Effects of Task-Oriented Balance Training on Postural Control and Functional Recovery in Patients with Acute Stroke
Date Issued
2009
Date
2009
Author(s)
Chen, Nai-Yu
Abstract
Background and Purposes: Impaired sitting balance and trunk control ability is a prevalent problem faced by patients with acute stroke. Task-oriented training has been shown effective in improving balance and ambulation ability of patients with chronic stroke, but effective clinical trials targeting at early trunk control or balance training are still scarce. The purposes of this study were to investigate whether an additional two-week, task-oriented, balance and trunk control training program started in the early phase of stroke during hospitalization would be not only safe and tolerable for patients but also effective on improving their postural control and functional recovery in the later phase. Methods: Fifteen patients admitted to the NTUH due to recent stroke (≦14 days post onset) were randomly assigned to the experimental (EXP, n= 8) or control (CON, n= 7) group. The EXP group received a two-week task-oriented training combined with the conventional physical therapy training, and the CON group received a two-week passive range of motion exercise combined with the conventional physical therapy training. The intensity of additional training in both groups was the same, which was 30 minutes a day, 5 days a week, for 2 weeks. Times spent on conventional and additional exercises and vital sign before and after additional exercise, were documented for each training session during the 2-week study intervention in both groups. For the EXP group, the Borg Rate of Perceived Exertion was documented. In addition, any adverse event during or after additional training in each group was also documented. Outcome measures, including the Motricity Index (MI), Trunk Control Test (TCT), Postural Assessment Scale for Stroke patients (PASS), Functional Ambulatory Category (FAC), Barthel Index (BI), and modified Rankin Scale (mRS) were collected at pre-training, post-training, and at 3 months after stroke. Results: The EXP and CON groups started to receive additional training program 7.9± 2.6 days and 9.4± 2.8 days post stroke onset for a total of 257± 45 minutes and 267± 22 minutes, respectively. Fifteen subjects completed all study phases according to their group assignment. The demographic characteristics at baseline were similar between groups (p> .05). As expected, subjects in the EXP group received more task-oriented training and the CON group received more range of motion exercise, which reached statistically significant differences (p< .05). The EXP group did not present more adverse events or unstable vital sign induced by additional intervention during the 2-week intervention as compared to the CON group (p> .05). There were no statistically significant differences between the groups at post-training and 3 months after stroke with regard to all the outcome measures (p> .05). Subjects in both groups significantly improved in these variables from pre-training to post-training and to the 3-month follow-up (p< .05). However, during the pre-training to post-training period, the EXP group had a larger effect size on the postural control ability (the PASS score); the EXP group also showed significant improvement in ambulation ability (the FAC) (p< .05) but the CON group did not (p> .05). During the post-training to follow-up assessments period, the EXP group had larger effect size on the muscle strength (the MI score) and the activities of daily living ability (the BI score), but the effect size of the PASS became similar between groups. Conclusions: The additional two-week, task-oriented, balance and trunk control training program combined with conventional physical therapy was safe, feasible, and tolerable in the early phase of stroke. Compared to the additional passive range of motion exercise program, this additional task-oriented training program led to more improvement on the postural control ability, and ambulation ability in the training phase. These effects may be due to dose-related, task-specific effects. Larger randomized controlled clinical trials are needed to further test these findings.
Subjects
acute stroke
task-oriented
balance
postural control
functional recovery
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