Effects of Task Oriented Exercises with Altered Sensory Input on Balance and Functional Mobility in Chronic Stroke: A Pilot Randomized Controlled Trial

Abstract

Background: Stroke subjects presented with greater postural instability which lead to challenge their balance control in sensory conflict conditions. Studies have shown that deficits of sensorimotor integration and an inability to select the appropriate sensory input are associated with balance measures following stroke.However, limited studies have been focused to sensorimotor integration in balance rehabilitation. Objective: Our study aimed to evaluate the Task Oriented Training (TOT) with sensory manipulation to enhance balance and functional mobility in chronic stroke subjects. Design: Randomized controlled pilot study. Setting: Department of Physiotherapy in a Tertiary care Hospital. Subjects: A convenience sample consisting of 26 hemi paretic subjects at least 6 months post stroke duration with Brunnstrom's recovery stage ≥5 for the lower limb and Berg Balance Score of 40 or above were randomly assigned control group (n=13) and in experimental group (n=13). Interventions: Control group received the conventional physical therapy and in the Experimental group received TOT with manipulations of sensory inputs and provision of sensory conflict for the trunk and lower limb focusing on balance and mobility were implemented for 15 sessions, 5 days a week for 3 weeks with each session of 45-60 mints duration. Outcome measures: Dynamic Gait Index (DGI), Timed Up and Go Test (TUGT) and Fall Efficacy Scale (FES) were analyzed before and after the training. Results: Post training there was a significant improvement in all the outcome measurements for both the groups. However components 3, 4 and 5 of DGI, TUGT and FES of experimental group had a highly significant statistical difference between-group analysis with p<.05. Conclusion:Task oriented exercises with altered sensory input was found to be effective in improving functional mobility in terms of dynamic balance and reduction in their fear of fall levels after a 3 week training program.

Effect of Task Oriented Circuit Training Versus Trunk Rehabilitation on Balance, Trunk Control and Functional Ambulation in Chronic Stroke Patients: A Comparative Study

“…7 The decreased ability to maintain static and dynamic balance in stroke has also been related to the inability in selecting reliable visual, vestibular and somatosensory information in order to produce proper motor action necessary to maintain postural stability and balance. 8 Stroke patients shows muscle weakness, abnormal muscle tone, and disorder in balance and posture control, which results in difficulty in locomotion. 4 Although majority of patients with stroke walk independently, they are not able to walk efficiently .4 Speed, depression, level of ADLs, use of a walking aid, and the strength of ankle dorsiflexion, knee flexion, knee extension were all found to be significant factors influencing balance in patients with stroke.…”

“…The inability in selecting reliable visual, vestibular and somatosensory information in order to produce proper motor action necessary to maintain postural stability and balance results in the decreased ability to maintain static and dynamic balance in stroke. 8 One of the most serious consequences of stroke is gait dysfunction. Propulsion, upright stability, shock absorption and energy conservation are required during normal gait.…”

Functional Training for Lower Extremities in Stroke Survivors: A Scoping Review

“…The intervention protocol and its components for functional training of the lower extremities were described in nine studies involving stroke patients. These studies include those by Salbach et al [ 18 ], Mendoza et al [ 22 ], Kuberan et al [ 23 ], Choi and Kang [ 28 ], Mudge et al [ 29 ], English et al [ 30 ], Dean et al [ 31 ], Ma et al [ 32 ], and Martins et al [ 33 ]. The various components of lower extremity functional training that were investigated include walking in 29 studies, balance in 23 studies, sit-to-stand in 13 studies, stair climbing in six studies, and weight bearing in three studies.…”

Effect of Task Oriented Training on Spasticity in Post Stroke Individuals

“…Task oriented approach is a clinical therapeutic approach built on rehabilitation science and is constructed on the principles of motor re-learning, motor control, and neuroplasticity. It validates patients with functional disabilities to self-motivate and then select and perform various tasks followed by practicing them accordingly 2 . Rehabilitation poststroke has evolved over the past few years from analytical approaches to task oriented training approaches that imply training of the basic functions, skills and movements (anatomical).…”