Report #041

#041 – 6 Articles on Balance and Gait after stroke in 2021

ByAl-Jallad

Estimated reading time: 6 minutes, 18 seconds

1 – Treadmill walking improves walking speed and distance in ambulatory people after stroke and is not inferior to overground walking

Systematic review of randomized trials with meta-analysis. (Open Access)

🙋‍♀️Research questions

  • Does mechanically assisted walking improve walking speed, distance and participation compared with no/non-walking intervention or overground walking after stroke?
  • Are any benefits maintained beyond the intervention period?

💉Intervention

Experimental

  • Mechanically assisted walking provided either by treadmill or any other type of gait trainer, without body-weight support

Comparisons:

  • Mechanically assisted walking versus no/non-walking intervention
  • Mechanically assisted walking versus the same amount of over-ground walking

Outcomes measures

  • Walking speed, Walking distance, Participation

📊Results

  • 16 trials, which included 713 participants.
  • Treadmill walking increased walking speed by 0.13 m/s and distance by 46m compared with no/non-walking intervention.
  • The effect of treadmill walking on walking distance was similar or somewhat better than the effect of over-ground walking from moderate quality evidence.
  • Treadmill walking and over-ground walking had very similar effects on participation.

🔚Conclusion

  • Treadmill walking is effective and not inferior to overground walking in terms of walking speed and distance in ambulatory people after stroke.
  • This suggests that it is not the mode of walking that is important but the practice of walking itself.

2 – Effectiveness of walking training on balance, motor functions, activity, participation and quality of life in people with chronic stroke

A systematic review with meta-analysis and meta-regression of recent randomized controlled trials (Restricted Access)

🎯Aim

  • To review and quantify the effects of walking training for the improvement of various aspects of physical function of people with chronic stroke.

📊Results

15 Randomized controlled trials.

  • Treadmill walking training was more effective on balance and motor functions.
  • Overground walking training improved significantly walking endurance, walking speed, participation, and quality of life.
  • Aquatic training improved balance.
  • The Meta-regression analysis did not show significant effect of total training time on the effect sizes.

🔚Conclusion

  • Treadmill and overground walking protocols consisting of ≥30 min sessions conducted at least 3 days per week for about 8 weeks are beneficial for improving motor impairments, activity limitations, participation, and quality of life in people with chronic stroke.

3 – Effects of Lower Limb Constraint-Induced Movement Therapy in People With Stroke

A Systematic Review and Meta-Analysis (Open Access)

🎯Aim

  • Investigate the effects of lower limb constraint-induced movement therapy (CIMT) studies of any design in people with stroke.

📊Results

  • 16 studies, 6 in the meta-analysis, and included 306 participant.
  • The systematic review showed that that, lower limb CIMT improves motor function, balance, functional mobility, walking speed, oxygen uptake, weight bearing, knee extensor spasticity, exertion before and after commencement of activities, quality of life, and kinematic outcomes.
  • The meta-analysis of 6 studies showed no difference between CIMT and controls except for quality of life.

🔚Conclusion

  • Lower limb CIMT is effective at improving outcomes such balance, functional mobility, motor function, gait speed, oxygen uptake, exertion before and after commencement of activities, knee extensor spasticity, weight bearing, lower limb kinematic, and quality of life following a stroke. However, based on the current evidence, it is only superior to the control at improving quality of life.
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4 – Functional electrical stimulation of the peroneal nerve improves post-stroke gait speed when combined with physiotherapy

A systematic review and meta-analysis. (Restricted Access)

🎯Aim

  • To evaluate the effectiveness of FES applied to the paretic peroneal nerve on gait speed, active ankle dorsiflexion mobility, balance, and functional mobility.

📊Results

14 studies providing data for 1115 participants.

Intervention:

  • Twelve studies used peroneal nerve devices and 2 used conventional FES on the peroneal nerve, one study used implanted electrodes to stimulate the peroneal nerve.
  • 20 to 60 minutes/session, 1 to 5 days per week or every day at home for 4 to 30 weeks, for 2 to 30 weeks or just 1 day.

The effect of FES:

  • Some evidence indicates that FES can induce electrophysiological modifications over time (increase maximal voluntary contraction and motor-evoked potential), indicating that FES could improve voluntary motor control.
  • When combined with physiotherapy, FES could improve gait speed, stability, and functional mobility
  • Gait speed: most studies that associated FES with physiotherapy reached a mean difference of 0.08 to 0.19 m/s. (minimal clinically significant changes for gait speed is 0.10 to 0.18 m/s).
  • Studies that combined FES with unsupervised exercises and regular activities at home were ineffective in improving gait speed.

🔚Conclusions

  • This meta-analysis revealed low quality evidence for positive effects of FES on gait speed when combined with physiotherapy.
  • FES can improve ankle dorsiflexion, balance, and functional mobility. However, considering the low quality of evidence and the high heterogeneity, these results must be interpreted carefully.

5 – The effects of lower extremity cross-training on gait and balance in stroke patients

A double-blinded randomized controlled trial. (Open Access)

🎯Aim

  • Investigate the effects of cross-training on gait and balance in hemiplegic patients when applied to the affected and unaffected lower extremities.

💉Interventions and groups

60 participants, 20 in each group

Groups:

  • Control group (CG), who did not receive cross-training,
  • Direct cross-training group(DCG), who received cross-training to the lower extremity on the affected side.
  • Indirect cross-training group (ICG), who received cross-training to the lower extremity on the unaffected side.

Interventions:

  • All groups underwent general neurological physiotherapy for 30 mins, twice daily, 5 days/week for 4 weeks consisting of joint movement exercise, strength training, and balance exercise.
  • Two intervention groups underwent 30 mins of crosstraining instead of general neurological physiotherapy once daily, 3 days/week for 4 weeks.
  • For cross-training, a strong resistance was applied by the therapist until a response was achieved on the contralateral lower extremity at the end range of motion. Resistance was consistently applied for 10 seconds once a response was achieved.

📊Results

  • Gait ability showed no significant differences between the three groups postintervention, but in the comparison between pre- and postintervention measurements for the TUG and the 10MWT, the CG showed no significant changes while the DCG and ICG showed significant functional improvement.
  • CG and ICG approached the minimal walking speed for community ambulation of 54m/min.
  • Balance function, all three groups showed significant increases in the area for the affected side, unaffected side, anterior, posterior, and overall limits of stability. In the between-group comparison, although there were no significant differences between the groups in any of the limits of stability either pre-or post-intervention, the size of the change in the two intervention groups was larger than that of the CG.
  • Balance ability, measured in terms of the limits of stability, increased in both the DCG and ICG, who received cross-training, but there was no difference with the CG.

🔚Conclusion

  • We propose a clinical application of indirect cross-training to improve gait and balance function in those stroke patients who have difficulties with direct interventions.
  • In addition, we suggest that cross-training on the unaffected side may also be beneficial for patients experiencing other diseases that cannot directly intervene in the affected side due to contagious skin diseases, burns, and pain.

6 – Effect of Cognitive Function on Balance and Posture Control after Stroke

A retrospective case-control study (Open Access)

🧪Method

Data of 32 patients with hemiplegic gait after stroke. Patients were divided into two groups: the observation group, comprising patients with cognitive impairment (CI), and the control group, comprising patients without CI.

📊Results

  • Patients with poor cognitive function had worse balance and posture control.
  • Compared to walking straight, turning around and sitting down required more cognitive resources.
  • Patients with hemiplegia with CI had a greater risk of fall during turning around or sitting down.
  • These results suggested that we should pay more attention to the training of turning around or sitting down in the balance training of patients with CI after stroke.

References: Each article title is a link.

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