Effects of Proprioceptive Neuromuscular Facilitation and Treadmill Training on the Balance and Walking Ability of Stroke Patients

BACKGROUND: Walking independently after a stroke can be difficult or impossible, and walking reeducation is vital. But the approach used is often arbitrary, relying on the devices available and subjective evaluations by the doctor/physiotherapist. Objective decision making tools could be useful. OBJECTIVES: To develop a decision making algorithm able to select for post-stroke patients, based on their motor skills, an appropriate mode of treadmill training (TT), including type of physiotherapist support/supervision required and safety conditions necessary. METHODS: We retrospectively analyzed data from 97 post-stroke inpatients admitted to a NeuroRehabilitation unit. Patients attended TT with body weight support (BWSTT group) or without support (FreeTT group), depending on clinical judgment. Patients’ sociodemographic and clinical characteristics, including the Cumulative Illness Rating Scale (CIRS) plus measures of walking ability (Functional Ambulation Classification [FAC], total Functional Independence Measure [FIM] and Tinetti Performance-Oriented Mobility Assessment [Tinetti]) and fall risk profile (Morse and Stratify) were retrieved from institutional database. RESULTS: No significant differences emerged between the two groups regarding sociodemographic and clinical characteristics. Regarding walking ability, FAC, total FIM and its Motor component and the Tinetti scale differed significantly between groups (for all, p < 0.001). FAC and Tinetti scores were used to elaborate a decision making algorithm classifying patients into 4 risk/safety (RS) classes. As expected, a strong association (Pearson chi-squared, p < 0.0001) was found between RS classes and the initial BWSTT/FreeTT classification. CONCLUSION: This decision making algorithm provides an objective tool to direct post-stroke patients, on admission to the rehabilitation facility, to the most appropriate form of TT.

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Abstract W P141: Anti-Gravity Treadmill Training Leads to Superior Walking Ability Compared to Conventional Physical Therapy in Chronic Community Dwelling Stroke Survivors

Stroke ◽

10.1161/str.46.suppl_1.wp141 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Heather Popp ◽

Joan Breen ◽

Tom Ferlito ◽

Sandy Kiley

Keyword(s):

Physical Therapy ◽

Community Dwelling ◽

Treadmill Training ◽

Walking Ability ◽

Walk Test ◽

Stroke Patients ◽

Gait Quality ◽

Blood Pressures ◽

6 Minute Walk Test ◽

Minute Walk

The Anti-gravity (AG) treadmill is a new modality, initially used by athletes and astronauts allowing precise unweighting up to 80% of body weight. Patients are enclosed in a cockpit which unweights by filling with air, allowing patients to be safely progressed at higher speed and longer durations than the conventional treadmill. Only a few case studies report outcomes of stroke patients using this system. Methods: We trialled the AG system on 9 (5 men, 4 women) community dwelling, chronic stroke patients between 6/2014 and 8/2014 as part of an outpatient physical therapy (PT) program. 7/9 patients received AG treatment following conventional treadmill training, while 2 began new PT treatments with the AG system. Endurance was measured with the standardized 6 minute walk test before initiation and after completion of AG system treatments. Various other PT and stroke outcomes were measured. Results: 8 ischemic and 1 hemorrhage stroke patients with average age 63 (49-79); average NIHSS of 7.9 (range 3-15) and Modified Rankin Scores of 4 for 5 patients and 3 for 4 were treated an average of 21.4(range 11-86) months post stroke. Patients received an average of 5 sessions (2-8) over an average of 2.8 weeks ((1-4). Blood Pressures monitored pre and post each treatment were stable. No adverse complications or pain occurred. All patients reported subjectively experiencing improvement in gait quality with AG system use. 89% (8/9) patients had improved 6" walk test scores following AG treatments. 7/9 patients had received conventional treadmill training during skilled PT prior to initiation of AG treatments. In the 1 month prior to AG treatment, 3/7 of these patients had worsening of 6" walk scores; 2/7 improved, and 2/7 had no change. Of the 7/9 patients receiving AG treatment following usual treadmill training, 6/7 had improved 6" walk scores (range 2-17%). 6 minute walk scores improved by 81% and 1% in 2 patients initiating AG training without preceding treadmill training. All patients had improved walking duration and speed on AG compared to traditional treadmill. Conclusions: AG treadmill treatment was reported to be positive and led to improved walking and endurance compared to conventional treadmill training in this pilot group of chronic community dwelling stroke patients.

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Effects of progressive backward body weight suppoted treadmill training on gait ability in chronic stroke patients: A randomized controlled trial

Technology and Health Care ◽

10.3233/thc-160720 ◽

2017 ◽

Vol 25 (5) ◽

pp. 867-876 ◽

Cited By ~ 5

Author(s):

Kyung Hun Kim ◽

Kyoung Bo Lee ◽

Young-Hyeon Bae ◽

Shirley S.M. Fong ◽

Suk Min Lee

Keyword(s):

Randomized Controlled Trial ◽

Body Weight ◽

Controlled Trial ◽

Chronic Stroke ◽

Treadmill Training ◽

Stroke Patients ◽

Randomized Controlled

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Assessment of the Effects of Rehabilitation on Balance Impairment in Patients After Ischemic Stroke According to Selected Tests and Scales

Polish Hyperbaric Research ◽

10.1515/phr-2015-0011 ◽

2015 ◽

Vol 51 (2) ◽

pp. 55-63 ◽

Cited By ~ 1

Author(s):

Magdalena Jaworska ◽

Tomasz Tuzim ◽

Małgorzata Starczyńska ◽

Magdalena Wilk-Frańczuk ◽

Agnieszka Pedrycz

Keyword(s):

Test Group ◽

Berg Balance Scale ◽

Modern Medicine ◽

Cerebral Stroke ◽

Stroke Patients ◽

Timed Up And Go ◽

Balance Test ◽

Raising Awareness ◽

Proprioceptive Neuromuscular Facilitation ◽

Age Range

Abstract Cerebral stroke is one of the most important issues for modern medicine. Despite the fact that numerous activities have been undertaken for the purpose of raising awareness and significance of prevention, this condition still remains one of the main reasons behind disability. The objective of the work was to assess the effects of the type of therapy, age and period from the incident occurrence, on the progress of rehabilitation of imbalance and body stability observed in a group of researched patients, on the basis of results obtained according to the Berg Balance Scale, tandem balance test, Kwolek’s loading symmetry index and Timed Up and Go test. The test group comprised of 55 post-stroke patients. The group consisted of 29 women (52.73%) and 26 men (47.27%). The average age of the subjects was 61.02 years (age range between 33-85 years). A number of the patients were subjected to rehabilitation with the use of classic kinesitherapy, whereas the remaining group underwent rehabilitation based on the proprioceptive neuromuscular facilitation method (PNF).

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Effectiveness of pelvic proprioceptive neuromuscular facilitation on trunk stability and gait parameter in stroke patients: A systemic review

Medical Journal of Dr D Y Patil Vidyapeeth ◽

10.4103/mjdrdypu.mjdrdypu_406_20 ◽

2021 ◽

Vol 0 (0) ◽

pp. 0

Author(s):

SmitR Shah ◽

Heta Doshi ◽

Chaitali Shah

Keyword(s):

Gait Parameter ◽

Systemic Review ◽

Stroke Patients ◽

Trunk Stability ◽

Proprioceptive Neuromuscular Facilitation

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Action observation therapy for improving arm function, walking ability, and daily activity performance after stroke: a systematic review and meta-analysis

Clinical Rehabilitation ◽

10.1177/0269215519839108 ◽

2019 ◽

Vol 33 (8) ◽

pp. 1277-1285 ◽

Cited By ~ 6

Author(s):

Tzu-Hsuan Peng ◽

Jun-Ding Zhu ◽

Chih-Chi Chen ◽

Ruei-Yi Tai ◽

Chia-Yi Lee ◽

...

Keyword(s):

Effect Size ◽

Action Observation ◽

Meta Analysis ◽

Effect Sizes ◽

Gait Velocity ◽

Walking Ability ◽

Stroke Patients ◽

Large Effect Size ◽

Subgroup Analyses ◽

Activity Performance

Objective:This study was to investigate the effectiveness of action observation therapy on arm and hand motor function, walking ability, gait performance, and activities of daily living in stroke patients.Design:Systematic review and meta-analysis of randomized controlled trials.Data sources:Searches were completed in January 2019 from electronic databases, including PubMed, Scopus, the Cochrane Library, and OTseeker.Review methods:Two independent reviewers performed data extraction and evaluated the study quality by the PEDro scale. The pooled effect sizes on different aspects of outcome measures were calculated. Subgroup analyses were performed to examine the impact of stroke phases on treatment efficacy.Results:Included were 17 articles with 600 patients. Compared with control treatments, the action observation therapy had a moderate effect size on arm and hand motor outcomes (Hedge’s g = 0.564; P < 0.001), a moderate to large effect size on walking outcomes (Hedge’s g = 0.779; P < 0.001), a large effect size on gait velocity (Hedge’s g = 0.990; P < 0.001), and a moderate to large effect size on activities of daily function (Hedge’s g = 0. 728; P = 0.004). Based on subgroup analyses, the action observation therapy showed moderate to large effect sizes in the studies of patients with acute/subacute stroke or those with chronic stroke (Hedge’s g = 0.661 and 0.783).Conclusion:This review suggests that action observation therapy is an effective approach for stroke patients to improve arm and hand motor function, walking ability, gait velocity, and daily activity performance.

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