intervention indicates that aquatic therapy is effective in supporting walking, balance, emotional status and health-related quality of life, spasticity, and physiological indicators. In comparison with land-based interventions, aquatic therapy shows superior effectiveness on balance, walking, muscular strength, proprioception, health-related quality of life, physiological indicators, and cardiorespiratory fitness. Only on independence in activities of daily living the land- and water-based exercise induce similar effects. Established concepts of water-based therapy (such as the Halliwick, Ai Chi, Watsu, or Bad Ragaz Ring methods) are the most effective, aquatic treadmill walking is the least effective. The current evidence is insufficient to support this therapy form within evidence-based rehabilitation. However, the available data indicate that this therapy can significantly improve a wide range of stroke-induced disabilities. Future research should devote more attention to this highly potent intervention.

Comparison of training effects between underwater treadmill gait training and overground gait training on the walking ability and respiratory function in patients with chronic severe hemiplegic stroke: A randomized, controlled, preliminary trial

Background: The need to develop a more effective intervention to obtain a functional recovery of stroke patients who are unable to perform land-based treadmill gait training has been widely reported. Thus, this pilot study aimed to identify a gait training type that could lead to improved gait and respiratory functioning in adult patients with chronic severe hemiplegic stroke.Objectives: To examine whether underwater treadmill or/and overground gait training could be more effective in stroke patients.Methods: In this single-blinded, randomized, controlled, comparative study, 22 patients with severe hemiplegic stroke in a rehabilitation hospital were randomly assigned to the experimental (underwater treadmill gait training) or control group (overground gait training). All participants performed a 60-min neurodevelopmental treatment (five times/week for 12 weeks). Each group performed 30-min underwater or overground gait training (two times/week for 12 weeks). Gait and respiratory function were measured before and after the 12-week training.Results: For the walking variables, step-time difference changes post-training showed significant differences between the groups (-.06 vs. +.04 s, p < .05). Both groups showed significant increases in the maximal voluntary volume (MVV) at post compared to pre training (p < .05). The post-training MVV values were significantly different between the two groups (+23.35 vs. +4.76 L, p < .05).Conclusions: In severe stroke patients, underwater treadmill gait training can be more effective in improving gait and respiratory function than overground gait training and could be an effective clinical intervention tool for the training of such patients.

Validation of the functional component of the Halliwick-ICF assessment scale

Introduction: Aquatic rehabilitation therapy can improve strength and functional ability. Previous studies measured outcomes on land but did not measure underwater functional ability.Purpose: This study aimed to validate the functional component of the Halliwick-ICF assessment scale, and to compare the scale between underwater and on-land activities.Methods: Rehabilitation and medical charts of individuals with brain lesions and/or spine injuries who underwent aquatic therapy were retrospectively reviewed. Twenty-one functional components of the Halliwick-ICF assessment scale items were categorized through exploratory factor analysis: center of gravity alteration, basic functional activity, and progressive basic functional activity. Confirmatory factor analysis was performed to evaluate the validity of the functional components of the Halliwick-ICF assessment scale. Spearman's correlation analyses were conducted using Medical Research Council sum and modified Barthel index scores.Results: Ninety-five participants (mean age: 53.4 years, range: 27-73 years) were included in the analysis. Convergence and discrimination validity for all three factors were established. Total scores of the scale showed correlations with the modified Barthel index (r = 0.636, p < .001) and Medical Research Council sum (r = 0.298, p = .01) scores.Conclusion: The functional components of the Halliwick-ICF assessment scale demonstrated validity with physical function on land, suggesting its usefulness in aquatic therapy.

Evaluation of the Feasibility of a Two-Week Course of Aquatic Therapy and Thalassotherapy in a Mild Post-Stroke Population

Strokes are a leading cause of disability in developed countries. Patients with disabilities need rehabilitation to improve their physical functioning, mental status, and quality of life. Currently, no high-quality evidence can be found attesting the benefits of any of the interventions that are nowadays used. Water-based exercise may improve the physical conditions and quality of life of people in the post-stroke phase. The objective of this study is to test whether aquatic therapy in an enriched environment at the seaside (a thalassotherapy center) could play a role in this condition. A quasi-experimental prospective study consisting of a specific program assessed 62 patients with a mild–moderate disability pre- and post-2 weeks of intensive treatment. They followed a thalassotherapy regimen including aquatic therapy in a sea water pool at 32–34 °C for 45 min daily five times a week. The outcomes measured were the Berg Balance scale, the Timed Up and Go test, the 10-meter walking test, the 6-min walking test, the Pain Visual Analogue Scale, the WHO Well-being index, EuroQoL VAS and EuroQoL 5D. We observed a significant improvement in all outcomes measured (p < 0.001, except mobility EuroQoL p < 0.05), except in the other four dimensions of the EuroQoL 5D and 10-metre walking test (NS). Conclusion: A two-week intensive course of aquatic therapy and thalassotherapy may be beneficial in the short term by reducing pain and improving the functional status and overall well-being of post-stroke patients.

Comparison of Aquatic Therapy vs. Dry Land Therapy to Improve Mobility of Chronic Stroke Patients

One of the most serious and disabling problems of stroke is pain and a decrease in balance, with the consequent increased risk of falls. The aim of the randomized controlled trial study was to compare the efficacy of three different treatment proposals to improve pain, gait, and balance in chronic stroke patients. Forty patients diagnosed with stroke were divided into three groups: the dry-land therapy group (control group) received sessions that included walking exercises and trunk mobility. The experimental group received Ai Chi aquatic therapy, and the combined group received alternating dry-land therapy sessions and Ai Chi aquatic therapy. The measurement instruments used were: the Tinetti balance and gait scale, the visual analog scale (VAS), 360° turn, single leg stance, and the 30-s stand test (CS-30). After twelve weeks of treatment, the results were significantly better for the combined therapy group and the experimental group compared to the dry-land therapy group (p < 0.01) in the VAS scale, CS-30, and 360° turn, although improvements were also found in the evaluations carried out in the aquatic therapy group. In total, for the Tinetti scale and single-leg stance, the differences between the groups were evident, although not statistically significant (p = 0.001). Aquatic therapy with Ai Chi and the combination of aquatic therapy with dry-land therapy was effective in improving pain, balance, and gait in patients with chronic stroke, thus improving their functional capacity and quality of life.

Comparison of underwater gait training and overground gait training for improving the walking and balancing ability of patients with severe hemiplegic stroke: A randomized controlled pilot trial

BACKGROUND

Walking training is an essential intervention to improve the function in stroke patients. However, only a limited number of gait training strategies are available for stroke patients with relatively severe disabilities.

RESEARCH QUESTION

Is underwater gait training or overground gait training more effective in severe stroke patients?

METHODS

A total of 21 patients with severe hemiplegic stroke were randomly assigned to the experimental and control groups. All participants (n = 21) received 60-minute sessions of general physical therapy, 5 times a week for a period of 12 weeks. Additionally, the experimental and control groups underwent underwater and overground walking training, respectively, for 30 min twice times a week for 12 weeks. Postural assessment for stroke score, center of pressure path length and velocity, step time and step length difference, and walking velocity were measured before and after the 12-week training.

RESULTS

Both groups showed a significant decrease in the center of pressure path length and velocity after the intervention compared to the values before the intervention (p < .05). However, there was no significant difference in the center of pressure path length and velocity changes after training between the two groups (p > .05). In the walking variables, the step length difference changes after training between the two groups showed a significant difference (p < .05). In the experimental group, the step length difference increased after the intervention compared to that before the intervention (+4.55 cm), whereas that of the control group decreased (-1.25 cm).

SIGNIFICANCE

In severe stroke patients, underwater gait training can be effective for improving balancing ability, but it may be less effective on the improvement of gait function than overground walking.

CLINICAL TRIAL REGISTRATION NUMBER

KCT0002587 (https://cris.nih.go.kr).

Effect of aquatic therapy on balance and gait in stroke survivors: A systematic review and meta-analysis

BACKGROUND

The evidence on aquatic therapy (AT) for improving balance and gait deficits post-stroke is unclear. Therefore, this study aimed to determine the effect of AT on balance and gait in stroke survivors.

METHODS

We searched CINAHL, PubMed, Web of Science, Aqua4balance, Ewac, Cochrane, and EMBASE databases from inception to 1^st November 2019.

RESULTS

Eleven studies with 455 participants were included for the review. Meta-analysis showed that AT was effective for improving balance (MD 3.23, 95% CI 1.06, 5.39; p = 0.004; I² = 61%) and gait speed (MD 0.77, 95% CI 0.25, 1.29; p = 0.004; I² = 0%) when delivered alone. AT was effective in improving cadence (MD 4.41, 95% CI 0.82, 8.00; p = 0.02; I² = 68%) when delivered as an adjunct to land-based therapy.

CONCLUSION

AT may be used to improve balance and gait after stroke; however, the evidence to support its use is still low.

The effects of Ai Chi for balance in individuals with chronic stroke: a randomized controlled trial

This study investigated the effectiveness of Ai Chi compared to conventional water-based exercise on balance performance in individuals with chronic stroke. A total of 20 individuals with chronic stroke were randomly allocated to receive either Ai Chi or conventional water-based exercise for 60 min/time, 3 times/week, and a total of 6 weeks. Balance performance assessed by limit of stability (LOS) test and Berg balance scale (BBS). Fugl-Meyer assessment (FMA) and gait performance were documented for lower extremity movement control and walking ability, respectively. Excursion and movement velocity in LOS test was significantly increased in anteroposterior axis after receiving Ai Chi (p = 0.005 for excursion, p = 0.013 for velocity) but not conventional water-based exercise. In particular, the improvement of endpoint excursion in the Ai Chi group has significant inter-group difference (p = 0.001). Both groups showed significant improvement in BBS and FMA yet the Ai Chi group demonstrated significantly better results than control group (p = 0.025). Ai Chi is feasible for balance training in stroke, and is able to improve weight shifting in anteroposterior axis, functional balance, and lower extremity control as compared to conventional water-based exercise.

Effects of a Kinect-based physical training program on body composition, functional fitness and depression in institutionalized older adults

Exergames have already been used as therapeutic tools to enhance both physical and cognitive functions in older adults.

AIM

To evaluate the effects of a Kinect-based physical activity program on the quality of life, depression, functional fitness and body composition in institutionalized older adults.

METHODS

A total of 50 older adults aged >60 years were selected and randomized to a control and video game group. Body composition was determined by means of anthropometric measurements. Quality of life was assessed using the WHOQOL-BREF questionnaire, and depression was classified using the Beck Depression inventory. Functional fitness was assessed using the Arm Curl, Chair Stand, 8-foot up-and-go, sit and reach, and the aerobic endurance test.

RESULTS

After 12 weeks of protocol, we observed a significant improvement in all functional fitness parameters.

CONCLUSIONS

Our findings suggest that a Kinect-based physical activity program seems to positively impact the three domains related to quality of life and directly associated with age (physical, social and psychological domains), and to promote a more active lifestyle in institutions housing older individuals. Geriatr Gerontol Int 2020; ••: ••-••.

Effects of hydrokinesitherapy on balance and walking ability in stroke survivors: a systematic review and meta-analysis of randomized controlled studies

BACKGROUND

Balance and walking impairment are common dysfunctions after stroke. Emerging data has demonstrated that hydrokinesitherapy may have a positive influence on improvement of balance and walking ability. However, there is no firm evidence to support these results. Therefore, the aim of this review is to evaluate the effects of hydrokinesitherapy in stroke survivors systematically.

METHODS

Medline, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, CINAHL and SPORTDiscus were systemic searched from their inception to Septemter 30, 2018. RevMan 5.3 software was used to perform data synthesis. The fixed-effect model or random-effect model was employed according to the results of heterogeneity test. The mean differences (MD) or standardized mean difference (SMD) was used to evaluate the pooled effect of hydrokinesitherapy on balance function, walking ability and activty of daily life (ADL).

RESULTS

A total of 13 studies were included involving 381 stroke survivors. Meta-analysis results indicated that hydrokinesitherapy could improve balance ability based on three test: Berg balance scale (BBS: MD = 3.84, 95% confidence interval (95% CI) 2.84 to 4.86, P < 0.001), Time Up To Go Test (TUGT: MD = - 1.22, 95% CI - 2.25 to - 0.18, P = 0.02, fixed-effect model), Functional Reach Test (FRT: MD = 2.41, 95% CI 1.49 to 3.33, P < 0.001). Additionally, we found a weakly positive effect on walking speed (SMD = 0.75, 95% CI 0.26 to 1.25, P = 0.003) and walking ability test (SMD = 0.36, 95% CI 0.04 to 0.68, P = 0.03). There was no significant difference between experimental group and control group in terms of ADL.

SHORT CONCLUSION

Hydrokinesitherapy can improve balance function and had a weakly positive effect on walking ability in stroke survivors. We did not find sufficient evidence to indicate that hydrokinesitherapy could improve the ADL of stroke survivors. However, due to the methodological shortcoming and small number of included studies, caution is needed when interpreting these results. Due to imprecision and publication bias, the quality of the evidence was downgraded to "low-quality" for the primary outcomes of balance and walking ability.

TRIAL REGISTRATION

CRD42018110787.

Evaluating the effectiveness of aquatic therapy on mobility, balance, and level of functional independence in stroke rehabilitation: a systematic review and meta-analysis

Objective:

To meta-analyze and systematically review the effectiveness of aquatic therapy in improving mobility, balance, and functional independence after stroke.

Data Sources:

Articles published in Medline, Embase, CINAHL, PsycINFO, and Scopus up to 20 August 2019.

Study Selection:

Studies met the following inclusion criteria: (1) English, (2) adult stroke population, (3) randomized or non-randomized prospectively controlled trial (RCT or PCT, respectively) study design, (4) the experimental group received >1 session of aquatic therapy, and (5) included a clinical outcome measure of mobility, balance, or functional independence.

Data Extraction:

Participant characteristics, treatment protocols, between-group outcomes, point measures, and measures of variability were extracted. Methodological quality was assessed using Physiotherapy Evidence Database (PEDro) tool, and pooled mean differences (MD) ± standard error and 95% confidence intervals (CI) were calculated for Functional Reach Test (FRT), Timed Up and Go Test (TUG), gait speed, and Berg Balance Scale (BBS).

Data Synthesis:

Nineteen studies (17 RCTs and 2 PCTs) with a mean sample size of 36 participants and mean PEDro score of 5.6 (range 4–8) were included. Aquatic therapy demonstrated statistically significant improvements over land therapy on FRT (MD = 3.511 ± 1.597; 95% CI: 0.381–6.642; P = 0.028), TUG (MD = 2.229 ± 0.513; 95% CI: 1.224–3.234; P < 0.001), gait speed (MD = 0.049 ± 0.023; 95% CI: 0.005–0.094; P = 0.030), and BBS (MD = 2.252 ± 0.552; 95% CI: 1.171–3.334; P < 0.001).

Conclusions:

While the effect of aquatic therapy on mobility and balance is statistically significant compared to land-based therapy, the clinical significance is less clear, highly variable, and outcome measure dependent.

Preventing Muscle Atrophy Following Strokes: A Reappraisal

Muscle atrophy leading to muscle weakness accounts for major cause of disabilities among stroke survivors. It amounts to compromised gait and prevails to viscous cycle of diminished physical capacities and compromised participation in rehabilitative tasks. There is predisposition to recurrent strokes due to added risk of developing metabolic syndrome. Therefore, beyond the shadow of doubt, there is ripple effect of rehabilitation and thereby muscle protection in these subsets of patients. Herein, we highlight upon the newer insights with regard to preventing muscle atrophy following strokes.

Hidrotherapy

Objective. The aim of this study was to compare the evolution of daily life activities of patients suffering from sequels of strokes who were submitted to hydrotherapy, conventional kinesiotherapy and those with no physiotherapeutic intervention. Method. A total of 152 patients of both genders were selected according to their arrival in the service and were submitted to hydrotherapy in isolation or together with classical kinesiotherapy, over six months. The 45-minute hydrotherapy and classical kinesiotherapy sessions were performed at least three times weekly. Functional activity was evaluated every three months to identify: the dependence, semi-dependence or independence on routine activities. Analysis of the functional activity was assessed by means of the Barthel index. Results. Of the 152 patients, 118 satisfied inclusion criteria. The participants were divided into three groups: 72 (61%) underwent conventional kinesiotherapy, 32 (27.1%) hydrotherapy followed by conventional kinesiotherapy and 14 (11.9%) had no physiotherapeutic interventions. The conventional kinesiotherapy with hydrotherapy group improved in relation to both the degree of independence and lighter motor sequels (p=0.001). The neurological deficit remained greater in the non-treatment group than in the others (p=0.01). Conclusion. The hydrotherapy may be considered a good coadjuvant procedure for patients with sequels due to stroke.

The effectiveness of group exercise for improving activity and participation in adult stroke survivors: a systematic review

BACKGROUND

Following post stroke rehabilitation, group exercise interventions can be used to continue improving cardiovascular fitness, activity levels, balance, gait, movement efficiency, and strengthening. However, little is known of the effectiveness of group exercise for improving activity and participation in stroke survivors.

OBJECTIVES

This review aims to assess the effectiveness of group exercise for improving activity and participation in adult stroke survivors.

DATA SOURCES

Databases searched were MEDLINE, Web of Science (Core collection), CINAHL, and the Cochrane Library.

STUDY ELIGIBILITY CRITERIA

Randomised controlled trials (RCTs) of group exercise using validated outcome measures of activity and participation for post stroke rehabilitation. Two independent reviewers assessed all abstracts, extracted data, conducted a narrative synthesis and assessed the quality of all included articles. The Cochrane Risk of Bias Tool assessed methodological quality and included outcome measure quality was assessed.

RESULTS

14 RCTs were included (n=624 chronic stroke survivors collectively). Studies ranged between 12 and 243 stroke participants with an average of left:right hemisphere lesions of 32:39 and average age was 66.7 years. Although intervention and control groups improved, no significant difference between group differences were evident.

CONCLUSION

and implications of key findings: The review found improvements are short-term and less evident at long-term follow up with little improvements in participation after 6months. However, this review was limited to the standard of intervention reporting. Further research should consider consistency in measuring underpinning mechanisms of group exercise interventions, which may explain the lack of activity changes in long-term follow-up.

SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO

CRD42017078917.

Effect of hydrokinesitherapy on balance and walking ability in post-stroke patients: A systematic review protocol

INTRODUCTION

Brain stroke is the second most common cause of death and major cause of disability in adults, representing a huge burden on patients and their families. Hydrokinesitherapy, a type of physical rehabilitation, may be beneficial to post-stroke recovery. We will systematically assess the clinical effectiveness and safety of hydrokinesitherapy for rehabilitation of stroke survivors in this review.

METHODS

We will perform a systematic search to identify all potentially relevant published studies on this topic. Online electronic databases including MEDLINE (via PubMed), EMBASE (via embase.com), Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, CINAHL (via EBSCOhost) and SPORTDiscus (via EBSCOhost) will be searched without language restrictions from their inception to September 30, 2018. All relevant randomized controlled trails (RCTs) will be screened according to predetermined inclusion criteria. Two independent reviewers will evaluate the methodological quality of each study included. One reviewer will extract data and another reviewer will check the accuracy. Any disagreements will be discussed with a third reviewer. The posture balance and walking ability will be defined as primary outcomes. Activities of daily living (ADL), drop-out and adverse events will also be assessed as secondary outcomes. The evaluation of methodological quality, data analysis will be completed using Cochrane Review Manager 5.3 according to Cochrane Handbook for Systematic Reviews of Interventions.

TRIAL REGISTRATION NUMBER

CRD42018110787.

Interventions involving repetitive practice improve strength after stroke: a systematic review

QUESTIONS

Do interventions involving repetitive practice improve strength after stroke? Are any improvements in strength accompanied by improvements in activity?

DESIGN

Systematic review of randomised trials with meta-analysis.

PARTICIPANTS

Adults who have had a stroke.

INTERVENTION

Any intervention involving repetitive practice compared with no intervention or a sham intervention.

OUTCOME MEASURES

The primary outcome was voluntary strength in muscles trained as part of the intervention. The secondary outcomes were measures of lower limb and upper limb activity.

RESULTS

Fifty-two studies were included. The overall SMD of repetitive practice on strength was examined by pooling post-intervention scores from 46 studies involving 1928 participants. The SMD of repetitive practice on strength when the upper and lower limb studies were combined was 0.25 (95% CI 0.16 to 0.34, I²=44%) in favour of repetitive practice. Twenty-four studies with a total of 912 participants investigated the effects of repetitive practice on upper limb activity after stroke. The SMD was 0.15 (95% CI 0.02 to 0.29, I²=50%) in favour of repetitive practice on upper limb activity. Twenty studies with a total of 952 participants investigated the effects of repetitive practice on lower limb activity after stroke. The SMD was 0.25 (95% CI 0.12 to 0.38, I²=36%) in favour of repetitive practice on lower limb activity.

CONCLUSION

Interventions involving repetitive practice improve strength after stroke, and these improvements are accompanied by improvements in activity.

REVIEW REGISTRATION

PROSPERO CRD42017068658. [de Sousa DG, Harvey LA, Dorsch S, Glinsky JV (2018) Interventions involving repetitive practice improve strength after stroke: a systematic review. Journal of Physiotherapy 64: 210-221].

The effectiveness of hydrokinesiotherapy on postural balance of hemiplegic patients after stroke: a systematic review and meta-analysis

Objective:

To summarize evidence on the effects of hydrokinesiotherapy (HT) on postural balance in hemiplegic patients after stroke and compare them with conventional land therapy.

Data sources:

A literature search until October 2017 was conducted on CINAHL, PubMed, Cochrane EBM Reviews, Cochrane Clinical Trials, DARE, MEDLINE, Physiotherapy Evidence Database (PEDro), PsycInfo and Rehabilitation and Sports Medicine Source.

Review methods:

Only randomized controlled trials with pre-intervention and post-intervention assessment on postural control have been included. Assessment of the quality (by Downs and Black quality assessment tool) of the included studies was performed by two reviewers, and a meta-analysis was undertaken.

Results:

A total of 11 trials on postural control with 305 stroke patients were included. The majority of studies showed a beneficial effect of HT in postural control of the patients. The meta-analysis showed statistically significant improvement ( P < 0.05) in Berg Balance Scale (BBS), mediolateral (ML) and anteroposterior (AP) sway velocity of center of pressure with eyes closed (EC) in both groups, but the mean differences in BBS (3.85 points), ML sway velocity of center of pressure (1.38 points) and AP sway velocity of center of pressure (1.64 points) were statistically improved ( P < 0.05) in HT over land therapy program.

Conclusion:

HT is superior to land therapy program regarding postural balance in terms of BBS, ML and AP sway velocity of center of pressure.

Aqua walking as an alternative exercise modality during cardiac rehabilitation for coronary artery disease in older patients with lower extremity osteoarthritis

Background

The purpose of this study was to examine the effects of aqua walking (AW) on coronary artery disease (CAD) and cardiorespiratory fitness in older adults with osteoarthritis in the lower extremity and compare it with that of traditional over-ground walking.

Methods

Sixty consecutive eligible patients who had undergone percutaneous coronary intervention for CAD with limited ambulation due to lower extremity osteoarthritis were recruited. They were randomly assigned to the AW program group, treadmill/track walking (TW) program group, or non-exercise control group (CON). Assessments were performed before and after 24 weeks of medically supervised exercise training.

Results

Significant differences were observed in the change in %body fat (TW: −2.7%, AW: −2.8%, CON: −0.4%), total cholesterol level (TW: −23.6 mg/dL, AW: −27.2 mg/dL, CON: 15.8 mg/dL), resting heart rate (TW: −6.3 bpm, AW: −6.9 bpm, CON: 1.3 bpm), and cardiorespiratory fitness expressed as VO₂ peak (TW: 2.3 mL/kg·min⁻¹, AW: 2.0 mL/kg·min⁻¹, CON: −2.5 mL/kg·min⁻¹) over 24 weeks among the groups. However, no significant differences in the change in these measures were found between the TW and AW groups.

Conclusion

AW appears to be a feasible alternative exercise modality to over-ground walking for cardiac rehabilitation and can be recommended for older adults with CAD and osteoarthritis.

Promoting Physical Activity and Nutrition in People With Stroke

The prevalence of cardiovascular disease, diabetes, and obesity is high in people with stroke. Risk factors for these conditions include hypertension, high cholesterol, and physical inactivity. These risk factors are common in people with stroke and often go unmanaged. Engagement in healthy behaviors is important for managing and preventing these risk factors and comorbid conditions. More specifically, physical activity and nutrition are key health behaviors for the management and maintenance of health in people with stroke. These health behaviors, by their very nature, are also occupations; thus, they are influenced by client factors, performance skills and patterns, and environments and contexts. This article discusses physical activity and nutrition within the context of the Occupational Therapy Practice Framework: Domain and Process and proposes potential roles for occupational therapy practitioners and researchers in developing, testing, and providing physical activity and nutrition interventions for people with stroke.

Effects of Pedalo® training on balance and fall risk in stroke patients

[Purpose] This study sought to examine the effects of Pedalo^® training on balance and fall risk in stroke patients. [Subjects and Methods] Thirty-one subjects with stroke were recruited and randomly allocated into two groups: the Pedalo^® group (n=15) and the Treadmill group (n=16). The Pedalo^® group performed conventional physical therapy program with Pedalo^® training for 30 minutes, five times a week, for 8 weeks, while the Treadmill group conducted conventional physical therapy programs and treadmill gait training for 30 minutes, five times a week, for 8 weeks. [Results] After intervention, both groups showed a significant improvement in balance. A significant greater balance improvement was found in the Pedalo^® group compared to the Treadmill group. Also, a significant reduction in risk of fall was seen in both group but this reduction was not significantly different between the two groups. [Conclusion] Pedalo^® training may be used to improve balance and reduce fall risk in stroke patients.

Efficacy of Aquatic Treadmill Training on Gait Symmetry and Balance in Subacute Stroke Patients

Objective

To determine the efficacy of aquatic treadmill training (ATT) as a new modality for stroke rehabilitation, by assessing changes in gait symmetry, balance function, and subjective balance confidence for the paretic and non-paretic leg in stroke patients.

Methods

Twenty-one subacute stroke patients participated in 15 intervention sessions of aquatic treadmill training. The Comfortable 10-Meter Walk Test (CWT), spatiotemporal gait parameters, Berg Balance Scale (BBS), and Activities-specific Balance Confidence scale (ABC) were assessed pre- and post-interventions.

Results

From pre- to post-intervention, statistically significant improvements were observed in the CWT (0.471±0.21 to 0.558±0.23, p<0.001), BBS (39.66±8.63 to 43.80±5.21, p<0.001), and ABC (38.39±13.46 to 46.93±12.32, p<0.001). The step-length symmetry (1.017±0.25 to 0.990±0.19, p=0.720) and overall temporal symmetry (1.404±0.36 to 1.314±0.34, p=0.218) showed improvement without statistical significance.

Conclusion

ATT improves the functional aspects of gait, including CWT, BBS and ABC, and spatiotemporal gait symmetry, though without statistical significance. Further studies are required to examine and compare the potential benefits of ATT as a new modality for stroke therapy, with other modalities.

Circuit class therapy for improving mobility after stroke

BACKGROUND

Circuit class therapy (CCT) offers a supervised group forum for people after stroke to practise tasks, enabling increased practice time without increasing staffing. This is an update of the original review published in 2010.

OBJECTIVES

To examine the effectiveness and safety of CCT on mobility in adults with stroke.

SEARCH METHODS

We searched the Cochrane Stroke Group Trials Register (last searched January 2017), CENTRAL (the Cochrane Library, Issue 12, 2016), MEDLINE (1950 to January 2017), Embase (1980 to January 2017), CINAHL (1982 to January 2017), and 14 other electronic databases (to January 2017). We also searched proceedings from relevant conferences, reference lists, and unpublished theses; contacted authors of published trials and other experts in the field; and searched relevant clinical trials and research registers.

SELECTION CRITERIA

Randomised controlled trials (RCTs) including people over 18 years old, diagnosed with stroke of any severity, at any stage, or in any setting, receiving CCT.

DATA COLLECTION AND ANALYSIS

Review authors independently selected trials for inclusion, assessed risk of bias in all included studies, and extracted data.

MAIN RESULTS

We included 17 RCTs involving 1297 participants. Participants were stroke survivors living in the community or receiving inpatient rehabilitation. Most could walk 10 metres without assistance. Ten studies (835 participants) measured walking capacity (measuring how far the participant could walk in six minutes) demonstrating that CCT was superior to the comparison intervention (Six-Minute Walk Test: mean difference (MD), fixed-effect, 60.86 m, 95% confidence interval (CI) 44.55 to 77.17, GRADE: moderate). Eight studies (744 participants) measured gait speed, again finding in favour of CCT compared with other interventions (MD 0.15 m/s, 95% CI 0.10 to 0.19, GRADE: moderate). Both of these effects are considered clinically meaningful. We were able to pool other measures to demonstrate the superior effects of CCT for aspects of walking and balance (Timed Up and Go: five studies, 488 participants, MD -3.62 seconds, 95% CI -6.09 to -1.16; Activities of Balance Confidence scale: two studies, 103 participants, MD 7.76, 95% CI 0.66 to 14.87). Two other pooled balance measures failed to demonstrate superior effects (Berg Blance Scale and Step Test). Independent mobility, as measured by the Stroke Impact Scale, Functional Ambulation Classification and the Rivermead Mobility Index, also improved more in CCT interventions compared with others. Length of stay showed a non-significant effect in favour of CCT (two trials, 217 participants, MD -16.35, 95% CI -37.69 to 4.99). Eight trials (815 participants) measured adverse events (falls during therapy): there was a non-significant effect of greater risk of falls in the CCT groups (RD 0.03, 95% CI -0.02 to 0.08, GRADE: very low). Time after stroke did not make a difference to the positive outcomes, nor did the quality or size of the trials. Heterogeneity was generally low; risk of bias was variable across the studies with poor reporting of study conduct in several of the trials.

AUTHORS' CONCLUSIONS

There is moderate evidence that CCT is effective in improving mobility for people after stroke - they may be able to walk further, faster, with more independence and confidence in their balance. The effects may be greater later after the stroke, and are of clinical significance. Further high-quality research is required, investigating quality of life, participation and cost-benefits, that compares CCT with standard care and that also investigates the influence of factors such as stroke severity and age. The potential risk of increased falls during CCT needs to be monitored.

Effects of Novel Guidance Tubing Gait on Electromyographic Neuromuscular Imbalance and Joint Angular Kinematics During Locomotion in Hemiparetic Stroke Patients

OBJECTIVE

To compare the immediate effects of conventional treadmill gait and guidance tubing gait (GTG) on electromyographic neuromuscular imbalance and knee joint kinematics in hemiparetic gait.

DESIGN

Case-control study.

SETTING

University medical center.

PARTICIPANTS

Participants (N=33; 19 men, 14 women) were patients with hemiparetic stroke (n=18 [experimental]; mean age ± SD, 39.2±16.8y) and healthy controls (n=15; mean age ± SD, 26.3±2.6y).

INTERVENTIONS

The GTG was provided for approximately 30 minutes and involved application of an assistive guidance force using the tubing, specifically to improve knee joint stabilization during midstance and increase knee joint flexion during midswing phase.

MAIN OUTCOME MEASURES

Clinical tests included the Korean Mini-Mental State Examination, Modified Ashworth Scale, Berg Balance Scale, manual muscle test, and knee joint range of motion and sensory tests. Knee joint muscle electromyographic and kinematic analyses were determined at pretest and posttest.

RESULTS

After the intervention, the experimental group showed significantly greater improvements in balanced quadriceps and hamstring electromyographic coactivation and knee joint kinematics relative to the control group (P=.005). The GTG intervention decreased overactive hamstring activity (P=.018) and reciprocally increased quadriceps activity (P<.001). The knee joint kinematic analysis showed significant changes in the hemiparetic stroke group (P=.004).

CONCLUSIONS

This study demonstrates the effectiveness of the tubing gait condition to restore knee joint muscle imbalance and kinematics in individuals with hemiparetic stroke who present with an abnormal hyperextension knee gait.

Underwater treadmill training and gait ability in the normal adult

[Purpose] Our working hypothesis is that underwater treadmill training improves normal people’s gait ability. [Subjects and Methods] Twenty-five healthy subjects with no orthopedic history of lower extremity were recruited. Gait training is performed using an underwater treadmill (HydroTrack^® Underwater Treadmill System, Conray, Inc., Phoenix, AZ, USA), for twenty minutes per session, five sessions a week for four weeks. The water temperature was set at about 33 °C and the depth was fixed to reach between the subjects’ xiphoid process and the navel. [Results] After the intervention, step length, velocity, and cadence increased significantly. [Conclusion] This study conducted underwater treadmill training with normal people, with positive effects on gait ability.

Balance evaluation techniques and physical therapy in post-stroke patients: A literature review

A stroke (cerebrovascular accident - CVA) is a significant social-economic issue. Approximately 15-30% of all patients develop life-long disability, 20% require over 3 months of specialized care in healthcare institutions, and the majority of the patients never recover the ability to maintain a proper vertical position. Such CVA sequelae as balance disturbances not only negatively affect patients' daily physical activity, but also result in social isolation. A number of standardized clinical scales, tests, and instrumental examination techniques have been proposed for evaluating not only post-CVA balance function, but also any changes in this function following various interventions. Even though scientific literature lists numerous methods and instruments for the improvement of balance after a CVA, not all of them are equally effective, and there have been rather controversial evaluations of some techniques. Nevertheless, the application of the majority of the techniques as complementary or alternative measures to traditional physical therapy (PT) frequently yields better results.