The influence of NDT-Bobath and PNF methods on the field support and total path length measure foot pressure (COP) in patients after stroke

Effects of Upper Limb Control on the Less-Affected Side on Upper Limb Function, Respiration, Balance, and Activities of Daily Living in Stroke

Background and Objectives: This study aimed to investigate the effects of upper limb control exercises on upper limb function, respiration, balance, and activities of daily living in patients with stroke. Materials and Methods: The 28 patients who met the selection criteria were randomly assigned to two groups of 14 patients each. Subsequently, upper limb control exercises using real-time feedback were applied. The same interventional exercise was applied to both the less-affected and affected limbs of the study participants, who were classified into a less-affected side upper limb control group and an affected side upper limb control exercise group. Interventional exercises, 30 min each, were performed five times weekly for 4 weeks, and follow-up examinations were performed 2 weeks after the end of exercise. Electronic muscle strength measurements and an electronic goniometer were used to evaluate upper limb function. A spirometer was used to measure respiration. Balance ability was evaluated using a force plate pressure distribution measuring system with a sensor that detects the movement of the body center on the ground. Daily life movements were evaluated using the Korean version of the modified Barthel index. Results: When examining the results, the upper limb function on the paralyzed side showed an increase in the electromyographic strength of shoulder joint depression and flexion angle. Improvements were also observed in respiration (forced vital capacity [L] and forced expiratory volume in 1 s [L]), balance (95% confidence ellipse area [mm2] and center of pressure displacement [mm]), and daily life activities, all of which showed statistically significant differences in the time × group interaction effect (p < 0.05). Conclusions: Thus, it was found that the upper limb control exercise on the less-affected side had a significant effect when the exercise was performed together with treatment on the affected side in patients with stroke. It is anticipated that this study will provide basic data for evaluating both the trunk and upper limbs of the less-affected and affected sides.

Effects of Rehabilitation Robot Training on Physical Function, Functional Recovery, and Daily Living Activities in Patients with Sub-Acute Stroke

Stroke often results in sensory deficits, muscular weakness, and diminished postural control, thereby restricting mobility and functional capabilities. It is important to promote neuroplasticity by implementing task-oriented exercises that induce changes in patients. Therefore, this study aimed to investigate the effects of rehabilitation robot training on physical function, functional recovery, and activities of daily living (ADLs) in patients with subacute stroke. The study participants were patients with subacute stroke receiving treatment at Hospitals A and B. They were selected as research subjects based on selection and exclusion criteria. The experimental group received rehabilitation robot training in sessions of 30 min, five times weekly, for a total of 20 sessions over four weeks. Conversely, the control group underwent standard rehabilitation equipment training with an identical frequency, duration, and number of sessions. Measurements were taken before and after the training period to assess changes in physical function, functional recovery, and activities of daily living using tools such as the MMT, BBS, FBG, FAC, FIM, and MBI. The results were as follows: in the within-group comparison, the rehabilitation robot training group showed significant differences in MMT, BBS, FBG, FAC, FIM, and MBI (p < 0.05), while the control group showed significant differences in FIM (p < 0.05). Statistically significant differences were observed in the time, group, and time × group interaction effects among the MMT, static seated FBG, dynamic seated FBG, FIM, and MBI (p < 0.05). Based on these results, rehabilitation robotic training resulted in significant improvements in physical function, functional recovery, and activities of daily living in patients with subacute stroke. Based on these findings, providing a basic protocol for a rehabilitation program that applies rehabilitation robot training to patients with subacute stroke may offer more effective treatment and outcomes in the future.

The Effects of Proprioceptive Neuromuscular Facilitation Pattern Kinesio Taping on Arm Swing, Balance, and Gait Parameters among Chronic Stroke Patients: A Randomized Controlled Trial

(1) Background: This study aimed to investigate the effects of proprioceptive neuromuscular facilitation pattern kinesio taping on arm swing, balance, and gait parameters among chronic stroke patients. (2) Methods: Twenty-eight participants were randomized into proprioceptive neuromuscular facilitation pattern kinesio taping during gait training (n = 14) and gait training (n = 14) groups. The proprioceptive neuromuscular facilitation pattern kinesio taping during gait training group employed proprioceptive neuromuscular facilitation pattern kinesio taping during 15 min treadmill-based gait training five times a week for four weeks, while the gait training group underwent the same gait training without proprioceptive neuromuscular facilitation pattern kinesio taping. Arm swing angle was measured using the Image J program, static balance was assessed with an AMTI force plate, dynamic balance was evaluated through the Timed Up and Go test, and gait parameters were recorded using the GAITRite system and the Dynamic Gait Index. (3) Results: After 4 weeks of training, the proprioceptive neuromuscular facilitation pattern kinesio taping during gait training group exhibited significant improvements in all variables compared to the baseline (p < 0.05), whereas the gait training group did not show statistically significant differences in any variables (p > 0.05). (4) Conclusions: This study demonstrates the effectiveness of proprioceptive neuromuscular facilitation pattern kinesio taping during gait training in enhancing arm swing angle, balance, and gait parameters.

Effect of Treadmill Training with Visual Biofeedback on Selected Gait Parameters in Subacute Hemiparetic Stroke Patients

BACKGROUND

Functional limitations after a stroke are unique to each person and often include impaired independent mobility. A reduction in existing gait deficits after a stroke is often one of the main goals of rehabilitation. Gait re-education after stroke is a complex process, which consists of the effects of many therapeutic interventions.

OBJECTIVE

The study aimed to analyze the effects of using a treadmill with visual feedback in gait re-education in the sub-acute stroke period and assess the impact of biofeedback treadmill training on selected gait parameters, improving static balance and reducing the need for orthopedic aids.

METHODS

The study included 92 patients (F: 45, M: 47) aged 63 ± 12 years, with post-ischemic sub-acute (within six months onset) stroke hemiparesis, treated at a neurological rehabilitation ward. All patients participated in a specific rehabilitation program, and in addition, patients in the study group (n = 62) have a further 10 min of treadmill training with visual feedback. Patients in the control group (n = 30) participated in additional conventional gait training under the direct supervision of a physiotherapist. The evaluation of static balance was assessed with the Romberg Test. A Biodex Gait Trainer 3 treadmill with biofeedback function was used to evaluate selected gait parameters (walking speed, step length, % limb loading, and traveled distance). The use of an orthopedic aid (walker or a crutch) was noted.

RESULTS

After four weeks of rehabilitation, step length, walking speed, traveled distance, and static balance were significantly improved for the study and control group (p < 0.05). Treadmill gait training yielded significantly better results than a conventional rehabilitation program. Only the study group observed a corrected walking base (p < 0.001). All participants showed a reduction in the use of walking aids (p = 0.006). There was no asymmetry in the % of limb loading for either group prior to or following rehabilitation.

CONCLUSIONS

The treadmill with visual biofeedback as conventional gait training has resulted in a significant improvement in parameters such as step length, walking speed, static balance, and a reduction in the use of locomotion aids. However, the achieved improvement in gait parameters is still not in line with the physiological norm.

Proprioceptive Neuromuscular Facilitation-Based Physical Therapy on the Improvement of Balance and Gait in Patients with Chronic Stroke: A Systematic Review and Meta-Analysis

The present study aims to determine the potential benefits of PNF on balance and gait function in patients with chronic stroke by using a systematic review and meta-analysis. Systematic review in the following databases: MEDLINE/PubMed, Physiotherapy Evidence Database (PEDro), Cochrane Library and Google Scholar. Studies up to September 2020 are included. A systematic database search was conducted for randomized control trials (RCTs) that investigated the effects of PNF intervention in patients with chronic stroke using balance and gait parameters as outcome measures. The primary outcomes of interest were Berg Balance Scale (BBS), Functional Reach Test (FRT), Timed Up and Go Test (TUG) and 10-Meter Walking Test (10MWT). Nineteen studies with 532 participants were included, of which twelve studies with 327 participants were included for meta-analysis. When the data were pooled, PNF made statistically significant improvements in balance with BBS, FRT and TUG (p < 0.05) or gait velocity with 10MWT (p < 0.001) when compared to the control. This review indicates that PNF is a potential treatment strategy in chronic stroke rehabilitation on balance and gait speed. Further high-quality research is required for concluding a consensus of intervention and research on PNF.

The effect of backward walking observational training on gait parameters and balance in chronic stroke: randomized controlled study

BACKGROUND

Backward walking (BW) and action observation training may potentially help people at risk of falls. Moreover, action observation training could be a potential intervention to improve gait after a stroke.

AIM

We aimed to identify the effects of BW action observational training (BWOT) on gait parameters and balance in chronic stroke patients.

DESIGN

Randomized, controlled study.

SETTING

Rehabilitation center.

POPULATION

Twenty-four chronic stroke patients were randomly assigned to BWOT (N.=12) and landscape observational training (LOT) (N.=12) groups.

METHODS

The BWOT group performed BW after watching a video of a BW, while the LOT group performed BW training after watching a video of a landscape. Both groups received traditional therapy for 5 days per week and BWOT for 3 days a week for 4 weeks. The primary and secondary outcomes were gait and balance, respectively. Static balance was measured using the 5 Times Sit-To-Stand Test (5TSTS), the center of pressure (COP) displacement, and weight distribution (WD) of the affected side. Dynamic balance was measured using the activity-specific balance confidence (ABC) scale.

RESULTS

The BWOT group showed significant improvements in gait velocity (p=0.001, η²=0.470), step length (P=0.007, η²=0.313), stride lengths (P<0.002, η²=0.431), 5TSTS (P=0.021, η²=0.231), COP velocity (P=0.022, η²=0.226), length (P=0.001, η²=0.504), WD of the affected side (P=0.033, η²=0.193), and ABC score (P=0.023, η²=0.226) than the LOT group.

CONCLUSIONS

The 4-week BWOT training program significantly improved the gait parameters and static and dynamic balance in stroke patients.

CLINICAL REHABILITATION IMPACT

BWOT is an accessible and effective method of rehabilitation training that can also be applied to conventional therapy as a useful method for improving the gait and balance after stroke.

Evaluating the Effects of Botulinum Toxin Injection and Physiotherapy on Post-Stroke Patients During One Year Observation - a Pilot Study

Introduction: Stroke is a serious health problem in the modern population. Spasticity is one of the consequences of stroke and affects about 30% of people. Increased muscle tone affects postural control disorders. Due to the specificity of spasticity, therapy in post-stroke patients is a challenge for neurological physiotherapy. Therefore, it requires the development of appropriate management standards . Study aim: The aim of the study was to evaluate the effectiveness of 3 combination therapy cycles based on botulinum toxin injection and physiotherapy for muscle tone, muscle strength and postural stability in post-stroke patients qualified for the spasticity treatment programme of the lower and upper limbs. Material and methods: The pilot study involved 12 patients (6 from the lower limb and 6 from the upper limb programme). The 1-year combination therapy programmes included 3 botulinum toxin injections and 3 weeks of physiotherapy after each injection. Clinical evaluation was conducted before and after the 1-year observation cycle. The results were evaluated using: MAS (Modified Ashworth Scale), MRC (Medical Research Council Scale) and posture stability test on a balance platform (BiodexSD). Results: A decrease was observed in muscle tone of the lower and upper limbs, as well as an increase in muscular strength of the upper limb. However, there were no noted statistical significance of the studied parameters. Conclusions: Physiotherapy in combination with the botulinum toxin is an important element of improvement in post-stroke patients. However, further research is needed to explicitly confirm its effectiveness.

The Bobath Concept (NDT) as rehabilitation in stroke patients: A systematic review

Background and Objectives:

The Bobath approach, also known as neurodevelopmental treatment (NDT), is a widely used concept in the rehabilitation of stroke patients with hemiparesis in many countries. This technique is being used since years all over the world; however, strong evidence of its usefulness is still not present. This review is aimed to find out its effectiveness based on the randomized controlled trials in the rehabilitation of stroke patients with motor disability and to compare it with other therapeutic techniques.

Materials and Methods:

A systematic literature search on PubMed Central, Science-Direct, Cochrane, Scopus, Clinical Trial Database, and Indian Clinical Trial Registry in English till 31^st July 2021 was undertaken. The review is published in Prospective Register of Systematic Reviews (PROSPERO) with registration number “CRD42019125400.” Physiotherapy Evidence-based Database (PEDro) score has been used for the quality assessment of the studies. Randomized clinical trials that studied the comparative effect of the NDT/Bobath concept on motor activity outcomes and cognition/behavior in stroke patients in comparison with other rehabilitative techniques were included.

Results:

No strong documentation describing the effectiveness of this neuro-developmental treatment or its supporting neuro-developmental treatment in comparison with other advanced neuro-physiotherapeutic techniques has been found so as to consider it as the recommended treatment for post-stroke hemiplegia/hemiparesis. Methodological aspects of selected studies for further research are suggested.

Interpretation and Conclusions:

This study is inconclusive in determining the effectiveness of the Bobath approach for the movement rehabilitation of stroke patients. These results are similar to the results of previous reviews done on the same topic.

Effects of Cognitive Sensory Motor Training on Lower Extremity Muscle Strength and Balance in Post Stroke Patients: A Randomized Controlled Study

BACKGROUND

Sensory motor impairment, the most common neuromuscular condition in stroke patients, often contributes to muscle weakness and imbalance.

OBJECTIVE

The purpose of this research was to investigate the effects of cognitive sensory-motor training (CSMT) on the muscle strength and balance ability in post-stroke patients.

METHODS

Thirty-five participants after stroke were randomly assigned to the CSMT (n = 17) or control group (n = 18). All participants received 30 min of training each time, five times per week, for six weeks. Lower extremity muscle strength of tibialis anterior (LEMTA) was evaluated using a digital muscular dynamometer. The Medical Research Council (MRC) scale was used to evaluate muscle strengths of the hip joint, knee joint, and ankle joint. For balance ability test, the center of pressure (COP) movement distance and limited of stability (LOS) were measured using BioRescue.

RESULTS

LEMTA, MRC scale, balance ability were significantly more improved in the CSMT group than in the control group (p < 0.05).

CONCLUSIONS

Our findings indicate that CSMT is beneficial and effective for improving muscle strength of the lower extremity and balance ability of post-stroke patients.

Effect of PNF and NDT Bobath Concepts on Ischemic Strokes Patients for Trunk Rehabilitation – A Randomized Pilot Study

Introduction: Recently, various systematic reviews and evidence-based clinical practice guidelines have evaluated the efficacy of stroke rehabilitation interventions. Across them proprioceptive neuromuscular facilitation (PNF) and neuro-developmental treatment (NDT) Bobath resulted to be an effective and widely used therapeutic approaches. Objective of the work: The aim of the study was to evaluate the therapeutic effectiveness of PNF and NDT Bobath concept for improvement of trunk motor control in patients after ischemic stroke. Materials and methods: The study consisted of 30 patients up to 3 months after ischemic stroke. Participants were randomly assigned to two study groups. Both group consisted of 15 patients underwent rehabilitation according to the PNF or NDT Bobath concept. Comparison of the changes in the Trunk Impairment Scale was the primary outcome. Results: The analysis of the values of total TIS scale showed a statistically significant improvement in both group. Within group analysis showed statistical significance among baseline and intermediate measurement, and among baseline and final measurement within both groups. The analysis of total TIS scale indicators between the PNF and Bobath groups showed no statistically significant differences. Conclusions: Both the PNF and Bobath concepts have proven to be effective in the treatment of posture control and there have been significant improvements in patients from both groups.

Bobath therapy is inferior to task-specific training and not superior to other interventions in improving lower limb activities after stroke: a systematic review

QUESTION

In adults with stroke, does Bobath therapy improve lower limb activity performance, strength or co-ordination when compared with no intervention or another intervention?

DESIGN

Systematic review of randomised trials with meta-analyses.

PARTICIPANTS

Adults after stroke.

INTERVENTION

Bobath therapy compared with another intervention or no intervention.

OUTCOME MEASURES

Lower limb activity performance (eg, sit to stand, walking, balance), lower limb strength and lower limb co-ordination. Trial quality was assessed using the PEDro scale.

RESULTS

Twenty-two trials were included in the review and 17 in the meta-analyses. The methodological quality of the trials varied, with PEDro scale scores ranging from 2 to 8 out of 10. No trials compared Bobath therapy to no intervention. Meta-analyses estimated the effect of Bobath therapy on lower limb activities compared with other interventions, including: task-specific training (nine trials), combined interventions (four trials), proprioceptive neuromuscular facilitation (one trial) and strength training (two trials). The pooled data indicated that task-specific training has a moderately greater benefit on lower limb activities than Bobath therapy (SMD 0.48), although the true magnitude of the benefit may be substantially larger or smaller than this estimate (95% CI 0.01 to 0.95). Bobath therapy did not clearly improve lower limb activities more than a combined intervention (SMD -0.06, 95% CI -0.73 to 0.61) or strength training (SMD 0.35, 95% CI -0.37 to 1.08). In one study, Bobath therapy was more effective than proprioceptive neuromuscular facilitation for improving standing balance (SMD -1.40, 95% CI -1.92 to -0.88), but these interventions did not differ on any other outcomes. Bobath therapy did not improve strength or co-ordination more than other interventions.

CONCLUSIONS

Bobath therapy was inferior to task-specific training and not superior to other interventions, with the exception of proprioceptive neuromuscular facilitation. Prioritising Bobath therapy over other interventions is not supported by current evidence.

REGISTRATION

PROSPERO CRD42019112451.

Ipsilateral proprioceptive neuromuscular facilitation patterns improve overflow and reduce foot drop in patients with demyelinating polyneuropathy

The purpose of this study was to evaluate the response of the tibialis anterior muscle (TAm) using surface electromyography in patients with Charcot-Marie-Tooth disease (CMT-IA), after ipsilateral proprioceptive neuromuscular patterns (PNF). Thirteen CMT-IA patients (both sexes) were treated twice a week, for 5 weeks, with bilateral PNF pattern, four times per treatment. During the execution of the patterns, we recorded the bilateral activation of the TAm in root mean square (RMS). We used the Student paired t-test for the first and last treatments, P-value set at <0.05. Clinical significance (CS) was obtained by subtracting the values of the first treatment from the last. Chopping pattern to the right side increased RMS for the right (t=−3.52, CS=52%), but not the left TAm (t= −3.35). Flexion-abduction with external rotation pattern to the right (t= −2.46, CS=55%) and left (t=−2.07, CS=53%) significantly increased RMS for TAm on both sides. Extension-adduction with internal rotation pattern to the right (t=−0.25) and left (t=−1.84) did not produce any changes in TAm. Ipsilateral PNF patterns selectively produce TAm overflow in peripheral polyneuropathy patients and can be successfully used as supportive therapy for foot drop.

Therapists' cues influence lower limb muscle activation and kinematics during gait training in subacute stroke

PURPOSE

Symmetrical gait is a key goal of rehabilitation post-stroke. Therapists employ techniques such as verbal instruction and haptic cues to increase activation of paretic muscles. We examined whether verbal or tactile cueing altered spatiotemporal gait parameters, kinematics and electromyography (EMG) of lower limb muscles on the more-affected side within a training session.

MATERIALS AND METHODS

Patients (n = 10) were recruited from rehabilitation services (<9 months post-stroke). Tactile (to the hip muscles) or verbal cues were provided on two testing days, 7-10 days apart (randomized order). Gait and angular kinematics were recorded using a Vicon motion capture system and muscle activation using EMG; at baseline (PRE), during the cue, directly afterwards without a cue (POST) and 20 min later without a cue (RETEST).

RESULTS

Both verbal and tactile cueing significantly increased muscle activity in paretic muscles but with no immediate effect on step length asymmetry. Tactile cues, more than verbal, temporarily altered gait speed, cadence and time in double support. Verbal cues caused more robust increases in muscle activation of vastus lateralis at weight acceptance and medial gastrocnemius activity from toe off to midswing.

CONCLUSIONS

Within a treatment session, tactile cues more effectively altered cadence and double support time while verbal cues more consistently increased vastus lateralis and medial gastrocnemius activity. The effectiveness of these methods in fostering motor relearning in the longer term is an important area for future research. Implications for Rehabilitation Therapist cueing alters muscle activity on hemiparetic side with no effects on symmetry. Tactile cues, more so than verbal cues, increase cadence and reduce time in double support. Verbal cues are more effective at increasing vastus lateralis and plantarflexor muscle activity.

Bobath and traditional approaches in post-stroke gait rehabilitation in adults

Study aim: The aim of this study was to compare the outcomes of a study of post-stroke gait reeducation using the Bobath neuro‑developmental treatment (NDT-Bobath) method and the traditional approach.

Material and methods: The study included 30 adult patients after ischemic stroke, aged 32-82. Patients were randomly assigned to one of the treatment groups: the study group (treated with the NDT-Bobath method combined with the traditional approach, ten sessions), and a reference group (treated with the traditional method only, ten sessions). The measurements (spatio-temporal gait parameters based on 10 m walking test: gait velocity, normalized gait velocity, cadence, normalized cadence, stride length, and normalized stride length) were administered twice: on admission (before the therapy) and after the last therapy session.

Results: Statistically significant and favorable changes in the gait velocity, cadence and stride length regarding their normalized values were observed. Moderate and high correlations among changes of assessed spatio-temporal gait parameters were observed in both groups.

Conclusions: The NDT-Bobath method may be regarded as a more effective form of gait post-stroke rehabilitation in young adults compared to traditional rehabilitation.