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

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.

Comparison between Three Therapeutic Options for the Treatment of Balance and Gait in Stroke: A Randomized Controlled Trial

Stroke patients are more likely to be at risk of falling, which leads to limitation in their abilities to perform daily living activities and participate in society. The aim was to compare the relative effectiveness of three different treatment groups for improvements in postural control and for improvements in balance. Forty-five participants diagnosed with acquired brain injury, with over one year's evolution, were divided into a dry land therapy group (control group), an experimental group (Ai Chi aquatic therapy), and a combined group (therapy on dry land and aquatic therapy with Ai Chi). The Berg balance scale, tandem stance, the timed up and go test, and the five times sit-to-stand test were used. After twelve weeks of treatment, the results improved significantly for the combined therapy group (p < 0.01), and were significantly higher compared to the dry land therapy group (p < 0.01). In addition, improvements were also found in the aquatic Ai Chi therapy group. In conclusion, aquatic Ai Chi and/or the combination of aquatic therapy with dry land therapy is effective for the improvement of static and dynamic balance and for enhancing functional capacity, therefore, increasing the quality of life of acquired brain injury patients.

Aquatic Therapy in Contemporary Neurorehabilitation: An Update

Aquatic therapy has been used extensively in a number of neurologic diseases and pathologies. This review describes disease-specific rehabilitative applications for this population. Recent research has offered scientific support for use in common neurological diseases that are part of rehabilitative practice, and very recent findings may create even firmer support for its use in these as well as other conditions. Stroke, Parkinsonism, and multiple sclerosis are areas that have recently received a significant number of published studies. Dementia is another area that has been more recently studied and received basic science support. Cerebral palsy has also had recent supportive evidence published. Available literature is reviewed to create a more evidence-based support for the use of aquatic therapy in neurorehabilitation.

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).

The effect of aquatic physical therapy in patients with stroke: A systematic review and meta-analysis

Objective: The purpose of this study was to evaluate the literature reports of qualitative and quantitative results of physical therapy treatments in the alternative aquatic setting for individuals affected by strokes. Method: PRISMA guidelines were used to carry out the systematic review and meta-analysis. Three bibliographic databases were searched: MEDLINE, PEDro, and the Cochrane Library. Papers included in the study were required to: (a) have a randomized controlled trial (RCT) design of research; and (b) be published in English; (c) be published during the last 10 years (2008-2018). Only randomized controlled trials were employed in the study. The quality of the clinical trials to be included was evaluated according to the Jadad scale. The internal validity was assessed according to the PEDro scale. Results: Eleven RCTs were initially identified in the systematic review. Eight of these were involved in the meta-analysis comparing outcomes and follow-up. Eight studies received a Jadad score of three, indicating a high level of quality. The remaining three studies achieved a lower score which indicated lower qualitative level. Nearly all of the results of the quantitative analysis were statistically significant (P < 0,05) and most of them favored of the experimental group subject to aquatic treatment. Conclusion: Aquatic physical therapy may be a valid means for the rehabilitation of people affected by stroke. The integration of this methodological approach with conventional physical therapy should be considered. However, more studies; a larger number of participants; and varying lengths of follow-up times are necessary.

Short-Term Modifications of Postural Balance Control in Young Healthy Subjects After Moderate Aquatic and Land Treadmill Running

Postural balance control can be altered by land treadmill (LTM) running. This impairment seems to be related to a disturbance of vestibular and visual information. However, no studies are available on aquatic treadmill (ATM) running. The aim of the present study was to investigate the effect of running at moderate intensity over ATM and LTM on the postural balance control both with opened (OE) and closed (CE) eyes. Center of pressure (CoP) trajectory of 20 healthy subjects was collected on a dynamometric platform before and after a 20-min-long running on ATM and LTM at the same rate of perceived exertion (Borg's scale: 3/10). Heart rate (HR) was recorded every 30 s during running. Stabilogram diffusion analysis (SDA) and sample entropy (SampEn) were calculated to deepen motor control mechanisms. HR values were lower during ATM running with respect to LTM running (p < 0.01). A significant effect of the treadmill factor was detected in the OE condition for the sway path (p < 0.01; η_p² = 0.364; Power: 0.879), the sway area (p < 0.01; η_p² = 0.324; Power: 0.816), and the ML oscillations (p < 0.01; η_p² = 0.390; Power: 0.911) while an effect of the time factor was detected for the ellipse area (p < 0.05; η_p² = 0.213; Power: 0.576). However, the effect size for all the parameters ranged from 0.06 (trivial) to 0.48 (small). In the OE condition, the SDA highlighted a significant effect of the treadmill factor on all the short-term diffusion coefficients which negatively influenced the open loop motor control strategies. In the CE condition, SampEn analysis underlined a significant decrease of the CoP regularity after LTM running. Although slight modifications of the mechanisms involved in the postural balance control occurred, ATM and LTM moderate running did not seriously threaten postural balance performance. Therefore, the usage of ATM should be taken into account in all those situations where the well-known advantages of the aquatic environment are priorities.

Strength training protocols in hemiparetic individuals post stroke: a systematic review

Abstract Introduction: Hemiparesis is one of the main sequels of stroke. Evidence suggests that muscle strength exercises are important in rehabilitation programs for hemiparetic patients, but wide variation in previously studied protocols makes the most suitable choice difficult in clinical practice. Objective: The aim of this study was to investigate strength training protocols for people with hemiparesis after stroke. Methods: A systematic review of literature was performed in the PubMed, PEDro (Physiotherapy Evidence Database), SciELO (Scientific Electronic Library Online), and LILACS (Latin American and Caribbean Literature in Health Science) databases. Only controlled clinical studies that contained strength training protocols for hemiparesis after stroke were selected. Results: In total, 562 articles were found. Of them, 12 were accepted for the systematic review. Although strength training protocols are effective in hemiparetic patients, we did not found a standard method for strength training. Conclusion: This systematic revision highlights the lack of a standard protocol for strength training, considering the following training parameters: volume, intensity, frequency, series, and repetitions. Isotonic exercises are most commonly used.