Effects of Exercise Therapy on Balance Capacity in Chronic Stroke

Abstract

A fter stroke, a main goal of rehabilitation is to promote independence in activities of daily living. An important determinant of activities of daily living performance is standing balance, which is a strong predictor of functional recovery 1,2 and walking capacity 3,4 and an important risk factor for falls 5 after stroke. Although the vast majority (75%) of people after stroke regain independent standing-balance capacity, 6 weightbearing asymmetry and increased postural sway often persist, as well as a diminished capacity to voluntarily shift body weight or to withstand external perturbations. 7 Hence, a keyBackground and Purpose-The purpose of this systematic review and meta-analysis was to investigate the effects of exercise training on balance capacity in people in the chronic phase after stroke. Furthermore, we aimed to identify which training regimen was most effective. Methods-Electronic databases were searched for randomized controlled trials evaluating the effects of exercise therapy on balance capacity in the chronic phase after stroke. Studies were included if they were of moderate or high methodological quality (PEDro score ≥4). Data were pooled if a specific outcome measure was reported in at least 3 randomized controlled trials. A sensitivity analysis and consequent subgroup analyses were performed for the different types of experimental training (balance and/or weight-shifting training, gait training, multisensory training, high-intensity aerobic exercise training, and other training programs). Results-Forty-three randomized controlled trials out of 369 unique hits were included. A meta-analysis could be conducted for the Berg Balance Scale (28 studies, n=985), Functional Reach Test (5 studies, n=153), Sensory Organization Test (4 studies, n=173), and mean postural sway velocity (3 studies, n=89). A significant overall difference in favor of the intervention group was found for the Berg Balance Scale (mean difference 2. Previous meta-analyses of the effects of exercise therapy on improving balance capacity have been inconclusive. [8][9][10][11] There seemed to be an effect of biofeedback training on postural sway and of repetitive task training on sit-to-stand activities, 8 but both types of training did not result in better performance on clinical tests of balance capacity. 9 In addition, it remained unclear which type of training regimen would be most effective. Furthermore, previous meta-analyses did not address whether training effects differed between poststroke stages. One systematic review reported that favorable effects of balance exercises were restricted to the chronic phase (≥6 months post onset), but a meta-analysis was not included to substantiate this statement. 12Nevertheless, several studies that have been published since suggest that exercise therapy may yield significant improvements in balance capacity in individuals in the chronic phase of stroke. 13,14 Evaluating the effects of exercise therapy in the chronic phase of stroke is of particular interest because the resu...

Proprioceptive neuromuscular facilitation to improve motor outcomes in older adults with chronic stroke

“…Despite proposed time frames post-stroke where therapy is projected to be most-effective, changes in neural structuring are expected to work at any time. 4 Although patients with stroke may experience a plateau in recovery, studies suggest that post-stroke rehabilitation that incorporates modifying a patient's exercise regimen (e.g. intensity, new exercises) are important in motor rehabilitation.…”

“…3 While several studies have reported that most gains from rehabilitation occur with the first 6 months after stroke, improvements have still been noted following well-targeted exercise therapy programs in more chronic presentations. 4 Interventions grounded in modern theories of neuromuscular re-education and neuroplasticity are needed to improve rehabilitation efforts and optimize functional outcomes. 5 Proprioceptive neuromuscular facilitation is a form of neuromuscular re-education that has been used in improving the function of patients with stroke.…”

Balance Training with Electromyogram-Triggered Functional Electrical Stimulation in the Rehabilitation of Stroke Patients

“…Muscle weakness on the side affected by stroke causes restriction of movement, which in turn affects balance and walking ability [3][4][5]. Strength and balance, therefore, represent major challenges in the rehabilitation of patients affected by stroke [6,7].…”

The impact of various physiotherapy programs on static and dynamic balance for patients after stroke

“…The findings of other studies have suggested that balance can be improved in the course of walking and exercise in which body weight bearing is required (Duijnhoven et al, 2016). According to scientists, walking improves along with balance (Yelnik et al, 2008).…”