Multi-Sensorimotor Training Improves Proprioception and Balance in Subacute Stroke Patients: A Randomized Controlled Pilot Trial

The effects of mechanical hippotherapy riding on postural control, balance, and quality of life (QoL) in patients with stroke

PURPOSED

This study aimed to investigate the effects of exercises by mechanical hippotherapy devices on postural control, balance, mobility, and Quality of Life in patients with stroke.

MATERIAL AND METHODS

This was a randomized controlled clinical trial with a total of 30 which were randomly divided into two groups. The participants in the mechanical hippotherapy group (MHG) (n = 15) were given exercises with a mechanical hippotherapy device for 15 min in addition to intensive conventional treatments (45 min), while the control group (CG) (n = 15) received additional 15 min of postural control and balance exercises for five days per week for four consecutive weeks. The primary outcome was The Berg Balance Scale (BBS). Secondary outcomes were the Fugl-Meyer (FM) Rating Scale, Biodex Balance Measurement (BBM), Trunk Impairment Scale (TIS), the Timed Up and Go Test (TUG) and quality of Life Short Form (SF-36).

RESULTS

In the MHG, FM-Lower extremity score (-6.4, p = 0.024), FM-Upper extremity score (-12.87, p = 0.013), TIS (-5.87, p = 0.04) and TUG (5.73, p = 0.027) improved statistically significant compared to CG.

CONCLUSION

Exercises using mechanical hippotherapy devices could improve postural control, functional mobility and balance in patients with stroke. It may also improve the quality of life.

CLINICAL TRIAL REGISTRATION NUMBER

NCT03528993IMPLICATIONS FOR REHABILITATIONNCT03528993It was concluded from our results that mechanical hippotherapy could be included in the treatment programs of stroke patients.

The effects of visual information deprivation and feedback balance training on balance in patients with stroke

BACKGROUND

Patients with stroke depend on visual information due to balance deficits. Therefore, it is believed that appropriate visual deprivation training could have an impact on improving balance abilities.

OBJECTIVE

The purpose of this study was to compare the effects of balance training performed in visual deprivation and feedback conditions on balance in stroke survivors.

METHODS

The 39 participants were randomly assigned to either the Visual Deprivation Group (VDG; n = 13), the Visual Feedback Group (VFG; n = 13), or the Control Group (CG; n = 13). The training sessions were conducted five times a week for three weeks. Participants completed the Berg Balance Scale (BBS), Timed Up and Go test (TUG), Four Square Step Test (FSST), and Limit of Stability (LOS) assessments.

RESULTS

The VDG showed significant improvements in BBS, FSST, TUG, and LOS. In VFG, significant improvements were observed in BBS and TUG. There were statistically significant differences among the groups in all variables related to balance.

CONCLUSION

The results of this study suggest that balance training under visual deprivation is effective in improving static and dynamic balance and gait in patients with stroke. In other words, patients with stroke need to reduce their over-reliance on visual information.

Effect of a 6-Wk Sensory-Motor Exercise Program on the Balance and Fatigue Severity in Women With Multiple Sclerosis

OBJECTIVE

This study aimed to investigate the impact of 6 wks of at-home sensory-motor exercises on balance and fatigue levels in women with multiple sclerosis, a progressive autoimmune disease affecting the central nervous system. Multiple sclerosis symptoms can significantly reduce quality of life.

DESIGN

In this quasi-experimental study, 26 female patients with multiple sclerosis aged 20-40 yrs with an expanded disability status scale of 0-4 were randomly assigned to control and experimental groups. The experimental group performed sensory-motor exercises for 6 wks, three sessions a week, and for 1 hr at home. Balance and fatigue were evaluated with Sharpened-Romberg tests (for static balance), a 6-step test of Get-Up and Go (for dynamic balance), and a Fatigue Severity Scale. At the end of the sixth week, these tests were re-evaluated like the pretest stage.

RESULTS

Experimental group showed better static balance and Fatigue Severity Scale than control group, but no difference in dynamic balance.

CONCLUSIONS

Considering the outbreak of COVID-19 and the resultant lockdown, the importance of exercise and physical activities in patients with multiple sclerosis, and the positive effects of sensory-motor exercises at home in the present study, these kinds of sensory-motor workouts are highly recommended to improve balance and reduce the fatigue in patients with multiple sclerosis.

Effect of Balance Training in Sitting Position Using Visual Feedback on Balance and Gait Ability in Chronic Stroke Patients

Chronic stroke often results in balance and gait impairments, significantly impacting patients' quality of life. The purpose of this study was to investigate whether the combined effect of unstable surface balance training and visual feedback, based on proprioceptive neuromuscular stimulation in patients with chronic stroke, is effective in restoring balance and gait ability. A total of 39 chronic stroke patients were randomly assigned to a visual feedback combined with unstable surface balance training group (VUSBG), an unstable surface balance training group (USBG), or a conventional physical therapy group (CG). This study was conducted with the Trunk Impairment Scale, the Bug Balance Scale, the Timed Get Up and Go Test, and Gait Analysis. VUSBG and USBG improved function and gait (stride length and hip/knee flexion angle), but there was no significant difference in the CG group. Specific results showed that the stride length in the VUSBG improved by 25% (p < 0.05), and the hip/knee flexion angle improved by 18% (p < 0.05). The post-hoc analysis revealed that VUSBG had a greater impact on the hip/knee flexion angle relative to the other two groups, as well as gait velocity and stride length relative to CG. Visual feedback complex exercise based on the principle of proprioceptive neuromuscular facilitation could be an intervention strategy to improve gait speed, trunk stability, and mobility in chronic stroke patients.

Which sites better represent the sensory function of hands in convalescent stroke patients? A study based on electrophysiological examination

Background

Assessing hand sensation in stroke patients is necessary; however, current clinical assessments are time-consuming and inaccurate.

Objective

This study aimed to explore the nature of light touch sensation and two-point discrimination (2-PD) of different hand sites in convalescent stroke patients based on somatosensory evoked potentials (SEP).

Methods

Light touch sensation and 2-PD of the thumb, the index finger, the little finger, thenar, and hypothenar were measured (n = 112) using sensory measurement tools. Sensory differences among the hand sites were then compared. The correlation analysis between SEP and the hemiplegic hand function was made. Sensory functions were divided into three levels: sensory intactness, sensory impairment, and sensory loss.

Results

Light touch sensations were mainly associated with sensory impairment in the finger and palm region. The 2-PD of the finger region was mainly sensory loss and that of the palm region was mainly sensory impairment. There was no statistical difference in the light touch sensation among the sites of the hand. The correlation coefficients between the 2-PD and SEP N20 amplitudes differed. The correlation coefficients of the thenar and hypothenar were the smallest, and that of the finger was the largest. Light touch sensation and 2-PD in patients with stroke were related to the hemiplegic hand function.

Conclusion

Any site on the hand could be selected as the measurement site for light touch sensation. The little finger and hypothenar may be appropriate sites when screening for 2-PD. To improve the patient's recovery they could receive more sensory stimulation of the hand.

Assessing bilateral ankle proprioceptive acuity in stroke survivors: An exploratory study

Background

Bilateral proprioception deficits were reported in stroke survivors. However, whether bilateral proprioception deficits exist in the ankle joint after stroke was unclear. Ankle proprioception is a significant predictor of balance dysfunction after stroke, and previous studies to date are lacking appropriate evaluation methods.

Objectives

We want to determine whether the active movement extent discrimination apparatus (AMEDA) is a reliable tool for assessing ankle proprioceptive acuity in stroke survivors and the presence of deficits in ankle proprioception on the affected and unaffected sides in patients after stroke.

Methods

Bilateral ankle proprioception was assessed in 20 stroke patients and 20 age-matched healthy controls using AMEDA. Test-retest reliability was assessed using the intraclass correlation coefficient (ICC).

Results

The ICC in the affected and unaffected sides was 0.713 and 0.74, respectively. Analysis of variance revealed significant deficits in ankle proprioception in subacute stroke survivors vs. healthy controls (F = 2.719, p = 0.045). However, there were no significant differences in proprioception acuity scores between the affected and unaffected sides in patients after stroke (F = 1.14, p = 0.331).

Conclusions

Stroke survivors had bilateral deficits in ankle proprioceptive acuity during active movements compared with age-matched healthy controls, underscoring the need to evaluate these deficits on both sides of the body and develop effective sensorimotor rehabilitation methods for this patient population. The AMEDA can reliably determine bilateral ankle proprioceptive acuity in stroke survivors.

The Effectiveness of Proprioceptive Training for Improving Motor Performance and Motor Dysfunction: A Systematic Review

Objective

Proprioceptive training is any intervention aiming to improve proprioceptive function with the ultimate goal to enhance motor function and performance. It has been promoted as an approach to enhance athletic performance and as a tool for sensorimotor rehabilitation. Numerous studies sought to provide evidence on the effectiveness of the approach. However, many different training regimes claiming to train proprioception report a variety of sensorimotor measures that are not directly comparable. This, in turn, makes it difficult to assess effectiveness across approaches. It is the objective of this study to systematically review recent empirical evidence to gain an understanding of which outcome measures are most sensitive, which populations may benefit most from proprioceptive training, and what are the effects on proprioceptive and motor systems.

Methods

Four major databases were searched. The following inclusion criteria were applied: (1) A quantified pre- and post-treatment measure of proprioceptive function. (2) An intervention or training program believed to influence or enhance proprioceptive function. (3) Contained at least one form of treatment or outcome measure that is indicative of somatosensory function and not confounded by information from other sensory modalities. 4) The study reported of at least one quantified measure of motor performance.

Results

Of the 3,297 articles identified by the database search, 70 studies met the inclusion criteria and were included for further review. Across studies, proprioceptive training led to comparable gains in both proprioceptive (+46%) and motor performance (+45%). The majority of studies (50/70) applied active movement interventions. Interventions applying somatosensory stimulation were most successful in clinical populations. Joint position sense error (JPSE) was the most commonly used proprioceptive measure and presents a reliable and feasible measure for clinical use.

Conclusion

Proprioceptive training can lead to significant improvements in proprioceptive and motor function across a range healthy and clinical populations. Regimens requiring active movement of the trainee tended to be most successful in improving sensorimotor performance. Conclusive evidence on how long training gains are retained is still lacking. There is no solid evidence about the underlying long-term neuroplastic changes associated proprioceptive training.

Effects of Task-Specific Training after Cognitive Sensorimotor Exercise on Proprioception, Spasticity, and Gait Speed in Stroke Patients: A Randomized Controlled Study

Background and objectives: Common problems in stroke patients include loss of proprioception, spasticity, and impaired gait. The purpose of this study was to examine the effects of task-specific training (TST) combined with cognitive sensorimotor exercise (CSE) on proprioception, spasticity and gait speed in stroke patients. Materials andMethods: Thirty-seven subjects were randomly divided into three groups; (1) the TST after CSE group (Experimental I, n = 13); (2) the TST group (Experimental II, n = 12), and (3) a conventional physical therapy training group (control group, n = 12). Evaluations were performed before the commencement of training and again eight weeks after training was initiated. An electrogoniometer was used to evaluate proprioception variation. The composite spasticity score (CSS) and MyotonePRO were used to evaluate spasticity. In addition, 10 m walk test was used to assess gait speed. Results: After training, the Experimental I group showed significant improvement in proprioception compared to the Experimental II and control group (p < 0.05). In CSS, gastrocnemius muscle tone (GMT) and gait speed among three groups, Experimental I group differed significantly after eight weeks of training compared to the control group (p < 0.05). Conclusions: These findings suggest that the TST combined with CSE provided significant improvements in proprioception, spasticity, and gait speed.

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 Sit-to-Stand Training Combined with Taping on Spasticity, Strength, Gait Speed and Quality of Life in Patients with Stroke: A Randomized Controlled Trial

Background and Objectives: Spasticity is one of the factors that make it more difficult to control posture in stroke patients. Taping has been used to manage muscle stiffness in various musculoskeletal disorders. Recently, it has been used to decrease spasticity in stroke patients, but the effect of taping combined with therapeutic exercise is still unclear. The purpose of the present study was to determine whether the sit-to-stand (STS) training combined with taping improves the ankle spasticity, muscle strength, gait speed, and quality of life in stroke patients. Material and Methods: The study recruited 40 stroke patients, who were randomly divided into two groups: the taping and STS training (TSTS) group (n = 20) and the STS group (n = 20). The subjects in the TSTS group underwent STS training with Kinesio taping on the tibialis anterior, calf and ankle joint, whereas the subjects in the STS group underwent only STS training. All participants underwent 30 sessions of STS training (30 minutes, 5 days per week for 6 weeks). The present study evaluated the spasticity of ankle plantar flexors by the mean of the composite spasticity score; the muscle strength and gait speed were evaluated using the handheld dynamometer and the 10-meter walk test, respectively, and the quality of life was assessed using the stroke-specific quality of life scale. Result: The TSTS group and the STS group showed significant improvements in spasticity, muscle strength, walking speed, and quality of life after the intervention (p < 0.05). The level of improvement in the TSTS group was significantly higher in spasticity, muscle strength, and walking speed compared to the STS group (p < 0.05). Conclusions: The present study demonstrated that STS training is effective for decreasing spasticity in stroke patients and suggested that additional taping intervention further improved this effect. In addition, improvement of muscle strength and gait function was observed with a significant decrease of ankle spasticity.

Intravenous injection of apelin-13 improves sensory-motor balance deficits caused by cerebral ischemic reperfusion injury in male wistar rats via restoration of nitric oxide

It has been reported that apelin-13 possesses neuroprotective effects against cerebral ischemia/reperfusion injury (IRI). Disabilities in sense, movement and balance are the major stroke complications which, result in a high rate of mortality. Here, effects of intravenous (IV) injection of apelin-13 on the severity of neural death, infarct volume, neurological defects and its association with nitric oxide (NO) were investigated. A rat model of cerebral IRI was created by middle cerebral artery occlusion (MCAO) for 60 min and restoration of blood flow for 23 h. Animals were randomly assigned into six groups: sham, ischemia (MCAO), vehicle (MCAO + PBS) and three treatment groups (MCAO + apelin-13 in 10, 20, 40 μg/kg doses, IV). All injections were carried out via tail vein injection 5 min before reperfusion. Neural loss and infarct volume were evaluated by Nissl and 2,3,5-triphenyltetrazolium chloride (TTC) staining, respectively. Neurological defects were scored by standard modified criteria. Serum NO was measured by colorimetric method. Apelin-13 in doses of 20 and 40 μg/kg significantly reduced neural death, infarct volume and disturbance of sensory-motor balance compared to control and vehicle groups (p < 0.05). Serum NO levels reduced in MCAO groups compared to sham. Apelin-13 restored serum NO levels at 20 μg/kg dose (p < 0.05). Our data showed beneficial effect of IV injection of apelin-13 on sensory-motor balance defects by reducing neural death and restoration of serum NO levels. The present study shows the validity of apelin-13 in treatment of ischemic stroke in different administration methods.